Science.gov

Sample records for review project patients

  1. Malignant melanoma slide review project: Patients from non-Kaiser hospitals in the San Francisco Bay Area. Final report

    SciTech Connect

    Reynolds, P.

    1993-01-05

    This project was initiated, in response to concerns that the observed excess of malignant melanoma among employees of Lawrence Livermore National Laboratory (LLNL) might reflect the incidence of disease diagnostically different than that observed in the general population. LLNL sponsored a slide review project, inviting leading dermatopathology experts to independently evaluate pathology slides from LLNL employees diagnosed with melanoma and those from a matched sample of Bay Area melanoma patients who did not work at the LLNL. The study objectives were to: Identify all 1969--1984 newly diagnosed cases of malignant melanoma among LLNL employees resident in the San Francisco-Oakland Metropolitan Statistical Area, and diagnosed at facilities other than Kaiser Permanente; identify a comparison series of melanoma cases also diagnosed between 1969--1984 in non-Kaiser facilities, and matched as closely as possible to the LLNL case series by gender, race, age at diagnosis, year of diagnosis, and hospital of diagnosis; obtain pathology slides for the identified (LLNL) case and (non-LLNL) comparison patients for review by the LLNL-invited panel of dermatopathology experts; and to compare the pathologic characteristics of the case and comparison melanoma patients, as recorded by the dermatopathology panel.

  2. Polypharmacy Reviews Among Elderly Populations Project: Assessing Needs in Patient-Provider Communication

    PubMed Central

    Balignasay, Mia-Danica; Nigg, Claudio R

    2013-01-01

    Adults sixty-five years of age and older are a growing population, and are the largest consumers of prescription and nonprescription medications in the United States with potentially increased medication interaction risks. Therefore, an investigation to determine if elderly populations at two minority serving, independent housing sites perceived any issues regarding their medication use, including any communication challenges with their providers. The data were collected using a survey in which participants had to recall information about their medication use and past provider interaction. Participants (N=21; 90.5% female; using 5.1 ± 2.6 medications) completed a needs assessment. Results indicated that patients felt comfortable talking to their doctors. However, the communication that occurs may not have included education on polypharmacy. Many participants did not believe that they could describe details about their medications, such as the purpose (47.6%), instructions (42.9%), side effects (66.7%), and the possible risk of addiction (42.9%). This assessment indicates a need for an intervention that is focused on communication about polypharmacy and medication review education. PMID:23386990

  3. 18 CFR 801.4 - Project review.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 18 Conservation of Power and Water Resources 2 2014-04-01 2014-04-01 false Project review. 801.4... POLICIES § 801.4 Project review. (a) The Compact provides generally that no project affecting the water... project review authority regarding proposed projects in the basin coming under the review of...

  4. 18 CFR 801.4 - Project review.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 18 Conservation of Power and Water Resources 2 2012-04-01 2012-04-01 false Project review. 801.4... POLICIES § 801.4 Project review. (a) The Compact provides generally that no project affecting the water... project review authority regarding proposed projects in the basin coming under the review of...

  5. 18 CFR 801.4 - Project review.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 18 Conservation of Power and Water Resources 2 2013-04-01 2012-04-01 true Project review. 801.4... POLICIES § 801.4 Project review. (a) The Compact provides generally that no project affecting the water... project review authority regarding proposed projects in the basin coming under the review of...

  6. 18 CFR 801.4 - Project review.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 18 Conservation of Power and Water Resources 2 2011-04-01 2011-04-01 false Project review. 801.4... POLICIES § 801.4 Project review. (a) The Compact provides generally that no project affecting the water... project review authority regarding proposed projects in the basin coming under the review of...

  7. 18 CFR 801.4 - Project review.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 18 Conservation of Power and Water Resources 2 2010-04-01 2010-04-01 false Project review. 801.4 Section 801.4 Conservation of Power and Water Resources SUSQUEHANNA RIVER BASIN COMMISSION GENERAL POLICIES § 801.4 Project review. (a) The Compact provides generally that no project affecting the water resources of the basin shall be undertaken...

  8. The life project book review - A correction.

    PubMed

    Tallo, Donato

    2016-05-01

    I was pleased to see your review of The Life Project by Helen Pearson (reviews, April 16). However, it contained one serious error. The original cohort study started in 1946 - not 1958 as stated. I was present at the book launch and have met the author - my grandmother is one of the 1946 original cohort members. That error apart, a great review and a good book. PMID:27154115

  9. Portable Common Execution Environment (PCEE) project review: Peer review

    NASA Technical Reports Server (NTRS)

    Locke, C. Douglass

    1991-01-01

    The purpose of the review was to conduct an independent, in-depth analysis of the PCEE project and to provide the results of said review. The review team was tasked with evaluating the potential contribution of the PCEE project to the improvement of the life cycle support of mission and safety critical (MASC) computing components for large, complex, non-stop, distributed systems similar to those planned for such NASA programs as the space station, lunar outpost, and manned missions to Mars. Some conclusions of the review team are as follow: The PCEE project was given high marks for its breath of vision on the overall problem with MASC software; Correlated with the sweeping vision, the Review Team is very skeptical that any research project can successfully attack such a broad range of problems; and several recommendations are made such as to identify the components of the broad solution envisioned, prioritizing them with respect to their impact and the likely ability of the PCEE or others to attack them successfully, and to rewrite its Concept Document differentiating the problem description, objectives, approach, and results so that the project vision becomes assessible to others.

  10. LLNL oil shale project review

    SciTech Connect

    Cena, R.J.

    1990-04-01

    Livermore's oil shale project is funded by two budget authorities, two thirds from base technology development and one third from environmental science. Our base technology development combines fundamental chemistry research with operation of pilot retorts and mathematical modeling. We've studied mechanisms for oil coking and cracking and have developed a detailed model of this chemistry. We combine the detailed chemistry and physics into oil shale process models (OSP) to study scale-up of generic second generation Hot-Recycled-Solid (HRS) retorting systems and compare with results from our 4 tonne-per-day continuous-loop HRS pilot retorting facility. Our environmental science program focuses on identification of gas, solid and liquid effluents from oil shale processes and development of abatement strategies where necessary. We've developed on-line instruments to quantitatively measure trace sulfur and nitrogen compounds released during shale pyrolysis and combustion. We've studied shale mineralogy, inorganic and organic reactions which generate and consume environmentally sensitive species. Figures, references, and tables are included with each discussion.

  11. Preliminary Design Reviews Project: SAPHIRE 8

    SciTech Connect

    Kurt G. Vedros; Curtis L. Smith

    2011-09-01

    The Preliminary Design Review (PDR) is intended to be performed at the conceptual phase of a design request. The design request is initiated with a Design Specification document which includes a problem statement, design details, a design checklist and supporting documentation and/or projected sample output. In addition to this, the design specification has a chapter devoted to the completion of the Preliminary Design Review. This document describes the process of documentation of the PDR in the Design Specification.

  12. Drawing on Experience. REPLAN Projects Review.

    ERIC Educational Resources Information Center

    Smith, Vernon; And Others

    This document reports good practice as learned in Britain's FEU (Further Education Unit) and NIACE (National Institute of Adult Continuing Education) programs aimed at providing educational opportunities for unemployed adults. Section 1 describes the review of projects that resulted in the document; mentions specific issues and problems relating…

  13. CADD/M project review: January 1981

    SciTech Connect

    Crowe, R.A.

    1981-01-30

    The Computer-aided Design, Drafting/Manufacturing (CADD/M) Project and its current status are reviewed. The Project's history is reviewed and its present programmatic impact is discussed. The investment to date (including FY 1981) is reported along with maintenance costs. Some user activities are also reviewed. The Programs receiving the majority of the benefits are Nuclear Design (ND), Military Applications (MA), and Nuclear Test Programs. In general the benefits include increased design/drafting personnel productivity, reductions in design turn-around time, and improved design quality and documentation. Each Division does, however, receive slightly different benefits because of different missions and operations. State-of-the-art technology that may impact planning is noted and the status of the research and development efforts is presented. The report concludes with the latest plan for further implementation of CAD/CAM technology.

  14. Dynamic infrared scene projection: a review

    NASA Astrophysics Data System (ADS)

    Williams, Owen M.

    1998-12-01

    Since the early 1990s, there has been major progress in the developing field of dynamic infrared scene projection, driven principally by the need for hardware-in-the-loop simulation of the oncoming generation of imaging infrared missile seekers and more recently by the needs for realistic simulation of the new generation of thermal imagers and forward-looking infrared systems. In this paper the current status of the dynamic infrared projection field is reviewed, commencing with an outline of its history. The requirements for dynamic infrared scene projection are examined, allowing a set of validity criteria to be developed. Each class of infrared projector that has been investigated—emissive, transmissive, reflective, laser scanner and phosphor—together with the specific technology initiatives within the class is described and examined against the validity criteria. In this way the leading dynamic infrared scene projection technologies are identified.

  15. NASA's Hypersonic Research Engine Project: A review

    NASA Technical Reports Server (NTRS)

    Andrews, Earl H.; Mackley, Ernest A.

    1994-01-01

    The goals of the NASA Hypersonic Research Engine (HRE) Project, which began in 1964, were to design, develop, and construct a high-performance hypersonic research ramjet/scramjet engine for flight tests of the developed concept over the speed range of Mach 4 to 8. The project was planned to be accomplished in three phases: project definition, research engine development, and flight test using the X-15A-2 research airplane, which was modified to carry hydrogen fuel for the research engine. The project goal of an engine flight test was eliminated when the X-15 program was canceled in 1968. Ground tests of full-scale engine models then became the focus of the project. Two axisymmetric full-scale engine models, having 18-inch-diameter cowls, were fabricated and tested: a structural model and combustion/propulsion model. A brief historical review of the project, with salient features, typical data results, and lessons learned, is presented. An extensive number of documents were generated during the HRE Project and are listed.

  16. Quality Assurance: Patient Chart Reviews

    NASA Astrophysics Data System (ADS)

    Oginni, B. M.; Odero, D. O.

    2009-07-01

    Recent developments in radiation therapy have immensely impacted the way the radiation dose is delivered to patients undergoing radiation treatments. However, the fundamental quality assurance (QA) issues underlying the radiation therapy still remain the accuracy of the radiation dose and the radiation safety. One of the major duties of clinical medical physicists in the radiation therapy departments still revolves around ensuring the accuracy of dose delivery to the planning target volume (PTV), the reduction of unintended radiation to normal organs and minimization of the radiation exposure to the medical personnel based on ALARA (as low as reasonably achievable) principle. Many of the errors in radiation therapy can be minimized through a comprehensive program of periodic checks. One of the QA procedures on the patient comes in the form of chart reviews which could be in either electronic or paper-based format. We present the quality assurance procedures that have to be performed on the patient records from the beginning and periodically to the end of the treatment, based on the guidelines from the American Association of Physicists in Medicine (AAPM) and American College of Physicians (ACP).

  17. Quality Assurance: Patient Chart Reviews

    SciTech Connect

    Oginni, B. M.; Odero, D. O.

    2009-07-06

    Recent developments in radiation therapy have immensely impacted the way the radiation dose is delivered to patients undergoing radiation treatments. However, the fundamental quality assurance (QA) issues underlying the radiation therapy still remain the accuracy of the radiation dose and the radiation safety. One of the major duties of clinical medical physicists in the radiation therapy departments still revolves around ensuring the accuracy of dose delivery to the planning target volume (PTV), the reduction of unintended radiation to normal organs and minimization of the radiation exposure to the medical personnel based on ALARA (as low as reasonably achievable) principle. Many of the errors in radiation therapy can be minimized through a comprehensive program of periodic checks. One of the QA procedures on the patient comes in the form of chart reviews which could be in either electronic or paper-based format. We present the quality assurance procedures that have to be performed on the patient records from the beginning and periodically to the end of the treatment, based on the guidelines from the American Association of Physicists in Medicine (AAPM) and American College of Physicians (ACP)

  18. Review by a local medical research ethics committee of the conduct of approved research projects, by examination of patients' case notes, consent forms, and research records and by interview.

    PubMed Central

    Smith, T.; Moore, E. J.; Tunstall-Pedoe, H.

    1997-01-01

    OBJECTIVE: To monitor the conduct of medical research projects that have already been approved by the local medical research ethics committee. DESIGN: Follow up study of ethically approved studies (randomly selected from all the studies approved in the previous year) by examination of patients' case notes, consent forms, and research records and by interview of the researchers at their workplace. SETTING: Tayside, Scotland (mixed rural and urban population). SUBJECTS: 30 research projects approved by Tayside local medical research ethics committee. MAIN OUTCOME MEASURES: Adherence to the agreed protocol, particularly for recruitment (obtaining and recording informed consent) and for specific requirements of the ethics committee, including notification of changes to the protocol and of adverse events. RESULTS: In one project only oral consent had been obtained, and in a quarter of the studies one or more consent forms were incorrectly completed. Inadequate filing of case notes in five studies and of consent forms in six made them unavailable for scrutiny. Adverse events were reported, but there was a general failure to report the abandoning or non-starting of projects in two studies the investigators failed to notify a change in the responsible researcher. CONCLUSIONS: Monitoring of medical research by local medical research ethics committees promotes and preserves ethical standards, protects subjects and researchers, discourages fraud, and has the support of investigators. We recommend that 10% of projects should undergo on-site review, with all others monitored by questionnaire. This would require about six person hours of time and a salary bill of 120 pounds per study monitored. PMID:9169403

  19. Auditory hallucinations: A review of the ERC "VOICE" project.

    PubMed

    Hugdahl, Kenneth

    2015-06-22

    In this invited review I provide a selective overview of recent research on brain mechanisms and cognitive processes involved in auditory hallucinations. The review is focused on research carried out in the "VOICE" ERC Advanced Grant Project, funded by the European Research Council, but I also review and discuss the literature in general. Auditory hallucinations are suggested to be perceptual phenomena, with a neuronal origin in the speech perception areas in the temporal lobe. The phenomenology of auditory hallucinations is conceptualized along three domains, or dimensions; a perceptual dimension, experienced as someone speaking to the patient; a cognitive dimension, experienced as an inability to inhibit, or ignore the voices, and an emotional dimension, experienced as the "voices" having primarily a negative, or sinister, emotional tone. I will review cognitive, imaging, and neurochemistry data related to these dimensions, primarily the first two. The reviewed data are summarized in a model that sees auditory hallucinations as initiated from temporal lobe neuronal hyper-activation that draws attentional focus inward, and which is not inhibited due to frontal lobe hypo-activation. It is further suggested that this is maintained through abnormal glutamate and possibly gamma-amino-butyric-acid transmitter mediation, which could point towards new pathways for pharmacological treatment. A final section discusses new methods of acquiring quantitative data on the phenomenology and subjective experience of auditory hallucination that goes beyond standard interview questionnaires, by suggesting an iPhone/iPod app.

  20. A Compilation and Review of Alaska Energy Projects

    SciTech Connect

    Arlon Tussing; Steve Colt

    2008-12-31

    There have been many energy projects proposed in Alaska over the past several decades, from large scale hydro projects that have never been built to small scale village power projects to use local alternative energy sources, many of which have also not been built. This project was initially intended to review these rejected projects to evaluate the economic feasibility of these ideas in the light of current economics. This review included contacting the agencies responsible for reviewing and funding these projects in Alaska, including the Alaska Energy Authority, the Denali Commission, and the Arctic Energy Technology Development Laboratory, obtaining available information about these projects, and analyzing the economic data. Unfortunately, the most apparent result of this effort was that the data associated with these projects was not collected in a systematic way that allowed this information to be analyzed.

  1. Atmospheric Ionizing Radiation (AIR) Project Review

    NASA Technical Reports Server (NTRS)

    Singleterry, R. C., Jr.; Wilson, J. W.; Whitehead, A. H.; Goldhagen, P. E.

    1999-01-01

    The National Council on Radiation Protection and Measurement (NCRP) and the National Academy of Science (NAS) established that the uncertainty in the data and models associated with the high-altitude radiation environment could and should be reduced. In response, the National Aeronautics and Space Administration (NASA) and the U.S. Department of Energy Environmental Measurements Laboratory (EML) created the Atmospheric Ionizing Radiation (AIR) Project under the auspices of the High Speed Research (HSR) Program Office at the Langley Research Center. NASA's HSR Program was developed to address the potential of a second-generation supersonic transport. A critical element focussed on the environmental issues, including the threat to crew and passengers posed by atmospheric radiation. Various international investigators were solicited to contribute instruments to fly on an ER-2 aircraft at altitudes similar to those proposed for the High Speed Civil Transport (HSCT). A list of participating investigators, their institutions, and instruments with quantities measured is presented. The flight series took place at solar minimum (radiation maximum) with northern, southern, and east/west flights. The investigators analyzed their data and presented preliminary results at the AIR Workshop in March, 1998. A review of these results are included.

  2. 40 CFR 149.102 - Project review authority.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 23 2011-07-01 2011-07-01 false Project review authority. 149.102 Section 149.102 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) SOLE SOURCE AQUIFERS Review of Projects Affecting the Edwards Underground Reservoir, A...

  3. 40 CFR 149.102 - Project review authority.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... (CONTINUED) SOLE SOURCE AQUIFERS Review of Projects Affecting the Edwards Underground Reservoir, A Designated Sole Source Aquifer in the San Antonio, Texas Area § 149.102 Project review authority. (a) Once an area... which the Administrator determines may contaminate the aquifer so as to create a significant hazard...

  4. 40 CFR 149.102 - Project review authority.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... (CONTINUED) SOLE SOURCE AQUIFERS Review of Projects Affecting the Edwards Underground Reservoir, A Designated Sole Source Aquifer in the San Antonio, Texas Area § 149.102 Project review authority. (a) Once an area... which the Administrator determines may contaminate the aquifer so as to create a significant hazard...

  5. 40 CFR 149.102 - Project review authority.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... (CONTINUED) SOLE SOURCE AQUIFERS Review of Projects Affecting the Edwards Underground Reservoir, A Designated Sole Source Aquifer in the San Antonio, Texas Area § 149.102 Project review authority. (a) Once an area... which the Administrator determines may contaminate the aquifer so as to create a significant hazard...

  6. Doctor-Patient Communication: A Review

    PubMed Central

    Ha, Jennifer Fong; Longnecker, Nancy

    2010-01-01

    Effective doctor-patient communication is a central clinical function in building a therapeutic doctor-patient relationship, which is the heart and art of medicine. This is important in the delivery of high-quality health care. Much patient dissatisfaction and many complaints are due to breakdown in the doctor-patient relationship. However, many doctors tend to overestimate their ability in communication. Over the years, much has been published in the literature on this important topic. We review the literature on doctor-patient communication. PMID:21603354

  7. [Strategies for improving care of oncologic patients: SHARE Project results].

    PubMed

    Reñones Crego, María de la Concepción; Fernández Pérez, Dolores; Vena Fernández, Carmen; Zamudio Sánchez, Antonio

    2016-01-01

    Cancer treatment is a major burden for the patient and its family that requires an individualized management by healthcare professionals. Nurses are in charge of coordinating care and are the closest healthcare professionals to patient and family; however, in Spain, there are not standard protocols yet for the management of oncology patients. The Spanish Oncology Nursing Society developed between 2012 and 2014 the SHARE project, with the aim of establishing strategies to improve quality of life and nursing care in oncology patients. It was developed in 3 phases. First, a literature search and review was performed to identify nursing strategies, interventions and tools to improve cancer patients' care. At the second stage, these interventions were agreed within a group of oncology nursing experts; and at the third phase, a different group of experts in oncology care categorized the interventions to identify the ones with highest priority and most feasible to be implemented. As a result, 3 strategic actions were identified to improve nursing care during cancer treatment: To provide a named nurse to carry out the follow up process by attending to the clinic or telephonic consultation, develop therapeutic education with adapted protocols for each tumor type and treatment and ensure specific training for nurses on the management of the cancer patients. Strategic actions proposed in this paper aim to improve cancer patients' healthcare and quality of life through the development of advanced nursing roles based on a higher level of autonomy, situating nurses as care coordinators to assure an holistic care in oncology patients.

  8. Commentary: quality improvement projects: how do we protect patients' rights?

    PubMed

    Diamond, Louis H; Kliger, Alan S; Goldman, Richard S; Palevsky, Paul M

    2004-01-01

    A recent ruling by the Office of Human Research Protection (OHRP) has renewed an ongoing debate over whether Institutional Review Boards (IRBs) should have oversight not only over clinical research but also over quality improvement projects (QIPs). The authors discussed the similarities and differences among clinical practice, QIPs, and clinical research, pointing out issues to consider when identifying the most appropriate method for QIP oversight and accountability. They note that potential solutions must address ethical issues (eg, patient safety, privacy, and self-determination) and weigh the effect of the underlying QIP goal (administrative versus clinical improvement) on an individual patient and patient populations. They conclude that because QIPs are an extension of clinical practice and have elements of clinical research, it too should have an oversight system. Institutional or regional quality improvement boards, operating parallel to current IRBs, are suggested as 1 means of ensuring that QIP participants are offered the same protections as those who take part in clinical research.

  9. Report of the Project on Contracting, Review, and Assessment Procedures.

    ERIC Educational Resources Information Center

    Vermont Community Colleges, Montpelier.

    The broad purpose of this project was to examine all aspects of the Community College of Vermont (CCV) review and contracting process and to recommend changes to the CCV Review Board and Decision Team for implementation. Examination focused on the present program, the contract format, Local Review Committee procedures, the counseling process, and…

  10. Followup review of major system aquisitions and major projects

    SciTech Connect

    Not Available

    1990-11-21

    In 1985, we reviewed the Department's procedures and practices for managing and controlling its major acquisition program, both for major systems and major projects. The 1985 review resulted in the identification of significant deficiencies. We found, for example, deficiencies relating to documentation and reporting requirements for major acquisitions. The purpose of this review was to determine if this condition had been corrected. The review included an examination of applicable laws, Executive Orders, Office of Management and Budget (OMB) Circulars, and Department policies. We examined key documents prepared for major acquisitions and reviewed reports used by senior Departmental officials to monitor these projects. Our audit was based primarily on a limited review of documentation available at Department of Energy (DOE) Headquarters. We did not extend our review of the issues raised in this report because we concluded that the management of major acquisitions was of such importance to the Department at this time that expedited reporting was needed.

  11. Scottish Conservation Projects in the School Environment--A Review.

    ERIC Educational Resources Information Center

    Cooke, Nicholas

    1985-01-01

    Traces the development and the successful efforts of the Scottish Conservation Projects Trust (SCP). Presents examples of practical outdoor conservation programs and identifies participant groups in the SCP network. Also reviews future plans. (ML)

  12. Determinants of patient adherence: a review of systematic reviews

    PubMed Central

    Kardas, Przemyslaw; Lewek, Pawel; Matyjaszczyk, Michal

    2013-01-01

    Purpose: A number of potential determinants of medication non-adherence have been described so far. However, the heterogenic quality of existing publications poses the need for the use of a rigorous methodology in building a list of such determinants. The purpose of this study was a systematic review of current research on determinants of patient adherence on the basis of a recently agreed European consensus taxonomy and terminology. Methods: MEDLINE, EMBASE, CINAHL, Cochrane Library, IPA, and PsycINFO were systematically searched for systematic reviews published between 2000/01/01 and 2009/12/31 that provided determinants on non-adherence to medication. The searches were limited to reviews having adherence to medication prescribed by health professionals for outpatient as a major topic. Results: Fifty-one reviews were included in this review, covering 19 different disease categories. In these reviews, exclusively assessing non-adherence to chronic therapies, 771 individual factor items were identified, of which most were determinants of implementation, and only 47—determinants of persistence with medication. Factors with an unambiguous effect on adherence were further grouped into 8 clusters of socio-economic-related factors, 6 of healthcare team- and system-related factors, 6 of condition-related factors, 6 of therapy-related factors, and 14 of patient-related factors. The lack of standardized definitions and use of poor measurement methods resulted in many inconsistencies. Conclusions: This study provides clear evidence that medication non-adherence is affected by multiple determinants. Therefore, the prediction of non-adherence of individual patients is difficult, and suitable measurement and multifaceted interventions may be the most effective answer toward unsatisfactory adherence. The limited number of publications assessing determinants of persistence with medication, and lack of those providing determinants of adherence to short-term treatment identify

  13. [Improving patient safety through voluntary peer review].

    PubMed

    Kluge, S; Bause, H

    2015-01-01

    The intensive care unit (ICU) is one area of the hospital in which processes and communication are of primary importance. Errors in intensive care units can lead to serious adverse events with significant consequences for patients. Therefore quality and risk-management are important measures when treating critically ill patients. A pragmatic approach to support quality and safety in intensive care is peer review. This approach has gained significant acceptance over the past years. It consists of mutual visits by colleagues who conduct standardised peer reviews. These reviews focus on the systematic evaluation of the quality of an ICU's structure, its processes and outcome. Together with different associations, the State Chambers of Physicians and the German Medical Association have developed peer review as a standardized tool for quality improvement. The common goal of all stakeholders is the continuous and sustainable improvement in intensive care with peer reviews significantly increasing and improving communication between professions and disciplines. Peer reviews secure the sustainability of planned change processes and consequently lead the way to an improved culture of quality and safety.

  14. 40 CFR 149.102 - Project review authority.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... which the Administrator determines may contaminate the aquifer so as to create a significant hazard to... the Act, except the final determination that a project may contaminate the aquifer through its... review any project which he considers may potentially contaminate the aquifer through its recharge...

  15. 18 CFR 806.4 - Projects requiring review and approval.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... requiring review and approval as set forth in this section, § 806.5, or 18 CFR part 801. (i) Any project... determined by the commissioners or Executive Director pursuant to § 806.5 or 18 CFR part 801. Such project..., turf products, livestock, or poultry, or for aquaculture, to the extent that, and for so long as,...

  16. Patient adherence to medical treatment: a review of reviews

    PubMed Central

    van Dulmen, Sandra; Sluijs, Emmy; van Dijk, Liset; de Ridder, Denise; Heerdink, Rob; Bensing, Jozien

    2007-01-01

    Background Patients' non-adherence to medical treatment remains a persistent problem. Many interventions to improve patient adherence are unsuccessful and sound theoretical foundations are lacking. Innovations in theory and practice are badly needed. A new and promising way could be to review the existing reviews of adherence to interventions and identify the underlying theories for effective interventions. That is the aim of our study. Methods The study is a review of 38 systematic reviews of the effectiveness of adherence interventions published between 1990 and 2005. Electronic literature searches were conducted in Medline, Psychinfo, Embase and the Cochrane Library. Explicit inclusion and exclusion criteria were applied. The scope of the study is patient adherence to medical treatment in the cure and care sector. Results Significant differences in the effectiveness of adherence interventions were found in 23 of the 38 systematic reviews. Effective interventions were found in each of four theoretical approaches to adherence interventions: technical, behavioural, educational and multi-faceted or complex interventions. Technical solutions, such as a simplification of the regimen, were often found to be effective, although that does not count for every therapeutic regimen. Overall, our results show that, firstly, there are effective adherence interventions without an explicit theoretical explanation of the operating mechanisms, for example technical solutions. Secondly, there are effective adherence interventions, which clearly stem from the behavioural theories, for example incentives and reminders. Thirdly, there are other theoretical models that seem plausible for explaining non-adherence, but not very effective in improving adherence behaviour. Fourthly, effective components within promising theories could not be identified because of the complexity of many adherence interventions and the lack of studies that explicitly compare theoretical components

  17. [Strategies for improving care of oncologic patients: SHARE Project results].

    PubMed

    Reñones Crego, María de la Concepción; Fernández Pérez, Dolores; Vena Fernández, Carmen; Zamudio Sánchez, Antonio

    2016-01-01

    Cancer treatment is a major burden for the patient and its family that requires an individualized management by healthcare professionals. Nurses are in charge of coordinating care and are the closest healthcare professionals to patient and family; however, in Spain, there are not standard protocols yet for the management of oncology patients. The Spanish Oncology Nursing Society developed between 2012 and 2014 the SHARE project, with the aim of establishing strategies to improve quality of life and nursing care in oncology patients. It was developed in 3 phases. First, a literature search and review was performed to identify nursing strategies, interventions and tools to improve cancer patients' care. At the second stage, these interventions were agreed within a group of oncology nursing experts; and at the third phase, a different group of experts in oncology care categorized the interventions to identify the ones with highest priority and most feasible to be implemented. As a result, 3 strategic actions were identified to improve nursing care during cancer treatment: To provide a named nurse to carry out the follow up process by attending to the clinic or telephonic consultation, develop therapeutic education with adapted protocols for each tumor type and treatment and ensure specific training for nurses on the management of the cancer patients. Strategic actions proposed in this paper aim to improve cancer patients' healthcare and quality of life through the development of advanced nursing roles based on a higher level of autonomy, situating nurses as care coordinators to assure an holistic care in oncology patients. PMID:27237729

  18. BOOK REVIEW: Science Fair Projects: Physics

    NASA Astrophysics Data System (ADS)

    Reynolds, Helen

    2000-11-01

    I have often thought that the notion of a Science Fair is intrinsically a good one but have never set one up. With this book such an undertaking is possible, with 47 projects from which you can choose. Each project has a clearly stated purpose with an overview that contains the physics you need to get started. A hypothesis, or sometimes two, and a procedure detailing what the student should do follow this. The materials to be used are those you should be able to find at home, and safety guidelines as well as places the student needs adult help are clearly marked. Every project asks the student to write down the results of their experiment and decide whether or not their hypothesis was correct. There are also suggestions for taking each project further. Some of these projects are standard experiments that you may already do with students in class, for example, making plasticine boats, string telephones and levers. Most are interesting twists on standard experiments such as using a wedge as a simple machine, home-made spinning toys and the experiments with light bulbs. The latter are the only real cause for concern if students were to do these things at home as adult supervision would be essential. This is obviously an American book, though. Teachers in British classrooms would need to work out how to deal with the references to temperature in Fahrenheit and mass in ounces. Length is usually given in centimetres as well as inches. Translations of soda bottles and bobby pins would also be needed. This book is designed to be full of ideas and to give structure to projects students can do at home, not to provide ideas that you can transport into the classroom. It does this very well and I would recommend it to anyone thinking of starting up a Science Fair. Alternatively, this is an excellent resource for more interesting homework assignments that would put more responsibility on the student and give them something fun to do.

  19. Renal failure in burn patients: a review

    PubMed Central

    Emara, S.S.; Alzaylai, A.A.

    2013-01-01

    Summary Burn care providers are usually challenged by multiple complications during the management of acute burns. One of the most common complications worldwide is renal failure. This article reviews the various aspects of renal failure management in burn patients. Two different types of renal failures develop in these patients. The different aetiological factors, incidence, suspected prognosis, ways of diagnosing, as well as prevention methods, and the most accepted treatment modalities are all discussed. A good understanding and an effective assessment of the problem help to reduce both morbidity and mortality in burn management. PMID:23966893

  20. Reviewing the integration of patient data: how systems are evolving in practice to meet patient needs

    PubMed Central

    Cruz-Correia, Ricardo J; Vieira-Marques, Pedro M; Ferreira, Ana M; Almeida, Filipa C; Wyatt, Jeremy C; Costa-Pereira, Altamiro M

    2007-01-01

    Background The integration of Information Systems (IS) is essential to support shared care and to provide consistent care to individuals – patient-centred care. This paper identifies, appraises and summarises studies examining different approaches to integrate patient data from heterogeneous IS. Methods The literature was systematically reviewed between 1995–2005 to identify articles mentioning patient records, computers and data integration or sharing. Results Of 3124 articles, 84 were included describing 56 distinct projects. Most of the projects were on a regional scale. Integration was most commonly accomplished by messaging with pre-defined templates and middleware solutions. HL7 was the most widely used messaging standard. Direct database access and web services were the most common communication methods. The user interface for most systems was a Web browser. Regarding the type of medical data shared, 77% of projects integrated diagnosis and problems, 67% medical images and 65% lab results. More recently significantly more IS are extending to primary care and integrating referral letters. Conclusion It is clear that Information Systems are evolving to meet people's needs by implementing regional networks, allowing patient access and integration of ever more items of patient data. Many distinct technological solutions coexist to integrate patient data, using differing standards and data architectures which may difficult further interoperability. PMID:17565667

  1. Patient rights in Iran: a review article.

    PubMed

    Joolaee, Soodabeh; Hajibabaee, Fatemeh

    2012-01-01

    A significant development for conducting research on patient rights has been made in Iran over the past decade. This study is conducted in order to review and analyze the previous studies that have been made, so far, concerning patient rights in Iran. This is a comprehensive review study conducted by searching the Iranian databases, Scientific Information Database, Iranian Research Institute for Information Science and Technology, Iran Medex and Google using the Persian equivalent of keywords for 'awareness', 'attitude', and 'patient rights'. For pertinent Iranian papers published in English, scientific databases PubMed, and Google Scholar were searched using the keyword 'patient rights' and 'Iran'. A total of 41 Persian and five English articles were found for these keywords, only 26 of which fulfilled the objective of our study. The increasing number of papers published indicates that from 1999 onwards, this subject has begun to draw the attention of Iranian researchers in a progressive fashion and Iranian papers in English have also been compiled and published in international sources.

  2. Patient engagement in research: a systematic review

    PubMed Central

    2014-01-01

    Background A compelling ethical rationale supports patient engagement in healthcare research. It is also assumed that patient engagement will lead to research findings that are more pertinent to patients’ concerns and dilemmas. However; it is unclear how to best conduct this process. In this systematic review we aimed to answer 4 key questions: what are the best ways to identify patient representatives? How to engage them in designing and conducting research? What are the observed benefits of patient engagement? What are the harms and barriers of patient engagement? Methods We searched MEDLINE, EMBASE, PsycInfo, Cochrane, EBSCO, CINAHL, SCOPUS, Web of Science, Business Search Premier, Academic Search Premier and Google Scholar. Included studies were published in English, of any size or design that described engaging patients or their surrogates in research design. We conducted an environmental scan of the grey literature and consulted with experts and patients. Data were analyzed using a non-quantitative, meta-narrative approach. Results We included 142 studies that described a spectrum of engagement. In general, engagement was feasible in most settings and most commonly done in the beginning of research (agenda setting and protocol development) and less commonly during the execution and translation of research. We found no comparative analytic studies to recommend a particular method. Patient engagement increased study enrollment rates and aided researchers in securing funding, designing study protocols and choosing relevant outcomes. The most commonly cited challenges were related to logistics (extra time and funding needed for engagement) and to an overarching worry of a tokenistic engagement. Conclusions Patient engagement in healthcare research is likely feasible in many settings. However, this engagement comes at a cost and can become tokenistic. Research dedicated to identifying the best methods to achieve engagement is lacking and clearly needed. PMID

  3. [The patient pathway, an essential element of the care project].

    PubMed

    Despiau, Frédéric; Bombail, Marie; Le Duff, Gérard; Peoc'h, Nadia; Labatut, Raymonde; Ceaux, Christine

    2015-05-01

    Constructing an innovative care project in oncology, common to two healthcare institutions with different statuses, was a challenge for the directors of nursing of the Claudius-Regaud Institute and Toulouse university hospital. The patient care pathway was a major organisational element of the project, keyto ensuring high quality patient care, from the diagnosis through to the personalised post-cancer plan. PMID:26126375

  4. Congressional hearing reviews NSF major research and facilities projects

    NASA Astrophysics Data System (ADS)

    Showstack, Randy

    2012-03-01

    An 8 March congressional hearing about the U.S. National Science Foundation's Major Research Equipment and Facilities Construction (NSF MREFC) account focused on fiscal management and accountability of projects in that account and reviewed concerns raised by NSF's Office of Inspector General (OIG). NSF established the MREFC account in 1995 to better plan and manage investments in major equipment and facilities projects, which can cost from tens of millions to hundreds of millions of dollars, and the foundation has funded 17 MREFC projects since then. The Obama administration's proposed fiscal year (FY) 2013 budget includes funding for four MREFC projects: Advanced Laser Gravitational-Wave Observatory (AdvLIGO), Advanced Technology Solar Telescope (ATST), National Ecological Observatory (NEON), and Ocean Observatories Initiative (OOI). The hearing, held by a subcommittee of the House of Representatives' Committee on Science, Space, and Technology, reviewed management oversight throughout the life cycles of MREFC projects and concerns raised in recent OIG reports about the use of budget contingency funds. NSF's February 2012 manual called "Risk management guide for large facilities" states that cost contingency is "that portion of the project budget required to cover `known unknowns,'" such as planning and estimating errors and omissions, minor labor or material price fluctuations, and design developments and changes within the project scope. Committee members acknowledged measures that NSF has made to improve the MREFC oversight process, but they also urged the agency to continue to take steps to ensure better project management.

  5. Emerging lessons from the drug effectiveness review project.

    PubMed

    Neumann, Peter J

    2006-01-01

    The Drug Effectiveness Review Project (DERP) is an alliance of fifteen states and two private organizations, which have pooled resources to synthesize and judge clinical evidence for drug-class reviews. The experience shines a bright light on challenges involved in implementing an evidence-based medicine process to inform drug formulary decisions: When should evidence reviewers accept surrogate markers and assume therapeutic class effects? How open and participatory should review procedures be? Should reviewers consider cost-effectiveness information? What is the appropriate role of the public sector in judging evidence? The DERP illustrates that attempts to undertake evidence-based reviews, apart from the methods themselves, which continue to evolve, involve questions of organization, process, and leadership. PMID:16757486

  6. The drug effectiveness review project: an important step forward.

    PubMed

    Gibson, Mark; Santa, John

    2006-01-01

    Peter Neumann's paper on the Drug Effectiveness Review Project (DERP) is a constructive if incomplete point of departure for discussing the work done by the project and the use of that work by decision-makers in states and elsewhere. This Perspective attempts to establish the proper context for judging the DERP by comparing its product and processes with those commonly produced and used by industry and other parties. It also provides a direct response to the criticisms of the project noted by Neumann. PMID:16757487

  7. Patient safety and electromagnetic protection: a review.

    PubMed

    Carranza, Noemí; Febles, Víctor; Hernández, José A; Bardasano, José L; Monteagudo, José L; Fernández de Aldecoa, José C; Ramos, Victoria

    2011-05-01

    A systematic literature review was carried out to study patient security and possible harmful effects, immunity and interferences on medical devices, and effectiveness and transmission problems in healthcare and hospital environments due to electromagnetic interferences. The objective was to determine already-reported cases of patient security, immunity of medical devices, and transmission/reception failure in order to evaluate safety and security of patients. Literature published in the last 10 years has been reviewed by searching in bibliographic databases, journals, and proceedings of conferences. Search strategies developed in electronic databases identified a total of 820 references, with 50 finally being included. The study reveals the existence of numerous publications on interferences in medical devices due to radiofrequency fields. However, literature on effectiveness, transmission problems and measurements of electromagnetic fields is limited. From the studies collected, it can be concluded that several cases of serious interferences in medical instruments have been reported. Measures of electromagnetic fields in healthcare environments have been also reported, concluding that special protective measures should be taken against electromagnetic interferences by incoming radio waves. PMID:21451324

  8. The Virtual Factory Teaching System (VFTS): Project Review and Results.

    ERIC Educational Resources Information Center

    Kazlauskas, E. J.; Boyd, E. F., III; Dessouky, M. M.

    This paper presents a review of the Virtual Factory Teaching (VFTS) project, a Web-based, multimedia collaborative learning network. The system allows students, working alone or in teams, to build factories, forecast demand for products, plan production, establish release rules for new work into the factory, and set scheduling rules for…

  9. Videotex Project Reviews II. Research Report Prepared for OCLC.

    ERIC Educational Resources Information Center

    Widing, Robert E., II; Talarzyk, W. Wayne

    Designed to provide an overview of the nature and focus of activity in the fledgling videotex industry in the United States and Canada, this updated and extended report presents in-depth reviews of 26 projects which reflect the involvement of such industries as publishing, retailing, agriculture, banking, other financial intermediaries,…

  10. 44 CFR 65.8 - Review of proposed projects.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... AND MAPPING OF SPECIAL HAZARD AREAS § 65.8 Review of proposed projects. A community, or an individual.... 65.8 Section 65.8 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT... Conditional Letter of Map Revision, in accordance with 44 CFR part 72. The data required to support...

  11. 44 CFR 65.8 - Review of proposed projects.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... AND MAPPING OF SPECIAL HAZARD AREAS § 65.8 Review of proposed projects. A community, or an individual.... 65.8 Section 65.8 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT... Conditional Letter of Map Revision, in accordance with 44 CFR part 72. The data required to support...

  12. 44 CFR 65.8 - Review of proposed projects.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... AND MAPPING OF SPECIAL HAZARD AREAS § 65.8 Review of proposed projects. A community, or an individual.... 65.8 Section 65.8 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT... Conditional Letter of Map Revision, in accordance with 44 CFR part 72. The data required to support...

  13. 44 CFR 65.8 - Review of proposed projects.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... AND MAPPING OF SPECIAL HAZARD AREAS § 65.8 Review of proposed projects. A community, or an individual.... 65.8 Section 65.8 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT... Conditional Letter of Map Revision, in accordance with 44 CFR part 72. The data required to support...

  14. 44 CFR 65.8 - Review of proposed projects.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... AND MAPPING OF SPECIAL HAZARD AREAS § 65.8 Review of proposed projects. A community, or an individual.... 65.8 Section 65.8 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT... Conditional Letter of Map Revision, in accordance with 44 CFR part 72. The data required to support...

  15. 18 CFR 806.4 - Projects requiring review and approval.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... requiring review and approval as set forth in this section, § 806.5, or 18 CFR part 801. The taking or... § 806.5 or 18 CFR part 801. Such project sponsors shall be notified in writing by the Executive Director... forage crops, trees, flowers, shrubs, turf products, livestock, or poultry, or for aquaculture, to...

  16. 18 CFR 806.4 - Projects requiring review and approval.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... requiring review and approval as set forth in this section, § 806.5, or 18 CFR part 801. The taking or... § 806.5 or 18 CFR part 801. Such project sponsors shall be notified in writing by the Executive Director... forage crops, trees, flowers, shrubs, turf products, livestock, or poultry, or for aquaculture, to...

  17. 18 CFR 806.4 - Projects requiring review and approval.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... requiring review and approval as set forth in this section, § 806.5, or 18 CFR part 801. The taking or... § 806.5 or 18 CFR part 801. Such project sponsors shall be notified in writing by the Executive Director... forage crops, trees, flowers, shrubs, turf products, livestock, or poultry, or for aquaculture, to...

  18. A Review of Research on Project STAR and Path Ahead

    ERIC Educational Resources Information Center

    Sohn, Kitae

    2016-01-01

    Understanding the effects of class size reduction (CSR) has been an enduring issue in education. For the past 3 decades, Project STAR has stimulated research and policy discussions regarding the effects of CSR on a variety of outcomes. Schanzenbach (2007) reviewed STAR studies and concluded that small classes improved student academic outcomes.…

  19. 76 FR 60774 - Review and Approval of Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-30

    ..., 2011 (76 FR 41154) may be submitted to the Commission on or before November 10, 2011. ADDRESSES... 10, 2011, the written comment deadline for proposed rules that appeared in 76 FR 41154-41157 July 13... COMMISSION 18 CFR Part 806 Review and Approval of Projects AGENCY: Susquehanna River Basin Commission....

  20. 77 FR 14272 - Review and Approval of Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-09

    ... From the Federal Register Online via the Government Publishing Office SUSQUEHANNA RIVER BASIN COMMISSION 18 CFR Part 806 Review and Approval of Projects CFR Correction In Title 18 of the Code of Federal Regulations, Part 400 to End, revised as of April 1, 2011, on page 118, in Sec. 806.6, (b)(1)(i) and (ii)...

  1. 18 CFR 806.4 - Projects requiring review and approval.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... requiring review and approval as set forth in this section, § 806.5, or 18 CFR part 801. The taking or... determined by the commissioners or Executive Director pursuant to § 806.5 or 18 CFR part 801. Such project... groundwater or surface water, shall also be subject to the standards set forth in § 806.23. Except to...

  2. Implications of the Donaldson decision: a model for periodic review of committed patients.

    PubMed

    Crane, L; Zonana, H; Wizner, S

    1977-11-01

    In 1976 the Connecticut Valley Hospital, the Yale University School of Law, and the department of psychiatry of the Yale School of Medicine, undertook a project in which all involuntary patients at the hospital, a total of 107, were reviewed by three interdisciplinary panels, each composed of a law student, a psychiatric resident, and a hospital social worker. The major purposes of the project were to identify those patients entitled to release under the Donaldson criteria, to develop a model review procedure, and to assess the need for alternative placements. The panels found no patients resembling Kenneth Donaldson, but they did find 53 per cent of the patients inappropriately detained on involuntary status. However, in most cases the recommendation was transfer to a nursing home because of the patient's high degree of disability. The authors emphaxize the importance of periodic external reviews of commitment status.

  3. Researchers' experience with project management in health and medical research: Results from a post-project review

    PubMed Central

    2011-01-01

    Background Project management is widely used to deliver projects on time, within budget and of defined quality. However, there is little published information describing its use in managing health and medical research projects. We used project management in the Alcohol and Pregnancy Project (2006-2008) http://www.ichr.uwa.edu.au/alcoholandpregnancy and in this paper report researchers' opinions on project management and whether it made a difference to the project. Methods A national interdisciplinary group of 20 researchers, one of whom was the project manager, formed the Steering Committee for the project. We used project management to ensure project outputs and outcomes were achieved and all aspects of the project were planned, implemented, monitored and controlled. Sixteen of the researchers were asked to complete a self administered questionnaire for a post-project review. Results The project was delivered according to the project protocol within the allocated budget and time frame. Fifteen researchers (93.8%) completed a questionnaire. They reported that project management increased the effectiveness of the project, communication, teamwork, and application of the interdisciplinary group of researchers' expertise. They would recommend this type of project management for future projects. Conclusions Our post-project review showed that researchers comprehensively endorsed project management in the Alcohol and Pregnancy Project and agreed that project management had contributed substantially to the research. In future, we will project manage new projects and conduct post-project reviews. The results will be used to encourage continuous learning and continuous improvement of project management, and provide greater transparency and accountability of health and medical research. The use of project management can benefit both management and scientific outcomes of health and medical research projects. PMID:21635721

  4. 1990 DOE/SANDIA crystalline photovoltaic technology project review meeting

    SciTech Connect

    Ruby, D.S.

    1990-07-01

    This document serves as the proceedings for the annual project review meeting held by Sandia's Photovoltaic Cell Research Division and Photovoltaic Technology Division. It contains information supplied by each organization making a presentation at the meeting, which was held August 7 through 9, 1990 at the Sheraton Hotel in Albuquerque, New Mexico. Sessions were held to discuss national photovoltaic programs, one-sun crystalline silicon cell research, concentrator silicon cell research, concentrator 3-5 cell research, and concentrating collector development.

  5. 7 CFR 634.14 - Review and approval of project applications.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... project, including: (i) Cost effectiveness of BMP's, (ii) Size of the area and BMP's needed, and (iii... 7 Agriculture 6 2013-01-01 2013-01-01 false Review and approval of project applications. 634.14... Authorization and Funding § 634.14 Review and approval of project applications. (a) In reviewing...

  6. 7 CFR 1486.506 - When will a project be reviewed?

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 10 2011-01-01 2011-01-01 false When will a project be reviewed? 1486.506 Section... Reporting, Evaluation, and Compliance § 1486.506 When will a project be reviewed? Any project or activity funded under the program is subject to review or audit at any time during the course of implementation...

  7. 7 CFR 1486.506 - When will a project be reviewed?

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false When will a project be reviewed? 1486.506 Section... Reporting, Evaluation, and Compliance § 1486.506 When will a project be reviewed? Any project or activity funded under the program is subject to review or audit at any time during the course of implementation...

  8. [Nuclear energy and environment: review of the IAEA environmental projects].

    PubMed

    Fesenko, S; Fogt, G

    2012-01-01

    The review of the environmental projects of the International Atomic Energy Agency is presented. Basic IAEA documents intended to protect humans and the Environment are considered and their main features are discussed. Some challenging issues in the area of protection of the Environment and man, including the impact of nuclear facilities on the environment, radioactive waste management, and remediation of the areas affected by radiological accidents, nuclear testing and sites of nuclear facilities are also discussed. The need to maintain the existing knowledge in radioecology and protection of the environment is emphasised.

  9. 1989 DOE/Sandia crystalline photovoltaic technology project review meeting

    SciTech Connect

    Basore, P.A.

    1989-06-01

    This document serves as the proceedings for the annual project review meeting held by Sandia's Photovoltaic Cell Research Division and Photovoltaic Technology Division. It contains information supplied by each organization making a presentation at the meeting, which was held 11-13 July 1989 at the Marriott Hotel in Albuquerque, NM. Information supplied by other Sandia contractor and single-page data sheets generated by the cognizant Sandia Technical Liasion for each contract are also included. Sessions were held to discuss national and international photovoltaic programs, one-sun crystalline silicon cell research, concentrator silicon cell research, concentrator III-V cell research, and concentrating collector development.

  10. The Blue Button Project: Engaging Patients in Healthcare by a Click of a Button.

    PubMed

    Mohsen, Mona Omar; Aziz, Hassan A

    2015-01-01

    The Blue Button project has become a way for many Americans to download their health records by just a click in any way that suits them, such as in print, on a thumb drive, or on their mobile devices and smartphones. Several organizations have developed and applied Blue Buttons on their websites to allow beneficiaries to securely access and view personal medical information and claims. The purpose of this literature review is to highlight the significance of the Blue Button project in the field of health information management. Findings suggest that the project could empower and engage consumers and patients in a healthcare system by allowing access to medical records, thereby promoting better management and overall improvement of their healthcare. To date, the project has gained wide support from insurers, technology companies, and health providers despite the challenges of standardization and interoperability. PMID:26755898

  11. The Blue Button Project: Engaging Patients in Healthcare by a Click of a Button

    PubMed Central

    Mohsen, Mona Omar; Aziz, Hassan A.

    2015-01-01

    The Blue Button project has become a way for many Americans to download their health records by just a click in any way that suits them, such as in print, on a thumb drive, or on their mobile devices and smartphones. Several organizations have developed and applied Blue Buttons on their websites to allow beneficiaries to securely access and view personal medical information and claims. The purpose of this literature review is to highlight the significance of the Blue Button project in the field of health information management. Findings suggest that the project could empower and engage consumers and patients in a healthcare system by allowing access to medical records, thereby promoting better management and overall improvement of their healthcare. To date, the project has gained wide support from insurers, technology companies, and health providers despite the challenges of standardization and interoperability. PMID:26755898

  12. Mild bleeding disorders: review of 120 patients.

    PubMed

    Bolton-Maggs, P; Wilkinson, L S

    1984-01-01

    Of 120 patients presenting with mild bleeding disorders, 63 were found to have a definite coagulopathy. The commonest disorders were haemophilia, Christmas disease and von Willebrand's disease (vWd), the latter being predominant. Diagnosis led to prophylactic treatment prior to surgery in 18 patients with prevention of excessive haemorrhage. Three patients who had received blood products developed hepatitis. DDAVP (desamino-cys-1-8-D-arginine vasopressin) is the treatment of choice in suitable mildly affected patients with haemophilia A and vWd. Examination of blood group distribution suggests an excess of group O among patients with bleeding disorders, especially those with vWd.

  13. Design review report: project development specifications for project W-314, tank farm resoration and safe operation, phase I

    SciTech Connect

    Boes, K.A., Fluor Daniel Hanford

    1997-02-27

    This Design Review Report (DRR) documents the closure of all Review Cormnent Record sheets associated with the design reviews conducted for the Project W-314 Phase 1 Project Development Specification (PDS) Requirements Analysis. The DRR includes the documented comments and their respective dispositions for the W-314 PDS Requirements Analysis documents associated with Transfer Piping, Valve Pit Manifolds, Pit Leak Detection, Master Pump Shutdown, and Special Protective Coating. Acceptance of the comment dispositions and closure of the review comments is indicated by the Signatures of the participating reviewers.

  14. 42 CFR 52h.11 - What are the review criteria for contract projects and proposals?

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... HUMAN SERVICES GRANTS SCIENTIFIC PEER REVIEW OF RESEARCH GRANT APPLICATIONS AND RESEARCH AND DEVELOPMENT... carrying out its review of a project concept under § 52h.10(a) or § 52h.10(b), the peer review group shall... its review of unsolicited contract proposals under § 52h.9, the peer review group shall take...

  15. 42 CFR 52h.11 - What are the review criteria for contract projects and proposals?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... HUMAN SERVICES GRANTS SCIENTIFIC PEER REVIEW OF RESEARCH GRANT APPLICATIONS AND RESEARCH AND DEVELOPMENT... carrying out its review of a project concept under § 52h.10(a) or § 52h.10(b), the peer review group shall... its review of unsolicited contract proposals under § 52h.9, the peer review group shall take...

  16. Patient delay in the diagnosis and treatment of tuberculosis in China: findings of case detection projects

    PubMed Central

    Enarson, D. A.; Chiang, C-Y.; Rusen, I. D.; Qiu, L-X.; Kan, X-H.; Yuan, Y-L.; Du, J.; Zhang, T-H.; Li, Y.; Li, X-F.; Du, C-T.; Zhang, L-X.

    2015-01-01

    Objective: 1) To assess patient delay among new smear-positive pulmonary tuberculosis (PTB) patients in accessing health services in seven FIDELIS (Fund for Innovative DOTS Expansion through Local Initiatives to Stop TB) projects from 2003 to 2008 in China; 2) to compare treatment delay by province; and 3) to assess factors associated with delay. Method: Records of new smear-positive PTB patients were reviewed. Data sources were the consultation book, laboratory register, patient record, treatment card and the PWLAHS (people with limited access to health services) evaluation form. Data were collected using a standard questionnaire, cross-checked by staff from the sites and by the International Union Against Tuberculosis and Lung Disease (The Union) and analysed by The Union. Results: Of the 75 401 new smear-positive PTB patients included in the study, 63–89% were PWLAHS. The average gross domestic product of the project sites and at national level were respectively US$557 and US$998. The median patient delay was 93 days (range 68–128). Delays were longer among females, older patients, rural residents and PWLAHS. Delayed access to health services was significantly associated with a greater number of symptoms. Conclusion: Patient delay in accessing health care in China was lengthy; TB care and control needs to be improved. PMID:26400603

  17. 42 CFR 137.301 - How are project and program environmental review costs identified?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false How are project and program environmental review... Construction Nepa Process § 137.301 How are project and program environmental review costs identified? (a) The... development to identify program and project related costs associated with carrying out...

  18. 42 CFR 137.301 - How are project and program environmental review costs identified?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false How are project and program environmental review... Construction Nepa Process § 137.301 How are project and program environmental review costs identified? (a) The... development to identify program and project related costs associated with carrying out...

  19. Effective Nurse Communication With Type 2 Diabetes Patients: A Review.

    PubMed

    Mulder, Bob C; Lokhorst, Anne Marike; Rutten, Guy E H M; van Woerkum, Cees M J

    2015-08-01

    Many type 2 diabetes mellitus patients have difficulties reaching optimal blood glucose control. With patients treated in primary care by nurses, nurse communication plays a pivotal role in supporting patient health. The twofold aim of the present review is to categorize common barriers to nurse-patient communication and to review potentially effective communication methods. Important communication barriers are lack of skills and self-efficacy, possibly because nurses work in a context where they have to perform biomedical examinations and then perform patient-centered counseling from a biopsychosocial approach. Training in patient-centered counseling does not seem helpful in overcoming this paradox. Rather, patient-centeredness should be regarded as a basic condition for counseling, whereby nurses and patients seek to cooperate and share responsibility based on trust. Nurses may be more successful when incorporating behavior change counseling based on psychological principles of self-regulation, for example, goal setting, incremental performance accomplishments, and action planning.

  20. 1992 DOE/Sandia crystalline photovoltaic technology project review meeting

    SciTech Connect

    Maish, A.

    1992-07-01

    This document serves as the proceedings for the annual project review meeting held by Sandia National Laboratories` Photovoltaic Technology and Photovoltaic Evaluation Departments. It contains information supplied by organizations making presentations at the meeting, which was held July 14--15, 1992 at the Sheraton Old Town Hotel in Albuquerque, New Mexico. Overview sessions covered the Department of Energy (DOE) program, including those at Sandia and the National Renewable Energy Laboratory (NREL), and non-DOE programs, including the EPRI concentrator collector program, The Japanese crystalline silicon program, and some concentrating photovoltaic activities in Europe. Additional sessions included papers on Sandia`s Photovoltaic Device Fabrication Laboratory`s collaborative research, cell processing research, the activities of the participants in the Concentrator Initiative Program, and photovoltaic technology evaluation at Sandia and NREL.

  1. [Literature review of the subject of a research project].

    PubMed

    Vilanova, J C

    2012-01-01

    It can be very complicated to obtain relevant information through searching the medical literature if you do not know how it is organized and indexed or if you do not know how to use the specialized databases. For a successful review of the literature, you need to know what you are looking for and the key words for an effective search of the specialized databases and libraries and especially of the internet. It is essential to critically evaluate the information selected. Finally, using a reference manager can facilitate the gathering, organization, systematization, and integration of the bibliographic references in the documents generated in the study. This article aims to provide guidelines for efficient searching for information and for accurate, critical use of the literature. It makes recommendations about strategies for managing references to help to ensure the success of a research project.

  2. Determinants of patient choice of healthcare providers: a scoping review

    PubMed Central

    2012-01-01

    Background In several northwest European countries, a demand-driven healthcare system has been implemented that stresses the importance of patient healthcare provider choice. In this study, we are conducting a scoping review aiming to map out what is known about the determinants of patient choice of a wide range of healthcare providers. As far as we know, not many studies are currently available that attempt to draw a general picture of how patients choose a healthcare provider and of the status of research on this subject. This study is therefore a valuable contribution to the growing amount of literature about patient choice. Methods We carried out a specific type of literature review known as a scoping review. Scoping reviews try to examine the breadth of knowledge that is available about a particular topic and therefore do not make selections or apply quality constraints. Firstly, we defined our research questions and searched the literature in Embase, Medline and PubMed. Secondly, we selected the literature, and finally we analysed and summarized the information. Results Our review shows that patients’ choices are determined by a complex interplay between patient and provider characteristics. A variety of patient characteristics determines whether patients make choices, are willing and able to choose, and how they choose. Patients take account of a variety of structural, process and outcome characteristics of providers, differing in the relative importance they attach to these characteristics. Conclusions There is no such thing as the typical patient: different patients make different choices in different situations. Comparative information seems to have a relatively limited influence on the choices made by many patients and patients base their decisions on a variety of provider characteristics instead of solely on outcome characteristics. The assumptions made in health policy about patient choice may therefore be an oversimplification of reality. Several

  3. The communication goals and needs of cancer patients: a review.

    PubMed

    Hack, Thomas F; Degner, Lesley F; Parker, Patricia A

    2005-10-01

    The aim of this review paper is to critique the empirical literature pertaining to the communication needs and goals of cancer patients, and to provide direction for research in this area. According to the conceptual framework of Feldman-Stewart et al., patient-physician communication occurs for the fundamental purpose of addressing each participant's goal(s). This review is divided into two categories of goals: (a) optimal medical management of the cancer, and (b) optimal attention to the patient's psychosocial response to cancer. Optimal medical management includes discussions about disease status and the treatment plan, and the effectiveness of these discussions is frequently determined by assessing patient understanding, satisfaction, and well-being. The literature suggests that cancer patients continue to have unmet communication needs, and communication outcomes are enhanced when physicians attend to the emotional needs of patients. Research gaps in communication research are highlighted, including the need for additional study of several external factors affecting the patient and provider.

  4. Evaluation of patient involvement in a systematic review and meta-analysis of individual patient data in cervical cancer treatment

    PubMed Central

    2012-01-01

    Background In April 2005, researchers based at the Medical Research Council Clinical Trials Unit, set out to involve women affected by cervical cancer in a systematic review and meta-analysis of individual patient data to evaluate treatments for this disease. Each of the women had previously been treated for cervical cancer. Following completion of the meta-analysis, we aimed to evaluate the process of involvement from the researcher and research partner perspective. Methods An advisory group was first established to give advice on recruiting, supporting and involving women and led to efforts to recruit women to take part in the systematic review using different approaches. Evaluation of the process and outcomes of the partnership between the systematic reviewers and the patients, in respect to what the partnership achieved; what worked well and what were the difficulties; what was learned and the resource requirements, took place during the conduct of the meta-analysis and again after completion of the project. Results Six women, each of whom had received treatments for cervical cancer, were recruited as Patient Research Partners and five of these women subsequently took part in a variety of activities around the systematic review. They attended progress meetings and all but one attended a meeting at which the first results of the review were presented to all collaborators and gave feedback. Three of the women also became involved in a further related research project which led to an editorial publication from the patient perspective and also participated, along with two lead researchers, in the evaluation of the process and outcomes. While they were generally positive about the experience, one Patient Research Partner questioned the extent of the impact patients could make to the systematic review process. Conclusions In general, researchers and patient research partners felt that they had learned a lot from the process and considered it to have been a positive

  5. Status Review of Wildlife Mitigation, Columbia Basin Hydroelectric Projects, Washington Facilities (Intrastate) Final Report.

    SciTech Connect

    Howerton, Jack

    1984-11-01

    This report was prepared for BPA in fulfillment of section 1004 (b)(1) of the Pacific Northwest Electric Power Planning and Conservation Act of 1980, to review the status of past, present, and proposed future wildlife planning and mitigation program at existing hydroelectric projects in the Columbia River Basin. The project evaluations will form the basis for determining any needed remedial measures or additional project analysis. Projects addressed are: Merwin Dam; Swift Project; Yale Project; Cowlitz River; Boundary Dam; Box Canyon Dam; Lake Chelan; Condit Project; Enloe Project; Spokane River; Tumwater and Dryden Dam; Yakima; and Naches Project.

  6. Review of PV Inverter Technology Cost and Performance Projections

    SciTech Connect

    Navigant Consulting Inc.

    2006-01-01

    The National Renewable Energy Laboratory (NREL) has a major responsibility in the implementation of the U.S. Department of Energy's (DOE's) Solar Energy Technologies Program. Sandia National Laboratories (SNL) has a major role in supporting inverter development, characterization, standards, certifications, and verifications. The Solar Energy Technologies Program recently published a Multiyear Technical Plan, which establishes a goal of reducing the Levelized Energy Cost (LEC) for photovoltaic (PV) systems to $0.06/kWh by 2020. The Multiyear Technical Plan estimates that, in order to meet the PV system goal, PV inverter prices will need to decline to $0.25-0.30 Wp by 2020. DOE determined the need to conduct a rigorous review of the PV Program's technical and economic targets, including the target set for PV inverters. NREL requested that Navigant Consulting Inc.(NCI) conduct a review of historical and projected cost and performance improvements for PV inverters, including identification of critical barriers identified and the approaches government might use to address them.

  7. 42 CFR 137.294 - What is the typical IHS environmental review process for construction projects?

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... process for construction projects? 137.294 Section 137.294 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT... process for construction projects? (a) Most IHS construction projects normally do not have a significant... current IHS procedures, an environmental review is performed on all construction projects. During the...

  8. 42 CFR 137.294 - What is the typical IHS environmental review process for construction projects?

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... process for construction projects? 137.294 Section 137.294 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT... process for construction projects? (a) Most IHS construction projects normally do not have a significant... current IHS procedures, an environmental review is performed on all construction projects. During the...

  9. 42 CFR 137.294 - What is the typical IHS environmental review process for construction projects?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... process for construction projects? 137.294 Section 137.294 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT... process for construction projects? (a) Most IHS construction projects normally do not have a significant... current IHS procedures, an environmental review is performed on all construction projects. During the...

  10. 7 CFR 1486.506 - When will a project be reviewed?

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... CORPORATION, DEPARTMENT OF AGRICULTURE EXPORT PROGRAMS EMERGING MARKETS PROGRAM Reporting, Evaluation, and Compliance § 1486.506 When will a project be reviewed? Any project or activity funded under the program...

  11. 7 CFR 1486.506 - When will a project be reviewed?

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... CORPORATION, DEPARTMENT OF AGRICULTURE EXPORT PROGRAMS EMERGING MARKETS PROGRAM Reporting, Evaluation, and Compliance § 1486.506 When will a project be reviewed? Any project or activity funded under the program...

  12. 7 CFR 1486.506 - When will a project be reviewed?

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... CORPORATION, DEPARTMENT OF AGRICULTURE EXPORT PROGRAMS EMERGING MARKETS PROGRAM Reporting, Evaluation, and Compliance § 1486.506 When will a project be reviewed? Any project or activity funded under the program...

  13. 78 FR 26319 - Deepwater Horizon Oil Spill; Proposal of Future Early Restoration Projects and Environmental Reviews

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-06

    ... Restoration Projects and Environmental Reviews AGENCY: National Oceanic and Atmospheric Administration... Horizon oil spill (Trustees) intend to propose the additional early restoration projects described below to continue the process of using early restoration funding to restore natural resources,...

  14. An Open Library of CT Patient Projection Data

    PubMed Central

    Chen, Baiyu; Leng, Shuai; Yu, Lifeng; Holmes, David; Fletcher, Joel; McCollough, Cynthia

    2016-01-01

    Lack of access to projection data from patient CT scans is a major limitation for development and validation of new reconstruction algorithms. To meet this critical need, we are building a library of CT patient projection data in an open and vendor-neutral format, DICOM-CT-PD, which is an extended DICOM format that contains sinogram data, acquisition geometry, patient information, and pathology identification. The library consists of scans of various types, including head scans, chest scans, abdomen scans, electrocardiogram (ECG)-gated scans, and dual-energy scans. For each scan, three types of data are provided, including DICOM-CT-PD projection data at various dose levels, reconstructed CT images, and a free-form text file. Several instructional documents are provided to help the users extract information from DICOM-CT-PD files, including a dictionary file for the DICOM-CT-PD format, a DICOM-CT-PD reader, and a user manual. Radiologist detection performance based on the reconstructed CT images is also provided. So far 328 head cases, 228 chest cases, and 228 abdomen cases have been collected for potential inclusion. The final library will include a selection of 50 head, chest, and abdomen scans each from at least two different manufacturers, and a few ECG-gated scans and dual-source, dual-energy scans. It will be freely available to academic researchers, and is expected to greatly facilitate the development and validation of CT reconstruction algorithms. PMID:27239087

  15. An open library of CT patient projection data

    NASA Astrophysics Data System (ADS)

    Chen, Baiyu; Leng, Shuai; Yu, Lifeng; Holmes, David; Fletcher, Joel; McCollough, Cynthia

    2016-03-01

    Lack of access to projection data from patient CT scans is a major limitation for development and validation of new reconstruction algorithms. To meet this critical need, we are building a library of CT patient projection data in an open and vendor-neutral format, DICOM-CT-PD, which is an extended DICOM format that contains sinogram data, acquisition geometry, patient information, and pathology identification. The library consists of scans of various types, including head scans, chest scans, abdomen scans, electrocardiogram (ECG)-gated scans, and dual-energy scans. For each scan, three types of data are provided, including DICOM-CT-PD projection data at various dose levels, reconstructed CT images, and a free-form text file. Several instructional documents are provided to help the users extract information from DICOM-CT-PD files, including a dictionary file for the DICOM-CT-PD format, a DICOM-CT-PD reader, and a user manual. Radiologist detection performance based on the reconstructed CT images is also provided. So far 328 head cases, 228 chest cases, and 228 abdomen cases have been collected for potential inclusion. The final library will include a selection of 50 head, chest, and abdomen scans each from at least two different manufacturers, and a few ECG-gated scans and dual-source, dual-energy scans. It will be freely available to academic researchers, and is expected to greatly facilitate the development and validation of CT reconstruction algorithms.

  16. Auditory hallucinations: A review of the ERC “VOICE” project

    PubMed Central

    Hugdahl, Kenneth

    2015-01-01

    In this invited review I provide a selective overview of recent research on brain mechanisms and cognitive processes involved in auditory hallucinations. The review is focused on research carried out in the “VOICE” ERC Advanced Grant Project, funded by the European Research Council, but I also review and discuss the literature in general. Auditory hallucinations are suggested to be perceptual phenomena, with a neuronal origin in the speech perception areas in the temporal lobe. The phenomenology of auditory hallucinations is conceptualized along three domains, or dimensions; a perceptual dimension, experienced as someone speaking to the patient; a cognitive dimension, experienced as an inability to inhibit, or ignore the voices, and an emotional dimension, experienced as the “voices” having primarily a negative, or sinister, emotional tone. I will review cognitive, imaging, and neurochemistry data related to these dimensions, primarily the first two. The reviewed data are summarized in a model that sees auditory hallucinations as initiated from temporal lobe neuronal hyper-activation that draws attentional focus inward, and which is not inhibited due to frontal lobe hypo-activation. It is further suggested that this is maintained through abnormal glutamate and possibly gamma-amino-butyric-acid transmitter mediation, which could point towards new pathways for pharmacological treatment. A final section discusses new methods of acquiring quantitative data on the phenomenology and subjective experience of auditory hallucination that goes beyond standard interview questionnaires, by suggesting an iPhone/iPod app. PMID:26110121

  17. RENEW—a renal redesign project in predialysis patient care

    PubMed Central

    Sau Fan Chow, Josephine; Jobburn, Kim; Chapman, Margaret; Suranyi, Michael

    2016-01-01

    Background An ageing population and geographical growth, along with an increase in the number of people that reside in specific location, are increasing the demand for renal replacement therapies. Hospital-based haemodialysis units are struggling to cope with the associated physical, staffing and cost demands. Home-based dialysis therapies are known to be more cost effective with superior social, physical health and survival outcomes. Methods ‘RENEW, a renal redesign project, examined the pre-dialysis health care experience of renal patients to find opportunities to improve patient care outcomes and increase the uptake of home-based dialysis therapies. This article details two crucial parts of the approach to change management: (i) diagnostics—an inclusive, client focused, multidisciplinary approach to identify issues relating to the pre-dialysis journey—and (ii) solution design—an inclusive problem-solving approach to identify and marry solutions to the issues identified during diagnostics. Results Based on feedback from patients/caregivers and staff interviews, utilizing a clinical redesign methodology, a new model of care was developed, implemented and subsequently embedded into clinical practice. The results have been evident via improved care coordination, enhanced patient preparation for dialysis, improved patient psychosocial welfare and, importantly, an increased number of patients planned for and commencing home dialysis. This has empowered patients by giving them the confidence, knowledge and skills to be actively engaged in their own care. The project resulted in significant expenditure avoidance. Conclusion Change management strategies with successful implementation are vital components of evolving clinical practice to achieve both clinical and organizational goals.

  18. RENEW—a renal redesign project in predialysis patient care

    PubMed Central

    Sau Fan Chow, Josephine; Jobburn, Kim; Chapman, Margaret; Suranyi, Michael

    2016-01-01

    Background An ageing population and geographical growth, along with an increase in the number of people that reside in specific location, are increasing the demand for renal replacement therapies. Hospital-based haemodialysis units are struggling to cope with the associated physical, staffing and cost demands. Home-based dialysis therapies are known to be more cost effective with superior social, physical health and survival outcomes. Methods ‘RENEW, a renal redesign project, examined the pre-dialysis health care experience of renal patients to find opportunities to improve patient care outcomes and increase the uptake of home-based dialysis therapies. This article details two crucial parts of the approach to change management: (i) diagnostics—an inclusive, client focused, multidisciplinary approach to identify issues relating to the pre-dialysis journey—and (ii) solution design—an inclusive problem-solving approach to identify and marry solutions to the issues identified during diagnostics. Results Based on feedback from patients/caregivers and staff interviews, utilizing a clinical redesign methodology, a new model of care was developed, implemented and subsequently embedded into clinical practice. The results have been evident via improved care coordination, enhanced patient preparation for dialysis, improved patient psychosocial welfare and, importantly, an increased number of patients planned for and commencing home dialysis. This has empowered patients by giving them the confidence, knowledge and skills to be actively engaged in their own care. The project resulted in significant expenditure avoidance. Conclusion Change management strategies with successful implementation are vital components of evolving clinical practice to achieve both clinical and organizational goals. PMID:27679723

  19. Kabuki syndrome: a review study of three hundred patients.

    PubMed

    Wessels, Marja W; Brooks, Alice S; Hoogeboom, Jeannette; Niermeijer, Martinus F; Willems, Patrick J

    2002-04-01

    The Kabuki (make-up) syndrome identified in 1981 has been reported in more than three hundred patients. Typical findings include mild to moderate mental retardation, fetal pads, cleft palate, and characteristic facies with long palpebral fissures, everted lower lateral eyelids and arched eyebrows. Postnatal growth retardation, skeletal and visceral anomalies are present in a large percentage of patients. We review here the characteristics of this peculiar syndrome in three hundred patients. PMID:12002156

  20. Engaging patients and stakeholders in research proposal review: the patient-centered outcomes research institute.

    PubMed

    Fleurence, Rachael L; Forsythe, Laura P; Lauer, Michael; Rotter, Jason; Ioannidis, John P A; Beal, Anne; Frank, Lori; Selby, Joseph V

    2014-07-15

    The inaugural round of merit review for the Patient-Centered Outcomes Research Institute (PCORI) in November 2012 included patients and other stakeholders, as well as scientists. This article examines relationships among scores of the 3 reviewer types, changes in scoring after in-person discussion, and the effect of inclusion of patient and stakeholder reviewers on the review process. In the first phase, 363 scientists scored 480 applications. In the second phase, 59 scientists, 21 patients, and 31 stakeholders provided a "prediscussion" score and a final "postdiscussion" score after an in-person meeting for applications. Bland-Altman plots were used to characterize levels of agreement among and within reviewer types before and after discussion. Before discussion, there was little agreement among average scores given by the 4 lead scientific reviewers and patient and stakeholder reviewers. After discussion, the 4 primary reviewers showed mild convergence in their scores, and the 21-member panel came to a much stronger agreement. Of the 25 awards with the best (and lowest) scores after phase 2, only 13 had ranked in the top 25 after the phase 1 review by scientists. Five percent of the 480 proposals submitted were funded. The authors conclude that patient and stakeholder reviewers brought different perspectives to the review process but that in-person discussion led to closer agreement among reviewer types. It is not yet known whether these conclusions are generalizable to future rounds of peer review. Future work would benefit from additional data collection for evaluation purposes and from long-term evaluation of the effect on the funded research.

  1. Project Icarus: A Review of the Daedalus Main Propulsion System

    NASA Astrophysics Data System (ADS)

    French, J. R.

    The epochal Daedalus study [1], the first known serious engineering study of an interstellar spacecraft, was conducted nearly 40 years ago. With the inception of the present Icarus Study [2], it seems appropriate that the original work be reviewed in the perspective of today and a perhaps modified view of future technical evolution. The main propulsion system being the most demanding and least certain of the technologies involved, it is appropriate to begin there. The Daedalus system depends upon focused electron beams to achieve fusion in targets which are fired axially down the engine reflector to the beam focus point. Serious problems appear with this approach in that, fluctuations of the focusing magnetic field caused by the previous detonation can be expected to deflect and defocus the beams. The problem of accelerating the target particles to sufficient speed to reach the target point in the interval between detonations will be challenging as well. Timing of the entire operation is a major issue. Questions arise as to whether the beams can in fact achieve fusion conditions even if perfectly timed and focused due to effects in the plasma generated. Mechanical oscillations in the engine structure caused by the periodic energy pulsed from the detonations could easily destroy the engine structure. These and other problems are discussed with an eye toward guiding future work on similar concepts or perhaps directing future studies toward other methods. This paper is a submission of the Project Icarus study group.

  2. Treating Insomnia: A Review of Patient Perceptions Toward Treatment.

    PubMed

    Cheung, Janet M Y; Bartlett, Delwyn J; Armour, Carol L; Saini, Bandana

    2016-01-01

    Patient views about their treatment for insomnia often dictate outcome. This review explores the literature relating to the patients' global perceptions toward treatment for insomnia. A strategic literature search was conducted using five databases (PubMed, CINAHL, Medline, PsycINFO, and Embase). The 57 research articles included for this review were mapped out chronologically across three key stages of treatment-seeking (pretreatment appraisal, actual treatment experiences, and posttreatment evaluation). Patient perceptions played an important role across these three key stages and influenced subsequent health behaviors such as the initiation of help-seeking, treatment uptake, treatment adherence, and treatment adjustment. Patients' perceptions toward treatment were heavily grounded by their psychosocial contexts. Clinical implications and future directions for including patient-centered metrics in mainstream practice and research are discussed.

  3. Training in Patient Navigation: A Review of the Research Literature.

    PubMed

    Ustjanauskas, Amy E; Bredice, Marissa; Nuhaily, Sumayah; Kath, Lisa; Wells, Kristen J

    2016-05-01

    Despite the proliferation of patient navigation programs designed to increase timely receipt of health care, little is known about the content and delivery of patient navigation training, or best practices in this arena. The current study begins to address these gaps in understanding, as it is the first study to comprehensively review descriptions of patient navigation training in the peer-reviewed research literature. Seventy-five patient navigation efficacy studies published since 1995, identified through PubMed and by the authors, were included in this narrative review. Fifty-nine of the included studies (79%) mentioned patient navigation training, and 55 of these studies additionally provided a description of training. Most studies did not thoroughly document patient navigation training practices. Additionally, several topics integral to the role of patient navigators, as well as components of training central to successful adult learning, were not commonly described in the research literature. Descriptions of training also varied widely across studies in terms of duration, location, format, learning strategies employed, occupation of trainer, and content. These findings demonstrate the need for established standards of navigator training as well as for future research on the optimal delivery and content of patient navigation training.

  4. eHealth for Patient Engagement: A Systematic Review

    PubMed Central

    Barello, Serena; Triberti, Stefano; Graffigna, Guendalina; Libreri, Chiara; Serino, Silvia; Hibbard, Judith; Riva, Giuseppe

    2016-01-01

    eHealth interventions are recognized to have a tremendous potential to promote patient engagement. To date, the majority of studies examine the efficacy of eHealth in enhancing clinical outcomes without focusing on patient engagement in its specificity. This paper aimed at reviewing findings from the literature about the use of eHealth in engaging patients in their own care process. We undertook a comprehensive literature search within the peer-reviewed international literature. Eleven studies met the inclusion criteria. eHealth interventions reviewed were mainly devoted to foster only partial dimensions of patient engagement (i.e., alternatively cognitive, emotional or behavioral domains related to healthcare management), thus failing to consider the complexity of such an experience. This also led to a great heterogeneity of technologies, assessed variables and achieved outcomes. This systematic review underlines the need for a more holistic view of patient needs to actually engage them in eHealth interventions and obtaining positive outcomes. In this sense, patient engagement constitute a new frontiers for healthcare models where eHealth could maximize its potentialities. PMID:26779108

  5. 42 CFR 137.294 - What is the typical IHS environmental review process for construction projects?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... current IHS procedures, an environmental review is performed on all construction projects. During the IHS... 42 Public Health 1 2010-10-01 2010-10-01 false What is the typical IHS environmental review process for construction projects? 137.294 Section 137.294 Public Health PUBLIC HEALTH SERVICE,...

  6. 42 CFR 137.294 - What is the typical IHS environmental review process for construction projects?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... current IHS procedures, an environmental review is performed on all construction projects. During the IHS... 42 Public Health 1 2011-10-01 2011-10-01 false What is the typical IHS environmental review process for construction projects? 137.294 Section 137.294 Public Health PUBLIC HEALTH SERVICE,...

  7. 36 CFR 1010.14 - Review of proposals by project applicants.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...), the Trust shall make its own evaluation of the environmental issues and shall take responsibility for... ENVIRONMENTAL QUALITY § 1010.14 Review of proposals by project applicants. (a) An EA shall be required for each... project applicant until such time as the appropriate environmental review documents have been prepared...

  8. 36 CFR 1010.14 - Review of proposals by project applicants.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...), the Trust shall make its own evaluation of the environmental issues and shall take responsibility for... ENVIRONMENTAL QUALITY § 1010.14 Review of proposals by project applicants. (a) An EA shall be required for each... project applicant until such time as the appropriate environmental review documents have been prepared...

  9. 36 CFR 1010.14 - Review of proposals by project applicants.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...), the Trust shall make its own evaluation of the environmental issues and shall take responsibility for... ENVIRONMENTAL QUALITY § 1010.14 Review of proposals by project applicants. (a) An EA shall be required for each... project applicant until such time as the appropriate environmental review documents have been prepared...

  10. 77 FR 18885 - Improving Performance of Federal Permitting and Review of Infrastructure Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-28

    ..., employees, or agents, or any other person. (Presidential Sig.) THE WHITE HOUSE, March 22, 2012. [FR Doc... and Review of Infrastructure Projects Memorandum of March 22, 2012--Expediting Review of Pipeline Projects From Cushing, Oklahoma, to Port Arthur, Texas, and Other Domestic Pipeline Infrastructure...

  11. Implants in disabled patients: A review and update

    PubMed Central

    Romero-Pérez, María J.; Mang-de la Rosa, María R.; López-Jimenez, Julián; Fernández-Feijoo, Javier

    2014-01-01

    The range of indications for dental implants has broadened enormously owing to their predictability and the improvement of patient satisfaction in terms of stability, comfort, aesthetics and functionality. The aim of this article is to review those indications in patients with mental or physical disabilities as the difficulty to cope with oral hygiene often leads to teeth extraction, adding edentulousness to the impairments already present. Following that goal, available literature in Pubmed database, Scopus, Web of Knowledge and The Cochrane Library database about dental implants placement in these patients has been reviewed, assessing the variables of each study: number of patients, sex, average age, oral hygiene, parafunctional habits, impairment, bone quality, protocol of implant surgery, necessity of deep intravenous sedation or general anesthesia, follow-up period and number of failures. The comparison with studies involving other patient populations without mental or physical impediments did not show statistically significant differences in terms of the failure rate recorded. Although there is not much literature available, the results of this review seem to suggest that osseointegrated oral implants could be a therapeutic option in patients who suffer from any physical or psychological impairment. The success of an oral rehabilitation depends mainly on an adequate selection of the patients. Key words:Implants, disabled, sedation. PMID:24608221

  12. How patients' review sites will change health care.

    PubMed

    Hotopf, Max

    2013-10-01

    TripAdvisor has changed how the travel industry treats customers. Is the same likely to happen to health services? Review sites are growing fast across Europe, propelled by expansions in patient choice. What impact will they have on the medical profession and on providers, both public and private? How will they change the nature of health care? To address these questions, those at the forefront of developing review sites in Europe were interviewed. PMID:23904237

  13. Patient engagement in the inpatient setting: a systematic review

    PubMed Central

    Prey, Jennifer E; Woollen, Janet; Wilcox, Lauren; Sackeim, Alexander D; Hripcsak, George; Bakken, Suzanne; Restaino, Susan; Feiner, Steven; Vawdrey, David K

    2014-01-01

    Objective To systematically review existing literature regarding patient engagement technologies used in the inpatient setting. Methods PubMed, Association for Computing Machinery (ACM) Digital Library, Institute of Electrical and Electronics Engineers (IEEE) Xplore, and Cochrane databases were searched for studies that discussed patient engagement (‘self-efficacy’, ‘patient empowerment’, ‘patient activation’, or ‘patient engagement’), (2) involved health information technology (‘technology’, ‘games’, ‘electronic health record’, ‘electronic medical record’, or ‘personal health record’), and (3) took place in the inpatient setting (‘inpatient’ or ‘hospital’). Only English language studies were reviewed. Results 17 articles were identified describing the topic of inpatient patient engagement. A few articles identified design requirements for inpatient engagement technology. The remainder described interventions, which we grouped into five categories: entertainment, generic health information delivery, patient-specific information delivery, advanced communication tools, and personalized decision support. Conclusions Examination of the current literature shows there are considerable gaps in knowledge regarding patient engagement in the hospital setting and inconsistent use of terminology regarding patient engagement overall. Research on inpatient engagement technologies has been limited, especially concerning the impact on health outcomes and cost-effectiveness. PMID:24272163

  14. Patient exposure tracking: the IAEA smart card project.

    PubMed

    Rehani, Madan M; Frush, Donald P

    2011-09-01

    The existing approach of radiation protection is largely based on the collective dose to the population with provisions for protection at an individual level through justification and optimisation. With the individual patient dose now exceeding the life-long occupational dose to a worker in a typical radiology practice, there is a need to establish approaches based on the protection of an individual patient. Radiation exposure tracking seems a way forward in this respect. Technological advances in recent years have provided opportunities for tracking to becoming a reality. The IAEA project on Smart Card/SmartRadTrack is described in this paper. The tracking is now a reality in a few dozen centres in many countries connected by picture archiving and communication systems, and there is hope that this will extend to cover other countries and continents.

  15. Review of Evaluation Procedures Used in Project POWER.

    ERIC Educational Resources Information Center

    Ohio State Univ., Columbus. Center on Education and Training for Employment.

    Project POWER is a workplace literacy program conducted by Triton College. The project offers courses in English as a Second Language (ESL) and Adult Basic Education (ABE) to employers who are willing to pay their employees for half their class time and for 15 percent of the instructional costs. By the end of January 1990, the project had…

  16. 18 CFR 806.5 - Projects that may require review and approval.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 18 Conservation of Power and Water Resources 2 2014-04-01 2014-04-01 false Projects that may require review and approval. 806.5 Section 806.5 Conservation of Power and Water Resources SUSQUEHANNA... Director: (1) Projects that may affect interstate water quality. (2) Projects within a member state...

  17. 18 CFR 806.5 - Projects that may require review and approval.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 18 Conservation of Power and Water Resources 2 2013-04-01 2012-04-01 true Projects that may require review and approval. 806.5 Section 806.5 Conservation of Power and Water Resources SUSQUEHANNA... Director: (1) Projects that may affect interstate water quality. (2) Projects within a member state...

  18. 18 CFR 806.5 - Projects that may require review and approval.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 18 Conservation of Power and Water Resources 2 2012-04-01 2012-04-01 false Projects that may require review and approval. 806.5 Section 806.5 Conservation of Power and Water Resources SUSQUEHANNA... Director: (1) Projects that may affect interstate water quality. (2) Projects within a member state...

  19. Status Review of Wildlife Mitigation, Columbia Basin Hydroelectric Projects, Columbia River Mainstem Facilities, 1984 Final Report.

    SciTech Connect

    Howerton, Jack; Hwang, Diana

    1984-11-01

    This report reviews the status of past, present, and proposed future wildlife planning and mitigation programs at existing hydroelectric projects in the Columbia River Basin. The project evaluations will form the basis for determining any needed remedial measures or additional project analysis. Each hydropower facility report is abstracted separately for inclusion in the Energy Data Base.

  20. The Influence of Gatekeeping and Utilization Review on Patient Satisfaction

    PubMed Central

    Kerr, Eve A; Hays, Ron D; Mitchinson, Allison; Lee, Martin; Siu, Albert L

    1999-01-01

    OBJECTIVE To examine the influence of utilization review and denial of specialty referrals on patient satisfaction with overall medical care, willingness to recommend one’s physician group to a friend, and desire to disenroll from the health plan. DESIGN Two cross-sectional questionnaires: one of physician groups and one of patient satisfaction. SETTING Eighty-eight capitated physician groups in California. PARTICIPANTS Participants were 11,710 patients enrolled in a large California network-model HMO in 1993 who received care in one of the 88 physician groups. MEASUREMENTS AND MAIN RESULTS Our main measures were how groups conducted utilization review for specialty referrals and tests, patient-reported denial of specialty referrals, and patient satisfaction with overall medical care. Patients in groups that required preauthorization for access to many types of specialists were significantly (p≤ .001) less satisfied than patients in groups that had few preauthorization requirements, even after adjusting for patient and other group characteristics. Patients who had wanted to see a specialist in the previous year but did not see one were significantly less satisfied than those who had wanted to see a specialist and actually saw one (p < .001). In addition, patients who did not see a specialist when desired were more likely to want to disenroll from the health plan than patients who saw the specialist (40% vs 18%, p≤ .001) and more likely not to recommend their group to a friend (38% vs 13%, p≤ .001). CONCLUSIONS Policies that limited direct access to specialists, and especially denial of patient-desired referrals, were associated with significantly lower patient satisfaction, increased desire to disenroll, and lower likelihood of recommending the group to a friend. Health plans and physician groups need to take these factors into account when designing strategies to reduce specialty care use. PMID:10337038

  1. Review of gastroesophageal reflux disease (GERD) in the diabetic patient.

    PubMed

    Punjabi, Paawan; Hira, Angela; Prasad, Shanti; Wang, Xiangbing; Chokhavatia, Sita

    2015-09-01

    This article reviews the known pathophysiological mechanisms of comorbid gastroesophageal reflux disease (GERD) in the diabetic patient, discusses therapeutic options in care, and provides an approach to its evaluation and management. We searched for review articles published in the past 10 years through a PubMed search using the filters diabetes mellitus, GERD, pathophysiology, and management. The search only yielded a handful of articles, so we independently included relevant studies from these review articles along with related citations as suggested by PubMed. We found diabetic patients are more prone to developing GERD and may present with atypical manifestations. A number of mechanisms have been proposed to elucidate the connection between these two diseases. Studies involving treatment options for comorbid disease suggest conflicting drug-drug interactions. Currently, there are no published guidelines specifically for the evaluation and management of GERD in the diabetic patient. Although there are several proposed mechanisms for the higher prevalence of GERD in the diabetic patient, this complex interrelationship requires further research. Understanding the pathophysiology will help direct diagnostic evaluation. In our review, we propose a management algorithm for GERD in the diabetic patient.

  2. Should we pay the patient? Review of financial incentives to enhance patient compliance.

    PubMed Central

    Giuffrida, A.; Torgerson, D. J.

    1997-01-01

    OBJECTIVE: To determine whether financial incentives increase patients' compliance with healthcare treatments. DATA SOURCES: Systematic literature review of computer databases--Medline, Embase, PsychLit, EconLit, and the Cochrane Database of Clinical Trials. In addition, the reference list of each retrieved article was reviewed and relevant citations retrieved. STUDY SELECTION: Only randomised trials with quantitative data concerning the effect, of financial incentives (cash, vouchers, lottery tickets, or gifts) on compliance with medication, medical advice, or medical appointments were included in the review. Eleven papers were identified as meeting the selection criteria. DATA EXTRACTION: Data on study populations, interventions, and outcomes were extracted and analysed using odds ratios and the number of patients needed to be treated to improve compliance by one patient. RESULTS: 10 of the 11 studies showed improvements in patient compliance with the use of financial incentives. CONCLUSIONS: Financial incentives can improve patient compliance. PMID:9314754

  3. Nonadherence to Medication Therapy in Haemodialysis Patients: A Systematic Review

    PubMed Central

    Ghimire, Saurav; Castelino, Ronald L.; Lioufas, Nicole M.; Peterson, Gregory M.; Zaidi, Syed Tabish R.

    2015-01-01

    Background End-stage kidney disease (ESKD) patients are often prescribed multiple medications. Together with a demanding weekly schedule of dialysis sessions, increased number of medicines and associated regimen complexity pre-dispose them at high risk of medication nonadherence. This review summarizes existing literature on nonadherence and identifies factors associated with nonadherence to medication therapy in patients undergoing haemodialysis. Methods A comprehensive search of PubMed, Embase, CINAHL, PsycInfo, and Cochrane Database of Systematic Reviews covering the period from 1970 through November 2014 was performed following a predefined inclusion and exclusion criteria. Reference lists from relevant materials were reviewed. Data on study characteristics, measures of nonadherence, prevalence rates and factors associated with nonadherence were collected. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was followed in conducting this systematic review. Results Of 920 relevant publications, 44 were included. The prevalence of medication nonadherence varied from 12.5% to 98.6%, with widespread heterogeneity in measures and definitions employed. Most common patient-related factors significantly associated with nonadherence were younger age, non-Caucasian ethnicity, illness interfering family life, being a smoker, and living single and being divorced or widowed. Similarly, disease-related factors include longevity of haemodialysis, recurrent hospitalization, depressive symptoms and having concomitant illness like diabetes and hypertension. Medication-related factors such as daily tablet count, total pill burden, number of phosphate binders prescribed and complexity of medication regimen were also associated with poor adherence. Conclusions A number of patient-, disease-, and medication-related factors are associated with medication nonadherence in haemodialysis patients. Clinicians should be aware of such factors so that

  4. Healthcare Staff Wellbeing, Burnout, and Patient Safety: A Systematic Review

    PubMed Central

    Hall, Louise H.; Johnson, Judith; Watt, Ian; Tsipa, Anastasia; O’Connor, Daryl B.

    2016-01-01

    Objective To determine whether there is an association between healthcare professionals’ wellbeing and burnout, with patient safety. Design Systematic research review. Data Sources PsychInfo (1806 to July 2015), Medline (1946 to July 2015), Embase (1947 to July 2015) and Scopus (1823 to July 2015) were searched, along with reference lists of eligible articles. Eligibility Criteria for Selecting Studies Quantitative, empirical studies that included i) either a measure of wellbeing or burnout, and ii) patient safety, in healthcare staff populations. Results Forty-six studies were identified. Sixteen out of the 27 studies that measured wellbeing found a significant correlation between poor wellbeing and worse patient safety, with six additional studies finding an association with some but not all scales used, and one study finding a significant association but in the opposite direction to the majority of studies. Twenty-one out of the 30 studies that measured burnout found a significant association between burnout and patient safety, whilst a further four studies found an association between one or more (but not all) subscales of the burnout measures employed, and patient safety. Conclusions Poor wellbeing and moderate to high levels of burnout are associated, in the majority of studies reviewed, with poor patient safety outcomes such as medical errors, however the lack of prospective studies reduces the ability to determine causality. Further prospective studies, research in primary care, conducted within the UK, and a clearer definition of healthcare staff wellbeing are needed. Implications This review illustrates the need for healthcare organisations to consider improving employees’ mental health as well as creating safer work environments when planning interventions to improve patient safety. Systematic Review Registration PROSPERO registration number: CRD42015023340. PMID:27391946

  5. Treatment considerations for patient with Amelogenesis Imperfecta: a review

    PubMed Central

    Chen, Chiung-Fen; Hu, Jan CC; Bresciani, Eduardo; Peters, Mathilde C; Estrella, Maria Regina

    2016-01-01

    Objectives Amelogenesis imperfecta (AI) is a group of inherited disorders primary affecting the structural of enamel. Patients with AI experience poor esthetic, excessive tooth sensitivity and compromised chewing function that dental treatments are frequently required at early age. This review describes the non-enamel implications, stage-specific management strategies and outcomes of selected restorative materials based on literature evidence. PMID:27274954

  6. The Recovery of Walking in Stroke Patients: A Review

    ERIC Educational Resources Information Center

    Jang, Sung Ho

    2010-01-01

    We reviewed the literature on walking recovery of stroke patients as it relates to the following subjects: epidemiology of walking dysfunction, recovery course of walking, and recovery mechanism of walking (neural control of normal walking, the evaluation methods for leg motor function, and motor recovery mechanism of leg). The recovery of walking…

  7. Support for patients with celiac disease: A literature review

    PubMed Central

    Card, Tim; Ciclitira, Paul J; Swift, Gillian L; Nasr, Ikram; Sanders, David S; Ciacci, Carolina

    2015-01-01

    Background Celiac disease (CD) is a lifelong disorder. Patients are at increased risk of complications and comorbidity. Objectives We conducted a review of the literature on patient support and information in CD and aim to issue recommendations about patient information with regards to CD. Methods Data source: We searched PubMed for English-language articles published between 1900 and June 2014, containing terms related to costs, economics of CD, or education and CD. Study selection: Papers deemed relevant by any of the participating authors were included in the study. Data synthesis: No quantitative synthesis of data was performed. Instead we formulated a consensus view of the information that should be offered to all patients with CD. Results There are few randomized clinical trials examining the effect of patient support in CD. Patients and their families receive information from many sources. It is important that health care personnel guide the patient through the plethora of facts and comments on the Internet. An understanding of CD is likely to improve dietary adherence. Patients should be educated about current knowledge about risk factors for CD, as well as the increased risk of complications. Patients should also be advised to avoid other health hazards, such as smoking. Many patients are eager to learn about future non-dietary treatments of CD. This review also comments on novel therapies but it is important to stress that no such treatment is available at present. Conclusion Based on mostly observational data, we suggest that patient support and information should be an integral part of the management of CD, and is likely to affect the outcome of CD. PMID:25922674

  8. A Review of Wind Project Financing Structures in the USA

    SciTech Connect

    Bolinger, Mark A; Harper, John; Karcher, Matthew

    2008-09-24

    The rapid pace of wind power development in the U.S. over the last decade has outstripped the ability of most project developers to provide adequate equity capital and make efficient use of project-related tax benefits. In response, the sector has created novel project financing structures that feature varying combinations of equity capital from project developers and third-party tax-oriented investors, and in some cases commercial debt. While their origins stem from variations in the financial capacity and business objectives of wind project developers, as well as the risk tolerances and objectives of equity and debt providers, each structure is, at its core, designed to manage project risk and allocate federal tax incentives to those entities that can use them most efficiently. This article surveys the six principal financing structures through which most new utility-scale wind projects (excluding utility-owned projects) in the U.S. have been financed from 1999 to the present. These structures include simple balance-sheet finance, several varieties of all-equity special allocation partnership 'flip' structures, and two leveraged structures. In addition to describing each structure's mechanics, the article also discusses its rationale for use, the types of investors that find it appealing and why, and its relative frequency of use in the market. The article concludes with a generalized summary of how a developer might choose one structure over another.

  9. Infant Mortality Review: Project Abstracts, Meeting Proceedings, and Product Information.

    ERIC Educational Resources Information Center

    National Center for Education in Maternal and Child Health, Washington, DC.

    This publication includes proceedings from a fall 1989 meeting attended by representatives of projects funded by the Maternal and Child Health Bureau of the U.S. Public Health Service as part of its infant mortality reduction initiative. It also contains abstracts describing the funded projects and a list of products available to others interested…

  10. Review of the Regional Biomass Energy Program: Technical projects

    SciTech Connect

    Lusk, P.

    1994-12-31

    This article summarizes technical projects of the regional Biomass Energy Program. Projects included are as follows: economic impact studies for renewable energy resources; alternative liquid fuels; Wood pellets fuels forum; residential fuel wood consumption; waste to energy decision-makers guide; fuel assessment for cogeneration facilities; municipal solid waste combustion characteristics.

  11. [Exercise in haemodyalisis patients: a literature systematic review].

    PubMed

    Segura-Ortí, Eva

    2010-01-01

    Exercise as a therapeutic tool used in End-stage renal disease patients (ESRD) in hemodialysis (HD) is not routinately applied, as it occurs with cardiac or respiratory patients. Lack of awareness of research in this field may contribute to the current situation. Thus, the aims of this review are: 1) to systematically review the literature of exercise training on adult HD patients or patients at a pre-HD stage; 2) to show the evidence on the benefits of exercise for counteracting physiological, functional and psychological impairments found even in older ESRD patients; 3) to recommend requirements of future research in order to include exercise prescription in the HD patients treatment. The Data bases reviewed from 2005 to 2009 were: MEDLINE (Ovid), CINAHL (EBSCOHost), SportDicus (EBSCOHost), Academic Search Complete (EBSCOHost), Fuente Académica (EBSCOHost), MedicLatina (EBSCOHost), PEDro y PubMed. Additionally, references from identified articles, several reviews on ESRD and abstracts to Nephrology Congresses were also reviewed. Randomized Controlled Trials on aerobic, strength and combined programs for HD patients were selected. Data from the studies was compiled and Van Tulder criteria were used for methodological quality assessment. Metanalysis included 6 studies on aerobic exercise, 2 on strength exercise and 5 on combined exercise programs. 640 patients were included in 16 included studies. Effects on physical function, health related quality of life and other secondary measurements were summarized by the Standardized Mean Difference (SMD) Moderate evidence exists on positive effects of aerobic training on peak oxygen consumption at the graded exercise test (SMD 6.55; CI 95%: 4.31-8.78). There is high evidence on positive effects of strength training on health related quality of life (SMD 11.03; CI 95%: 5.63-16.43). Finally, moderate evidence exists on positive effects of combined exercise on peak oxygen consumption at the graded exercise test (SMD 5.57; CI

  12. Extraosseous osteogenic sarcoma. A review of 48 patients

    SciTech Connect

    Sordillo, P.P.; Hajdu, S.I.; Magill, G.B.; Golbey, R.B.

    1983-02-15

    The clinical records and histologic material of 48 patients with extraosseous osteogenic sarcoma were reviewed. Most patients developed their tumors in the fifth or sixth decades of life. Five patients (10%) developed neoplasms in an area of prior radiation therapy, a median of 15 years after their exposure. Six patients (13%) related a history of trauma to the area where their extraosseous osteogenic sarcoma developed. The course of most patients was that of multiple local recurrences (69%) followed by pulmonary metastases (80%) and death (76%). Amputation or wide resection followed by irradiation appeared to be the most effective types of therapy, with median survivals greater than 60 months for patients receiving these treatments, compared to 28 months for patients initially treated with resection alone. Chemotherapy was not effective for patients with advanced disease; however, adjuvant chemotherapy after surgery may have been of value. Four of five patients who received adjuvant chemotherapy after surgery are alive and disease-free; the only two survivors after development of pulmonary metastases received adjuvant chemotherapy after surgical resection of visible pulmonary metastases.

  13. Sleep disorders in patients with myasthenia gravis: a systematic review

    PubMed Central

    Fernandes Oliveira, Ezequiel; Nacif, Sergio R.; Alves Pereira, Nixon; Fonseca, Nina Teixeira; Urbano, Jéssica Julioti; Perez, Eduardo Araújo; Cavalcante, Valéria; Santos Oliveira, Claudia; Insalaco, Giuseppe; Oliveira, Acary Sousa Bulle; Oliveira, Luis Vicente Franco

    2015-01-01

    [Purpose] This systematic review evaluated the presence of sleep-disordered breathing in patients with myasthenia gravis and clarified the role of physiotherapy. [Subjects and Methods] We followed the PRISMA declaration criteria. The evaluation was performed in accordance with the STROBE statement for observational and cross-sectional studies and the CONSORT checklist for clinical trials. Searches were followed by hand on MEDLINE, EMBASE, SciELO, PubMed Central, and the Cochrane Central Register of Controlled Trials. [Results] Our searches yielded a total of 36 studies published between 1970 and 2014. The number of patients involved ranged from 9–490. Of the 36 studies, 19 articles were excluded because they did not meet the inclusion criteria. Therefore, 17 observational, cross-sectional, or clinical studies assessing the quality of sleep and prevalence of sleep disorders in patients with myasthenia gravis were eligible for our review. [Conclusion] Some studies of patients with MG show that patients with MG are associated with poor sleep quality, excessive daytime sleepiness, presence of restless syndrome, and a higher incidence of SDB, while other studies do not report such associations. Therefore, given the current inconclusive evidence and limited literature, further study of sleep disturbances in patients with MG is needed. PMID:26180370

  14. Sleep disorders in patients with myasthenia gravis: a systematic review.

    PubMed

    Fernandes Oliveira, Ezequiel; Nacif, Sergio R; Alves Pereira, Nixon; Fonseca, Nina Teixeira; Urbano, Jéssica Julioti; Perez, Eduardo Araújo; Cavalcante, Valéria; Santos Oliveira, Claudia; Insalaco, Giuseppe; Oliveira, Acary Sousa Bulle; Oliveira, Luis Vicente Franco

    2015-06-01

    [Purpose] This systematic review evaluated the presence of sleep-disordered breathing in patients with myasthenia gravis and clarified the role of physiotherapy. [Subjects and Methods] We followed the PRISMA declaration criteria. The evaluation was performed in accordance with the STROBE statement for observational and cross-sectional studies and the CONSORT checklist for clinical trials. Searches were followed by hand on MEDLINE, EMBASE, SciELO, PubMed Central, and the Cochrane Central Register of Controlled Trials. [Results] Our searches yielded a total of 36 studies published between 1970 and 2014. The number of patients involved ranged from 9-490. Of the 36 studies, 19 articles were excluded because they did not meet the inclusion criteria. Therefore, 17 observational, cross-sectional, or clinical studies assessing the quality of sleep and prevalence of sleep disorders in patients with myasthenia gravis were eligible for our review. [Conclusion] Some studies of patients with MG show that patients with MG are associated with poor sleep quality, excessive daytime sleepiness, presence of restless syndrome, and a higher incidence of SDB, while other studies do not report such associations. Therefore, given the current inconclusive evidence and limited literature, further study of sleep disturbances in patients with MG is needed.

  15. Role orientation and community pharmacists' participation in a project to improve patient care.

    PubMed

    Pendergast, J F; Kimberlin, C L; Berardo, D H; McKenzie, L C

    1995-02-01

    Community pharmacists are being assigned increased responsibility in assuring the appropriateness and effectiveness of drug therapy. This increased responsibility is reflected in recently passed legislation (OBRA '90) in the United States that requires pharmacists to counsel patients about prescriptions received and to engage in prospective drug use review for Medicaid recipients. The potential impact of this legislation is unclear due to a dearth of research evaluating the effects of community pharmacists' activities on medication use. In addition, there is little research on pharmacists' willingness to assume increased responsibility. Research that would demonstrate the effectiveness of community pharmacists in improving therapeutic outcomes is hampered by problems inherent in conducting experimentally designed research in field settings. This paper examines two issues of concern in such studies--namely, the extent to which those who agree to participate in a demonstration project differ from those who decline to participate and the extent to which differential dropout from treatment and control conditions compromise the comparability of the two groups. Specifically, this report examines pharmacist characteristics related to participation in a demonstration project to improve the care of elderly patients. Community pharmacists in Florida who had earlier been asked to participate in a demonstration project (N = 418) were sent mail questionnaires to assess their attitudinal, demographic and employment characteristics. In particular, researchers were interested in the role orientation of pharmacists in regard to patient counseling and physician consultation, satisfaction with current jobs and career choices, employment settings and treatment vs control group assignment as predictors of participation in the research project. Demographic characteristics were also examined as possible predictors of participation.(ABSTRACT TRUNCATED AT 250 WORDS)

  16. Nocardia infections among immunomodulated inflammatory bowel disease patients: A review

    PubMed Central

    Abreu, Cândida; Rocha-Pereira, Nuno; Sarmento, António; Magro, Fernando

    2015-01-01

    Human nocardiosis, caused by Nocardia spp., an ubiquitous soil-borne bacteria, is a rare granulomatous disease close related to immune dysfunctions. Clinically can occur as an acute life-threatening disease, with lung, brain and skin being commonly affected. The infection was classically diagnosed in HIV infected persons, organ transplanted recipients and long term corticosteroid treated patients. Currently the widespread use of immunomodulators and immunossupressors in the treatment of inflammatory diseases changed this scenario. Our purpose is to review all published cases of nocardiosis in immunomodulated patients due to inflammatory diseases and describe clinical and laboratory findings. We reviewed the literature concerning human cases of nocardiosis published between 1980 and 2014 in peer reviewed journals. Eleven cases of nocardiosis associated with anti-tumor necrosis factor (TNF) prescription (9 related with infliximab and 2 with adalimumab) were identified; 7 patients had inflammatory bowel disease (IBD), 4 had rheumatological conditions; nocardia infection presented as cutaneous involvement in 3 patients, lung disease in 4 patients, hepatic in one and disseminated disease in 3 patients. From the 10 cases described in IBD patients 7 were associated with anti-TNF and 3 with steroids and azathioprine. In conclusion, nocardiosis requires high levels of clinical suspicion and experience of laboratory staff, in order to establish a timely diagnosis and by doing so avoid worst outcomes. Treatment for long periods tailored by the susceptibility of the isolated species whenever possible is essential. The safety of restarting immunomodulators or anti-TNF after the disease or the value of prophylaxis with cotrimoxazole is still debated. PMID:26074688

  17. A Review of Recent Advances in Perioperative Patient Safety

    PubMed Central

    Fowler, Alexander J.

    2013-01-01

    Major complications in surgery affect up to 16% of surgical procedures. Over the past 50 years, many patient safety initiatives have attempted to reduce such complications. Since the formation of the National Patient Safety Agency in 2001, there have been major advances in patient safety. Most recently, the production and implementation of the Surgical Safety Checklist by the World Health Organisation (WHO), a checklist ensuring that certain ‘never events’ (wrong-site surgery, wrong operation etc.) do not occur, irrespective of healthcare allowance. In this review, a summary of recent advances in patient safety are considered – including improvements in communication, understanding of human factors that cause mistakes, and strategies developed to minimise these. Additionally, the synthesis of best medical practice and harm minimisation is examined, with particular emphasis on communication and appreciation of human factors in the operating theatre. This is based on the resource management systems developed in other high risk industries (e.g. nuclear), and has also been adopted for other high risk medical areas. The WHO global movement to reduce surgical mortality has been highly successful, especially in the healthcare systems of developing nations where mortality reductions of up to 50% have been observed, and reductions in patient complications of 4%. Incident reporting has long been a key component of patient safety and continues to be so; allowing reflection and improved guideline formation. All patients are placed at risk in the surgical environment. It is crucial that this risk is minimised, whilst optimising the patient's outcome. In this review, recent advances in perioperative patient safety are examined and placed in context. PMID:26977290

  18. Assessment of Patient Empowerment - A Systematic Review of Measures

    PubMed Central

    Barr, Paul J.; Scholl, Isabelle; Bravo, Paulina; Faber, Marjan J.; Elwyn, Glyn; McAllister, Marion

    2015-01-01

    Background Patient empowerment has gained considerable importance but uncertainty remains about the best way to define and measure it. The validity of empirical findings depends on the quality of measures used. This systematic review aims to provide an overview of studies assessing psychometric properties of questionnaires purporting to capture patient empowerment, evaluate the methodological quality of these studies and assess the psychometric properties of measures identified. Methods Electronic searches in five databases were combined with reference tracking of included articles. Peer-reviewed articles reporting psychometric testing of empowerment measures for adult patients in French, German, English, Portuguese and Spanish were included. Study characteristics, constructs operationalised and psychometric properties were extracted. The quality of study design, methods and reporting was assessed using the COSMIN checklist. The quality of psychometric properties was assessed using Terwee’s 2007 criteria. Findings 30 studies on 19 measures were included. Six measures are generic, while 13 were developed for a specific condition (N=4) or specialty (N=9). Most studies tested measures in English (N=17) or Swedish (N=6). Sample sizes of included studies varied from N=35 to N=8261. A range of patient empowerment constructs was operationalised in included measures. These were classified into four domains: patient states, experiences and capacities; patient actions and behaviours; patient self-determination within the healthcare relationship and patient skills development. Quality assessment revealed several flaws in methodological study quality with COSMIN scores mainly fair or poor. The overall quality of psychometric properties of included measures was intermediate to positive. Certain psychometric properties were not tested for most measures. Discussion Findings provide a basis from which to develop consensus on a core set of patient empowerment constructs and for

  19. Formal design review report project W-151 mixer pump procurement

    SciTech Connect

    Crass, D.W.

    1997-01-21

    A formal design review for WHC-S-0040 was held on January 21, 1993. The review was completed January 29, 1993. No outstanding action items existed. Comments were recorded on Record Comment Record (RCR) forms and incorporated into the specification. The specification was considered acceptable, approved and issued as WHC-S-0040, Rev. 0 on March 4, 1993.

  20. Expressive writing interventions in cancer patients: a systematic review.

    PubMed

    Merz, Erin L; Fox, Rina S; Malcarne, Vanessa L

    2014-01-01

    Decades of research have suggested that expressive writing produces physical and psychological benefits in controlled laboratory experiments among healthy college students. This work has been extended to clinical and medical populations, including cancer patients. Although expressive writing could be a promising and inexpensive intervention for this population, the effects have not been systematically examined in oncology samples. A systematic review using PRISMA guidelines was conducted for experimental trials of cancer patients who participated in an expressive writing intervention. PsycINFO and PubMed/Medline were searched for peer-reviewed studies. Thirteen articles met the inclusion/exclusion criteria. Although the majority of the intervention effects were null, there were several main effects for expressive writing on sleep, pain, and general physical and psychological symptoms. Several moderators were identified, suggesting that expressive writing may be more or less beneficial based on individual characteristics such as social constraints. The reviewed studies were limited due to representativeness of the samples, performance, detection and patient-reported outcomes biases, and heterogeneity of the intervention protocol and writing prompts. Future studies with rigorous designs are needed to determine whether expressive writing is therapeutically effective in cancer patients.

  1. A systematic review of hospital foodservice patient satisfaction studies.

    PubMed

    Dall'Oglio, Immacolata; Nicolò, Rosanna; Di Ciommo, Vincenzo; Bianchi, Natalia; Ciliento, Gaetano; Gawronski, Orsola; Pomponi, Manuel; Roberti, Marco; Tiozzo, Emanuela; Raponi, Massimiliano

    2015-04-01

    The quality of hospital foodservice is one of the most relevant items of health care quality perceived by patients and by their families. Patient satisfaction is considered a way of measuring the quality of services provided. The purpose of this study was to retrieve and review the literature describing patient satisfaction with hospital foodservices. The systematic review was conducted on three electronic archives, PubMed, Excerpta Medica Database, and the Cumulative Index to Nursing and Allied Health Literature (1988 through 2012), to search for any articles reporting patient satisfaction with hospital foodservices. A total of 319 studies were identified. After removing duplicates, 149 abstracts were reviewed, particular attention being given to the presence of a description of the tool used. Thirty-one articles were selected and the full texts were reviewed. Half the studies (n=15) were performed in North America. Patient satisfaction scores were generally high, with some variation among hospitals and different modes of food delivery that was investigated through intervention studies. Qualitative studies were also reported (ethnographic-anthropologic methods with interviews and focus groups). Quantitative tools were represented by questionnaires, some of which relied on previous literature and only a few were validated with factorial analysis and/or Cronbach's α for internal consistency. Most analyses were conducted assuming a parametric distribution of results, an issue not primarily tested. More studies on the quality of hospital foodservice have been carried out in North America than in Europe. Also, a variety of tools, most of which have not been validated, have been used by the different investigating facilities. PMID:25634093

  2. Review of geography internship of convective wave project

    NASA Technical Reports Server (NTRS)

    Rademacher, Kurt R.; Collins, Charles

    1990-01-01

    The internship of the author is examined in detail. The acquisition of the internship, the personnel of the project, the project itself, and the goals associated with it are described. The authors orientation to the internship, the project's operations, and the conclusion of the findings are also described. The overall goal of the project was to determine the effect of convective waves on wind speeds in the middle and upper troposphere, and how these waves affect the general circulation on a global scale. A more specific goal of the author was the satellite analysis of cloud street formations. This was done to determine frequency and areas in which cloud streets occur off the East Asian and North American coastlines.

  3. UAS Integration in the NAS Project - FY 14 Annual Review

    NASA Technical Reports Server (NTRS)

    Grindle, Laurie; Randall, Debra; Hackenberg, Davis

    2014-01-01

    This briefing gives insight into the research activities and efforts being executed in order to integrate unmanned aircraft systems into the national airspace system. This briefing is to inform others of the UAS-NAS Projects progress and future directions.

  4. AgRISTARS. Project management report: Program review presentation to level 1, interagency coordination committee

    NASA Technical Reports Server (NTRS)

    1981-01-01

    The AgRISTARS supporting research projects in the areas of data systems, scene radiation, and pattern recognition are reviewed. The objectives, activities, and accomplishments of FY-80 and the objectives and status of FY-81 programs are described.

  5. Patient participation in public elections: a literature review.

    PubMed

    Regan, Paul; Hudson, Neal; McRory, Barry

    2011-03-01

    Healthcare organisations and nurse leaders have an important role in promoting patients' right to vote, through the development of policy guidelines, integrated networking and innovative practice. Patients' mental capacity to vote is usually assessed by nurses, who must therefore be aware of clients' voting rights and if the right resources are in place to help them do so. Patients' rights, as citizens, are recognised in law and in professional guidelines, but more needs to be done to protect their voting rights. There should also be better access to transport and family support, and more flexible electoral procedures. This article reviews the literature on promoting patients' participation in local and general elections and suggests that their voting rights should be endorsed by organisations and nurse leaders through policy guidelines and a flexible and proactive nursing approach to participation.

  6. A systematic review of psychosocial interventions for family carers of palliative care patients

    PubMed Central

    2010-01-01

    Background Being a family carer to a patient nearing the end of their life is a challenging and confronting experience. Studies show that caregiving can have negative consequences on the health of family carers including fatigue, sleep problems, depression, anxiety and burnout. One of the goals of palliative care is to provide psychosocial support to patients and families facing terminal illness. A systematic review of interventions for family carers of cancer and palliative care patients conducted at the start of this millennium demonstrated that there was a dearth of rigorous inquiry on this topic and consequently limited knowledge regarding the types of interventions likely to be effective in meeting the complex needs of family carers. We wanted to discern whether or not the evidence base to support family carers has improved. Furthermore, undertaking this review was acknowledged as one of the priorities for the International Palliative Care Family Carer Research Collaboration http://www.centreforpallcare.org. Methods A systematic review was undertaken in order to identify developments in family carer support that have occurred over the last decade. The focus of the review was on interventions that targeted improvements in the psychosocial support of family carers of palliative care patients. Studies were graded to assess their quality. Results A total of fourteen studies met the inclusion criteria. The focus of interventions included psycho-education, psychosocial support, carer coping, symptom management, sleep promotion and family meetings. Five studies were randomised controlled trials, three of which met the criteria for the highest quality evidence. There were two prospective studies, five pre-test/post-test projects and two qualitative studies. Conclusions The systematic review identified a slight increase in the quality and quantity of psychosocial interventions conducted for family carers in the last decade. More rigorous intervention research is

  7. Preliminary design review report for K Basin Dose Reduction Project

    SciTech Connect

    Blackburn, L.D.

    1996-01-01

    The strategy for reducing radiation dose, originating from radionuclides absorbed in the K East Basin concrete, is to raise the pool water level to provide additional shielding. This report documents a preliminary design review conducted to ensure that design approaches for cleaning/coating basin walls and modifying other basin components were appropriate. The conclusion of this review was that design documents presently conclusion of this review was that design documents presently completed or in process of modification are and acceptable basis for proceeding to complete the design.

  8. Some Equal-area, Conformal and Conventional Map Projections: A Tutorial Review

    NASA Astrophysics Data System (ADS)

    Ghaderpour, Ebrahim

    2016-09-01

    Map projections have been widely used in many areas such as geography, oceanography, meteorology, geology, geodesy, photogrammetry and global positioning systems. Understanding different types of map projections is very crucial in these areas. This paper presents a tutorial review of various types of current map projections such as equal-area, conformal and conventional. We present these map projections from a model of the Earth to a flat sheet of paper or map and derive the plotting equations for them in detail. The first fundamental form and the Gaussian fundamental quantities are defined and applied to obtain the plotting equations and distortions in length, shape and size for some of these map projections.

  9. Review of BPA Funded Sturgeon, Resident Fish and Wildlife Projects for 1990/1991.

    SciTech Connect

    United States. Bonneville Power Administration.

    1990-12-01

    The Bonneville Power Administration (BPA) held a public meeting on November 19--21, 1991, for the purpose of review, coordination, and consultation of the BPA-funded projects for sturgeon, resident fish, and wildlife in the Columbia River Basin (Basin). The comments received after the meeting were favorable and the participants agreed that the meeting was stimulating and productive. The information exchanged should lead to better coordination with other projects throughout the Basin. This document list the projects by title, the project leaders and BPA's project officers, and an abstract of each leader's presentation.

  10. National and Public Libraries in India: Review and Projections.

    ERIC Educational Resources Information Center

    Agrawal, S. P.; And Others

    1985-01-01

    Reviews functions, growth, and performance of Indian national and public libraries and proposes a plan of action covering: administrative infrastructure, library legislation, library resources, resource utilization, depository libraries, resource sharing, public library clientele, role of private organizations, staffing pattern, financial…

  11. An Approach to Tailoring Major Technical Reviews Based on Project Characteristics and Stakeholder Interests

    NASA Technical Reports Server (NTRS)

    Richstein, Alan B.; Nolte, Jerome T.; Pfarr, Barbara B.

    2004-01-01

    There are numerous technical reviews that occur throughout the systems engineering process life cycle. Many are well known by project managers and stakeholders such as developers and end users, an example of much is the critical design review (CDR). This major milestone for a large, complex new project may last two or more days, include an extensive agenda of topics, and entail hundreds of hours of developer time to prepare presentation materials and associated documents. Additionally, the weeks of schedule spent on review preparation is at least partly at the expense of other work. This paper suggests an approach for tailoring technical reviews, based on the project characteristics and the project manager s identification of the key stakeholders and understanding of their most important issues and considerations. With this insight the project manager can communicate to, manage expectations oc and establish formal agreement with the stakeholders as to which reviews, and at what depth, are most appropriate to achieve project success. The authors, coming from diverse organizations and backgrounds, have drawn on their personal experiences and summarized the best practices of their own organizations to create a common framework to provide guidance on the adaptation of design reviews to other system engineers.

  12. Review article: hepatitis vaccination in patients with chronic liver disease.

    PubMed

    Reiss, G; Keeffe, E B

    2004-04-01

    Evidence regarding the outcomes of viral super-infection in patients with chronic liver disease and practical strategies for hepatitis A and B vaccination of these individuals are reviewed. Patients with acute hepatitis A and chronic hepatitis B have a more severe clinical course and a higher death rate compared with otherwise healthy individuals with hepatitis A, and these differences are most pronounced in older patients and those with histological evidence of chronic hepatitis or cirrhosis, rather than in asymptomatic hepatitis B carriers. Patients with acute hepatitis A super-infection and chronic hepatitis C have an increased risk of fulminant hepatitis and death. In addition, patients with other chronic liver diseases also appear to be at increased risk for more severe disease with superimposed hepatitis A. Patients with chronic hepatitis B and hepatitis C virus co-infection have more severe laboratory abnormalities, more severe histological disease, a greater frequency of cirrhosis and complications of cirrhosis, and a higher incidence of hepatocellular carcinoma. Vaccines for both hepatitis A and B are safe and effective if used early in the course of chronic liver disease. Hepatitis A and B vaccination should be part of the routine management of patients with chronic liver disease, preferably as early as possible in the natural course of their disease.

  13. Cancer patients' perceptions of the good nurse: a literature review.

    PubMed

    Rchaidia, Leila; Dierckx de Casterlé, Bernadette; De Blaeser, Liesbeth; Gastmans, Chris

    2009-09-01

    This article discusses findings from a mixed method literature review that investigated cancer patients' perceptions of what constitutes a good nurse. To find pertinent articles, we conducted a systematic key word search of five journal databases (1998-2008). The application of carefully constructed inclusion criteria and critical appraisal identified 12 relevant articles. According to the patients, good nurses were shown to be characterized by specific, but inter-related, attitudes, skills and knowledge; they engage in person-to-person relationships, respect the uniqueness of patients, and provide support. Professional and trained skills as well as broad and specific nursing and non-nursing knowledge are important. The analysis revealed that these characteristics nurtured patient well-being, which manifests as optimism, trust, hope, support, confirmation, safety and comfort. Cancer patients' perceptions of what constitutes a good nurse represent an important source of knowledge that will enable the development of more comprehensive and practice-based views on good nursing care for such patients. These perceptions help us to understand how nurses effectively make a difference in cancer patient care.

  14. Sarcoidosis in Melanoma Patients: Case Report and Literature Review

    PubMed Central

    Beutler, Bryce D.; Cohen, Philip R.

    2015-01-01

    Sarcoidosis is a systemic inflammatory disease characterized by the development of noncaseating granulomas in multiple organ systems. Many hematologic malignancies and solid tumors, including melanoma, have been associated with sarcoidosis. We describe the clinical and pathologic findings of a 54-year-old man with melanoma-associated sarcoidosis. In addition, we not only review the literature describing characteristics of other melanoma patients with sarcoidosis, but also the features of melanoma patients with antineoplastic therapy-associated sarcoidosis. Sarcoidosis has been described in 80 melanoma patients; sufficient information for analysis was provided in 39 of these individuals. In 43.6% of individuals (17 out of 39), sarcoidosis was directly associated with melanoma; in 56.4% of oncologic patients (22 out of 39), sarcoidosis was induced by antineoplastic therapy that had been administered for the treatment of their metastatic melanoma. The discovery of melanoma preceded the development of sarcoidosis in 12 of the 17 (70.5%) individuals who did not receive systemic treatment. Pulmonary and/or cutaneous manifestations of sarcoidosis were common among both groups of patients. Most patients did not require treatment for sarcoidosis. Melanoma patients—either following antineoplastic therapy or without systemic treatment—may be at an increased risk to develop sarcoidosis. In antineoplastic therapy naive melanoma patients, a common etiologic factor—such as exposure to ultraviolet light—may play a role in their developing melanoma and sarcoidosis. PMID:26083934

  15. 13 CFR 302.9 - Inter-governmental review of projects.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Project under EDA's Public Works and Economic Development program or a proposed construction Project or... required by 15 CFR part 13 and Executive Order 12372, “Intergovernmental Review of Federal Programs,” as... planning organizations in metropolitan areas, as provided for in 15 CFR part 13....

  16. Second and Third Grade Students in the Hunters Point-Bayview SEED Project: A Diagnostic Review.

    ERIC Educational Resources Information Center

    Counelis, James Steve

    This report supplements the first South East Education Development project (SEED) on first grade children. Full and partial records of 624 second grade students and 591 third grade students are the basis of this diagnostic review. The empirical data obtained for the SEED project students included: each student's sex and number of full days in…

  17. 77 FR 58111 - Notice of Submission for OMB Review; Institute of Education Sciences; FAFSA Completion Project...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-19

    ... Notice of Submission for OMB Review; Institute of Education Sciences; FAFSA Completion Project Evaluation SUMMARY: The Institute of Education Sciences (IES) at the U.S. Department of Education (ED) is conducting... project will provide 80 Local Educational Agencies or school districts with access to data on...

  18. 32 CFR 211.7 - Initiating an Informal DoD Review of a Proposed Project.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 2 2012-07-01 2012-07-01 false Initiating an Informal DoD Review of a Proposed Project. 211.7 Section 211.7 National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) MISCELLANEOUS MISSION COMPATIBILITY EVALUATION PROCESS Project Evaluation...

  19. 32 CFR 211.7 - Initiating an Informal DoD Review of a Proposed Project.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 2 2013-07-01 2013-07-01 false Initiating an Informal DoD Review of a Proposed Project. 211.7 Section 211.7 National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) MISCELLANEOUS MISSION COMPATIBILITY EVALUATION PROCESS Project Evaluation...

  20. 32 CFR 211.6 - Initiating a Formal DoD Review of a Proposed Project.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 2 2012-07-01 2012-07-01 false Initiating a Formal DoD Review of a Proposed Project. 211.6 Section 211.6 National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) MISCELLANEOUS MISSION COMPATIBILITY EVALUATION PROCESS Project Evaluation...

  1. 32 CFR 211.6 - Initiating a Formal DoD Review of a Proposed Project.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 2 2013-07-01 2013-07-01 false Initiating a Formal DoD Review of a Proposed Project. 211.6 Section 211.6 National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) MISCELLANEOUS MISSION COMPATIBILITY EVALUATION PROCESS Project Evaluation...

  2. 32 CFR 211.6 - Initiating a formal DoD review of a proposed project.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 2 2014-07-01 2014-07-01 false Initiating a formal DoD review of a proposed project. 211.6 Section 211.6 National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) MISCELLANEOUS MISSION COMPATIBILITY EVALUATION PROCESS Project Evaluation...

  3. 32 CFR 211.7 - Initiating an informal DoD review of a proposed project.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 2 2014-07-01 2014-07-01 false Initiating an informal DoD review of a proposed project. 211.7 Section 211.7 National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) MISCELLANEOUS MISSION COMPATIBILITY EVALUATION PROCESS Project Evaluation...

  4. Opioid Drugs in Patients With Liver Disease: A Systematic Review

    PubMed Central

    Soleimanpour, Hassan; Safari, Saeid; Shahsavari Nia, Kavous; Sanaie, Sarvin; Alavian, Seyed Moayed

    2016-01-01

    Context The liver, one of the most important organs of the body, is known to be responsible for several functions. The functional contribution of the liver to the metabolism of carbohydrates, protein, drugs and toxins, fats and cholesterol and many other biological processes are still unknown. Liver disorders are classified into two types: acute and chronic. Different drugs are used in liver diseases to treat and control pain. Most pain relief medications such as opioids are metabolized via the liver; therefore, the adverse reactions of drugs are probably higher for patients with liver disease. The current study aimed to evaluate the effects of opioid drugs on patients with liver disease; therefore, it is necessary to select suitable opioids for such patients. Evidence Acquisition This review was written by referring to research literature including 70 articles and four textbooks published from 1958 to 2015 on various reputable sites. Searches were carried out on the key phrases of narcotic pain relievers (opioids), acute and chronic hepatic failure, opioid adverse drug reactions, drug-induced liver injury (DILI) and other similar keywords. References included a variety of research papers (descriptive and analytical), intervention and review articles. Results In patients with liver disease, administration of opioid analgesics should be observed, accurately. As a general rule, lower doses of drugs should be administered at regular intervals based on the signs of drug accumulation. Secondly, the interactions of opioid drugs with different levels of substrates of the P450 cytochrome enzyme should be considered. Conclusions Pain management in patients with liver dysfunction is always challenging to physicians because of the adverse reactions of drugs, especially opioids. Opioids should be used cautiously since they can cause sedation, constipation and sudden encephalopathy effects. Since the clearance of these drugs in patients with hepatic insufficiency is decreased

  5. 78 FR 53436 - Improving Performance of Federal Permitting and Review of Infrastructure Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-29

    ... ecological planning goals; utilizing landscape- and watershed-level mitigation practices; promoting the... goals and to increase the predictability of the siting, permitting, and review processes. This Request... information early in the project planning process to facilitate efficient and timely environmental reviews...

  6. Independent Research Projects in General Chemistry Classes as an Introduction to Peer-Reviewed Literature

    ERIC Educational Resources Information Center

    Tribe, Lorena; Cooper, Evan L.

    2008-01-01

    A well-structured independent literature research project with a poster session was used to introduce students to peer-reviewed literature in a general chemistry course. Overall, students reported an enhanced appreciation of the course due to performing research at some level, using peer-reviewed literature, and presenting their results in a…

  7. 44 CFR 70.9 - Review of proposed projects.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... of proposed projects. An individual who proposes to build one or more structures on a portion of... comments on whether the proposed structure(s), if built as proposed, will be in the SFHA. FEMA's comments will be issued in the form of a letter, termed a Conditional Letter of Map Amendment. The data...

  8. 44 CFR 70.9 - Review of proposed projects.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... of proposed projects. An individual who proposes to build one or more structures on a portion of... comments on whether the proposed structure(s), if built as proposed, will be in the SFHA. FEMA's comments will be issued in the form of a letter, termed a Conditional Letter of Map Amendment. The data...

  9. Secondary Health Project: Concepts Review. Research Report 70.

    ERIC Educational Resources Information Center

    Agency for Instructional Television, Bloomington, IN.

    This report describes a preliminary evaluation in September 1979 of 12 program topics and their stated objectives for an instructional television series, the Secondary School Health Project, which addresses issues relevant to the personal and social growth of adolescents. The study addressed the following questions: (1) How can the series' topics…

  10. Review Article: The Interdisciplinary Research Project in Environmental Education

    ERIC Educational Resources Information Center

    Berkes, Fikret; Butler, M. J. A.

    1975-01-01

    This article concerns an attempt to develop an interdisciplinary environment-oriented program in a Canadian graduate school. A problem-solving approach was utilized in a study of the environmental aspects of the pulp and paper industry. The success of this project coincided with a growing interdisciplinary trend in other universities. (MA)

  11. 75 FR 36301 - Review and Approval of Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-25

    ... final at 71 FR 78570, December 29, 2006, updating and expanding the range of projects subject to... Approval by Rule (ABR) natural gas pad site approvals issued under 18 CFR 806.22(f). However, ABRs issued... located. For applications to use public water supply a source for water in natural gas...

  12. REVIEW ARTICLE: UHP lamp systems for projection applications

    NASA Astrophysics Data System (ADS)

    Derra, Guenther; Moench, Holger; Fischer, Ernst; Giese, Hermann; Hechtfischer, Ulrich; Heusler, Gero; Koerber, Achim; Niemann, Ulrich; Noertemann, Folke-Charlotte; Pekarski, Pavel; Pollmann-Retsch, Jens; Ritz, Arnd; Weichmann, Ulrich

    2005-09-01

    Projection systems have found widespread use in conference rooms and other professional applications during the last decade and are now entering the home TV market at a considerable pace. Projectors as small as about one litre are able to deliver several thousand screen lumens and are, with a system efficacy of over 10 lm W-1, the most efficient display systems realized today. Short arc lamps are a key component for projection systems of the highest efficiency for small-size projection displays. The introduction of the ultra high performance (UHP) lamp system by Philips in 1995 can be identified as one of the key enablers of the commercial success of projection systems. The UHP lamp concept features outstanding arc luminance, a well suited spectrum, long life and excellent lumen maintenance. For the first time it combines a very high pressure mercury discharge lamp with extremely short and stable arc gap with a regenerative chemical cycle keeping the discharge walls free from blackening, leading to lifetimes of over 10 000 h. Since the introduction of the UHP lamp system, many important new technology improvements have been realized: burner designs for higher lamp power, advanced ignition systems, miniaturized electronic drivers and innovative reflector concepts. These achievements enabled the impressive increase of projector light output, a remarkable reduction in projector size and even higher optical efficiency in projection systems during the last years. In this paper the concept of the UHP lamp system is described, followed by a discussion of the technological evolution the UHP lamp has undergone so far. Last, but not least, the important improvements of the UHP lamp system including the electronic driver and the reflector are discussed.

  13. [Vital prognosis in advanced cancer patients: a systematic literature review].

    PubMed

    Tavares, Teresa; Gonçalves, Edna

    2013-01-01

    Prognostication is a critical medical task for the adequacy of treatment and management of priorities and expectations of patients and families. In 2005, the European Association of Palliative Care (EAPC) published recommendations on the formulation of vital prognosis in advanced cancer patients. The aim of this study is to analyze the literature subsequent to this review and to update the presented recommendations. Using the same strategy of the EAPC group, we performed a systematic literature search in the electronic databases PubMed and Scopus, which included original studies in adults with advanced cancer, without tumor-directed treatment, with a median survival of less than 90 days. The articles were analyzed and classified according to the level of evidence by two independent reviewers. The 41 articles analyzed allowed to keep grade A recommendations for clinical estimation of survival and Palliative Prognostic score and now also for Palliative Prognostic Index, performance status, dyspnea, lymphopenia and lactate dehydrogenase. Recommendations regarding the use of C-reactive protein, leukocytosis, azotemia, hypoalbuminemia and male gender as predictors reached grade B. To formulate the vital prognosis and to communicate it properly to the patient and family are core competencies of physicians, particularly of those who deal with end of life patients. The clinical impression combined with scientific evidence allows us to estimate more accurately the survival, allowing prioritizing and managing more appropriately the existing resources.

  14. Recommended frequency of ABPI review for patients wearing compression hosiery.

    PubMed

    Furlong, Winnie

    2015-11-11

    This paper is a sequel to the article 'How often should patients in compression have ABPI recorded?' ( Furlong, 2013 ). Monitoring ankle brachial pressure index (ABPI) is essential, especially in those patients wearing compression hosiery, as it can change over time ( Simon et al, 1994 ; Pankhurst, 2004 ), particularly in the presence of peripheral arterial disease (PAD). Leg ulceration caused by venous disease requires graduated compression ( Wounds UK, 2002 ; Anderson, 2008). Once healed, compression hosiery is required to help prevent ulcer recurrence ( Vandongen and Stacey, 2000 ). The Royal College of Nursing ( RCN, 2006 ) guidelines suggest 3-monthly reviews, including ABPI, with no further guidance. Wounds UK (2002) suggests that patients who have ABPI<0.9, diabetes, reduced mobility or symptoms of claudication should have at least 3/12 Doppler, and that those in compression hosiery without complications who are able to report should have vascular assessment yearly. PMID:26559232

  15. Pancreatic injury in patients with septic shock: A literature review

    PubMed Central

    Chaari, Anis; Abdel Hakim, Karim; Bousselmi, Kamel; Etman, Mahmoud; El Bahr, Mohamed; El Saka, Ahmed; Hamza, Eman; Ismail, Mohamed; Khalil, Elsayed Mahmoud; Kauts, Vipin; Casey, William Francis

    2016-01-01

    Sepsis and septic shock are life threatening condition associated with high mortality rate in critically-ill patients. This high mortality is mainly related to the inadequacy between oxygen delivery and cellular demand leading to the onset of multiorgan dysfunction. Whether this multiorgan failure affect the pancreas is not fully investigated. In fact, pancreatic injury may occur because of ischemia, overwhelming inflammatory response, oxidative stress, cellular apoptosis and/or metabolic derangement. Increased serum amylase and/or lipase levels are common in patients with septic shock. However, imaging test rarely reveal significant pancreatic damage. Whether pancreatic dysfunction does affect the prognosis of patients with septic shock or not is still a matter of debate. In fact, only few studies with limited sample size assessed the clinical relevance of the pancreatic injury in this group of patients. In this review, we aimed to describe the epidemiology and the physiopathology of pancreatic injury in septic shock patients, to clarify whether it requires specific management and to assess its prognostic value. Our main finding is that pancreatic injury does not significantly affect the outcome in septic shock patients. Hence, increased serum pancreatic enzymes without clinical features of acute pancreatitis do not require further imaging investigations and specific therapeutic intervention. PMID:27559431

  16. Pancreatic injury in patients with septic shock: A literature review.

    PubMed

    Chaari, Anis; Abdel Hakim, Karim; Bousselmi, Kamel; Etman, Mahmoud; El Bahr, Mohamed; El Saka, Ahmed; Hamza, Eman; Ismail, Mohamed; Khalil, Elsayed Mahmoud; Kauts, Vipin; Casey, William Francis

    2016-07-15

    Sepsis and septic shock are life threatening condition associated with high mortality rate in critically-ill patients. This high mortality is mainly related to the inadequacy between oxygen delivery and cellular demand leading to the onset of multiorgan dysfunction. Whether this multiorgan failure affect the pancreas is not fully investigated. In fact, pancreatic injury may occur because of ischemia, overwhelming inflammatory response, oxidative stress, cellular apoptosis and/or metabolic derangement. Increased serum amylase and/or lipase levels are common in patients with septic shock. However, imaging test rarely reveal significant pancreatic damage. Whether pancreatic dysfunction does affect the prognosis of patients with septic shock or not is still a matter of debate. In fact, only few studies with limited sample size assessed the clinical relevance of the pancreatic injury in this group of patients. In this review, we aimed to describe the epidemiology and the physiopathology of pancreatic injury in septic shock patients, to clarify whether it requires specific management and to assess its prognostic value. Our main finding is that pancreatic injury does not significantly affect the outcome in septic shock patients. Hence, increased serum pancreatic enzymes without clinical features of acute pancreatitis do not require further imaging investigations and specific therapeutic intervention. PMID:27559431

  17. Navigating the cancer journey: a review of patient navigator programs for Indigenous cancer patients.

    PubMed

    Whop, Lisa J; Valery, Patricia C; Beesley, Vanessa L; Moore, Suzanne P; Lokuge, Kamalini; Jacka, Catherine; Garvey, Gail

    2012-12-01

    Patient navigator programs have evolved to facilitate access to care and improve outcomes for Indigenous cancer patients. We reviewed the scientific literature on patient navigator programs in Indigenous people with cancer. We conducted a review of the published literature up to 13 April 2011. PubMed, MEDLINE and CINAHL databases were searched for original articles on Indigenous patient navigation programs. The review produced eight relevant articles covering two specific programs, the Native Sisters Program and the Walking Forward Program. Program descriptions, patient navigator's roles, cultural aspects and the impact of the programs were described. Patient navigators' roles in the programs varied, as did their qualifications, but importantly, all were Indigenous. Both programs aimed to increase participation in screening, remove barriers to treatment and decrease mortality. The Native Sisters Program documented an increase in adherence to breast screening among navigated American Indian participants, although there were substantial differences in the baseline screening adherence between navigated and non-navigated participants. The Walking Forward Program yielded on average 3 fewer days of treatment delays for navigated American Indians than for non-navigated American Indians. However, adjustments for socioeconomic characteristics and disease characteristics were not described. Although preliminary outcomes are seemingly positive, further rigorous evaluation of quantitative impacts are needed.

  18. Solar Technology Assessment Project. Volume VII. A review of OTEC

    SciTech Connect

    Yuen, P.C.

    1981-04-01

    The Ocean Thermal Energy Conversion (OTEC) principle is discussed along with general system and cycle types, specific OTEC designs, applications, and the ocean thermal resource. the historic development and present status of OTEC are reviewed. Power system components of the more technically advanced closed-cycle OTEC concept are discussed: heat exchangers, corrosion and biofouling countermeasures, working fluids, ammonia power systems, and on-platform seawater sytems. Several open-cycle features are also discussed. A critical review of the ocean engineering aspects of the OTEC power system is presented. Major subsystems such as platform, cold water pipe, mooring system, dynamic positioning system and power transmission cable system are assessed for their relationships with the ocean environment and with each other. Nine available studies of OTEC costs are reviewed, and tentative comparisons are made between OTEC and traditional fuel costs. OTEC products and markets are considered. Possible environmental and social effects of OTEC development are discussed. International and national laws regulating OTEC plants are reviewed, specifically, the United Nations Third Conference on the Law of the Sea and the Ocean Thermal Energy Conversion Act of 1980. Coast Guard regulations, OSHA laws, and state and local government regulations are also considered as well as attitudes of the utilities. (LEW)

  19. 75 FR 60617 - Review and Approval of Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-01

    ... inappropriately treating water as a ``commodity'' instead of as a ``common resource'' of the basin. Response... public water supply systems under the scope of withdrawals requiring review and approval; improve notice... impacts of water withdrawals and to require flow monitoring at water withdrawal sites. Response:...

  20. Status of power-reactor projects undergoing licensing review

    SciTech Connect

    Silver, E.G.

    1982-07-01

    Recent regulatory and other actions relating to power reactors undergoing licensing review are summarized in Table 1 as of May 1, 1982. Except as otherwise noted, all the information presented in this article is taken from NRC press releases or from the reactor docket file, both of which are available at the NRC Public Document Room, 1717 H Street NW, Washington, DC 20555.

  1. Summary for the Next Generation Nuclear Plant Project in Review

    SciTech Connect

    L.E. Demick

    2010-08-01

    This paper reports on the major progress that the NGNP Project has made toward developing and commercializing the HTGR technology. Significant R&D progress has been made in addressing key technical issues for qualification of the HTGR fuel and graphite, codification of high temperature materials and verification and validation of design codes. Work is also progressing in heat transfer/transport design and testing and in development of the high temperature steam electrolysis hydrogen production process. A viable licensing strategy has been formulated in coordination with the NRC and DOE. White papers covering key licensing issues have been and will continue to be submitted and necessary discussions of these key issues have begun with the NRC. Continued government support is needed to complete the Project objectives as established in the 2005 Energy Policy Act.

  2. Summary for the Next Generation Nuclear Plant Project in Review

    SciTech Connect

    L.E. Demick

    2010-09-01

    This paper reports on the major progress that the NGNP Project has made toward developing and commercializing the HTGR technology. Significant R&D progress has been made in addressing key technical issues for qualification of the HTGR fuel and graphite, codification of high temperature materials and verification and validation of design codes. Work is also progressing in heat transfer/transport design and testing and in development of the high temperature steam electrolysis hydrogen production process. A viable licensing strategy has been formulated in coordination with the NRC and DOE. White papers covering key licensing issues have been and will continue to be submitted and necessary discussions of these key issues have begun with the NRC. Continued government support is needed to complete the Project objectives as established in the 2005 Energy Policy Act.

  3. The outcomes of recent patient safety education interventions for trainee physicians and medical students: a systematic review

    PubMed Central

    Kirkman, Matthew A; Sevdalis, Nick; Arora, Sonal; Baker, Paul; Vincent, Charles; Ahmed, Maria

    2015-01-01

    Objective To systematically review the latest evidence for patient safety education for physicians in training and medical students, updating, extending and improving on a previous systematic review on this topic. Design A systematic review. Data sources Embase, Ovid Medline and PsycINFO databases. Study selection Studies including an evaluation of patient safety training interventions delivered to trainees/residents and medical students published between January 2009 and May 2014. Data extraction The review was performed using a structured data capture tool. Thematic analysis also identified factors influencing successful implementation of interventions. Results We identified 26 studies reporting patient safety interventions: 11 involving students and 15 involving trainees/residents. Common educational content included a general overview of patient safety, root cause/systems-based analysis, communication and teamwork skills, and quality improvement principles and methodologies. The majority of courses were well received by learners, and improved patient safety knowledge, skills and attitudes. Moreover, some interventions were shown to result in positive behaviours, notably subsequent engagement in quality improvement projects. No studies demonstrated patient benefit. Availability of expert faculty, competing curricular/service demands and institutional culture were important factors affecting implementation. Conclusions There is an increasing trend for developing educational interventions in patient safety delivered to trainees/residents and medical students. However, significant methodological shortcomings remain and additional evidence of impact on patient outcomes is needed. While there is some evidence of enhanced efforts to promote sustainability of such interventions, further work is needed to encourage their wider adoption and spread. PMID:25995240

  4. Project summaries: sixth DOE electrochemical contractor's review. Supplement

    SciTech Connect

    Not Available

    1984-06-01

    This document represents a compilation of project summaries of research supported by the Electrochemical Storage Program from January 1983 through June 1984. It is intended to be a technical overview for engineers and scientists in government, industry and academia who are interested in finding out more about this program. Overview, Sodium-Sulfur Battery, Battery Performance and Testing, Battery Analysis, Flow Batteries, Lithium Rechargeable Batteries, Alkaline Batteries, Metal-Air Batteries, Fuel Cells and Electrochemical Processes.

  5. Patient safety education for undergraduate medical students: a systematic review

    PubMed Central

    2011-01-01

    Background To reduce harm caused by health care is a global priority. Medical students should be able to recognize unsafe conditions, systematically report errors and near misses, investigate and improve such systems with a thorough understanding of human fallibility, and disclose errors to patients. Incorporating the knowledge of how to do this into the medical student curriculum is an urgent necessity. This paper aims to systematically review the literature about patient safety education for undergraduate medical students in terms of its content, teaching strategies, faculty availability and resources provided so as to identify evidence on how to promote patient safety in the curriculum for medical schools. This paper includes a perspective from the faculty of a medical school, a major hospital and an Evidence Based Medicine Centre in Sichuan Province, China. Methods We searched MEDLINE, ERIC, Academic Source Premier(ASP), EMBASE and three Chinese Databases (Chinese Biomedical Literature Database, CBM; China National Knowledge Infrastructure, CNKI; Wangfang Data) from 1980 to Dec. 2009. The pre-specified form of inclusion and exclusion criteria were developed for literature screening. The quality of included studies was assessed using Darcy Reed and Gemma Flores-Mateo criteria. Two reviewers selected the studies, undertook quality assessment, and data extraction independently. Differing opinions were resolved by consensus or with help from the third person. Results This was a descriptive study of a total of seven studies that met the selection criteria. There were no relevant Chinese studies to be included. Only one study included patient safety education in the medical curriculum and the remaining studies integrated patient safety into clinical rotations or medical clerkships. Seven studies were of a pre and post study design, of which there was only one controlled study. There was considerable variation in relation to contents, teaching strategies, faculty

  6. Patient Expectations and Patient-Reported Outcomes in Surgery: A Systematic Review

    PubMed Central

    Waljee, Jennifer; McGlinn, Evan P.; Sears, Erika Davis; Chung, Kevin C.

    2014-01-01

    Background Recent events in healthcare reform have brought national attention to integrating patient experiences and expectations into quality metrics. Few studies have comprehensively evaluated the effect of patient expectations on patient-reported outcomes (PROs) following surgery. The purpose of this study is to systematically review the available literature describing the relationship between patient expectations and postoperative PROs. Methods We performed a search of the literature published prior to November 1, 2012. Articles were included in the review if 1) primary data were presented 2) patient expectations regarding a surgical procedure were measured 3) PROs were measured, and 4) the relationship between patient expectations and PROs was specifically examined. PROs were categorized into five subgroups: satisfaction, quality of life (QOL), disability, mood disorder, and pain. We examined each study to determine the relationship between patient expectations and PROs as well as study quality. Results From the initial literature search yielding 1,708 studies, 60 articles were included. Fulfillment of expectations was associated with improved PROs among 24 studies. Positive expectations were correlated with improved PROs for 28 (47%) studies, and poorer PROs for 9 (15%) studies. Eighteen studies reported that fulfillment of expectations was correlated with improved patient satisfaction, and 10 studies identified that positive expectations were correlated with improved postoperative QOL. Finally, patients with positive preoperative expectations reported less pain (8 studies) and disability (15 studies) compared with patients with negative preoperative expectations. Conclusions Patient expectations are inconsistently correlated with PROs following surgery, and there is no accepted method to capture perioperative expectations. Future efforts to rigorously measure expectations and explore their influence on postoperative outcomes can inform clinicians and policy

  7. A review of NASA-sponsored technology assessment projects

    NASA Technical Reports Server (NTRS)

    Mascy, A. C.; Alexander, A. D., III; Wood, R. D.

    1978-01-01

    Recent technology assessment studies sponsored by NASA are reviewed, and a summary of the technical results as well as a critique of the methodologies are presented. The reviews include Assessment of Lighter-Than-Air Technology, Technology Assessment of Portable Energy RDT&P, Technology Assessment of Future Intercity Passenger Transportation Systems, and Technology Assessment of Space Disposal of Radioactive Nuclear Waste. The use of workshops has been introduced as a unique element of some of these assessments. Also included in this report is a brief synopsis of a method of quantifying opinions obtained through such group interactions. Representative of the current technology assessments, these studies cover a broad range of socio-political factors and issues in greater depth than previously considered in NASA sponsored studies. In addition to the lessons learned through the conduct of these studies, a few suggestions for improving the effectiveness of future technology assessments are provided.

  8. Characteristics of patients with pseudochylothorax—a systematic review

    PubMed Central

    Lama, Adriana; Toubes, María E.; Golpe, Antonio; Gude, Francisco; Álvarez-Dobaño, José M.; González-Barcala, Francisco J.; San José, Esther; Rodríguez-Núñez, Nuria; Rábade, Carlos; Rodríguez-García, Carlota; Valdés, Luis

    2016-01-01

    Background Pseudochylothorax (PCT) (cholesterol pleurisy or chyliform effusion) is a cholesterol-rich pleural effusion (PE) that is commonly associated with chronic inflammatory disorders. Nevertheless, the characteristics of patients with PCT are poorly defined. Methods A systematic review was performed across two electronic databases searching for studies reporting clinical findings, PE characteristics, and the most effective treatment of PCT. Case descriptions and retrospective studies were included. Results The review consisted of 62 studies with a total of 104 patients. Median age was 58 years, the male/female ratio was 2.6/1, and in the 88.5% of cases the etiology was tuberculosis (TB) or rheumatoid arthritis (RA). PE was usually unilateral (88%) and occupied greater than one-third of the hemithorax (96.3%). There was no evidence of pleural thickening in 20.6% of patients, and 14 patients had a previous PE. The pleural fluid (PF) was an exudate, usually milky (94%) and with a predominance of lymphocytes (61.1%). The most sensitive tests to establish the diagnosis were the cholesterol/triglycerides ratio (CHOL/TG ratio) >1, and the presence of cholesterol crystals (97.4% and 89.7%, respectively). PF culture for TB was positive in the 34.1% of patients. Favorable outcomes with medical treatment, therapeutic thoracentesis, decortication/pleurectomy, pleurodesis, thoracic drainage and thoracoscopic drainage were achieved in 78.9%, 47.8%, 86.7%, 66.6%, 37.5% and 42.9%, respectively. Conclusions PCT is usually tuberculous or rheumatoid, unilateral and the PF is a milky exudate. The presence of cholesterol crystals and a CHOL/TG ratio >1 are the most sensitive test for the diagnosis. The lack of pleural thickening does not rule out PCT. Treatment should be sequential, treating the underlying causes, and assessing the need for interventional techniques.

  9. Characteristics of patients with pseudochylothorax—a systematic review

    PubMed Central

    Lama, Adriana; Toubes, María E.; Golpe, Antonio; Gude, Francisco; Álvarez-Dobaño, José M.; González-Barcala, Francisco J.; San José, Esther; Rodríguez-Núñez, Nuria; Rábade, Carlos; Rodríguez-García, Carlota; Valdés, Luis

    2016-01-01

    Background Pseudochylothorax (PCT) (cholesterol pleurisy or chyliform effusion) is a cholesterol-rich pleural effusion (PE) that is commonly associated with chronic inflammatory disorders. Nevertheless, the characteristics of patients with PCT are poorly defined. Methods A systematic review was performed across two electronic databases searching for studies reporting clinical findings, PE characteristics, and the most effective treatment of PCT. Case descriptions and retrospective studies were included. Results The review consisted of 62 studies with a total of 104 patients. Median age was 58 years, the male/female ratio was 2.6/1, and in the 88.5% of cases the etiology was tuberculosis (TB) or rheumatoid arthritis (RA). PE was usually unilateral (88%) and occupied greater than one-third of the hemithorax (96.3%). There was no evidence of pleural thickening in 20.6% of patients, and 14 patients had a previous PE. The pleural fluid (PF) was an exudate, usually milky (94%) and with a predominance of lymphocytes (61.1%). The most sensitive tests to establish the diagnosis were the cholesterol/triglycerides ratio (CHOL/TG ratio) >1, and the presence of cholesterol crystals (97.4% and 89.7%, respectively). PF culture for TB was positive in the 34.1% of patients. Favorable outcomes with medical treatment, therapeutic thoracentesis, decortication/pleurectomy, pleurodesis, thoracic drainage and thoracoscopic drainage were achieved in 78.9%, 47.8%, 86.7%, 66.6%, 37.5% and 42.9%, respectively. Conclusions PCT is usually tuberculous or rheumatoid, unilateral and the PF is a milky exudate. The presence of cholesterol crystals and a CHOL/TG ratio >1 are the most sensitive test for the diagnosis. The lack of pleural thickening does not rule out PCT. Treatment should be sequential, treating the underlying causes, and assessing the need for interventional techniques. PMID:27621864

  10. New perspectives of volemic resuscitation in polytrauma patients: a review.

    PubMed

    Bedreag, Ovidiu Horea; Papurica, Marius; Rogobete, Alexandru Florin; Sarandan, Mirela; Cradigati, Carmen Alina; Vernic, Corina; Dumbuleu, Corina Maria; Nartita, Radu; Sandesc, Dorel

    2016-01-01

    Nowadays, fluid resuscitation of multiple trauma patients is still a challenging therapy. Existing therapies for volume replacement in severe haemorrhagic shock can lead to adverse reactions that may be fatal for the patient. Patients presenting with multiple trauma often develop hemorrhagic shock, which triggers a series of metabolic, physiological and cellular dysfunction. These disorders combined, lead to complications that significantly decrease survival rate in this subset of patients. Volume and electrolyte resuscitation is challenging due to many factors that overlap. Poor management can lead to post-resuscitation systemic inflammation causing multiple organ failure and ultimately death. In literature, there is no exact formula for this purpose, and opinions are divided. This paper presents a review of modern techniques and current studies regarding the management of fluid resuscitation in trauma patients with hemorrhagic shock. According to the literature and from clinical experience, all aspects regarding post-resuscitation period need to be considered. Also, for every case in particular, emergency therapy management needs to be rigorously respected considering all physiological, biochemical and biological parameters. PMID:27574675

  11. Pilates Exercise for Hypertensive Patients: A Review of the Literature.

    PubMed

    Gonzáles, Ana Inês; Nery, Tatyana; Fragnani, Samuel Geraldi; Pereira, Franciele; Lemos, Robson Rodrigues; Bezerra, Poliana Penasso; Haas, Patrícia

    2016-09-01

    Systemic arterial hypertension (SAH) has a prevalence of approximately 1 billion cases worldwide. The main goals for its treatment involve changes in a patient's lifestyle, with a strategy of management that aims to increase his or her level of physical activity, with a recommendation for aerobic and resistance exercise. Some evidence has suggested that training with isometric exercises can produce effects similar to aerobic exercise on blood pressure reduction. Conventional exercises that are currently used in rehabilitation of hypertensive patients show low adherence, with a lack of motivation on the part of those patients. In that context, the Pilates method, which uses isometric exercises, has been gaining in popularity and worldwide acceptance, and it has the potential to be an effective method. The current literature review shows the possible benefits of the Pilates method for rehabilitation of hypertensive patients. However, even though the method is a promising modality, the authors have found that future research appears to be necessary to evaluate the benefits of Pilates for hypertensive patients. PMID:27622959

  12. Fluid management of the neurological patient: a concise review.

    PubMed

    van der Jagt, Mathieu

    2016-01-01

    Maintenance fluids in critically ill brain-injured patients are part of routine critical care. Both the amounts of fluid volumes infused and the type and tonicity of maintenance fluids are relevant in understanding the impact of fluids on the pathophysiology of secondary brain injuries in these patients. In this narrative review, current evidence on routine fluid management of critically ill brain-injured patients and use of haemodynamic monitoring is summarized. Pertinent guidelines and consensus statements on fluid management for brain-injured patients are highlighted. In general, existing guidelines indicate that fluid management in these neurocritical care patients should be targeted at euvolemia using isotonic fluids. A critical appraisal is made of the available literature regarding the appropriate amount of fluids, haemodynamic monitoring and which types of fluids should be administered or avoided and a practical approach to fluid management is elaborated. Although hypovolemia is bound to contribute to secondary brain injury, some more recent data have emerged indicating the potential risks of fluid overload. However, it is acknowledged that many factors govern the relationship between fluid management and cerebral blood flow and oxygenation and more research seems warranted to optimise fluid management and improve outcomes. PMID:27240859

  13. Dental implant survival in diabetic patients; review and recommendations

    PubMed Central

    Dubey, Rajendra Kumar; Gupta, Deepesh Kumar; Singh, Amit Kumar

    2013-01-01

    Rising population of diabetic individuals across the world has become a big concern to the society. The persistent hyperglycemia may affect each and every tissue and consequently results in morbidity and eventually mortality in diabetic patients. A direct negative response of diabetes has been observed on oral tissues with few contradictions however, little are known about effect of diabetes on dental implant treatment and the consequent results. Many studies concerned with osteointegration and prognosis of dental implant in diabetic patients have been conducted and published since 1994. These studies have been critically reviewed to understand the impact of diabetes on the success of dental implant and the factors to improve osseointegration and consequently survival of dental implant in diabetic patients. Theoretical literatures and studies in diabetic animals substantiate high failure rate of implants but most of clinical studies indicated statistically insignificant failure of dental implants even in moderately uncontrolled diabetic patients. Success of dental implant in well and fairly controlled diabetic patients with proper treatment planning, prophylactic remedies and adequate postsurgical maintenance appears as good as normal individuals. PMID:24665167

  14. Physical exercise for patients with cystic fibrosis: a review.

    PubMed

    Stanghelle, J K

    1988-02-01

    Cystic fibrosis (CF) is an inherited, chronic disease which mainly affects the lungs and the nutrition. Intensive treatment has gradually improved the outcome for the patients. Exercise therapy has been increasingly advocated to be included in the CF regimen. Our own studies indicate that both short-term and long-term training ameliorate the physical conditions for CF patients, that there is no danger for well-trained CF patients--both boys and girls--to take part even in vigorous, prolonged exercises, and that CF patients might have a positive attitude toward physical activities. Of course, all physical activities have to be individually designed. A review of the literature is also given: The specific ventilatory factors in CF, the limitations of exercise, the problem with exercise-induced asthma, the training effect on lung drainage, on lung function, on infections, on biochemical and hormonal variables, on nutrition and the gastrointestinal tract, on the musculoskeletal apparatus, and on the mind. Nearly all these reports are favorable for a carefully monitored, high activity in CF patients. Practical considerations for activities are given.

  15. Systematic Review of Hospital Readmissions in Stroke Patients

    PubMed Central

    Barrow, Emily; Vuik, Sabine; Darzi, Ara; Aylin, Paul

    2016-01-01

    Background. Previous evidence on factors and causes of readmissions associated with high-impact users of stroke is scanty. The aim of the study was to investigate common causes and pattern of short- and long-term readmissions stroke patients by conducting a systematic review of studies using hospital administrative data. Common risk factors associated with the change of readmission rate were also examined. Methods. The literature search was conducted from 15 February to 15 March 2016 using various databases, such as Medline, Embase, and Web of Science. Results. There were a total of 24 studies (n = 2,126,617) included in the review. Only 4 studies assessed causes of readmissions in stroke patients with the follow-up duration from 30 days to 5 years. Common causes of readmissions in majority of the studies were recurrent stroke, infections, and cardiac conditions. Common patient-related risk factors associated with increased readmission rate were age and history of coronary heart disease, heart failure, renal disease, respiratory disease, peripheral arterial disease, and diabetes. Among stroke-related factors, length of stay of index stroke admission was associated with increased readmission rate, followed by bowel incontinence, feeding tube, and urinary catheter. Conclusion. Although risk factors and common causes of readmission were identified, none of the previous studies investigated causes and their sequence of readmissions among high-impact stroke users. PMID:27668120

  16. Systematic Review of Hospital Readmissions in Stroke Patients.

    PubMed

    Rao, Ahsan; Barrow, Emily; Vuik, Sabine; Darzi, Ara; Aylin, Paul

    2016-01-01

    Background. Previous evidence on factors and causes of readmissions associated with high-impact users of stroke is scanty. The aim of the study was to investigate common causes and pattern of short- and long-term readmissions stroke patients by conducting a systematic review of studies using hospital administrative data. Common risk factors associated with the change of readmission rate were also examined. Methods. The literature search was conducted from 15 February to 15 March 2016 using various databases, such as Medline, Embase, and Web of Science. Results. There were a total of 24 studies (n = 2,126,617) included in the review. Only 4 studies assessed causes of readmissions in stroke patients with the follow-up duration from 30 days to 5 years. Common causes of readmissions in majority of the studies were recurrent stroke, infections, and cardiac conditions. Common patient-related risk factors associated with increased readmission rate were age and history of coronary heart disease, heart failure, renal disease, respiratory disease, peripheral arterial disease, and diabetes. Among stroke-related factors, length of stay of index stroke admission was associated with increased readmission rate, followed by bowel incontinence, feeding tube, and urinary catheter. Conclusion. Although risk factors and common causes of readmission were identified, none of the previous studies investigated causes and their sequence of readmissions among high-impact stroke users. PMID:27668120

  17. Systematic Review of Hospital Readmissions in Stroke Patients

    PubMed Central

    Barrow, Emily; Vuik, Sabine; Darzi, Ara; Aylin, Paul

    2016-01-01

    Background. Previous evidence on factors and causes of readmissions associated with high-impact users of stroke is scanty. The aim of the study was to investigate common causes and pattern of short- and long-term readmissions stroke patients by conducting a systematic review of studies using hospital administrative data. Common risk factors associated with the change of readmission rate were also examined. Methods. The literature search was conducted from 15 February to 15 March 2016 using various databases, such as Medline, Embase, and Web of Science. Results. There were a total of 24 studies (n = 2,126,617) included in the review. Only 4 studies assessed causes of readmissions in stroke patients with the follow-up duration from 30 days to 5 years. Common causes of readmissions in majority of the studies were recurrent stroke, infections, and cardiac conditions. Common patient-related risk factors associated with increased readmission rate were age and history of coronary heart disease, heart failure, renal disease, respiratory disease, peripheral arterial disease, and diabetes. Among stroke-related factors, length of stay of index stroke admission was associated with increased readmission rate, followed by bowel incontinence, feeding tube, and urinary catheter. Conclusion. Although risk factors and common causes of readmission were identified, none of the previous studies investigated causes and their sequence of readmissions among high-impact stroke users.

  18. Nonpharmacologic airway clearance techniques in hospitalized patients: a systematic review.

    PubMed

    Andrews, Jeff; Sathe, Nila A; Krishnaswami, Shanthi; McPheeters, Melissa L

    2013-12-01

    Nonpharmacologic airway clearance techniques are used to reduce the sequelae of obstructive secretions. We systematically reviewed comparative studies of nonpharmacologic interventions that health professionals can employ to achieve mucus clearance in hospitalized or postoperative patients without cystic fibrosis, over the age of 12 months. We searched MEDLINE and other databases from 1990 to 2012 to identify relevant literature. Two reviewers independently assessed each study against predetermined inclusion/exclusion criteria. Two reviewers also independently extracted data regarding subject and intervention characteristics and outcomes, and assigned overall quality ratings. The 32 studies meeting the review criteria included 24 randomized controlled trials, 7 crossover randomized controlled trials, and one prospective cohort study. Studies were typically small and together included a total of 2,453 subjects (mean 76/study). Studies generally examined chest physical therapy/physiotherapy modalities in postoperative or critically ill subjects or those with COPD. Interventions, comparators, and populations varied considerably across studies, hampering our ability to draw firm conclusions. Interventions, including conventional chest physical therapy/physiotherapy, intrapulmonary percussive ventilation, and positive expiratory pressure, typically provided small benefits in pulmonary function, gas exchange, oxygenation, and need for/duration of ventilation, among other outcomes, but differences between groups were generally small and not significant. Harms of the techniques were not consistently reported, though airway clearance techniques were generally considered safe in studies that did comment on adverse effects. Further research with clearly characterized populations and interventions is needed to understand the potential benefits and harms of these techniques. PMID:24222708

  19. Reviewing 741 patients records in two hours with FASTVISU

    PubMed Central

    Escudié, Jean-Baptiste; Jannot, Anne-Sophie; Zapletal, Eric; Cohen, Sarah; Malamut, Georgia; Burgun, Anita; Rance, Bastien

    2015-01-01

    The secondary use of electronic health records opens up new perspectives. They provide researchers with structured data and unstructured data, including free text reports. Many applications been developed to leverage knowledge from free-text reports, but manual review of documents is still a complex process. We developed FASTVISU a web-based application to assist clinicians in reviewing documents. We used FASTVISU to review a set of 6340 documents from 741 patients suffering from the celiac disease. A first automated selection pruned the original set to 847 documents from 276 patients’ records. The records were reviewed by two trained physicians to identify the presence of 15 auto-immune diseases. It took respectively two hours and two hours and a half to evaluate the entire corpus. Inter-annotator agreement was high (Cohen’s kappa at 0.89). FASTVISU is a user-friendly modular solution to validate entities extracted by NLP methods from free-text documents stored in clinical data warehouses. PMID:26958189

  20. Independent management and financial review, Yucca Mountain Project, Nevada. Final report

    SciTech Connect

    1995-07-15

    The Yucca Mountain Project is one part of the Department of Energy`s Office of Civilian Radioactive Waste Management Program (the Program) which was established by the Nuclear Waste Policy Act of 1982, and as amended in 1987. The Program`s goal is to site the nation`s first geologic repository for the permanent disposal of high-level nuclear waste, in the form of spent fuel rod assemblies, generated by the nuclear power industry and a smaller quantity of Government radioactive waste. The Program, which also encompasses the transportation system and the multipurpose canister system was not the subject of this Report. The subject of this Review was only the Yucca Mountain Project in Nevada. While the Review was directed toward the Yucca Mountain Project rather than the Program as a whole, there are certain elements of the Project which cannot be addressed except through discussion of some Program issues. An example is the Total System Life Cycle Cost addressed in Section 7 of this report. Where Program issues are discussed in this Report, the reader is reminded of the scope limitations of the National Association of Regulatory Utility Commissioners (NARUC) contract to review only the Yucca Mountain Project. The primary scope of the Review was to respond to the specific criteria contained in the NARUC scope of work. In responding to these criteria, the Review Team understood that some interested parties have expressed concern over the requirements of the Nuclear Waste Policy Act relative to the Yucca Mountain Project and the nature of activities currently being carried out by the Department of Energy at the Yucca Mountain Project site. The Review Team has attempted to analyze relevant portions of the Nuclear Waste Policy Act as Amended, but has not conducted a thorough analysis of this legislation that could lead to any specific legal conclusions about all aspects of it.

  1. Mediators of Change in Psychosocial Interventions for Cancer Patients: A Systematic Review

    PubMed Central

    Moyer, Anne; Goldenberg, Matthew; Hall, Matthew A.; Knapp-Oliver, Sarah K.; Sohl, Stephanie J.; Sarma, Elizabeth A.; Schneider, Stefan

    2012-01-01

    Careful reviews and meta-analyses have made valuable contributions to understanding the efficacy of psychosocial interventions for cancer patients. An important next step is to determine the mediators that explain the influence of efficacious interventions on outcomes. This systematic review summarizes tests of mediating variables from twenty-two projects conducted from 1989–2010. Although all authors provided some type of rationale for considering particular mediating relationships, the investigations varied widely with respect to the extent to which formal theoretical constructs were tested, the type and goals of the interventions studied, and the broad types of outcomes and potential mediators examined. Although there was some evidence supporting selected mediating relationships, with positive findings often found when mediating variables represented behaviors targeted by an intervention, the findings were mixed. Expanding the focus of research to include mechanisms in psychosocial oncology intervention research is necessary for providing a unified picture of how mediating relationships may be operating in this field. PMID:22873734

  2. Electronic band structure and photoemission: A review and projection

    SciTech Connect

    Falicov, L.M.

    1987-09-01

    A brief review of electronic-structure calculations in solids, as a means of interpreting photoemission spectra, is presented. The calculations are, in general, of three types: ordinary one-electron-like band structures, which apply to bulk solids and are the basis of all other calculations; surface modified calculations, which take into account, self-consistently if at all possible, the presence of a vacuum-solid interface and of the electronic modifications caused thereby; and many-body calculations, which go beyond average-field approximations and consider dynamic rearrangement effects caused by electron-electron correlations during the photoemission process. 44 refs.

  3. Maggot therapy: a literature review of methods and patient experience.

    PubMed

    Menon, Jane

    Used in wound-bed preparation, larval therapy can be effective both clinically and financially, if used appropriately. In this article,the author reviews contemporary literature and key research on the benefits and challenges of using this therapy for wound care. The article focuses on debridement, as well as associated antimicrobial effects and psychological issues. Considerations and cautions that may affect clinical practice, such as pain management, peri-wound skin care, different methods of application and preparing the patient both physically and psychologically are also explored.

  4. Constructing a Patient Education System: A Performance Technology Project

    ERIC Educational Resources Information Center

    Bell, Edith E.

    2009-01-01

    The purpose of the patient education system described here was to distribute patient education material to and within medical practices managed by a small medical practice management company. The belief was that patient education opportunities improved health care outcomes and increased patient participation in health care decisions and compliance…

  5. Interaction between ingested nutrients and gut endocrine cells in patients with irritable bowel syndrome (Review)

    PubMed Central

    EL-SALHY, MAGDY; GILJA, ODD HELGE; GUNDERSEN, DORIS; HATLEBAKK, JAN G.; HAUSKEN, TRYGVE

    2014-01-01

    Several endocrine cell abnormalities have been reported in different segments of the gastrointestinal tract of patients with irritable bowel syndrome (IBS). These cells have specialized microvilli that project into the lumen; they function as sensors for the gut contents and respond to luminal stimuli (mostly ingested nutrients) by releasing hormones into the lamina propria, where they exert their effects via a paracrine/endocrine mode of action. Certain food items trigger the symptoms experienced by IBS patients, including those rich in fermentable oligo-, di- and monosaccharides, and polyols (FODMAPs). In this review, we present the argument that the effects of both FODMAPs and the proportional intake of proteins, fats and carbohydrates on IBS symptoms may be caused by an interaction with the gut endocrine cells. Since the gut hormones control and regulate gastrointestinal motility and sensation, this interaction may be responsible for abnormal gastrointestinal motility and the visceral hypersensitivity observed in these patients. There is no consistent evidence that IBS patients suffer from food allergy. The role of gluten intolerance in the development of IBS symptoms in these patients remains a matter of controversy. Individual guidance on food management, which includes restrictions in the intake of FODMAP-rich foods and testing diets with different proportions of proteins, fats and carbohydrates has been found to reduce the symptoms, improve the quality of life, and make the habitual diet of IBS patients more healthy. PMID:24939595

  6. Reviewing the Unmet Needs of Patients with Multiple Sclerosis

    PubMed Central

    Mehr, Stanton R.; Zimmerman, Marj P.

    2015-01-01

    Significant innovations in the treatment of patients with multiple sclerosis (MS) have primarily addressed the frequency of flare-ups in relapsing-remitting MS (RRMS). Many advances have been made in this area, and the medical community may be on the verge of a serious discussion of what constitutes a truly effective MS treatment. Certainly, it is important to further delay MS flare-ups and more effectively treat RRMS symptoms. However, great strides in reducing or preventing MS-related disability and providing neuroprotection have been elusive. Many unmet needs are still voiced by patients with MS, clinicians, and caregivers. Current information on the need for progress in various areas is reviewed in this article, including psychosocial care, treatments for progressive MS, biomarker identification, functional outcome measures, individualization of treatment, reducing side effects of medications, and improving medication adherence. PMID:26702334

  7. Sinus pilonidalis in patients of German military hospitals: a review.

    PubMed

    Kueper, Janina; Evers, Theo; Wietelmann, Kai; Doll, Dietrich; Roffeis, Jana; Schwabe, Philipp; Märdian, Sven; Wichlas, Florian; Krapohl, Björn-Dirk

    2015-01-01

    Pilonidal sinus disease (PSD) most commonly presents in young men when hair follicles enter through damaged epithelium and cause an inflammatory reaction. This results in the formation of fistular tracts. We reviewed studies based on a shared cohort of patients who presented at German military hospitals with PSD. The effect of the morphology of the sinus, perioperative protocol, and aftercare of the surgical treatment on the recurrence of PSD were evaluated. The drainage of acute abscesses before surgery, the application of methylene blue during surgery and open wound treatment were generally found to reduce the recurrence rate. A positive family history, postoperative epilation and primary suture as the healing method were found to elevate the recurrence rate. Long-term follow up of over 15 years was found to be a vital component of patient care as only 60% of the overall recurrences recorded had taken place by year 5 postoperatively.

  8. Review of BPA Funded Sturgeon, Resident Fish and Wildlife Projects, 1989/1990.

    SciTech Connect

    United States. Bonneville Power Administration.

    1990-12-01

    The Bonneville Power Administration (BPA) held a public meeting on November 6-7, 1990, for the purpose of review, coordination, and consultation of the BPA-funded projects for sturgeon, resident fish, and wildlife in the Columbia River Basin (Basin). The comments received after the meeting were favorable and the participants agreed that the meeting was stimulating and productive. The information exchanged should lead to better coordination with other projects throughout the Basin. The following pages list the projects by title, the project leaders and BPA's project officers, and an abstract of each leaders presentation. These summaries are in some cases preliminary; they are subject to change and should not be quoted without consulting the project leader.

  9. Assessment of Smolt Condition for Travel Time Analysis Project, 1987-1997 Project Review.

    SciTech Connect

    Schrock, Robin M.; Hans, Karen M.; Beeman, John W.

    1997-12-01

    The assessment of Smolt Condition for Travel Time Analysis Project (Bonneville Power Administration Project 87-401) monitored attributes of salmonid smolt physiology in the Columbia and Snake River basins from 1987 to 1997, under the Northwest Power Planning Council Fish and Wildlife Program, in cooperation with the Smolt Monitoring Program of the Fish Passage Center. The primary goal of the project was to investigate the physiological development of juvenile salmonids related to migration rates. The assumption was made that the level of smolt development, interacting with environmental factos such as flow, would be reflected in travel times. The Fish Passage Center applied the physiological measurements of smolt condition to Water Budget management, to regulate flows so as to decrease travel time and increase survival.

  10. Development of an artificial multifunctional foot: A project review

    NASA Astrophysics Data System (ADS)

    Almeida, João; Ferreira, Maria José; Lobarinhas, Pedro; Silva, Luís F.; Leite, Abílio; Araújo, Alfredo; Sousa, Fernando

    2013-10-01

    The main purpose of this project is the development of a multifunctional artificial foot, capable of duplicate a human foot in a laboratory environment, in order to evaluate and simulate footwear's performance under certain conditions. This foot is used as a laboratory prototype and is multisegmented, in order that each section is controlled independently in terms of heat generation and sweating rate, therefore it is possible to simulate more accurately the real behaviour of a human foot. The device produces thermal insulation values that will help to design footwear with better ability in terms of thermal comfort, replacing human volunteers in thermal comfort perception tests, which are very subjective. The prototype was already tested, and preliminary results indicated that thermal insulation values are within the range of expected values produced by other foot thermal manikins and by human volunteers' tests. This fact suggests that this lab prototype can be used infuture thermal comfort evaluations.

  11. Improving the acute care of COPD patients across Gloucestershire: a quality improvement project.

    PubMed

    Miller, Craig; Cushley, Claire; Redler, Kasey; Mitchell, Claire; Aynsley Day, Elizabeth; Mansfield, Helen; Nye, Abigail

    2015-01-01

    receiving all elements of the COPD admission care bundle, versus 63% in September 2014. Appropriate blood gas analysis, nebuliser administration, and respiratory review also improved. Prescription of steroids and antibiotics remained static, with 96% of patients receiving these treatments within four hours in the emergency department (ED). The only criteria which showed a decline was appropriate oxygen prescription, which dipped from 97% to 87%. After the effect of initial strategies plateaued, this quality improvement project facilitated a further increase in compliance with the CQUIN targets, both improving patient care, and safeguarding continued CQUIN funding. There is further work to be done to maintain and support further improvement in standards, and to encourage use of the COPD admission bundle paperwork for documentation purposes. PMID:26734406

  12. Clinical review: early patient mobilization in the ICU.

    PubMed

    Hodgson, Carol L; Berney, Sue; Harrold, Megan; Saxena, Manoj; Bellomo, Rinaldo

    2013-02-28

    Early mobilization (EM) of ICU patients is a physiologically logical intervention to attenuate critical illness-associated muscle weakness. However, its long-term value remains controversial. We performed a detailed analytical review of the literature using multiple relevant key terms in order to provide a comprehensive assessment of current knowledge on EM in critically ill patients. We found that the term EM remains undefined and encompasses a range of heterogeneous interventions that have been used alone or in combination. Nonetheless, several studies suggest that different forms of EM may be both safe and feasible in ICU patients, including those receiving mechanical ventilation. Unfortunately, these studies of EM are mostly single center in design, have limited external validity and have highly variable control treatments. In addition, new technology to facilitate EM such as cycle ergometry, transcutaneous electrical muscle stimulation and video therapy are increasingly being used to achieve such EM despite limited evidence of efficacy. We conclude that although preliminary low-level evidence suggests that EM in the ICU is safe, feasible and may yield clinical benefits, EM is also labor-intensive and requires appropriate staffing models and equipment. More research is thus required to identify current standard practice, optimal EM techniques and appropriate outcome measures before EM can be introduced into the routine care of critically ill patients.

  13. Clinical review: early patient mobilization in the ICU.

    PubMed

    Hodgson, Carol L; Berney, Sue; Harrold, Megan; Saxena, Manoj; Bellomo, Rinaldo

    2013-01-01

    Early mobilization (EM) of ICU patients is a physiologically logical intervention to attenuate critical illness-associated muscle weakness. However, its long-term value remains controversial. We performed a detailed analytical review of the literature using multiple relevant key terms in order to provide a comprehensive assessment of current knowledge on EM in critically ill patients. We found that the term EM remains undefined and encompasses a range of heterogeneous interventions that have been used alone or in combination. Nonetheless, several studies suggest that different forms of EM may be both safe and feasible in ICU patients, including those receiving mechanical ventilation. Unfortunately, these studies of EM are mostly single center in design, have limited external validity and have highly variable control treatments. In addition, new technology to facilitate EM such as cycle ergometry, transcutaneous electrical muscle stimulation and video therapy are increasingly being used to achieve such EM despite limited evidence of efficacy. We conclude that although preliminary low-level evidence suggests that EM in the ICU is safe, feasible and may yield clinical benefits, EM is also labor-intensive and requires appropriate staffing models and equipment. More research is thus required to identify current standard practice, optimal EM techniques and appropriate outcome measures before EM can be introduced into the routine care of critically ill patients. PMID:23672747

  14. Patient-based radiographic exposure factor selection: a systematic review

    SciTech Connect

    Ching, William; Robinson, John; McEntee, Mark

    2014-09-15

    Digital technology has wider exposure latitude and post-processing algorithms which can mask the evidence of underexposure and overexposure. Underexposure produces noisy, grainy images which can impede diagnosis and overexposure results in a greater radiation dose to the patient. These exposure errors can result from inaccurate adjustment of exposure factors in response to changes in patient thickness. This study aims to identify all published radiographic exposure adaptation systems which have been, or are being, used in general radiography and discuss their applicability to digital systems. Studies in EMBASE, MEDLINE, CINAHL and SCOPUS were systematically reviewed. Some of the search terms used were exposure adaptation, exposure selection, exposure technique, 25% rule, 15% rule, DuPont™ Bit System and radiography. A manual journal-specific search was also conducted in The Radiographer and Radiologic Technology. Studies were included if they demonstrated a system of altering exposure factors to compensate for variations in patients for general radiography. Studies were excluded if they focused on finding optimal exposures for an ‘average’ patient or focused on the relationship between exposure factors and dose. The database search uncovered 11 articles and the journal-specific search uncovered 13 articles discussing systems of exposure adaptation. They can be categorised as simple one-step guidelines, comprehensive charts and computer programs. Only two papers assessed the efficacy of exposure adjustment systems. No literature compares the efficacy of exposure adaptations system for film/screen radiography with digital radiography technology nor is there literature on a digital specific exposure adaptation system.

  15. 75 FR 13765 - Submission for OMB Review; Use of Project Labor Agreements for Federal Construction Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-23

    ... for public comments was published in the Federal Register at 74 FR 33953, on July 14, 2009. No... a project labor agreement (PLA), as they may decide appropriate, on large-scale construction... efficiency in Federal procurement. A PLA is a pre-hire collective bargaining agreement with one or more...

  16. A Review of NASA's Radiation-Hardened Electronics for Space Environments Project

    NASA Technical Reports Server (NTRS)

    Keys, Andrew S.; Adams, James H.; Patrick, Marshall C.; Johnson, Michael A.; Cressler, John D.

    2008-01-01

    NASA's Radiation Hardened Electronics for Space Exploration (RHESE) project develops the advanced technologies required to produce radiation hardened electronics, processors, and devices in support of the requirements of NASA's Constellation program. Over the past year, multiple advancements have been made within each of the RHESE technology development tasks that will facilitate the success of the Constellation program elements. This paper provides a brief review of these advancements, discusses their application to Constellation projects, and addresses the plans for the coming year.

  17. Breckinridge Project, initial effort. Report XI, Volume IV. Critical review of the design basis. [Critical review

    SciTech Connect

    1981-05-01

    Report XI, Technical Audit, is a compendium of research material used during the Initial Effort in making engineering comparisons and decisions. Volumes 4 and 5 of Report XI present those studies which provide a Critical Review of the Design Basis. The Critical Review Report, prepared by Intercontinental Econergy Associates, Inc., summarizes findings from an extensive review of the data base for the H-Coal process design. Volume 4 presents this review and assessment, and includes supporting material; specifically, Design Data Tabulation (Appendix A), Process Flow Sheets (Appendix B), and References (Appendix C). Volume 5 is a continuation of the references of Appendix C. Studies of a proprietary nature are noted and referenced, but are not included in these volumes. They are included in the Limited Access versions of these reports and may be reviewed by properly cleared personnel in the offices of Ashland Synthetic Fuels, Inc.

  18. Breckinridge Project, initial effort. Report XI, Volume V. Critical review of the design basis. [Critical review

    SciTech Connect

    1982-01-01

    Report XI, Technical Audit, is a compendium of research material used during the Initial Effort in making engineering comparisons and decisions. Volumes 4 and 5 of Report XI present those studies which provide a Critical Review of the Design Basis. The Critical Review Report, prepared by Intercontinental Econergy Associates, Inc., summarizes findings from an extensive review of the data base for the H-Coal process design. Volume 4 presents this review and assessment, and includes supporting material; specifically, Design Data Tabulation (Appendix A), Process Flow Sheets (Appendix B), and References (Appendix C). Volume 5 is a continuation of the references of Appendix C. Studies of a proprietary nature are noted and referenced, but are not included in these volumes. They are included in the Limited Access versions of these reports and may be reviewed by properly cleared personnel in the offices of Ashland Synthetic Fuels, Inc.

  19. Preventing Unintended Pregnancy: The Contraceptive CHOICE Project in Review.

    PubMed

    Birgisson, Natalia E; Zhao, Qiuhong; Secura, Gina M; Madden, Tessa; Peipert, Jeffrey F

    2015-05-01

    The Contraceptive CHOICE Project (CHOICE) sought to reduce unintended pregnancies in the St. Louis Region by removing cost, education, and access barriers to highly effective contraception. CHOICE was a prospective cohort study of over 9,000 women 14-45 years of age who received tiered contraceptive counseling to increase awareness of all reversible methods available, particularly long-acting reversible contraceptive (LARC) methods. Participants were provided with contraception of their choice at no cost for 2-3 years. We studied contraceptive method choice, continuation, and population outcomes of repeat abortion and teen pregnancy. Seventy-five percent of study participants chose one of the three LARC methods (46% levonorgestrel intrauterine system, 12% copper intrauterine device, and 17% subdermal implant). LARC users reported greater continuation than non-LARC users at 12 months (87% versus 57%) and 24 months (77% versus 41%). In our cohort, LARC methods were 20 times more effective than non-LARC methods. As a result, we observed a reduction in the percent of repeat abortions from 2006 to 2010 in St. Louis compared with Kansas City and nonmetropolitan Missouri and found substantial reductions in teen pregnancy, birth, and abortion (34.0, 19.4, and 9.7 per 1000 teens, respectively) compared with national rates among sexually experienced teens (158.5, 94.0, and 41.5 per 1000, respectively). Improved access to LARC methods can result in fewer unintended pregnancies and abortions and considerable cost savings to the health care system. PMID:25825986

  20. Culture, cultural factors and psychiatric diagnosis: review and projections

    PubMed Central

    ALARCÓN, RENATO D.

    2009-01-01

    This paper aims to provide conceptual justifications for the inclusion of culture and cultural factors in psychiatric diagnosis, and logistic suggestions as to the content and use of this approach. A discussion of the scope and limitations of current diagnostic practice, criticisms from different quarters, and the role and relevance of culture in the diagnostic encounter, precede the examination of advantages and disadvantages of the approach. The cultural content of psychiatric diagnosis should include the main, well-recognized cultural variables, adequate family data, explanatory models, and strengths and weaknesses of every individual patient. The practical aspects include the acceptance of “cultural discordances” as a component of an updated definition of mental disorder, and the use of a refurbished cultural formulation. Clinical “telescoping” strategies to obtain relevant cultural data during the diagnostic interview, and areas of future research (including field trials on the cultural formulation and on “culture bound syndromes”), are outlined. PMID:19812742

  1. Columbia Basin Fish and Wildlife Authority Project Abstracts; May 25-27, Portland, Oregon, 1997 Annual Review.

    SciTech Connect

    Allee, Brian J.

    1997-06-26

    Abstracts are presented from the 1997 Columbia Basin Fish and Wildlife Program Review of Projects. The purpose was to provide information and education on the approximate 127 million dollars in Northwest electric ratepayer fish and wildlife mitigation projects funded annually.

  2. Fish Habitat Improvement Projects in the Fifteenmile Creek and Trout Creek Basins of Central Oregon: Field Review and Management Recommendations.

    SciTech Connect

    Kauffman, J. Boone

    1993-07-01

    A field review of stream habitat improvement project sites in the lower Deschutes River Basin was conducted by riparian ecology, fisheries, and hydrology specialists. Habitat management objectives, limiting factors, project implementation, land use history, and other factors were discussed at each site. This information, in conjunction with the reviewer`s field inspections of portions of a particular habitat project, provided the basis for this report.

  3. Toxoplasmosis in immunocompromised patients in Iran: a systematic review and meta-analysis.

    PubMed

    Ahmadpour, Ehsan; Daryani, Ahmad; Sharif, Mahdi; Sarvi, Shahabeddin; Aarabi, Mohsen; Mizani, Azadeh; Rahimi, Mohammad Taghi; Shokri, Azar

    2014-12-15

    Although toxoplasmosis in immunocompetent individuals is generally asymptomatic, in immunocompromised patients (HIV/AIDS, cancer, and transplant patients), it can lead to serious pathological effects. This study included a systematic review and meta-analysis to comprehensively assess the seroprevalence rate of Toxoplasma infection in immunocompromised patients in Iran. Electronic English and Persian databases (PubMed, Google Scholar, ScienceDirect, Scopus, Magiran, Scientific Information Database [SID], IranMedex, and IranDoc), parasitology congresses, and projects and theses of Iranian medical universities, were systematically searched from 1997 to 2013 (published or unpublished data). In this paper, several studies that used serological methods for diagnosis of toxoplasmosis were selected. Analysis of seroprevalence estimates was pooled using a random-effects meta-analysis. Twenty-two studies, comprising 2,805 individuals, were included in the meta-analysis. Overall seroprevalence rate of Toxoplasma infection in Iranian immunocompromised patients was 50.01% (95% confidence interval, 43.85 to 56.17); however, there was significant heterogeneity among study groups. The results showed that seroprevalence rate of toxoplasmosis among transplant recipients, HIV/AIDS, and cancer patients in Iran was 55.1%, 50.05%, and 45.06%, respectively. In addition, IgM seroprevalence rate was estimated to be 4.85% (95% confidence interval, 2.22 to 8.41). This systematic review and meta-analysis identified a high seroprevalence rate of Toxoplasma infection among immunocompromised patients (50%). Consideration of management, design and provision of appropriate control measures of toxoplasmosis is highly recommended.

  4. New projects for CCGTs with coal gasification (Review)

    NASA Astrophysics Data System (ADS)

    Olkhovskii, G. G.

    2016-10-01

    Perspectives of using coal in combined-cycle gas turbine units (CCGTs), which are significantly more efficient than steam power plants, have been associated with preliminary coal gasification for a long time. Due to gasification, purification, and burning the resulting synthesis gas at an increased pressure, there is a possibility to intensify the processes occurring in them and reduce the size and mass of equipment. Physical heat evolving from gasification can be used without problems in the steam circuit of a CCGT. The downside of these opportunities is that the unit becomes more complex and expensive, and its competitiveness is affected, which was not achieved for CCGT power plants with coal gasification built in the 1990s. In recent years, based on the experience with these CCGTs, several powerful CCGTs of the next generation, which used higher-output and cost-effective gas-turbine plants (GTPs) and more advanced systems of gasification and purification of synthesis gas, were either built or designed. In a number of cases, the system of gasification includes devices of CO vapor reforming and removal of the emitted CO2 at a high pressure prior to fuel combustion. Gasifiers with air injection instead of oxygen injection, which is common in coal chemistry, also find application. In this case, the specific cost of the power station considerably decreases (by 15% and more). In units with air injection, up to 40% air required for separation is drawn from the intermediate stage of the cycle compressor. The range of gasified coals has broadened. In order to gasify lignites in one of the projects, a transfer reactor was used. The specific cost of a CCGT with coal gasification rose in comparison with the period when such units started being designed, from 3000 up to 5500 dollars/kW.

  5. Measurement of patient safety: a systematic review of the reliability and validity of adverse event detection with record review

    PubMed Central

    Hanskamp-Sebregts, Mirelle; Zegers, Marieke; Vincent, Charles; van Gurp, Petra J; de Vet, Henrica C W; Wollersheim, Hub

    2016-01-01

    Objectives Record review is the most used method to quantify patient safety. We systematically reviewed the reliability and validity of adverse event detection with record review. Design A systematic review of the literature. Methods We searched PubMed, EMBASE, CINAHL, PsycINFO and the Cochrane Library and from their inception through February 2015. We included all studies that aimed to describe the reliability and/or validity of record review. Two reviewers conducted data extraction. We pooled κ values (κ) and analysed the differences in subgroups according to number of reviewers, reviewer experience and training level, adjusted for the prevalence of adverse events. Results In 25 studies, the psychometric data of the Global Trigger Tool (GTT) and the Harvard Medical Practice Study (HMPS) were reported and 24 studies were included for statistical pooling. The inter-rater reliability of the GTT and HMPS showed a pooled κ of 0.65 and 0.55, respectively. The inter-rater agreement was statistically significantly higher when the group of reviewers within a study consisted of a maximum five reviewers. We found no studies reporting on the validity of the GTT and HMPS. Conclusions The reliability of record review is moderate to substantial and improved when a small group of reviewers carried out record review. The validity of the record review method has never been evaluated, while clinical data registries, autopsy or direct observations of patient care are potential reference methods that can be used to test concurrent validity. PMID:27550650

  6. Patient-based radiographic exposure factor selection: a systematic review

    PubMed Central

    Ching, William; Robinson, John; McEntee, Mark

    2014-01-01

    Introduction Digital technology has wider exposure latitude and post-processing algorithms which can mask the evidence of underexposure and overexposure. Underexposure produces noisy, grainy images which can impede diagnosis and overexposure results in a greater radiation dose to the patient. These exposure errors can result from inaccurate adjustment of exposure factors in response to changes in patient thickness. This study aims to identify all published radiographic exposure adaptation systems which have been, or are being, used in general radiography and discuss their applicability to digital systems. Methods Studies in EMBASE, MEDLINE, CINAHL and SCOPUS were systematically reviewed. Some of the search terms used were exposure adaptation, exposure selection, exposure technique, 25% rule, 15% rule, DuPont™ Bit System and radiography. A manual journal-specific search was also conducted in The Radiographer and Radiologic Technology. Studies were included if they demonstrated a system of altering exposure factors to compensate for variations in patients for general radiography. Studies were excluded if they focused on finding optimal exposures for an ‘average’ patient or focused on the relationship between exposure factors and dose. Results The database search uncovered 11 articles and the journal-specific search uncovered 13 articles discussing systems of exposure adaptation. They can be categorised as simple one-step guidelines, comprehensive charts and computer programs. Conclusion Only two papers assessed the efficacy of exposure adjustment systems. No literature compares the efficacy of exposure adaptations system for film/screen radiography with digital radiography technology nor is there literature on a digital specific exposure adaptation system. PMID:26229654

  7. They Said It Couldn't Be Done: Student Services Program Review Project Final Report.

    ERIC Educational Resources Information Center

    1986

    This report contains the final products of the Student Services Program Review Project (SSPRP), which was designed to develop evaluation models to measure the efficacy of the various student services programs provided by the California community colleges. The first sections of the report offer introductory information on the goals and activities…

  8. Application of Program Evaluation and Review Technique (PERT) within a Curriculum Development Project.

    ERIC Educational Resources Information Center

    Foster, Carol; Lent, James R.

    1986-01-01

    PERT (Program Evaluation and Review Technique) was applied to a federal project developing curriculum materials for the mentally retarded. A 34-step process lattice and PERT chart were useful for long-range planning, supervising the activity, providing accountability, and training new staff members. (Author/DB)

  9. Project CERES. Ceres Unified School District, Ceres, California. A Submission to the Joint Dissemination Review Panel.

    ERIC Educational Resources Information Center

    Baker, Octave V.

    One of seven career education programs chosen for nationwide dissemination by the Department of Health, Education, and Welfare's Joint Dissemination Review Panel (JDRP), Project CERES (Career Education Responsive to Every Student) is being conducted for grades K-6 with planned expansion to grades 7-12. For the years 1972-76, it received funding…

  10. 78 FR 63276 - Interim Policy, FAA Review of Solar Energy System Projects on Federally Obligated Airports

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-23

    ... Federal Aviation Administration Interim Policy, FAA Review of Solar Energy System Projects on Federally... federally obligated airports to construct solar energy systems on airport property. FAA is adopting an... for measuring ocular impact of proposed solar energy systems which are effective upon publication....

  11. Review of the Literature Regarding Early Memories and Their Emerging Use in Projective Spiritual Assessment.

    ERIC Educational Resources Information Center

    Bustrum, Joy M.

    This doctoral research seeks to demonstrate the clinical utility of early memories by reviewing the current literature and providing a rationale for extending this research into the spiritual arena by highlighting the lack of available projective spiritual measures. Specific areas covered include an overview of early memory theory, technique and…

  12. Chemical research projects office fuel tank sealants review. [flight testing of fluorosilicone sealants

    NASA Technical Reports Server (NTRS)

    Rosser, R. W.; Parker, J. A.

    1974-01-01

    The status of high-temperature fuel tank sealants for military and potentially commercial supersonic aircraft is examined. The interrelationships of NASA's sealants program comprise synthesis and development of new fluoroether elastomers, sealant prediction studies, flight simulation and actual flight testing of best state-of-the-art fluorosilicone sealants. The technical accomplishments of these projects are reviewed.

  13. Project CAP. Boston Mountains Educational Cooperative, Greenland, Arkansas. A Submission to the Joint Dissemination Review Panel.

    ERIC Educational Resources Information Center

    Hamilton, Jack A.; Kaplan, Carol B.

    One of seven career education programs chosen for nationwide dissemination by the Department of Health, Education, and Welfare's Joint Dissemination Review Panel (JDRP), Project CAP (Career Awareness Program) is being conducted for grades 1-8 in Greenland, Arkansas. For the years 1974-77, it received funding from both federal and local sources. It…

  14. Biggest Pork Barrel Ever: $225-Million for Projects That Bypassed Merit Reviews.

    ERIC Educational Resources Information Center

    Cordes, Colleen

    1988-01-01

    Congress has quietly approved millions of dollars for campus research projects not subjected to traditional merit reviews. The wisdom of allowing legislators to direct federal money to specific campuses is questioned less and less, and the practice is more prevalent than ever. (MSE)

  15. 7 CFR 634.14 - Review and approval of project applications.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 6 2012-01-01 2012-01-01 false Review and approval of project applications. 634.14 Section 634.14 Agriculture Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF AGRICULTURE LONG TERM CONTRACTING RURAL CLEAN WATER PROGRAM...

  16. 7 CFR 634.14 - Review and approval of project applications.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 6 2011-01-01 2011-01-01 false Review and approval of project applications. 634.14 Section 634.14 Agriculture Regulations of the Department of Agriculture (Continued) NATURAL RESOURCES CONSERVATION SERVICE, DEPARTMENT OF AGRICULTURE LONG TERM CONTRACTING RURAL CLEAN WATER PROGRAM...

  17. Phase 5 storage (Project W-112) Central Waste Complex operational readiness review, final report

    SciTech Connect

    Wight, R.H.

    1997-05-30

    This document is the final report for the RFSH conducted, Contractor Operational Readiness Review (ORR) for the Central Waste Complex (CWC) Project W-112 and Interim Safety Basis implementation. As appendices, all findings, observations, lines of inquiry and the implementation plan are included.

  18. 18 CFR 806.5 - Projects that may require review and approval.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... characteristics of water resources of interstate streams designated by the Commission under separate resolution... 18 Conservation of Power and Water Resources 2 2010-04-01 2010-04-01 false Projects that may require review and approval. 806.5 Section 806.5 Conservation of Power and Water Resources...

  19. 18 CFR 806.5 - Projects that may require review and approval.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... characteristics of water resources of interstate streams designated by the Commission under separate resolution... 18 Conservation of Power and Water Resources 2 2011-04-01 2011-04-01 false Projects that may require review and approval. 806.5 Section 806.5 Conservation of Power and Water Resources...

  20. Summary of literature review of risk communication: Hanford Environmental Dose Reconstruction Project

    SciTech Connect

    Byram, S.J.

    1991-05-01

    The Hanford Environmental Dose Reconstruction (HEDR) Project will estimate radiation exposures people may have received from radioactive materials released during past operations at the Department of Energy's Hanford Site near Richland, Washington. The project is being conducted by Pacific Northwest Laboratory (PNL) under the direction of an independent Technical Steering Panel (TSP). The Centers for Disease Control (CDC) will use HEDR dose estimates in studies to investigate a potential link between thyroid disease and historical Hanford emissions. The HEDR Project was initiated to address public concerns about the possible health impacts from past releases of radioactive materials from Hanford. The TSP recognized early in the project that special mechanisms would be required to communicate effectively to the many different concerned audiences. To identify and develop these mechanisms, the TSP issued Directive 89-7 to PNL in May 1989. The TSP directed PNL to examine methods to communicate the causes and effects of uncertainties in the dose estimates. A literature review was conducted as the first activity in response to the TSP's directive. This report presents the results of the literature review. The objective of the literature review was to identify key principles'' that could be applied to develop communications strategies for the project. 26 refs., 6 figs.

  1. Summary of the National Demonstration Project and recommendations for the patient-centered medical home.

    PubMed

    Crabtree, Benjamin F; Nutting, Paul A; Miller, William L; Stange, Kurt C; Stewart, Elizabeth E; Jaén, Carlos Roberto

    2010-01-01

    This article summarizes findings from the National Demonstration Project (NDP) and makes recommendations for policy makers and those implementing patient-centered medical homes (PCMHs) based on these findings and an understanding of diverse efforts to transform primary care. The NDP was launched in June 2006 as the first national test of a particular PCMH model in a diverse sample of 36 family practices, randomized to facilitated or self-directed groups. An independent evaluation team used a multimethod evaluation strategy, analyzing data from direct observation, depth interviews, e-mail streams, medical record audits, and patient and clinical staff surveys. Peer-reviewed manuscripts from the NDP provide answers to 4 key questions: (1) Can the NDP model be built? (2) What does it take to build the NDP model? (3) Does the NDP model make a difference in quality of care? and (4) Can the NDP model be widely disseminated? We find that although it is feasible to transform independent practices into the NDP conceptualization of a PCMH, this transformation requires tremendous effort and motivation, and benefits from external support. Most practices will need additional resources for this magnitude of transformation. Recommendations focus on the need for the PCMH model to continue to evolve, for delivery system reform, and for sufficient resources for implementing personal and practice development plans. In the meantime, we find that much can be done before larger health system reform. PMID:20530397

  2. Interventions for smoking cessation in hospitalised patients: a systematic review

    PubMed Central

    Munafo, M; Rigotti, N; Lancaster, T; Stead, L; Murphy, M

    2001-01-01

    BACKGROUND—An admission to hospital provides an opportunity to help people stop smoking. Individuals may be more open to help at a time of perceived vulnerability, and may find it easier to quit in an environment where smoking is restricted or prohibited. Providing smoking cessation services during hospitalisation may help more people to attempt and sustain an attempt to quit. The purpose of this paper is to systematically review the effectiveness of interventions for smoking cessation in hospitalised patients.
METHODS—We searched the Cochrane Tobacco Addiction Group register, CINAHL, and the Smoking and Health database for studies of interventions for smoking cessation in hospitalised patients. Randomised and quasi-randomised trials of behavioural, pharmacological, or multi-component interventions to help patients stop smoking conducted with hospitalised patients who were current smokers or recent quitters were included. Studies of patients admitted for psychiatric disorders or substance abuse, those that did not report abstinence rates, and those with follow up of less than 6 months were excluded. Two of the authors extracted data independently for each paper, with assistance from others.
RESULTS—Intensive intervention (inpatient contact plus follow up for at least 1 month) was associated with a significantly higher cessation rate compared with controls (Peto odds ratio (OR) 1.82,95% CI 1.49 to 2.22). Any contact during hospitalisation followed by minimal follow up failed to detect a statistically significant effect on cessation rate, but did not rule out a 30% increase in smoking cessation (Peto OR 1.09, 95% CI 0.91 to 1.31). There was insufficient evidence to judge the effect of interventions delivered only during the hospital stay. Although the interventions increased quit rates irrespective of whether nicotine replacement therapy (NRT) was used, the results for NRT were compatible with other data indicating that it increases quit rates. There was no

  3. A decision tool to guide the ethics review of a challenging breed of emerging genomic projects.

    PubMed

    Joly, Yann; So, Derek; Osien, Gladys; Crimi, Laura; Bobrow, Martin; Chalmers, Don; Wallace, Susan E; Zeps, Nikolajs; Knoppers, Bartha

    2016-08-01

    Recent projects conducted by the International Cancer Genome Consortium (ICGC) have raised the important issue of distinguishing quality assurance (QA) activities from research in the context of genomics. Research was historically defined as a systematic effort to expand a shared body of knowledge, whereas QA was defined as an effort to ascertain whether a specific project met desired standards. However, the two categories increasingly overlap due to advances in bioinformatics and the shift toward open science. As few ethics review policies take these changes into account, it is often difficult to determine the appropriate level of review. Mislabeling can result in unnecessary burdens for the investigators or, conversely, in underestimation of the risks to participants. Therefore, it is important to develop a consistent method of selecting the review process for genomics and bioinformatics projects. This paper begins by discussing two case studies from the ICGC, followed by a literature review on the distinction between QA and research and a comparative analysis of ethics review policies from Canada, the United States, the United Kingdom, and Australia. These results are synthesized into a novel two-step decision tool for researchers and policymakers, which uses traditional criteria to sort clearly defined activities while requiring the use of actual risk levels to decide more complex cases. PMID:26785834

  4. Acupuncture for patients with chronic urticaria: a systematic review protocol

    PubMed Central

    Yao, Qin; Ye, Yongming; Liu, Xiaoxu; Qin, Zongshi; Liu, Zhishun

    2015-01-01

    Introduction This systematic review protocol aims to describe a meta-analysis to assess the effectiveness and safety of acupuncture therapy for patients with chronic urticaria. Methods and analysis We will electronically search the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, the Web of Science, Traditional Chinese Medicine, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Database (VIP database) and Wan-Fang Database from their inception. Other sources will also be searched, including the reference lists of identified publications and conference proceedings. Any clinical randomised controlled trials related to acupuncture for treating chronic urticaria without restriction of publication status and languages will be included. Study selection, data extraction and assessment of study quality will be performed independently by 2 researchers. Data will be synthesised by either the fixed-effects or random-effects model according to a heterogeneity test. Improvement in pruritus and wheals will be assessed as the primary outcomes. Adverse events, quality of life and the recurrence rate after at least 3 months of the treatment will also be evaluated as secondary outcomes. RevMan V.5.2 statistical software will be used for meta-analysis, if possible. If it is not appropriate for a meta-analysis, then a descriptive analysis or a subgroup analysis will be conducted. The results will be expressed as a risk ratio for dichotomous data and mean difference (MD) or standardised MD for continuous data. Dissemination and ethics The protocol of this systematic review will be disseminated in a peer-reviewed journal and presented at relevant conferences. It is not necessary for a formal ethical approval because the data are not individualised. Trial registration number PROSPERO CRD42015015702. PMID:26338683

  5. Letter report: Media information review, 1991. Hanford Environmental Dose Reconstruction Project

    SciTech Connect

    Harvey, G.L.

    1992-04-01

    The media information review, requested by the Communications Subcommittee of the Technical Steering Panel (TSP), provides a general indication of the media`s areas of interests with regard to the Hanford Environmental Dose Reconstruction (HEDR) Project. This review briefly assesses 24 newspaper and magazine articles collected between September 1991 and January 1992 by Pacific Northwest Laboratory (PNL). Articles that mention the project, activities closely associated with it, or members of the Panel were included in the analysis. Attempts were made to identify general categories and issues found within the articles and display the results in an order of ranking. This review is unscientific and is not meant to display a technical analysis of the materials.

  6. Projecting Future Heat-Related Mortality under Climate Change Scenarios: A Systematic Review

    PubMed Central

    Barnett, Adrian Gerard; Wang, Xiaoming; Vaneckova, Pavla; FitzGerald, Gerard; Tong, Shilu

    2011-01-01

    Background: Heat-related mortality is a matter of great public health concern, especially in the light of climate change. Although many studies have found associations between high temperatures and mortality, more research is needed to project the future impacts of climate change on heat-related mortality. Objectives: We conducted a systematic review of research and methods for projecting future heat-related mortality under climate change scenarios. Data sources and extraction: A literature search was conducted in August 2010, using the electronic databases PubMed, Scopus, ScienceDirect, ProQuest, and Web of Science. The search was limited to peer-reviewed journal articles published in English from January 1980 through July 2010. Data synthesis: Fourteen studies fulfilled the inclusion criteria. Most projections showed that climate change would result in a substantial increase in heat-related mortality. Projecting heat-related mortality requires understanding historical temperature–mortality relationships and considering the future changes in climate, population, and acclimatization. Further research is needed to provide a stronger theoretical framework for projections, including a better understanding of socioeconomic development, adaptation strategies, land-use patterns, air pollution, and mortality displacement. Conclusions: Scenario-based projection research will meaningfully contribute to assessing and managing the potential impacts of climate change on heat-related mortality. PMID:21816703

  7. Radiocarpal and Midcarpal Instability in Rheumatoid Patients: A Systematic Review

    PubMed Central

    Raven, Eric E.J.; van den Bekerom, Michel P.J.; Beumer, Annechien; van Dijk, C. Niek

    2015-01-01

    Background: This study was aimed at identifying the criteria for the diagnosis of Radiocarpal instability in rheumatoid arthritis RA). Methods: The main databases were searched to identify studies describing the pathophysiology of Radiocarpal instability in patients with RA. We focussed on the epidemiology, radiographic parameters, criteria for instability and on treatment options. Results. In the search 108 articles were found, of these 12 studies were included for this review. Instability occurs in at an average of 35.2% of the rheumatoid wrists. The instability was found between 8 and 13 years after onset of rheumatoid arthritis. A strong correlation was found between instability, duration of RA and Larsen score. Several radiographic methods were described to evaluate Radiocarpal instability in RA. Several treatment options for instability in patients with RA are described. All with their own indications and limitations. Conclusion: On a standard AP radiograph deformity can be measured using the carpal height and the ulnar translation index of Chamay. This gives an indication for instability. For describing the deterioration of the joints the Larsen score is most used. If there are more radiographs in time the Simmen classification can be used. For real assessment of instability dynamic radiographs are needed. Level of Evidence: Level IV. PMID:26448803

  8. Stroke warning campaigns: delivering better patient outcomes? A systematic review

    PubMed Central

    Mellon, Lisa; Doyle, Frank; Rohde, Daniela; Williams, David; Hickey, Anne

    2015-01-01

    largely absent from studies, limiting the potential replication of successful interventions. Conclusions Positive intervention effects were reported in the majority of studies; however, methodological weaknesses evident in a number of studies limited the generalizability of the observed effects. Reporting of specific intervention design was suboptimal and impeded the identification of key intervention components for reducing patient delay. The parallel delivery of public and professional interventions further limited the identification of successful intervention components. A lack of studies of sound methodological quality using, at a minimum, a controlled before and after design was identified in this review, and thus studies incorporating a rigorous study design are required to strengthen the evidence for public interventions to reduce patient delay in stroke. The potential clinical benefits of public interventions are far-reaching, and the challenge remains in translating knowledge improvements and correct behavioral intentions to appropriate behavior when stroke occurs. PMID:25750550

  9. The Iodine Satellite (iSat) Project Development Towards Critical Design Review (CDR)

    NASA Technical Reports Server (NTRS)

    Dankanich, John W.; Selby, Michael; Polzin, Kurt A.; Kamhawi, Hani; Hickman, Tyler; Byrne, Larry

    2016-01-01

    Despite the prevalence of Small Satellites in recent years, the systems flown to date have very limited propulsion capability. SmallSats are typically secondary payloads and have significant constraints for volume, mass, and power in addition to limitations on the use of hazardous propellants or stored energy (i.e. high pressure vessels). These constraints limit the options for SmallSat maneuverability. NASA's Space Technology Mission Directorate approved the iodine Satellite flight project for a rapid demonstration of iodine Hall thruster technology in a 12U configuration under the Small Spacecraft Technology Program. The project formally began in FY15 as a partnership between NASA MSFC, NASA GRC, and Busek Co, Inc., with the Air Force supporting the propulsion technology maturation. The team is in final preparation of the Critical Design Review prior to initiating the fabrication and integration phase of the project. The iSat project is on schedule for a launch opportunity in November 2017.

  10. Department of Energy review of the National Spallation Neutron Source Project

    SciTech Connect

    1997-06-01

    A Department of Energy (DOE) review of the Conceptual Design Report (CDR) for the National Spallation Neutron Source (NSNS) was conducted. The NSNS will be a new high-power spallation neutron source; initially, it will operate at 1 megawatt (MW), but is designed to be upgradeable to significantly higher power, at lower cost, when accelerator and target technologies are developed for higher power. The 53-member Review Committee examined the projected cost, schedule, technical scope, and management structure described in the CDR. For each of the major components of the NSNS, the Committee determined that the project team had produced credible designs that can be expected to work well. What remains to be done is to integrate the design of these components. With the exception of the liquid mercury target, the NSNS Project will rely heavily on proven technologies and, thus, will face a relatively low risk to successful project completion. The Total Project Cost (TPC) presented to the Committee in the CDR was $1.266 billion in as-spent dollars. In general, the Committee felt that the laboratory consortium had presented a credible estimate for each of the major components but that value engineering might produce some savings. The construction schedule presented to the Committee covered six years beginning in FY 1999. The Committee questioned whether all parts of the project could be completed according to this schedule. In particular, the linac and the conventional facilities appeared to have overly optimistic schedules. The NSNS project team was encouraged to reexamine these activities and to consider a more conservative seven-year schedule. Another concern of the Committee was the management structure. In summary, the Committee felt that this Conceptual Design Report was a very credible proposal, and that there is a high probability for successful completion of this major project within the proposed budget, although the six-year proposed schedule may be optimistic.

  11. Strategies and impacts of patient and family engagement in collaborative mental healthcare: protocol for a systematic and realist review

    PubMed Central

    Menear, Matthew; Gervais, Michel; Careau, Emmanuelle; Chouinard, Maud-Christine; Cloutier, Guylaine; Delorme, André; Dogba, Maman Joyce; Dugas, Michèle; Gagnon, Marie-Pierre; Gilbert, Michel; Harvey, Diane; Houle, Janie; Kates, Nick; Knowles, Sara; Martin, Neasa; Nease, Donald; Pluye, Pierre; Samson, Esther; Zomahoun, Hervé Tchala Vignon; Légaré, France

    2016-01-01

    Introduction Collaborative mental healthcare (CMHC) has garnered worldwide interest as an effective, team-based approach to managing common mental disorders in primary care. However, questions remain about how CMHC works and why it works in some circumstances but not others. In this study, we will review the evidence on one understudied but potentially critical component of CMHC, namely the engagement of patients and families in care. Our aims are to describe the strategies used to engage people with depression or anxiety disorders and their families in CMHC and understand how these strategies work, for whom and in what circumstances. Methods and analysis We are conducting a review with systematic and realist review components. Review part 1 seeks to identify and describe the patient and family engagement strategies featured in CMHC interventions based on systematic searches and descriptive analysis of these interventions. We will use a 2012 Cochrane review of CMHC as a starting point and perform new searches in multiple databases and trial registers to retrieve more recent CMHC intervention studies. In review part 2, we will build and refine programme theories for each of these engagement strategies. Initial theory building will proceed iteratively through content expert consultations, electronic searches for theoretical literature and review team brainstorming sessions. Cluster searches will then retrieve additional data on contexts, mechanisms and outcomes associated with engagement strategies, and pairs of review authors will analyse and synthesise the evidence and adjust initial programme theories. Ethics and dissemination Our review follows a participatory approach with multiple knowledge users and persons with lived experience of mental illness. These partners will help us develop and tailor project outputs, including publications, policy briefs, training materials and guidance on how to make CMHC more patient-centred and family-centred. PROSPERO

  12. Media information review, January--June 1992. Hanford Environmental Dose Reconstruction Project

    SciTech Connect

    Harvey, G.L.

    1992-07-01

    The media information review, requested by the Communications Subcommittee of the Technical Steering Panel (TSP), provides a general indication of the media`s areas of interests with regard to the Hanford Environmental Dose Reconstruction (HEDR) Project. This review briefly assesses 14 newspaper articles/advertisements collected between January and June 1992 by Battelle Pacific Northwest Laboratories (BNW). Articles that mention the project, activities closely associated with it, or members of the Panel were included in the analysis. The sources of the articles and announcements include most newspapers in the Northwest (dailies and weeklies) as collected and distributed to the US Department of Energy (DOE) and Hanford contractors by Westinghouse Hanford Company, Communications. National and international media coverage was provided during the review period by Burrelle`s Press Clipping Service, New York, and A.T.P., New Jersey. The articles and advertisements represent those collected and judged applicable to issues and activities associated with the Technical Steering Panel and the Hanford Environmental dose Reconstruction Project. The collection is not considered inclusive of every written account of the subject, but as good a representative collection as reasonable. This review is unscientific and is not meant to display a technical analysis of the materials.

  13. [Behavior profile of psychogeriatric patients in substitute care projects: nursing home care and home for the aged].

    PubMed

    Boom-Poels, P G

    1994-03-01

    This article describes behaviour profiles of psychogeriatric patients participating in some substitute care projects. The behaviour of 55 patients from five residential homes participating in these projects were rated on the Behaviour Rating Scale for Psychogeriatric Inpatients (GIP). These data were compared with GIP-data of two reference groups: elderly people in residential homes and patients in psychogeriatric nursing homes (supervision, intensive care and nursing care requiring patients). Patients in the projects have, compared to the other people in residential homes, more cognitive and social disabilities. Compared to the patients in nursing homes, the patients in the projects have less social, cognitive and psychomotor disabilities, but more emotional problems, like suspicious, melancholic and dependent behaviour. These results show that patients in substitute care projects have a specific behaviour profile. The profile can be used for careful selection of patients in these projects.

  14. Design review report: 200 East upgrades for Project W-314, tank farm restoration and safe operations

    SciTech Connect

    Boes, K.A.

    1998-04-15

    This Design Review Report (DRR) documents the contractor design verification methodology and records associated with project W-314`s 200 East (200E) Upgrades design package. The DRR includes the documented comments and their respective dispositions for this design. Acceptance of the comment dispositions and closure of the review comments is indicated by the signatures of the participating reviewers. Project W-314 is a project within the Tank Waste Remediation System (TWRS) Tank Waste Retrieval Program. This project provides capital upgrades for the existing Hanford tank farm waste transfer, instrumentation, ventilation, and electrical infrastructure systems. To support established TWRS programmatic objectives, the project is organized into two distinct phases. The initial focus of the project (i.e., Phase 1) is on waste transfer system upgrades needed to support the TWRS Privatization waste feed delivery system. Phase 2 of the project will provide upgrades to support resolution of regulatory compliance issues, improve tank infrastructure reliability, and reduce overall plant operating/maintenance costs. Within Phase 1 of the W-314 project, the waste transfer system upgrades are further broken down into six major packages which align with the project`s work breakdown structure. Each of these six sub-elements includes the design, procurement, and construction activities necessary to accomplish the specific tank farm upgrades contained within the package. The first design package (AN Valve Pit Upgrades) was completed in November 1997, and the associated design verification activities are documented in HNF-1893. The second design package, 200 East (200E) Upgrades, was completed in March 1998. This design package identifies modifications to existing valve pits 241-AX-B and 241-A-B, as well as several new waste transfer pipelines to be constructed within the A Farm Complex of the 200E Area. The scope of the valve pit modifications includes new pit cover blocks, valve

  15. [Neurotic symptoms of borderline patients: a case review study].

    PubMed

    Hayashi, N

    1992-01-01

    The author investigated neurotic symptoms of borderline patients by reviewing the clinical charts of twenty-six patients of longer than one year treatment period (8 men, 18 women; 23 patients with DSM III-R borderline personality disorder (BPD), 14 with schizotypal personality disorder (SPD), (11 BPD-SPD overlaps); age at the first contact: mean = 24.3 y. o., SD = 6.7 y. o.; treatment period: mean = 51 months, SD = 35 months). The diagnoses of the comorbid neurotic disorders were obsessive compulsive disorder: 5 cases (19% (BPD: 22%, SPD: 7%)), somatoform disorder: 5 (19% (BPD: 22%, SPD: 21%)), panic disorder: 4 (15% (BPD: 17%, SPD: 14%)), social phobia: 2 (8% (BPD: 9%, SPD: 7%)), dissociative disorder: 2 (8% (BPD: 9%, SPD: 0%)), and generalized anxiety disorder: 1 (4% (BPD: 4%, SPD: 7%)). The neurotic symptoms identified in the charts of the subjects were as follows; symptoms of social phobia: 11 cases (42% (BPD: 43%, SPD: 43%)) including 6 with anthropophobic symptoms (23% (BPD: 26%, SPD: 36%)), obsessive compulsive symptoms and diffuse and floating anxiety: 9 (35% (BPD: 39%, SPD: 38%)), panic attacks: 8 (31% (BPD: 35%, SPD: 36%)), conversion symptoms: 7 (27% (BPD: 30%, SPD: 21%)), dissociative episodes: 6 (23% (BPD: 26%, SPD: 7%)), depersonalization: 5 (19% (BPD: 22%, SPD: 14%)), multiple apprehensive expectations: 4 (15% (BPD: 17%, SPD: 14%)), derealization: 3 (12% (BPD: 13%, SPD: 14%)), hyperventilation attacks: 3 (12% (BPD: 13%, SPD: 7%)), and somatization: 1 (4% (BPD: 4%, SPD: 7%)). In short, 54% (BPD: 61%, SPD: 43%) of the subjects had comorbid neurotic disorders, and 92% (BPD: 91%, SPD: 93%) reported at least one, and 54% (BPD: 61%, SPD: 50%), more than two kinds of neurotic symptoms, though no specific symptom correlating with BPD or SPD diagnosis was found. These findings suggest that neurotic symptoms and neurotic disorders cannot be ignored as peripheral in the borderline symptomatology. By analyzing in detail the neurotic experiences, the author

  16. 75 FR 32539 - Agency Information Collection (Dental Patient Satisfaction Survey) Activities Under OMB Review

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-08

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS AFFAIRS Agency Information Collection (Dental Patient Satisfaction Survey) Activities Under OMB Review... Form 10-0503).'' Title: Survey of Healthcare Experiences, Dental Patient Satisfaction Survey, VA...

  17. 42 CFR 137.365 - What is the procedure for the Secretary's review and approval of project planning and design...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Secretary in Establishing and Implementing Construction Project Agreements § 137.365 What is the procedure... planning standards identified in the construction project agreement. The Secretary shall review and approve design documents for general compliance with requirements of the construction project agreement. (b)...

  18. 42 CFR 137.365 - What is the procedure for the Secretary's review and approval of project planning and design...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Secretary in Establishing and Implementing Construction Project Agreements § 137.365 What is the procedure... planning standards identified in the construction project agreement. The Secretary shall review and approve design documents for general compliance with requirements of the construction project agreement. (b)...

  19. 42 CFR 137.365 - What is the procedure for the Secretary's review and approval of project planning and design...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Secretary in Establishing and Implementing Construction Project Agreements § 137.365 What is the procedure... planning standards identified in the construction project agreement. The Secretary shall review and approve design documents for general compliance with requirements of the construction project agreement. (b)...

  20. 42 CFR 137.365 - What is the procedure for the Secretary's review and approval of project planning and design...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... Secretary in Establishing and Implementing Construction Project Agreements § 137.365 What is the procedure... planning standards identified in the construction project agreement. The Secretary shall review and approve design documents for general compliance with requirements of the construction project agreement. (b)...

  1. 42 CFR 137.365 - What is the procedure for the Secretary's review and approval of project planning and design...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Secretary in Establishing and Implementing Construction Project Agreements § 137.365 What is the procedure... planning standards identified in the construction project agreement. The Secretary shall review and approve design documents for general compliance with requirements of the construction project agreement. (b)...

  2. [Acute neurorehabilitation in neurooncology: Swiss Pilot Project and review of the litterature].

    PubMed

    Diserens, Karin; Robert, Jean-Paul; Pellet, Cristina; Berney, Loric; Levivier, Marc; Hottinger, Andreas F

    2016-04-27

    New treatment modalities in oncology, radiation oncology and surgery have led to a significant improvement in life expectancy for cancer patients. Some will however develop severe neurologic deficits that will impact their quality of life. To limit this impact, it is essential to offer optimal neurorehabilitation. In this context, a pilot project of early and intensive neurorehabilitation for brain tumor patients has been set up. A collaboration between the teams of neurooncology, acute neurorehabilitation and neurosurgery from the CHUV and the Clinique La Lignière allows an intensive and direct neurorehabilitation following neurosurgery. This neuroreeducation has allowed 75% of the patients included in this program to return home. PMID:27281944

  3. Ares I Crew Launch Vehicle Project: Forward Plan to Preliminary Design Review

    NASA Technical Reports Server (NTRS)

    Dumbacher, Daniel L.; Reuter, James L.

    2007-01-01

    The Exploration Launch Projects Office, located at NASA's Marshall Space Flight Center, conducted the Ares I Crew Launch Vehicle System Requirements Review (SRR) at the end of 2006, a mere year after the project team was assembled. In Ares' first year, extensive trade studies and evaluations were conducted to refine the design initially recommended by the Exploration Systems Architecture Study, conceptual designs were analyzed for fitness, and the contractual framework was assembled to enable a development effort unparalleled in American space flight since the Space Shuttle. Now, the project turns its focus to the Preliminary Design Review (PDR), scheduled for 2008. Taking into consideration the findings of the SRR, the design of the Ares I is being tightened and refined to meet the operability, reliability, and affordability goals outlined by the Constellation Program. As directed in NASA Procedure and Regulation (NPR) 7123, NASA Systems Engineering Procedural Requirements, the Ares I SRR examined "the functional and performance requirements defined for the system and the preliminary program or project plan and ensures that the requirements and the selected concept will satisfy the mission." The SRR was conducted to ensure the system- and element-level design and interface requirements are defined prior to proceeding into the project's design phase. The Exploration Launch Projects Control Board convened on December 19,2006, and accepted the findings of the SRR and the go-forward plan proceeding to PDR. Based upon these findings, the Ares project believes that operability must drive the vehicle's design, and that a number of design challenges, including system mass and reliability, must be addressed as part of the progress to PDR.

  4. Grouping Handicapped and Non-Handicapped Children in Mainstream Settings. The Functional Mainstreaming for Success (FMS) Project. Project Review Papers. Final Report--Part 3.

    ERIC Educational Resources Information Center

    Striefel, Sebastian; And Others

    The review papers are a product of the 3-year project, "Functional Mainstreaming for Success," designed to develop a model for instructional mainstreaming of 162 handicapped children (3-6 years old) in community settings. The major feature of the project was development of a full reverse mainstreamed preschool program, which included children with…

  5. Improving patient care through student leadership in team quality improvement projects.

    PubMed

    Tschannen, Dana; Aebersold, Michelle; Kocan, Mary Jo; Lundy, Francene; Potempa, Kathleen

    2015-01-01

    In partnership with a major medical center, senior-level nursing students completed a root cause analysis and implementation plan to address a unit-specific quality issue. To evaluate the project, unit leaders were asked their perceptions of the value of the projects and impact on patient care, as well as to provide exemplars depicting how the student root cause analysis work resulted in improved patient outcome and/or unit processes. Liaisons noted benefits of having an RCA team, with positive impact on patient outcomes and care processes.

  6. ALARA Design Review for the Resumption of the Plutonium Finishing Plant (PFP) Cementation Process Project Activities

    SciTech Connect

    DAYLEY, L.

    2000-06-14

    The requirements for the performance of radiological design reviews are codified in 10CFR835, Occupational Radiation Protection. The basic requirements for the performance of ALARA design reviews are presented in the Hanford Site Radiological Control Manual (HSRCM). The HSRCM has established trigger levels requiring radiological reviews of non-routine or complex work activities. These requirements are implemented in site procedures HNF-PRO-1622 and 1623. HNF-PRO-1622 Radiological Design Review Process requires that ''radiological design reviews [be performed] of new facilities and equipment and modifications of existing facilities and equipment''. In addition, HNF-PRO-1623 Radiological Work Planning Process requires a formal ALARA Review for planned activities that are estimated to exceed 1 person-rem total Dose Equivalent (DE). The purpose of this review is to validate that the original design for the PFP Cementation Process ensures that the principles of ALARA (As Low As Reasonably Achievable) were included in the original project design. That is, that the design and operation of existing Cementation Process equipment and processes allows for the minimization of personnel exposure in its operation, maintenance and decommissioning and that the generation of radioactive waste is kept to a minimum.

  7. A Review of Psychosocial Outcomes for Patients Seeking Cosmetic Surgery

    PubMed Central

    Honigman, Roberta J.; Phillips, Katharine A.; Castle, David J.

    2006-01-01

    The authors reviewed the literature on psychological and psychosocial outcomes for individuals undergoing cosmetic surgery, to address whether elective cosmetic procedures improve psychological well-being and psychosocial functioning and whether there are identifiable predictors of an unsatisfactory psychological outcome. They conducted a search of appropriate computerized databases for studies that evaluated psychological and psychosocial status both before and after elective cosmetic surgery. They identified 37 relevant studies of varying cosmetic procedures that utilized disparate methodologies. Overall, patients appeared generally satisfied with the outcome of their procedures, although some exhibited transient and some exhibited longer-lasting psychological disturbance. Factors associated with poor psychosocial outcome included being young, being male, having unrealistic expectations of the procedure, previous unsatisfactory cosmetic surgery, minimal deformity, motivation based on relationship issues, and a history of depression, anxiety, or personality disorder. Body dysmorphic disorder was also recognized by some studies as a predictor of poor outcome, a finding reinforced by reference to the psychiatric literature. The authors conclude that although most people appear satisfied with the outcome of cosmetic surgical procedures, some are not, and attempts should be made to screen for such individuals in cosmetic surgery settings. PMID:15083026

  8. Quality Improvement Project to Improve Patient Satisfaction With Pain Management: Using Human-Centered Design.

    PubMed

    Trail-Mahan, Tracy; Heisler, Scott; Katica, Mary

    2016-01-01

    In this quality improvement project, our health system developed a comprehensive, patient-centered approach to improving inpatient pain management and assessed its impact on patient satisfaction across 21 medical centers. Using human-centered design principles, a bundle of 6 individual and team nursing practices was developed. Patient satisfaction with pain management, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems pain composite score, increased from the 25th to just under the 75th national percentile.

  9. The 1991 DOE/Sandia Crystalline Photovoltaic Technology Project Review Meeting

    NASA Astrophysics Data System (ADS)

    Whipple, M. L.

    1991-07-01

    This document serves as the proceedings for the manual project review meeting held by Sandia's Photovoltaic Technology Research Division. It contains information supplied by each organization making a presentation at the meeting, which was held July 30 through 31, 1991 at the Sheraton Hotel in Albuquerque, New Mexico. Sessions were held to discuss national photovoltaic programs, one-sun crystalline silicon cell research, concentrator silicon cell research, and concentrating collector development.

  10. Learning to Live Together: A Review of UNESCO's Associated Schools Project Network

    NASA Astrophysics Data System (ADS)

    Schweisfurth, Michele

    2005-05-01

    Some 7400 schools belong to the global network of UNESCO's Associated School Project Network. They are committed to promoting ideals such as human rights, intercultural understanding, peace and environmental protection. This study is based on an extensive review undertaken in 2003. It discusses the origins and analyzes the achievements of the Associated School Project Network in bringing change to schools, communities and national policy. The analysis employs a variety of models of educational innovation and reform in order to assess the horizontal and vertical impact of the Associated School Project Network. It draws general conclusions on the usefulness of such networks for intercultural learning and educational and social change. Key issues include the commitment of stakeholders; the treatment of culturally sensitive issues; cultural interpretations of certain subjects; the value of horizontal networks; and the difficulty of achieving vertical impact on national policy-making.

  11. The Iodine Satellite (iSat) Project Development Towards Critical Design Review

    NASA Technical Reports Server (NTRS)

    Dankanich, John W.; Calvert, Derek; Kamhawi, Hani; Hickman, Tyler; Szabo, James; Byrne, Lawrence

    2015-01-01

    Despite the prevalence of small satellites in recent years, the systems flown to date have very limited propulsion capability. SmallSats are typically secondary payloads and have significant constraints for volume, mass, and power in addition to limitations on the use of hazardous propellants or stored energy. These constraints limit the options for SmallSat maneuverability. NASA's Space Technology Mission Directorate approved the iodine Satellite flight project for a rapid demonstration of iodine Hall thruster technology in a 12U (cubesat units) configuration under the Small Spacecraft Technology Program. The mission is a partnership between NASA MSFC, NASA GRC, and Busek Co, Inc., with the Air Force supporting the propulsion technology maturation. The team is working towards the critical design review in the final design and fabrication phase of the project. The current design shows positive technical performance margins in all areas. The iSat project is planned for launch readiness in the spring of 2017.

  12. UNOCAL Parachute Creek Shale Oil Project. Monitoring review committee meeting report. Annual meeting, 1987-1988

    SciTech Connect

    Not Available

    1988-05-25

    The Energy Security Act of 1980 established a program to provide financial assistance to private industry in the construction and operation of commercial-scale synthetic fuels plants. The Parachute Creek Shale Oil Program is one of four projects awarded financial assistance. The support agreement included development of an Environmental Monitoring Plan incorporating existing compliance monitoring and twenty-two supplemental monitoring points for water, air, solid waste, worker health and safety, and socio-economic impacts during the period 1986-1993. A Monitoring Review Committee (MRC) comprised of representatives from the Project, U.S. Department of Treasury, U.S. Department of Energy, U.S. Environmental Protection Agency, and the state convene each year to discuss monitoring information and trends in environmental and health surveillance. This report documents the first annual MRC meeting, held at the Project.

  13. Parachute Creek Shale Oil Project Monitoring Review Committee meeting report, August 9, 1990

    SciTech Connect

    Not Available

    1990-01-01

    The Energy Security Act of 1980 established a program to provide financial assistance to private industry in the construction and operation of commercial-scale synthetic fuels plants. The Parachute Creek Shale Oil Program is one of the four projects awarded financial assistance. The support agreement included development of an Environmental Monitoring Plan, incorporating existing compliance monitoring and supplemental monitoring on water, air, solid waste, worker health and safety, and socioeconomic impacts during the period 1986-1993. Phase I of the project is to produce 10,000 barrels per day of syncrude from oil shale, using the Unishale B process. The third annual meeting of the Monitoring Review Committee for the project included discussions of air, water and biological monitoring programs; spent shale pile inspecting; industrial hygiene monitoring; and medical assessments. Results of sampling 18 supplemental locations found no areas of significant environmental concern.

  14. Involving patients in patient safety programmes: A scoping review and consensus procedure by the LINNEAUS collaboration on patient safety in primary care

    PubMed Central

    Trier, Hans; Valderas, Jose M; Wensing, Michel; Martin, Helle Max; Egebart, Jonas

    2015-01-01

    ABSTRACT Background: Patient involvement has only recently received attention as a potentially useful approach to patient safety in primary care. Objective: To summarize work conducted on a scoping review of interventions focussing on patient involvement for patient safety; to develop consensus-based recommendations in this area. Methods: Scoping review of the literature 2006–2011 about methods and effects of involving patients in patient safety in primary care identified evidence for previous experiences of patient involvement in patient safety. This information was fed back to an expert panel for the development of recommendations for healthcare professionals and policy makers. Results: The scoping review identified only weak evidence in support of the effectiveness of patient involvement. Identified barriers included a number of patient factors but also the healthcare workers’ attitudes, abilities and lack of training. The expert panel recommended the integration of patient safety in the educational curricula for healthcare professionals, and expected a commitment from professionals to act as first movers by inviting and encouraging the patients to take an active role. The panel proposed a checklist to be used by primary care clinicians at the point of care for promoting patient involvement. Conclusion: There is only weak evidence on the effectiveness of patient involvement in patient safety. The recommendations of the panel can inform future policy and practice on patient involvement in safety in primary care. PMID:26339838

  15. Performance review of the National Blood Safety Improvement Project in Korea (2004-2009)

    PubMed Central

    Kim, Sinyoung; Kim, Moon Jung; Lee, Sang Won; Shin, Young Hack; Choi, Young Sil; Lee, Dong Han

    2013-01-01

    Background In 2004, the Korean government and blood transfusion community deliberated on the issue of a national blood system reform and agreed to implement a 5-year project (2004-2009) to further improve safety measures. Our study delineates the basis of the current national blood program and analyzes the performance of this 5-year project initiated by the Korean government. Methods A performance review of the 5-year project was conducted from May 2009 to February 2010 using various approaches. Numerous data and documentation were collected from the Korean Red Cross and the Korean Centers for Disease Control and Prevention and reviewed by experts. Approximately 20 interviews with representatives of stakeholder groups were conducted to gather information, opinions, and perceptions. We conducted a nationwide field survey on a total of 144 blood donor centers. Results Among the 5 major categories of the 5-year project, blood donor recruitment, laboratory testing, and product manufacturing were improved in terms of quality performance. Specifically, government's financial support ensured that the infrastructure of blood donor centers and blood laboratory centers improved. The pivotal role of the government contributed to improvements in the national blood program and enhanced national surveillance for blood safety. Conclusion Korea has made a tremendous effort with positive outcomes to provide safety measures for blood products for transfusion in its citizens. In all areas of blood management, from blood donations to transfusions, continuous developments in monitoring safety standards and practices are paramount. PMID:23826584

  16. Medical Utilization of Kiosks in the Delivery of Patient Education: A Systematic Review

    PubMed Central

    Yvonne Chan, Yu-Feng; Nagurka, Roxanne; Bentley, Suzanne; Ordonez, Edgardo; Sproule, William

    2014-01-01

    Background: The utilization of kiosks has previously been shown to be effective for collecting information, delivering educational modules, and providing access to health information. We discuss a review of current literature for the utilization of kiosks for the delivery of patient education. Methods: The criteria for inclusion in this literature review were: (1) study discusses the utilization of kiosks for patient health education; (2) study discusses the use of touch screens for patient health information; (3) published in English. Our review includes searches via MEDLINE databases and Google Scholar for the years 1996-2014. Results: Overall, 167 articles were screened for final eligibility, and after discarding duplicates and non-eligible studies with abstract. Full-text review of 28 articles was included in the final analysis. Conclusion: The review of available literature demonstrates the effectiveness of touch screen kiosks to educate patients and to improve healthcare, both at a performance and cost advantage over other modes of patient education. PMID:25097831

  17. Economic Development Impacts of Community Wind Projects: A Review and Empirical Evaluation

    SciTech Connect

    Lantz, E.; Tegen, S.

    2009-01-01

    Community wind projects have long been touted (both anecdotally and in the literature) to increase the economic development impacts of wind projects, but most analyses of community wind have been based on expected results from hypothetical projects. This report provides a review of previous economic development analyses of community wind projects and compares these projected results with empirical impacts from projects currently in operation. A review of existing literature reveals two primary conclusions. First, construction-period impacts are often thought to be comparable for both community-and absentee-owned facilities. Second, operations-period economic impacts are observed to be greater for community-owned projects. The majority of studies indicate that the range of increased operations-period impact is on the order of 1.5 to 3.4 times. New retrospective analysis of operating community wind projects finds that total employment impacts from completed community wind projects are estimated to be on the order of four to six 1-year jobs per-MW during construction and 0.3 to 0.6 long-term jobs per-MW during operations. In addition, when comparing retrospective results of community wind to hypothetical average absentee projects, construction-period employment impacts are 1.1 to 1.3 times higher and operations-period impacts are 1.1 to 2.8 times higher for community wind. Comparing the average of the completed community wind projects studied here with retrospective analysis of the first 1,000 MW of wind in Colorado and Iowa indicates that construction-period impacts are as much as 3.1 times higher for community wind, and operations-period impacts are as much as 1.8 times higher. Ultimately, wind projects are a source of jobs and economic development, and community wind projects are shown to have increased impact both during the construction and operations-period of a wind power plant. The extent of increased impact is primarily a function of local ownership and

  18. Reviews.

    ERIC Educational Resources Information Center

    Science Teacher, 1988

    1988-01-01

    Presents information and concerns regarding computer courseware, books, and audiovisual materials reviewed by teachers. Covers a variety of topics including dissection of common classroom specimens, medicine, acid rain projects, molecules, the water cycle, erosion, plankton, and evolution. Notes on availability, price, and needed equipment, where…

  19. Systematic review of measurement properties of patient-reported outcome measures used in patients undergoing hip and knee arthroplasty

    PubMed Central

    Harris, Kristina; Dawson, Jill; Gibbons, Elizabeth; Lim, Chris R; Beard, David J; Fitzpatrick, Raymond; Price, Andrew J

    2016-01-01

    Objectives To identify patient-reported outcome measures (PROMs) that have been developed and/or used with patients undergoing hip or knee replacement surgery and to provide a shortlist of the most promising generic and condition-specific instruments. Methods A systematic review of the literature was performed to identify measures used in patients undergoing hip and knee replacement and extract and evaluate information on their methodological quality. Results Thirty-two shortlisted measures were reviewed for the quality of their measurement properties. On the basis of the review criteria, the measures with most complete evidence to date are the Oxford Hip Score (OHS) (for patients undergoing hip replacement surgery) and the Oxford Knee Score (OKS), with OKS-Activity and Participation Questionnaire (for patients undergoing knee replacement surgery). Conclusion A large number of these instruments lack essential evidence of their measurement properties (eg, validity, reliability, and responsiveness) in specific populations of patients. Further research is required on almost all of the identified measures. The best-performing condition-specific PROMs were the OKS, OHS, and Western Ontario and McMaster Universities Osteoarthritis Index. The best-performing generic measure was the Short Form 12. Researchers can use the information presented in this review to inform further psychometric studies of the reviewed measures. PMID:27524925

  20. “Nothing About Me Without Me”: An Interpretative Review of Patient Accessible Electronic Health Records

    PubMed Central

    Callahan, Ryan; Sevdalis, Nick; Mayer, Erik K; Darzi, Ara

    2015-01-01

    Background Patient accessible electronic health records (PAEHRs) enable patients to access and manage personal clinical information that is made available to them by their health care providers (HCPs). It is thought that the shared management nature of medical record access improves patient outcomes and improves patient satisfaction. However, recent reviews have found that this is not the case. Furthermore, little research has focused on PAEHRs from the HCP viewpoint. HCPs include physicians, nurses, and service providers. Objective We provide a systematic review of reviews of the impact of giving patients record access from both a patient and HCP point of view. The review covers a broad range of outcome measures, including patient safety, patient satisfaction, privacy and security, self-efficacy, and health outcome. Methods A systematic search was conducted using Web of Science to identify review articles on the impact of PAEHRs. Our search was limited to English-language reviews published between January 2002 and November 2014. A total of 73 citations were retrieved from a series of Boolean search terms including “review*” with “patient access to records”. These reviews went through a novel scoring system analysis whereby we calculated how many positive outcomes were reported per every outcome measure investigated. This provided a way to quantify the impact of PAEHRs. Results Ten reviews covering chronic patients (eg, diabetes and hypertension) and primary care patients, as well as HCPs were found but eight were included for the analysis of outcome measures. We found mixed outcomes across both patient and HCP groups, with approximately half of the reviews showing positive changes with record access. Patients believe that record access increases their perception of control; however, outcome measures thought to create psychological concerns (such as patient anxiety as a result of seeing their medical record) are still unanswered. Nurses are more likely than

  1. Perioperative outcomes and type of anesthesia in hip surgical patients: An evidence based review

    PubMed Central

    Opperer, Mathias; Danninger, Thomas; Stundner, Ottokar; Memtsoudis, Stavros G

    2014-01-01

    Over the last decades the demand for hip surgery, be it elective or in a traumatic setting, has greatly increased and is projected to expand even further. Concurrent with demographic changes the affected population is burdened by an increase in average comorbidity and serious complications. It has been suggested that the choice of anesthesia not only affects the surgery setting but also the perioperative outcome as a whole. Therefore different approaches and anesthetic techniques have been developed to offer individual anesthetic and analgesic care to hip surgery patients. Recent studies on comparative effectiveness utilizing population based data have given us a novel insight on anesthetic practice and outcome, showing favorable results in the usage of regional vs general anesthesia. In this review we aim to give an overview of anesthetic techniques in use for hip surgery and their impact on perioperative outcome. While there still remains a scarcity of data investigating perioperative outcomes and anesthesia, most studies concur on a positive outcome in overall mortality, thromboembolic events, blood loss and transfusion requirements when comparing regional to general anesthesia. Much of the currently available evidence suggests that a comprehensive medical approach with emphasis on regional anesthesia can prove beneficial to patients and the health care system. PMID:25035837

  2. Is Propofol Safe For Food Allergy Patients? A Review of the Evidence.

    PubMed

    Dziedzic, Arkadiusz

    2016-01-01

    Allergic cross-reactivity between propofol and food is frequently considered as a risk factor for perioperative allergic hypersensitivity reactions and anaphylaxis during dental anaesthesia and sedation. Better understanding of of this cross-reactivity is important to providing safe care. There are, however, conflicting assumptions about anaphylactic reactions to propofol in patients reporting allergy to certain type of the food. Egg and/or soya allergy are often cited as contraindications to propofol administration but the evidence remains unclear. The main goal of this article is to review the available advice and evidence about the cross-reactivity between propofol and foods. A literature search was undertaken. The current published evidence does not elucidate that propofol allergy and food allergies are linked directly, but this drug should be used with caution in atopic patients with allergies to egg and/or soya bean oil. Clinical audit projects may gather data on anaphylactic events during anaesthesia and may aid the profession in this dilemma.

  3. 78 FR 79079 - Agency Information Collection (Dental Patient Satisfaction Survey); Activities under OMB Review

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-27

    ... AFFAIRS Agency Information Collection (Dental Patient Satisfaction Survey); Activities under OMB Review... . Please refer to ``OMB Control No. 2900- 0764 (Dental Patient Satisfaction Survey)'' in any correspondence....gov . Please refer to ``OMB Control No. 2900-0764 (Dental Patient Satisfaction Survey)'' in...

  4. Smoking cessation care among patients with head and neck cancer: a systematic review

    PubMed Central

    McCarter, Kristen; Martínez, Úrsula; Britton, Ben; Baker, Amanda; Bonevski, Billie; Carter, Gregory; Beck, Alison; Wratten, Chris; Guillaumier, Ashleigh; Halpin, Sean A

    2016-01-01

    Objective To examine the effectiveness of smoking cessation interventions in improving cessation rates and smoking related behaviour in patients with head and neck cancer (HNC). Design A systematic review of randomised and non-randomised controlled trials. Methods We searched the following data sources: CENTRAL in the Cochrane Library, MEDLINE, EMBASE, PsycINFO and CINAHL up to February 2016. A search of reference lists of included studies and Google Scholar (first 200 citations published online between 2000 and February 2016) was also undertaken. The methodological quality of included studies was assessed using the Effective Public Health Practice Project Quality Assessment Tool (EPHPP). 2 study authors independently screened and extracted data with disagreements resolved via consensus. Results Of the 5167 studies identified, 3 were eligible and included in the review. Trial designs of included studies were 2 randomised controlled trials and 1 non-randomised controlled trial. 2 studies received a weak methodological rating and 1 received a moderate methodological rating. The trials examine the impact of the following interventions: (1) nurse delivered cognitive–behaviour therapy (CBT) via telephone and accompanied by a workbook, combined with pharmacotherapy; (2) nurse and physician brief advice to quit and information booklets combined with pharmacotherapy; and (3) surgeon delivered enhanced advice to quit smoking augmented by booster sessions. Only the trial of the nurse delivered CBT and pharmacotherapy reported significant increases in smoking cessation rates. 1 study measured quit attempts and the other assessed consumption of cigarettes per day and readiness to change. There was no significant improvement in quit attempts or cigarettes smoked per day among patients in the intervention groups, relative to control. Conclusions There are very few studies evaluating the effectiveness of smoking cessation interventions that report results specific to the HNC

  5. The "CROMa" Project: A Care Pathway for Clinical Management of Patients with Bisphosphonate Exposure.

    PubMed

    Capocci, Mauro; Romeo, Umberto; Cocco, Fabio; Bignozzi, Isabella; Annibali, Susanna; Ottolenghi, Livia

    2014-01-01

    Aim. To describe 7 years of activity of "CROMa" (Coordination of Research on Osteonecrosis of the Jaws) project of "Sapienza" University of Rome. Materials and Methods. A preventive and therapeutic care pathway was created for patients with bisphosphonates (BPs) exposure. Demographic, social, behavioural, pharmacological, and clinical variables were registered in a dedicated database. Results. In the project, 502 patients, 403 females and 99 males, were observed. Bone pathologies were 79% osteometabolic diseases (OMD) and 21% metastatic cancer (CA). Females were 90% in OMD group and 41% in CA. BP administration was 54% oral, 31% IV, and 11% IM; 89% of BPs were amino-BP and 11% non-amino-BP. Consistently with bone pathology (OMD/CA), alendronate appears to be prevalent for OMD (40% relative), while zoledronate was indicated in 92% of CA patients. Out of 502 cases collected, 28 BRONJ were detected: 17 of them were related to IV BP treatment. Preventive oral assessment was required for 50% of CA patients and by 4% of OMD patients. Conclusions. The proposed care pathway protocols for BP exposed patients appeared to be useful to meet treatment and preventive needs, in both oncological and osteometabolic diseases patients. Patients' and physicians' prevention awareness can be the starting point of a multilevel prevention system.

  6. 30 CFR 585.708 - What are the CVA's or project engineer's primary duties for fabrication and installation review?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 30 Mineral Resources 2 2012-07-01 2012-07-01 false What are the CVA's or project engineer's primary duties for fabrication and installation review? 585.708 Section 585.708 Mineral Resources BUREAU... Certified Verification Agent § 585.708 What are the CVA's or project engineer's primary duties...

  7. 30 CFR 585.708 - What are the CVA's or project engineer's primary duties for fabrication and installation review?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 30 Mineral Resources 2 2013-07-01 2013-07-01 false What are the CVA's or project engineer's primary duties for fabrication and installation review? 585.708 Section 585.708 Mineral Resources BUREAU... Certified Verification Agent § 585.708 What are the CVA's or project engineer's primary duties...

  8. 30 CFR 585.708 - What are the CVA's or project engineer's primary duties for fabrication and installation review?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 30 Mineral Resources 2 2014-07-01 2014-07-01 false What are the CVA's or project engineer's primary duties for fabrication and installation review? 585.708 Section 585.708 Mineral Resources BUREAU... Certified Verification Agent § 585.708 What are the CVA's or project engineer's primary duties...

  9. 18 CFR 401.35 - Classification of projects for review under Section 3.8 of the Compact.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... direct by notice to the project sponsor or land owner as having a potential substantial water quality... 18 Conservation of Power and Water Resources 2 2012-04-01 2012-04-01 false Classification of projects for review under Section 3.8 of the Compact. 401.35 Section 401.35 Conservation of Power and...

  10. 18 CFR 401.35 - Classification of projects for review under Section 3.8 of the Compact.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... direct by notice to the project sponsor or land owner as having a potential substantial water quality... 18 Conservation of Power and Water Resources 2 2013-04-01 2012-04-01 true Classification of projects for review under Section 3.8 of the Compact. 401.35 Section 401.35 Conservation of Power and...

  11. 18 CFR 401.35 - Classification of projects for review under Section 3.8 of the Compact.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... direct by notice to the project sponsor or land owner as having a potential substantial water quality... 18 Conservation of Power and Water Resources 2 2014-04-01 2014-04-01 false Classification of projects for review under Section 3.8 of the Compact. 401.35 Section 401.35 Conservation of Power and...

  12. Identification of suicidal ideations with the help of projective tests: a review.

    PubMed

    Kumar, Devvarta; Nizamie, S Haque; Abhishek, Priyadarshee; Prasanna, Lavanya Tumkur

    2014-12-01

    Identification of the presence of suicidal ideations in an individual is crucial for the timely intervention. However, these ideations may remain unidentified as an individual with serious intentions of self-harm may not express them explicitly. Various projective tests can provide crucial clues to clinicians about the presence of suicidal ideations in an individual's mind. The present review is intended to update clinicians working in the field of suicide prevention about salient findings on these tests which can serve as a ready reckoner for them. We also highlight the status of research in this domain. PMID:25153298

  13. River Protection Project Integrated safety management system phase II verification review plan - 7/29/99

    SciTech Connect

    SHOOP, D.S.

    1999-09-10

    The purpose of this review is to verify the implementation status of the Integrated Safety Management System (ISMS) for the River Protection Project (RPP) facilities managed by Fluor Daniel Hanford, Inc. (FDH) and operated by Lockheed Martin Hanford Company (LMHC). This review will also ascertain whether within RPP facilities and operations the work planning and execution processes are in place and functioning to effectively protect the health and safety of the workers, public, environment, and federal property over the RPP life cycle. The RPP ISMS should support the Hanford Strategic Plan (DOERL-96-92) to safely clean up and manage the site's legacy waste and deploy science and technology while incorporating the ISMS central theme to ''Do work safely'' and protect human health and the environment.

  14. First NASA Aviation Safety Program Weather Accident Prevention Project Annual Review

    NASA Technical Reports Server (NTRS)

    Colantonio, Ron

    2000-01-01

    The goal of this Annual Review was to present NASA plans and accomplishments that will impact the national aviation safety goal. NASA's WxAP Project focuses on developing the following products: (1) Aviation Weather Information (AWIN) technologies (displays, sensors, pilot decision tools, communication links, etc.); (2) Electronic Pilot Reporting (E-PIREPS) technologies; (3) Enhanced weather products with associated hazard metrics; (4) Forward looking turbulence sensor technologies (radar, lidar, etc.); (5) Turbulence mitigation control system designs; Attendees included personnel from various NASA Centers, FAA, National Weather Service, DoD, airlines, aircraft and pilot associations, industry, aircraft manufacturers and academia. Attendees participated in discussion sessions aimed at collecting aviation user community feedback on NASA plans and R&D activities. This CD is a compilation of most of the presentations presented at this Review.

  15. Patients' experiences of privacy and dignity. Part 1: a literature review.

    PubMed

    Whitehead, Juliet; Wheeler, Herman

    This article reviews the literature on patients' privacy and dignity and concludes that interest in the topic goes back to psychiatric patients in the 1960s, with the 1990s seeing a shift to all hospitals. A number of databases were used to obtain information for the literature review. Findings revealed United Kingdom (UK) government policies designed to raise the profile of patients' privacy and dignity. UK research on patients' privacy/dignity is limited, although there is universal interest. While a variety of methodologies have been used in previous research, and there is consistency in findings, more research is indicated. Previous research spanned topics such as elderly patients, medical and surgical patients, palliative care, rehabilitative settings and child-bearing women. A conceptual framework and definitions of privacy and dignity were examined. Although healthcare professionals and patients attach importance to patients' privacy, there is insufficient understanding of the problem. Limitations of previous research have been discussed.

  16. Professional Support of Self-Help Groups: A Support Group Project for Chronic Fatigue Syndrome Patients.

    ERIC Educational Resources Information Center

    Carlsen, Benedicte

    2003-01-01

    Study follows a collaborative support group project between a team of health professionals and a Chronic Fatigue Syndrome patients' group. While advantageous for professionals to decide upon the aim of a joint intervention in dialogue with participants, simply asking participants what their aims are does not guarantee actual agreement. Case study…

  17. Knowledge Translation of Interprofessional Collaborative Patient-Centred Practice: The Working Together Project Experience

    ERIC Educational Resources Information Center

    MacDonald, Colla J.; Archibald, Douglas; Stodel, Emma; Chambers, Larry W.; Hall, Pippa

    2008-01-01

    The Working Together (WT) project involved the design and delivery of an online learning resource for healthcare teams in long-term care (LTC) so that knowledge regarding interprofessional collaborative patient-centred practice (ICPCP) could be readily accessed and then transferred to the workplace. The purpose of this paper is to better…

  18. Review of the independent risk assessment of the proposed Cabrillo liquified natural gas deepwater port project.

    SciTech Connect

    Gritzo, Louis Alan; Hightower, Marion Michael; Covan, John Morgan; Luketa-Hanlin, Anay Josephine

    2006-01-01

    In March 2005, the United States Coast Guard requested that Sandia National Laboratories provide a technical review and evaluation of the appropriateness and completeness of models, assumptions, analyses, and risk management options presented in the Cabrillo Port LNG Deepwater Port Independent Risk Assessment-Revision 1 (Cabrillo Port IRA). The goal of Sandia's technical evaluation of the Cabrillo Port IRA was to assist the Coast Guard in ensuring that the hazards to the public and property from a potential LNG spill during transfer, storage, and regasification operations were appropriately evaluated and estimated. Sandia was asked to review and evaluate the Cabrillo Port IRA results relative to the risk and safety analysis framework developed in the recent Sandia report, ''Guidance on Risk Analysis and Safety Implications of a Large Liquefied Natural Gas (LNG) Spill over Water''. That report provides a framework for assessing hazards and identifying approaches to minimize the consequences to people and property from an LNG spill over water. This report summarizes the results of the Sandia review of the Cabrillo Port IRA and supporting analyses. Based on our initial review, additional threat and hazard analyses, consequence modeling, and process safety considerations were suggested. The additional analyses recommended were conducted by the Cabrillo Port IRA authors in cooperation with Sandia and a technical review panel composed of representatives from the Coast Guard and the California State Lands Commission. The results from the additional analyses improved the understanding and confidence in the potential hazards and consequences to people and property from the proposed Cabrillo Port LNG Deepwater Port Project. The results of the Sandia review, the additional analyses and evaluations conducted, and the resolutions of suggested changes for inclusion in a final Cabrillo Port IRA are summarized in this report.

  19. 43 CFR 404.51 - Are proposed projects under the Rural Water Supply Program reviewed by the Administration?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Water Supply Program reviewed by the Administration? 404.51 Section 404.51 Public Lands: Interior... SUPPLY PROGRAM Feasibility Studies § 404.51 Are proposed projects under the Rural Water Supply Program... the Reclamation's Rural Water Supply Program. This includes review under Executive Order 12322...

  20. What Is Our Current Understanding of One-to-One Computer Projects: A Systematic Narrative Research Review

    ERIC Educational Resources Information Center

    Fleischer, Hakan

    2012-01-01

    The aim of this article is to review cross-disciplinary accumulated empirical research on one-to-one computer projects in school settings as published in peer-reviewed journals between 2005 and 2010, particularly the results of teacher- and pupil-oriented studies. Six hundred and five research articles were screened at the abstract and title…

  1. Projective Identification, Self-Disclosure, and the Patient's View of the Object: The Need for Flexibility

    PubMed Central

    Waska, Robert T.

    1999-01-01

    Certain patients, through projective identification and splitting mechanisms, test the boundaries of the analytic situation. These patients are usually experiencing overwhelming paranoid-schizoid anxieties and view the object as ruthless and persecutory. Using a Kleinian perspective, the author advocates greater analytic flexibility with these difficult patients who seem unable to use the standard analytic environment. The concept of self-disclosure is examined, and the author discusses certain technical situations where self-disclosure may be helpful.(The Journal of Psychotherapy Practice and Research 1999; 8:225–233) PMID:10413442

  2. Implant surgery in healthy compromised patients-review of literature

    PubMed Central

    Gheorghiu, IM; Stoian, IM

    2014-01-01

    Systemic diseases are of major importance in terms of prosthetic restorations supported by dental implants in healthy compromised patients. Each treatment stage from conception of the treatment plan to the long-term monitoring is under the necessity of the interdisciplinary approach to the underlying disease. Abbreviations: healthy compromised patients = HCP PMID:25870664

  3. A review of basic patient rights in psychiatric care.

    PubMed

    Cady, Rebecca F

    2010-01-01

    Although patient rights is a concept that all nurse managers need to be aware of, this concept often becomes confusing when applied to patients undergoing psychiatric treatment. It is important for the nurse manager to understand the basic rights that psychiatric patients are entitled to, to best be able to help staff nurses under his/her supervision to protect these rights. The nurse manager on a psychiatric unit often serves as a reference for staff nurses, and even for physicians, when questions regarding patient rights present themselves. The nurse manager should be certain to discuss these issues with the facility's legal and risk management team to be aware of particulars of the law of the state in which the facility is located, as state laws may differ somewhat in their treatment of psychiatric patients.

  4. Hyphema due to blunt injury: a review of 118 patients

    PubMed Central

    Ulagantheran, V; Ahmad Fauzi, M S; Reddy, S C

    2010-01-01

    AIM To determine the causes, associated ocular findings and visual acuity on presentation, complications and visual outcome following treatment in patients of hyphema due to blunt injury METHODS A retrospective study was performed in 118 patients with hyphema due to blunt injury admitted in University of Malaya Medical Centre, Kuala Lumpur, Malaysia. The gender, age, race, cause of blunt injury resulting in hyphema, eye involved, vision at admission, other associated ophthalmological findings, complications and visual outcome were noted from the case records of patients. The data were analyzed using SPSS programme. RESULTS Males were more predominantly affected (93.2%). Two-thirds of patients (67.8%) were aged below 30 years. Sports related injury (38.1%) was the most common cause for hyphema. Hyphema disappeared within 5 days in 66.9% of patients. Iris injuries were very commonly associated in the form of mydriasis, sphincter tear and iridodialysis. Associated vitreous haemorrhage was noted in 11.9% of patients. During the hospital stay, secondary haemorrhage was observed in 3.4% of patients. The best corrected vision of 6/18 or better was noted in 85.4% of patients at the last follow-up. The follow-up of these subjects was very poor and thus the incidence of secondary glaucoma could not be established. Moderate blood staining of cornea occurred in 0.8% of patients. CONCLUSION Sports related injury is the most common cause of hyphema in Malaysia. Good visual recovery, without serious complications, is possible with appropriate and in-time treatment in hyphema patients due to blunt injury. PMID:22553571

  5. Utilization of a Preemptive, Multimodal Analgesic Regimen in Adult Ambulatory Septoplasty Patients: A Quality Improvement Project.

    PubMed

    Morgan, Brett; Stanik-Hutt, Julie

    2015-01-01

    This paper describes a quality improvement project designed to decrease postoperative pain, decrease post-operative nausea and vomiting (PONV), decrease time in the recovery room, and increase patient satisfaction in adult ambulatory septoplasty patients using a multimodal, preemptive analgesic regimen. The project was conducted in a community hospital setting with nine operating rooms, and a twenty one bed recovery room. Project participants included certified registered nurse anesthetists, anesthesiologists, operating room nurses, recovery room nurses, and otolaryngology surgeons. Following a period of departmental education, adult patients scheduled for outpatient septoplasty surgery received a preoperative regimen of medications that included gabapentin, celecoxib, and acetaminophen. Using a pre-post test design, (intervention group n = 17, non-intervention group n = 17) data was collected from patient and analyzed using SPSS version 18.0. The change in practice resulted in a significant decrease in pain scores in the recovery room and on discharge from the recovery room. In addition, patients who received the preemptive regimen also required significantly fewer opioid medications and were ready to be discharged from the recovery room in less time.

  6. [The French project ETOILE: review of clinical data for light ion hadrontherapy].

    PubMed

    Pommier, P; Balosso, J; Bolla, M; Gérard, J P

    2002-12-01

    The Lawrence Berkeley Laboratory was the pioneer in light ions hadrontherapy with almost 2500 patients treated between 1957 and 1993 with Helium and Neon. The NIRS (National Institute For Radiological Science, Chiba, Japan) was the first dedicated medical centre for cancer with more than 1200 patients exclusively treated with carbon ion from 1994. A three-year 70 to 100% local control was reported for radio-resistant cancers, supporting the use of high LET particles. Hypo-fractionation was particularly explored for lung cancers and hepatocarcinoma (4 sessions only). Dose escalation studies demonstrated a tumour dose-effect and permitted to precise dose constraints for healthy tissues especially for the rectum. More than 140 patients were treated with carbon ion exclusively or associated with photons since 1997 in the GSI laboratory Gesellschaft Für Schwerionenforschung, Darmstadt, Germany). A very high local control was also obtained for radioresistant cancer of the base of the skull. Preliminary clinical data seem to confirm the expected therapeutic gain with light ions, due to their ballistic and radio-biological properties, and justify the European projects for the construction of dedicated medical facilities for cancers. The French "Etoile" project will be integrated in the European hadrontherapy network "Enlight", with the objectives to coordinate technologic, medical and economic features.

  7. [Development and validation of indicators for best patient safety practices: the ISEP-Brazil Project].

    PubMed

    Gama, Zenewton André da Silva; Saturno-Hernández, Pedro Jesus; Ribeiro, Denise Nieuwenhoff Cardoso; Freitas, Marise Reis de; Medeiros, Paulo José de; Batista, Almária Mariz; Barreto, Analúcia Filgueira Gouveia; Lira, Benize Fernandes; Medeiros, Carlos Alexandre de Souza; Vasconcelos, Cilane Cristina Costa da Silva; Silva, Edna Marta Mendes da; Faria, Eduardo Dantas Baptista de; Dantas, Jane Francinete; Neto, José Gomes; Medeiros, Luana Cristina Lins de; Sicolo, Miguel Angel; Fonseca, Patrícia de Cássia Bezerra; Costa, Rosângela Maria Morais da; Monte, Francisca Sueli; Melo, Veríssimo de

    2016-09-19

    Efficacious patient safety monitoring should focus on the implementation of evidence-based practices that avoid unnecessary harm related to healthcare. The ISEP-Brazil project aimed to develop and validate indicators for best patient safety practices in Brazil. The basis was the translation and adaptation of the indicators validated in the ISEP-Spain project and the document Safe Practices for Better Healthcare (U.S. National Quality Forum), recommending 34 best practices. A 25-member expert panel validated the indicators. Reliability and feasibility were based on a pilot study in three hospitals with different management formats (state, federal, and private). Seventy-five best practice indicators were approved (39 structure; 36 process) for 31 of the 34 recommendations. The indicators were considered valid, reliable, and useful for monitoring patient safety in Brazilian hospitals.

  8. [Development and validation of indicators for best patient safety practices: the ISEP-Brazil Project].

    PubMed

    Gama, Zenewton André da Silva; Saturno-Hernández, Pedro Jesus; Ribeiro, Denise Nieuwenhoff Cardoso; Freitas, Marise Reis de; Medeiros, Paulo José de; Batista, Almária Mariz; Barreto, Analúcia Filgueira Gouveia; Lira, Benize Fernandes; Medeiros, Carlos Alexandre de Souza; Vasconcelos, Cilane Cristina Costa da Silva; Silva, Edna Marta Mendes da; Faria, Eduardo Dantas Baptista de; Dantas, Jane Francinete; Neto, José Gomes; Medeiros, Luana Cristina Lins de; Sicolo, Miguel Angel; Fonseca, Patrícia de Cássia Bezerra; Costa, Rosângela Maria Morais da; Monte, Francisca Sueli; Melo, Veríssimo de

    2016-01-01

    Efficacious patient safety monitoring should focus on the implementation of evidence-based practices that avoid unnecessary harm related to healthcare. The ISEP-Brazil project aimed to develop and validate indicators for best patient safety practices in Brazil. The basis was the translation and adaptation of the indicators validated in the ISEP-Spain project and the document Safe Practices for Better Healthcare (U.S. National Quality Forum), recommending 34 best practices. A 25-member expert panel validated the indicators. Reliability and feasibility were based on a pilot study in three hospitals with different management formats (state, federal, and private). Seventy-five best practice indicators were approved (39 structure; 36 process) for 31 of the 34 recommendations. The indicators were considered valid, reliable, and useful for monitoring patient safety in Brazilian hospitals. PMID:27653192

  9. Improving patient and project outcomes using interorganisational innovation, collaboration and co-design.

    PubMed

    Evans, Liz; Green, Stuart; Howe, Cathy; Sharma, Kiran; Marinho, Fatima; Bell, Derek; Thomas, Paul

    2014-01-01

    Background Common mental disorders (CMDs) are a leading cause of disability. The Department of Health has launched a large-scale initiative to improve access to evidence-based psychological treatments, such as cognitive behavioural therapy (CBT), through the Improving Access to Psychological Therapy (IAPT) programme. Access to IAPT services by black and minority ethnic (BME) communities is lower than for other groups. Setting The London Borough of Ealing in west London; a diverse borough with areas of high BME population and relatively high deprivation. Aim To compare the outcomes of two linked quality improvement (QI) projects undertaken by Ealing Mental Health and Wellbeing Service (MHWBS), both with the same aim of increasing access to talking therapies for BME communities. Methods Application of QI methodologies supported by the NIHR CLAHRC for northwest London in two different settings in Ealing. One, the 'Southall project', was set within a wider initiative for collaborative improvements and shared learning (the Southall Initiative for Integrated Care) in an ethnically diverse area of Ealing; it was undertaken between April 2010 and September 2011. The second, 'the Ealing project', operated in the two other Ealing localities that did not have the advantage of a broader initiative for collaborative improvements; it was undertaken between April 2011 and September 2012. Results Comparison of the monthly referral rates of BME patients (standardised per 10 000 general practitioner (GP)-registered patients) show that the Southall project was more effective in increasing referrals from BME communities than the Ealing project. Conclusion Broad local participation and ownership in the project design of the Southall project may explain why it was more effective in achieving its aims than the Ealing project which lacked these ownership-creating mechanisms.

  10. [Surgery and transfusion in Jehovah's witness patient. Medical legal review].

    PubMed

    Loriau, J; Manaouil, C; Montpellier, D; Graser, M; Jarde, O

    2004-06-01

    The religious convictions of the witnesses of Jehovah leads them to refuse transfusion of blood, of its major components and of blood sparing procedures breaking the physical contact between the patient and his blood. We recall the rules of good practice in case of elective surgery concerning exhaustive information of the patient within multidisciplinary team associating anesthetist and surgeon advised by the forensic pathologist. This consultation must, to our point of view, be concluded by a report which summarizes what is accepted or not by the patient. This report will be initialed by the patient. This consultation can never lead the physician to swear to never use a transfusion whatever the circumstances. In case of emergency if and only some conditions are met (everything was made to convince the patient, vital emergency, no therapeutic choice, therapeutic care adapted to the patient heath status), the physician can be brought to overpass the patient's will to not receive blood transfusion. Current jurisprudence has, to date, never recognized as faulty the physicians having practiced such transfusions whenever they took place within a precise framework. PMID:15220098

  11. Retrospective review of diagnostic histopathology samples in research projects: transparency should be the practice with respect to diagnostic discordance.

    PubMed

    Bjugn, Roger; Casati, Bettina

    2012-11-01

    Retrospective review of diagnostic histopathology samples in secondary research projects may generate cases with discordance in diagnosis between the pathologist originally signing out the sample and the reviewer. In this article the authors discuss ethical and legal issues involved in secondary review and propose how diagnostic discrepancies in research projects can be handled. Research participants have the right to know about and control the handling of personal data. Researchers have a duty to inform research participants about research findings of relevance to the current or future health or quality of life. Such feedback is to be provided within a healthcare framework. The authors recommend that pathology laboratories should require researchers to provide feedback on diagnostic discrepancies of potentially clinical significance in secondary research projects using retrospective review of diagnostic histopathology material. The pathology laboratory in charge of the archival material should be responsible for the follow-up on such cases.

  12. [Cognitive impairment in patients with COPD: a review].

    PubMed

    Cleutjens, F A H M; Janssen, D J A; Gijsen, C; Dijkstra, J B; Ponds, R W H M; Wouters, E F M

    2014-01-01

    COPD (Chronic Obstructive Pulmonary Disease) is a respiratory disease characterized by progressive and largely irreversible airway limitation and extrapulmonary problems. The prevalence of COPD increases with age. Mental health problems, including cognitive capacity limitations, occur frequently. Patients with COPD may have problems with cognitive functioning, either globally or in single cognitive domains, such as information processing, attention and concentration, memory, executive functioning and self-regulation. Possible causes are hypoxemia, hypercapnia, exacerbations and decreased physical activity. Cognitive problems in these patients may be related to structural brain abnormalities, such as gray matter pathologic changes and the loss of white matter integrity. Because of the negative impact on health and daily life, it is important to assess cognitive functioning in patients with COPD in order to optimize patient-oriented treatment and to reduce personal discomfort, hospital admissions and mortality.

  13. Implementing Thrombosis Guidelines in Cancer Patients: A Review

    PubMed Central

    Farge-Bancel, Dominique; Bounameaux, Henri; Brenner, Benjamin; Büller, Harry R.; Kakkar, Ajay; Pabinger, Ingrid; Streiff, Michael; Debourdeau, Philippe

    2014-01-01

    Venous thromboembolism is a frequent and serious complication in patients with cancer. It is an independent prognostic factor of death in cancer patients and the second leading cause of death, but physicians often underestimate its importance, as well as the need for adequate prevention and treatment. Management of venous thromboembolism in patients with cancer requires the coordinated efforts of a wide range of clinicians, highlighting the importance of a multidisciplinary approach. However, a lack of consensus among various national and international clinical practice guidelines has contributed to knowledge and practice gaps among practitioners, and inconsistent approaches to venous thromboembolism. The 2013 international guidelines for thrombosis in cancer have sought to address these gaps by critically re-evaluating the evidence coming from clinical trials and synthesizing a number of guidelines documents. An individualized approach to prophylaxis is recommended for all patients. PMID:25386357

  14. Medical comorbidity and projected survival in patients admitted to a specialist addictions in-patient unit

    PubMed Central

    Mogford, Daniel V.; Lawrence, Rebecca J.

    2016-01-01

    Aims and method To investigate the burden of medical comorbidity in a population receiving in-patient treatment for drug and alcohol problems. All patients admitted over a 6-month period were included in the data-set. We recorded diagnostic information on admission that allowed the calculation of predicted 10-year survival using a previously validated comorbidity index. Results Despite the majority of the sample having a predicted 10-year survival chance of greater than 75%, a sizeable minority (16.7%) are carrying a high burden of medical comorbidity, with a predicted 10-year survival chance of less than 50%. More than half (55.2%) of these patients were under the age of 55. Chronic respiratory disease was the most frequent diagnosis. Clinical implications In-patient substance misuse units serve a complicated group of patients, whose needs are met by active medical input, resident medical cover and effective liaison with general hospitals. This is important when planning and commissioning treatment services. The high burden of respiratory disease suggests the utility of robust smoking cessation interventions among this population. PMID:27752344

  15. Safety of patients--actual problem of modern medicine (review).

    PubMed

    Tsintsadze, Neriman; Samnidze, L; Beridze, T; Tsintsadze, M; Tsintsadze, Nino

    2011-09-01

    Safety of patients is actual problem of up-to-date medicine. The current successful treatment of various sicknesses is achieved by implementation in clinical practice such medical preparations (medications), which are characterized with the high therapeutic activity, low toxicity and prolonged effects. In spite of evidence of the pharmacotherapeutical advances, the frequency of complications after medication has grown - that is why the safety of patients is the acute actual problem of medicine and ecological state of human population today. PMID:22156680

  16. Pharmacokinetic Changes and Dosing Modification of Aminoglycosides in Critically Ill Obese Patients: A Literature Review

    PubMed Central

    Velissaris, Dimitrios; Karamouzos, Vasilios; Marangos, Markos; Pierrakos, Charalampos; Karanikolas, Menelaos

    2014-01-01

    The objective of the paper is to review the literature and provide recommendations for use of aminoglycoside antibiotics in critically ill obese patients. Literature search in PubMed for all articles on the use of aminoglycosides in critically ill obese patients was conducted, and all articles related to pharmacokinetics in obesity were reviewed. Bibliographies of all searched manuscripts were also reviewed in an attempt to find additional references. Although aminoglycoside pharmacokinetics have been described in detail, data on aminoglycoside use and appropriate dose modification in critically ill obese patients are very limited. Knowledge on aminoglycoside pharmacokinetics and use in critically ill obese patients is incomplete. Pathophysiologic changes in obesity can result in sub- or supra-therapeutic aminoglycoside plasma concentrations, especially in the presence of sepsis. Rigorous clinical studies are needed to establish aminoglycoside dosing guidelines in critically ill obese patients with sepsis. PMID:24883145

  17. Hawaii Energy Strategy Project 2: Fossil Energy Review. Task IV. Scenario development and analysis

    SciTech Connect

    Yamaguchi, N.D.; Breazeale, K.

    1993-12-01

    The Hawaii Energy Strategy (HES) Program is a seven-project effort led by the State of Hawaii Department of Business, Economic Development & Tourism (DBEDT) to investigate a wide spectrum of Hawaii energy issues. The East-West Center`s Program on Resources: Energy and Minerals, has been assigned HES Project 2, Fossil Energy Review, which focuses on fossil energy use in Hawaii and the greater regional and global markets. HES Project 2 has four parts: Task I (World and Regional Fossil Energy Dynamics) covers petroleum, natural gas, and coal in global and regional contexts, along with a discussion of energy and the environment. Task II (Fossil Energy in Hawaii) focuses more closely on fossil energy use in Hawaii: current utilization and trends, the structure of imports, possible future sources of supply, fuel substitutability, and energy security. Task III`s emphasis is Greenfield Options; that is, fossil energy sources not yet used in Hawaii. This task is divided into two sections: first, an in-depth {open_quotes}Assessment of Coal Technology Options and Implications for the State of Hawaii,{close_quotes} along with a spreadsheet analysis model, which was subcontracted to the Environmental Assessment and Information Sciences Division of Argonne National Laboratory; and second, a chapter on liquefied natural gas (LNG) in the Asia-Pacific market and the issues surrounding possible introduction of LNG into the Hawaii market.

  18. Treatment of older patients with colorectal cancer: a perspective review

    PubMed Central

    Kordatou, Z.; Kountourakis, P.

    2014-01-01

    In a continuously aging population, the burden of colorectal cancer (CRC) is rising among older patients. Despite the fact that almost half of the cases occur in patients over 75 years, this age group is subjected to disparities regarding diagnostic and therapeutic options. So far, exclusion of older patients from randomized clinical trials has resulted in a lack of evidence-based guidelines. Nevertheless, newer data from studies specifically targeting older patients and subgroup analyses indicate that proper treatment planning and specific medical and geriatric assessment can achieve a safe and beneficial treatment result in older patients, often with similar outcomes to their younger counterparts. Resection of the primary tumour, if feasible, should be the primary goal of surgery aiming for cure, although it should be avoided under emergency conditions. Chronological age per se should not be an exclusion criterion for adjuvant or palliative chemotherapy, or targeted therapies. Careful patient selection, dose adjustments, close monitoring and early intervention in the event of side effects are essential. The benefits of treatment must be balanced with potential effects of treatment and patients’ wishes. PMID:24790652

  19. Optimal management of cervical cancer in HIV-positive patients: a systematic review

    PubMed Central

    Ntekim, Atara; Campbell, Oladapo; Rothenbacher, Dietrich

    2015-01-01

    The clinical management of cervical cancer in HIV-positive patients has challenges mainly due to the concerns on immune status. At present, their mode of management is similar to HIV-seronegative patients involving the use of chemotherapy and radiotherapy concurrently as indicated. HIV infection, cancer, radiotherapy, and chemotherapy lower immunity through reduction in CD4 cell counts. At present there are no treatment guidelines for HIV-positive patients. This study was done to systematically review the literature on cervical cancer management in HIV-positive patients and treatment outcomes. A systematic literature search was done in the major databases to identify studies on the management of HIV-positive patients with cervical cancer. Identified studies were assessed for eligibility and inclusion in the review following the guidelines of The Cochrane Handbook for Systematic Reviews and CRD's (Centre for Reviews and Dissemination) guidance for undertaking reviews in health care. Eight eligible studies were identified from the literature. Three of them were prospective while five were retrospective studies. Notably, the average age at diagnosis of cervical cancer in HIV-positive patients was a decade lower than in seronegative patients. There was no difference in distribution of stages of disease at presentation between HIV-positive and negative patients. Mild acute toxicity (Grades 1 and 2) was higher in HIV-positive patients than in HIV-negative patients in hematopoietic system. In the grades 3 and 4 reactions, anemia was reported in 4% versus 2% while gastrointestinal reactions were reported in 5% versus 2% respectively. In general, patients who were started early on HAART had higher rates of treatment completion. The study supports the suggestion that HAART should be commenced early at cervical cancer diagnosis in HIV-positive patients diagnosed with cervical cancer to ensure less toxicity and better treatment compliance. PMID:26136407

  20. Optimal management of cervical cancer in HIV-positive patients: a systematic review.

    PubMed

    Ntekim, Atara; Campbell, Oladapo; Rothenbacher, Dietrich

    2015-09-01

    The clinical management of cervical cancer in HIV-positive patients has challenges mainly due to the concerns on immune status. At present, their mode of management is similar to HIV-seronegative patients involving the use of chemotherapy and radiotherapy concurrently as indicated. HIV infection, cancer, radiotherapy, and chemotherapy lower immunity through reduction in CD4 cell counts. At present there are no treatment guidelines for HIV-positive patients. This study was done to systematically review the literature on cervical cancer management in HIV-positive patients and treatment outcomes. A systematic literature search was done in the major databases to identify studies on the management of HIV-positive patients with cervical cancer. Identified studies were assessed for eligibility and inclusion in the review following the guidelines of The Cochrane Handbook for Systematic Reviews and CRD's (Centre for Reviews and Dissemination) guidance for undertaking reviews in health care. Eight eligible studies were identified from the literature. Three of them were prospective while five were retrospective studies. Notably, the average age at diagnosis of cervical cancer in HIV-positive patients was a decade lower than in seronegative patients. There was no difference in distribution of stages of disease at presentation between HIV-positive and negative patients. Mild acute toxicity (Grades 1 and 2) was higher in HIV-positive patients than in HIV-negative patients in hematopoietic system. In the grades 3 and 4 reactions, anemia was reported in 4% versus 2% while gastrointestinal reactions were reported in 5% versus 2% respectively. In general, patients who were started early on HAART had higher rates of treatment completion. The study supports the suggestion that HAART should be commenced early at cervical cancer diagnosis in HIV-positive patients diagnosed with cervical cancer to ensure less toxicity and better treatment compliance. PMID:26136407

  1. Rubber dam isolation in pediatric patients: a review.

    PubMed

    Karaouzas, Litsa; Kim, Youngjoo E; Boynton, James R

    2012-01-01

    The rubber dam has been available to the dental profession for over 145 years and can serve as an invaluable tool to dental practitioners. Here we review the rubber dam and its application on children including advantages and disadvantages associated with its use and alternative isolation methods.

  2. Agrobacterium radiobacter bacteremia in pediatric patients: case report and review.

    PubMed

    Amaya, Rene A; Edwards, Morven S

    2003-02-01

    Agrobacterium radiobacter is an opportunistic pathogen often associated with indwelling catheters. We report five children with central venous catheter-associated A. radiobacter bacteremia and review the characteristics of pediatric Agrobacterium infections. Cure was achieved with appropriate antibiotics, often ticarcillin-clavulanate and gentamicin, and removal of the catheter.

  3. Implementing practice management strategies to improve patient care: the EPIC project.

    PubMed

    Attwell, David; Rogers-Warnock, Leslie; Nemis-White, Joanna

    2012-01-01

    Healthcare gaps, the difference between usual care and best care, are evident in Canada, particularly with respect to our aging, ailing population. Primary care practitioners are challenged to identify, prevent and close care gaps in their practice environment given the competing demands of informed, litigious patients with complex medical needs, ever-evolving scientific evidence with new treatment recommendations across many disciplines and an enhanced emphasis on quality and accountability in healthcare. Patient-centred health and disease management partnerships using measurement, feedback and communication of practice patterns and outcomes have been shown to narrow care gaps. Practice management strategies such as the use of patient registries and recall systems have also been used to help practitioners better understand, follow and proactively manage populations of patients in their practice. The Enhancing Practice to Improve Care project was initiated to determine the impact of a patient-centred health and disease management partnership using practice management strategies to improve patient care and outcomes for patients with chronic kidney disease (CKD). Forty-four general practices from four regions of British Columbia participated and, indeed, demonstrated that care and outcomes for patients with CKD could be improved via the implementation of practice management strategies in a patient-centred partnership measurement model of health and disease management.

  4. Spent Nuclear Fuel (SNF) Project Cask and MCO Helium Purge System Design Review Completion Report Project A.5 and A.6

    SciTech Connect

    ARD, K.E.

    2000-04-19

    This report documents the results of the design verification performed on the Cask and Multiple Canister Over-pack (MCO) Helium Purge System. The helium purge system is part of the Spent Nuclear Fuel (SNF) Project Cask Loadout System (CLS) at 100K area. The design verification employed the ''Independent Review Method'' in accordance with Administrative Procedure (AP) EN-6-027-01.

  5. A framework of counseling for patients with stroke in nursing: a narrative literature review.

    PubMed

    Oikarinen, Anne; Kääriäinen, Maria; Kyngäs, Helvi

    2014-10-01

    Stroke is a major cause of death in developed countries. Its prevalence and disability burden are expected to increase in the future because of an aging population. The consequences of stroke are specific to the individual. Whereas some patients experience long-term functional and cognitive deficits, others may recover completely and be discharged quickly. Counseling is needed to help patients and their families cope with the effects of stroke after discharge. This is a systematic literature review with a narrative analysis. The purpose was to describe the content and characteristics of stroke patients' counseling. A review of studies published between January 2000 and February 2013 describing stroke patients' counseling was conducted by CINAHL and Medline databases. Studies were selected based on inclusion criteria, and the quality of the included studies was assessed. The final data (n = 33) were extracted and synthesized. Seven prominent themes were identified in the literature relating to (a) information about the disease and concerns regarding stroke, (b) the aims of counseling, (c) counseling methods, (d) interaction as a method for counseling, (e) the stroke nurse as a counselor, (f) emotional support, and (g) decision making in patients' care. The results of the review show that stroke patients' counseling is a multifaceted phenomenon with distinctive characteristics. The findings of the review can be used to develop counseling for patients with stroke and their families. In addition, the review can be used when educating stroke nurses for stroke units. PMID:25188689

  6. Advanced Mixed Waste Treatment Project melter system preliminary design technical review meeting

    SciTech Connect

    Eddy, T.L.; Raivo, B.D.; Soelberg, N.R.; Wiersholm, O.

    1995-02-01

    The Idaho National Engineering Laboratory Advanced Mixed Waste Treatment Project sponsored a plasma are melter technical design review meeting to evaluate high-temperature melter system configurations for processing heterogeneous alpha-contaminated low-level radioactive waste (ALLW). Thermal processing experts representing Department of Energy contractors, the Environmental Protection Agency, and private sector companies participated in the review. The participants discussed issues and evaluated alternative configurations for three areas of the melter system design: plasma torch melters and graphite arc melters, offgas treatment options, and overall system configuration considerations. The Technical Advisory Committee for the review concluded that graphite arc melters are preferred over plasma torch melters for processing ALLW. Initiating involvement of stakeholders was considered essential at this stage of the design. For the offgas treatment system, the advisory committee raised the question whether to a use wet-dry or a dry-wet system. The committee recommended that the waste stream characterization, feed preparation, and the control system are essential design tasks for the high-temperature melter treatment system. The participants strongly recommended that a complete melter treatment system be assembled to conduct tests with nonradioactive surrogate waste material. A nonradioactive test bed would allow for inexpensive design and operational changes prior to assembling a system for radioactive waste treatment operations.

  7. A review of projection radiography of plasma and biological objects in X-Pinch radiation

    NASA Astrophysics Data System (ADS)

    Shelkovenko, T. A.; Pikuz, S. A.; Hammer, D. A.

    2016-03-01

    A review of studies on the X-pinch as a radiation source for X-ray projection shadow radiography (XPSR) and X-ray absorption spectroscopy (XAS) is presented. The ultimate capabilities of the techniques and ways of their achievement are considered. XPSR has been successfully used to study high-energy-density plasma objects, in particular, exploding wires and wire arrays. Using XPSR, the internal structure and dynamics of a wire explosion and wire array implosion have been investigated for the first time, which has made it possible to develop an adequate consistent theory of the processes occurring in the wire loads of generators with currents from several units of kiloamperes to a few tens of megamperes. The use of XAS for diagnostics of wire loads has allowed one for the first time to measure the parameters of matter in the wire core and plasma corona of the load. X-ray images of various biological objects have obtained, including those with the use of the phase contrast method. This review is a logical continuation of the review "X-Pinch" [Plasma Phys. Rep. 41, 319, 493 (2015)], in which the X-pinch as a physical object was considered.

  8. Impact of climate change on UK estuaries: A review of past trends and potential projections

    NASA Astrophysics Data System (ADS)

    Robins, Peter E.; Skov, Martin W.; Lewis, Matt J.; Giménez, Luis; Davies, Alan G.; Malham, Shelagh K.; Neill, Simon P.; McDonald, James E.; Whitton, Timothy A.; Jackson, Suzanna E.; Jago, Colin F.

    2016-02-01

    UK estuarine environments are regulated by inter-acting physical processes, including tidal, wave, surge, river discharge and sediment supply. They regulate the fluxes of nutrients, pollutants, pathogens and viruses that determine whether coastlines achieve the Good Environmental Status (GEnS) required by the EU's Marine Strategy Directive. We review 20th century trends and 21st century projections of changes to climatic drivers, and their potential for altering estuarine bio-physical processes. Sea-level rise will cause some marine habitats to expand, and others diminish in area extent. The overall consequences of estuarine morphodynamics to these habitat shifts, and vice-versa, are unknown. Increased temperatures could intensify microbial pathogen concentrations and increase public health risk. The patterns of change of other climatic drivers are difficult to predict (e.g., river flows and storm surges). Projected increased winter river flows throughout UK catchments will enhance the risks of coastal eutrophication, harmful algal blooms and hypoxia in some contexts, although there are spatial variabilities in river flow projections. The reproductive success of estuarine biota is sensitive to saline intrusion and corresponding turbidity maxima, which are projected to gradually shift landwards as a result of sea-level rise. Although more-frequent flushing events in winter and longer periods of drought in summer are predicted, whereby the subsequent estuarine mixing and recovery rates are poorly understood. With rising estuarine salinities, subtidal species can penetrate deeper into estuaries, although this will depend on the resilience/adaptation of the species. Many climate and impact predictions lack resolution and spatial cover. Long-term monitoring and increased research, which considers the catchment-river-estuary-coast system as a whole, is needed to support risk predicting and mitigatory strategies.

  9. Clinical characteristics of perinatal psychiatric patients: a chart review study.

    PubMed

    Battle, Cynthia L; Zlotnick, Caron; Miller, Ivan W; Pearlstein, Teri; Howard, Margaret

    2006-05-01

    Although postpartum depression and other perinatal disorders have been the subject of increased research attention, important questions remain regarding women who actively seek psychiatric treatment during pregnancy and the postpartum period. In this study, we examined clinical records of 500 perinatal psychiatric patients who received treatment in a psychiatric day hospital (N = 398) or outpatient behavioral health clinic (N = 102). Patients' presenting diagnoses, psychiatric history, treatment course, and depressive symptoms were recorded. The majority of women had major depression as their primary diagnosis, with an average Edinburgh Postnatal Depression Scale score of over 20. Many depressed patients were diagnosed with comorbid anxiety and substance abuse disorders. Although most women were willing to take psychotropic medications, a sizable minority were not, particularly those who were breast-feeding. For more than a third of the sample, the treatment sought while pregnant or postpartum represented their first contact with the mental health system. Treatment implications are discussed. PMID:16699387

  10. Behavioral Interventions to Reduce Alcohol Use Among Patients with Hepatitis C: A Systematic Review.

    PubMed

    Sims, Omar T; Maynard, Quentin R; Melton, Pam A

    2016-10-01

    Alcohol use is a barrier to pharmacologic treatment for hepatitis C virus (HCV). It is advantageous for medical and clinical social workers engaged in HCV care to be knowledgeable of behavioral interventions that can be used to reduce alcohol use among patients with HCV. This article identifies and describes studies that designed and implemented behavioral interventions to reduce alcohol use among patients with HCV in clinical settings. To achieve this goal, this article conducts a rigorous systematic review to identify peer-reviewed articles, describes each behavioral intervention, and reports primary outcomes of each study included in the review. PMID:27295132

  11. Hypersensitive reactions to local dental anesthetics and patient information: critical review of a drug leaflet

    PubMed Central

    Simonet, Daniel

    2011-01-01

    This paper discusses the case of a patient who experienced adverse reactions to a local anesthetic. It reviews symptoms of adverse reactions, possible causes, patient management, and alternative anesthesia modes. The second part of the paper discusses the product leaflet information and the associated legal issues. PMID:22915891

  12. Cancer in the Family: Review of the Psychosocial Perspectives of Patients and Family Members

    ERIC Educational Resources Information Center

    Mitschke, Diane B.

    2008-01-01

    As advances in cancer care have led to more treatment options and longer survival for cancer patients, a focus on quality of life for patients and their families has gained importance. This review provides a discussion of stress and coping theory, documents the relevance of this topic area for social work practice, and illuminates the results of a…

  13. 76 FR 71623 - Agency Information Collection (Spinal Cord Injury Patient Care Survey) Under OMB Review

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-18

    ... AFFAIRS Agency Information Collection (Spinal Cord Injury Patient Care Survey) Under OMB Review AGENCY.... 2900-New (VA Form 10-0515).'' SUPPLEMENTARY INFORMATION: Title: Spinal Cord Injury Patient Care Survey... Collection. Abstract: Information collected on VA Form 10-0515 will be used to determine spinal cord...

  14. Review article: systematic review of three key strategies designed to improve patient flow through the emergency department.

    PubMed

    Elder, Elizabeth; Johnston, Amy Nb; Crilly, Julia

    2015-10-01

    To explore the literature regarding three key strategies designed to promote patient throughput in the ED. CINAHL, Medline, PubMed, Scopus and Australian Government databases were searched for articles published between 1980 and 2014 using the key search terms ED flow/throughput, ED congestion, crowding, overcrowding, models of care, physician-assisted triage, medical assessment units, nurse practitioner, did not wait (DNW) and ED length of stay (LOS). Abstracts and articles not published in English and articles published before 1980 were excluded from the review. Quantitative and qualitative studies were considered for inclusion. The National Health Medical Research Council (NHMRC) Level of Evidence Hierarchy (2009) was applied to included studies. Twenty-one articles met criteria for review. The level of evidence assessed using the NHMRC guidelines of studies ranged from I to IV, with the majority falling into the Level II-2 (n = 6) and III-3 (n = 9) range. ED LOS was the outcome most often reported. Study quality was limited with few studies adjusting for confounding factors. Only one level I systematic review was included in this review. Advanced practice nursing roles, physician-assisted triage and medical assessment units are models of care that can positively impact ED throughput. They have been shown to decrease ED LOS and DNW rates. Confounding factors, such as site specific staffing requirements, patient acuity and rest-of-hospital processes, can also impact on patient throughput through the ED. PMID:26206428

  15. Review article: systematic review of three key strategies designed to improve patient flow through the emergency department.

    PubMed

    Elder, Elizabeth; Johnston, Amy Nb; Crilly, Julia

    2015-10-01

    To explore the literature regarding three key strategies designed to promote patient throughput in the ED. CINAHL, Medline, PubMed, Scopus and Australian Government databases were searched for articles published between 1980 and 2014 using the key search terms ED flow/throughput, ED congestion, crowding, overcrowding, models of care, physician-assisted triage, medical assessment units, nurse practitioner, did not wait (DNW) and ED length of stay (LOS). Abstracts and articles not published in English and articles published before 1980 were excluded from the review. Quantitative and qualitative studies were considered for inclusion. The National Health Medical Research Council (NHMRC) Level of Evidence Hierarchy (2009) was applied to included studies. Twenty-one articles met criteria for review. The level of evidence assessed using the NHMRC guidelines of studies ranged from I to IV, with the majority falling into the Level II-2 (n = 6) and III-3 (n = 9) range. ED LOS was the outcome most often reported. Study quality was limited with few studies adjusting for confounding factors. Only one level I systematic review was included in this review. Advanced practice nursing roles, physician-assisted triage and medical assessment units are models of care that can positively impact ED throughput. They have been shown to decrease ED LOS and DNW rates. Confounding factors, such as site specific staffing requirements, patient acuity and rest-of-hospital processes, can also impact on patient throughput through the ED.

  16. Spouses of Cancer Patients: A Review of the Literature.

    ERIC Educational Resources Information Center

    Keitel, Merle A.; And Others

    1990-01-01

    Discusses impact on the spouse when his or her partner is being treated for cancer. Defines the disease, outlines treatment effects, and describes issues affecting psychological and marital adjustment of spouses. Offers implications for counselors who work with spouses of cancer patients. (Author/NB)

  17. A systematic review of patient-reported measures of burden of treatment in three chronic diseases

    PubMed Central

    Eton, David T; Elraiyah, Tarig A; Yost, Kathleen J; Ridgeway, Jennifer L; Johnson, Anna; Egginton, Jason S; Mullan, Rebecca J; Murad, Mohammad Hassan; Erwin, Patricia J; Montori, Victor M

    2013-01-01

    Background Burden of treatment refers to the workload of health care and its impact on patient functioning and well-being. There are a number of patient-reported measures that assess burden of treatment in single diseases or in specific treatment contexts. A review of such measures could help identify content for a general measure of treatment burden that could be used with patients dealing with multiple chronic conditions. We reviewed the content and psychometric properties of patient-reported measures that assess aspects of treatment burden in three chronic diseases, ie, diabetes, chronic kidney disease, and heart failure. Methods We searched Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, and EBSCO CINAHL through November 2011. Abstracts were independently reviewed by two people, with disagreements adjudicated by a third person. Retrieved articles were reviewed to confirm relevance, with patient-reported measures scrutinized to determine consistency with the definition of burden of treatment. Descriptive information and psychometric properties were extracted. Results A total of 5686 abstracts were identified from the database searches. After abstract review, 359 full-text articles were retrieved, of which 76 met our inclusion criteria. An additional 22 articles were identified from the references of included articles. From the 98 studies, 57 patient-reported measures of treatment burden (full measures or components within measures) were identified. Most were multi-item scales (89%) and assessed treatment burden in diabetes (82%). Only 15 measures were developed using direct patient input and had demonstrable evidence of reliability, scale structure, and multiple forms of validity; six of these demonstrated evidence of sensitivity to change. We identified 12 content domains common across measures and disease types. Conclusion Available measures of treatment burden in single diseases can inform derivation of a patient-centered measure of the construct in patients with

  18. “Il Corpo Ritrovato”: Dermocosmetological Skin Care Project for the Oncologic Patient

    PubMed Central

    Fabbrocini, G.; Romano, M. C.; Cameli, N.; Mariano, M.; Pastore, F.; Annunziata, M. C.; Mazzella, C.; De Vita, Valerio; Mauriello, Maria Chiara; Monfrecola, G.

    2011-01-01

    Neoplastic disease and its therapeutic options have a huge impact on the patient's quality of life from both the emotional and the working point of view. The project “Il Corpo Ritrovato” aims at creating an interdisciplinary network of physicians to improve the quality of life of the oncologic patient, focusing on such important aspects as dermocosmetological skin care but also on the evaluation of new therapeutic and diagnostic algorithms in order to make further progress in the field of prevention. PMID:22084736

  19. Increasing patient attendance in a pediatric obesity clinic: a quality improvement project.

    PubMed

    Geer, Betty; Porter, Renee M; Haemer, Matthew; Krajicek, Marilyn J

    2014-01-01

    Research supports intensive lifestyle interventions (>25 contact hours/six months) to treat childhood obesity. Success requires retention in program. This quality improvement project's purpose was to increase attendance of follow-up patients in a childhood obesity clinic by 10%. A pretest posttest design was used. Three months of baseline data were collected, followed by 52 weeks of intervention data. Data were analyzed using descriptive statistics and Fisher's exact test. Follow-up patient attendance improved significantly from 69% to 81% (z=1.76, p=.039 (95% CI=0.2822, 1.0021)). Simple and inexpensive interventions can significantly increase attendance of obese children in follow-up.

  20. Use of the adult attachment projective picture system in psychodynamic psychotherapy with a severely traumatized patient.

    PubMed

    George, Carol; Buchheim, Anna

    2014-01-01

    The following case study is presented to facilitate an understanding of how the attachment information evident from Adult Attachment Projective Picture System (AAP) assessment can be integrated into a psychodynamic perspective in making therapeutic recommendations that integrate an attachment perspective. The Adult Attachment Projective Picture System (AAP) is a valid representational measure of internal representations of attachment based on the analysis of a set of free response picture stimuli designed to systematically activate the attachment system (George and West, 2012). The AAP provides a fruitful diagnostic tool for psychodynamic-oriented clinicians to identify attachment-based deficits and resources for an individual patient in therapy. This paper considers the use of the AAP with a traumatized patient in an inpatient setting and uses a case study to illustrate the components of the AAP that are particularly relevant to a psychodynamic conceptualization. The paper discusses also attachment-based recommendations for intervention.

  1. Use of the adult attachment projective picture system in psychodynamic psychotherapy with a severely traumatized patient

    PubMed Central

    George, Carol; Buchheim, Anna

    2014-01-01

    The following case study is presented to facilitate an understanding of how the attachment information evident from Adult Attachment Projective Picture System (AAP) assessment can be integrated into a psychodynamic perspective in making therapeutic recommendations that integrate an attachment perspective. The Adult Attachment Projective Picture System (AAP) is a valid representational measure of internal representations of attachment based on the analysis of a set of free response picture stimuli designed to systematically activate the attachment system (George and West, 2012). The AAP provides a fruitful diagnostic tool for psychodynamic-oriented clinicians to identify attachment-based deficits and resources for an individual patient in therapy. This paper considers the use of the AAP with a traumatized patient in an inpatient setting and uses a case study to illustrate the components of the AAP that are particularly relevant to a psychodynamic conceptualization. The paper discusses also attachment-based recommendations for intervention. PMID:25140164

  2. Systematic review on what works, what does not work and why of implementation of mobile health (mHealth) projects in Africa

    PubMed Central

    2014-01-01

    Background Access to mobile phone technology has rapidly expanded in developing countries. In Africa, mHealth is a relatively new concept and questions arise regarding reliability of the technology used for health outcomes. This review documents strengths, weaknesses, opportunities, and threats (SWOT) of mHealth projects in Africa. Methods A systematic review of peer-reviewed literature on mHealth projects in Africa, between 2003 and 2013, was carried out using PubMed and OvidSP. Data was synthesized using a SWOT analysis methodology. Results were grouped to assess specific aspects of project implementation in terms of sustainability and mid/long-term results, integration to the health system, management process, scale-up and replication, and legal issues, regulations and standards. Results Forty-four studies on mHealth projects in Africa were included and classified as: “patient follow-up and medication adherence” (n = 19), “staff training, support and motivation” (n = 2), “staff evaluation, monitoring and guidelines compliance” (n = 4), “drug supply-chain and stock management” (n = 2), “patient education and awareness” (n = 1), “disease surveillance and intervention monitoring” (n = 4), “data collection/transfer and reporting” (n = 10) and “overview of mHealth projects” (n = 2). In general, mHealth projects demonstrate positive health-related outcomes and their success is based on the accessibility, acceptance and low-cost of the technology, effective adaptation to local contexts, strong stakeholder collaboration, and government involvement. Threats such as dependency on funding, unclear healthcare system responsibilities, unreliable infrastructure and lack of evidence on cost-effectiveness challenge their implementation. mHealth projects can potentially be scaled-up to help tackle problems faced by healthcare systems like poor management of drug stocks, weak surveillance and reporting systems or

  3. The Swift Supergiant Fast X-Ray Transients Project:. [A Review, New Results and Future Perspectives

    NASA Technical Reports Server (NTRS)

    Romano, P.; Mangano, V.; Ducci, L.; Esposito, P.; Vercellone, S.; Bocchino, F.; Burrows, D. N.; Kennea, J. A.; Krimm, H. A.; Gehrels, N.; Farinelli, R.; Ceccobello, C.

    2013-01-01

    We present a review of the Supergiant Fast X-ray Transients (SFXT) Project, a systematic investigation of the properties of SFXTs with a strategy that combines Swift monitoring programs with outburst follow-up observations. This strategy has quickly tripled the available sets of broad-band data of SFXT outbursts, and gathered a wealth of out-of-outburst data, which have led us to a broad-band spectral characterization, an assessment of the fraction of the time these sources spend in each phase, and their duty cycle of inactivity. We present some new observational results obtained through our outburst follow-ups, as fitting examples of the exceptional capabilities of Swift in catching bright flares and monitor them panchromatically.

  4. Projecting hydropower production under future climates: a review of modelling challenges and open questions

    NASA Astrophysics Data System (ADS)

    Schaefli, Bettina

    2015-04-01

    Hydropower is a pillar for renewable electricity production in almost all world regions. The planning horizon of major hydropower infrastructure projects stretches over several decades and consideration of evolving climatic conditions plays an ever increasing role. This review of model-based climate change impact assessments provides a synthesis of the wealth of underlying modelling assumptions, highlights the importance of local factors and attempts to identify the most urgent open questions. Based on existing case studies, it critically discusses whether current hydro-climatic modelling frameworks are likely to provide narrow enough water scenario ranges to be included into economic analyses for end-to-end climate change impact assessments including electricity market models. This will be completed with an overview of not or indirectly climate-related boundary conditions, such as economic growth, legal constraints, national subsidy frameworks or growing competition for water, which might locally largely outweigh any climate change impacts.

  5. Improving patient and project outcomes using interorganisational innovation, collaboration and co-design

    PubMed Central

    Green, Stuart; Howe, Cathy; Sharma, Kiran; Marinho, Fatima; Bell, Derek; Thomas, Paul

    2014-01-01

    Background Common mental disorders (CMDs) are a leading cause of disability. The Department of Health has launched a large-scale initiative to improve access to evidence-based psychological treatments, such as cognitive behavioural therapy (CBT), through the Improving Access to Psychological Therapy (IAPT) programme. Access to IAPT services by black and minority ethnic (BME) communities is lower than for other groups. Setting The London Borough of Ealing in west London; a diverse borough with areas of high BME population and relatively high deprivation. Aim To compare the outcomes of two linked quality improvement (QI) projects undertaken by Ealing Mental Health and Wellbeing Service (MHWBS), both with the same aim of increasing access to talking therapies for BME communities. Methods Application of QI methodologies supported by the NIHR CLAHRC for northwest London in two different settings in Ealing. One, the ‘Southall project’, was set within a wider initiative for collaborative improvements and shared learning (the Southall Initiative for Integrated Care) in an ethnically diverse area of Ealing; it was undertaken between April 2010 and September 2011. The second, ‘the Ealing project’, operated in the two other Ealing localities that did not have the advantage of a broader initiative for collaborative improvements; it was undertaken between April 2011 and September 2012. Results Comparison of the monthly referral rates of BME patients (standardised per 10 000 general practitioner (GP)-registered patients) show that the Southall project was more effective in increasing referrals from BME communities than the Ealing project. Conclusion Broad local participation and ownership in the project design of the Southall project may explain why it was more effective in achieving its aims than the Ealing project which lacked these ownership-creating mechanisms. PMID:25949710

  6. The prevalence of infections and patient risk factors in home health care: A systematic review

    PubMed Central

    Shang, Jingjing; Ma, Chenjuan; Poghosyan, Lusine; Dowding, Dawn; Stone, Patricia

    2015-01-01

    Background Home health care (HHC) has been the fastest growing health care sector for the past 3 decades. The uncontrolled home environment, increased use of indwelling devices, and the complexity of illnesses among HHC patients lead to increased risk for infections. Methods A systematic review of studies evaluating infection prevalence and risk factors among adult patients who received HHC services was conducted and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Literature was searched using Medline, PubMed, and the Cumulative Index to Nursing and Allied Health as well as hand searching. Two reviewers independently assessed study quality using validated quality assessment checklists. Results Twenty-five studies met the inclusion criteria and were reviewed. The infection rates and identified risk factors for infections varied dramatically between studies. In general, patients receiving home parental nutrition treatments had higher infection rates than patients receiving home infusion therapy. The identified risk factors were limited by small sample sizes and other methodologic flaws. Conclusions Establishing a surveillance system for HHC infections, identifying patients at high risk for infections, tailoring HHC and patient education based on patient living conditions, and facilitating communication between different health care facilities will enhance infection control in HHC settings. Future studies should use a nationally representative sample and multivariate analysis for the identification of risk factors for infections. PMID:24656786

  7. Review of perioperative pain management of opioid-dependent patients.

    PubMed

    Vadivelu, Nalini; Mitra, Sukanya; Kai, Alice M; Kodumudi, Gopal; Gritsenko, Karina

    2016-01-01

    Opioid dependence can occur due to prescription opioid use, recreational opioid use, or as a result of opioid use for the treatment of drug addiction. Pain control in these patients is truly a challenge. It is important to understand the patient's condition such as the phenomenon of drug dependence, drug addiction, and pseudoaddiction to provide effective analgesia. This may be accomplished using appropriate multimodal therapies and by treatment of coexisting diseases such as anxiety. The goal is to provide effective analgesia, prevent cognitive and emotional problems, and produce a positive postoperative rehabilitation process. Multimodal options include pharmacological and nonpharmacological approaches, psychological support, and interventional pain procedures, all focused toward providing optimal pain control while preventing undertreatment, withdrawal symptoms, and other complications. PMID:27575830

  8. Review of patient safety in time-varying gradient fields.

    PubMed

    Schaefer, D J; Bourland, J D; Nyenhuis, J A

    2000-07-01

    In magnetic resonance, time-varying gradient magnetic fields (dB/dt) may stimulate nerves or muscles by inducing electric fields in patients. Models predicted mean peripheral nerve and cardiac stimulation thresholds. For gradient ramp durations of less than a few milliseconds, mean peripheral nerve stimulation is a safe indicator of high dB/dt. At sufficient amplitudes, peripheral nerve stimulation is perceptible (i.e., tingling or tapping sensations). Magnetic fields from simultaneous gradient axes combine almost as a vector sum to produce stimulation. Patients may become uncomfortable at amplitudes 50%-100% above perception thresholds. In dogs, respiratory stimulation has been induced at about 300% of mean peripheral nerve thresholds. Cardiac stimulation has been induced in dogs by small gradient coils at thresholds near Reilly's predictions. Cardiac stimulation required nearly 80 times the energy needed to produce nerve stimulation in dogs. Nerve and cardiac stimulation thresholds for dogs were unaffected by 1.5-T magnetic fields.

  9. Design review report: AN valve pit upgrades for Project W-314, tank farm restoration and safe operations

    SciTech Connect

    Boes, K.A.

    1998-01-13

    This Design Review Report (DRR) documents the contractor design verification methodology and records associated with project W-314`s AN Valve Pit Upgrades design package. The DRR includes the documented comments and their respective dispositions for this design. Acceptance of the comment dispositions and closure of the review comments is indicated by the signatures of the participating reviewers. Project W-314, Tank Farm Restoration and Safe Operations, is a project within the Tank Waste Remediation System (TWRS) Tank Waste Retrieval Program. This project provides capital upgrades for the existing Hanford tank farms` waste transfer, instrumentation, ventilation, and electrical infrastructure systems. To support established TWRS programmatic objectives, the project is organized into two distinct phases. The initial focus of the project (i.e., Phase 1) is on waste transfer system upgrades needed to support the TWRS Privatization waste feed delivery system. Phase 2 of the project will provide upgrades to support resolution of regulatory compliance issues, improve tank infrastructure reliability, and reduce overall plant operating/maintenance costs. Within Phase 1 of the W-314 project, the waste transfer system upgrades are further broken down into six major packages which align with the project`s work breakdown structure. Each of these six sub-elements includes the design, procurement, and construction activities necessary to accomplish the specific tank farm upgrades contained within the package. The first package to be performed is the AN Valve Pit Upgrades package. The scope of the modifications includes new pit cover blocks, valve manifolds, leak detectors, transfer line connections (for future planned transfer lines), and special protective coating for the 241-AN-A and 241-AN-B valve pits.

  10. A comprehensive review of urologic complications in patients with diabetes.

    PubMed

    Arrellano-Valdez, Fernando; Urrutia-Osorio, Marta; Arroyo, Carlos; Soto-Vega, Elena

    2014-01-01

    Diabetes Mellitus (DM) is a chronic disease characterized by hyperglycemia, as a result of abnormal insulin production, insulin function, or both. DM is associated with systemic complications, such as infections, neuropathy and angiopathy, which involve the genitourinary tract. The three most significant urologic complications include: bladder cystopathy, sexual dysfunction and urinary tract infections. Almost half of the patients with DM have bladder dysfunction or cystopathy, which can be manifested in women as hypersensitivity (in 39-61% of the diabetic women) or neurogenic bladder. In males it can be experienced as lower urinary tract symptoms (in 25% of diabetic males with a nearly twofold increased risk when seen by age groups). Additionally, an increased prostate volume affects their micturition as well as their urinary tract. Involving sexual dysfunction in women, it includes reduced libido, decreased arousal, clitoral erectile dysfunction and painful or non-sensitive intercourse; and in diabetic males it varies from low libido, ejaculatory abnormalities and erectile dysfunction. Globally, sexual disorders have a prevalence of 18-42%. Erectile dysfunction is ranked as the third most important complication of DM. Urinary tract infections are observed frequently in diabetic patients, and vary from emphysematous infections, Fournier gangrene, staghorn infected lithiasis to repetitive bacterial cystitis. The most frequent finding in diabetic women has been lower urinary tract infections. Because of the high incidence of obesity worldwide and its association with diabetes, it is very important to keep in mind the urologic complication associated with DM in patients, in order to better diagnose and treat this population.

  11. Perioperative management of peritoneal dialysis patients: review of abdominal surgery.

    PubMed

    Kleinpeter, Myra A; Krane, N Kevin

    2006-01-01

    On abdominal computed tomography scan for evaluation of hematuria, the index patient, a 23-year-old male, was found to have multiple renal cysts bilaterally. He had been on peritoneal dialysis for 6 years, complicated by intermittent episodes of exit-site infection and peritonitis. Over time, he developed recurrent urinary tract infection and nephrolithiasis with intermittent hematuria. His maintenance dose of recombinant erythropoietin was discontinued, and he maintained a normal hemoglobin level. Annual surveillance of the bilateral renal cysts with magnetic resonance imaging revealed development of a complex cystic mass that warranted further investigation. Following a urology consultation, laparoscopic nephrectomy was performed without complications and with minimal interruption of PD. Pathology evaluation revealed renal cell carcinoma within the renal parenchyma and multiple cystic structures consistent with acquired cystic kidney disease. No clear recommendations exist in the literature regarding continuation or interruption of PD in the perioperative period for planned nephrectomy, tumor resection, or other uncomplicated abdominal or retroperitoneal procedures. A perioperative management strategy for PD patients requiring abdominal or retroperitoneal surgery is outlined here. If these recommendations are followed, patients may continue PD with minimal interruption, preservation of the peritoneal membrane, and few complications.

  12. Decreasing IV Infiltrates in the Pediatric Patient--System-Based Improvement Project.

    PubMed

    Major, Tracie Wilt; Huey, Tricia K

    2016-01-01

    Intravenous infiltrates pose tremendous risk for the hospitalized pediatric patient. Infiltrate events increase hospital-acquired harm, the number of painful procedures, use of supplies, length of stay, and nursing time; it threatens relationships essential in patient- and family-centered care. The goal of this quality improvement project was to achieve a 10% decrease in the baseline infiltrate rate on two inpatient units and in the overall infiltrate rate across all of the pediatric units. A Lean Six Sigma methodology was used to guide project activities. Improvement strategies focused on evidence-based education, intravenous (IV) catheter securement, and family engagement. A comparative purposive sample was used to evaluate the pre- and post-implementation period to determine if desired project success measures were achieved. Data analysis revealed positive results across all units, with the number of events (n = 51 pre; n = 19 post) and the infiltration rates (13.5 pre; 7.1 post) decreasing over a three-month period. A decrease was also noted in the overall percent of IVs that infiltrated in the first 24 hours (45% pre; 42% post). A statistically significant increase (t = 15.16; p < 0.001) was noted in nurses' education pre- and post-assessment survey scores. The family engagement strategy revealed overall parental responses to be 88% positive. By decreasing infiltrates, quality of care improved, resulting in the delivery of safe, effective, and patient-centered IV therapy.

  13. Systematic review of patient-reported outcome measures (PROMs) for assessing disease activity in rheumatoid arthritis

    PubMed Central

    de Jonge, Marieke J; Fransen, Jaap; Kievit, Wietske; van Riel, Piet LCM

    2016-01-01

    Patient assessment of disease activity in rheumatoid arthritis (RA) may be useful in clinical practice, offering a patient-friendly, location independent, and a time-efficient and cost-efficient means of monitoring the disease. The objective of this study was to identify patient-reported outcome measures (PROMs) to assess disease activity in RA and to evaluate the measurement properties of these measures. Systematic literature searches were performed in the PubMed and EMBASE databases to identify articles reporting on clinimetric development or evaluation of PROM-based instruments to monitor disease activity in patients with RA. 2 reviewers independently selected articles for review and assessed their methodological quality based on the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) recommendations. A total of 424 abstracts were retrieved for review. Of these abstracts, 56 were selected for reviewing the full article and 34 articles, presenting 17 different PROMs, were finally included. Identified were: Rheumatoid Arthritis Disease Activity Index (RADAI), RADAI-5, Patient-based Disease Activity Score (PDAS) I & II, Patient-derived Disease Activity Score with 28-joint counts (Pt-DAS28), Patient-derived Simplified Disease Activity Index (Pt-SDAI), Global Arthritis Score (GAS), Patient Activity Score (PAS) I & II, Routine Assessment of Patient Index Data (RAPID) 2–5, Patient Reported Outcome-index (PRO-index) continuous (C) & majority (M), Patient Reported Outcome CLinical ARthritis Activity (PRO-CLARA). The quality of reports varied from poor to good. Typically 5 out of 10 clinimetric domains were covered in the validations of the different instruments. The quality and extent of clinimetric validation varied among PROMs of RA disease activity. The Pt-DAS28, RADAI, RADAI-5 and RAPID 3 had the strongest and most extensive validation. The measurement properties least reported and in need of more evidence were: reliability

  14. Systematic review of patient-reported outcome measures (PROMs) for assessing disease activity in rheumatoid arthritis.

    PubMed

    Hendrikx, Jos; de Jonge, Marieke J; Fransen, Jaap; Kievit, Wietske; van Riel, Piet Lcm

    2016-01-01

    Patient assessment of disease activity in rheumatoid arthritis (RA) may be useful in clinical practice, offering a patient-friendly, location independent, and a time-efficient and cost-efficient means of monitoring the disease. The objective of this study was to identify patient-reported outcome measures (PROMs) to assess disease activity in RA and to evaluate the measurement properties of these measures. Systematic literature searches were performed in the PubMed and EMBASE databases to identify articles reporting on clinimetric development or evaluation of PROM-based instruments to monitor disease activity in patients with RA. 2 reviewers independently selected articles for review and assessed their methodological quality based on the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) recommendations. A total of 424 abstracts were retrieved for review. Of these abstracts, 56 were selected for reviewing the full article and 34 articles, presenting 17 different PROMs, were finally included. Identified were: Rheumatoid Arthritis Disease Activity Index (RADAI), RADAI-5, Patient-based Disease Activity Score (PDAS) I & II, Patient-derived Disease Activity Score with 28-joint counts (Pt-DAS28), Patient-derived Simplified Disease Activity Index (Pt-SDAI), Global Arthritis Score (GAS), Patient Activity Score (PAS) I & II, Routine Assessment of Patient Index Data (RAPID) 2-5, Patient Reported Outcome-index (PRO-index) continuous (C) & majority (M), Patient Reported Outcome CLinical ARthritis Activity (PRO-CLARA). The quality of reports varied from poor to good. Typically 5 out of 10 clinimetric domains were covered in the validations of the different instruments. The quality and extent of clinimetric validation varied among PROMs of RA disease activity. The Pt-DAS28, RADAI, RADAI-5 and RAPID 3 had the strongest and most extensive validation. The measurement properties least reported and in need of more evidence were: reliability

  15. Systematic review of patient-reported outcome measures (PROMs) for assessing disease activity in rheumatoid arthritis

    PubMed Central

    de Jonge, Marieke J; Fransen, Jaap; Kievit, Wietske; van Riel, Piet LCM

    2016-01-01

    Patient assessment of disease activity in rheumatoid arthritis (RA) may be useful in clinical practice, offering a patient-friendly, location independent, and a time-efficient and cost-efficient means of monitoring the disease. The objective of this study was to identify patient-reported outcome measures (PROMs) to assess disease activity in RA and to evaluate the measurement properties of these measures. Systematic literature searches were performed in the PubMed and EMBASE databases to identify articles reporting on clinimetric development or evaluation of PROM-based instruments to monitor disease activity in patients with RA. 2 reviewers independently selected articles for review and assessed their methodological quality based on the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) recommendations. A total of 424 abstracts were retrieved for review. Of these abstracts, 56 were selected for reviewing the full article and 34 articles, presenting 17 different PROMs, were finally included. Identified were: Rheumatoid Arthritis Disease Activity Index (RADAI), RADAI-5, Patient-based Disease Activity Score (PDAS) I & II, Patient-derived Disease Activity Score with 28-joint counts (Pt-DAS28), Patient-derived Simplified Disease Activity Index (Pt-SDAI), Global Arthritis Score (GAS), Patient Activity Score (PAS) I & II, Routine Assessment of Patient Index Data (RAPID) 2–5, Patient Reported Outcome-index (PRO-index) continuous (C) & majority (M), Patient Reported Outcome CLinical ARthritis Activity (PRO-CLARA). The quality of reports varied from poor to good. Typically 5 out of 10 clinimetric domains were covered in the validations of the different instruments. The quality and extent of clinimetric validation varied among PROMs of RA disease activity. The Pt-DAS28, RADAI, RADAI-5 and RAPID 3 had the strongest and most extensive validation. The measurement properties least reported and in need of more evidence were: reliability

  16. Endocrine disruptors and female cancer: Informing the patients (Review).

    PubMed

    Del Pup, Lino; Mantovani, Alberto; Luce, Amalia; Cavaliere, Carla; Facchini, Gaetano; Di Francia, Raffaele; Caraglia, Michele; Berretta, Massimiliano

    2015-07-01

    Pollutants altering the endocrine system, known as endocrine disruptors (ED), may modify the risk of female cancers. The carcinogenic effect of ED on humans has been confirmed by experimental studies for various substances including pesticides, DDT, dioxins, phthalates, bisphenol A, diethylstilbestrol, as well as heavy metals, but it is difficult to quantify precisely for several reasons hereby reviewed. Carcinogenesis is a complex and multifactorial mechanism that manifests itself over a long period of time, making difficult the detection of the specific contribution of the pollutants, whose absorbed dose is often unknown. The combined effect of various substances leads to complex interactions whose outcome is difficult to predict. These substances may accumulate and carry out their harmful effect on critical periods of life, probably also at doses considered harmless to an adult. ED can also have epigenetic adverse effects on the health of future generations. In conclusion, the carcinogenic effects of endocrine disruptors on female cancer types is plausible although additional studies are needed to clarify their mechanisms and entities. In the last part of the review we suggest ways to reduce ED exposure as it is mandatory to implement necessary measures to limit exposure, particularly during those periods of life most vulnerable to the impact of oncogenic environmental causes, such as the embryonic period and puberty. PMID:25998096

  17. On the usage of health records for the design of virtual patients: a systematic review

    PubMed Central

    2013-01-01

    Background The process of creating and designing Virtual Patients for teaching students of medicine is an expensive and time-consuming task. In order to explore potential methods of mitigating these costs, our group began exploring the possibility of creating Virtual Patients based on electronic health records. This review assesses the usage of electronic health records in the creation of interactive Virtual Patients for teaching clinical decision-making. Methods The PubMed database was accessed programmatically to find papers relating to Virtual Patients. The returned citations were classified and the relevant full text articles were reviewed to find Virtual Patient systems that used electronic health records to create learning modalities. Results A total of n = 362 citations were found on PubMed and subsequently classified, of which n = 28 full-text articles were reviewed. Few articles used unformatted electronic health records other than patient CT or MRI scans. The use of patient data, extracted from electronic health records or otherwise, is widespread. The use of unformatted electronic health records in their raw form is less frequent. Patient data use is broad and spans several areas, such as teaching, training, 3D visualisation, and assessment. Conclusions Virtual Patients that are based on real patient data are widespread, yet the use of unformatted electronic health records, abundant in hospital information systems, is reported less often. The majority of teaching systems use reformatted patient data gathered from electronic health records, and do not use these electronic health records directly. Furthermore, many systems were found that used patient data in the form of CT or MRI scans. Much potential research exists regarding the use of unformatted electronic health records for the creation of Virtual Patients. PMID:24011027

  18. Progress made towards enhancement of rheumatology education and practice in Zambia: review of an ILAR-supported project.

    PubMed

    Chipeta, James; Njobvu, Panganani; McGill, Paul E; Bucala, Richard

    2014-01-01

    The burden of non-communicable diseases such as musculoskeletal diseases in the developing world is often overshadowed by the more prevalent infectious diseases. Generally, there is gross underestimation of the burden of rheumatologic disease in the backdrop of scanty or indeed non-existent rheumatology services in these countries. Local studies conducted in the last two decades in Zambia have documented the increasing burden of rheumatologic conditions in the country. There are unfortunately negligible rheumatology services in the country both at tertiary or primary health-care facility levels. There is thus an urgent need to build capacity for these services so as to improve the care and management of rheumatic conditions. Here, we review progress made by an International League of Associations for Rheumatology (ILAR)-supported project that has run for the past 2 years (2012-2013) with the objective of enhancing paediatric and adult rheumatology education and practice so as to stimulate positive change in practice and related care services in Zambia. During this short time of the project, substantial progress has been made in the areas of paediatric and adult rheumatology services enhancement at the University Teaching Hospital, Lusaka: streamlining of referrals and follow-ups of rheumatology patients, laying foundations for short- and long-term medical education in rheumatology and raising public awareness of rheumatic diseases. The progress made by this grant underscores the suitability of the ILAR mission statement "think global, act local" demonstrating that even with minimum resources and networking, improvement of rheumatology care in developing countries is attainable. PMID:24752350

  19. What is known about the patient's experience of medical tourism? A scoping review

    PubMed Central

    2010-01-01

    Background Medical tourism is understood as travel abroad with the intention of obtaining non-emergency medical services. This practice is the subject of increasing interest, but little is known about its scope. Methods A comprehensive scoping review of published academic articles, media sources, and grey literature reports was performed to answer the question: what is known about the patient's experience of medical tourism? The review was accomplished in three steps: (1) identifying the question and relevant literature; (2) selecting the literature; (3) charting, collating, and summarizing the information. Overall themes were identified from this process. Results 291 sources were identified for review from the databases searched, the majority of which were media pieces (n = 176). A further 57 sources were included for review after hand searching reference lists. Of the 348 sources that were gathered, 216 were ultimately included in this scoping review. Only a small minority of sources reported on empirical studies that involved the collection of primary data (n = 5). The four themes identified via the review were: (1) decision-making (e.g., push and pull factors that operate to shape patients' decisions); (2) motivations (e.g., procedure-, cost-, and travel-based factors motivating patients to seek care abroad); (3) risks (e.g., health and travel risks); and (4) first-hand accounts (e.g., patients' experiential accounts of having gone abroad for medical care). These themes represent the most discussed issues about the patient's experience of medical tourism in the English-language academic, media, and grey literatures. Conclusions This review demonstrates the need for additional research on numerous issues, including: (1) understanding how multiple information sources are consulted and evaluated by patients before deciding upon medical tourism; (2) examining how patients understand the risks of care abroad; (3) gathering patients' prospective and retrospective

  20. ‘Practical’ resources to support patient and family engagement in healthcare decisions: a scoping review

    PubMed Central

    2014-01-01

    Background Extensive literature exists on public involvement or engagement, but what actual tools or guides exist that are practical, tested and easy to use specifically for initiating and implementing patient and family engagement, is uncertain. No comprehensive review and synthesis of general international published or grey literature on this specific topic was found. A systematic scoping review of published and grey literature is, therefore, appropriate for searching through the vast general engagement literature to identify ‘patient/family engagement’ tools and guides applicable in health organization decision-making, such as within Alberta Health Services in Alberta, Canada. This latter organization requested this search and review to inform the contents of a patient engagement resource kit for patients, providers and leaders. Methods Search terms related to ‘patient engagement’, tools, guides, education and infrastructure or resources, were applied to published literature databases and grey literature search engines. Grey literature also included United States, Australia and Europe where most known public engagement practices exist, and Canada as the location for this study. Inclusion and exclusion criteria were set, and include: English documents referencing ‘patient engagement’ with specific criteria, and published between 1995 and 2011. For document analysis and synthesis, document analysis worksheets were used by three reviewers for the selected 224 published and 193 grey literature documents. Inter-rater reliability was ensured for the final reviews and syntheses of 76 published and 193 grey documents. Results Seven key themes emerged from the literature synthesis analysis, and were identified for patient, provider and/or leader groups. Articles/items within each theme were clustered under main topic areas of ‘tools’, ‘education’ and ‘infrastructure’. The synthesis and findings in the literature include 15 different terms and

  1. Problem based review: The patient with acute monoarthritis.

    PubMed

    Suresh, Ernest

    2013-01-01

    Acute monoarthritis is a common medical emergency with wide differential diagnosis. Common underlying causes include trauma, septic arthritis, crystal induced arthritis (gout and pseudogout), and reactive arthritis. Of these, septic arthritis is the diagnosis not to miss because of its association with significant morbidity and mortality. Precise diagnosis of the underlying cause of monoarthritis relies on a good history, physical examination findings, and results of focussed investigations. In this article, a practical approach to diagnosis and initial management of patients presenting with acute monoarthritis is described with the aid of a case vignette.

  2. Medication Adherence in Patients with Bipolar Disorder: A Comprehensive Review.

    PubMed

    Levin, Jennifer B; Krivenko, Anna; Howland, Molly; Schlachet, Rebecca; Sajatovic, Martha

    2016-09-01

    Poor medication adherence is a pervasive problem that causes disability and suffering as well as extensive financial costs among individuals with bipolar disorder (BD). Barriers to adherence are numerous and cross multiple levels, including factors related to bipolar pathology and those unique to an individual's circumstances. External factors, including treatment setting, healthcare system, and broader health policies, can also affect medication adherence in people with BD. Fortunately, advances in research have suggested avenues for improving adherence. A comprehensive review of adherence-enhancement interventions for the years 2005-2015 is included. Specific bipolar adherence-enhancement approaches that target knowledge gaps, cognitive patterns, specific barriers, and motivation may be helpful, as may approaches that capitalize on technology or novel drug-delivery systems. However, much work remains to optimally facilitate long-term medication adherence in people with BD. For adherence-enhancement approaches to be widely adapted, they need to be easily accessible, affordable, and practical. PMID:27435356

  3. Methods to improve rehabilitation of patients following breast cancer surgery: a review of systematic reviews

    PubMed Central

    Loh, Siew Yim; Musa, Aisya Nadia

    2015-01-01

    Context Breast cancer is the most prevalent cancer amongst women but it has the highest survival rates amongst all cancer. Rehabilitation therapy of post-treatment effects from cancer and its treatment is needed to improve functioning and quality of life. This review investigated the range of methods for improving physical, psychosocial, occupational, and social wellbeing in women with breast cancer after receiving breast cancer surgery. Method A search for articles published in English between the years 2009 and 2014 was carried out using The Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, PubMed, and ScienceDirect. Search terms included: ‘breast cancer’, ‘breast carcinoma’, ‘surgery’, ‘mastectomy’, ‘lumpectomy’, ‘breast conservation’, ‘axillary lymph node dissection’, ‘rehabilitation’, ‘therapy’, ‘physiotherapy’, ‘occupational therapy’, ‘psychological’, ‘psychosocial’, ‘psychotherapy’, ‘exercise’, ‘physical activity’, ‘cognitive’, ‘occupational’, ‘alternative’, ‘complementary’, and ‘systematic review’. Study selection Systematic reviews on the effectiveness of rehabilitation methods in improving post-operative physical, and psychological outcomes for breast cancer were selected. Sixteen articles met all the eligibility criteria and were included in the review. Data extraction Included review year, study aim, total number of participants included, and results. Data synthesis Evidence for exercise rehabilitation is predominantly in the improvement of shoulder mobility and limb strength. Inconclusive results exist for a range of rehabilitation methods (physical, psycho-education, nutritional, alternative-complementary methods) for addressing the domains of psychosocial, cognitive, and occupational outcomes. Conclusion There is good evidence for narrowly-focused exercise rehabilitation in improving physical outcome particularly for shoulder

  4. Review of delirium in patients with Parkinson's disease.

    PubMed

    Vardy, Emma R L C; Teodorczuk, Andrew; Yarnall, Alison J

    2015-11-01

    Parkinson's disease (PD) is common and has a number of associated neuropsychiatric disturbances. Of these, delirium has historically been under-recognised. Delirium is an acute disturbance of attention and awareness that fluctuates, and is accompanied by an additional disturbance of cognition. As delirium is known to carry a particularly poor prognosis in terms of morbidity and mortality, and the relationship between delirium and dementia is becoming better defined, we completed a literature review of delirium in the context of PD. A literature search was completed using the databases PubMed, Embase and Ovid Medline. PubMed (1945-2014) was searched in September 2014; Embase (1974-2014); and Ovid Medline (1946-2014) in October 2014. The search terms 'delirium' and 'Parkinsons' in combination were used. Large studies using a robust definition of delirium were lacking in PD. There is the suggestion that PD is a risk factor for delirium and that delirium negatively impacts upon the motor symptom trajectory. Deficits in the neurotransmitters dopamine and acetylcholine are implicated in the pathophysiology of delirium in PD. Systemic inflammation also appears to have a role. Treatment of delirium in PD should include medication review and cautious use of atypical antipsychotics where pharmacological treatment is indicated. Of the atypical antipsychotics studied, quetiapine has the least extrapyramidal side effects. Evidence suggests a specific link between delirium and PD but well-designed clinical studies to evaluate the prevalence, impact and treatment of delirium in PD are required. Given the potential to improve outcomes through delirium prevention we conclude that delirium in PD is an area worthy of further study.

  5. Clinical outcomes in pediatric hemodialysis patients in the USA: lessons from CMS' ESRD CPM Project.

    PubMed

    Neu, Alicia M; Frankenfield, Diane L

    2009-07-01

    Although prospective randomized trials have provided important information and allowed the development of evidence-based guidelines in adult hemodialysis (HD) patients, with approximately 800 prevalent pediatric HD patients in the United States, such studies are difficult to perform in this population. Observational data obtained through the Center for Medicare & Medicaid Services' (CMS') End Stage Renal Disease (ESRD) Clinical Performance Measures (CPM) Project have allowed description of the clinical care provided to pediatric HD patients as well as identification of risk factors for failure to reach adult targets for clinical parameters such as hemoglobin, single-pool Kt/V (spKt/V) and serum albumin. In addition, studies linking data from the ESRD CPM Project and the United States Renal Data System have allowed evaluation of associations between achievement of those targets and the outcomes of hospitalization and death. The results of those studies, while unable to prove cause and effect, suggest that the adult ESRD CPM targets may assist in identifying pediatric HD patients at risk for poor outcomes. PMID:18509683

  6. Problem based review: a patient with Parkinson's disease.

    PubMed

    Arora, A; Fletcher, P

    2013-01-01

    Parkinson's disease (PD) is a chronic, progressive neurodegenerative disease characterized by bradykinesia, tremor and/ or rigidity, often with gait disturbance and postural instability. In addition to these typical features, patients with PD may experience further problems related to the disease itself or to the medications used to treat it. These comorbid problems include neuropsychiatric conditions (including psychosis, hallucinations, excessive daytime sleepiness, anxiety, depression, fatigue and dementia) as well as problems associated with autonomic nervous system function such as bowel and bladder function. PD can also present in emergency situations with a 'neuroleptic malignant like picture' and acute psychosis. It is not uncommon to see motor fluctuations due to drug interactions and 'withdrawal' symptoms following dose reduction of dopamine agonists. In patients with PD, disturbances of mental state constitute some of the most difficult treatment challenges of advanced disease, often limiting effective treatment of motor symptoms and leading to increased disability and poor quality of life. While some of these symptoms may be alleviated by antiparkinsonian medication, especially if they are 'off-period' related, treatment-related phenomena are usually exacerbated by increasing the number or dosage of antiparkinsonian drugs. Elimination of exacerbating factors and simplification of drug regimens are the first and most important steps in improvement of such symptoms.

  7. Intracranial Metastatic Disease Spares the Limbic Circuit: A Review of 697 Metastatic Lesions in 107 Patients

    SciTech Connect

    Marsh, James C.; Herskovic, Arnold M.; Gielda, Benjamin T.; Hughes, Frank F.; Hoeppner, Thomas; Turian, Julius; Abrams, Ross A.

    2010-02-01

    Purpose: We report the incidence of metastatic involvement of the limbic circuit in a retrospective review of patients treated at our institution. This review was performed to assess the feasibility of selectively sparing the limbic system during whole-brain radiotherapy and prophylactic cranial irradiation. Methods and Materials: We identified 697 intracranial metastases in 107 patients after reviewing contrast-enhanced CT and/or MR image sets for each patient. Lesions were localized to the limbic circuit or to the rest of the brain/brain stem. Patients were categorized by tumor histology (e.g., non-small-cell lung cancer, small-cell lung cancer, breast cancer, and other) and by total number of intracranial metastases (1-3, oligometastatic; 4 or more, nonoligometastatic). Results: Thirty-six limbic metastases (5.2% of all metastases) were identified in 22 patients who had a median of 16.5 metastases/patient (limbic metastases accounted for 9.9% of their lesions). Sixteen metastases (2.29%) involved the hippocampus, and 20 (2.86%) involved the rest of the limbic circuit; 86.2% of limbic metastases occurred in nonoligometastatic patients, and 13.8% occurred in oligometastatic patients. The incidence of limbic metastases by histologic subtype was similar. The incidence of limbic metastases in oligometastatic patients was 4.9% (5/103): 0.97%, hippocampus; 3.9%, remainder of the limbic circuit. One of 53 oligometastatic patients (1.9%) had hippocampal metastases, while 4/53 (7.5%) had other limbic metastases. Conclusions: Metastatic involvement of the limbic circuit is uncommon and limited primarily to patients with nonoligometastatic disease, supporting our hypothesis that it is reasonable to selectively exclude or reduce the dose to the limbic circuit when treating patients with prophylactic cranial irradiation or whole-brain radiotherapy for oligometastatic disease not involving these structures.

  8. Asthma out of control? A structured review of recent patient surveys

    PubMed Central

    Holgate, Stephen T; Price, David; Valovirta, Erkka

    2006-01-01

    Background An understanding of the needs and behaviors of asthma patients is important in developing an asthma-related healthcare policy. The primary goal of the present review was to assess patient perspectives on key issues in asthma and its management, as captured in patient surveys. Methods Local, national, and multinational asthma surveys were reviewed to assess patient perspectives, and where possible healthcare provider (HCP) perspectives, on key issues, including diagnosis, treatment, control, quality of life, and other patient-centered outcomes. Twenty-four surveys, conducted or published between 1997 and 2003 in Europe and North America, were included in this review. Substantial differences among studies prevented a formal meta-analysis; instead, data were pooled to allow for general comparisons and qualitative analysis. Results The results indicate that patients' knowledge of the underlying causes of asthma and treatment options remains inadequate. Moreover, patients often tolerate poor symptom control, possess meager knowledge of correct drug usage, and display insufficient adherence to therapy. Many patients have a low expectation of receiving an appropriate therapy or of having a positive encounter with the HCP. Among HCPs, there is evidence of inadequate understanding of disease etiology and poor or unstructured communication with patients, resulting often in inaccurate assessment of disease severity. Moreover, patients often underreport their symptoms and severity, which in turn could lead to misclassification and undertreatment. Conclusion Improving patient education about the importance of achieving optimal asthma control, along with improved communication between patients and HCPs, emphasizing treatment options and optimal treatment of inflammation, may lead to better outcomes and improved asthma management in daily practice. PMID:17140420

  9. Contracts for field projects and supporting research on enhanced oil recovery. Progress review number 87

    SciTech Connect

    1997-10-01

    Approximately 30 research projects are summarized in this report. Title of the project, contract number, company or university, award amount, principal investigators, objectives, and summary of technical progress are given for each project. Enhanced oil recovery projects include chemical flooding, gas displacement, and thermal recovery. Most of the research projects though are related to geoscience technology and reservoir characterization.

  10. [Why do cardiologists disregard sexual health of their patients? A critical review].

    PubMed

    Scardi, Sabino

    2016-05-01

    Sexual activity is an essential aspect of normal human function, well-being and quality of life. Sexual dysfunction is a common problem of increasing incidence in patients with cardiovascular disease, particularly younger and male, and continues over time in life, but these issues are not often discussed in daily practice both for a limited patient-physician relationship and clinicians' poor knowledge. Many studies suggest that the majority of patients and their partners have questions or concerns about their sexual health. Healthcare providers can help their patients if they are aware of the problem. Cardiologists need more knowledge and specific practical training in providing information on sexual concerns and sexual counseling to cardiac patients. This review aims at providing clinicians with most recent evidence about sexual dysfunction, and its management in patients with cardiac disease. Sexual couseling of cardiac patients is an important role for healthcare providers.

  11. Secondary use of structured patient data: interim results of a systematic review.

    PubMed

    Vuokko, Riikka; Mäkelä-Bengs, Päivi; Hyppönen, Hannele; Doupi, Persephone

    2015-01-01

    In addition to patient care, EHR data are increasingly in demand for secondary purposes, e.g. administration, research and enterprise resource planning. We conducted a systematic literature review and subsequent analysis of 85 articles focusing on the secondary use of structured patient records. We grounded the analysis on how patient records have been structured, how these structures have been evaluated and what are the main results achieved from the secondary use viewpoint. We conclude that secondary use requires complete and interoperable patient records, which in turn depend on better alignment of primary and secondary users' needs and benefits. PMID:25991152

  12. Sleeping on a problem: the impact of sleep disturbance on intensive care patients - a clinical review.

    PubMed

    Delaney, Lori J; Van Haren, Frank; Lopez, Violeta

    2015-01-01

    Sleep disturbance is commonly encountered amongst intensive care patients and has significant psychophysiological effects, which protract recovery and increases mortality. Bio-physiological monitoring of intensive care patients reveal alterations in sleep architecture, with reduced sleep quality and continuity. The etiological causes of sleep disturbance are considered to be multifactorial, although environmental stressors namely, noise, light and clinical care interactions have been frequently cited in both subjective and objective studies. As a result, interventions are targeted towards modifiable factors to ameliorate their impact. This paper reviews normal sleep physiology and the impact that sleep disturbance has on patient psychophysiological recovery, and the contribution that the clinical environment has on intensive care patients' sleep.

  13. Automated patient setup and gating using cone beam computed tomography projections

    NASA Astrophysics Data System (ADS)

    Wan, Hanlin; Bertholet, Jenny; Ge, Jiajia; Poulsen, Per; Parikh, Parag

    2016-03-01

    In radiation therapy, fiducial markers are often implanted near tumors and used for patient positioning and respiratory gating purposes. These markers are then used to manually align the patients by matching the markers in the cone beam computed tomography (CBCT) reconstruction to those in the planning CT. This step is time-intensive and user-dependent, and often results in a suboptimal patient setup. We propose a fully automated, robust method based on dynamic programming (DP) for segmenting radiopaque fiducial markers in CBCT projection images, which are then used to automatically optimize the treatment couch position and/or gating window bounds. The mean of the absolute 2D segmentation error of our DP algorithm is 1.3+/- 1.0 mm for 87 markers on 39 patients. Intrafraction images were acquired every 3 s during treatment at two different institutions. For gated patients from Institution A (8 patients, 40 fractions), the DP algorithm increased the delivery accuracy (96+/- 6% versus 91+/- 11% , p  <  0.01) compared to the manual setup using kV fluoroscopy. For non-gated patients from Institution B (6 patients, 16 fractions), the DP algorithm performed similarly (1.5+/- 0.8 mm versus 1.6+/- 0.9 mm, p  =  0.48) compared to the manual setup matching the fiducial markers in the CBCT to the mean position. Our proposed automated patient setup algorithm only takes 1-2 s to run, requires no user intervention, and performs as well as or better than the current clinical setup.

  14. Integrated Framework for Patient Safety and Energy Efficiency in Healthcare Facilities Retrofit Projects.

    PubMed

    Mohammadpour, Atefeh; Anumba, Chimay J; Messner, John I

    2016-07-01

    There is a growing focus on enhancing energy efficiency in healthcare facilities, many of which are decades old. Since replacement of all aging healthcare facilities is not economically feasible, the retrofitting of these facilities is an appropriate path, which also provides an opportunity to incorporate energy efficiency measures. In undertaking energy efficiency retrofits, it is vital that the safety of the patients in these facilities is maintained or enhanced. However, the interactions between patient safety and energy efficiency have not been adequately addressed to realize the full benefits of retrofitting healthcare facilities. To address this, an innovative integrated framework, the Patient Safety and Energy Efficiency (PATSiE) framework, was developed to simultaneously enhance patient safety and energy efficiency. The framework includes a step -: by -: step procedure for enhancing both patient safety and energy efficiency. It provides a structured overview of the different stages involved in retrofitting healthcare facilities and improves understanding of the intricacies associated with integrating patient safety improvements with energy efficiency enhancements. Evaluation of the PATSiE framework was conducted through focus groups with the key stakeholders in two case study healthcare facilities. The feedback from these stakeholders was generally positive, as they considered the framework useful and applicable to retrofit projects in the healthcare industry.

  15. Integrated Framework for Patient Safety and Energy Efficiency in Healthcare Facilities Retrofit Projects.

    PubMed

    Mohammadpour, Atefeh; Anumba, Chimay J; Messner, John I

    2016-07-01

    There is a growing focus on enhancing energy efficiency in healthcare facilities, many of which are decades old. Since replacement of all aging healthcare facilities is not economically feasible, the retrofitting of these facilities is an appropriate path, which also provides an opportunity to incorporate energy efficiency measures. In undertaking energy efficiency retrofits, it is vital that the safety of the patients in these facilities is maintained or enhanced. However, the interactions between patient safety and energy efficiency have not been adequately addressed to realize the full benefits of retrofitting healthcare facilities. To address this, an innovative integrated framework, the Patient Safety and Energy Efficiency (PATSiE) framework, was developed to simultaneously enhance patient safety and energy efficiency. The framework includes a step -: by -: step procedure for enhancing both patient safety and energy efficiency. It provides a structured overview of the different stages involved in retrofitting healthcare facilities and improves understanding of the intricacies associated with integrating patient safety improvements with energy efficiency enhancements. Evaluation of the PATSiE framework was conducted through focus groups with the key stakeholders in two case study healthcare facilities. The feedback from these stakeholders was generally positive, as they considered the framework useful and applicable to retrofit projects in the healthcare industry. PMID:27492415

  16. [Disease management for heart failure patients: role of wireless technologies for telemedicine. The ICAROS project].

    PubMed

    Villani, Alessandra; Malfatto, Gabriella; Della Rosa, Francesco; Branzi, Giovanna; Boarin, Simona; Borghi, Claudio; Cosentino, Eugenio; Gualerzi, Massimo; Coruzzi, Paolo; Molinari, Enrico; Compare, Angelo; Cassi, Maurizio; Collatina, Stefano; Parati, Gianfranco

    2007-02-01

    Healthcare costs for heart failure are increasing. The need for a better care, however, has to be matched with a policy of cost containment. A way to improve the cost-effectiveness of heart failure care is the disease management approach, in which therapy, education and follow-up are tailored for each patient by a multidisciplinary team. Such a complex intervention can be facilitated by the use of telemedicine, which allows the remote control of considerable amounts of clinical data. In Italy, a few studies with telemedicine have been reported. A recent development in this field is represented by the ICAROS project (Integrated Care vs Conventional Intervention in Cardiac Failure Patients: Randomized Open Label Study), whose aim is to improve the clinical and psychological care of heart failure patients employing advanced wireless telecommunication technology. So far, we randomized 60 patients: 30 in usual ambulatory care, 30 in an intensive treatment group. The latter patients were instructed to use a portable computer to get in touch daily with the heart failure clinic and receive feedback instruction for the management of drug therapy and daily problems. At the first year of follow-up, the treatment group showed good compliance to drug prescriptions, and could easily handle the portable computer. The preliminary results of this ongoing study support the feasibility and appropriateness of new technologies for the management of heart failure, even in elderly patients in whom a limited expertise with these appliances could have been anticipated.

  17. [Disease management for heart failure patients: role of wireless technologies for telemedicine. The ICAROS project].

    PubMed

    Villani, Alessandra; Malfatto, Gabriella; Della Rosa, Francesco; Branzi, Giovanna; Boarin, Simona; Borghi, Claudio; Cosentino, Eugenio; Gualerzi, Massimo; Coruzzi, Paolo; Molinari, Enrico; Compare, Angelo; Cassi, Maurizio; Collatina, Stefano; Parati, Gianfranco

    2007-02-01

    Healthcare costs for heart failure are increasing. The need for a better care, however, has to be matched with a policy of cost containment. A way to improve the cost-effectiveness of heart failure care is the disease management approach, in which therapy, education and follow-up are tailored for each patient by a multidisciplinary team. Such a complex intervention can be facilitated by the use of telemedicine, which allows the remote control of considerable amounts of clinical data. In Italy, a few studies with telemedicine have been reported. A recent development in this field is represented by the ICAROS project (Integrated Care vs Conventional Intervention in Cardiac Failure Patients: Randomized Open Label Study), whose aim is to improve the clinical and psychological care of heart failure patients employing advanced wireless telecommunication technology. So far, we randomized 60 patients: 30 in usual ambulatory care, 30 in an intensive treatment group. The latter patients were instructed to use a portable computer to get in touch daily with the heart failure clinic and receive feedback instruction for the management of drug therapy and daily problems. At the first year of follow-up, the treatment group showed good compliance to drug prescriptions, and could easily handle the portable computer. The preliminary results of this ongoing study support the feasibility and appropriateness of new technologies for the management of heart failure, even in elderly patients in whom a limited expertise with these appliances could have been anticipated. PMID:17402355

  18. Progressive Mobility Protocol Reduces Venous Thromboembolism Rate in Trauma Intensive Care Patients: A Quality Improvement Project.

    PubMed

    Booth, Kathryn; Rivet, Josh; Flici, Richelle; Harvey, Ellen; Hamill, Mark; Hundley, Douglas; Holland, Katelyn; Hubbard, Sandra; Trivedi, Apurva; Collier, Bryan

    2016-01-01

    The intensive care unit (ICU) trauma population is at high risk for complications associated with immobility. The purpose of this project was to compare ICU trauma patient outcomes before and after implementation of a structured progressive mobility (PM) protocol. Outcomes included hospital and ICU stays, ventilator days, falls, respiratory failure, pneumonia, or venous thromboembolism (VTE). In the preintervention cohort, physical therapy (PT) consults were placed 53% of the time. This rose to more than 90% during the postintervention period. PT consults seen within 24 hr rose from a baseline 23% pre- to 74%-94% in the 2 highest compliance postintervention months. On average, 40% of patients were daily determined to be too unstable for mobility per protocol guidelines-most often owing to elevated intracranial pressure. During PM sessions, there were no adverse events (i.e., extubation, hypoxia, fall). There were no significant differences in clinical outcomes between the 2 cohorts regarding hospital and ICU stays, average ventilator days, mortality, falls, respiratory failure, or pneumonia overall or within ventilated patients specifically. There was, however, a difference in the incidence of VTE between the preintervention cohort (21%) and postintervention cohort (7.5%) (p = .0004). A PM protocol for ICU trauma patients is safe and may reduce patient deconditioning and VTE complications in this high-risk population. Multidisciplinary commitment, daily protocol reinforcement, and active engagement of patients/families are the cornerstones to success in this ICU PM program. PMID:27618376

  19. Psychiatric and psychological comorbidities in patients with psoriasis- a review.

    PubMed

    Rabin, F; Bhuiyan, S I; Islam, T; Haque, M A; Islam, M A

    2012-10-01

    Psoriasis is a common inflammatory skin disease. The impact of psoriasis on quality of life is significant even when it involves relatively limited body surface area (BSA). Life stresses have been found as both a cause of psoriasis and as an aggravating factor in the disease. In different large epidemiological studies up to 79% patients of psoriasis had a negative impact on their lives, and Psoriasis was reported to be associated stressful life event in 10-90%, depression in 24-51%, felt shame and embarrassment over their appearance in 89%, lack of confidence in 42%, family friction in 26%, wish to be dead to active suicidal ideation in 9.7-5.5%, addiction and alcoholism in 18% and also significant impact upon sexual function. Children with psoriasis had 25-47% higher risk of developing any psychiatric disorder, 23-62% higher risk of develop depression and 32-250% higher risk of anxiety.

  20. Is video review of patient encounters an effective tool for medical student learning? A review of the literature

    PubMed Central

    Hammoud, Maya M; Morgan, Helen K; Edwards, Mary E; Lyon, Jennifer A; White, Casey

    2012-01-01

    Purpose To determine if video review of student performance during patient encounters is an effective tool for medical student learning. Methods Multiple bibliographic databases that include medical, general health care, education, psychology, and behavioral science literature were searched for the following terms: medical students, medical education, undergraduate medical education, education, self-assessment, self-evaluation, self-appraisal, feedback, videotape, video recording, televised, and DVD. The authors examined all abstracts resulting from this search and reviewed the full text of the relevant articles as well as additional articles identified in the reference lists of the relevant articles. Studies were classified by year of student (preclinical or clinical) and study design (controlled or non-controlled). Results A total of 67 articles met the final search criteria and were fully reviewed. Most studies were non-controlled and performed in the clinical years. Although the studies were quite variable in quality, design, and outcomes, in general video recording of performance and subsequent review by students with expert feedback had positive outcomes in improving feedback and ultimate performance. Video review with self-assessment alone was not found to be generally effective, but when linked with expert feedback it was superior to traditional feedback alone. Conclusion There are many methods for integrating effective use of video-captured performance into a program of learning. We recommend combining student self-assessment with feedback from faculty or other trained individuals for maximum effectiveness. We also recommend additional research in this area. PMID:23761999

  1. Pemetrexed clinical studies in performance status 2 patients with non-small cell lung cancer (Review).

    PubMed

    Zinner, Ralph; Visseren-Grul, Carla; Spigel, David R; Obasaju, Coleman

    2016-01-01

    Because poor performance status (PS) is an independent prognostic factor in non-small cell lung cancer (NSCLC), PS scores are widely used by oncologists to make treatment decisions. Advanced NSCLC patients with an Eastern Cooperative Oncology Group PS of 2 have poor prognoses and are frequently excluded from clinical trials. This article reviews the efficacy and safety of pemetrexed in this patient group. We identified English-language literature (through March 2015) involving completed and ongoing studies through searches of PubMed, meeting abstracts, ClinicalTrials.gov and the European Clinical Trials Register; search terms included 'pemetrexed,' 'NSCLC' and 'PS2'. Only studies reporting ≥1 subset analysis of PS2 patients receiving pemetrexed were chosen. Our search identified a total of ten pemetrexed studies in PS2 patients. Eight studies included only chemonaive patients, one study included both chemonaive patients and patients with one prior chemotherapy regimen and one study included only patients with one prior regimen. In subset analyses in these studies, PS2 patients had worse outcomes than PS0-1 patients regardless of treatment. In a phase 3 study, chemonaive advanced NSCLC patients with PS2 receiving pemetrexed‑carboplatin versus pemetrexed experienced improved overall survival [hazard ratio (HR)=0.62; P=0.001], progression-free survival (HR=0.46; P<0.001) and response (P=0.032). This review confirms the poorer outcomes in PS2 vs. PS0-1 patients. Although it is not an approved combination therapy, in clinical studies, PS2 patients treated with pemetrexed plus carboplatin as first-line therapy had improved response rates and survival. Additional research on PS2 patients is needed.

  2. Tri-State Synfuels Project Review: Volume 12. Fluor project status. [Proposed Henderson, Kentucky coal to gasoline plant; engineering

    SciTech Connect

    Not Available

    1982-06-01

    The purpose of this report is to document and summarize activities associated with Fluor's efforts on the Tri-State Synfuels Project. The proposed facility was to be coal-to-transport fuels facility located in Henderson, Kentucky. Tri-State Synfuels Company was participating in the project as a partner of the US Department of Energy per terms of a Cooperative Agreement resulting from DOE's synfuel's program solicitation. Fluor's initial work plan called for preliminary engineering and procurement services to the point of commitment for construction for a Sasol Fischer-Tropsch plant. Work proceeded as planned until October 1981 when results of alternative coal-to-methanol studies revealed the economic disadvantage of the Synthol design for US markets. A number of alternative process studies followed to determine the best process configuration. In January 1982 Tri-State officially announced a change from Synthol to a Methanol to Gasoline (MTG) design basis. Further evaluation and cost estimates for the MTG facility eventually led to the conclusion that, given the depressed economic outlook for alternative fuels development, the project should be terminated. Official announcement of cancellation was made on April 13, 1982. At the time of project cancellation, Fluor had completed significant portions of the preliminary engineering effort. Included in this report are descriptions and summaries of Fluor's work during this project. In addition location of key project data and materials is identified and status reports for each operation are presented.

  3. A systematic review of time studies to assess the impact of patient transfers on nurse workload.

    PubMed

    Blay, Nicole; Duffield, Christine M; Gallagher, Robyn; Roche, Michael

    2014-12-01

    Patients in hospital are increasingly being moved between clinical units and between bedspaces; however, the impact of patient transfers and bedspace moves on nurses' workload is not known. Time studies are an established observational research method that can be used to determine the duration of time taken to perform an activity or process. This review systematically searched four databases for literature published between 2000 and 2013 for observational time study techniques and patient transfers as a nurse activity. Eleven publications from three countries were included in the review. All studies used timing techniques to explore nurse work associated with the transfer process. The review highlights the duration of time spent by nurses on certain aspects of the transfer process. However, as few studies published results from timings, the impact on nurse time is likely to be higher than indicated. Further research is recommended. PMID:24689656

  4. A systematic review of time studies to assess the impact of patient transfers on nurse workload.

    PubMed

    Blay, Nicole; Duffield, Christine M; Gallagher, Robyn; Roche, Michael

    2014-12-01

    Patients in hospital are increasingly being moved between clinical units and between bedspaces; however, the impact of patient transfers and bedspace moves on nurses' workload is not known. Time studies are an established observational research method that can be used to determine the duration of time taken to perform an activity or process. This review systematically searched four databases for literature published between 2000 and 2013 for observational time study techniques and patient transfers as a nurse activity. Eleven publications from three countries were included in the review. All studies used timing techniques to explore nurse work associated with the transfer process. The review highlights the duration of time spent by nurses on certain aspects of the transfer process. However, as few studies published results from timings, the impact on nurse time is likely to be higher than indicated. Further research is recommended.

  5. Use and toxicity of complementary and alternative medicines among patients visiting emergency department: Systematic review

    PubMed Central

    Jatau, Abubakar Ibrahim; Aung, Myat Moe Thwe; Kamauzaman, Tuan Hairulnizam Tuan; Chedi, Basheer A. Z.; Sha’aban, Abubakar; Rahman, Ab Fatah Ab

    2016-01-01

    Many studies have been conducted in health-care settings with regards to complementary and alternative medicine (CAM) use among patients. However, information regarding CAM use among patients in the emergency department (ED) is scarce. The aim of this article was to conduct a systematic review of published studies with regards to CAM use among the ED patients. A literature search of published studies from inception to September 2015 was conducted using PubMed, Scopus, and manual search of the reference list. 18 studies that met the inclusion criteria were reviewed. The prevalence rate of CAM use among ED patients across the studies ranged of 1.4-68.1%. Herbal therapy was the sub-modality of CAM most commonly used and frequently implicated in CAM-related ED visits. Higher education, age, female gender, religious affiliation, and chronic diseases were the most frequent factors associated with CAM use among the ED patients. Over 80% of the ED physicians did not ask the patients about the CAM therapy. Similarly, 80% of the ED patients were ready to disclose CAM therapy to the ED physician. The prevalence rate of CAM use among patients at ED is high and is growing with the current increasing popularity, and it has been a reason for some of the ED visits. There is a need for the health-care professionals to receive training and always ask patients about CAM therapy to enable them provide appropriate medical care and prevent CAM-related adverse events. PMID:27104042

  6. Do patients in hospitals benefit from single rooms? A literature review.

    PubMed

    van de Glind, Irene; de Roode, Stanny; Goossensen, Anne

    2007-12-01

    In the context of growing attention for 'healing environments' and 'evidence based design' an increasing number of hospitals have decided to provide single-bedded rooms. However it remains unclear to what extent these policy decisions are based on scientific evidence. The aim of this study is to review the literature on benefits of single patient rooms for patients. The following outcome measures were used: privacy and dignity, patient satisfaction with care, noise and quality of sleep, hospital infection rates, recovery rates, and patient safety issues. We selected 25 studies for review. Randomized controlled trials on this subject were scarce, but other empirical studies have been found. We found that single rooms have a moderate effect on patient satisfaction with care, noise and quality of sleep, and the experience of privacy and dignity. Conflicting results have been found on hospital infection rates. Some studies did not show significant differences, while others concluded that single rooms decrease the risk of hospital infections. Evidence on recovery rates and patient safety was lacking. Too few sound studies were found to evaluate the effects of single patient rooms thoroughly. Future research should build the body of knowledge on single-bedded rooms in order to explore their impact on well-being and healing on both patients and staff. Also consequences of single rooms to management of care should be explored. Research should support policy making by exploring, indicating and initiating improvements in patient housing and quality of care.

  7. A quality improvement project: Strategies to reduce intradialytic hypotension in hemodialysis patients.

    PubMed

    Ghaffar, Umbar; Easom, Andrea K

    2015-05-01

    Intradialytic hypotension is defined as a decrease in systolic blood pressure by ≥ 20 mm Hg or a decrease in mean arterial pressure by 10 mm Hg, and is associated with symptoms that include abdominal discomfort, yawning, sighing, nausea, vomiting, muscle cramps, restlessness, dizziness or fainting, and anxiety. The incidence of a symptomatic reduction in blood pressure during (or immediately following) dialysis ranges from 15-50% of dialysis sessions. It is a major cause for morbidity in elderly hemodialysis patients and those with cardiovascular compromise. It impairs patient well-being, limits ultrafiltration, and increases the risk for coronary and cerebral ischemic events as well as vascular access thrombosis. Several studies have shown a poorer survival in dialysis patients who experience frequent hypotensive episodes on dialysis as opposed to those who do not. In our outpatient dialysis unit, we identified that 9% of our dialysis patients experienced a decrease in their systolic blood pressure to below 80 during dialysis. The purpose of this quality improvement project was to study the factors associated with intradialytic hypotension in these patients and institute appropriate measures to mitigate this issue. Another aim was to educate the dialysis staff on how to manage these patients. Patients were selected using data from weekly rounding reports and orders were written for interventions including ultrafiltration profiling, cool (36 degrees C) dialysate, weight-based ultrafiltration, etc. Outcomes were studied over a period of 3 months. We found that up to 40% of patients experienced an improvement in their blood pressure profile over the period of the study, suggesting that simple changes to dialysis prescription can result in a significant reduction in the incidence of intradialytic hypotension.

  8. A Systematic Review of Applying Patient Satisfaction Outcomes in Plastic Surgery

    PubMed Central

    Clapham, Philip J.; Pushman, Allison G.; Chung, Kevin C.

    2015-01-01

    Background We performed a systematic review of patient satisfaction studies in the Plastic Surgery literature. The specific aim was to evaluate the status of satisfaction research that has been undertaken to date and to identify areas for improvement. Methods Four medical databases were searched using satisfaction and Plastic Surgery related search terms. Quality of selected articles was assessed by two trained reviewers. Results Out of the total of 2,936 articles gleaned by the search, 178 were included in the final review. The majority of the articles (58%) in our review examined patient satisfaction in breast surgery populations. Additionally, 53% of the articles were limited in scope and only measured features of care in one or two domains of satisfaction. Finally, the majority of the studies (68%) were based solely on the use of ad-hoc satisfaction measurement instruments that did not undergo a formal development. Conclusion Given the important policy implications of patient satisfaction data within Plastic Surgery, we found a need to further refine research on patient satisfaction in Plastic Surgery. The scarcity of satisfaction research in the craniofacial, hand, and other reconstructive specialties, as well as the narrow scope of satisfaction measurement and the use of unvalidated instruments are current barriers preventing Plastic Surgery patient satisfaction studies from producing meaningful results. PMID:20517109

  9. Is Gastroparesis Found More Frequently in Patients with Cystic Fibrosis? A Systematic Review

    PubMed Central

    Corral, Juan E.; Dye, Corey W.; Mascarenhas, Maria R.; Barkin, Jamie S.; Salathe, Matthias; Moshiree, Baharak

    2016-01-01

    Cystic fibrosis (CF) is associated with different gastrointestinal motility disturbances and syndromes. We aim to assess gastric emptying in patients with CF compared to healthy controls by a systematic review of existing literature. Medical databases and abstracts from major gastroenterology and CF meetings were reviewed. Emptying times in CF patients were compared with healthy controls using random effects models. Subgroup analysis stratified results by age and diagnostic modality. Nineteen studies from 7 countries included 574 subjects (359 CF patients and 215 controls). Using pooled analysis frequency of gastroparesis was high (38%, 95% CI 30–45%) but results were highly dependent on the diagnostic modality. Delayed gastric emptying is more common in CF compared to general population. Scintigraphy identified rapid gastric emptying in a subgroup of CF patients, but this finding disappeared with adequate pancreatic enzyme replacement and after other diagnostic modalities were included. PMID:27313953

  10. A systematic review of disease-related stigmatization in patients living with inflammatory bowel disease

    PubMed Central

    Taft, Tiffany H; Keefer, Laurie

    2016-01-01

    Chronic illness stigma is a global public health issue. Most widely studied in HIV/AIDS and mental illness, stigmatization of patients living with inflammatory bowel disease (IBD), chronic autoimmune conditions affecting the digestive tract, has garnered increasing attention in recent years. In this paper, we systematically review the scientific literature on stigma as it relates to IBD across its three domains: perception, internalization, and discrimination experiences. We aim to document the current state of research, identify gaps in our knowledge, recognize unique challenges that IBD patients may face as they relate to stigmatization, and offer suggestions for future research directions. Based on the current review, patients living with IBD may encounter stigmatization and this may, in turn, impact several patient outcomes including quality of life, psychological functioning, and treatment adherence. Significant gaps exist related to the understanding of IBD stigma, providing opportunity for future studies to address this important public health issue. PMID:27022294

  11. Twenty-five years of obstetric patient satisfaction in North America: a review of the literature.

    PubMed

    Wilcock, A; Kobayashi, L; Murray, I

    1997-03-01

    The North American literature on obstetric patient satisfaction of the past 25 years was reviewed using two major computerized databases. The articles identified by these searches were supplemented with other research articles identified in reference lists. The review highlights the difficulties inherent in the use of many different methodologies to study obstetric patient satisfaction. The main methodologies have been mailed questionnaires, telephone interviews, and semistructured interviews, with data collection periods ranging from 24 hours to 2 years postpartum. The various approaches to data collection make comparison of results among studies exceedingly difficult. The reluctance of patients to criticize their caregivers has been problematic and is evidenced by satisfaction ratings that are positively skewed. Factors that have been reported to be most influential in obstetric patient satisfaction include communication, control, participation in decision making, presence of a support person, information/prenatal classes, nursing care services, length of stay, and physical environment. The relative importance of these factors, however, has not been ascertained.

  12. Is Gastroparesis Found More Frequently in Patients with Cystic Fibrosis? A Systematic Review.

    PubMed

    Corral, Juan E; Dye, Corey W; Mascarenhas, Maria R; Barkin, Jamie S; Salathe, Matthias; Moshiree, Baharak

    2016-01-01

    Cystic fibrosis (CF) is associated with different gastrointestinal motility disturbances and syndromes. We aim to assess gastric emptying in patients with CF compared to healthy controls by a systematic review of existing literature. Medical databases and abstracts from major gastroenterology and CF meetings were reviewed. Emptying times in CF patients were compared with healthy controls using random effects models. Subgroup analysis stratified results by age and diagnostic modality. Nineteen studies from 7 countries included 574 subjects (359 CF patients and 215 controls). Using pooled analysis frequency of gastroparesis was high (38%, 95% CI 30-45%) but results were highly dependent on the diagnostic modality. Delayed gastric emptying is more common in CF compared to general population. Scintigraphy identified rapid gastric emptying in a subgroup of CF patients, but this finding disappeared with adequate pancreatic enzyme replacement and after other diagnostic modalities were included. PMID:27313953

  13. Cancer survivorship research: a review of the literature and summary of current NCI-designated cancer center projects.

    PubMed

    Harrop, J Phil; Dean, Julie A; Paskett, Electra D

    2011-10-01

    The number of cancer survivors and the amount of cancer survivorship research have grown substantially during the past three decades. This article provides a review of interventional and observational cancer survivorship research efforts as well as a summary of current cancer survivorship research projects being conducted by National Cancer Institute-designated cancer centers in an effort to identify areas that need further attention.

  14. Trends in Research on Project-Based Science and Technology Teaching and Learning at K-12 Levels: A Systematic Review

    ERIC Educational Resources Information Center

    Hasni, Abdelkrim; Bousadra, Fatima; Belletête, Vincent; Benabdallah, Ahmed; Nicole, Marie-Claude; Dumais, Nancy

    2016-01-01

    Project-based teaching is nothing new; it originates from the work of authors like Dewey and Kilpatrick. Recent decades have seen renewed interest in this approach. In many countries, it is currently considered to be an innovative approach to science and technology (S&T) teaching. In this article, we present a systematic review of what recent…

  15. DOE responses to Ecology review comments for ``Sampling and analysis plans for the 100-D Ponds voluntary remediation project``

    SciTech Connect

    1996-12-31

    The Sampling and Analysis Plan describes the sampling and analytical activities which will be performed to support closure of the 100-D Ponds at the Hanford Reservation. This report contains responses by the US Department of Energy to Ecology review for ``Sampling and Analysis Plan for the 100-D Ponds Voluntary Remediation Project.``

  16. Investigating the Quality of Project-Based Science and Technology Learning Environments in Elementary School: A Critical Review of Instruments

    ERIC Educational Resources Information Center

    Thys, Miranda; Verschaffel, Lieven; Van Dooren, Wim; Laevers, Ferre

    2016-01-01

    This paper provides a systematic review of instruments that have the potential to measure the quality of project-based science and technology (S&T) learning environments in elementary school. To this end, a comprehensive literature search was undertaken for the large field of S&T learning environments. We conducted a horizontal bottom-up…

  17. 43 CFR 404.51 - Are proposed projects under the Rural Water Supply Program reviewed by the Administration?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 43 Public Lands: Interior 1 2014-10-01 2014-10-01 false Are proposed projects under the Rural Water Supply Program reviewed by the Administration? 404.51 Section 404.51 Public Lands: Interior Regulations Relating to Public Lands BUREAU OF RECLAMATION, DEPARTMENT OF THE INTERIOR RECLAMATION RURAL WATER SUPPLY PROGRAM Feasibility Studies §...

  18. Patient disclosure of medical errors in paediatrics: A systematic literature review.

    PubMed

    Koller, Donna; Rummens, Anneke; Le Pouesard, Morgane; Espin, Sherry; Friedman, Jeremy; Coffey, Maitreya; Kenneally, Noah

    2016-05-01

    Medical errors are common within paediatrics; however, little research has examined the process of disclosing medical errors in paediatric settings. The present systematic review of current research and policy initiatives examined evidence regarding the disclosure of medical errors involving paediatric patients. Peer-reviewed research from a range of scientific journals from the past 10 years is presented, and an overview of Canadian and international policies regarding disclosure in paediatric settings are provided. The purpose of the present review was to scope the existing literature and policy, and to synthesize findings into an integrated and accessible report. Future research priorities and policy implications are then identified.

  19. The Association Between Patient-Reported and Objective Oral Anticancer Medication Adherence Measures: A Systematic Review

    PubMed Central

    Atkinson, Thomas M.; Rodríguez, Vivian M.; Gordon, Mallorie; Avildsen, Isabelle K.; Emanu, Jessica C.; Jewell, Sarah T.; Anselmi, Kimberly A.; Ginex, Pamela K.

    2016-01-01

    Problem Identification Oral anticancer medication (OAM) use has been steadily increasing, leading to several patient benefits. A notable challenge for nurses is accurate monitoring of patient OAM regimens because nonadherence is associated with poor health outcomes and decreased survival. Currently, no gold standard measure of OAM adherence exists. The authors conducted a systematic review of the association between objective and patient-reported measures of OAM adherence. Literature Search A systematic electronic literature search was conducted using PubMed, EMBASE, Scopus, PsycINFO®, Cochrane Library, Web of Science, and CINAHL® databases through November 2014. Data Evaluation Articles were independently reviewed to determine whether they included an original characterization of the level of association between objective and patient-reported measures of OAM adherence. Synthesis From a total of 11,135 articles retrieved, eight studies met inclusion criteria. Objective adherence was primarily assessed using pill counts or Medication Event Monitoring System (MEMSCap™). Patient-reported adherence was most commonly assessed using study-specific questionnaires. Significant positive correlations were observed between objective and patient-reported adherence across most studies, with three studies reporting higher rates of adherence via patient reporting. Conclusions Despite variation in the OAMs and measures used, patient-reported adherence rates were equal to or higher than objective adherence measures across studies. Social desirability bias may be a concern; however, given the significant concordance observed, using patient-reported methods in future studies of OAM adherence may be justified. Implications for Nursing This review provides evidence to support nursing use of patient-reported measures to accurately monitor OAM adherence and potentially improve the quality of patient–provider communication. PMID:27541550

  20. Boston type 1 keratoprosthesis from patient selection through postoperative management: a review for the keratoprosthetic surgeon

    PubMed Central

    Williamson, Samantha L; Cortina, M Soledad

    2016-01-01

    For the anterior segment surgeon, the implantation of Boston type 1 keratoprosthesis is a multistep process that begins with careful patient selection. Success depends on thorough preoperative evaluation, detailed surgical planning, and frequent postoperative follow-up. New practice patterns have emerged for each of these phases as the international experience with keratoprosthesis grows. This review details special considerations that can improve outcomes and also allow surgeons to consider its use in challenging patient populations at each step. PMID:27041986

  1. Body image among eating disorder patients with disabilities: a review of published case studies.

    PubMed

    Cicmil, Nela; Eli, Karin

    2014-06-01

    While individual cases of eating disorder (ED) patients with disabilities have been reported, there has been little synthesis of their experiences of body image and thin idealization. This study reviews 19 published clinical reports of ED patients with sensory, mobility-related, or intellectual disabilities and evaluates the extent to which their experiences align with or challenge current conceptions of body image in ED. ED patients with visual impairment reported a profound disturbance of body image, perceived intersubjectively and through tactile sensations. Reducing dependence in mobility was an important motivation to control body size for ED patients with mobility-related disabilities. ED as a way of coping with and compensating for the psychosocial consequences of disability was a recurrent theme for patients across a range of disabilities. These experiential accounts of ED patients with disabilities broaden current understandings of body image to include touch and kinaesthetic awareness, intersubjective dynamics, and perceptions of normalcy.

  2. Implementing the Patient-Centered Medical Home: Observation and Description of the National Demonstration Project

    PubMed Central

    Stewart, Elizabeth E.; Nutting, Paul A.; Crabtree, Benjamin F.; Stange, Kurt C.; Miller, William L.; Jaén, Carlos Roberto

    2010-01-01

    PURPOSE We provide an overall description of the National Demonstration Project (NDP) intervention to transform family practices into patient-centered medical homes. METHODS An independent evaluation team used multiple data sources and methods to describe the design and implementation of the NDP. These included direct observation of the implementation team and project meetings, site visits to practices, depth interviews with practice members and implementation team members, access to practice communications (eg, telephone calls, e-mails), and public domain materials (eg, the NDP Web site). RESULTS The American Academy of Family Physicians created a new division called TransforMED, which launched the 24-month NDP in June 2006. From 337 family medicine practices completing an extensive online application, 36 were selected and randomized to a facilitated group, which received tailored, intensive assistance and services from TransforMED, or a self-directed group, which received very limited assistance. Three facilitators from diverse backgrounds in finance, practice management, and organizational psychology used multiple practice change strategies including site visits, e-mails, metrics, and learning sessions. The self-directed practices worked primarily on their own, but self-organized a retreat midway through the project. The intervention model for the project evolved to be consistent with the emerging national consensus principles of the patient-centered medical home. The independent evaluation team studied the NDP and provided ongoing feedback to inform the implementation process. CONCLUSIONS The NDP illustrates that complex practice change interventions must combine flexibility in the intervention model, implementation strategy, and the evaluation, in order to maximize ongoing learning. PMID:20530392

  3. Music therapy with Alzheimer's patients and their family caregivers: a pilot project.

    PubMed

    Brotons, Melissa; Marti, Patricia

    2003-01-01

    The purpose of this paper is to present the results of a pilot project sponsored by a private foundation in Spain ("Fundació la Caixa"), in order to demonstrate some of the applications of music therapy, and to measure more systematically some of its effects on people with a probable diagnosis of Alzheimer's Disease and Related Disorders (ADRD) in early-moderate stages of the disease, and their family caregivers. Subjects for this project were 14 patients (5 women and 9 men) with a probable diagnosis of Alzheimer's disease, and 14 family caregivers (9 women and 5 men) from a rural area outside of Barcelona. Their age range was 70 to 80 years. Prior to the beginning of the project, a neuropsychologist specialized in gerontology administered a series of standardized tests to the participants. These same tests were administered again 2 days before the end of the project and 2 months later for follow-up purposes. The results of the satisfaction questionnaire showed that the caregivers perceived an improvement in the social and emotional areas of their patients, and statistical tests showed significant differences between pre and posttest scores in the following tests: (a) Dementia Scale (X2 = 12.29, p = .002), (b) NPI (X2 = 17.72, p = .001), (c) the Cohen-Mansfield agitation scale (X2 = 11.45, p = .003), (d) Burden Interview (X2 = 9.19, p = .01), (e) Memory and Behavior Problems Checklist (frequency subscale) (X2 = 11.09, p = .004), (f) STAI-S (X2 = 14.72, p = .001), and (g) Beck's Depression Inventory (X2 = 9.38, p = .009). These results and their implications are discussed extensively.

  4. Diet and inflammatory bowel disease: review of patient-targeted recommendations.

    PubMed

    Hou, Jason K; Lee, Dale; Lewis, James

    2014-10-01

    Patients have strong beliefs about the role of diet in the cause of inflammatory bowel disease (IBD) and in exacerbating or alleviating ongoing symptoms from IBD. The rapid increase in the incidence and prevalence of IBD in recent decades strongly suggests an environmental trigger for IBD, one of which may be dietary patterns. There are several pathways where diet may influence intestinal inflammation, such as direct dietary antigens, altering the gut microbiome, and affecting gastrointestinal permeability. However, data that altering diet can change the natural history of IBD are scarce, and evidence-based dietary guidelines for patients with IBD are lacking. Patients, therefore, seek nonmedical resources for dietary guidance, such as patient support groups and unverified sources on the Internet. The aim of this review is to identify patient-targeted dietary recommendations for IBD and to critically appraise the nutritional value of these recommendations. We review patient-targeted dietary information for IBD from structured Internet searches and popular defined diets. Patient-targeted dietary recommendations focus on food restrictions and are highly conflicting. High-quality dietary intervention studies are needed to facilitate creation of evidence-based dietary guidelines for patients with IBD. PMID:24107394

  5. Elderly cancer patients' psychopathology: a systematic review: aging and mental health.

    PubMed

    Parpa, Efi; Tsilika, Eleni; Gennimata, Vassiliki; Mystakidou, Kyriaki

    2015-01-01

    This review of the literature on elderly cancer patients and their psychiatric disorders was undertaken to determine the extent of the problem. It consists of articles with elderly cancer patients. Keyword terms included "cancer", "elderly", "aging", "geriatric", "psychiatric disorders", "psychiatric symptoms", "psychological problems", "aged >60 years", "sucidal ideation, geriatric, cancer", "suicide geriatric cancer". We conducted searches on the following databases: PubMed; PsychINFO (1980-2013); finally, 102 publications were suitable for the current review. Depression in elderly cancer patients is the most common disorder in elderly cancer patients associated with disability, morbidity and mortality. Anxiety disorders may be less frequent in geriatric patients; however, it seemed to be a major problem in late life. Psychiatric disorders are common in geriatric patients with cancer especially at advanced stages of the disease. In addition, health care professionals can help provide treatment and emotional support. Future research should aim to provide data about the real prevalence and severity of psychiatric disorders in elderly patients with cancer, for the improvement of patients' quality of life and their caregivers.

  6. Effects of Screening for Psychological Distress on Patient Outcomes in Cancer: a Systematic Review

    PubMed Central

    Meijer, Anna; Roseman, Michelle; Delisle, Vanessa C.; Milette, Katherine; Levis, Brooke; Syamchandra, Achyuth; Stefanek, Michael E.; Stewart, Donna E.; de Jonge, Peter; Coyne, James C.; Thombs, Brett D.

    2013-01-01

    Objective Several practice guidelines recommend routine screening for psychological distress in cancer care. The objective was to evaluate the effect of screening cancer patients for psychological distress by assessing the (1) effectiveness of interventions to reduce distress among patients identified as distressed; and (2) effects of screening for distress on distress outcomes. Methods CINAHL, Cochrane, EMBASE, ISI, MEDLINE, PsycINFO, and SCOPUS databases were searched through April 6, 2011 with manual searches of 45 relevant journals, reference list review, citation tracking of included articles, and trial registry reviews through June 30, 2012. Articles in any language on cancer patients were included if they (1) compared treatment for patients with psychological distress to placebo or usual care in a randomized controlled trial (RCT); or (2) assessed the effect of screening on psychological distress in a RCT. Results There were 14 eligible RCTs for treatment of distress, and 1 RCT on the effects of screening on patient distress. Pharmacological, psychotherapy and collaborative care interventions generally reduced distress with small to moderate effects. One study investigated effects of screening for distress on psychological outcomes, and it found no improvement. Conclusion Treatment studies reported modest improvement in distress symptoms, but only a single eligible study was found on the effects of screening cancer patients for distress, and distress did not improve in screened patients versus those receiving usual care. Because of the lack of evidence of beneficial effects of screening cancer patients for distress, it is premature to recommend or mandate implementation of routine screening. PMID:23751231

  7. Diet and Inflammatory Bowel Disease: Review of Patient-Targeted Recommendations

    PubMed Central

    Hou, Jason K.; Lee, Dale; Lewis, James

    2014-01-01

    Patients have strong beliefs about the role of diet in the cause of inflammatory bowel disease (IBD) and in exacerbating or alleviating ongoing symptoms from IBD. The rapid increase in the incidence and prevalence of IBD in the past several decades strongly suggests an environmental trigger for IBD, one of which may be dietary patterns. There are several pathways where diet may influence intestinal inflammation such as direct dietary antigens, altering the gut microbiome, and affecting gastrointestinal permeability. However, data that altering diet can change the natural history of IBD are scarce and evidence based dietary guidelines for patients with IBD are lacking. Patients therefore seek non-medical resources for dietary guidance such as patient support groups and unverified sources on the internet. The aim of this review is to identify patient-targeted dietary recommendations for IBD and to critically appraise the nutritional value of these recommendations. We review patient-targeted dietary information for IBD from structured internet searches and popular defined diets. Patient-targeted dietary recommendations focus on food restrictions and are highly conflicting. High quality dietary intervention studies are needed to facilitate creation of evidence-based dietary guidelines for patients with IBD. PMID:24107394

  8. The Doctor-Patient Relationship in the Adolescent Cancer Setting: A Developmentally Focused Literature Review.

    PubMed

    Siembida, Elizabeth J; Bellizzi, Keith M

    2015-09-01

    Several national reports and many individuals in the clinical oncology community have defined the adolescent and young adult (AYA) cancer population as individuals diagnosed between the ages of 15 and 39. However, neuroscience and developmental research have identified important decision-making skills (e.g., information processing, reasoning, emotion regulation) that are not fully developed during adolescence, making general, AYA-focused doctor-patient interaction guidelines potentially questionable for the adolescent cancer population. Most studies include adolescents in samples of pediatric cancer patients or include adolescents in samples of young adult cancer patients, but studies rarely consider adolescent cancer patients as a distinct, developmentally unique group. A systematic literature review was undertaken in October 2014 to begin to understand what is known about the doctor-patient relationship and communication preferences within adolescent oncology. From the 25 included studies, three important conclusions emerged: (1) discrepancies among adolescent patients, parents, and providers about the desired extent of involvement in treatment-related decisions; (2) patient desire for developmentally and culturally appropriate information provision; and (3) the desire and preference for how information is delivered, with recognition that these preferences may change with age. There was some variation in themes by study design, with studies directly observing medical consultations reporting less adolescent involvement in discussions than studies that surveyed doctors. The results of this review support the need for developmentally focused research and clinical guidelines that emphasize the experience of adolescent cancer patients separate from their older and younger counterparts.

  9. Environmental Variables That Influence Patient Satisfaction: A Review of the Literature.

    PubMed

    MacAllister, Lorissa; Zimring, Craig; Ryherd, Erica

    2016-10-01

    Patient's perception of care-referred to as patient satisfaction-is of great interest in the healthcare industry, as it becomes more directly tied to the revenue of the health system providers. The perception of care has now become important in addition to the actual health outcome of the patient. The known influencers for the patient perception of care are the patient's own characteristics as well as the quality of service received. In patient surveys, the physical environment is noted as important for being clean and quiet but is not considered a critical part of patient satisfaction or other health outcomes. Patient perception of care is currently measured as patient satisfaction, a systematic collection of perceptions of social interactions from an individual person as well as their interaction with the environment. This exploration of the literature intends to explore the rigorous, statistically tested research conducted that has a spatial predictor variable and a health or behavior outcome, with the intent to begin to further test the relationships of these variables in the future studies. This literature review uses the patient satisfaction framework of components of influence and identifies at least 10 known spatial environmental variables that have been shown to have a direct connection to the health and behavior outcome of a patient. The results show that there are certain features of the spatial layout and environmental design in hospital or work settings that influence outcomes and should be noted in the future research. PMID:27492078

  10. Does primary medical practitioner involvement with a specialist team improve patient outcomes? A systematic review.

    PubMed

    Mitchell, Geoffrey; Del Mar, Chris; Francis, Daniel

    2002-11-01

    Patients with chronic or complex medical or psychiatric conditions are treated by many practioners, including general practitioners (GPs). Formal liaison between primary and specialist is often assumed to offer benefits to patients. The aim of this study was to assess the efficacy of formal liaison of GPs with specialist service providers on patient health outcomes, by conducting a systematic review of the published literature in MEDLINE, EMBASE, PsychINFO, CINAHL and Cochrane Library databases using the following search terms: 'family physician': synonyms of 'patient care planning', 'patient discharge' and 'patient care team'; and synonyms of 'randomised controlled trials'. Seven studies were identified, involving 963 subjects and 899 controls. Most health outcomes were unchanged, although some physical and functional health outcomes were improved by formal liaison between GPs and specialist services, particularly among chronic mental illness patients. Some health outcomes worsened during the intervention. Patient retention rates within treatment programmes improved with GP involvement, as did patient satisfaction. Doctor (GP and specialist) behaviour changed with reports of more rational use of resources and diagnostic tests, improved clinical skills, more frequent use of appropriate treatment strategies, and more frequent clinical behaviours designed to detect disease complications. Cost effectiveness could not be determined. In conclusion, formal liaison between GPs and specialist services leaves most physical health outcomes unchanged, but improves functional outcomes in chronically mentally ill patients. It may confer modest long-term health benefits through improvements in patient concordance with treatment programmes and more effective clinical practice. PMID:12434964

  11. Intestinal Infections Among Febrile Hospitalized Patients in the Republic of Armenia: A Retrospective Chart Review.

    PubMed

    Zardaryan, Eduard; Paronyan, Lusine; Bakunts, Vahe; Gevorgyan, Zaruhi; Asoyan, Vigen; Apresyan, Hripsime; Hovhannisyan, Alvard; Palayan, Karo; Kuchuloria, Tinatin; Rivard, Robert G; Bautista, Christian T

    2016-10-01

    In the past, several enteric outbreaks in 1996, 1998, 1999, and 2003 caused by Salmonella typhi, a Gram-negative bacterium, have occurred in Armenia. This study describes the demographic, epidemiological, and clinical characteristics of febrile hospitalized patients with intestinal infections in Armenia. Using a chart review study design, medical data from adult patients who were hospitalized at the Nork hospital during 2010-2012 were reviewed. A total of 600 medical charts were reviewed. Of these, 51 % were diagnosed with intestinal infections. Among these patients, 59 % had an intestinal infection of known etiology, with three main pathogens identified: Salmonella sp. (32 %), Shigella sp. (32 %), and Staphylococcus aureus (18 %). After controlling for the calendar year, age in years, and gender, patients detected with Salmonella sp. were more likely to reported the presence of a family member with similar signs or symptoms [odds ratio (OR) 9.0; 95 % CI 2.4-33.7] and the lack of a water tap at home (OR 3.9; 95 % CI 1.7-9.5). Evidence indicates that Salmonella sp., Shigella sp., and S. aureus as the most common etiologies reported among febrile hospitalized patients. A high percentage of patients had intestinal infections of unknown etiology; thus, improvement in laboratory capacity (enabling more advanced tests, such as polymerase chain reaction) would increase the identification of the enteropathogens causing disease in Armenia. PMID:26992893

  12. Does adherence therapy improve medication adherence among patients with schizophrenia? A systematic review.

    PubMed

    Hegedüs, Anna; Kozel, Bernd

    2014-12-01

    Non-adherence to medication is highly prevalent in patients with schizophrenia. Adherence therapy aims to improve medication adherence of these patients by applying techniques of cognitive behavioural therapy, psycho-education, and motivational interviewing. Even though adherence therapy is frequently discussed and researched, its effectiveness is still uncertain. This paper aims to review the effectiveness of adherence therapy on the medication adherence of patients with schizophrenia. To this end, six electronic databases were systematically searched for randomized, controlled trials on adherence therapy from January 2002 to March 2013. Four trials met the inclusion criteria and were incorporated into the review. The findings suggest that adherence therapy does not improve patients' medication adherence in comparison to treatment as usual or a control intervention. However, all the studies reviewed showed high-adherence ratings at baseline. Thus, further well-designed studies that target adherence therapy to patients who are non-adherent to their medication are needed for a more profound understanding of its effectiveness. In addition, if adherence therapy is aimed not only at improving medication adherence, but also to reach an agreement whereby the patient's decision not to take his medication is accepted, the shared decision-making process needs to be assessed as well.

  13. BPA-Solicited Technical Review of "Echo Meadows Project Winter Artificial Recharge: Final Report for 2001 Baseline", Technical Report 2004.

    SciTech Connect

    Morgan, David

    2004-02-01

    The purpose of this report was to provide, at BPA's request, a technical review of interim products received for Project 2001-015-00 under contract 6925. BPA sometimes solicits technical reviews for Fish and Wildlife products or issues where outside expertise is required. External review of complex project deliverables assures BPA as a funding agency that the contractor is continuing with scientifically-credible experimental techniques envisioned in the original proposal. If the project's methodology proves feasible, there could be potential applications beyond the project area to similar situations in the Columbia Basin. The Experiment involves artificial flooding during high flow periods and a determination of the portion of the return flows that end up in the Umatilla River during low flow months and within acceptable water quality parameters (e.g., low temperature, few contaminants). Flooding could be a critical water source for aquatic organisms at times of the year when flows in the lower reaches of the Umatilla River are low and water is warmer than would be desired. The experiment was proposed to test whether 'this process, recharges the shallow aquifers of the old flood plain, for natural filtration through the alluvial soils as it returns to the Umatilla River, cleaner and cooler (about 50 degree Fahrenheit) five to six month later (about July and August) substantially cooling the river and [making it] more beneficial to anadromous [fish]'. A substantial amount of preliminary data had been collected and preliminary results were submitted in an interim report 'Echo Meadows Project Winter Artificial Recharge: Final Report for 2001 Baseline (December 2002)'. A substantial amount of addition funding was provided for the last cycle of flooding (Phases II) and final analyses of the full compliment of data collected over the life of the contract (Phase III). Third party scientific review may assist the contractor in producing a higher quality Final Report with

  14. Ethical review of projects involving non-human primates funded under the European Union's 7th Research Framework Programme.

    PubMed

    Sauer, Ursula; Phillips, Barry; Reid, Kirsty; Schmit, Véronique; Jennings, Maggy

    2013-09-01

    Internet searches were performed on projects involving non-human primates ('primates') funded under the European Union (EU) 7th Research Framework Programme (FP7), to determine how project proposals are assessed from an ethical point of view. Due to the incompleteness of the information publicly available, the types and severity of the experiments could not be determined with certainty, although in some projects the level of harm was considered to be 'severe'. Information was scarce regarding the numbers of primates, their sourcing, housing, care and fate, or the application of the Three Rs within projects. Project grant holders and the relevant Commission officer were consulted about their experiences with the FP7 ethics review process. Overall, it was seen as meaningful and beneficial, but some concerns were also noted. Ethical follow-up during project performance and upon completion was recognised as a valuable tool in ensuring that animal welfare requirements were adequately addressed. Based upon the outcome of the survey, recommendations are presented on how to strengthen the ethical review process under the upcoming Framework Programme 'Horizon 2020', while adequately taking into account the specific requirements of Directive 2010/63/EU, with the aim of limiting the harms inflicted on the animals and the numbers used, and ultimately, replacing the use of primates altogether. PMID:24168134

  15. Striking a balance between national interests and patients' needs: cross-border projects meeting European challenges.

    PubMed

    Burger, Renate; Kostera, Thomas

    2010-01-01

    The article deals with the new opportunities for EU member state citizens to go abroad for medical treatment. The European Court of Justice has facilitated the access to medical treatment for EU citizens in other EU states. This development has worried national governments since they feared reduced control in their healthcare systems. The cross-border project "healthacross" between Austria and the Czech Republic however illustrates in which way authorities can respond to patients needs in two different countries. Nevertheless a plethora of administrative and practical problems have to be solved for cross-border co-operation in the provision of healthcare. PMID:21391444

  16. County of Strathcona No. 20, Sherwood Park, Alberta, Canada. Review Development Project, Phase 1: System Review Design.

    ERIC Educational Resources Information Center

    Corbishley, B.; And Others

    This review of the Strathcona County school system (Alberta, Canada) makes recommendations based on information gathered in 1986. Following an introductory chapter, chapter 2 summarizes findings and recommendations. The review involved surveys of employees, community members, and community groups. Recommendations concern organization, evaluation,…

  17. Patient Receptivity to Tobacco Cessation Counseling and Services in a Dental Teaching Institute: A Patient Review

    PubMed Central

    Patil, Pavan Uday; Vivek, S; Chandrasekhar, Thatimatla; Parimi, Nalini; Praveen, B H; Lingaraj, Sunil

    2015-01-01

    Background: The dentists are in a unique position to render tobacco cessation counseling to their patients. The current study is set to assess the attitudes of tobacco users toward tobacco cessation counseling attending a dental teaching institute and hospital in Andhra Pradesh. Materials and Methods: A systematic random sampling method was used to select the sample. Survey was conducted among 660 patients attending a dental teaching institute. Patients who have completed oral examination in the department of oral medicine and radiology were asked to complete pretested questionnaire. The questionnaire was designed in both English and Telugu (local language). Results: Among the study subjects 88.9% were planning to quit the habit, 72.27% had agreed that they discussed about ill-effects of tobacco, 82% of the subjects said that dentist should routinely offer quit tobacco assistance and services. Conclusion: The present study indicates the majority of patients are receptive towards tobacco counseling and services in the dental setting. In this study, the majority of tobacco users were planning to quit. Majority of patients were unaware of the resources available to help them to quit. Dentists have a significant opportunity to disseminate information to patients who need assistance in quitting the habit of tobacco usage. PMID:25709362

  18. Patient Compliance in Home-Based Self-Care Telehealth Projects.

    PubMed

    Maeder, Anthony; Poultney, Nathan; Morgan, Gary; Lippiatt, Robert

    2015-12-01

    This paper presents the findings of a literature review on patient compliance in home-based self-care telehealth monitoring situations, intended to establish a knowledge base for this aspect which is often neglected alongside more conventional clinical, economic and service evaluations. A systematic search strategy led to 72 peer-reviewed published scientific papers being selected as most relevant to the topic, 58 of which appeared in the last 10 years. Patient conditions in which most evidence for compliance was found were blood pressure, heart failure and stroke, diabetes, asthma, chronic obstructive pulmonary disease and other respiratory diseases. In general, good compliance at the start of a study was found to drop off over time, most rapidly in the period immediately after the start. Success factors identified in the study included the extent of patient health education, telehealth system implementation style, user training and competence in system usage, active human support from the healthcare provider and maintaining strong participant motivation. PMID:26556057

  19. Temporal phase unwrapping algorithms for fringe projection profilometry: A comparative review

    NASA Astrophysics Data System (ADS)

    Zuo, Chao; Huang, Lei; Zhang, Minliang; Chen, Qian; Asundi, Anand

    2016-10-01

    In fringe projection profilometry (FPP), temporal phase unwrapping is an essential procedure to recover an unambiguous absolute phase even in the presence of large discontinuities or spatially isolated surfaces. So far, there are typically three groups of temporal phase unwrapping algorithms proposed in the literature: multi-frequency (hierarchical) approach, multi-wavelength (heterodyne) approach, and number-theoretical approach. In this paper, the three methods are investigated and compared in detail by analytical, numerical, and experimental means. The basic principles and recent developments of the three kind of algorithms are firstly reviewed. Then, the reliability of different phase unwrapping algorithms is compared based on a rigorous stochastic noise model. Furthermore, this noise model is used to predict the optimum fringe period for each unwrapping approach, which is a key factor governing the phase measurement accuracy in FPP. Simulations and experimental results verified the correctness and validity of the proposed noise model as well as the prediction scheme. The results show that the multi-frequency temporal phase unwrapping provides the best unwrapping reliability, while the multi-wavelength approach is the most susceptible to noise-induced unwrapping errors.

  20. Call for Enrolling More Professionals in the IFCC Project on Laboratory Errors and Patient Safety.

    PubMed

    Plebani, Mario; Laura, Sciacovelli

    2011-03-01

    Patient safety is the foundation of good care. In the last decades, a body of evidence has been accumulated to demonstrate that pre- and post-analytical phase are more vulnerable to errors in laboratory medicine than the analytical phase. Aims of the project of the IFCC Working Group on "Laboratory Errors and Patient Safety" (WG-LEPS) are: a) to develop a series of Quality Indicators (QIs), specifically designed for clinical laboratories, b) to create a common reporting system for clinical laboratories based on standardized data collection, and c) to define state-of the-art and Quality Specifications (QSs) for each QI Preliminary results demonstrate that a Model of Quality Indicators can serve as a tool to monitor and control the pre-, intra- and post-analytical activities. However, only after enrolling a more consistent number of clinical laboratories, it should be possible to assure consistency to the data collected and reliability to the QIs identified and to related QSs.

  1. Students meeting with caregivers of cancer patient: results of an experience-based learning project.

    PubMed

    Atasoy, Beste M; Sarikaya, Ozlem; Kuscu, M Kemal; Yondem, Merve; Buyukkara, Elif; Eken, E Gokcen; Kahyaoglu, Figen

    2012-12-01

    The communication between medical students and cancer caregivers, and the problems they have experienced as well as the outcomes for their professional development before starting clinical practice was assessed in the context of a student research project. Data were collected by questionnaires or by 20 to 40-min long interviews with cancer caregivers. Their communications with physicians, hearing the bad news, and health service satisfaction were questioned. Therefore, the caregivers trusted the professional approach of their physician. However, they expected more empathic communication in the process of diagnosis and therapy. Development of empathy and trust-based communication between patients and physicians and enhancement of the quality of devoted time to cancer patients and caregivers may have an effect on the course of disease. Interviewer students mentioned that they developed communication skills about difficult clinical tasks and in delivering bad news face to face to cancer caregivers before starting their clinical education. PMID:22733617

  2. The role of antioxidant micronutrients in the rate of recovery of burn patients: a systematic review.

    PubMed

    Adjepong, Mary; Agbenorku, Pius; Brown, Patricia; Oduro, Ibok

    2016-01-01

    Burn injury can be detrimental to the health of individuals, meanwhile victims lose proteins and micronutrients in wound exudates. Victims also experience extensive protein catabolism. These make them prone to malnutrition. Burn patients also suffer a lot of emotional trauma that reduce nutrient intake. The aim of this paper was to review primary evidence on the effect of antioxidant micronutrients on the recovery rate of burn patients. Electronic databases such as PubMed, BioMed, and Cochrane were systematically searched between January 1, 2014, and January 30, 2014. Keywords include vitamin A, vitamin C, vitamin E, ascorbic acid, zinc, copper, selenium, tocopherol, carotenoids, dietary intake, supplementation, wound healing, infection, recovery rate, and burn patients. The systematic search was done to retrieve all published data from 1990 to 2013. A total of 518 journal articles were obtained, and after the removal of duplicates, reviews, commentaries, and studies with non-human subjects, 11 papers were accepted for review. The review considered only papers that were published, and there might be some unpublished data that may have been omitted. Generally, the wound healing time and infection rates were reduced by the administration of the antioxidant micronutrients. The review revealed that there was no such published work in developing countries and children were excluded from most studies. It was also stated clearly that there was no uniformity in burn management; hence, there is a need for more studies on burn management in various populations. PMID:27574687

  3. Metal-on-Metal Hip Arthroplasty: A Review of Adverse Reactions and Patient Management.

    PubMed

    Drummond, James; Tran, Phong; Fary, Camdon

    2015-01-01

    Recent alarming joint registry data highlighting increased revision rates has prompted further research into the area of metal-on-metal hip replacements and resurfacings. This review article examines the latest literature on the topic of adverse reactions to metal debris and summarises the most up-to-date guidelines on patient management. Adverse reactions to metal debris can cause significant damage to soft tissue and bone if not diagnosed early. Furthermore, not every patient with an adverse reaction to metal debris will be symptomatic. As such, clinicians must remain vigilant when assessing and investigating these patients in order to detect failing implants and initiate appropriate management. PMID:26132653

  4. Camouflage therapy workshop for pediatric dermatology patients: a review of 6 cases.

    PubMed

    Padilla-España, L; del Boz, J; Ramírez-López, M B; Fernández-Sánchez, M E

    2014-06-01

    Certain skin conditions, such as vitiligo, acne, vascular malformations, and surgical scars, can impair the quality of life of pediatric patients, especially adolescents-even to the point of hindering psychosocial development. We review the cases of 6 patients with discoloration or scarring, predominantly of the face, who attended our cosmetic camouflage workshops from January through December 2012. The quality-of-life impact of their skin disorder was assessed before and after workshop attendance. Cosmetic camouflage is an easily replicated, cheap, and noninvasive adjunctive treatment of great potential value in managing skin conditions that impair the physical and emotional well-being of pediatric patients. PMID:24369988

  5. A Technological Review of the Instrumented Footwear for Rehabilitation with a Focus on Parkinson's Disease Patients.

    PubMed

    Maculewicz, Justyna; Kofoed, Lise Busk; Serafin, Stefania

    2016-01-01

    In this review article, we summarize systems for gait rehabilitation based on instrumented footwear and present a context of their usage in Parkinson's disease (PD) patients' auditory and haptic rehabilitation. We focus on the needs of PD patients, but since only a few systems were made with this purpose, we go through several applications used in different scenarios when gait detection and rehabilitation are considered. We present developments of the designs, possible improvements, and software challenges and requirements. We conclude that in order to build successful systems for PD patients' gait rehabilitation, technological solutions from several studies have to be applied and combined with knowledge from auditory and haptic cueing.

  6. Metal-on-Metal Hip Arthroplasty: A Review of Adverse Reactions and Patient Management

    PubMed Central

    Drummond, James; Tran, Phong; Fary, Camdon

    2015-01-01

    Recent alarming joint registry data highlighting increased revision rates has prompted further research into the area of metal-on-metal hip replacements and resurfacings. This review article examines the latest literature on the topic of adverse reactions to metal debris and summarises the most up-to-date guidelines on patient management. Adverse reactions to metal debris can cause significant damage to soft tissue and bone if not diagnosed early. Furthermore, not every patient with an adverse reaction to metal debris will be symptomatic. As such, clinicians must remain vigilant when assessing and investigating these patients in order to detect failing implants and initiate appropriate management. PMID:26132653

  7. Solitary central osteoma of mandible in a geriatric patient: Report and review

    PubMed Central

    Bhujbal, Ravi B.; Nayak, Ajay G.

    2016-01-01

    Solitary central osteomas of jaw are extremely rare lesions with only few previously documented cases. This paper reports a case of large solitary central osteoma involving mandible symphysis- parasymphysis region in an elderly female patient. A brief review of similar cases reported in the literature is also provided in this paper. Key words:Osteomas, osteogenic,bone, tumor, jaw, mandible. PMID:27034765

  8. A systematic review of sleep disorders in patients with chronic kidney disease undergoing hemodialysis

    PubMed Central

    Fonseca, Nina Teixeira; Urbano, Jessica Julioti; Nacif, Sergio Roberto; Silva, Anderson Soares; Peixoto, Roger Andre Oliveira; Urbano, Giovanni Julioti; Oliveira, Ezequiel Fernandes; Santos, Israel Reis; Oliveira, Claudia Santos; Insalaco, Giuseppe; Oliveira, Luis Vicente Franco

    2016-01-01

    The purpose of this study was to conduct a systematic review of the available evidence on sleep disorders in patients with end stage renal disease (ESRD) undergoing hemodialysis (HD). [Subjects and Methods] Two independent reviewers performed a computer-assisted search of the MEDLINE, SciELO, LILACS, and BIREME Virtual Health Library medical databases from their inception to November 2015. [Results] One thousand one hundred twenty-six articles were found that met the inclusion criteria. Articles were excluded if they were not in English, the patients did not undergo HD, or the studies were not cross-sectional or clinical trials. After reading the full text, a further 300 studies were excluded because they did not use polysomnography. The remaining 18 studies with ESRD patients undergoing HD comprised 8 clinical trials and 10 cross-sectional studies. This systematic review followed the criteria outlined by the PRISMA declaration. [Conclusion] In this systematic review, a high prevalence of sleep disorders was observed in ESRD, including sleep-disordered breathing. This knowledge may enable health professionals to devise new strategies for the diagnosis and treatment of these patients, in order to reduce morbidity and mortality and improve their quality of life. PMID:27512289

  9. The cost-effectiveness of patient decision aids: A systematic review.

    PubMed

    Trenaman, Logan; Bryan, Stirling; Bansback, Nick

    2014-12-01

    The Affordable Care Act includes provisions to encourage patient-centered care through the use of shared decision making (SDM) and patient decision aids (PtDA). PtDAs are tools that can help encourage SDM by providing information about competing treatment options and elucidating patients׳ values and preferences. Implementing PtDAs into routine practice may incur additional costs through training or increases in physician time. Prominent commentaries have proposed that these costs might be offset if patients choose less expensive options than their providers. However, the cost-effectiveness of PtDAs to date is unclear. The aim of this study was to review the economic evidence from PtDA trials. Our search identified 5347 articles, with 29 included following full-text review. Only one economic evaluation of a PtDA has been completed, which found a PtDA to be cost-saving in women with menorrhagia. Other studies included in the review indicated that PtDAs will likely increase up-front costs, but in some contexts may reduce short-term costs by reducing the uptake of invasive treatments, such as elective surgery. Few studies comprehensively captured long-term costs or measured benefits in a manner conducive to economic evaluation (QALYs or general health utilities). Our review suggests that policy makers currently have insufficient economic evidence to appropriately consider their investments in PtDAs.

  10. Instruments to assess patient satisfaction after teleconsultation and triage: a systematic review

    PubMed Central

    Allemann Iseli, Martina; Kunz, Regina; Blozik, Eva

    2014-01-01

    Background Patient satisfaction is crucial for the acceptance, use, and adherence to recommendations from teleconsultations regarding health care requests and triage services. Objectives Our objectives are to systematically review the literature for multidimensional instruments that measure patient satisfaction after teleconsultation and triage and to compare these for content, reliability, validity, and factor analysis. Methods We searched Medline, the Cumulative Index to Nursing and Allied Health Literature, and PsycINFO for literature on these instruments. Two reviewers independently screened all obtained references for eligibility and extracted data from the eligible articles. The results were presented using summary tables. Results We included 31 publications, describing 16 instruments in our review. The reporting on test development and psychometric characteristics was incomplete. The development process, described by ten of 16 instruments, included a review of the literature (n=7), patient or stakeholder interviews (n=5), and expert consultations (n=3). Four instruments evaluated factor structure, reliability, and validity; two of those four demonstrated low levels of reliability for some of their subscales. Conclusion A majority of instruments on patient satisfaction after teleconsultation showed methodological limitations and lack rigorous evaluation. Users should carefully reflect on the content of the questionnaires and their relevance to the application. Future research should apply more rigorously established scientific standards for instrument development and psychometric evaluation. PMID:25028538

  11. A systematic review of sleep disorders in patients with chronic kidney disease undergoing hemodialysis.

    PubMed

    Fonseca, Nina Teixeira; Urbano, Jessica Julioti; Nacif, Sergio Roberto; Silva, Anderson Soares; Peixoto, Roger Andre Oliveira; Urbano, Giovanni Julioti; Oliveira, Ezequiel Fernandes; Santos, Israel Reis; Oliveira, Claudia Santos; Insalaco, Giuseppe; Oliveira, Luis Vicente Franco

    2016-07-01

    The purpose of this study was to conduct a systematic review of the available evidence on sleep disorders in patients with end stage renal disease (ESRD) undergoing hemodialysis (HD). [Subjects and Methods] Two independent reviewers performed a computer-assisted search of the MEDLINE, SciELO, LILACS, and BIREME Virtual Health Library medical databases from their inception to November 2015. [Results] One thousand one hundred twenty-six articles were found that met the inclusion criteria. Articles were excluded if they were not in English, the patients did not undergo HD, or the studies were not cross-sectional or clinical trials. After reading the full text, a further 300 studies were excluded because they did not use polysomnography. The remaining 18 studies with ESRD patients undergoing HD comprised 8 clinical trials and 10 cross-sectional studies. This systematic review followed the criteria outlined by the PRISMA declaration. [Conclusion] In this systematic review, a high prevalence of sleep disorders was observed in ESRD, including sleep-disordered breathing. This knowledge may enable health professionals to devise new strategies for the diagnosis and treatment of these patients, in order to reduce morbidity and mortality and improve their quality of life.

  12. The Tell-Tale Tasks: A Review of Saccadic Research in Psychiatric Patient Populations

    ERIC Educational Resources Information Center

    Gooding, Diane C.; Basso, Michele A.

    2008-01-01

    This review focuses on saccade research with adult psychiatric patients. It begins with an introduction of the various types of saccades and the tasks used to evoke them. The functional significance of the different types of eye movements is briefly discussed. Research findings regarding the saccadic performance of different adult psychiatric…

  13. Dental treatment of the pregnant patient: literature review and guidelines for the practicing clinician.

    PubMed

    Shessel, Bradley A; Portnof, Jason E; Kaltman, Steven I; Nitsch, Romy

    2013-01-01

    The purpose of this review article is to assist the practicing clinician by categorizing and packaging useful clinical information into a format that will assist with the treatment of pregnant patients. Our goal is to offer the scientific foundations that lead to current practice guidelines, specifically those that are of particular relevance to today's dental professional.

  14. The Use of Errorless Learning Strategies for Patients with Alzheimer's Disease: A Literature Review

    ERIC Educational Resources Information Center

    Li, Ruijie; Liu, Karen P. Y.

    2012-01-01

    The aim of this article was to review the evidence of errorless learning on learning outcomes in patients with early-stage Alzheimer's disease. A computer-aided literature search from 1999 to 2011 was carried out using MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO and PsycArticles. Keywords included…

  15. The Prevalence of Body Dysmorphic Disorder in Patients Undergoing Cosmetic Surgery: a Systematic Review.

    PubMed

    Panayi, Andreana

    2015-09-01

    Body dysmorphic disorder (BDD) is a somatoform disorder characterised by a distressing obsession with an imagined or slight appearance defect, which can significantly impair normal day-to-day functioning. Patients with BDD often first present, and are hence diagnosed, in cosmetic surgery settings. Several studies have investigated the prevalence rate of BDD in the general population or have done so for patients referring to cosmetic medical centers. To date, however, no review has been undertaken to compare the prevalence in the general community versus in a cosmetic surgery setting. Despite the lack of such a review it is a commonly held belief that BDD is more common in patients seeking cosmetic surgery. The current study aims to review the available literature in order to investigate whether BDD is indeed more prevalent in patients requesting cosmetic surgery, and if that is the case, to provide possible reasons for the difference in prevalence. In addition this review provides evidence on the effectiveness of cosmetic surgery as a treatment of BDD.

  16. Comprehensive approach to utilization review based on patient-specific costing data.

    PubMed

    Potvin, K A; Leclair, M C

    1995-01-01

    The Ottawa General Hospital (OGH) is one of a growing number of institutions that has implemented a cost accounting system. The ability to track costs on a patient-specific basis provides an exciting avenue for reviewing the use of resources. With the accumulation of a complete fiscal year of data, the hospital recently embarked on a review process to identify opportunities for more detailed review with practitioners. This will support the OGH's surgical approach of targeting cuts, rather than making across-the-board reductions. The objective is to allow the hospital to maintain the highest levels of quality and service as the eroding funding situation allows. This paper describes the comprehensive approach taken by the review team to identify populations of patients that were relatively homogeneous and yet showed the greatest practice pattern variances between physicians. The method described provides a template for others to summarize large amounts of data and stratify patient groups for more detailed analysis of the patient care delivery process.

  17. Evaluation of the Role of Enteral Nutrition in Managing Patients with Diabetes: A Systematic Review

    PubMed Central

    Ojo, Omorogieva; Brooke, Joanne

    2014-01-01

    The aim of this systematic review is to evaluate the role of enteral nutrition in managing patients with diabetes on enteral feed. The prevalence of diabetes is on the increase in the UK and globally partly due to lack of physical activities, poor dietary regimes and genetic susceptibility. The development of diabetes often leads to complications such as stroke, which may require enteral nutritional support. The provision of enteral feeds comes with its complications including hyperglycaemia which if not managed can have profound consequences for the patients in terms of clinical outcomes. Therefore, it is essential to develop strategies for managing patients with diabetes on enteral feed with respect to the type and composition of the feed. This is a systematic review of published peer reviewed articles. EBSCOhost Research, PubMed and SwetsWise databases were searched. Reference lists of identified articles were reviewed. Randomised controlled trials comparing enteral nutrition diabetes specific formulas with standard formulas were included. The studies which compared diabetes specific formulas (DSF) with standard formulas showed that DSF was more effective in controlling glucose profiles including postprandial glucose, HbA1c and insulinemic response. The use of DSF appears to be effective in managing patients with diabetes on enteral feed compared with standard feed. PMID:25412151

  18. Evaluation of the role of enteral nutrition in managing patients with diabetes: a systematic review.

    PubMed

    Ojo, Omorogieva; Brooke, Joanne

    2014-11-18

    The aim of this systematic review is to evaluate the role of enteral nutrition in managing patients with diabetes on enteral feed. The prevalence of diabetes is on the increase in the UK and globally partly due to lack of physical activities, poor dietary regimes and genetic susceptibility. The development of diabetes often leads to complications such as stroke, which may require enteral nutritional support. The provision of enteral feeds comes with its complications including hyperglycaemia which if not managed can have profound consequences for the patients in terms of clinical outcomes. Therefore, it is essential to develop strategies for managing patients with diabetes on enteral feed with respect to the type and composition of the feed. This is a systematic review of published peer reviewed articles. EBSCOhost Research, PubMed and SwetsWise databases were searched. Reference lists of identified articles were reviewed. Randomised controlled trials comparing enteral nutrition diabetes specific formulas with standard formulas were included. The studies which compared diabetes specific formulas (DSF) with standard formulas showed that DSF was more effective in controlling glucose profiles including postprandial glucose, HbA1c and insulinemic response. The use of DSF appears to be effective in managing patients with diabetes on enteral feed compared with standard feed.

  19. A systematic review of sleep disorders in patients with chronic kidney disease undergoing hemodialysis.

    PubMed

    Fonseca, Nina Teixeira; Urbano, Jessica Julioti; Nacif, Sergio Roberto; Silva, Anderson Soares; Peixoto, Roger Andre Oliveira; Urbano, Giovanni Julioti; Oliveira, Ezequiel Fernandes; Santos, Israel Reis; Oliveira, Claudia Santos; Insalaco, Giuseppe; Oliveira, Luis Vicente Franco

    2016-07-01

    The purpose of this study was to conduct a systematic review of the available evidence on sleep disorders in patients with end stage renal disease (ESRD) undergoing hemodialysis (HD). [Subjects and Methods] Two independent reviewers performed a computer-assisted search of the MEDLINE, SciELO, LILACS, and BIREME Virtual Health Library medical databases from their inception to November 2015. [Results] One thousand one hundred twenty-six articles were found that met the inclusion criteria. Articles were excluded if they were not in English, the patients did not undergo HD, or the studies were not cross-sectional or clinical trials. After reading the full text, a further 300 studies were excluded because they did not use polysomnography. The remaining 18 studies with ESRD patients undergoing HD comprised 8 clinical trials and 10 cross-sectional studies. This systematic review followed the criteria outlined by the PRISMA declaration. [Conclusion] In this systematic review, a high prevalence of sleep disorders was observed in ESRD, including sleep-disordered breathing. This knowledge may enable health professionals to devise new strategies for the diagnosis and treatment of these patients, in order to reduce morbidity and mortality and improve their quality of life. PMID:27512289

  20. The level of association between functional performance status measures and patient-reported outcomes in cancer patients: a systematic review

    PubMed Central

    Andreotti, Charissa F.; Roberts, Kailey E.; Saracino, Rebecca M.; Hernandez, Marisol; Basch, Ethan

    2016-01-01

    Purpose The process of assessing patient symptoms and functionality using patient-reported outcomes (PROs) and functional performance status (FPS) is an essential aspect of patient-centered oncology research and care. However, PRO and FPS measures are often employed separately or inconsistently combined. Thus, the purpose of this study was to conduct a systematic review of the level of association between PRO and FPS measures to determine their differential or combined utility. Methods A systematic search was conducted using five databases (1966 to February 2014) to identify studies that described an association between PRO and FPS. Studies were excluded if they were non-cancer specific, did not include adults aged 18 or older, or were review articles. Publications were selected for review by consensus among two authors, with a third author arbitrating as needed. Results A total of 18 studies met inclusion criteria. FPS was primarily assessed by clinicians using the ECOG Performance Status or Karnofsky Performance Status measures. PROs were captured using a variety of measures, with numerous domains assessed (e.g., pain, fatigue, and general health status). Concordance between PROs and FPS measures was widely variable, falling in the low to moderate range (0.09–0.72). Conclusions Despite consistency in the method of capture of PROs or FPS, domain capture varied considerably across reviewed studies. Irrespective of the method of capturing PROs or FPS, the quantified level of association between these two areas was moderate at best, providing evidence that FPS and PRO assessments offer unique information to assist clinicians in their decision-making. PMID:26314706

  1. Patient reporting of suspected adverse drug reactions: a review of published literature and international experience

    PubMed Central

    Blenkinsopp, A; Wilkie, P; Wang, M; Routledge, P A

    2007-01-01

    Aims To synthesize data from published studies and international experience to identify evidence of potential benefits and drawbacks of direct patient reporting of suspected adverse drug reactions (ADRs) by patients. Methods Structured search of MEDLINE, CINAHL and PsycINFO supplemented by internet searches and requests for information to key contacts. Results Seven studies (eight papers) were included in the review. None of the studies concerned spontaneous reporting by patients. Information on patient reporting systems was obtained for six countries, with summary data reported by four. Patient reports identified possible new ADRs that had not previously been reported by health professionals. The quality of patient reports appears to be similar to that of health professional reports. There is some evidence that patients report an ADR when they consider their health professional has not paid attention to their concerns. Patient reports may, at least initially, be more time consuming to process. Conclusions Overall, the evidence indicates that patient reporting of suspected ADRs has more potential benefits than drawbacks. Evaluation of patient reporting systems is needed to provide further evidence. PMID:17274788

  2. The clinical role of glutamine supplementation in patients with multiple trauma: a narrative review.

    PubMed

    Al Balushi, R M; Cohen, J; Banks, M; Paratz, J D

    2013-01-01

    Glutamine is considered an essential amino acid during stress and critical illness. Parenteral glutamine supplementation in critically ill patients has been shown to improve survival rate and minimise infectious complications, costs and hospital length-of-stay. However, glutamine supplementation in patients receiving enteral nutrition and the best method of administration are still controversial. The purpose of this article is to provide a narrative review of the current evidence and trials of enteral and parenteral glutamine supplementation in multiple trauma patients. A search in PubMed and EMBASE was conducted and relevant papers that investigated the effect of enteral or parenteral glutamine supplementation in patients with multiple trauma were reviewed. Although recent nutritional guidelines recommend that glutamine supplementation should be considered in these patients, further well-designed trials are required to provide a confirmed conclusion. Due to the inconclusive results of enteral glutamine supplementation trials in patients receiving enteral nutrition, future trials should focus on intravenous glutamine supplementation in patients requiring enteral nutrition and on major clinical outcome measures (e.g. mortality rate, infectious complications).

  3. A systematic review of patient-related risk factors for catheter-related thrombosis.

    PubMed

    Leung, Amy; Heal, Clare; Perera, Marlon; Pretorius, Casper

    2015-10-01

    To identify patient-related risk factors for venous thrombosis in patients with central venous catheters (CVC) or peripherally inserted central catheters (PICC). We performed a systematic review of the literature assessing patient-related risk factors for thrombosis related to CVC or PICC. The databases PubMed, Ovid and the Cochrane library were searched for observational studies pertaining to patient-related risk factors for CVC and PICC-related thrombosis. The initial search through PubMed, Ovid and the Cochrane library yielded 516 results. After 71 duplicates were removed, 445 articles were assessed for eligibility based on title and abstract. Four hundred and eleven articles were then excluded and 33 full text articles were manually assessed for eligibility. Eight articles were eliminated as they did not contain content relevant to the review. Twenty-five studies were then selected to assess 20 risk factors. There were no consistent significant associations for catheter-related thrombosis across the twenty-five studies. Multiple studies identified age, malignancy, diabetes, obesity, chemotherapy, thrombophilia and a history of thrombosis as significant risk factors for catheter-related thrombosis. Inconsistent findings among studies make it difficult to establish which patient-related risk factors are associated with catheter-related thrombosis. Future studies could include larger sample sizes and more cases of catheter-related thrombosis to produce more significant results. Identification of patient-related risk factors could lead to early recognition of upper limb deep vein thrombosis in patients with catheters, thereby preventing complications.

  4. A systematic review of patient-rated measures of radiodermatitis in breast cancer radiotherapy

    PubMed Central

    Schnur, Julie B.; Love, Bianca; Scheckner, Bari L.; Green, Sheryl; Wernicke, A. Gabriella; Montgomery, Guy H.

    2013-01-01

    During breast cancer radiotherapy, nearly all patients will experience radiodermatitis. Study objectives were to: 1) systematically review the literature on radiodermatitis and breast cancer; 2) summarize and describe patient-rated radiodermatitis measures; 3) determine whether consensus exists regarding subjective radiodermatitis measurement; and 4) provide recommendations for future research. PubMed and CINAHL were searched from their inception through August 2009. Study inclusion/exclusion criteria were: full abstract available; manuscript in English; focused on radiodermatitis resulting from breast cancer radiotherapy, and described a patient-rated empirical assessment of radiodermatitis. Three reviewers examined abstracts, and decisions about inclusion were reached by consensus. 22/237 mutually identified studies met selection criteria. Using a standardized abstraction form, three authors independently extracted relevant information. Results indicated that: 1) only 9% of the studies reviewed included a patient-rated measure; 2) generally, extant scales are very brief and focus almost exclusively on physical reactions, and 3) there is no “gold standard” measure of patient-rated radiodermatitis at this time. We conclude that significantly more research is needed to determine the best (most valid, reliable, sensitive, comprehensive) measure(s) to evaluate the experience of radiodermatitis from the patient’s perspective, and that further scale development efforts are needed. PMID:20838323

  5. Patient characteristics that affect the outcome of total hip arthroplasty: a review

    PubMed Central

    Young, Nancy L.; Cheah, David; Waddell, James P.; Wright, James G.

    1998-01-01

    Objective To review the literature regarding patient factors pertinent to the outcome of total hip arthroplasty (THA). Data sources MEDLINE from 1966 onward (key words “hip prosthesis” and “treatment outcome”) and literature previously known to the authors and cited in papers from all sources. Study selection All identified studies were included provided the methodology permitted assessment of the effect of patient factors and a clear outcome was defined (either prosthesis survival or specific functional outcomes). Data extraction The patient factors, methods and outcomes described in each paper were summarized on a data extraction form. Data synthesis All data were reviewed by one author. This process was repeated by a second author, and the findings were reviewed by the remaining 2 authors to verify the findings. The best functional outcomes and prosthesis survival rates were reported among patients who were between 45 and 75 years of age, weighed less than 70 kg, had strong social support, had a higher educational level, had better preoperative functional status and had no comorbid disease. Conclusion Important research remains to be done to examine the magnitude and interaction of patient factors on the outcome of THA. PMID:9627543

  6. Armored brain in patients with hydrocephalus after shunt surgery: review of the literatures.

    PubMed

    Taha, Mahmoud M

    2012-01-01

    Armored brain or chronic calcified subdural hematoma is a rare complication of cerebrospinal fluid diversion with few cases reported in the literature. Seventeen patients with this pathology have been published. A complete review of the literatures regarding this topic has been collected and discussed. The author also presents a 12- year old boy with triventricular hydrocephalus who had undergone ventriculoperitoneal medium pressure shunt system since birth. The patient presented to our clinic with a 2-year history of seizures. The patient was conscious and without neurological deficits on examination. Computed tomography of the brain showed bilateral high density mass with surface calcification. X ray skull and MRI confirmed the calcified subdural hematoma bilaterally. We preferred conservative treatment and the patient continued his antiepileptic treatment. At one year follow up, the patient had the same neurological state. The case highlights the importance of frequent follow up CT brain after shunt surgery.

  7. Centipede bite victims: a review of patients presenting to two emergency departments in Hong Kong.

    PubMed

    Fung, H T; Lam, S K; Wong, O F

    2011-10-01

    OBJECTIVE. To review the clinical characteristics of patients presenting after centipede bites in Hong Kong. DESIGN. Descriptive case series. SETTING. Emergency departments of two public hospitals in Hong Kong. PATIENTS. Patients presenting after centipede bites between 2006 and 2010. MAIN OUTCOME MEASURES. Demographics, time and locations of bites, symptoms and signs, treatments and outcomes. RESULTS. A total of 46 relevant patient records were retrieved. The bites were frequently at night, indoors, on lower limbs, and consistently resulted in pain. The majority of the victims were treated with analgesia, anti-histamines, and antibiotics. One patient developed necrosis and five re-attended for delayed pruritus and relapsed/recurrent swelling. CONCLUSIONS. Centipede bites are usually uncomplicated, but may lead to necrosis or delayed hypersensitive reactions.

  8. Effect of lumbar stabilization exercises on the balance ability of patients with stroke: a systematic review.

    PubMed

    Ko, Dae-Sik; Jung, Dae-In; Bae, Sang-Yeol

    2014-12-01

    [Purpose] This study performed a systematic literature review of the ability of lumbar stabilization exercises (LSE) to improve the balance ability of stroke patients. [Subjects and Methods] A systematic review was conducted of four databases. The papers retrieved were evaluated based on the following inclusion criteria: 1) design, a controlled clinical trial; 2) intervention, LSE; 3) outcome, change in balance ability; and 4) year of publication, 2000 to 2013. [Results] The findings of 6 papers were compared to determine the effects of lumbar stabilization exercises on stroke patients' balance abilities. The papers had methodological quality scores of 5-8 on the PEDro scale. [Conclusion] Lumbar stabilization exercises have a positive influence on stroke patients' balance abilities.

  9. Diffusion tensor imaging studies on arcuate fasciculus in stroke patients: a review.

    PubMed

    Jang, Sung Ho

    2013-01-01

    Aphasia is one of the most common and devastating sequelae of stroke. The arcuate fasciculus (AF), an important neural tract for language function, connects Broca's and Wernicke's areas. In this review article, previous diffusion tensor imaging (DTI) studies on the AF in stroke patients were reviewed with regard to the usefulness for diagnosis (seven studies), prediction of prognosis (two studies), and recovery of aphasia (three studies). Although scant studies on this topic have been conducted in stroke patients, DTI for the AF appears to provide useful information on the presence or severity of injury of the AF, prognosis prediction of aphasia, and recovery mechanisms of aphasia in stroke patients. Therefore, further DTI studies on these topics should be encouraged, especially studies on prognosis prediction and recovery mechanisms of aphasia. In addition, research on other neural tracts known to be involved in aphasia as well as the AF in both hemispheres should be encouraged. PMID:24198780

  10. Bench-to-bedside review: Early tracheostomy in critically ill trauma patients

    PubMed Central

    Shirawi, Nehad; Arabi, Yaseen

    2006-01-01

    A significant proportion of trauma patients require tracheostomy during intensive care unit stay. The timing of this procedure remains a subject of debate. The decision for tracheostomy should take into consideration the risks and benefits of prolonged endotracheal intubation versus tracheostomy. Timing of tracheostomy is also influenced by the indications for the procedure, which include relief of upper airway obstruction, airway access in patients with cervical spine injury, management of retained airway secretions, maintenance of patent airway and airway access for prolonged mechanical ventilation. This review summarizes the potential advantages of tracheostomy versus endotracheal intubation, the different indications for tracheostomy in trauma patients and studies examining early versus late tracheostomy. It also reviews the predictors of prolonged mechanical ventilation, which may guide the decision regarding the timing of tracheostomy. PMID:16356202

  11. Bench-to-bedside review: early tracheostomy in critically ill trauma patients.

    PubMed

    Shirawi, Nehad; Arabi, Yaseen

    2006-02-01

    A significant proportion of trauma patients require tracheostomy during intensive care unit stay. The timing of this procedure remains a subject of debate. The decision for tracheostomy should take into consideration the risks and benefits of prolonged endotracheal intubation versus tracheostomy. Timing of tracheostomy is also influenced by the indications for the procedure, which include relief of upper airway obstruction, airway access in patients with cervical spine injury, management of retained airway secretions, maintenance of patent airway and airway access for prolonged mechanical ventilation. This review summarizes the potential advantages of tracheostomy versus endotracheal intubation, the different indications for tracheostomy in trauma patients and studies examining early versus late tracheostomy. It also reviews the predictors of prolonged mechanical ventilation, which may guide the decision regarding the timing of tracheostomy. PMID:16356202

  12. Optimal Time to Surgery for Patients Requiring Laparoscopic Appendectomy: An Integrative Review.

    PubMed

    Gardiner, Therese M; Gillespie, Brigid M

    2016-02-01

    Acute appendicitis is the most common condition requiring emergency surgery worldwide. Although current guidelines recommend prompt appendectomy as the preferred treatment, no time interval for surgery has been indicated. We used an integrative review methodology to critically evaluate evidence on the relationship between time to surgery and hospital length of stay and to identify the ideal time to surgery for patients undergoing appendectomy. We included 14 studies in our synthesis, most of which (n = 9/14, 64%) indicated that longer time delays to surgical intervention increased hospital length of stay for patients presenting with appendicitis. Researchers report that the optimal time for surgery is 24 to 36 hours after symptom onset, or 10 to 24 hours from admission. The results of our review indicate that patient symptoms on presentation may signify advancing pathology and may be more important than the time delay interval in defining surgical priority. PMID:26849985

  13. Intensive medical student involvement in short-term surgical trips provides safe and effective patient care: a case review

    PubMed Central

    2011-01-01

    Background The hierarchical nature of medical education has been thought necessary for the safe care of patients. In this setting, medical students in particular have limited opportunities for experiential learning. We report on a student-faculty collaboration that has successfully operated an annual, short-term surgical intervention in Haiti for the last three years. Medical students were responsible for logistics and were overseen by faculty members for patient care. Substantial planning with local partners ensured that trip activities supplemented existing surgical services. A case review was performed hypothesizing that such trips could provide effective surgical care while also providing a suitable educational experience. Findings Over three week-long trips, 64 cases were performed without any reported complications, and no immediate perioperative morbidity or mortality. A plurality of cases were complex urological procedures that required surgical skills that were locally unavailable (43%). Surgical productivity was twice that of comparable peer institutions in the region. Student roles in patient care were greatly expanded in comparison to those at U.S. academic medical centers and appropriate supervision was maintained. Discussion This demonstration project suggests that a properly designed surgical trip model can effectively balance the surgical needs of the community with an opportunity to expose young trainees to a clinical and cross-cultural experience rarely provided at this early stage of medical education. Few formalized programs currently exist although the experience above suggests the rewarding potential for broad-based adoption. PMID:21884604

  14. Outcome of ureteroscopy for stone disease in patients with horseshoe kidney: Review of world literature

    PubMed Central

    Ishii, Hiro; Rai, Bhavan; Traxer, Olivier; Kata, Slawomir G.; Somani, Bhaskar K.

    2015-01-01

    Introduction and Objectives: The management of urolithiasis in patients with horseshoe kidney (HSK) is difficult. Stone formation occurred in 1:5 patients with HSK due to impaired urinary drainage and infections. Percutaneous nephrolithotomy and shock wave lithotripsy can be technically challenging due to altered anatomy. Materials and Methods: We conducted a systematic review of the literature to look at the role of ureteroscopy for stone management in these patients. We searched MEDLINE, PubMed and the Cochrane Library from January 1990 to April 2013 for results of ureteroscopy and stone treatment in HSK patients. Inclusion criteria were all English language articles reporting on ureteroscopy in patients with HSK. Data were extracted on the outcomes and complications. Results: A total of 3 studies was identified during this period. Forty-one patients with HSK underwent flexible ureteroscopy and stone treatment. The mean age was 42 with a male:female ratio nearly 3:1. The mean stone size was 16 mm (range: 3-35 mm). The mean operating time was 86 min with multiple stones seen in 15 patients. All 41 patients had a ureteral access sheath used and flexible ureteroscopy and holmium laser fragmentation done. Thirty-two (78%) patients were stone-free with a mean hospital stay of 1-day. Minor complications (Clavien I or II) were seen in 13 (32%) of which 6 had stent discomfort, 3 needed intravenous antibiotics for <24 h, 3 had hematuria of which 2 needed blood transfusion and one had pyelonephritis needing re-admission and antibiotics. There were no major complications found in the review. Conclusions: Retrograde stone treatment using ureteroscopy and lasertripsy in HSK patients can be performed with good stone clearance rate, but with a slightly higher complication rate. This procedure should, therefore, be done in high volume stone center with an experienced stone surgeon/team. PMID:26692667

  15. A pharmacy-based medication reconciliation and review program in hemodialysis patients: a prospective study

    PubMed Central

    Foote, Edward F.

    2016-01-01

    Background: Hemodialysis (HD) patients are on multiple medications, see many prescribers and have many hospitalizations which put them at risk for medication record discrepancies and medication related problems (MRP). Being able to effectively identify and reconcile these medication issues is crucial in reducing hospitalizations, morbidities, and mortalities. The care of the hemodialysis patients can be enhanced by incorporating a pharmacist into the interprofessional team. There is little data in the literature on medication record discrepancies and MRP’s in dialysis patients. Objective: The objectives of this research were to determine the types of medication discrepancies and MRPs in dialysis patients and if recommendations for changes based on these findings were accepted by providers. Methods: Patients were asked to bring medications to the dialysis unit for review. Discrepancy and MRP recommendations were communicated to the unit staff via written progress notes. A follow-up was performed an average of 33 days later to determine if the recommendations were accepted. Results: Overall, in 93 unique patients, 376 discrepancies (3.1 per patient) and 64 MRPs (0.5 per patient) were identified. The most common type of discrepancy and MRP was drug omission and indication without drug, respectively. Of the total 440 interventions, 77% were ultimately accepted. Discrepancies were more likely to be accepted as compared to MRPs (85% vs. 27%, respectively). Conclusion: Medication record discrepancies and MRPs are common in dialysis patients. Recommendations related to discrepancies were more likely to be accepted by the providers as compared to MRPs. Medication records became inaccurate within 12 months. A pharmacy-based medication reconciliation and review program may have an important impact on the care of hemodialysis patients.

  16. 78 FR 59011 - Improving Performance of Federal Permitting and Review of Infrastructure Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-25

    ... Process for significant onshore electric transmission projects requiring Federal authorizations. This RFI... seeking information on a draft Integrated, Interagency Pre-Application (IIP) Process for significant onshore electric transmission projects requiring Federal authorizations. This notice announces...

  17. Review of project definition studies of possible on-site uses of superconducting super collider assets and facilities. Final report

    SciTech Connect

    1994-12-01

    This document reports on the results of a peer review and evaluation of studies made of potential uses of assets from the terminated Superconducting Super Collider (SSC) project. These project definition studies focused on nine areas of use of major assets and facilities at the SSC site near Waxahachie, Texas. The studies were undertaken as part of the effort to maximize the value of the investment made in the SSC and were supported by two sets of grants, one to the Texas National Research Laboratory Commission (TNRLC) and the second to various universities and other institutions for studies of ideas raised by a public call for expressions of interest. The Settlement Agreement, recently signed by the Department of Energy (DOE) and TNRLC, provides for a division of SSC property. As part of the goal of maximizing the value of the SSC investment, the findings contained in this report are thus addressed to officials in both the Department and TNRLC. In addition, this review had several other goals: to provide constructive feedback to those doing the studies; to judge the benefits and feasibility (including funding prospects) of the projects studied; and to help worthy projects become reality by matching projects with possible funding sources.

  18. Review of project definition studies of possible on-site uses of superconducting super collider assets and facilities

    SciTech Connect

    1994-12-01

    This document reports on the results of a peer review and evaluation of studies made of potential uses of assets from the terminated Superconducting Super Collider (SSC) project. These project definition studies focused on nine areas of use of major assets and facilities at the SSC site near Waxahachie, Texas. The studies were undertaken as part of the effort to maximize the value of the investment made in the SSC and were supported by two sets of grants, one to the Texas National Research Laboratory Commission (TNRLC) and the second to various universities and other institutions for studies of ideas raised by a public call for expressions of interest. The Settlement Agreement, recently signed by the Department of Energy (DOE) and TNRLC, provides for a division of SSC property. As part of the goal of maximizing the value of the SSC investment, the findings contained in this report are thus addressed to officials in both the Department and TNRLC. In addition, this review had several other goals: to provide constructive feedback to those doing the studies; to judge the benefits and feasibility (including funding prospects) of the projects studied; and to help worthy projects become reality by matching projects with possible funding sources.

  19. Organizing Pneumonia in Rheumatoid Arthritis Patients: A Case-Based Review

    PubMed Central

    Mori, Shunsuke; Koga, Yukinori; Sugimoto, Mineharu

    2015-01-01

    We treated 21 patients with organizing pneumonia (OP) associated with rheumatoid arthritis (RA) or related to biological disease-modifying antirheumatic drugs (DMARDs) at our institution between 2006 and 2014. Among these cases, 3 (14.3%) preceded articular symptoms of RA, 4 (19.0%) developed simultaneously with RA onset, and 14 (66.7%) occurred during follow-up periods for RA. In the case of OP preceding RA, increased levels of anti-cyclic citrullinated peptide antibodies and rheumatoid factor were observed at the OP onset. RA disease activity was related to the development of OP in the simultaneous cases. In the cases of OP developing after RA diagnosis, 10 of 14 patients had maintained low disease activity with biological DMARD therapy at the OP onset, and among them, 6 patients developed OP within the first year of this therapy. In the remaining four patients, RA activity was not controlled at the OP onset. All patients responded well to systemic steroid therapy, but two patients suffered from relapses of articular and pulmonary symptoms upon steroid tapering. In most of the RA patients, DMARD therapy was introduced or restarted during the steroid tapering. We successfully restarted a biological DMARD that had not been previously used for patients whose RA would otherwise have been difficult to control. In this study, we also perform a review of the literature on RA-associated or biological DMARD-related OP and discuss the pathogenesis and management of OP occurring in RA patients. PMID:26543387

  20. Organizing Pneumonia in Rheumatoid Arthritis Patients: A Case-Based Review.

    PubMed

    Mori, Shunsuke; Koga, Yukinori; Sugimoto, Mineharu

    2015-01-01

    We treated 21 patients with organizing pneumonia (OP) associated with rheumatoid arthritis (RA) or related to biological disease-modifying antirheumatic drugs (DMARDs) at our institution between 2006 and 2014. Among these cases, 3 (14.3%) preceded articular symptoms of RA, 4 (19.0%) developed simultaneously with RA onset, and 14 (66.7%) occurred during follow-up periods for RA. In the case of OP preceding RA, increased levels of anti-cyclic citrullinated peptide antibodies and rheumatoid factor were observed at the OP onset. RA disease activity was related to the development of OP in the simultaneous cases. In the cases of OP developing after RA diagnosis, 10 of 14 patients had maintained low disease activity with biological DMARD therapy at the OP onset, and among them, 6 patients developed OP within the first year of this therapy. In the remaining four patients, RA activity was not controlled at the OP onset. All patients responded well to systemic steroid therapy, but two patients suffered from relapses of articular and pulmonary symptoms upon steroid tapering. In most of the RA patients, DMARD therapy was introduced or restarted during the steroid tapering. We successfully restarted a biological DMARD that had not been previously used for patients whose RA would otherwise have been difficult to control. In this study, we also perform a review of the literature on RA-associated or biological DMARD-related OP and discuss the pathogenesis and management of OP occurring in RA patients.

  1. Quality of Life in Patients with an Implantable Cardioverter Defibrillator: A Systematic Review.

    PubMed

    Tomzik, Juliane; Koltermann, Katharina C; Zabel, Markus; Willich, Stefan N; Reinhold, Thomas

    2015-01-01

    Despite the indisputable mortality advantages of implantable cardioverter defibrillators (ICDs), no consensus exists regarding their impact on quality of life (QoL). This systematic review investigates differences in QoL between patients with ICDs and controls. We systematically searched the MEDLINE, EMBASE, Cochrane, Web of Science, and PsychINFO databases. Articles were included if they were published after the year 2000 and reported on original studies with a control group. Five randomized controlled trials with a total of 5,138 patients and 10 observational studies with a total of 1,513 patients met the inclusion criteria. Nine studies found comparable QoL for ICD recipients and patients in the control groups, three studies found an increased QoL for ICD patients, and three studies found a decreased QoL for ICD patients. The question of whether QoL relates to ICD therapy cannot be answered conclusively due to the heterogeneity of the existing studies. Lower QoL was apparent among patients with an ICD who experienced several device discharges. Medical staff should be particularly aware of the signs of both psychological and physical disorders in these patients. Further investigations on QoL in ICD patients are desirable, but ethical reasons restrict the conduct of randomized trials. PMID:26664905

  2. Quality of Life in Patients with an Implantable Cardioverter Defibrillator: A Systematic Review

    PubMed Central

    Tomzik, Juliane; Koltermann, Katharina C.; Zabel, Markus; Willich, Stefan N.; Reinhold, Thomas

    2015-01-01

    Despite the indisputable mortality advantages of implantable cardioverter defibrillators (ICDs), no consensus exists regarding their impact on quality of life (QoL). This systematic review investigates differences in QoL between patients with ICDs and controls. We systematically searched the MEDLINE, EMBASE, Cochrane, Web of Science, and PsychINFO databases. Articles were included if they were published after the year 2000 and reported on original studies with a control group. Five randomized controlled trials with a total of 5,138 patients and 10 observational studies with a total of 1,513 patients met the inclusion criteria. Nine studies found comparable QoL for ICD recipients and patients in the control groups, three studies found an increased QoL for ICD patients, and three studies found a decreased QoL for ICD patients. The question of whether QoL relates to ICD therapy cannot be answered conclusively due to the heterogeneity of the existing studies. Lower QoL was apparent among patients with an ICD who experienced several device discharges. Medical staff should be particularly aware of the signs of both psychological and physical disorders in these patients. Further investigations on QoL in ICD patients are desirable, but ethical reasons restrict the conduct of randomized trials. PMID:26664905

  3. A patient with erythema nodosus leprosum and Chagas cardiopathy: challenges in patient management and review of the literature.

    PubMed

    Trindade, Maria Ângela B; Carvalho, Noemia B; Belfort, Elaini C; Pagliari, Carla; Gakiya, Erika; Sakai-Valente, Neusa Y; Benard, Gil; Shikanai-Yasuda, Maria A

    2011-06-01

    We report a patient with severe multi-bacillary leprosy complicated by recurrent episodes of erythema nodosum necrotisans that required thalidomide and/or corticosteroids during follow-up. Although the patient was from an area to which Chagas disease is endemic, this diagnosis was initially missed and was only investigated when heart failure developed in the patient. The difficulties of managing erythema nodosum necrotisans and heart failure concomitantly and those involved in excluding the diagnosis of acute myocarditis caused by reactivation of Chagas disease secondary to the immunosuppressive regimen are discussed. Other potential causes for the heart failure and possible interactions between the two diseases and their treatments are discussed. We also reviewed the literature for the association between leprosy and Chagas disease, both of which are highly endemic in Brazil. This case emphasizes the importance of searching for subclinical co-infections in leprosy patients because reactions frequently develop during specific treatment in these patients, and these reactions require prolonged therapy with immunosuppressive drugs.

  4. Ethical Review of Undergraduate Student Research Projects: A Proportionate, Transparent and Efficient Process?

    ERIC Educational Resources Information Center

    Hack, Catherine J.

    2012-01-01

    Undergraduate research projects in the life sciences encompass a broad range of studies, some of which may require the participation of human subjects or other activities which may raise ethical concerns. As universities are accountable for all projects undertaken under their auspices they must ensure that these projects adhere to legal…

  5. What impedes and what facilitates a quality improvement project for older hospitalized patients?

    PubMed Central

    Ijkema, Roelie; Langelaan, Maaike; van de Steeg, Lotte; Wagner, Cordula

    2014-01-01

    Objective To gain insight into which factors impede, and which facilitate, the implementation of a complex multi-component improvement initiative in hospitalized older patients. Design A qualitative study based on semi-structured interviews. The three dimensions of Pettigrew and Whipp's theoretical framework, namely, Process, Content and Context, were used to undertake a structured data analysis. Setting The study was conducted in 19 Dutch hospitals implementing the Frail Elderly Project. Participants Sixty-five members of staff, including physicians, nurses and members of the policy team. Intervention The Frail Elderly Project, a Dutch quality improvement program, aims to decrease adverse events in frail older hospitalized people by implementing screening instruments and interventions targeting delirium, falls, malnutrition and physical impairment. Main outcome measures The management of the process of implementation, participants' opinions of the program elements and contextual factors which influence the implementation. Results Barriers to implementation included two process factors (insufficient involvement of clinicians and lack of time), two content factors (having divergent objectives and concerns about recommended program elements) and two contextual factors (a lack of knowledge of delirium and minimal insight into the purposes and effects of the program). Facilitating factors included one process factor (leadership), one content factor (flexibility in choosing methods) and two contextual factors (the program's guidance and the use of digital patient records). Conclusion We identified the barriers and the factors which facilitate implementing complex multi-component improvement programs concerning care for older patients. These barriers must be resolved in future improvement programs in order to ensure successful implementation. PMID:24282154

  6. Health-related quality of life in Guillain-Barré syndrome patients: a systematic review.

    PubMed

    Darweesh, Sirwan K L; Polinder, Suzanne; Mulder, Maxim J H L; Baena, Cristina P; van Leeuwen, Nikki; Franco, Oscar H; Jacobs, Bart C; van Doorn, Pieter A

    2014-03-01

    Guillain-Barré syndrome (GBS) encompasses a broad spectrum of health-related quality of life (HRQL) determinants, including mobility, fatigue, pain, and depression. We systematically reviewed the literature on functional outcome domains in which GBS patients experience limitations in the short and long terms and evaluated determinants of HRQL in GBS patients. MEDLINE and EMBASE were systematically searched by two independent reviewers for articles covering HRQL data of GBS patients. Of 730 abstracts screened, 17 articles covering data of 14 studies matched the selection criteria. The included articles showed that many GBS patients experienced physical limitations, even years after the acute phase of the disease, while results were inconsistent for perceived levels of pain, fatigue, and general mental well-being. Only three papers covered HRQL assessments at more than one time point, generally showing large improvements in HRQL in the first year after GBS onset, but not thereafter. We appraised the methodological quality of included studies using a 13-item checklist; none of the articles fulfilled all items and only seven articles presented data on correlations between HRQL and determinants. In conclusion, the majority of studies on HRQL in GBS patients are cross-sectional and of low methodological quality. This paper provides guidance for much needed high-quality studies on patterns of patient-perceived recovery after GBS onset.

  7. Rubinstein-Taybi syndrome: Clinical profile of 11 patients and review of literature

    PubMed Central

    Kumar, Suresh; Suthar, Renu; Panigrahi, Inusha; Marwaha, Ram K.

    2012-01-01

    BACKGROUND: Rubinstein-Taybi syndrome (RSTS) is a rare congenital neurodevelopmental disorder, characterized by postnatal growth deficiency, typical dysmorphic features, broad thumbs and toes, and mental retardation. Very few cases are reported in literature from developing countries. Diagnosis is often delayed due to non-familiarity with the characteristic features of this syndrome. AIMS: To report 11 cases of RSTS and to review the current literature. SETTINGS AND DESIGN: Retrospective study conducted in genetic and metabolic unit of a tertiary care teaching hospital in north India over a period of 3½ years. MATERIALS AND METHODS: 11 patients with diagnosis of RSTS were identified, and their case sheets were reviewed. RESULTS: Developmental delay was presenting complaint in 10 patients, and seizure in 1 case. 7 patients had microcephaly (head circumference below −3 SD), and a prominent beaked nose was seen in 9 patients. The intelligence quotient (IQ) varied from 22-62 in 7 patients who had mental retardation. The most notable features in hands were broadness, shortening, and flattening of the distal phalanx of thumbs or great toes. Additionally, we also noted webbing of neck, microphthalmia, and pachygyria (on MRI brain) in 1 patient each. CONCLUSIONS: The diagnosis of RSTS is primarily clinical and based on characteristic phenotype that is often combined with a variety of somatic anomalies. An early diagnosis facilitates appropriate genetic counseling and in planning the management. PMID:23162289

  8. Antibiotic efficacy in patients with a moderate probability of acute rhinosinusitis: a systematic review.

    PubMed

    Burgstaller, Jakob M; Steurer, Johann; Holzmann, David; Geiges, Gabriel; Soyka, Michael B

    2016-05-01

    The aim of this systematic review was to synthesize the results of original studies assessing antibiotic efficacy at different time points after initiating treatment in patients with a moderate probability of acute bacterial rhinosinusitis. We searched the Cochrane library for systematic reviews on the efficacy of antibiotic treatment in patients with acute rhinosinusitis (ARS). Only randomized controlled trials (RCTs) that compared treatment of any antibiotic with placebo were included. The synthesis of the results of six RCTs showed a benefit of antibiotic treatment compared to placebo for the rate of improvement after 3 [pooled odds ratio (OR) 2.78 (95 % confidence interval (CI) 1.39-5.58)] and 7 [OR 2.29 (95 % CI 1.19-4.41)] days after initiation in patients with symptoms and signs of ARS lasting for 7 or more days. After 10 days [pooled OR 1.36 (95 % CI 0.66-2.90)], improvement rates did not differ significantly between patients treated with or without antibiotics. Compared to placebo, antibiotic treatment relieves symptoms in a significantly higher proportion of patients within the first days of treatment. Reporting an overall average treatment efficacy may underestimate treatment benefits in patients with a self-limiting illness.

  9. Reviews

    NASA Astrophysics Data System (ADS)

    2001-11-01

    BOOK REVIEW Search for Life BOOK REVIEW Health Physics BOOK REVIEW Language and Literacy in Science Education BOOK REVIEW Science Web Reader—Physics Correction GCSE BOOK REVIEW Physics for Higher Tier GCSE BOOK REVIEW Modular Science GCSE BOOK REVIEW Modular Science for AQA: Foundation level and Higher level GCSE BOOK REVIEW Physics for OCR A GCSE BOOK REVIEW Physics Matters, 3rd edition GCSE BOOK REVIEW Physics GCSE BOOK REVIEW Science Foundations: Physics (new edition) GCSE BOOK REVIEW Target Science: Physics Foundation Tier GCSE BOOK REVIEW Target Science: Physics Foundation Tier: AQA WEB WATCH Medical physics organizations

  10. How Patients Take Malaria Treatment: A Systematic Review of the Literature on Adherence to Antimalarial Drugs

    PubMed Central

    Bruxvoort, Katia; Goodman, Catherine; Kachur, S. Patrick; Schellenberg, David

    2014-01-01

    Background High levels of patient adherence to antimalarial treatment are important in ensuring drug effectiveness. To achieve this goal, it is important to understand levels of patient adherence, and the range of study designs and methodological challenges involved in measuring adherence and interpreting results. Since antimalarial adherence was reviewed in 2004, there has been a major expansion in the use of artemisinin-based combination therapies (ACTs) in the public sector, as well as initiatives to make them more widely accessible through community health workers and private retailers. These changes and the large number of recent adherence studies raise the need for an updated review on this topic. Objective We conducted a systematic review of studies reporting quantitative results on patient adherence to antimalarials obtained for treatment. Results The 55 studies identified reported extensive variation in patient adherence to antimalarials, with many studies reporting very high adherence (90–100%) and others finding adherence of less than 50%. We identified five overarching approaches to assessing adherence based on the definition of adherence and the methods used to measure it. Overall, there was no clear pattern in adherence results by approach. However, adherence tended to be higher among studies where informed consent was collected at the time of obtaining the drug, where patient consultations were directly observed by research staff, and where a diagnostic test was obtained. Conclusion Variations in reported adherence may reflect factors related to patient characteristics and the nature of their consultation with the provider, as well as methodological variations such as interaction between the research team and patients before and during the treatment. Future studies can benefit from an awareness of the impact of study procedures on adherence outcomes, and the identification of improved measurement methods less dependent on self-report. PMID:24465418

  11. A Systematic Review of Music Therapy Practice and Outcomes with Acute Adult Psychiatric In-Patients

    PubMed Central

    Carr, Catherine; Odell-Miller, Helen; Priebe, Stefan

    2013-01-01

    Background and Objectives There is an emerging evidence base for the use of music therapy in the treatment of severe mental illness. Whilst different models of music therapy have been developed in mental health care, none have specifically accounted for the features and context of acute in-patient settings. This review aimed to identify how music therapy is provided for acute adult psychiatric in-patients and what outcomes have been reported. Review Methods A systematic review using medical, psychological and music therapy databases. Papers describing music therapy with acute adult psychiatric in-patients were included. Analysis utilised narrative synthesis. Results 98 papers were identified, of which 35 reported research findings. Open group work and active music making for nonverbal expression alongside verbal reflection was emphasised. Aims were engagement, communication and interpersonal relationships focusing upon immediate areas of need rather than longer term insight. The short stay, patient diversity and institutional structure influenced delivery and resulted in a focus on single sessions, high session frequency, more therapist direction, flexible use of musical activities, predictable musical structures, and clear realistic goals. Outcome studies suggested effectiveness in addressing a range of symptoms, but were limited by methodological shortcomings and small sample sizes. Studies with significant positive effects all used active musical participation with a degree of structure and were delivered in four or more sessions. Conclusions No single clearly defined model exists for music therapy with adults in acute psychiatric in-patient settings, and described models are not conclusive. Greater frequency of therapy, active structured music making with verbal discussion, consistency of contact and boundaries, an emphasis on building a therapeutic relationship and building patient resources may be of particular importance. Further research is required to

  12. A narrative review of the published chiropractic literature regarding older patients from 2001–2010

    PubMed Central

    Gleberzon, Brian J.

    2011-01-01

    Introduction: The purpose of this article was to perform a narrative review of the chiropractic literature regarding older patients between 2001 and 2010. Methods: A three step search strategy of the literature involved electronic searching, hand searching and reference tracking. Results: One hundred and eighty eight articles germane to chiropractic geriatric practice and education were retrieved. Discussion: Compared to the review of the literature conducted prior to 2000, the number of references on chiropractic geriatric education increased from 3 to 11, the number of demographic studies increased from 9 to 18, the number of case reports increased from 25 to 83, the number of clinical trials increased from 4 to 21 (only two RCTs found) and the number of references on clinical guidelines and general clinical information increased from 18 to 55. Conclusion: This review found 188 retrievable articles available to practitioners to effectively care plan for their older patients, a better than three fold increase in the number of references found during a similar review conducted at the end of the previous decade. However, there is clearly a gap in the evidence base of chiropractic geriatric care, particularly the under-representation of clinical trials of all kinds involving older chiropractic patients. PMID:21629461

  13. Estimation of a genetically viable population for multigenerational interstellar voyaging: Review and data for project Hyperion

    NASA Astrophysics Data System (ADS)

    Smith, Cameron M.

    2014-04-01

    Designing interstellar starships for human migration to exoplanets requires establishing the starship population, which factors into many variables including closed-ecosystem design, architecture, mass and propulsion. I review the central issues of population genetics (effects of mutation, migration, selection and drift) for human populations on such voyages, specifically referencing a roughly 5-generation (c. 150-year) voyage currently in the realm of thought among Icarus Interstellar's Project Hyperion research group. I present several formulae as well as concrete numbers that can be used to help determine populations that could survive such journeys in good health. I find that previously proposed such populations, on the order of a few hundred individuals, are significantly too low to consider based on current understanding of vertebrate (including human) genetics and population dynamics. Population genetics theory, calculations and computer modeling determine that a properly screened and age- and sex-structured total founding population (Nc) of anywhere from roughly 14,000 to 44,000 people would be sufficient to survive such journeys in good health. A safe and well-considered Nc figure is 40,000, an Interstellar Migrant Population (IMP) composed of an Effective Population [Ne] of 23,400 reproductive males and females, the rest being pre- or post-reproductive individuals. This number would maintain good health over five generations despite (a) increased inbreeding resulting from a relatively small human population, (b) depressed genetic diversity due to the founder effect, (c) demographic change through time and (d) expectation of at least one severe population catastrophe over the 5-generation voyage.

  14. Protocol for the China PEACE (Patient-centered Evaluative Assessment of Cardiac Events) Million Persons Project pilot

    PubMed Central

    Lu, Jiapeng; Xuan, Si; Downing, Nicholas S; Wu, Chaoqun; Li, Li; Krumholz, Harlan M; Jiang, Lixin

    2016-01-01

    Introduction Collection of high-quality data from large populations is considered essential to generate knowledge that is critical to an era of precision medicine. Cardiovascular disease (CVD) is a leading cause of mortality in China and is a suitable focus of an initiative to discover factors that would improve our ability to assess and modify individual risk. Methods and analysis The pilot phase of China PEACE (Patient-centered Evaluative Assessment of Cardiac Events) Million Persons Project is being conducted during 2014–2015 in four provinces across China to demonstrate the feasibility of a population-based assessment. It is designed to screen 0.4 million community-dwelling residents aged 40–75 years with measurements of blood pressure, height and weight, a lipid blood test, and a questionnaire on cardiovascular-related health status. Participants identified at high risk of CVD receive further health assessments, including ECG, ultrasound scan, blood and urine analysis, and a questionnaire on lifestyle and medical history. Collection of blood and urine samples is used to establish a biobank. High-risk subjects are also counselled with suggestions regarding potential lifestyle changes. In addition, high-risk subjects are followed-up either in a return clinic visit or by telephone interview, with measurement of blood pressure, weight, ECG, and a questionnaire on survival status, hospitalisations and lifestyle. The first 0.1 million participants screened were used to conduct a preliminary analysis, with information on baseline characteristics, health-related behaviours, anthropometric variables, medical history, and prevalence of high-risk subjects. Ethics and dissemination The central ethics committee at the China National Center for Cardiovascular Disease (NCCD) approved the pilot. Written informed consent is obtained from all participants on entry into the project. Findings will be disseminated in future peer-reviewed papers and will inform strategies

  15. Prolactin and hostility in hospitalised patients and healthy women: A systematic review and meta-analysis.

    PubMed

    Barry, J A; Moran, E; Thomas, M; Hardiman, P J

    2015-01-01

    The aim of this systematic review and meta-analysis was to assess any difference in the self-ratings of hostility in mentally healthy women with different levels of prolactin (PRL). Electronic databases (PubMed, MEDLINE, EMBASE and the Cochrane Library) were searched up to 2nd July 2012 for published literature comparing hostility levels in women with different levels of PRL. Keyword pairs ('prolactin' and 'aggression', 'prolactin' and 'hostil*', 'prolactin' and 'anger', and 'prolactin' and 'angry') were entered simultaneously. From 1065 resulting titles, and one unpublished study, 214 articles underwent full-text review by authors JB and EM. Studies were selected based on clinical relevance. Eight comparative studies consisting of 242 female patients with high PRL levels, 207 female patients with normal PRL levels and 127 healthy controls with normal PRL levels were included. Data were analysed using the inverse variance method with a random-effects model. Analysis revealed significantly higher hostility in patients with high PRL compared with that in healthy control women (Z = 1.94, p < 0.05; Hedges' g = 0.72; 95% confidence interval [CI]: -0.01-1.45), significantly higher hostility in patient controls compared with that in healthy controls (Z = 1.94, p < 0.05; Hedges' g = 0.47; 95% CI: 0.00-0.94) and non-significantly higher hostility levels in patients with high PRL compared with that in patients with normal PRL levels (Z = 1.45, p < 0.15; Hedges' g = 0.38; 95% CI: -0.13-0.89). In this meta-analysis, hostility appears to be accounted for partly by PRL levels and also partly by patient status, perhaps due to the stress of being a patient. Methodological considerations and implications for patient care are discussed.

  16. Review of the utilization of HEEPF – competitive projects for educational enhancement in the Egyptian medical sector

    PubMed Central

    Abdellah, Galal Abdel-Hamid; Taher, Salah El-Din Mohamed Fahmy; Hosny, Somaya

    2008-01-01

    In Egypt, the medical sector has been facing the same problems that challenged the system of higher education in the past decades, mainly an increasing student enrollment, limited resources, and old governance and bylaws. These constraints and the escalating paucity of resources have had a major negative influence on quality of education. Consequently, thoughts of educational reform came forward in the form of competitive projects, which have attracted several institutes from the health sector to improve their educational performance. The aim of this paper is to review the share of the medical sector in the higher education enhancement project fund (HEEPF), its outcomes, sustainability, and to provide recommendations for keeping the momentum of reform pursuit in the future. The methodology included obtaining statistics pertaining to the medical sector in Egypt as regards colleges, students, and staff. We also reviewed the self-studies of the medical sector colleges, HEEPF projects reports, performance appraisal reports, and World Bank reports on HEEPF achievements in order to retrieve the required data. Results showed that medical sector had a large share of the HEEPF (28.5% of projects) as compared to its size (8% of student population). The projects covered 10 areas; the frequency distribution of which ranged between 4.4% (creation of new programs) to 97.8% (human resource development). In conclusion, educational enhancement in the medical sector in Egypt could be apparently achieved through the HEEPF competitive projects. A study of the long-term impact of these projects on the quality of education is recommended PMID:18423028

  17. Review of the utilization of HEEPF--competitive projects for educational enhancement in the Egyptian medical sector.

    PubMed

    Abdel-Hamid Abdellah, Galal; El-Din Mohamed Fahmy Taher, Salah; Hosny, Somaya

    2008-04-18

    In Egypt, the medical sector has been facing the same problems that challenged the system of higher education in the past decades, mainly an increasing student enrollment, limited resources, and old governance and bylaws. These constraints and the escalating paucity of resources have had a major negative influence on quality of education. Consequently, thoughts of educational reform came forward in the form of competitive projects, which have attracted several institutes from the health sector to improve their educational performance. The aim of this paper is to review the share of the medical sector in the higher education enhancement project fund (HEEPF), its outcomes, sustainability, and to provide recommendations for keeping the momentum of reform pursuit in the future. The methodology included obtaining statistics pertaining to the medical sector in Egypt as regards colleges, students, and staff. We also reviewed the self-studies of the medical sector colleges, HEEPF projects reports, performance appraisal reports, and World Bank reports on HEEPF achievements in order to retrieve the required data. Results showed that medical sector had a large share of the HEEPF (28.5% of projects) as compared to its size (8% of student population). The projects covered 10 areas; the frequency distribution of which ranged between 4.4% (creation of new programs) to 97.8% (human resource development). In conclusion, educational enhancement in the medical sector in Egypt could be apparently achieved through the HEEPF competitive projects. A study of the long-term impact of these projects on the quality of education is recommended.

  18. W-519 Sagebrush Mitigation Project FY-2004 Final Review and Status

    SciTech Connect

    Durham, Robin E.; Sackschewsky, Michael R.

    2004-09-30

    This report summarizes activities conducted as mitigation for loss of sagebrush-steppe habitats due to Project W-519, the construction of the infrastructure for the Tank Waste Remediation System Vitrification Plant. The focus of this report is to provide a review and final status of mitigation actions performed through FY2004. Data collected since FY1999 have been included where appropriate. The Mitigation Action Plan (MAP) for Project W-519 prescribed three general actions to be performed as mitigation for the disturbance of approximately 40 ha (100 acres) of mature sagebrush-steppe habitat. These actions included: (1) transplanting approximately 130,000 sagebrush seedlings on the Fitzner-Eberhardt Arid Lands Ecology Reserve (ALE); (2) rectification of the new transmission line corridor via seeding with native grasses and sagebrush; and (3) research on native plant species with a goal of increasing species diversity in future mitigation or restoration actions. Nearly 130,000 Wyoming big sagebrush seedlings where planted on ALE during FY2000 and FY2001. About 39,000 of those seedlings were burned during the 24-Command Fire of June 2000. The surviving and subsequent replanting has resulted in about 91,000 seedlings that were planted across four general areas on ALE. A 50% survival rate at any monitoring period was defined as the performance standard in the MAP for this project. Data collected in 2004 indicate that of the over 5000 monitored plants, 51.1% are still alive, and of those the majority are thriving and blooming. These results support the potential for natural recruitment and the ultimate goal of wildlife habitat replacement. Thus, the basic performance standard for sagebrush survival within the habitat compensation planting has been met. Monitoring activities conducted in 2004 indicate considerable variation in seedling survival depending on the type of plant material, site conditions, and to a lesser extent, treatments performed at the time of planting

  19. Documentation of various approaches and outcomes in patients on warfarin undergoing dental procedures: a review article

    PubMed Central

    Shaer, Fayez El; Raslan, Ismael; Osaimi, Nora Al; Bawazeer, Ghada; Alayobi, Fhakr; Alhogbani, Tarek; Kharabsheh, Suliman; Habeeb, Walid Al

    2016-01-01

    Appropriate management of patients with mechanical prosthetic valves on warfarin during dental procedures is crucial. If the patients continue warfarin, they might develop bleeding, while interruption of therapy can cause thromboembolic events. Bridging therapy (mostly heparin) is used in some patients, while others stop medications. There is no unifying protocol. Information on management of patients on warfarin undergoing dental procedures in Saudi Arabia is lacking. Therefore, the current study aimed to provide more insight into various approaches utilized by clinicians to deal with such patients at a large teaching hospital in Riyadh, and to evaluate the frequency and severity of bleeding and thromboembolic complications during different types of dental procedures in this population. This was a cohort study. Patient records were used to collect data on peri-procedural management of patients on warfarin, continuation or interruption of warfarin therapy, as well as bleeding and thromboembolic complications. Fifty medical records were reviewed from March to October 2012. Regarding management, 10% had no proper documentation, 74% underwent bridging therapy, 12% discontinued warfarin therapy, and 4% continued warfarin. Of the patients, 31% had minor bleeding (15% in patients on bridging therapy and 16% in patients continuing warfarin). Thromboembolic complications were documented in 4%, (2% in those on bridging therapy and 2% in those discontinuing warfarin). Patients on bridging therapy (heparin) were admitted to the hospital for a mean of five days, and none of the other patients were admitted. Adopting the protocol to continue warfarin caused bleeding tendency that was controlled with the usual measures, with more cost effectiveness, and no thromboembolic risks. PMID:27679745

  20. Documentation of various approaches and outcomes in patients on warfarin undergoing dental procedures: a review article

    PubMed Central

    Shaer, Fayez El; Raslan, Ismael; Osaimi, Nora Al; Bawazeer, Ghada; Alayobi, Fhakr; Alhogbani, Tarek; Kharabsheh, Suliman; Habeeb, Walid Al

    2016-01-01

    Appropriate management of patients with mechanical prosthetic valves on warfarin during dental procedures is crucial. If the patients continue warfarin, they might develop bleeding, while interruption of therapy can cause thromboembolic events. Bridging therapy (mostly heparin) is used in some patients, while others stop medications. There is no unifying protocol. Information on management of patients on warfarin undergoing dental procedures in Saudi Arabia is lacking. Therefore, the current study aimed to provide more insight into various approaches utilized by clinicians to deal with such patients at a large teaching hospital in Riyadh, and to evaluate the frequency and severity of bleeding and thromboembolic complications during different types of dental procedures in this population. This was a cohort study. Patient records were used to collect data on peri-procedural management of patients on warfarin, continuation or interruption of warfarin therapy, as well as bleeding and thromboembolic complications. Fifty medical records were reviewed from March to October 2012. Regarding management, 10% had no proper documentation, 74% underwent bridging therapy, 12% discontinued warfarin therapy, and 4% continued warfarin. Of the patients, 31% had minor bleeding (15% in patients on bridging therapy and 16% in patients continuing warfarin). Thromboembolic complications were documented in 4%, (2% in those on bridging therapy and 2% in those discontinuing warfarin). Patients on bridging therapy (heparin) were admitted to the hospital for a mean of five days, and none of the other patients were admitted. Adopting the protocol to continue warfarin caused bleeding tendency that was controlled with the usual measures, with more cost effectiveness, and no thromboembolic risks.

  1. Improving the governance of patient safety in emergency care: a systematic review of interventions

    PubMed Central

    Hesselink, Gijs; Berben, Sivera; Beune, Thimpe

    2016-01-01

    Objectives To systematically review interventions that aim to improve the governance of patient safety within emergency care on effectiveness, reliability, validity and feasibility. Design A systematic review of the literature. Methods PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Database of Systematic Reviews and PsychInfo were searched for studies published between January 1990 and July 2014. We included studies evaluating interventions relevant for higher management to oversee and manage patient safety, in prehospital emergency medical service (EMS) organisations and hospital-based emergency departments (EDs). Two reviewers independently selected candidate studies, extracted data and assessed study quality. Studies were categorised according to study quality, setting, sample, intervention characteristics and findings. Results Of the 18 included studies, 13 (72%) were non-experimental. Nine studies (50%) reported data on the reliability and/or validity of the intervention. Eight studies (44%) reported on the feasibility of the intervention. Only 4 studies (22%) reported statistically significant effects. The use of a simulation-based training programme and well-designed incident reporting systems led to a statistically significant improvement of safety knowledge and attitudes by ED staff and an increase of incident reports within EDs, respectively. Conclusions Characteristics of the interventions included in this review (eg, anonymous incident reporting and validation of incident reports by an independent party) could provide useful input for the design of an effective tool to govern patient safety in EMS organisations and EDs. However, executives cannot rely on a robust set of evidence-based and feasible tools to govern patient safety within their emergency care organisation and in the chain of emergency care. Established strategies from other high-risk sectors need to be evaluated in emergency care settings, using an

  2. Personal Prayer in Patients Dealing with Chronic Illness: A Review of the Research Literature

    PubMed Central

    Jors, Karin; Baumann, Klaus

    2015-01-01

    Background. Prayer is commonly used among patients for health purposes. Therefore, this review focused on three main questions: (1) why do people turn to prayer in times of illness?, (2) what are the main topics of their prayers?, and (3) how do they pray? Method. We undertook a systematic review of the literature by searching the databases PubMed, Medline, and PsycINFO. The following inclusion criteria were used: (1) participants in the study were patients dealing with an illness, (2) the study examined the use of private rather than intercessory prayer, and (3) the content and purpose of prayer rather than its effects were investigated. Results. 16 articles were included in the final review. Participants suffered from a variety of chronic diseases, mostly cancer. Five main categories for the reasons and topics of prayer were found: (1) disease-centered prayer, (2) assurance-centered prayer, (3) God-centered prayer, (4) others-centered prayer, and (5) lamentations. Among these, disease-centered prayer was most common. Conclusions. Although most patients with chronic diseases do pray for relief from their physical and mental suffering, the intention of their prayers is not only for healing. Rather, prayer can be a resource that allows patients to positively transform the experience of their illness. PMID:25815041

  3. Whiplash associated disorders: a review of the literature to guide patient information and advice

    PubMed Central

    McClune, T; Burton, A; Waddell, G

    2002-01-01

    Methods: A systematic literature search was conducted, which included both clinical and non-clinical articles to encompass the wide range of patients' informational needs. From the studies and previous reviews retrieved, 163 were selected for detailed review. The review process considered the quantity, consistency, and relevance of all selected articles. These were categorised under a grading system to reflect the quality of the evidence, and then linked to derived evidence statements. Results: The main messages that emerged were: physical serious injury is rare; reassurance about good prognosis is important; over-medicalisation is detrimental; recovery is improved by early return to normal pre-accident activities, self exercise, and manual therapy; positive attitudes and beliefs are helpful in regaining activity levels; collars, rest, and negative attitudes and beliefs delay recovery and contribute to chronicity. These findings were synthesised into patient centred messages with the potential to reduce the risk of chronicity. Conclusions: The scientific evidence on whiplash associated disorders is of variable quality, but sufficiently robust and consistent for the purpose of guiding patient information and advice. While the delivery of appropriate messages can be both oral and written, consistency is imperative, so an innovative patient educational booklet, The Whiplash Book, has been developed and published. PMID:12421771

  4. A review of self-report medication side effect questionnaires for mental health patients.

    PubMed

    Ashoorian, Deena; Davidson, Rowan; Rock, Daniel; Gudka, Sajni; Clifford, Rhonda

    2014-11-30

    Side effects of psychotropic medications are important determinants of adherence to treatment. Discussion between the patient and clinician facilitated through the use of a side effect self-report questionnaire (SRQ) could lead to improved communications and treatment adherence. The aim of this review was to 1) identify all currently available side effect SRQs used in the assessment of mental health patients' subjective experiences, 2) evaluate the characteristics of the studies and 3) assess the psychometric properties of each of the questionnaires. Eight electronic databases were searched for peer-reviewed published articles. Six side effect SRQs were identified. Two independent reviewers assessed the quality of the study designs and psychometric properties of the identified SRQs. All questionnaires consisted of closed questions relating to antipsychotic side effects and completion times ranged from 5 to 20 min. Five questionnaires had undergone some form of psychometric testing, ranging from basic to comprehensive. There is a need in everyday clinical practice for a side effect communication tool applicable to all psychotropic medications, which allows the patient to express their subjective beliefs about their medications. This could provide an important contribution to the working relationship between patients and clinicians leading to informed decision-making and improved adherence.

  5. Personal prayer in patients dealing with chronic illness: a review of the research literature.

    PubMed

    Jors, Karin; Büssing, Arndt; Hvidt, Niels Christian; Baumann, Klaus

    2015-01-01

    Background. Prayer is commonly used among patients for health purposes. Therefore, this review focused on three main questions: (1) why do people turn to prayer in times of illness?, (2) what are the main topics of their prayers?, and (3) how do they pray? Method. We undertook a systematic review of the literature by searching the databases PubMed, Medline, and PsycINFO. The following inclusion criteria were used: (1) participants in the study were patients dealing with an illness, (2) the study examined the use of private rather than intercessory prayer, and (3) the content and purpose of prayer rather than its effects were investigated. Results. 16 articles were included in the final review. Participants suffered from a variety of chronic diseases, mostly cancer. Five main categories for the reasons and topics of prayer were found: (1) disease-centered prayer, (2) assurance-centered prayer, (3) God-centered prayer, (4) others-centered prayer, and (5) lamentations. Among these, disease-centered prayer was most common. Conclusions. Although most patients with chronic diseases do pray for relief from their physical and mental suffering, the intention of their prayers is not only for healing. Rather, prayer can be a resource that allows patients to positively transform the experience of their illness. PMID:25815041

  6. A systematic review of dental disease in patients undergoing cancer therapy

    PubMed Central

    Napeñas, Joel J.; Hodgson, Brian D.; Stokman, Monique A.; Mathers-Stauffer, Vickie; Elting, Linda S.; Spijkervet, Fred K. L.; Brennan, Michael T.

    2010-01-01

    Introduction This purpose of this systematic review was to evaluate the literature and update our current understanding of the impact of present cancer therapies on the dental apparatus (teeth and periodontium) since the 1989 NIH Development Consensus Conference on the Oral Complications of Cancer Therapies. Review method A systematic literature search was conducted with assistance from a research librarian in the databases MEDLINE/PubMed and EMBASE for articles published between 1 January 1990 and 31 December 2008. Each study was independently assessed by two reviewers. Taking into account predetermined quality measures, a weighted prevalence was calculated for the prevalence of dental caries, severe gingival disease, and dental infection. Data on DMFT/dmft, DMFS/dmfs, plaque, and gingival indexes were also gathered. The level of evidence, recommendation, and guideline (if possible) were given for published preventive and management strategies. Results Sixty-four published papers between 1990 and 2008 were reviewed. The weighted overall prevalence of dental caries was 28.1%. The overall DMFT for patients who were post-antineoplastic therapy was 9.19 (SD, 7.98; n = 457). The overall plaque index for patients who were post-antineoplastic therapy was 1.38 (SD, 0.25; n = 189). The GI for patients who were post-chemotherapy was 1.02 (SD, 0.15; n = 162). The weighted prevalence of dental infections/abscess during chemotherapy was reported in three studies and was 5.8%. Conclusions Patients who were post-radiotherapy had the highest DMFT. The use of fluoride products and chlorhexidine rinses are beneficial in patients who are post-radiotherapy. There continues to be lack of clinical studies on the extent and severity of dental disease that are associated with infectious complications during cancer therapy. PMID:20449756

  7. Interventions to improve patient hand hygiene: a systematic review.

    PubMed

    Srigley, J A; Furness, C D; Gardam, M

    2016-09-01

    Nosocomial pathogens may be acquired by patients via their own unclean hands, but there has been relatively little emphasis on patient hand hygiene as a tool for preventing healthcare-associated infections (HCAIs). The aim of this systematic review was to determine the efficacy of patient hand hygiene interventions in reducing HCAIs and improving patient hand hygiene rates compared to usual care. Electronic databases and grey literature were searched to August 2014. Experimental and quasi-experimental studies were included if they evaluated a patient hand hygiene intervention conducted in an acute or chronic healthcare facility and included HCAI incidence and/or patient hand hygiene rates as an outcome. All steps were performed independently by two investigators. Ten studies were included, most of which were uncontrolled before-after studies (N=8). The majority of interventions (N=7) were multi-modal, with components similar to healthcare worker hand hygiene programmes, including education, reminders, audit and feedback, and provision of hand hygiene products. Six studies reported HCAI outcomes and four studies assessed patient hand hygiene rates; all demonstrated improvements but were at moderate to high risk of bias. In conclusion, interventions to improve patient hand hygiene may reduce the incidence of HCAIs and improve hand hygiene rates, but the quality of evidence is low. Future studies should use stronger designs and be more selective in their choice of outcomes. PMID:27262906

  8. Interventions to improve patient hand hygiene: a systematic review.

    PubMed

    Srigley, J A; Furness, C D; Gardam, M

    2016-09-01

    Nosocomial pathogens may be acquired by patients via their own unclean hands, but there has been relatively little emphasis on patient hand hygiene as a tool for preventing healthcare-associated infections (HCAIs). The aim of this systematic review was to determine the efficacy of patient hand hygiene interventions in reducing HCAIs and improving patient hand hygiene rates compared to usual care. Electronic databases and grey literature were searched to August 2014. Experimental and quasi-experimental studies were included if they evaluated a patient hand hygiene intervention conducted in an acute or chronic healthcare facility and included HCAI incidence and/or patient hand hygiene rates as an outcome. All steps were performed independently by two investigators. Ten studies were included, most of which were uncontrolled before-after studies (N=8). The majority of interventions (N=7) were multi-modal, with components similar to healthcare worker hand hygiene programmes, including education, reminders, audit and feedback, and provision of hand hygiene products. Six studies reported HCAI outcomes and four studies assessed patient hand hygiene rates; all demonstrated improvements but were at moderate to high risk of bias. In conclusion, interventions to improve patient hand hygiene may reduce the incidence of HCAIs and improve hand hygiene rates, but the quality of evidence is low. Future studies should use stronger designs and be more selective in their choice of outcomes.

  9. Sofosbuvir: a review of its use in patients with chronic hepatitis C.

    PubMed

    Keating, Gillian M

    2014-07-01

    Sofosbuvir (Sovaldi(®)) is a nucleotide hepatitis C virus (HCV) NS5B polymerase inhibitor that has pangenotypic antiviral activity and a high genetic barrier to resistance. This article reviews the clinical efficacy and tolerability of sofosbuvir in patients with chronic hepatitis C and summarizes its pharmacological properties. Interferon-free treatment with sofosbuvir plus ribavirin achieved high sustained virological response (SVR) rates in treatment-naïve and treatment-experienced patients with HCV genotype 2 or 3 infection, and also had efficacy in patients with HCV genotype 1 infection. Sofosbuvir plus ribavirin was also effective in patients co-infected with HCV and HIV, and sofosbuvir plus ribavirin administered prior to liver transplantation prevented recurrent HCV infection in the majority of patients who had HCV RNA levels below the limit of quantification at the time of transplantation. Sofosbuvir plus peginterferon-α-2a and ribavirin achieved high SVR rates in patients with HCV genotype 1 infection, and also appeared effective in patients with HCV genotype 4, 5 or 6 infection. Oral sofosbuvir was generally well tolerated in patients with chronic hepatitis C. The most commonly reported adverse events and laboratory abnormalities were consistent with those expected with ribavirin and peginterferon-α. In conclusion, sofosbuvir represents an important advance in the treatment of chronic hepatitis C.

  10. Anthracycline-Related Cardiotoxicity in Patients with Acute Myeloid Leukemia and Down Syndrome: A Literature Review.

    PubMed

    Hefti, Erik; Blanco, Javier G

    2016-01-01

    Pediatric patients with Down syndrome (DS) are at an increased risk of developing certain cancers. Specifically, patients with DS have a reported 10-20-fold increased risk of developing acute myeloid leukemia (AML). Anthracycline-based treatment regimens achieve good results in patients with DS and AML. It has been proposed that DS status constitutes a risk factor for the cardiotoxicity associated with the use of anthracyclines in the pediatric setting. However, published evidence pointing toward an increased risk of cardiotoxicity in patients with DS is relatively scarce and conflictive. This concise review compiles literature relating to the incidence of anthracycline-related cardiotoxicity in pediatric patients with DS. In general, reports from trials using anthracyclines at the maximum recommended dose showed increases in the incidence of anthracycline-related cardiotoxicity in patients with DS in comparison with trials that used anthracyclines at reduced doses. Evidence from the literature suggests that patients with DS can achieve favorable therapeutic outcomes after receiving treatment with reduced doses of anthracyclines to minimize the potential for cardiotoxicity. Further prospective trials, along with the available evidence, would assist the design of treatment protocols for patients with pediatric leukemias and DS.

  11. Morbidity and mortality among patients with respiratory syncytial virus infection: a 2-year retrospective review.

    PubMed

    Anderson, Neil W; Binnicker, Matthew J; Harris, Dana M; Chirila, Razvan M; Brumble, Lisa; Mandrekar, Jay; Hata, D Jane

    2016-07-01

    Previous studies have demonstrated high morbidity and mortality for adult patients with respiratory syncytial virus (RSV) infection. We performed a retrospective, multicenter, two-year chart review of all patients (n = 334) testing positive for RSV by the ProFlu + (®) Influenza A/B and RSV assay (Hologic, Bedford, MA). We analyzed indicators of morbidity and mortality in children <6 years old, immunocompetent and immunosuppressed adults, and transplant patients. Significant morbidity and mortality was observed among hematopoietic stem cell transplant patients (7.3%, 60-day mortality), solid organ transplant patients (13.3%, 60-day mortality), and COPD patients (12.8%, 60-day mortality). Of the patients positive for RSV, 144 (43.1%) of 334 received antibacterials or antifungals following diagnosis. Of these patients, a bacterial or fungal pathogen was not recovered from 60% of cases. Despite advances in RSV treatment, certain populations appear to be inadequately treated, while others appear to be inappropriately treated with unnecessary antimicrobials. PMID:27179369

  12. Left atrial size and risk of stroke in patients in sinus rhythm. A systematic review.

    PubMed

    Overvad, Thure Filskov; Nielsen, Peter Brønnum; Larsen, Torben Bjerregaard; Søgaard, Peter

    2016-08-01

    Little is known about the risk of stroke associated with left atrial enlargement in patients in sinus rhythm, and whether such patients may have an unmet need for thromboprophylaxis. In this systematic review we summarise the existing evidence concerning left atrial size and risk of stroke in patients in sinus rhythm. Nine cohort studies were identified, analysing a total of 67,875 participants and 3,093 stroke outcomes. Rates of stroke per 100 person-years in patients with left atrial enlargement and in sinus rhythm ranged from 0.59 in a population-based cohort to 2.06 in patients referred for echocardiography. All studies reported a higher risk of stroke with larger/enlarged left atrium compared to smaller/normal sized left atrium. Two studies found indications of modification by sex, with only positive associations observed in women. Left atrial enlargement may represent an important predictor of stroke across a variety of patient populations in sinus rhythm. The underlying aetiology explaining this observed higher risk is likely to be multifactorial and not confined to a potential direct effect of left atrial enlargement on thromboembolic risk. Formal stroke risk stratification among patients with left atrial enlargement may further help identify patients who stand to gain from preventive antithrombotic therapy.

  13. Response to the independent technical review of the UMTRA Project procedures and practices for well drilling and development

    SciTech Connect

    Not Available

    1994-07-01

    This report is a response to the findings and recommendations contained in the ITR report. The text of this document summarizes each ITR finding and recommendation, presents the TAC response, and concludes that implementation of many of the recommendations would benefit the UMTRA Project. Implementation of the recommendations represents ongoing improvement to the TAC well installation and development procedures and will result, in lower overall project costs. Appendix B is an implementation plan that groups similar or complementary action items, provides a schedule for implementation, identifies the group or people responsible for the changes, and estimates hours to implement the changes. The four major action items are as follows: (1) ITR Reevaluation, (2) Well Installation SOP Review and Revision, (3) Well Installation Contract Review and Revision, and (4) TAC and DOE Communications Improvement. The hours listed to implement the improvements are intended to be estimates for budgeting and planning purposes for the remainder of this fiscal year and the upcoming fiscal year.

  14. Interruptions of nurses' activities and patient safety: an integrative literature review1

    PubMed Central

    Monteiro, Cintia; Avelar, Ariane Ferreira Machado; Pedreira, Mavilde da Luz Gonçalves

    2015-01-01

    OBJECTIVES: to identify characteristics related to the interruption of nurses in professional practice, as well as to assess the implications of interruptions for patient safety. METHOD: integrative literature review. The following databases were searched: Pubmed/Medline, LILACS, SciELO and Cochrane Library, using the descriptors interruptions and patient safety. An initial date was not established, but the final date was December 31, 2013. A total of 29 papers met the inclusion criteria. RESULTS: all the papers included describe interruptions as a harmful factor for patient safety. Data analysis revealed three relevant categories: characteristics of interruptions, implications for patient safety, and interventions to minimize interruptions. CONCLUSION: interruptions favor the occurrence of errors in the health field. Therefore, there is a need for further studies to understand such a phenomenon and its effects on clinical practice. PMID:25806646

  15. Migraine with persistent aura in a Mexican patient: case report and review of the literature.

    PubMed

    San-Juan, O D; Zermeño, P F

    2007-05-01

    Persistent aura symptoms in patients with migraine are rare but well documented. The International Headache Society defines persistent aura without infarction as when the aura symptoms persist for > 1 week without radiographic evidence of infarction. The visual aura of migraine attacks has been explained by cortical spreading depression. We describe a case of a 28-year-old Mexican woman, who presented with persistent aura symptoms, and a literature review. The patient had a 24-year history of migraine headache. In November 2005 the patient had an attack which started with scintillating scotomas bilaterally associated with photopsias and amaurosis followed by migraine headache. All imaging studies were negative. The episode lasted 35 days and probably resolved with nimodipine therapy. Persistent aura symptoms are rare entities. This is the first case documented of a Mexican patient with persistent aura without infarction and probably resolved with nimodipine therapy.

  16. Anesthetic management of a patient with giant retroperitoneal liposarcoma: case report with literature review

    PubMed Central

    Feng, Dandan; Xu, Fangxia; Wang, Meng; Gu, Xiaoping; Ma, Zhengliang

    2015-01-01

    Patients with giant retroperitoneal liposarcomas are considered at great risks of perioperative complications and require meticulous anaesthetic management. There have been few reports about anaesthetic management of giant retroperitoneal liposarcoma. We present the case of a 66-year-old patient who suffered from a giant retroperitoneal liposarcoma (diameter 45 cm and weigh 4.5 kg), needing a resection surgery under general anesthesia. We successfully managed anesthesia procedures in this patient using FloTrac/VigileoTM monitoring system without major perioperative complications. The surgery was completed uneventfully and the patient recovered smoothly. After reviewing the literature, we summarize FloTrac/VigileoTM monitoring system is useful to help anaesthesiologists adjust infusion rate to maintain the stability of circulatory state. Anesthetic monitoring, fluid management and temperature control need to be focused in the anesthetic management. PMID:26770605

  17. Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews

    PubMed Central

    Paré, Guy; Jaana, Mirou

    2015-01-01

    Background Growing interest on the effects of home telemonitoring on patients with chronic heart failure (HF) has led to a rise in the number of systematic reviews addressing the same or very similar research questions with a concomitant increase in discordant findings. Differences in the scope, methods of analysis, and methodological quality of systematic reviews can cause great confusion and make it difficult for policy makers and clinicians to access and interpret the available evidence and for researchers to know where knowledge gaps in the extant literature exist. Objective This overview aims to collect, appraise, and synthesize existing evidence from multiple systematic reviews on the effectiveness of home telemonitoring interventions for patients with chronic heart failure (HF) to inform policy makers, practitioners, and researchers. Methods A comprehensive literature search was performed on MEDLINE, EMBASE, CINAHL, and the Cochrane Library to identify all relevant, peer-reviewed systematic reviews published between January 1996 and December 2013. Reviews were searched and screened using explicit keywords and inclusion criteria. Standardized forms were used to extract data and the methodological quality of included reviews was appraised using the AMSTAR (assessing methodological quality of systematic reviews) instrument. Summary of findings tables were constructed for all primary outcomes of interest, and quality of evidence was graded by outcome using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) system. Post-hoc analysis and subgroup meta-analyses were conducted to gain further insights into the various types of home telemonitoring technologies included in the systematic reviews and the impact of these technologies on clinical outcomes. Results A total of 15 reviews published between 2003 and 2013 were selected for meta-level synthesis. Evidence from high-quality reviews with meta-analysis indicated that taken collectively

  18. A retrospective chart review of pirfenidone-treated patients in Sweden: the REPRIS study

    PubMed Central

    Sköld, Carl Magnus; Janson, Christer; Elf, Åsa Klackenberg; Fiaschi, Marie; Wiklund, Kerstin; Persson, Hans Lennart

    2016-01-01

    Background Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive lung disease that usually results in respiratory failure and death. Pirfenidone was approved as the first licensed therapy for IPF in Europe based on phase III trials where patients with a forced vital capacity (FVC) >50% of predicted were included. The aim of this study was to characterise patients treated with pirfenidone in Swedish clinical practice and to describe the adherence to the reimbursement restriction since reimbursement was only applied for patients with FVC below 80% of predicted. Methods This was a retrospective, observational chart review of IPF patients treated with pirfenidone from three Swedish university clinics. Patients initiated on treatment during the period 28 June 2012 to 20 November 2014 were included. Data on patient characteristics, basis of diagnosis, treatment duration, quality of life, and adverse drug reactions (ADRs) were collected from medical charts. Results Forty-four patients were screened and 33 were included in the study. The mean treatment duration from start of pirfenidone until discontinuation or end of study was 38 weeks. At the initiation of pirfenidone treatment, FVC was 62.7% (12.1) [mean (SD)], diffusion capacity (DLco) was 45.1% (13.8) of predicted, and the ratio of forced expiratory volume on 1 sec (FEV1) to FVC was 0.78 (0.1). The percentage of patients with an FVC between 50 and 80% was 87%. Ten of the patients had ADRs including gastrointestinal and skin-related events, cough and signs of impaired hepatic function, but this led to treatment discontinuation in only two patients. Conclusion Data from this chart review showed that adherence to the Swedish reimbursement restriction was followed in the majority of patients during the study period. At the start of pirfenidone treatment, lung function, measured as FVC, was lower in the present cohort of Swedish IPF patients compared with other registry and real-life data. About a third of the

  19. Cancer Survivorship Research: A Review of the Literature and Summary of Current NCI-Designated Cancer Center Projects

    PubMed Central

    Harrop, J. Phil; Dean, Julie A.; Paskett, Electra D.

    2011-01-01

    The number of cancer survivors and amount of cancer survivorship research has grown substantially during the past three decades. This paper provides a review of interventional and observational cancer survivorship research efforts as well as a summary of current cancer survivorship research projects being conducted by National Cancer Institute-designated cancer centers in an effort to identify areas that need further attention. PMID:21980012

  20. Reconstructive surgery for hypospadias: A systematic review of long-term patient satisfaction with cosmetic outcomes

    PubMed Central

    Adams, Julie; Bracka, Aivar

    2016-01-01

    Introduction: Research on long-term results of hypospadias has focused on surgical techniques and functional outcomes, and it is only recently that patient satisfaction with appearance and psychosocial outcomes have been considered. The aim of this study was to provide an evidence-based systematic review of adolescent and adult patient perceptions of cosmetic outcomes following childhood surgery for hypospadias. Methods: A systematic review was performed in accordance with the PRISMA and PICO guidelines, and studies assessed using the Oxford Centre for Evidence-Based Medicine system. MEDLINE, PsycInfo, EMBASE, and CINAHL databases were searched from 1974 to 2014 for clinical studies containing patient perceptions of appearance, deformity, and social embarrassment following hypospadias surgery. Results: A total of 495 publications were retrieved, of which 28 met the inclusion criteria. Due to study design/outcome measure, heterogeneity data were synthesized narratively. Results indicate (i) patient perceptions of penile size do not differ greatly from the norm; (ii) perceptions of appearance findings are inconsistent, partially due to improving surgical techniques; (iii) patients who are approaching, or have reached, sexual maturity hold more negative perceptions and are more critical about the cosmetic outcomes of surgery than their prepubertal counterparts; (iv) patients report high levels of perceptions of deformity and social embarrassment; and (v) there is a lack of data using validated measurement tools assessing long-term patient perceptions of cosmetic outcomes, particularly with patients who have reached genital maturity. Conclusions: Protocols for clinical postpuberty follow-up and methodologically sound studies, using validated assessment tools, are required for the accurate assessment of cosmetic and psychological outcomes of hypospadias surgery. PMID:27127350