Science.gov

Sample records for review project patients

  1. 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 the...

  2. 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 the...

  3. 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 the...

  4. Project Intrex: A General Review

    ERIC Educational Resources Information Center

    Overhage, Carl F.; Reintjes, J. Francis

    1974-01-01

    A review of M.I.T.'s INformation TRansfer EXperiments (Project Intrex). The Intrex system includes an augmented catalog stored inan online interactive computer in combination with full-text storage on microfiche. There are discussions of details of the catalog structure, user experiments, economic studies, and information-system networking.…

  5. 18 CFR 801.4 - Project review.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Section 801.4 Conservation of Power and Water Resources SUSQUEHANNA RIVER BASIN COMMISSION GENERAL... resources of the basin shall be undertaken by any person, governmental authority, or other entity prior to... project review authority regarding proposed projects in the basin coming under the review of the...

  6. Improving adequacy of hemodialysis in Northern California ESRD patients: a final project report. Provider Participants and Medical Review Board of the TransPacific Renal Network.

    PubMed

    Brown, J; Josephson, M

    2000-10-01

    The National Core Indicators Project, initiated in 1994, has brought progressive changes in adequacy of dialysis for end-stage renal disease (ESRD) patients in the TransPacific Renal Network and across the United States. The 1998 Core Indicator Project showed each Network's standing for percentage of patients with urea reduction ratio (URR) > or = 0.65 and average URR. The TransPacific Renal Network ranked 12(th) among the 18 Networks for this adequacy measure. The goals of this project were to improve the Network standing in the United States for the percent of patients with URR > or = 0.65, eliminate or reduce the barriers to achieving adequate dialysis, and evaluate URR versus KT/V data and the variances occurring with these measures. In January 1999, data were collected from all 113 Northern California hemodialysis facilities for quarter 4, 1998, to evaluate adequacy. Each facility provided patient population (N) for KT/V and URR samples, facility averages for KT/V and URR, number of patients with KT/V > or = 1.2 and URR > or = 0.65, and data on post-blood-urea-nitrogen (BUN) sampling methods. A random selection of 10% (12) providers with data below the US and Network standards was selected for an intensive assessment. Using baseline measurements, on-site data were collected from a random selection of the patient population. Chart data were reviewed, analyzed, and discussed in an exit interview with the facility management. On-site visits were performed in July/June 1999. The primary focus included adequacy data and process of care that affect adequacy outcomes, concurrent review of patients receiving treatment at the time of the site visit, and general medical record review. In Phase I, only 12 facilities showed an average URR below 0.65. All facilities reported an average KT/V greater than the DOQI target of 1.2. Forty-two facilities had their percentage of patients with a URR below the national benchmark; only 18 facilities had their percentage of patients

  7. A review of projection graphics.

    PubMed

    Biggerstaff, D E

    1986-07-01

    An overview of planning and development of artwork for projection is given so lectures can improve their visual aids. Slide design and presentation hints offer additional help to increase efficiency and effectiveness in preparing a lecture.

  8. Review of Projective Personality Assessment Techniques.

    ERIC Educational Resources Information Center

    Obrzut, John E.

    This paper reviews the literatuare on projective techniques of personality assessment and their use by school psychologists. Following a brief survey of the development of projective techniques, several of the most widely used techniques are briefly discussed, i.e., the Thematic Apperception Test (TAT), the Childrens Apperception Test (CAT), the…

  9. Review of Projective Personality Assessment Techniques.

    ERIC Educational Resources Information Center

    Obrzut, John E.

    This paper reviews the literatuare on projective techniques of personality assessment and their use by school psychologists. Following a brief survey of the development of projective techniques, several of the most widely used techniques are briefly discussed, i.e., the Thematic Apperception Test (TAT), the Childrens Apperception Test (CAT), the…

  10. A systematic review and individual patient data meta-analysis on intra-abdominal hypertension in critically ill patients: the wake-up project. World initiative on Abdominal Hypertension Epidemiology, a Unifying Project (WAKE-Up!).

    PubMed

    Malbrain, M L N G; Chiumello, D; Cesana, B M; Reintam Blaser, A; Starkopf, J; Sugrue, M; Pelosi, P; Severgnini, P; Hernandez, G; Brienza, N; Kirkpatrick, A W; Schachtrupp, A; Kempchen, J; Estenssoro, E; Vidal, M G; De Laet, I; De Keulenaer, B L

    2014-03-01

    Intra-abdominal hypertension (IAH), defined as a pathologically increase in intraabdominal pressure, is commonly found in critically ill patients. While IAH has been associated with several abdominal as well as extra-abdominal conditions, few studies have examined the occurrence of IAH in relation to mortality. The aim of this paper was to evaluate the prognostic role of IAH and its risk factors at admission in critically ill patients across a wide range of settings and countries. An individual patient meta-analysis of all available data and a systematic review of published (in full or as abstract) medical databases and studies between 1996 and June 2012 were performed. The search was limited to "clinical trials" and "randomized controlled trials", "adults", using the terms "intra-abdominal pressure", "intraabdominal hypertension" combined with any of the terms "outcome" and "mortality". All together data on 2707 patients, representing 21 centers from 11 countries was obtained. Data on 1038 patients were not analysed because of the following exclusion criteria: no IAP value on admission (N.=712), absence of information on ICU outcome (N.=195), age <18 or >95 years (N.=131). Data from 1669 individual patients (19 centers from 9 countries) were analyzed in the meta-analysis. Presence of IAH was defined as a sustained increase in IAP equal to or above 12 mmHg. At admission the mean overall IAP was 9.9±5.0 mmHg, with 463 patients (27.7%) presenting IAH with a mean IAP of 16.3±3.4 mmHg. The only independent predictors for IAH were SOFA score and fluid balance on the day of admission. Five hundred thirteen patients (30.8%) died in intensive care. The independent predictors for intensive care mortality were IAH, SAPS II score, SOFA score and admission category. This systematic review and individual patient data meta-analysis shows that IAH is frequently present in critically ill patients and it is an independent predictor for mortality.

  11. Review of NASA's Hypersonic Research Engine Project

    NASA Technical Reports Server (NTRS)

    Andrews, Earl H.; Mackley, Ernest A.

    1993-01-01

    The goals of the NASA Hypersonic Research Engine (HRE) Project, which began in 1964, were to design, develop, and construct a hypersonic research ramjet/scramjet engine for high performance and to flight-test the developed concept over the speed range from Mach 3 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 aircraft, 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 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 a combustion/propulsion model. A brief historical review of the project with salient features, typical data results, and lessons learned is presented.

  12. A systematic review of telemedicine projects in Colombia.

    PubMed

    Rey-Moreno, Carlos; Reigadas, Javier Simó; Villalba, Estrella Everss; Vinagre, Juan Jose; Fernández, Andrés Martínez

    2010-01-01

    A systematic review of telemedicine projects in Colombia was conducted. We searched electronic databases, and also searched for relevant Internet websites. Each project manager was contacted by telephone to identify projects which had not actually been carried out. They were interviewed to request information about the projects they were managing, and whether they knew of other projects in Colombia. The search process identified 43 different projects, which were classified into two groups: telemedicine research initiatives and projects for providing health-care services via telemedicine. There were 32 projects which provided telemedicine services, of which 14 had been finished, 11 remained active, 4 were being implemented and no data were available about the state of the other 3. Health-care services had been provided using telemedicine to at least 550,000 patients. The projects had connected more than 650 health-care institutions, mainly in deprived areas of the country. Unfortunately, although many projects seem to have had a positive effect, none of them had been rigorously evaluated, and therefore in the absence of scientific evidence no general recommendations can be made. However, the methodology of the present study appears suitable for similar reviews of telemedicine in other developing countries.

  13. 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.

  14. 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.

  15. 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…

  16. 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.

  17. Critical Design Reviews Project: SAPHIRE 8

    SciTech Connect

    Kurt G. Vedros; Curtis L. Smith

    2011-09-01

    The Critical Design Review (CDR) is intended to be performed at the phase of the design request immediately before proceeding to implementation of the 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. The document then records the process through the Preliminary Design Review (PDR) and on to the finalized design specification. In addition to this, the design specification has a chapter devoted to the completion of the CDR. This document describes the process of documentation of the CDR in the Design Specification.

  18. Maximum entropy PDF projection: A review

    NASA Astrophysics Data System (ADS)

    Baggenstoss, Paul M.

    2017-06-01

    We review maximum entropy (MaxEnt) PDF projection, a method with wide potential applications in statistical inference. The method constructs a sampling distribution for a high-dimensional vector x based on knowing the sampling distribution p(z) of a lower-dimensional feature z = T (x). Under mild conditions, the distribution p(x) having highest possible entropy among all distributions consistent with p(z) may be readily found. Furthermore, the MaxEnt p(x) may be sampled, making the approach useful in Monte Carlo methods. We review the theorem and present a case study in model order selection and classification for handwritten character recognition.

  19. 18 CFR 806.4 - Projects requiring review and approval.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    .... Hydroelectric projects, except to the extent that such projects involve a withdrawal, shall be exempt from the... construed as exempting hydroelectric projects from review and approval under any other category of project... 18 Conservation of Power and Water Resources 2 2013-04-01 2012-04-01 true Projects...

  20. 18 CFR 806.4 - Projects requiring review and approval.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    .... Hydroelectric projects, except to the extent that such projects involve a withdrawal, shall be exempt from the... construed as exempting hydroelectric projects from review and approval under any other category of project... 18 Conservation of Power and Water Resources 2 2010-04-01 2010-04-01 false Projects...

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

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    .... Hydroelectric projects, except to the extent that such projects involve a withdrawal, shall be exempt from the... construed as exempting hydroelectric projects from review and approval under any other category of project... 18 Conservation of Power and Water Resources 2 2012-04-01 2012-04-01 false Projects...

  2. 18 CFR 806.4 - Projects requiring review and approval.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    .... Hydroelectric projects, except to the extent that such projects involve a withdrawal, shall be exempt from the... construed as exempting hydroelectric projects from review and approval under any other category of project... 18 Conservation of Power and Water Resources 2 2014-04-01 2014-04-01 false Projects...

  3. 18 CFR 806.4 - Projects requiring review and approval.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    .... Hydroelectric projects, except to the extent that such projects involve a withdrawal, shall be exempt from the... construed as exempting hydroelectric projects from review and approval under any other category of project... 18 Conservation of Power and Water Resources 2 2011-04-01 2011-04-01 false Projects...

  4. Peterborough projects put patients first.

    PubMed

    Baillie, Jonathan

    2009-09-01

    In one of the architectural practice's largest ever contracts of its kind, Nightingale Associates is playing a major part in a pound 335 million local health reconfiguration project (the Greater Peterborough Health Investment Plan) which should see primary and acute care provision transformed in Peterborough and its surrounds. Jonathan Baillie reports on the completion of two impressive new Nightingale-designed buildings constructed as key scheme elements.

  5. Review of telemedicine projects in Taiwan.

    PubMed

    Chen, H S; Guo, F R; Chen, C Y; Chen, J H; Kuo, T S

    2001-05-01

    Taiwan is a heavily populated country, with a small land area and many mountains and isolated islands. Because medical resources are unequally distributed, high quality accessible medical care is a major problem in rural areas. Medical personnel are unwilling to practice in rural areas because of fear of isolation from peers and lack of continuing medical education (CME) in those areas. Telemedicine provides a timeless and spaceless measure for teleconsultation and education. The development of telemedicine in Taiwan began under the National Information Infrastructure (NII) Project. Distance education and teleconsultation were the first experimental projects during the initiation research stage. The cost and effectiveness of the hardware and network bandwidth were evaluated. In the promotion research stage, applications in different medical disciplines were tested to promote multipoint videoconference, electronic journals and VOD. Investigation of user satisfaction put on more emphasis on improving application functions. In 1998, a new Cyber Medical Center (CMC) international collaboration project was begun, integrating technologies of multimedia, networking, database management, and the World Wide Web. The aim of the CMC is to create a multimedia network system for the management of electronic patient records, teleconsultation, online continuing medical education, and information services on the web. A Taiwan mirror site of Virtual Hospital and two international telemedicine trials through Next Generation Internet (NGI) were done at the end of 1998. In the future, telemedicine systems in Taiwan are expected to combine the Internet and broadband CATV, ADSL, and DBS networking to connect clinics, hospitals, insurance organizations, and public health administrations; and, finally, to extend to every household.

  6. Breast cancer patient stories project.

    PubMed

    Tanna, Nuttan; Buijs, Helene; Pitkin, Joan; Reichert, Robert

    2012-12-01

    It is estimated that there are almost half a million women living with or beyond a breast cancer diagnosis in the UK, often referred to as the breast cancer survivor population. We report on the setting up of a dedicated breast cancer and menopause symptoms service (BCMS), and present results from research undertaken with breast cancer survivors with the aim of obtaining their perspectives on the BCMS service. An action-oriented approach incorporating improvement science methodology has been used to help develop and drive changes to support a high standard of NHS patient care delivery for women with breast cancer within the BCMS setting. Evaluation was undertaken of this innovative service using qualitative methodology, and included discussion within a focus group setting, patient consent to record discussion, followed by thematic analysis of transcription. Women who have survived breast cancer identified a need for specialist support to help improve their quality of life, which is also affected by menopause type symptomology. This support can be provided within the BCMS service setting. Our recommendations are that the BCMS service model is incorporated into any regional or national breast cancer patient pathway and service redesign work in place. Breast cancer survivors would support the setting up of a BCMS service, and would actively help raise awareness and market this service.

  7. 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.

  8. 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

  9. 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.

  10. 75 FR 36301 - Review and Approval of Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-25

    ... From the Federal Register Online via the Government Publishing Office SUSQUEHANNA RIVER BASIN COMMISSION 18 CFR Parts 806 and 808 Review and Approval of Projects AGENCY: Susquehanna River Basin... proposed rules that would amend the project review regulations of the Susquehanna River Basin Commission...

  11. 40 CFR 149.102 - Project review authority.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 24 2012-07-01 2012-07-01 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...

  12. 40 CFR 149.102 - Project review authority.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 24 2013-07-01 2013-07-01 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...

  13. 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...

  14. 40 CFR 149.102 - Project review authority.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 23 2014-07-01 2014-07-01 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...

  15. Field Review of Fish Habitat Improvement Projects in Central Idaho.

    SciTech Connect

    Beschta, Robert L.; Griffith, Jack; Wesche, Thomas A.

    1993-05-01

    The goal of this field review was to provide information to the Bonneville Power Administration (BPA) regarding previous and ongoing fish habitat improvement projects in central Idaho. On July 14, 1992, the review team met at the Sawtooth National Recreation Area office near Ketchum, Idaho, for a slide presentation illustrating several habitat projects during their construction phases. Following the slide presentation, the review team inspected fish habitat projects that have been implemented in the last several years in the Stanley Basin and adjacent valleys. At each site the habitat project was described to the field team and a brief period for project inspection followed. The review team visited approximately a dozen sites on the Challis, Sawtooth, and Boise National Forests over a period of approximately two and a half days. There are two objectives of this review namely to summarize observations for specific field sites and to provide overview commentary regarding the BPA habitat improvement program in central Idaho.

  16. [Differentiated review of biomedical research projects by ethics committees].

    PubMed

    Portales, María Bernardita; Michaud, Patricio; Salas, Sofía P; Beca, Juan Pablo

    2017-03-01

    Ten years after the approval of the Chilean bill that regulates scientific research in humans (Law Nº 20.120), and considering the current status of accreditation and training of many Research Ethics Committee (REC), it is necessary to analyze their performance. We analyzed the Chilean experience with REC aiming to propose a differential type of review, considering the risks to research participants. To improve the quality of the review and the efficiency of these committees, we propose to differentiate the revisions depending on the type of project, its methods and its risks. Initially, the types of review should be classified as exempt from review, expedited review and full review by the committee. In this proposal the type of review is confirmed or can be modified by a designated member of the committee after an initial review of the project. Thus, the deliberation and review times of the committee could be optimized avoiding delays in their revision.

  17. Environmental Restoration Project, Peer Review Process Assessment.

    DTIC Science & Technology

    1996-12-01

    are risk based, technically sound, and cost effective, the Air Force instituted a peer review program in 1992. The objective of this research is to...describe and analyze the peer review process. Through triangulation of data from interviews, observations, official and academic documents, and surveys...characteristics. A questionnaire was used to gather perceptions of peer review effectiveness--the criterion variable--and of the seven constructs. A total of 141

  18. LBNL report of the vetting review of the GRETINA project

    SciTech Connect

    Robinson, K.E.; Bercovitz, J.H.; Bieser, F.S.; Jared, R.C.; Karpenko, V.P.; Klein, S.R.; Lesko, K.T.; Rasson, J.E.; Ritter, H.G.; Tull, C.E.; Wells, R.; Wieman, H.H.

    2004-03-29

    GRETINA is a gamma-ray detector array capable of reconstructing the energy and spatial positions of gamma-ray interactions within the germanium crystals. It will be used to study the structure and stability of nuclei under various conditions. The new capabilities provided by gamma-ray tracking will give large gains in sensitivity for a large number of experiments, particularly those aimed at nuclei far from beta stability. A proposal for GRETINA was submitted to DOE in June 2003. It presented the scientific case, the readiness of technical development, the design, the suggested management organizations, and a proposed cost and schedule. The GRETINA proposal received its CD0 approval in August 2003. The CD-1 review will be held on December 3 and 4, 2003, and will be handled by the DOE-N. This report presents the charge to the GRETINA vetting review committee, and the findings, comments and recommendations of this committee. The purpose of this project vetting review was to assure that the GRETINA project is on track to provide DOE and the nuclear physics community with the agreed upon deliverables within the agreed upon budget and schedule. The vetting review committee was asked to cover both technical and management aspects of the GRETINA Project. Reviewers offer expert knowledge in relevant areas and provide recommendations and findings to the project's management team. Upon successful completion, the Laboratory's Integrated Project Management Office (IPMO) will recommend signoff of the project to the Laboratory Directorate. The GRETINA vetting review committee was asked to consider all relevant aspects of the project's management, project execution plan (PEP), technical approach and status, cost estimate, resources, schedule and risk and, in doing so, to advise as to whether the GRETINA Project was likely to successfully provide the agreed upon deliverables within the agreed upon budget and schedule. The review committee was asked to identify any project areas

  19. 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).

  20. 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)

  1. [Patient safety indicators for acute care hospitals: a systematic review].

    PubMed

    Gouvêa, Carla Simone Duarte de; Travassos, Claudia

    2010-06-01

    A systematic review was conducted to identify the strategies used in the development of patient safety indicators for acute care hospitals. The data sources were MEDLINE, EMBASE, websites, and reference lists from articles and documents. Fourteen projects on the development of indicators were included. The review showed the use of different terms with varying definitions of quality and patient safety. The literature review and participation by specialists and other stakeholders characterized the projects. Of the 285 identified indicators, 125 were classified in more than one quality dimension. The most frequent combination was safety and effectiveness. Most were medication indicators, and more than half were outcome indicators. In developing patient safety indicators, the results show the importance of considering variations in culture and medical practice, the availability of information systems, and the capacity of hospitals and health systems to implement effective monitoring systems.

  2. 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.

  3. Project Management of Randomized Clinical Trials: A Narrative Review

    PubMed Central

    Goodarzynejad, Hamidreza; Babamahmoodi, Abdolreza

    2015-01-01

    Context: A well-structured protocol for a clinical trial may be able to answer clinical questions, but it cannot be deemed enough to ensure success in the face of incompetent management of time as well as human and economic resources. To address this problem, in this article, we present our literature review on evidence as to how a good knowledge of proper management among researchers can enhance the likelihood of the success of clinical trial projects. Evidence Acquisition: Using multiple search strategies, we conducted a literature review on published studies in the English language from 2002 to 2012 by searching the Cochrane Database of Systematic Reviews, MEDLINE, Google Scholar, and EMBASE. Results: Our review suggests that a successful trial requires a work plan or work scope as well as a timeline. The trial manager should subsequently manage the study in accordance with the plan and the timeline. Many research units have called for a clinical project manager with scientific background and regulatory skills to effect coordination among various aspects of a clinical trial. Conclusions: Project management may benefit both the managerial and scientific aspects of medical projects and reduce fund waste. However, little has been written to date on project management in the context of clinical research. The suggestions represent the views of the individual authors. To provide a high level of evidence in this regard, we recommend that a randomized controlled trial be performed to compare trial projects progressed with and without the use of project management. PMID:26430517

  4. Project Review of the Experimental Diving Unit

    DTIC Science & Technology

    1994-06-01

    by CF along with 2 proto- type Surface Supplied CUMA (SS CUMA) from Fullerton Sherwood Engineering Ltd. A SS CUMA would provide longer dive endurance...were purchased from Exotemp Systems. - 16- Nil repo. PROJECTIONS The glov and batery evaluation will continue during CUMA decompression table development... type of apparatus and it would be difficult to relate results from this test to those from other countries. Therefore, a new test method and acceptable

  5. Learning based on patient case reviews: an interview study

    PubMed Central

    Andersen, Rikke Sand; Hansen, Rikke Pilegaard; Søndergaard, Jens; Bro, Flemming

    2008-01-01

    Background Recent theories on adult learning recommend that learning is situated in real-life contexts. Learning is considered a continuous process in which every new experience builds on, and integrates with, previously accumulated experiences. Reviewing and reflecting on patient cases is in line with this learning approach. There has, however, been remarkably little research into how patient cases might be applied in professional education. The purpose of this article is to present family physicians' perceptions of the learning process initiated by reviewing patient cases. Methods Thirteen family physicians, who had all participated in a large project on cancer diagnosis in family practice (the CAP-project), currently carried out at the Research Unit for General Practice, University of Aarhus were interviewed on their experiences of reviewing patient cases. In the CAP-project family physicians (n = 467, 81%) in the County of Aarhus (640 000 inhabitants) completed 2,212 (83%) detailed questionnaires on all newly diagnosed patients with cancer encountered in their practices during a one year period (2004–2005). In order to complete the questionnaire the family physicians were required to perform a systematic case review of each patient: they had to consult their records to provide dates of symptom-presentation, investigations and treatments initiated, and reflect on previous encounters with the patients to give detailed information on his/hers knowledge of the patients' care seeking behaviour, mental health and risk factors. The purpose of this article is to present indebt interview-data on family physicians' perceptions of the learning process initiated by reviewing patient cases, and their evaluations of using patient case reviews as a learning method in family practice. Results The process of reflection initiated by reviewing patient cases enabled family physicians to reconsider their clinical work procedures which potentially supported the transition from

  6. Learning based on patient case reviews: an interview study.

    PubMed

    Andersen, Rikke Sand; Hansen, Rikke Pilegaard; Søndergaard, Jens; Bro, Flemming

    2008-09-05

    Recent theories on adult learning recommend that learning is situated in real-life contexts. Learning is considered a continuous process in which every new experience builds on, and integrates with, previously accumulated experiences. Reviewing and reflecting on patient cases is in line with this learning approach. There has, however, been remarkably little research into how patient cases might be applied in professional education. The purpose of this article is to present family physicians' perceptions of the learning process initiated by reviewing patient cases. Thirteen family physicians, who had all participated in a large project on cancer diagnosis in family practice (the CAP-project), currently carried out at the Research Unit for General Practice, University of Aarhus were interviewed on their experiences of reviewing patient cases. In the CAP-project family physicians (n = 467, 81%) in the County of Aarhus (640 000 inhabitants) completed 2,212 (83%) detailed questionnaires on all newly diagnosed patients with cancer encountered in their practices during a one year period (2004-2005). In order to complete the questionnaire the family physicians were required to perform a systematic case review of each patient: they had to consult their records to provide dates of symptom-presentation, investigations and treatments initiated, and reflect on previous encounters with the patients to give detailed information on his/hers knowledge of the patients' care seeking behaviour, mental health and risk factors.The purpose of this article is to present indebt interview-data on family physicians' perceptions of the learning process initiated by reviewing patient cases, and their evaluations of using patient case reviews as a learning method in family practice. The process of reflection initiated by reviewing patient cases enabled family physicians to reconsider their clinical work procedures which potentially supported the transition from individual competence to personal

  7. Alvarado Flood Risk Management Modifications to Existing Project Section 408 Review. Review Plan

    DTIC Science & Technology

    2012-12-26

    39181-CJBO MEMORANDUM FOR Commander, St. Paul District SUBJECT: Review Plan Approval for the Alvarado , Minnesota, Flood Risk Management...Modifications to Existing Project, Section 408 1. References: a. Memorandum, CEMVP-EC, 3 August 2012, subject: Review Plan for Alvarado Flood Risk... Alvarado , MN, Flood Risk f\\1anagement Modi£ ications to Existing Project, Section 4 0 8 Review Plan (encl 2) . c. EC 1165-2-214, 15 December 2012, subject

  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. [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.

  10. Southwire Company Splitting of Projects Review

    EPA Pesticide Factsheets

    This document may be of assistance in applying the New Source Review (NSR) air permitting regulations including the Prevention of Significant Deterioration (PSD) requirements. This document is part of the NSR Policy and Guidance Database. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

  11. Review of Craven County Wood Energy Project

    EPA Pesticide Factsheets

    This document may be of assistance in applying the New Source Review (NSR) air permitting regulations including the Prevention of Significant Deterioration (PSD) requirements. This document is part of the NSR Policy and Guidance Database. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

  12. 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.

  13. Financing Renewable Energy Projects in Developing Countries: A Critical Review

    NASA Astrophysics Data System (ADS)

    Donastorg, A.; Renukappa, S.; Suresh, S.

    2017-08-01

    Access to clean and stable energy, meeting sustainable development goals, the fossil fuel dependency and depletion are some of the reasons that have impacted developing countries to transform the business as usual economy to a more sustainable economy. However, access and availability of finance is a major challenge for many developing countries. Financing renewable energy projects require access to significant resources, by multiple parties, at varying points in the project life cycles. This research aims to investigate sources and new trends in financing RE projects in developing countries. For this purpose, a detail and in-depth literature review have been conducted to explore the sources and trends of current RE financial investment and projects, to understand the gaps and limitations. This paper concludes that there are various internal and external sources of finance available for RE projects in developing countries.

  14. [Review and analysis of the review results of Taiwan nurses association nursing projects (2011~2013)].

    PubMed

    Chang, Li-Yin; Chen, Yu-Chih; Huang, Kuang-Chi; Huang, Jui-Lan; Lee, Tso-Ying

    2015-04-01

    Nursing projects are a key part of N4 professional competency training for nursing personnel. Low passage rates for these projects have been shown to negatively affect the intent of nursing personnel to advance further in the nursing ladder system. This study analyzes the scores for nursing projects between 2011 and 2013, the passage rate for these projects, and the differences in passage rates between different types of projects. This retrospective and descriptive study collected data on nursing projects conducted under the auspices of the Taiwan Nurses Association between 2011 and 2013. Furthermore, the comments of reviewers on 100 nursing projects were randomly selected and subjected to content analysis. A total of 3,359 nursing projects were examined. Eliminating unqualified nursing projects left a total of 3,246 projects for the dataset. A total of 1,099 projects were scored with passing grades, giving a passing rate of 33.9%. The authors of these passing projects worked primarily in northern Taiwan, worked in medical centers, and worked in intensive care departments. The projects submitted by authors in central Taiwan had the highest average score and passing rate, while those living in offshore islands had the lowest average score and passing rate. Most of the project topics belonged to the category: "improvement of nursing service skills or quality" (77.3%). Items with the lowest scores were: validation of questions, analysis of the current situation, and evaluation of results. The topics of nursing projects did not relate significantly to passing rate. However, years of experience, geographic location of hospital, level of institution, and department each had a statistically significant impact on the passage rate. A content analysis of reviewer comments was used to extract common problems. Most of the positive comments were related to the category of "literature review and reference", while most of the negative comments were related to the categories of

  15. Baseline review of the U.S. LHC Accelerator project

    SciTech Connect

    1998-02-01

    The Department of Energy (DOE) Review of the U.S. Large Hadron Collider (LHC) Accelerator project was conducted February 23--26, 1998, at the request of Dr. John R. O`Fallon, Director, Division of High Energy Physics, Office of Energy Research, U.S. DOE. This is the first review of the U.S. LHC Accelerator project. Overall, the Committee found that the U.S. LHC Accelerator project effort is off to a good start and that the proposed scope is very conservative for the funding available. The Committee recommends that the project be initially baselined at a total cost of $110 million, with a scheduled completion data of 2005. The U.S. LHC Accelerator project will supply high technology superconducting magnets for the interaction regions (IRs) and the radio frequency (rf) straight section of the LHC intersecting storage rings. In addition, the project provides the cryogenic support interface boxes to service the magnets and radiation absorbers to protect the IR dipoles and the inner triplet quadrupoles. US scientists will provide support in analyzing some of the detailed aspects of accelerator physics in the two rings. The three laboratories participating in this project are Brookhaven National Laboratory, Fermi National Accelerator Laboratory (Fermilab), and Lawrence Berkeley National Laboratory. The Committee was very impressed by the technical capabilities of the US LHC Accelerator project team. Cost estimates for each subsystem of the US LHC Accelerator project were presented to the Review Committee, with a total cost including contingency of $110 million (then year dollars). The cost estimates were deemed to be conservative. A re-examination of the funding profile, costs, and schedules on a centralized project basis should lead to an increased list of deliverables. The Committee concluded that the proposed scope of US deliverables to CERN can be readily accomplished with the $110 million total cost baseline for the project. The current deliverables should serve as

  16. 76 FR 60774 - Review and Approval of Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-30

    ... From the Federal Register Online via the Government Publishing Office SUSQUEHANNA RIVER BASIN COMMISSION 18 CFR Part 806 Review and Approval of Projects AGENCY: Susquehanna River Basin Commission. ACTION... inform the public of an extension of the comment period for proposed rules of the Susquehanna River Basin...

  17. 40 CFR 149.102 - Project review authority.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 22 2010-07-01 2010-07-01 false Project review authority. 149.102 Section 149.102 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS... which the Administrator determines may contaminate the aquifer so as to create a significant hazard to...

  18. Organization Design for Dynamic Fit: A Review and Projection

    DTIC Science & Technology

    2014-01-01

    TYPE 3. DATES COVERED 00-00-2014 to 00-00-2014 4. TITLE AND SUBTITLE Organization Design for Dynamic Fit: A Review and Projection 5a. CONTRACT...Creativity and improvisation in jazz and organizations: Implications for organizational learning. Organization Science 9(5): 605-622. Boudreau JW

  19. 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,…

  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) are...

  1. 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.…

  2. 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.…

  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. Framework for Advancing the Reporting of Patient Engagement in Rheumatology Research Projects.

    PubMed

    Hamilton, Clayon B; Leese, Jenny C; Hoens, Alison M; Li, Linda C

    2017-07-01

    The term "patient engagement in research" refers to patients and their surrogates undertaking roles in the research process beyond those of study participants. This paper proposes a new framework for describing patient engagement in research, based on analysis of 30 publications related to patient engagement. Over the past 15 years, patients' perspectives have been instrumental in broadening the scope of rheumatology research and outcome measurement, such as evaluating fatigue in rheumatoid arthritis. Recent reviews, however, highlight low-quality reporting of patient engagement in research. Until we have more detailed information about patient engagement in rheumatology research, our understanding of how patients' perspectives are being integrated into research projects remains limited. When authors follow our guidance on the important components for describing patients' roles and function as "research partners," researchers and other knowledge users will better understand how patients' perspectives were integrated in their research projects.

  5. 18 CFR 806.5 - Projects that may require review and approval.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... require review and approval. 806.5 Section 806.5 Conservation of Power and Water Resources SUSQUEHANNA RIVER BASIN COMMISSION REVIEW AND APPROVAL OF PROJECTS General Provisions § 806.5 Projects that may require review and approval. (a) The following projects, if not otherwise requiring review and approval...

  6. 18 CFR 806.5 - Projects that may require review and approval.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... require review and approval. 806.5 Section 806.5 Conservation of Power and Water Resources SUSQUEHANNA RIVER BASIN COMMISSION REVIEW AND APPROVAL OF PROJECTS General Provisions § 806.5 Projects that may require review and approval. (a) The following projects, if not otherwise requiring review and approval...

  7. 18 CFR 806.5 - Projects that may require review and approval.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... require review and approval. 806.5 Section 806.5 Conservation of Power and Water Resources SUSQUEHANNA RIVER BASIN COMMISSION REVIEW AND APPROVAL OF PROJECTS General Provisions § 806.5 Projects that may require review and approval. (a) The following projects, if not otherwise requiring review and approval...

  8. [The Ana Teresa project: the way to deinstitutionalize mental patients?].

    PubMed

    Costa, E; Borenstein, M S

    1999-01-01

    This project shows a new way of treatment for chronical and sheltered patients, to which the main objective is to offer a quality of life that allows them to be patients with personality, and citizens with all their potentialities.

  9. 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.

  10. Patient participation in ERS guidelines and research projects: the EMBARC experience.

    PubMed

    Chalmers, James D; Timothy, Alan; Polverino, Eva; Almagro, Marta; Ruddy, Thomas; Powell, Pippa; Boyd, Jeanette

    2017-09-01

    The European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) is a European Respiratory Society (ERS) Clinical Research Collaboration dedicated to improving research and clinical care for people with bronchiectasis. EMBARC has created a European Bronchiectasis Registry, funded by the ERS and by the European Union (EU) Innovative Medicines Initiative Programme. From the outset, EMBARC had the ambition to be a patient-focussed project. In contrast to many respiratory diseases, however, there are no specific patient charities or European patient organisations for patients with bronchiectasis and no existing infrastructure for patient engagement. This article describes the experience of EMBARC and the European Lung Foundation in establishing a patient advisory group and then engaging this group in European guidelines, an international registry and a series of research studies. Patient involvement in research, clinical guidelines and educational activities is increasingly advocated and increasingly important. Genuine patient engagement can achieve a number of goals that are critical to the success of an EU project, including focussing activities on patient priorities, allowing patients to direct the clinical and research agenda, and dissemination of guidelines and research findings to patients and the general public. Here, we review lessons learned and provide guidance for future ERS task forces, EU-funded projects or clinical research collaborations that are considering patient involvement. To understand the different ways in which patients can contribute to clinical guidelines, research projects and educational activities.To understand the barriers and potential solutions to these barriers from a physician's perspective, in order to ensure meaningful patient involvement in clinical projects.To understand the barriers and potential solutions from a patient's perspective, in order to meaningfully involve patients in clinical projects.

  11. 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

  12. Patient involvement. The Derby Theatre Project experience.

    PubMed

    Ainsworth, David

    2003-12-01

    Patient involvement adds power and value to service redesign. Patient views can be extremely powerful when influencing clinical staff. They also provide a strong management case for change. Patient choice should be built into any service redesign. A model for improvement should form a template that can be amended to suit patient need and should take account of patient views. Patient views should be objective. Patients can give a better opinion of how services should be shaped when given a choice of what could be done. A model should offer different routes along a journey so that patients can say what they would prefer to happen.

  13. Sexual dysfunction in cancer patients: a review.

    PubMed

    Cakar, B; Karaca, B; Uslu, R

    2013-01-01

    Cancer is a life-threatening disease despite the advanced therapeutic strategies now available. A common problem is that physicians and patients tend to concentrate on intensive medical treatment options and underestimate the treatment-related adverse effects. In this review, we summarize one of these adverse effects in cancer patients; sexual dysfunction (SD). In addition, current therapeutic choices with optimal doses and patient selection strategies are defined. All patients should be informed about problems associated with therapy-related SD and must be guided toward the most appropriate therapeutic options before starting treatment.

  14. Improving physician-patient interactions: a review.

    PubMed

    Strecher, V J

    1983-01-01

    The interaction between physician and patient comprises aspects of communication common to any two human beings and other aspects peculiar to the roles exclusively adopted by physicians and patients. In this review, nonverbal and verbal elements of general communication are discussed, detailing important aspects of vocal tone, body postures, appearance, and verbal cues that may influence attributions made of physicians by patients. Role-related elements of physician-patient interactions are discussed in light of findings from research on interactions between physicians and patients. Developmental elements of general communication are discussed, relating stages tht evolve in interactions to physician-patient interactions. Finally, an examination is made of how interpersonal skills are taught to physicians and medical students. Discussion of what skills are specified for teaching, whether they are effectively taught, and whether the learning of these skills produces desired patient health-related outcomes is presented.

  15. 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

  16. Interregional healthcare: patient stories and chart reviews.

    PubMed

    Miller, E H; Nordquist, D A; Doran, K A; Ahern, C K; Karsten, Y M

    1998-01-01

    The literature and healthcare provider experiences leave questions about which interventions might best assist patients during interregional healthcare. The research was conducted to gain information on the current reality of interregional healthcare for patients needing tertiary cardiovascular care distant from their home. A purposive sample of patients having a cardiovascular diagnosis who were transferred for procedures or surveillance to a tertiary site were interviewed (n = 17), and their charts were reviewed (n = 27). Six broad themes were extracted from the interviews and chart reviews: healthcare provider behaviors, healthcare system issues, patient education or information, discharge from the hospital, overall reflections on the healthcare experience, and healthcare communication issues. A redesign of interregional healthcare is needed to address the areas of care and expert behaviors by providers, documentation, continuity, communication, education, and rehabilitation/adaption. The advanced practice nurse is well suited to lead these practice changes.

  17. [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.

  18. A project to promote better communication with patients.

    PubMed

    Campbell, Sandra

    Good communication skills are essential when interacting with patients, especially when breaking bad news and dealing with difficult situations. National and local recognition of gaps in nurse education in such skills within the Forth Valley Acute Operating Division led to a multidisciplinary project that aimed to improve them. This article describes how this project was piloted.

  19. [A project to promote patient positioning accuracy in operating rooms].

    PubMed

    Huang, Jui-Chen; Pan, Shu-Pan; Huang, Yi-Tzu; Chen, Shu-Hua

    2011-12-01

    Inappropriate patient positioning during surgery causes respiratory pattern changes, inadequate gaseous exchange, tissue hypoperfusion and disruption of skin integrity. Inadvertent loosening of positioning devices on a patient in our ward during surgery caused surgical field contamination. We thus proposed a project to promote patient positioning accuracy in operating rooms to improve patient safety. This project was intended to promote accurate patient positioning by operating room nurses, raise nursing professionalism, ensure patient safety, and avoid unnecessary patient injury. Under the project, we held educational training programs, developed patient positioning standard operating procedures (SOPs) and check lists, inspected all positioning assistance devices, purchased additional belt restraint straps, and conducted periodic monitoring. Patient positioning execution accuracy increased from 80% to 100%; cognition of patient positioning increased from 88% to 100%. The operating room committee adopted the proposed procedures and they are now SOPs in all operating rooms at our hospital. We suggest including the SOPs developed in this project in continuous education programs and urge making well-designed positioning assistance devices available to protect patient safety during surgery.

  20. 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

  1. [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.

  2. A review of patients on methadone maintenance.

    PubMed

    Taj, R; Keenan, E; O'Connor, J J

    1995-01-01

    This study involves a review of 178 patients on a strictly monitored methadone maintenance programme. All patients had a minimum of 9 years of intravenous drug misuse. 35.7% were HIV positive, 55.7% males and 29% females had previous prison sentences. On average patients had undergone 3.26 out-patient and 0.9 in-patient detoxification. 46.1% had attempted rehabilitation in the past. Out of 25,470 urine samples obtained while on the programme, 10.8% were positive for opiates, 19.2% for benzodiazepines, 32.5% for cannabis, 4.92% for alcohol and 2.27% for amphetamines. Long history of misuse, multiple custodial sentences, previous unsuccessful rehabilitation and positive HIV status were associated with acceptance for maintenance. Frequency of urinalysis, and results triggering dose change can effectively reduce illicit drug use.

  3. 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

  4. 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.

  5. Renal failure in burn patients: a review.

    PubMed

    Emara, S S; Alzaylai, A A

    2013-03-31

    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.

  6. 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

  7. 42 CFR 52h.11 - What are the review criteria for contract projects and proposals?

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 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 into...

  8. 42 CFR 52h.11 - What are the review criteria for contract projects and proposals?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 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 into...

  9. 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 into...

  10. 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 into...

  11. 36 CFR 1010.14 - Review of proposals by project applicants.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 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 and... materials concerning the proposal sufficient to permit the Trust to carry out its environmental review...

  12. 36 CFR 1010.14 - Review of proposals by project applicants.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 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 and... materials concerning the proposal sufficient to permit the Trust to carry out its environmental review...

  13. 42 CFR 137.301 - How are project and program environmental review costs identified?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 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 environmental... foreseeable environmental review activities. (b) If unforeseen environmental review and compliance costs are...

  14. 42 CFR 137.301 - How are project and program environmental review costs identified?

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 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 environmental... foreseeable environmental review activities. (b) If unforeseen environmental review and compliance costs are...

  15. 42 CFR 137.301 - How are project and program environmental review costs identified?

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 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 environmental... foreseeable environmental review activities. (b) If unforeseen environmental review and compliance costs are...

  16. 42 CFR 137.301 - How are project and program environmental review costs identified?

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 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 environmental... foreseeable environmental review activities. (b) If unforeseen environmental review and compliance costs are...

  17. [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. Copyright © 2011 SERAM. Published by Elsevier Espana. All rights reserved.

  18. 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.

  19. 13 CFR 302.9 - Inter-governmental review of projects.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... projects. 302.9 Section 302.9 Business Credit and Assistance ECONOMIC DEVELOPMENT ADMINISTRATION... review of projects. (a) When an Eligible Applicant is not a State, Indian Tribe or other general purpose... Project under EDA's Public Works and Economic Development program or a proposed construction Project or...

  20. 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.

  1. Acute epiglottitis: A review of 50 patients.

    PubMed

    Lon, Shafkat Ahmad; Lateef, Mohd; Sajad, Mir

    2006-04-01

    We reviewed 50 patients admitted to the department of Otorhinolaryngology and Head & Neck Surgery of Govt Medical College Srinagar from September 19% to September 2002 diagnosed with acute epiglottitis. Male were more commonly involved than females in the ratio of 2.8:1 with only 6 cases younger than 10 years of age. The highest incidence was in the month of January (22%). The common symptoms of acute epiglottitis were sorethroat(92%) and odynophagia(88%). Any patient with sudden onset of these symptoms should be suspected of having acute epiglottitis and should have an indirect laryngoscopy. Blood culture was obtained in 20 cases Cultures were positive only in 5 cases, out of which 4 were positive for Hemophilus influenzae type B. Throat cultures were not obtamed The primary treatment of acute epiglottitis is intravenous antibiotics, steriods, and humidified air. Treacheostomy was needed only in 4 patients. There were no deaths.

  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. Notification: Project Notification Memorandum for OIG Evaluation of EPA's Regulatory Flexibility Act Retrospective Reviews

    EPA Pesticide Factsheets

    Project #OPE-FY11-0024, January 6, 2012. Our overall evaluation objective remains to assess the efficiency and effectiveness of policies and procedures in place for conducting RFA Section 610 retrospective reviews and the concerns regarding past reviews.

  4. 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.

  5. 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.

  6. Telemedicine and telecare for older patients--a systematic review.

    PubMed

    van den Berg, Neeltje; Schumann, Maika; Kraft, Kathleen; Hoffmann, Wolfgang

    2012-10-01

    Telemedicine is increasingly becoming a reality in medical care for the elderly. We performed a systematic literature review on telemedicine healthcare concepts for older patients. We included controlled studies in an ambulant setting that analyzed telemedicine interventions involving patients aged ≥60 years. 1585 articles matched the specified search criteria, thereof, 68 could be included in the review. Applications address an array of mostly frequent diseases, e.g. cardiovascular disease (N=37) or diabetes (N=18). The majority of patients is still living at home and is able to handle the telemedicine devices by themselves. In 59 of 68 articles (87%), the intervention can be categorized as monitoring. The largest proportion of telemedicine interventions consisted of measurements of vital signs combined with personal interaction between healthcare provider and patient (N=24), and concepts with only personal interaction (telephone or videoconferencing, N=14). The studies show predominantly positive results with a clear trend towards better results for "behavioral" endpoints, e.g. adherence to medication or diet, and self-efficacy compared to results for medical outcomes (e.g. blood pressure, or mortality), quality of life, and economic outcomes (e.g. costs or hospitalization). However, in 26 of 68 included studies, patients with characteristic limitations for older patients (e.g. cognitive and visual impairment, communication barriers, hearing problems) were excluded. A considerable number of projects use rather sophisticated technology (e.g. videoconferencing), limiting ready translation into routine care. Future research should focus on how to adapt systems to the individual needs and resources of elderly patients within the specific frameworks of the respective national healthcare systems. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  7. Cataracts in Diabetic Patients: A Review Article

    PubMed Central

    Javadi, Mohammad-Ali; Zarei-Ghanavati, Siamak

    2008-01-01

    The number of people with diabetes mellitus is increasing and cataracts are one of the most common causes of visual impairment in these subjects. Advances in cataract surgical techniques and instrumentation have generally improved the outcomes; however,surgery may not be safe and effective in certain individuals with pre-existing retinal pathology or limited visual potential. This review article aims to address different aspects surrounding cataracts in diabetic patients. In a computerized MEDLINE search,relevant studies were selected by two authors using the keywords “diabetes mellitus”, “cataract”, “diabetic retinopathy” and “diabetic maculopathy”. PMID:23479523

  8. 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

    ...; Use of Project Labor Agreements for Federal Construction Projects AGENCY: Department of Defense (DOD... collection requirement regarding Use of Project Labor Agreements for Federal Construction Projects. A request... for Federal Construction Projects, in all correspondence. FOR FURTHER INFORMATION CONTACT: Mr. Ernest...

  9. Fuel transfer system ALARA design review - Project A.15

    SciTech Connect

    KUEBERTH, L.R.

    2001-11-12

    One mission of the Spent Nuclear Fuel (SNF) Project is to move the SNF from the K Basins in the Hanford 100K Area to an interim dry storage at the Canister Storage Building (CSB) in the Hanford 200 East Area. The Fuel Transfer System (FTS) is a subproject that will move the SNF from the 105K East (KE) Facility to the 105K West (KW) Facility. The SNF will be treated for shipment to the Cold Vacuum Drying (CVD) facility at the KW Basin. The SNF canisters will be loaded underwater into a Shielded Transfer Cask (STC) in the KE Basin. The fully loaded STC will be brought out of the water and placed into a Cask Transfer Overpack (CTO) by the STC Straddle Carrier. As the STC is removed from the water, it will be washed down with demineralized water by an manual rinse system. The CTO with the STC inside will be placed on a transport trailer and transferred to the KW Basin as an intra-facility transfer. The CTO will be unloaded from the shipping trailer at the KW Basin and the STC will be removed from the CTO. The STC will then be lowered into the KW Basin water and the fuel will be removed. The SNF will then be processed for shipment to the CVD. As soon as all of the fuel has been removed from the STC, the cask will be removed from the KW Basin water and placed into the CTO. The CTO will again be placed on the trailer for transport back to the KE Basin where the entire cycle will be repeated approximately 400 times. This document records the As Low As Reasonably Achievable (ALARA) findings and design recommendations/requirements by the SNF Project noted during the Final Design Review of the STC, CTO, STC Transfer System, Annexes and Roadways for support of FTS. This document is structured so that all statements that include the word ''shall'' represent design features that have been or will be implemented within the project scope. Statements that include the words ''should'' or ''recommend'' represent ALARA design features to be evaluated for future implementation.

  10. Review of global energy and carbon dioxide projections

    SciTech Connect

    Keepin, B.

    1986-01-01

    The concentration of carbon dioxide (CO/sub 2/) in the Earth's atmosphere has risen steadily over the last century, giving rise to the widely publicized ''greenhouse effect,'' believed to be responsible for a gradual warming trend in the Earth's climate. In addition to CO/sub 2/, recent studies have revealed increasing atmospheric concentrations of other ''greenhouse'' gases (e.g. methane, nitrous oxide, and chlorofluorocarbons) that may well exacerbate this warming trend considerably. While the sources of these latest gases have not yet been clearly identified, emissions of CO/sub 2/ into the atmosphere are known to come from anthropogenic sources, primarily the combustion of fossil fuels. Thus an important component in the investigation of future global warming is an understanding of future carbon emissions, which in turn requires a study of future energy developments, particularly fossil fuel consumption. Various attempts have recently been made to project the global energy future and corresponding CO/sub 2/ emissions several decades ahead. This paper provides a critical review of some of these efforts.

  11. 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

  12. 36 CFR § 1010.14 - Review of proposals by project applicants.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... applicants. § 1010.14 Section § 1010.14 Parks, Forests, and Public Property PRESIDIO TRUST ENVIRONMENTAL QUALITY § 1010.14 Review of proposals by project applicants. (a) An EA shall be required for each proposal... project applicant until such time as the appropriate environmental review documents have been prepared and...

  13. 36 CFR 1010.14 - Review of proposals by project applicants.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...), 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 and...

  14. 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 and...

  15. 77 FR 18885 - Improving Performance of Federal Permitting and Review of Infrastructure Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-28

    ... From the Federal Register Online via the Government Publishing Office ] Vol. 77 Wednesday, No. 60 March 28, 2012 Part II The President Executive Order 13604--Improving Performance of Federal Permitting and Review of Infrastructure Projects Memorandum of March 22, 2012--Expediting Review of Pipeline Projects From Cushing, Oklahoma, to Port...

  16. Learning from open source software projects to improve scientific review

    PubMed Central

    Ghosh, Satrajit S.; Klein, Arno; Avants, Brian; Millman, K. Jarrod

    2012-01-01

    Peer-reviewed publications are the primary mechanism for sharing scientific results. The current peer-review process is, however, fraught with many problems that undermine the pace, validity, and credibility of science. We highlight five salient problems: (1) reviewers are expected to have comprehensive expertise; (2) reviewers do not have sufficient access to methods and materials to evaluate a study; (3) reviewers are neither identified nor acknowledged; (4) there is no measure of the quality of a review; and (5) reviews take a lot of time, and once submitted cannot evolve. We propose that these problems can be resolved by making the following changes to the review process. Distributing reviews to many reviewers would allow each reviewer to focus on portions of the article that reflect the reviewer's specialty or area of interest and place less of a burden on any one reviewer. Providing reviewers materials and methods to perform comprehensive evaluation would facilitate transparency, greater scrutiny, and replication of results. Acknowledging reviewers makes it possible to quantitatively assess reviewer contributions, which could be used to establish the impact of the reviewer in the scientific community. Quantifying review quality could help establish the importance of individual reviews and reviewers as well as the submitted article. Finally, we recommend expediting post-publication reviews and allowing for the dialog to continue and flourish in a dynamic and interactive manner. We argue that these solutions can be implemented by adapting existing features from open-source software management and social networking technologies. We propose a model of an open, interactive review system that quantifies the significance of articles, the quality of reviews, and the reputation of reviewers. PMID:22529798

  17. 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…

  18. 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.

  19. 13 CFR 302.9 - Inter-governmental review of projects.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... projects. 302.9 Section 302.9 Business Credit and Assistance ECONOMIC DEVELOPMENT ADMINISTRATION... authority (the “Authority”) in the Region a minimum of fifteen (15) days to review and comment on a proposed Project under EDA's Public Works and Economic Development program or a proposed construction Project...

  20. Information and Communications Technologies Health Projects in Panama: A Systematic Review and their Relation with Public Policies.

    PubMed

    Sánchez, Gema Anabel Castillo; Berbey, Aranzazu; de la Torre-Díez, Isabel; López-Coronado, Miguel

    2017-07-01

    This paper presents a review about Information and Communications Technologies (ICTs) health projects in Panama. The main contribution is to provide a vision of the situation in Panama, allowing an understanding of the dynamics of health policies and how they have affected the implementation of ICT's Projects to improve the health of Panamanians. We analyze the projects found with ICT's in health of Panama, which allow us to see a perspective of projects information is obtained from 2000 to 2016, however it is important to highlight that there may be other projects that we do not know because we did not find enough information or evidence of the same. That is why this review has interviews with key personnel, who have guided us with the search for information. 56% of technology projects are concentrated in the capital city and only 16% in the province of Chiriquí. 64% of these projects are focused on the development of information systems, mainly focused on electronic patient registration. And 60% refers to projects related to primary health care. The MINSA and CSS both with a 20% participation in ICT project, in addition we can notice the dispersion of projects for hospitals, where each one is developing programs per their needs or priorities. The national information about ICT projects of Health, it has been notorious the state of dispersion and segmented of public health information. We consider that it is a natural consequence of Policy in Panamanian Health System. This situation limits the information retrieval and knowledge of ICT in Health of Panama. To stakeholders, this information is directed so that health policies are designed towards a more effective and integral management, administering the ICT's as tools for the well-being of most the Panamanian population, including indigenous group.

  1. Experiences in the realisation of a research project on anthroposophical medicine in patients with advanced cancer.

    PubMed

    von Rohr, E; Pampallona, S; van Wegberg, B; Hürny, C; Bernhard, J; Heusser, P; Cerny, T

    2000-08-26

    To date most of the published studies on the effectiveness of complementary therapies in cancer patients have yielded controversial results because of questionable methodology. Research strategies and methodologies acceptable to both conventional and unconventional medicine are difficult to find due to different belief systems. In this publication we describe the development and implementation of a project conducted as part of National Research Programme 34 (NFP 34). Detailed analysis of our experiences might provide some information on how to deal with practical difficulties in the planning and conduct of further research projects in this field. The project involved the anthroposophical Lukas Clinic in Arlesheim and the Institute of Medical Oncology of the University Hospital, Berne. This interdisciplinary research project was devised to study the relative merits of these two schools of medicine in the care of advanced cancer patients. The project was made up of three components: (1) a registration study aimed at comparing the case mix at the two institutions; (2) a three armed randomised study on the effectiveness of supportive therapy, comparing anthroposophy to psychosocial group therapy, and (3) a longitudinal study to monitor the evaluation of quality of life of patients at the anthroposophical clinic. After a brief review of the study protocol, which presents the theoretical framework of the project, problems of its implementation are described. Aspects of accrual, acceptance of randomisation and data availability are presented using simple descriptive statistics and logistic regression. The registration study was duly completed with a total of 567 patients. For several reasons (not meeting inclusion requirements, high refusal rate) the accrual into the randomised study was slower than expected and required modification of the original design specifications with regard to inclusion criteria and data collection schedule. Additionally, a high dropout rate

  2. Exercise in bipolar patients: A systematic review.

    PubMed

    Melo, Matias Carvalho Aguiar; Daher, Elizabeth De Francesco; Albuquerque, Saulo Giovanni Castor; de Bruin, Veralice Meireles Sales

    2016-07-01

    Sedentary lifestyle is frequent in psychiatric disorders, however the directions of this association and benefits of physical activity are unclear. This is a systematic review about exercise in patients with bipolar disorder. We performed a systematic literature search of studies published in English (1995 Jan to 2016 Jan) in PubMed, and Cochrane Library combining the medical terms 'physical activity' or 'sedentary' or 'physical exercise' with 'bipolar disorder' or 'mania' or 'bipolar depression'. Thirty-one studies were selected and included 15,587 patients with bipolar disorder. Sedentary lifestyle varied from 40% to 64.9%. Physical activity was associated with less depressive symptoms, better quality of life and increased functioning. Some evidence indicates a relationship between vigorous exercises and mania. Three prospective cohorts were reported; and no prospective randomized controlled trial was identified. Three studies focused on biomarkers in bipolar patients; and one reported the relationship between exercise and sleep in this group. Two assessed physical exercise in adolescents. (1) Differences between studies preventing a unified analysis; (2) most studies were cross-sectional; (3) motivation for exercising is a selection bias in most studies; (4) no intervention study assessing only physical exercise; (5) lack of studies comparing exercise across mood states. Generally, exercise was associated with improved health measures including depressive symptoms, functioning and quality of life. Evidence was insufficient to establish a cause-effect relationship between mood and physical exercise. Future research including randomized trials is needed to clarify the role of physical activity in bipolar patients. Copyright © 2016 Elsevier B.V. All rights reserved.

  3. 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

  4. Clinical pathway for patients with Chronic Myeloid Leukaemia: The Euriclea Project.

    PubMed

    Botti, Stefano; Gargiulo, Gianpaolo; Bombaci, Felice; Artioli, Giovanna; Cosentino, Chiara; Pignatelli, Adriana Concetta; Torino, Daniela; Lionetti, Maria Marcella; Samarani, Emanuela; Cappucciati, Lorella; Bordiga, Paola; Diodati, Antonella; Caffarri, Cristiana; Rosini, Irene; Pane, Fabrizio

    2017-07-18

    The use of Tirosine Kinase Ihnibitors (TKIs) for the treatment of Chronic Myeloid Leukemia (CML) has definitely represented a turning point in the treatment of the onco-hematological diseases. Over the years, the interest of physicians, nurses, patients and caregivers has increasingly focused on the aspects of the humanization of care, the management of side effects and on the full and constant therapeutic adherence. The aim of the project was to define patient-oriented care processes, based on a proactive approach that can fully respond to the new health needs of CML patients. A nursing expert Working Group (WG) was established. WG reviewed literature about CML patients assistance and then it was conducted a survey on organizational models for the treatment of CML patients, adopted by Italian haematologic and transplant centers.  Finally, the main issues regarding CML patients care were identified and discussed on a multiprofessional basis. Euriclea Project for care of CML patients with the description of a new and expanded nurse role was defined. The Nurse Case Manager or Nursing Clinical Experts were identified as key people for the management of the side effects of treatment, the promotion of the therapeutic adherence and the evaluation of efficacy and effectiveness of the process through the identification of specific indicators for structure, process and outcome. The focal areas of the care process were identified so as to define a different approach to the CML patient, through a holistic view of care and the multidisciplinary interventions.

  5. 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.

  6. 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

  7. An Open Library of CT Patient Projection Data.

    PubMed

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

    2016-02-27

    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.

  8. 78 FR 18481 - Project-Level Predecisional Administrative Review Process

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-27

    ... must be based on previously submitted specific written comments regarding the proposed project or... written comments regarding the proposed project and activity and attributed to the objector, unless the... land management plans. The Department invited the public to provide written comments...

  9. 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.

  10. 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

  11. Factors influencing the development of primary care data collection projects from electronic health records: a systematic review of the literature.

    PubMed

    Gentil, Marie-Line; Cuggia, Marc; Fiquet, Laure; Hagenbourger, Camille; Le Berre, Thomas; Banâtre, Agnès; Renault, Eric; Bouzille, Guillaume; Chapron, Anthony

    2017-09-25

    Primary care data gathered from Electronic Health Records are of the utmost interest considering the essential role of general practitioners (GPs) as coordinators of patient care. These data represent the synthesis of the patient history and also give a comprehensive picture of the population health status. Nevertheless, discrepancies between countries exist concerning routine data collection projects. Therefore, we wanted to identify elements that influence the development and durability of such projects. A systematic review was conducted using the PubMed database to identify worldwide current primary care data collection projects. The gray literature was also searched via official project websites and their contact person was emailed to obtain information on the project managers. Data were retrieved from the included studies using a standardized form, screening four aspects: projects features, technological infrastructure, GPs' roles, data collection network organization. The literature search allowed identifying 36 routine data collection networks, mostly in English-speaking countries: CPRD and THIN in the United Kingdom, the Veterans Health Administration project in the United States, EMRALD and CPCSSN in Canada. These projects had in common the use of technical facilities that range from extraction tools to comprehensive computing platforms. Moreover, GPs initiated the extraction process and benefited from incentives for their participation. Finally, analysis of the literature data highlighted that governmental services, academic institutions, including departments of general practice, and software companies, are pivotal for the promotion and durability of primary care data collection projects. Solid technical facilities and strong academic and governmental support are required for promoting and supporting long-term and wide-range primary care data collection projects.

  12. Cardiovascular risk in hypertensive patients: results of the Pandora project.

    PubMed

    Cocchi, Roberto; Degli Esposti, Ezio; Ruffo, Pierfrancesco; Buda, Stefano; Valpiani, Giorgia; Sturani, Alessandra

    2002-01-01

    The aim of the Pandora project is to collect epidemiological information, check diagnostic and therapeutic pathways, and assess outcomes in a large hypertensive population. This report presents the results on patients enrolled in the study between 1997-1999. Twenty-one general practitioners working in the Ravenna Local Health Service took part in the study. They were supplied with IBM compatible PCs and were trained to enter the patient's data (age, gender, familiarity for cardiovascular diseases, smoking, hospitalisations for cardiovascular disorders, diabetes, blood pressure, total cholesterolemia, creatininemia, antihypertensive therapy) on So.Ge.Pa. software. Cardiovascular risk factors were assessed according to the WHO - ISH joint committee recommendations. 2,608 treated hypertensive patients were enrolled, 65% of whom showed inadequate blood pressure control. The prevalence of inadequate BP control was higher in patients on multiple-drug antihypertensive therapy compared with those on monotherapy (71.9% vs. 47.9%), in older than in younger patients (70.7% vs. 56.1%) and in patients with three cardiovascular risk factors, or diabetes, or affected target organs, compared to those with two or less risk factors (72.4% vs. 63.3%), (p < 0.001 for all). 63.6% of patients were at risk for age, 36.6% for family history of cardiovascular diseases and 31.7% for severe hypercholesterolemia. BP control was inadequate in a large percentage of patients, but it was particularly unsatisfactory in the elderly and in patients with high cardiovascular risk. A cluster of cardiovascular risk factors was found in both adequately and inadequately controlled hypertensive patients.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. Ethics Review of Research Projects Involving Human Subjects.

    ERIC Educational Resources Information Center

    Olivier, Steve

    2002-01-01

    Maltreatment of subjects has led to the introduction of an ethics review process for research involving humans. Institutional Review Boards (IRBs) require investigators to justify their human research to peers prior to recruiting participants. This paper describes the composition, functions, and duties of IRBs; the effectiveness and…

  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. Reviewing Your Student Discipline Policy: A Project Worth the Investment.

    ERIC Educational Resources Information Center

    Stoner, Edward N., II

    To promote a good living/learning environment, it is important for institutions to review their student discipline processes and policies regularly. Many members of the campus community may play a part in reviewing student discipline policies, including public affairs spokespeople, faculty and staff throughout the institution, student affairs…

  1. Polarimetric Interferometric SAR: Literature Review and an Assessment of its Utility for DND: TIF Project Memorandum

    DTIC Science & Technology

    2003-09-01

    SAR : Literature Review and an Assessment of its utility for DND TIF Project.Memorandum Karim E. Mattar, Maureen L. Yeremy and Chuck Livingstone...September 2003 Canada 20031119 057 Polarimetric Interferometric SAR : Literature Review and an Assessment of its utility for DND TIF Project Memorandum Karim...Radar ( SAR ) is a recent area of research that has had significant attention from the mid-1990s. This area of research has combined the utility of two SAR

  2. 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…

  3. 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...

  4. 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.

  5. 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.

  6. 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.

  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 required...

  8. 77 FR 47337 - Project-Level Predecisional Administrative Review Process

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-08

    ... projects and activities implementing land and resource management plans developed under the Forest and Rangeland Renewable Resources Planning Act of 1974, and documented with a Record of Decision (ROD) or... and resource management plans * * * and shall modify the procedure for appeals of decisions concerning...

  9. A Review of the AIDP Project After the First Year.

    ERIC Educational Resources Information Center

    Broadbent, William A.

    This document provides an assessment of the progress Leeward Community College has made toward fulfilling the objectives of its five-year 1.4 million dollar Advanced Institutional Development Program (AIDP) grant at the end of the first year of funding. Essentially, the objectives of the project fall into four major program areas: community…

  10. 77 FR 8095 - Review and Approval of Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-14

    ... hydrocarbon development project to an out-of- basin treatment or disposal facility; insert language... issued to include hydrocarbon development of any kind utilizing the waters of the basin, not just... include other forms of hydrocarbon development without first determining if the ABR program is ]...

  11. 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)

  12. Ensuring vitamin D supplementation in nursing home patients--a quality improvement project.

    PubMed

    Yanamadala, Mamata; Heflin, Mitchell T; White, Heidi K; Buhr, Gwendolen T

    2012-01-01

    Randomized controlled trials have shown that adequate vitamin D supplementation in nursing home (NH) residents reduces the rates of falls and fractures. In our NH, review of medication administration records of all patients (n = 101) revealed that only 34.6% of the patients were currently prescribed adequate doses of vitamin D, revealing a need for intervention. We designed a Quality Improvement (QI) project with the objective of improving the vitamin D prescription rate in our NH. We used the Plan-Do-Study-Act (PDSA) approach to implement this QI project. Patients not currently prescribed an adequate dose of vitamin D were identified and started on a daily dose of 800 IU of vitamin D. Additionally, patients who were experiencing falls while on an adequate dose of vitamin D for 3 months were examined for the possibility of vitamin D deficiency and were started on 50,000 IU of vitamin D per week for 12 weeks if they were found to be vitamin D-deficient based on blood levels of 25-hydroxy-vitamin D below 30 ng/mL. We found that with several PDSA cycles over a period of 5 months, the prescription rate for vitamin D was increased to 86%, surpassing our initial goal of 80%. In conclusion, we found that a multidisciplinary QI program utilizing multiple PDSA cycles was effective in reaching target prescription rates for vitamin D supplementation in a population of NH patients.

  13. 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.

  14. A review of quality surveillance projects on cosmetics in Taiwan.

    PubMed

    Chung, Meng-Hsuan; Huang, Wei-Sheng; Chang, Yu-Chang; Chen, Yu-Hsuan; Lee, Ming-Shin; Huang, Shou-Chieh; Chen, Yu-Pen; Shih, Daniel Yang-Chih; Cheng, Hwei-Fang

    2014-12-01

    The Food and Drug Administration in Taiwan is responsible for the quality regulation and control of cosmetics. In order to have a clear understanding of the trends in the product quality monitoring outcomes and the regulatory control measures over the past years, this study has put together the reports of nine cosmetic surveillance projects conducted between 1982 and 2012. The findings can be used as a reference in developing a more solid quality monitoring plan and management system for cosmetic products. Results show that permanent wave products, hair dye products, and phthalate esters in cosmetic products have the highest average noncompliance rates at 39.2%, 14.2%, and 11.2%, respectively. These are followed by the average noncompliance rates of mercury in products, sunscreen products, and microorganisms in products, at 8.5%, 7.1%, and 5.5%, respectively, and the remaining three projects averaging below 4.1%. Since 1997, when new standards were announced and assistance to manufacturers was reinforced, the noncompliance rates of permanent wave products decreased annually, until 2007, when it was fully qualified for the standards. Overall, the study showed that the noncompliance rates of permanent wave products and for levels of phthalate esters, mercury, and hydroquinone in cosmetic products have all decreased in the previous years. The results of surveillance projects conducted after 2005 revealed only one noncompliance sample with lead, arsenic, and cadmium, whereas the surveillance projects on permanent wave products and chloroform- and 1,4-dioxane-containing products revealed full compliance with regulation standards. However, the noncompliance rates for microorganisms in cosmetics and the ingredients in hair dye products and sunscreen products were still high. These high-risk products must be monitored. These surveillance projects are conducted to ensure the safety of cosmetics in the market. Copyright © 2014. Published by Elsevier B.V.

  15. Patient involvement in health care decision making: a review.

    PubMed

    Vahdat, Shaghayegh; Hamzehgardeshi, Leila; Hessam, Somayeh; Hamzehgardeshi, Zeinab

    2014-01-01

    Patient participation means involvement of the patient in decision making or expressing opinions about different treatment methods, which includes sharing information, feelings and signs and accepting health team instructions. Given the importance of patient participation in healthcare decision making which empowers patients and improves services and health outcomes, this study was performed to review previous studies on patient participation in healthcare decision making. To prepare this narrative review article, researchers used general and specific search engines, as well as textbooks addressing this subject for an in-depth study of patient involvement in healthcare decision-making. As a result, 35 (out of 100 relevant) articles and also two books were selected for writing this review article. BASED ON THE REVIEW OF ARTICLES AND BOOKS, TOPICS WERE DIVIDED INTO SIX GENERAL CATEGORIES: definition of participation, importance of patient participation, factors influencing participation of patients in healthcare decisions, method of patient participation, tools for evaluating participation, and benefits and consequences of patient participation in health care decision-making. IN MOST STUDIES, FACTORS INFLUENCING PATIENT PARTICIPATION CONSISTED OF: factors associated with health care professionals such as doctor-patient relationship, recognition of patient's knowledge, allocation of sufficient time for participation, and also factors related to patients such as having knowledge, physical and cognitive ability, and emotional connections, beliefs, values and their experiences in relation to health services.

  16. 42 CFR 52h.11 - What are the review criteria for contract projects and proposals?

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... carrying out its review of a project concept under § 52h.10(a) or § 52h.10(b), the peer review group shall... approach, the adequacy of the methodology to be utilized in carrying out the activity. (b) In carrying out...

  17. 18 CFR 806.7 - Concurrent project review by member jurisdictions.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 18 Conservation of Power and Water Resources 2 2014-04-01 2014-04-01 false Concurrent project review by member jurisdictions. 806.7 Section 806.7 Conservation of Power and Water Resources SUSQUEHANNA... by an agency or the Commission, or any other matter to support cooperative review activities. Permits...

  18. 18 CFR 806.7 - Concurrent project review by member jurisdictions.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 18 Conservation of Power and Water Resources 2 2012-04-01 2012-04-01 false Concurrent project review by member jurisdictions. 806.7 Section 806.7 Conservation of Power and Water Resources SUSQUEHANNA... by an agency or the Commission, or any other matter to support cooperative review activities. Permits...

  19. 18 CFR 806.7 - Concurrent project review by member jurisdictions.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 18 Conservation of Power and Water Resources 2 2013-04-01 2012-04-01 true Concurrent project review by member jurisdictions. 806.7 Section 806.7 Conservation of Power and Water Resources SUSQUEHANNA... by an agency or the Commission, or any other matter to support cooperative review activities. Permits...

  20. Social media use among patients and caregivers: a scoping review

    PubMed Central

    Hamm, Michele P; Chisholm, Annabritt; Shulhan, Jocelyn; Milne, Andrea; Scott, Shannon D; Given, Lisa M; Hartling, Lisa

    2013-01-01

    Objective To map the state of the existing literature evaluating the use of social media in patient and caregiver populations. Design Scoping review. Data sources Medline, CENTRAL, ERIC, PubMed, CINAHL Plus Full Text, Academic Search Complete, Alt Health Watch, Health Source, Communication and Mass Media Complete, Web of Knowledge and ProQuest (2000–2012). Study selection Studies reporting primary research on the use of social media (collaborative projects, blogs/microblogs, content communities, social networking sites, virtual worlds) by patients or caregivers. Data extraction Two reviewers screened studies for eligibility; one reviewer extracted data from relevant studies and a second performed verification for accuracy and completeness on a 10% sample. Data were analysed to describe which social media tools are being used, by whom, for what purpose and how they are being evaluated. Results Two hundred eighty-four studies were included. Discussion forums were highly prevalent and constitute 66.6% of the sample. Social networking sites (14.8%) and blogs/microblogs (14.1%) were the next most commonly used tools. The intended purpose of the tool was to facilitate self-care in 77.1% of studies. While there were clusters of studies that focused on similar conditions (eg, lifestyle/weight loss (12.7%), cancer (11.3%)), there were no patterns in the objectives or tools used. A large proportion of the studies were descriptive (42.3%); however, there were also 48 (16.9%) randomised controlled trials (RCTs). Among the RCTs, 35.4% reported statistically significant results favouring the social media intervention being evaluated; however, 72.9% presented positive conclusions regarding the use of social media. Conclusions There is an extensive body of literature examining the use of social media in patient and caregiver populations. Much of this work is descriptive; however, with such widespread use, evaluations of effectiveness are required. In studies that have examined

  1. Patient Perceptions of Participating in the RSNA Image Share Project: a Preliminary Study.

    PubMed

    Hiremath, Atheeth; Awan, Omer; Mendelson, David; Siegel, Eliot L

    2016-04-01

    The purpose of this study was to gauge patient perceptions of the RSNA Image Share Project (ISP), a pilot program that provides patients access to their imaging studies online via secure Personal Health Record (PHR) accounts. Two separate Institutional Review Board exempted surveys were distributed to patients depending on whether they decided to enroll or opt out of enrollment in the ISP. For patients that enrolled, a survey gauged baseline computer usage, perceptions of online access to images through the ISP, effect of patient access to images on patient-physician relationships, and interest in alternative use of images. The other survey documented the age and reasons for declining participation for those that opted out of enrolling in the ISP. Out of 564 patients, 470 enrolled in the ISP (83 % participation rate) and 456 of these 470 individuals completed the survey for a survey participation rate of 97 %. Patients who enrolled overwhelmingly perceived access to online images as beneficial and felt it bolstered their patient-physician relationship. Out of 564 patients, 94 declined enrollment in the ISP and all 94 individuals completed the survey for a survey participation rate of 100 %. Patients who declined to participate in the ISP cited unreliable access to Internet and existing availability of non-web-based intra-network images to their physicians. Patients who participated in the ISP found having a measure of control over their images to be beneficial and felt that patient-physician relationships could be negatively affected by challenges related to image accessibility.

  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. 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.

  4. Data Review of the Hot Dry Rock Project at Fenton Hill, New Mexico

    SciTech Connect

    GeothermEx, Inc.

    1998-12-01

    This report reviews the data collected during the hot dry rock experimental project conducted by the US Department of Energy and Los Alamos National Laboratory at Fenton Hill, New Mexico from about 1971 through 1995. Five main categories of data were reviewed: (1) geologic data; (2) flow test data; (3) reservoir modeling data; (4) chemical tracer data; and (5) seismic data. The review determines the important data sets from the project, determines where and how these data are stored, and evaluates whether further analyses of the data might be likely to yield additional information valuable to the geothermal industry or to the further development of enhanced geothermal systems.

  5. REVIEW: Projection x-ray lithography implemented using point sources

    NASA Astrophysics Data System (ADS)

    Artyukov, I. A.; Balakireva, L. L.; Bijkerk, F.; Vinogradov, Aleksandr V.; Zorev, N. N.; Kozhevnikov, I. V.; Kondratenko, V. V.; Ogurtsov, O. F.; Ponomarenko, A. G.; Fedorenko, A. I.

    1992-02-01

    An analysis is made of the state of the art of x-ray lithography and x-ray optics. The principles of design and configurations of projection x-ray lithographic systems are considered. An analysis is made of the main trends of research on these topics proceeding in the laboratories in the Soviet Union, USA, Japan, and Great Britain. The problems encountered in the development of multilayer normal-incidence x-ray mirrors are described.

  6. 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)

  7. 44 CFR 70.9 - Review of proposed projects.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... MAP CORRECTION Mapping Deficiencies Unrelated to Community-Wide Elevation Determinations § 70.9 Review... will be issued in the form of a letter, termed a Conditional Letter of Map Amendment. The data required to support such requests are the same as those required for final Letters of Map Amendment in...

  8. 44 CFR 70.9 - Review of proposed projects.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... MAP CORRECTION Mapping Deficiencies Unrelated to Community-Wide Elevation Determinations § 70.9 Review... will be issued in the form of a letter, termed a Conditional Letter of Map Amendment. The data required to support such requests are the same as those required for final Letters of Map Amendment in...

  9. 44 CFR 70.9 - Review of proposed projects.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... MAP CORRECTION Mapping Deficiencies Unrelated to Community-Wide Elevation Determinations § 70.9 Review... will be issued in the form of a letter, termed a Conditional Letter of Map Amendment. The data required to support such requests are the same as those required for final Letters of Map Amendment in...

  10. 44 CFR 70.9 - Review of proposed projects.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... MAP CORRECTION Mapping Deficiencies Unrelated to Community-Wide Elevation Determinations § 70.9 Review... will be issued in the form of a letter, termed a Conditional Letter of Map Amendment. The data required to support such requests are the same as those required for final Letters of Map Amendment in...

  11. 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.

  12. Conceptualisation of patient satisfaction: a systematic narrative literature review.

    PubMed

    Batbaatar, Enkhjargal; Dorjdagva, Javkhlanbayar; Luvsannyam, Ariunbat; Amenta, Pietro

    2015-09-01

    Patient satisfaction concept is widely measured due to its appropriateness to health service; however, evidence suggests that it is a poorly developed concept. This article is a first part of a two-part series of research with a goal to review a current conceptual framework of patient satisfaction and to bring the concept for further operationalisation procedures. The current article aimed to review a theoretical framework that helps the next article to review determinants of patient satisfaction for designing a measurement system. The study used a systematic review method, meta-narrative review, based on the RAMESES guideline with the phases of screening evidence, appraisal evidence, data extraction and synthesis. Patient satisfaction theoretical articles were searched on the two databases MEDLINE and CINAHL. Inclusion criteria were articles published between 1980 and 2014, and English language papers only. There were 36 articles selected for the synthesis. Results showed that most of the patient satisfaction theories and formulations are based on marketing theories and defined as how well health service fulfils patient expectations. However, review demonstrated that a relationship between expectation and satisfaction is unclear and the concept expectation itself is not distinctly theorised as well. Researchers brought satisfaction theories from other fields to the current healthcare literature without much adaptation. Thus, there is a need to attempt to define the patient satisfaction concept from other perspectives or to learn how patients evaluate the care rather than struggling to describe it by consumerist theories. © Royal Society for Public Health 2015.

  13. Does a central review platform improve the quality of radiotherapy for rectal cancer? Results of a national quality assurance project.

    PubMed

    Joye, Ines; Lambrecht, Maarten; Jegou, David; Hortobágyi, Eszter; Scalliet, Pierre; Haustermans, Karin

    2014-06-01

    Quality assurance (QA) for radiation treatment has become a priority since poorly delivered radiotherapy can negatively influence patient outcome. Within a national project we evaluated the feasibility of a central review platform and its role in improving uniformity of clinical target volume (CTV) delineation in daily practice. All Belgian radiotherapy departments were invited to participate and were asked to upload CTVs for rectal cancer treatment onto a secured server. These were centrally reviewed and feedback was given per e-mail. For each five consecutive patients per centre, the overlap parameter dice coefficient (DC) and the volumetric parameters volumetric ratio (RV) and commonly contoured volume (VCC) were calculated. Twenty departments submitted 1224 eligible cases of which 909 were modified (74.3%). There was a significant increase in RV and VCC between the first ten patients per centre and the others. This was not seen for DC. Statistical analysis did not show a further significant improvement in delineation over the entire review period. Central review was feasible and increased the uniformity in CTV delineation in the first ten rectal cancer patients per centre. The observations in this study can be used to optimize future QA initiatives. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  14. Future patient demand for shoulder arthroplasty by younger patients: national projections.

    PubMed

    Padegimas, Eric M; Maltenfort, Mitchell; Lazarus, Mark D; Ramsey, Matthew L; Williams, Gerald R; Namdari, Surena

    2015-06-01

    The outcomes of shoulder arthroplasties in younger patients (55 years or younger) are not as reliable compared with those of the general population. Greater risk of revision and higher complication rates in younger patients present direct costs to the healthcare system and indirect costs to the patient in terms of quality of life. Previous studies have suggested an increased demand for shoulder arthroplasties overall, but to our knowledge, the demand in younger patients has not been explored. We asked: (1) What was the demand for shoulder arthroplasties between 2002 and 2011 in the United States for all patients and a specific subpopulation of patients who were 55 years old or younger? (2) How is the demand for shoulder arthroplasties in younger patients projected to change through 2030? (3) How is procedural demand projected to change in younger patients through 2030, and specifically, what can we anticipate in terms of hemiarthroplasty volume compared with that of total shoulder arthroplasty? We used the National Inpatient Sample database to identify primary shoulder arthroplasties performed between 2002 and 2011. A Poisson regression model was developed using the National Inpatient Sample data and United States Census Bureau projections on future population changes to predict estimated national demand for total shoulder arthroplasties and hemiarthroplasties in all patients and in the subpopulation 55 years old or younger. This model was projected until 2030, with associated 95% CIs. We then specifically analyzed the projected demand of hemiarthroplasties and compared this with demand for all arthroplasty procedures in the younger patient population. Demand for shoulder arthroplasties in patients 55 years or younger is increasing at a rate of 8.2% per year (95% CI, 7.06%-9.35%), compared with a growth rate of 12.1% (95% CI, 8.35%-16.02%) per year for patients older than 55 years. In 2002, 15.9% (3587 of 22,617 captured in the National Inpatient Sample) of

  15. 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.

  16. The insomnia patient perspective, a narrative review.

    PubMed

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

    2013-01-01

    Insomnia is a common sleep disorder associated with substantial direct and indirect costs, yet there is a strong propensity among patients to self-medicate which often delays professional help. Understanding the process which underpins the initiation, engagement and adherence to insomnia treatment(s) is a vital step for understanding this phenomenon. The current paper explores how the patient perspective has been conceptualized in the research literature and its implications for insomnia treatment and health care delivery. A literature search was conducted using Embase, Medline and PsycINFO databases. Articles have been thematically organized into patient correlates of health behaviors, patient experiences and treatment attitudes. Deferral of professional help among insomnia patients is partially related to barriers embedded in the health care system and patient health beliefs.

  17. 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.

  18. 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.

  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. "Communication by impact" and other forms of non-verbal communication: a review of transference, countertransference and projective identification.

    PubMed

    Böhmer, M W

    2010-07-01

    This article aims to review the importance, place and especially the emotional impact of non-verbal communication in psychiatry. The paper argues that while biological psychiatry is in the ascendency with increasing discoveries being made about the functioning of the brain and psycho-pharmacology, it is important to try and understand what is happening between psychiatrist and patient. The importance of being aware of the subtleties of this interaction is argued, as are the roles of phenomena such as transference, counter-transference and projective identification. The workings and use of these phenomena are explored as central in the doctor-patient interaction, as well as the consequences of failure to utilize and understand these phenomena. The author reviews - amongst others - the work of the analysts Casement, Gabbard, Goldstein, Ogden and Symington.

  1. Diastematomyelia: a retrospective review of 138 patients.

    PubMed

    Cheng, B; Li, F T; Lin, L

    2012-03-01

    Diastematomyelia is a rare congenital abnormality of the spinal cord. This paper summarises more than 30 years' experience of treating this condition. Data were collected retrospectively on 138 patients with diastematomyelia (34 males, 104 females) who were treated at our hospital from May 1978 to April 2010. A total of 106 patients had double dural tubes (type 1 diastematomyelia), and 32 patients had single dural tubes (type 2 diastematomyelia). Radiographs, CT myelography, and MRI showed characteristic kyphoscoliosis, widening of the interpedicle distance, and bony, cartilaginous, and fibrous septum. The incidences of symptoms including characteristic changes of the dorsal skin, neurological disorders, and congenital spinal or foot deformity were significantly higher in type 1 than in type 2. Surgery is more effective for patients with type 1 diastematomyelia; patients without surgery showed no improvement.

  2. [Development of projective reduplication in psychosomatic patients. II. Attempt at an assessment].

    PubMed

    Ullrich, G

    1988-01-01

    Starting with a clinical description of the "projective reduplication" this construct is being critically evaluated on the basis of recent publications on the psychosomatic patient's "pseudo-normality". These studies cast further doubt on the assumption of a "projective reduplication" mechanism as a valid, specific characteristic of this patient population. Recent research results suggest a non-projective, specific sensibility in perception in psychosomatic patients rather than a deficit. The assumption of non-differentiation between self and others as part of the "projective reduplication" mechanism is finally being interpreted as a sequel to the specific "patient career" of psychosomatic patients and the effects of their being clinically evaluated for psychosomatic illness.

  3. 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.

  4. Pollution Control Projects and New Source Review (NSR) Applicability

    EPA Pesticide Factsheets

    This document may be of assistance in applying the New Source Review (NSR) air permitting regulations including the Prevention of Significant Deterioration (PSD) requirements. This document is part of the NSR Policy and Guidance Database. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

  5. OAQPS Review and Conclusions on Lynchburg Foundry Project

    EPA Pesticide Factsheets

    This document may be of assistance in applying the New Source Review (NSR) air permitting regulations including the Prevention of Significant Deterioration (PSD) requirements. This document is part of the NSR Policy and Guidance Database. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

  6. [A review of the Eye Health Care Project in Tajimi].

    PubMed

    Yamamoto, Tetsuya; Araie, Makoto; Iwase, Aiko; Kitazawa, Yoshiaki

    2009-05-01

    The results of the Eye Health Care Project in Tajimi, conducted concurrently with the Tajimi Study, a population-based prevalence survey of glaucoma by the Japan Glaucoma Society, are summarized. The project was carried out from September, 2000 to October, 2001. The target population was 50,165, out of which 14,779 citizens participated, which yielded a response rate of 29.5%. A study on the efficacy of the van Herick method showed that 65.9% of eyes with grade 1 or 2 had gonioscopically narrow angles with grade 2 or less of the Shaffer classification and that 17.9% of eyes with van Herick grade 1 were angle-closure suspects and 5.6% of grade 2 were also suspect. In a disc hemorrhage study, hemorrhage was found in 8.2% of glaucoma cases and 0.2% of non-glaucoma participants. Similarly, superior segmental optic hypoplasia was found in 0.3% of the participants studied. The central corneal thickness (CCT) averaged 517.5 +/- 29.8 microm (mean +/- standard deviation). True IOP was estimated by the equation: Estimated IOP (mmHg) = Measured IOP - 0.012 * (CCT (microm) - 520), which means that a 100 microm change in CCT may cause a 1.2 mmHg measurement error in IOP. The average IOP in ophthalmologically normal eyes was 14.1 +/- 2.3 mmHg. The IOP showed negative correlation with age, corneal radius of curvature, and refractive error, and it was positively correlated with CCT, systolic blood pressure, and body mass index. In addition, the points of discussion of the original papers are described.

  7. Preoperative patient assessment: a review of the literature and recommendations.

    PubMed Central

    Barnard, N. A.; Williams, R. W.; Spencer, E. M.

    1994-01-01

    The aims of preoperative assessment of patients are outlined, and the role of clinical and laboratory testing is defined. Following a review of the literature, guidelines for requesting such investigations are suggested. PMID:7979066

  8. A review of patient satisfaction: 1. Concepts of satisfaction.

    PubMed

    Newsome, P R; Wright, G H

    1999-02-27

    Against a background of growing consumerism, satisfying patients has become a key task for all healthcare providers. This paper reviews current conceptual models of consumer satisfaction, including the one most dominant in the marketing literature--disconfirmation theory.

  9. Implementation of a pharmacist medication review clinic for haemodialysis patients.

    PubMed

    Mirkov, Sanja

    2009-06-19

    To implement the Pharmacist Medication Review Clinic and establish a sustainable clinical pharmacy service. Prospective clinical medication review conducted by trained clinical pharmacists using standardised tools. Pharmacists' intervention included medication recommendation and patient education. From December 2007 to July 2008, medication reviews were conducted with 64 haemodialysis patients. Patients were taking on average 13 medications. Drug-related problems (DRPs) were identified in 92% of medication reviews (a total of 278 DRPs). The major DRP was non-adherence with medication regimen (33%), followed by medication requiring dose decrease (9.3%) and indication requiring new medication (8.6%). The risk factors for multiple DRPs were ethnicity, length of time on dialysis and age. New Zealand (NZ) Maori and Pacific Peoples were more likely to have more than three DRPs compared to patients of European descent. (NZ Maori: OR 7.49, 95%CI 1.15-48.9, p=0.035; Pacific Peoples: OR 5.4, 95%CI 0.96-30.34, p=0.055) and patients who spent 3.5 to 6.3 years on dialysis (OR 7.48, 95%CI 1.45-38.76, p=0.016). Patients older than 55 were less likely to have more than three DRPs compared to younger patients (OR 0.14, 95%CI 0.03-0.69, p=0.016). Pharmacist-led medication review clinic identified drug-related problems (DRPs) and risk factors for DRPs in haemodialysis patients.

  10. Decreasing Falls in Acute Care Medical Patients: An Integrative Review.

    PubMed

    Rowan, Leslie; Veenema, Tener Goodwin

    Falls in acute care medical patients are a complex problem impacted by the constantly changing risk factors affecting this population. This integrative literature review analyzes current evidence to determine factors that continue to make falls a top patient safety problem within the medical unit microsystem. The goal of this review is to develop an evidence-based structure to guide process improvement and effective use of organization resources.

  11. 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

  12. Compendium of Dental Residents’ Research Projects and Literature Reviews for 1989

    DTIC Science & Technology

    1990-05-01

    USAFSAM-SR-90-2 DEC FILE COPY, COMPENDIUM OF DENTAL RESIDENTS’ RESEARCH PROJECTS AND LITERATURE REVIEWS *. 1989 SN SDTIC EL ECTE Mo!r Joe B. Drane...special report was submitted by personnel of the Dental Investigation Service, Clinical Sciences Division, USAF School of Aerospace Medicine, Human...Security Classification) Compendium of Dental Residents’ Research Projects and Literature Revie,,is - 1989 12. PERSONAL AUTHOR(S) Drane, Joe B. III 13a

  13. 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.

  14. 78 FR 18348 - Submission for OMB Review; Use of Project Labor Agreements for Federal Construction Projects

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-26

    ... and society. Central to this process is the solicitation of comments from the public. This process... percent from the previous fiscal year. In effect, the collective burden of compliance for the public is..., consideration is given to entity reviewing instructions; using technology to collect, process, and...

  15. 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.

  16. Quantum memories. A review based on the European integrated project ``Qubit Applications (QAP)''

    NASA Astrophysics Data System (ADS)

    Simon, C.; Afzelius, M.; Appel, J.; Boyer de La Giroday, A.; Dewhurst, S. J.; Gisin, N.; Hu, C. Y.; Jelezko, F.; Kröll, S.; Müller, J. H.; Nunn, J.; Polzik, E. S.; Rarity, J. G.; de Riedmatten, H.; Rosenfeld, W.; Shields, A. J.; Sköld, N.; Stevenson, R. M.; Thew, R.; Walmsley, I. A.; Weber, M. C.; Weinfurter, H.; Wrachtrup, J.; Young, R. J.

    2010-05-01

    We perform a review of various approaches to the implementation of quantum memories, with an emphasis on activities within the quantum memory sub-project of the EU integrated project “Qubit Applications”. We begin with a brief overview over different applications for quantum memories and different types of quantum memories. We discuss the most important criteria for assessing quantum memory performance and the most important physical requirements. Then we review the different approaches represented in “Qubit Applications” in some detail. They include solid-state atomic ensembles, NV centers, quantum dots, single atoms, atomic gases and optical phonons in diamond. We compare the different approaches using the discussed criteria.

  17. Patient Web Portals to Improve Diabetes Outcomes: A Systematic Review

    PubMed Central

    Mayberry, Lindsay Satterwhite; Mulvaney, Shelagh A.; Hess, Rachel

    2011-01-01

    Patient web portals (PWPs), defined as the integration of electronic medical records and patient health records, have been related to enhanced patient outcomes. A literature review was conducted to characterize the design and evaluation of PWPs to improve health care processes and outcomes in diabetes. A summary of 26 articles revealed the positive impact PWPs have on patient outcomes, patient-provider communication, disease management, and access to and patient satisfaction with health care. Innovative and useful approaches included the evaluation of specific components of the PWPs, assessing the impact of PWPs on mediators of health behaviors, such as patient distress, identification of barriers to use, and patient willingness to pay for access. Future research should focus on relevant processes that mediate patient and provider use, impact on health care utilization, and a patient-centered approach to the design and integration of educational opportunities afforded through PWPs. PMID:20890688

  18. Patient safety in otolaryngology: a descriptive review.

    PubMed

    Danino, Julian; Muzaffar, Jameel; Metcalfe, Chris; Coulson, Chris

    2017-03-01

    Human evaluation and judgement may include errors that can have disastrous results. Within medicine and healthcare there has been slow progress towards major changes in safety. Healthcare lags behind other specialised industries, such as aviation and nuclear power, where there have been significant improvements in overall safety, especially in reducing risk of errors. Following several high profile cases in the USA during the 1990s, a report titled "To Err Is Human: Building a Safer Health System" was published. The report extrapolated that in the USA approximately 50,000 to 100,000 patients may die each year as a result of medical errors. Traditionally otolaryngology has always been regarded as a "safe specialty". A study in the USA in 2004 inferred that there may be 2600 cases of major morbidity and 165 deaths within the specialty. MEDLINE via PubMed interface was searched for English language articles published between 2000 and 2012. Each combined two or three of the keywords noted earlier. Limitations are related to several generic topics within patient safety in otolaryngology. Other areas covered have been current relevant topics due to recent interest or new advances in technology. There has been a heightened awareness within the healthcare community of patient safety; it has become a major priority. Focus has shifted from apportioning blame to prevention of the errors and implementation of patient safety mechanisms in healthcare delivery. Type of Errors can be divided into errors due to action and errors due to knowledge or planning. In healthcare there are several factors that may influence adverse events and patient safety. Although technology may improve patient safety, it also introduces new sources of error. The ability to work with people allows for the increase in safety netting. Team working has been shown to have a beneficial effect on patient safety. Any field of work involving human decision-making will always have a risk of error. Within

  19. 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.

  20. Review of EOR (enhanced oil recovery) project trends and thermal EOR (enhanced oil recovery) technology

    SciTech Connect

    Pautz, J. F.; Sarathi, P.; Thomas, R.

    1990-03-01

    Information on United States (US) enhanced oil recovery (EOR) projects is analyzed to discern trends in applications of EOR technologies. This work is based on an evaluation of current literature and analysis of the Department of Energy (DOE) EOR project data base which contains information on over 1,300 projects. Three-quarters of current US oil production attributed to EOR is derived from thermal EOR processes (TEOR). Changes in the technology of TEOR since the 1984 Enhanced Oil Recovery'' study by the National Petroleum Council (NPC) are reviewed in terms of the current applied technology and reported research. 87 refs., 4 figs., 20 tabs.

  1. Patient education in schizophrenia: a review.

    PubMed

    Merinder, L B

    2000-08-01

    To identify and analyse methodology and results of studies of patient education in schizophrenia. A literature search was made in the databases Medline, Excerpta Medica, Psychlit and Cinahl. Most studies demonstrate that knowledge and compliance can be improved by educational interventions. Compliance seems to be most readily influenced by interventions including behavioural components. A few studies indicate that relapse and symptomatology can be influenced by educational interventions as well. No influence of the duration of interventions was found. Where educability is studied, age, medication and level of symptoms are potential predictors. Due to methodological limitations and insufficient reporting the results of available studies on patient education in schizophrenia are far from conclusive. The demonstration of the efficacy of patient education in improving knowledge and compliance is most consistent.

  2. 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.

  3. Patient Safety and Workplace Bullying: An Integrative Review.

    PubMed

    Houck, Noreen M; Colbert, Alison M

    Workplace bullying is strongly associated with negative nursing outcomes, such as work dissatisfaction, turnover, and intent to leave; however, results of studies examining associations with specific patient safety outcomes are limited or nonspecific. This integrative review explores and synthesizes the published articles that address the impact of workplace nurse bullying on patient safety.

  4. 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

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

    PubMed

    Alarcón, Renato D

    2009-10-01

    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.

  6. Fertility Preservation for Cancer Patients: A Review

    PubMed Central

    Ajala, Tosin; Rafi, Junaid; Larsen-Disney, Peter; Howell, Richard

    2010-01-01

    Infertility can arise as a consequence of treatment of oncological conditions. The parallel and continued improvement in both the management of oncology and fertility cases in recent times has brought to the fore-front the potential for fertility preservation in patients being treated for cancer. Oncologists must be aware of situations where their treatment will affect fertility in patients who are being treated for cancer and they must also be aware of the pathways available for procedures such as cryopreservation of gametes and/or embryos. Improved cancer care associated with increased cure rates and long term survival, coupled with advances in fertility treatment means that it is now imperative that fertility preservation is considered as part of the care offered to these patients. This can only be approached within a multidisciplinary setting. There are obvious challenges that still remain to be resolved, especially in the area of fertility preservation in prepubertal patients. These include ethical issues, such as valid consent and research in the area of tissue retrieval, cryopreservation, and transplantation. PMID:20379357

  7. Blepharospasm: a review of 264 patients.

    PubMed Central

    Grandas, F; Elston, J; Quinn, N; Marsden, C D

    1988-01-01

    The natural history and response to different treatments have been evaluated in 264 patients with blepharospasm. The mean age of onset was 55.8 years and there was a female preponderance of 1.8 to 1. Dystonia elsewhere was found in 78% of patients, usually in the cranial-cervical region, and appeared to follow a somatotopic progression. A family history of blepharospasm or dystonia elsewhere was found in 9.5% of cases, which suggests a genetic predisposition. Ocular lesions preceded the onset of blepharospasm in 12.1% of cases. The response to drugs was inconsistent, although initial improvement was experienced by one fifth of patients treated with anticholinergics. Twenty-nine bilateral facial nerve avulsion operations were performed with benefit in 27 cases; but recurrences appeared in 22, on average one year after surgery. Botulinum toxin injections were performed in 151 patients. Significant improvement was achieved in 118 cases. Mean duration of benefit was 9.2 weeks. Transient ptosis and diplopia were the commonest side effects. PMID:3404184

  8. An e-Chart Review of Chaplains' Interventions and Outcomes: A Quality Improvement and Documentation Practice Enhancement Project.

    PubMed

    Stang, Vivian B

    2017-09-01

    In Canada, the spiritual care landscape in health care settings is becoming more regulated and standardized documentation is part of this rigorous environment. Staff chaplains at The Ottawa Hospital participated in a Quality Improvement project that aimed to advance patient-centered care through better charting practices. A sample of 104 spiritual-care assessments that had been posted on the patient electronic health record was examined. This chart review focused on chaplains' activities that were reported as interventions as well as chaplain-reported outcomes for the patient. These interventions and outcomes were coded into discreet categories in order to get a better sense of the activities and the impact of their work. The chaplains' electronic charting content and practices were evaluated. Chaplains found that the Quality Improvement process was beneficial as they updated their electronic templates in order to meet the new reporting requirements of the College of Registered Psychotherapists of Ontario.

  9. Attachment Studies with Borderline Patients: A Review

    PubMed Central

    Agrawal, Hans R.; Gunderson, John; Holmes, Bjarne M.; Lyons-Ruth, Karlen

    2006-01-01

    Clinical theorists have suggested that disturbed attachments are central to borderline personality disorder (BPD) psychopathology. This article reviews 13 empirical studies that examine the types of attachment found in individuals with this disorder or with dimensional characteristics of BPD. Comparison among the 13 studies is handicapped by the variety of measures and attachment types that these studies have employed. Nevertheless, every study concludes that there is a strong association between BPD and insecure attachment. The types of attachment found to be most characteristic of BPD subjects are unresolved, preoccupied, and fearful. In each of these attachment types, individuals demonstrate a longing for intimacy and—at the same time—concern about dependency and rejection. The high prevalence and severity of insecure attachments found in these adult samples support the central role of disturbed interpersonal relationships in clinical theories of BPD. This review concludes that these types of insecure attachment may represent phenotypic markers of vulnerability to BPD, suggesting several directions for future research. PMID:15204804

  10. Assessment of Contributions to Patient Safety Knowledge by the Agency for Healthcare Research and Quality-Funded Patient Safety Projects

    PubMed Central

    Sorbero, Melony E S; Ricci, Karen A; Lovejoy, Susan; Haviland, Amelia M; Smith, Linda; Bradley, Lily A; Hiatt, Liisa; Farley, Donna O

    2009-01-01

    Objective To characterize the activities of projects funded in Agency for Healthcare Research and Quality (AHRQ)' patient safety portfolio and assess their aggregate potential to contribute to knowledge development. Data Sources Information abstracted from proposals for projects funded in AHRQ' patient safety portfolio, information on safety practices from the AHRQ Evidence Report on Patient Safety Practices, and products produced by the projects. Study Design This represented one part of the process evaluation conducted as part of a longitudinal evaluation based on the Context–Input–Process–Product model. Principal Findings The 234 projects funded through AHRQ' patient safety portfolio examined a wide variety of patient safety issues and extended their work beyond the hospital setting to less studied parts of the health care system. Many of the projects implemented and tested practices for which the patient safety evidence report identified a need for additional evidence. The funded projects also generated a substantial body of new patient safety knowledge through a growing number of journal articles and other products. Conclusions The projects funded in AHRQ' patient safety portfolio have the potential to make substantial contributions to the knowledge base on patient safety. The full value of this new knowledge remains to be confirmed through the synthesis of results. PMID:21456108

  11. Assessment of contributions to patient safety knowledge by the Agency for Healthcare Research and Quality-funded patient safety projects.

    PubMed

    Sorbero, Melony E S; Ricci, Karen A; Lovejoy, Susan; Haviland, Amelia M; Smith, Linda; Bradley, Lily A; Hiatt, Liisa; Farley, Donna O

    2009-04-01

    To characterize the activities of projects funded in Agency for Healthcare Research and Quality (AHRQ)'s patient safety portfolio and assess their aggregate potential to contribute to knowledge development. Information abstracted from proposals for projects funded in AHRQ's patient safety portfolio, information on safety practices from the AHRQ Evidence Report on Patient Safety Practices, and products produced by the projects. This represented one part of the process evaluation conducted as part of a longitudinal evaluation based on the Context–Input–Process–Product model. The 234 projects funded through AHRQ's patient safety portfolio examined a wide variety of patient safety issues and extended their work beyond the hospital setting to less studied parts of the health care system. Many of the projects implemented and tested practices for which the patient safety evidence report identified a need for additional evidence. The funded projects also generated a substantial body of new patient safety knowledge through a growing number of journal articles and other products. The projects funded in AHRQ's patient safety portfolio have the potential to make substantial contributions to the knowledge base on patient safety. The full value of this new knowledge remains to be confirmed through the synthesis of results

  12. Adverse effects of isolation in hospitalised patients: a systematic review.

    PubMed

    Abad, C; Fearday, A; Safdar, N

    2010-10-01

    The use of transmission precautions such as contact isolation in patients known to be colonised or infected with multidrug-resistant organisms is recommended in healthcare institutions. Although essential for infection control, contact isolation has recently been associated with adverse effects in patients. We undertook a systematic review to determine whether contact isolation leads to psychological or physical problems for patients. Studies were included if (1) hospitalised patients were placed under isolation precautions for an underlying medical indication, and (2) any adverse events related to the isolation were evaluated. We found 16 studies that reported data regarding the impact of isolation on patient mental well-being, patient satisfaction, patient safety or time spent by healthcare workers in direct patient care. The majority showed a negative impact on patient mental well-being and behaviour, including higher scores for depression, anxiety and anger among isolated patients. A few studies also found that healthcare workers spent less time with patients in isolation. Patient satisfaction was adversely affected by isolation if patients were kept uninformed of their healthcare. Patient safety was also negatively affected, leading to an eight-fold increase in adverse events related to supportive care failures. We found that contact isolation may negatively impact several dimensions of patient care. Well-validated tools are necessary to investigate these results further. Large studies examining a number of safety indicators to assess the adverse effects of isolation are needed. Patient education may be an important step to mitigate the adverse psychological effects of isolation and is recommended.

  13. 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.

  14. 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.

  15. 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.

  16. 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 1486.506 Agriculture Regulations of the Department of Agriculture (Continued) COMMODITY CREDIT CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS EMERGING MARKETS PROGRAM...

  17. 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 1486.506 Agriculture Regulations of the Department of Agriculture (Continued) COMMODITY CREDIT CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS EMERGING MARKETS PROGRAM...

  18. 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.

  19. 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.

  20. 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....

  1. A Review of Recent Workplace Literacy Programs and a Projection of Future Challenges.

    ERIC Educational Resources Information Center

    Mikulecky, Larry; And Others

    The state of workplace literacy in the United States was reviewed, and future challenges facing workplace literacy programs given projected economic and demographic changes were examined. First, statistical information from 121 workplace literacy program reports entered into the ERIC database between 1990 and 1993 was synthesized in an analysis of…

  2. Automatic Format Recognition of MARC Bibliographic Elements: A Review and Projection

    ERIC Educational Resources Information Center

    Butler, Brett

    1974-01-01

    Review and discussion of the techniques of automatic format recognition (AFR) of bibliographic data. Comparison of record-building facilities of Library of Congress, University of California (both AFR techniques), and Ohio College Library Center (non-AFR). Projection of a next logical generation, original format recognition. (Author/LS)

  3. NAIT CPD. Competency Profile Development: A Systems Approach for Program Review Projects.

    ERIC Educational Resources Information Center

    Dhariwal, Mave

    The Engineering Technologies Division of the Northern Alberta Institute of Technology (NAIT) in Canada has developed a systems approach to program review called Competency Profile Development (CPD). This approach utilizes a combination of organizational communication, project management, management-by-objectives, a modified Developing A Curriculum…

  4. Developmental Career Guidance Project, Pima County, Arizona. A Submission to the Joint Dissemination Review Panel.

    ERIC Educational Resources Information Center

    McBain, Susan L.; Jung, Steven M.

    One of seven career education programs chosen for nationwide dissemination by the Department of Health, Education, and Welfare's Joint Dissemination Review Panel (JDRP), the Developmental Career Guidance Project for grades K-12 is being conducted in Pima County, Arizona. For the years 1971-75, it received its funding primarily from the Arizona…

  5. 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…

  6. A May American Economic Review Papers Seminar and an Analytic Project for Advanced Undergraduates

    ERIC Educational Resources Information Center

    Elliott, Catherine S.

    2004-01-01

    The author describes two learning activities for teaching economics at the advanced undergraduate level: a May American Economic Review (AER) papers seminar and an analytic project. Both activities help students learn to "do economics." The May AER papers seminar promotes in-depth synthesis and interpretation on the basis of printed session papers…

  7. Do Community-Based Arts Projects Result in Social Gains? A Review of the Literature.

    ERIC Educational Resources Information Center

    Newman, Tony; Curtis, Katherine; Stephens, Jo

    2003-01-01

    A review of evaluations of community-based arts projects illustrates the methodological challenges of evaluating the arts and the issue of whether and how quantitative methods should be used. Eight studies revealed self-reports of personal, social, economic, and educational change, with few negative consequences. (Contains 52 references.) (SK)

  8. Review of the Research and Development Program of Harvard Project Physics.

    ERIC Educational Resources Information Center

    Welch, Wayne W.

    The purpose of this paper is to summarize and review the results of the Harvard Project Physics (HPP) research and evaluation activity to make available to interested science educators the design, implementation, and results of a major curriculum evaluation effort. This activity was conducted during the years 1965-1970 and had considerable support…

  9. A Project for Restructuring Teacher Education: Review of the First Year.

    ERIC Educational Resources Information Center

    Lewis, Mary Daly

    1992-01-01

    Reviews the first year of a teacher education restructuring project at Roosevelt University in Chicago (Illinois). Major goals include developing relationships with Chicago schools to create professional development school models for field experiences and support for beginning teachers and examining and restructuring the university's education,…

  10. 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

  11. Projecting future heat-related mortality under climate change scenarios: a systematic review.

    PubMed

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

    2011-12-01

    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. We conducted a systematic review of research and methods for projecting future heat-related mortality under climate change scenarios. 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. 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. Scenario-based projection research will meaningfully contribute to assessing and managing the potential impacts of climate change on heat-related mortality.

  12. Patient satisfaction with musculoskeletal physical therapy care: a systematic review.

    PubMed

    Hush, Julia M; Cameron, Kirsten; Mackey, Martin

    2011-01-01

    Patient satisfaction is an important patient-centered health outcome. To date, no systematic review of the literature on patient satisfaction with musculoskeletal physical therapy care has been conducted. The purpose of this study was to systematically and critically review the literature to determine the degree of patient satisfaction with musculoskeletal physical therapy care and factors associated with satisfaction. The databases CINAHL, MEDLINE, and EBM Reviews were searched from inception to September 2009. Articles were included if the design was a clinical trial, observational study, survey, or qualitative study; patient satisfaction was evaluated; and the study related to the delivery of musculoskeletal physical therapy services conducted in an outpatient setting. The search located 3,790 citations. Fifteen studies met the inclusion criteria. Two authors extracted patient satisfaction data and details of each study. A meta-analysis of patient satisfaction data from 7 studies was conducted. The pooled estimate of patient satisfaction was 4.44 (95% confidence interval=4.41-4.46) on a scale of 1 to 5, where 5 indicates high satisfaction and 1 indicates high dissatisfaction. Additional data were summarized in tables and critically appraised. Nonrespondent bias from individual studies may affect the accuracy and representativeness of these data. Patients are highly satisfied with musculoskeletal physical therapy care delivered across outpatient settings in northern Europe, North America, the United Kingdom, and Ireland. The interpersonal attributes of the therapist and the process of care are key determinants of patient satisfaction. An unexpected finding was that treatment outcome was infrequently and inconsistently associated with patient satisfaction. Physical therapists can enhance the quality of patient-centered care by understanding and optimizing these determinants of patient satisfaction.

  13. 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. © 2015 Society for Public Health Education.

  14. Skills review: the CHF patient. A review of BLS ssessment and care of the congestive heart failure patient.

    PubMed

    Brophy, John R

    2009-08-01

    As an EMT-B, there will be times when your assessment and treatment skills will be put to the test as you find yourself on scene with a critical patient and no ALS backup. Your ability to recognize patients with critical symptoms and do the most good for them within the EMT-B scope of practice could have a tremendous impact on patient survival. The importance of rapid but accurate assessment of both the clinical presentation and the patient's history cannot be overemphasized. This article will review BLS assessment and care of the congestive heart failure (CHF) patient.

  15. Use of targeted medication reviews to deliver preconception care: A demonstration project.

    PubMed

    DiPietro Mager, Natalie A; Bright, David R; Markus, Dani; Weis, Lindsey; Hartzell, David M; Gartner, James

    To demonstrate the ability of a statewide network of community pharmacists to provide preconception care services with the use of targeted medication reviews (TMRs). Community pharmacists are well qualified and well positioned to assist in this public health priority; however, there are no documented case studies of pharmacists providing preconception care with the use of TMRs. Through the demonstration project, pharmacists provided educational TMRs focused on 3 elements of preconception care to women aged 15 to 45 years enrolled in a nonprofit managed care plan: (1) medications that may cause fetal harm (category D/X); (2) folic acid use; and (3) immunizations. TMRs were generated and released to the individual pharmacy where that patient had prescriptions filled. Any practicing pharmacist in Ohio participating in the medication therapy management platform with a patient in the sample received a TMR notification. The pharmacists documented and billed for the service through this commercially available platform. Nineteen weeks after implementation of the TMRs, 1149 individual pharmacists from 818 different pharmacies had completed at least 1 TMR. Pharmacists completed 33% of all TMR opportunities with a 65% success rate. Establishing new services that were focused on preconception care resulted in rapid integration into existing medication therapy management processes in hundreds of pharmacies across Ohio. These results may help to provide justification for additional payers to reimburse for similar services. Through demonstrating the impact on preconception care, the role of the community pharmacist may continue to expand to include provision of additional preventive care services following the model developed in this initiative. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

  16. 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

  17. 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.

  18. Nutritional risk assessment in critically ill cancer patients: systematic review

    PubMed Central

    Fruchtenicht, Ana Valéria Gonçalves; Poziomyck, Aline Kirjner; Kabke, Geórgia Brum; Loss, Sérgio Henrique; Antoniazzi, Jorge Luiz; Steemburgo, Thais; Moreira, Luis Fernando

    2015-01-01

    Objective To systematically review the main methods for nutritional risk assessment used in critically ill cancer patients and present the methods that better assess risks and predict relevant clinical outcomes in this group of patients, as well as to discuss the pros and cons of these methods according to the current literature. Methods The study consisted of a systematic review based on analysis of manuscripts retrieved from the PubMed, LILACS and SciELO databases by searching for the key words “nutritional risk assessment”, “critically ill” and “cancer”. Results Only 6 (17.7%) of 34 initially retrieved papers met the inclusion criteria and were selected for the review. The main outcomes of these studies were that resting energy expenditure was associated with undernourishment and overfeeding. The high Patient-Generated Subjective Global Assessment score was significantly associated with low food intake, weight loss and malnutrition. In terms of biochemical markers, higher levels of creatinine, albumin and urea were significantly associated with lower mortality. The worst survival was found for patients with worse Eastern Cooperative Oncologic Group - performance status, high Glasgow Prognostic Score, low albumin, high Patient-Generated Subjective Global Assessment score and high alkaline phosphatase levels. Geriatric Nutritional Risk Index values < 87 were significantly associated with mortality. A high Prognostic Inflammatory and Nutritional Index score was associated with abnormal nutritional status in critically ill cancer patients. Among the reviewed studies that examined weight and body mass index alone, no significant clinical outcome was found. Conclusion None of the methods reviewed helped to define risk among these patients. Therefore, assessment by a combination of weight loss and serum measurements, preferably in combination with other methods using scores such as Eastern Cooperative Oncologic Group - performance status, Glasgow Prognostic

  19. Conceptual framework for drug usage review, medical audit and other patient care review procedures.

    PubMed

    Stolar, M H

    1977-02-01

    The following concepts are discussed: (1) quality assurance programs, (2) drug usage review, (3) utilization review, (4) peer review, (5) medical audit, (6) patient care audit and (7) medical care evaluation studies. A framework within which all types of hospital quality assurance mechanisms can be constructed is proposed and their interrelationships are described. The pharmacist's particpiation in the hospital's overall quality assurance program is stressed in two main areas-drug usage review, performed jointly with the medical staff, and quality assurance of pharmaceutical services, a peer review function of the pharmacy profession. These services are primarily drug distribution and control, drug information, clinical pharmacy, continuing education, and other pharmacy and pharmacist functions. Both functions may be viewed as parts of the pharmacy audit, one of several patient care audits within the facility. Pharmacists in skilled nursing facilities have quality assurance responsibilities similar to those of hospital-based pharmacists.

  20. How outcomes are achieved through patient portals: a realist review.

    PubMed

    Otte-Trojel, Terese; de Bont, Antoinette; Rundall, Thomas G; van de Klundert, Joris

    2014-01-01

    To examine how patient portals contribute to health service delivery and patient outcomes. The specific aims were to examine how outcomes are produced, and how variations in outcomes can be explained. We used a realist review method, which aims to describe how 'an intervention works, for whom, and in what circumstances' by analyzing patterns between context, mechanism, and outcomes. We reviewed 32 evaluation studies of patient portals published since 2003. The reviewed evaluations indicate that as a complement to existing health services, patient portals can lead to improvements in clinical outcomes, patient behavior, and experiences. Four different mechanisms are reported to yield the reported outcome improvements. These are patient insight into personal health information, activation of information, interpersonal continuity of care, and service convenience. The vast majority of evaluations were conducted in integrated health service networks in the USA, and we detected no substantial variation in outcomes across these networks. Patient portals may impact clinical outcomes and health service delivery through multiple mechanisms. Given the relative uniformity of evaluation contexts, we were not able to detect patterns in how patient portals work in different contexts. Nonetheless, it appears from the overwhelming proportion of patient portal evaluations coming from integrated health service networks, that these networks provide more fertile contexts for patient portals to be effective. To improve the understanding of how patient portals work, future evaluations of patient portals should capture information about mechanisms and context that influence their outcomes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  1. Patient-Reported Mobility: A Systematic Review.

    PubMed

    Pinto-Carral, Arrate; Fernández-Villa, Tania; Molina de la Torre, Antonio José

    2016-07-01

    To identify the self-administered instruments to assess mobility in adults with disability, to link the mobility assessed by these instruments to the International Classification of Functioning, Disability and Health (ICF), and to evaluate their methodological quality. Scopus, Science Direct, and Web of Science were systematically searched up to July 2015. Studies on the development and validation of self-administered questionnaires in which at least half of the items were related to movement or mobility were included. The mobility assessed by the instruments was classified according to the ICF categories. The methodological quality was assessed according to the Consensus-based Standards for the Selection of Health Measurement Instruments checklist. Of 5791 articles, 34 studies were eligible for inclusion. Only 10 of the instruments contained items that exclusively assessed mobility. The most frequently linked ICF categories were "changing basic body position" (19.4%), "walking" (14.8%), and "moving around" (13.5%). Measurement properties evaluated included internal consistency (5 studies), reliability (5 studies), measurement error (1 study), content validity (9 studies), structural validity (4 studies), hypotheses testing (6 studies), and responsiveness (1 study). Only content validity obtained the highest quality, probably because the studies included in the review reported the development and initial validation of the instruments. Self-administered mobility questionnaires published in the scientific literature assess mobility activities rather than functions related to movement, and do so from the perspective of disability, frequently including self-care and domestic life as domains for assessment. The instruments that presented the highest methodological quality were the Outpatient Physical Therapy Improvement in Movement Assessment Log, the Movement Ability Measure, and the Mobility Activities Measure for Inpatient Rehabilitation Settings. Copyright © 2016

  2. The Cochrane Library review titles that are important to users of health care, a Cochrane Consumer Network project

    PubMed Central

    Wale, Janet L.; Belizán, María; Nadel, Jane; Jeffrey, Claire; Vij, Sita L.

    2011-01-01

    Abstract Background  The Cochrane Consumer Network is an internet‐based community of international users of health care contributing to the work of The Cochrane Collaboration, whose mission is to inform healthcare decision making through development of systematic reviews of best evidence on healthcare interventions. Objective  To prioritize existing review titles listed on The Cochrane Library from a healthcare user perspective, with particular emphasis on patients, carers and health consumers. Design  An online survey was developed and after piloting was made available internationally. The broad dissemination strategy targeted Consumer Network members and Cochrane Review Group editorial staff to identify champions who notified patient support groups and participated in snowballing. The first part of the survey defined criteria that could be applied to review titles and asked survey respondents to rank them. The second part asked respondents to select a health area and prioritize review titles that were of importance to them. Each health area corresponded to a Cochrane Review Group. Results and discussion  Sufficient responses were obtained from 522 valid responses to prioritize review topics in 19 health areas. A total of 321 respondents completed the titles assessment. The types of prioritized interventions were determined by the health area. An important observation was the emphasis on lifestyle and non‐medication therapies in many of the included health areas. The clearest exception to this broad observation was where acute care is required such as antibiotics for acute respiratory tract and HIV‐associated infections and for cardiac conditions. For some cancers, advanced cancer interventions were prioritized. The most important criteria were for the title to convey a clear meaning and the title conveyed that the review would have an impact on health and well‐being. The least important criteria were that the topic was newsworthy or prioritized in

  3. Do patients always prefer quicker treatment? : a discrete choice analysis of patients' stated preferences in the London Patient Choice Project.

    PubMed

    Burge, Peter; Devlin, Nancy; Appleby, John; Rohr, Charlene; Grant, Jonathan

    2004-01-01

    The London Patient Choice Project (LPCP) was established to offer NHS patients more choice over where and when they receive treatment, and to reduce waiting times. The LPCP offered those patients waiting around 6 months for elective procedures a choice of treatment at an alternative NHS or private hospital, or treatment at an overseas hospital.The aim of this article is to investigate the following questions regarding patients' response to choice: (a) What are the factors that patients consider when deciding whether to accept the alternatives they are offered? (b) What is the relative importance to patients of each factor when making their choices, i.e. what trade-offs are patients prepared to make between time waited and other factors? (c) Are there any systematic differences between subgroups of patients (in terms of their personal, health and sociodemographic characteristics) in their response to choice?Patients' preferences were elicited using a discrete choice experiment. Patients eligible to participate in the LPCP were recruited prior to being offered their choice between hospitals and each presented with seven hypothetical choices via a self-completed questionnaire. Data were received from 2114 patients. Thirty percent of respondents consistently chose their 'current' over the 'alternative' hospital. All the attributes and levels examined in the experiment were found to exhibit a significant influence on patients' likelihood of opting for an alternative provider, in the expected direction. Age, education and income had an important effect on the 'uptake' of choice. Our results suggest several important implications for policy. First, there may be equity concerns arising from some patient subgroups being more predisposed to accept choice. Second, although reduced waiting time is important to most patients, it is not all that matters. For example, the reputation of the proffered alternatives is of key importance, suggesting careful thought is required about

  4. 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.

  5. Osteopathy for primary headache patients: a systematic review

    PubMed Central

    Cerritelli, Francesco; Lacorte, Eleonora; Ruffini, Nuria; Vanacore, Nicola

    2017-01-01

    Objective This systematic review aimed to assess the efficacy, effectiveness, safety, and tolerability of osteopathic manipulative treatment (OMT) in patients with headache. Background Migraine is one of the most common and disabling medical conditions. It affects more than 15% of the general population, causing high global socioeconomic costs, and the currently available treatment options are inadequate. Methods We systematically reviewed all available studies investigating the use of OMT in patients with migraine and other forms of headache. Results The search of literature produced six studies, five of which were eligible for review. The reviewed papers collectively support the notion that patients with migraine can benefit from OMT. OMT could most likely reduce the number of episodes per month as well as drug use. None of the included studies, however, was classified as low risk of bias according to the Cochrane Collaboration’s tool for assessing risk of bias. Conclusion The results from this systematic review show a preliminary low level of evidence that OMT is effective in the management of headache. However, studies with more rigorous designs and methodology are needed to strengthen this evidence. Moreover, this review suggests that new manual interventions for the treatment of acute migraine are available and developing. PMID:28352200

  6. Patient safety strategies targeted at diagnostic errors: a systematic review.

    PubMed

    McDonald, Kathryn M; Matesic, Brian; Contopoulos-Ioannidis, Despina G; Lonhart, Julia; Schmidt, Eric; Pineda, Noelle; Ioannidis, John P A

    2013-03-05

    Missed, delayed, or incorrect diagnosis can lead to inappropriate patient care, poor patient outcomes, and increased cost. This systematic review analyzed evaluations of interventions to prevent diagnostic errors. Searches used MEDLINE (1966 to October 2012), the Agency for Healthcare Research and Quality's Patient Safety Network, bibliographies, and prior systematic reviews. Studies that evaluated any intervention to decrease diagnostic errors in any clinical setting and with any study design were eligible, provided that they addressed a patient-related outcome. Two independent reviewers extracted study data and rated study quality. There were 109 studies that addressed 1 or more intervention categories: personnel changes (n = 6), educational interventions (n = 11), technique (n = 23), structured process changes (n = 27), technology-based systems interventions (n = 32), and review methods (n = 38). Of 14 randomized trials, which were rated as having mostly low to moderate risk of bias, 11 reported interventions that reduced diagnostic errors. Evidence seemed strongest for technology-based systems (for example, text message alerting) and specific techniques (for example, testing equipment adaptations). Studies provided no information on harms, cost, or contextual application of interventions. Overall, the review showed a growing field of diagnostic error research and categorized and identified promising interventions that warrant evaluation in large studies across diverse settings.

  7. Implants in disabled patients: a review and update.

    PubMed

    Romero-Pérez, María-Jesús; Mang-de la Rosa, María del Rocio; López-Jimenez, Julián; Fernández-Feijoo, Javier; Cutando-Soriano, Antonio

    2014-09-01

    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.

  8. 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

  9. Sinonasal extramedullary plasmacytoma: a systematic review of 175 patients.

    PubMed

    D'Aguillo, Christine; Soni, Resha S; Gordhan, Chirag; Liu, James K; Baredes, Soly; Eloy, Jean Anderson

    2014-02-01

    This study reviews the published literature related to extramedullary sinonasal plasmacytomas. Clinical presentation, demographics, treatment, and outcomes of this uncommon disease are reported. A systematic review of studies for sinonasal plasmacytomas from 1950 to 2012 was conducted. A PubMed database search, both for articles related to this condition along with bibliographies of those selected articles, was performed. Articles were examined for patient data that reported disease outcome. Sixty-seven journal articles were included in this analysis, comprising a total of 175 cases. Radiotherapy was the most common treatment modality, used in 89 cases, followed by a combination of surgery and radiotherapy, and surgery alone. A total of 71.8% of patients were alive after a median follow-up of 39 months, independent of treatment modality. A combination of radiotherapy and chemotherapy was rarely used but had the best treatment outcome, with 88.9% of patients (8/9 patients) alive. Of the 3 most common treatment modalities, a combination of radiotherapy and surgery had the most favorable outcomes. Sixteen patients (9.1%) converted to multiple myeloma, with the majority of these patients (75.0%) receiving radiotherapy alone as their treatment modality. This review contains the largest pool of sinonasal plasmacytoma patients to date and suggests aggressive radiotherapy is the most common treatment modality for this condition. Of the 3 most common treatment modalities, a combination of surgery and radiotherapy was shown to have the best survival outcomes. © 2013 ARS-AAOA, LLC.

  10. Impact of patients' psychiatric hospitalization on caregivers: a systematic review.

    PubMed

    Weller, Bridget E; Faulkner, Madelaine; Doyle, Otima; Daniel, Stephanie S; Goldston, David B

    2015-05-01

    A systematic literature review was conducted to assess the impact of patients' psychiatric hospitalizations on caregivers. A systematic search of the Web of Knowledge, PsycINFO, and MEDLINE (PubMed) was conducted for peer-reviewed articles published in English before August 31, 2013. Qualitative, quantitative, and mixed-methods studies were included if they focused on the outcomes of caregivers of either adult or youth patients and presented data collected directly from caregivers of patients who had been psychiatrically hospitalized. Twenty-nine articles met the inclusion criteria. The review found that caregivers are heterogeneous in their reaction to patients' psychiatric hospitalization; however, many report distress. Many caregivers have reported experiencing stigma, disruptions in daily life, worse general medical health, economic strain, and changes in relationships after hospitalization. Negative reactions to the hospitalization may decrease over time, but distress can remain elevated compared with the general population. Nonetheless, many caregivers have also reported experiencing positive changes as a result of the hospitalization. The reaction of caregivers may be influenced by the severity of the patient's psychiatric problems as well as the caregiver's demographic characteristics and style of coping. Caregivers experience a range of reactions to psychiatric hospitalizations. Providing caregivers with psychoeducation about their possible reaction to hospitalization and teaching them coping techniques may improve clinical outcomes for patients. Future research is needed to understand the heterogeneity in caregivers' reactions to patients' psychiatric hospitalization.

  11. 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. © 2015 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

  12. Narrative review of the UK Patient Safety Research Portfolio.

    PubMed

    Waring, Justin; Rowley, Emma; Dingwall, Robert; Palmer, Cecily; Murcott, Toby

    2010-01-01

    The UK Patient Safety Research Portfolio (PSRP) commissioned 38 studies investigating the threats to patient safety in various clinical settings and evaluating safety-related service interventions. This paper reviews 27 of these studies, drawing out emergent and cross-cutting themes in terms of theory, research methods and thematic findings. Given the diversity of PSRP studies, the paper takes a narrative approach that allows for qualitative description, interpretation and synthesis of the studies and their findings. The theoretical review shows the majority of PSRP studies draw upon a patient safety 'orthodoxy', developed from the concepts and models associated with the human factors approach. The methodological review shows that a diverse range of research designs and techniques have been utilized. Although many follow in the 'scientific' tradition, interpretative, mixed and innovative methods have been integral to research. The thematic review of findings highlights significant contributions to knowledge in the areas of 'people', 'organizations', and 'technology'. As well as identifying the various sources of risk in the organization and delivery of patient care, the studies also evaluate and make recommendations about service change and improvement. The PSRP has provided the foundations for significant theoretical, methodological and empirical advances in the area of patient safety. The findings and recommendations make important contributions to policy formulation and implementation as well as professional and managerial practice. Through this body of research the PSRP has supported the formation and growth of a thriving research community across academic, policy and professional communities.

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

    PubMed

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

    2014-01-01

    To systematically review existing literature regarding patient engagement technologies used in the inpatient setting. 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. 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. 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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  14. 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

  15. 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…

  16. Reducing discards of fish at sea: a review of European pilot projects.

    PubMed

    Catchpole, Tom L; Gray, Tim S

    2010-01-01

    This paper is about improving the viability of discard-reduction pilot projects. One way to address the problem of wasteful discarding of fish at sea is to initiate pilot projects to trial potential solutions, such as selective gear, area closures, discard bans and data enhancement, which could subsequently be adopted by the fishing industry, either voluntarily or through regulation. However, such pilot projects are often difficult both to set up and to sustain through to completion and implementation. This study reviewed 15 discard-related pilot projects to find out what were the most important determinants of their success or lack of it, and to recommend ways in which the prospects of future pilots could be improved. The review identifies the seven most important factors associated with the viability of the pilot projects - fisheries crises; incentivization; funding; expertise; leadership; and enforcement - and shows how fisheries regulators could take steps to reinforce these factors - by faster responses to crises; more incentives and funding; greater use of fishers' knowledge and leadership; and better enforcement mechanisms. 2009. Published by Elsevier Ltd. All rights reserved.

  17. 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.

  18. Reviews of individual patient data (IPD) are useful for geriatrics: an overview of available IPD reviews.

    PubMed

    van de Glind, Esther M M; Rhodius-Meester, Hanneke F M; Reitsma, Johannes B; Hooft, Lotty; van Munster, Barbara C

    2014-06-01

    To determine how many individual patient data (IPD) reviews that included older people were available in MEDLINE and whether the effectiveness of treatments differed between older and younger individuals. Overview of IPD reviews. A MEDLINE search was conducted for IPD reviews of randomized controlled trials published before July 2012. IPD reviews that presented a regression model that included age as a factor or a subgroup analysis of individuals aged 70 and older or in which all participants were aged 70 and older. Whether the IPD reviews reported similar conclusions for the younger and older populations was evaluated. Twenty-six IPD reviews with a subgroup of older individuals and eight reviews with only older individuals were included (median N = 3,351). The most important reason for choosing an IPD review was the ability to perform a subgroup analysis in the older population. Fourteen IPD reviews suggested that older people should receive different treatments from younger people because of differences in effectiveness, six of which indicated that the investigated treatment(s) should be avoided in older adults. IPD review is a valuable approach for generating evidence in older adults. Treatment effects frequently differed between older and younger individuals. Still, IPD results should be applied to older adults cautiously, because they are often excluded from primary trials. The collaborative sharing of raw data should be promoted to improve evidence-based decisions for this group. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

  19. The effectiveness of orthopedic patient education in improving patient outcomes: a systematic review protocol.

    PubMed

    Majid, Norhaini; Lee, Susan; Plummer, Virginia

    2015-01-01

    The objective of this review is to identify the effectiveness of patient education for orthopedic surgery patients. More specifically, the objectives are to identify the effectiveness of patient education on:length of staysatisfactionpain levelcost of carefunctional abilitiesknowledgeanxietyquality of life in orthopedic settings. Patient education is an essential part of practice for all healthcare professionals. In the orthopedic setting, effective patient education contributes to positive patient outcomes. Patient education is critical to ensure that patients receive appropriate information to assist in the pre-admission, peri-operative treatment and rehabilitation process for the patient. The process of patient education is essentially one where the patient comes to understand his or her physical condition and self-care using the experience and guidance of the multidisciplinary team.With an effective and well-structured patient education program, the cost benefit for health care provider and patient includes a shortened length of stay, and reduced cost of care. According to Huang et al. a simplified pre-operative education program reduced the length of stay and cost of care. Similarly, Jones et al. found that length of stay of a patient who received pre-operative education was reduced. In that study, the mean length of stay was significantly reduced from seven days in patients who did not received pre-operative education to five days in patients who received pre-operative education. These results suggest that pre-operative education programs are an effective method in reducing the length of stay of orthopedic patients.Johansson et al. also described pre-operative education for orthopedic patients in a systematic review published in 2005. They discussed the effect of patient education on the orthopedic patient and found that knowledge, anxiety, pain, length of hospital stay, performance of exercise and mobilization, self-efficacy, patient compliance, adherence

  20. 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.

  1. Discordance between patient report and chart review of risk factors for antimicrobial resistance in ED patients.

    PubMed

    Caterino, Jeffrey M; Graham, Lauren; King, Andrew; Hoppes, Tyler

    2013-09-01

    The objective of this study is to identify the level of agreement between patient self-report and chart review for presence of antimicrobial resistance (AR) risk factors in emergency department (ED) patients. This is a cross-sectional analysis of adult ED patients from July 2010 to January 2011. All ED patients 18 years or older were eligible. Exclusion criteria included pregnant women, prisoners, altered mental status, non-English speakers, traumas, and patients unable to provide consent. Data were obtained by ED patient interview and review of the preceding 3 months of the medical record. We report the difference between patient self-report and chart review of identifying 1 or more AR risk factors using McNemar's χ(2). The test statistic was also calculated for individual risk factors and significance adjusted for multiple comparisons (P < .003). Agreement was calculated using κ with 95% confidence intervals (CIs). Risk factor domains assessed included nursing home residence, recent health care utilization, current indwelling devices, and medical history. Among 289 patients, 1 or more risk factors were reported by 68% (95% CI, 63%-74%) of patients and found in 59% (95% CI, 53%-65%) of charts, a difference of 9.7% (95% CI, 5.3%-14%) (P < .001; κ = 0.72). Patients were more likely to report recent antibiotic use (42% vs 29%; P < .001; κ = 0.52) and recent surgery (17% vs 11%; P < .001; κ = 0.64). There is disagreement between ED patient self-report and medical record review for many AR risk factors. This could affect both clinical care and results of ED research studies relying on chart reviews. Patient self-report identifies a greater number of AR risk factors than chart review. © 2013.

  2. 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

  3. Ethics review for a multi-site project involving Tribal Nations in the Northern Plains

    PubMed Central

    Angal, Jyoti; Petersen, Julie M.; Tobacco, Deborah; Elliott, Amy J.

    2016-01-01

    Increasingly, Tribal Nations are forming ethics review panels, which function separately from institutional research review boards (IRBs). The emergence of strong community representation coincides with a widespread effort supported by the Department of Health and Human Services and other federal agencies to establish a single IRB for all multi-site research. This article underscores the value of a tribal ethics review board and describes the tribal oversight for the Safe Passage Study - a multi-site, community-based project in the Northern Plains. Our experience demonstrates the benefits of tribal ethics review and makes a strong argument for including tribal oversight in future regulatory guidance for multi-site, community based research. PMID:26928897

  4. Review of insulin therapy and pen use in hospitalized patients.

    PubMed

    Davis, Estella M; Foral, Pamela A; Dull, Ryan B; Smith, April N

    2013-05-01

    Hyperglycemia is common among hospitalized patients, affecting approximately 40% of patients at the time of hospital admission, despite the fact that 1 in every 8 patients has no previous diagnosis of diabetes. Hyperglycemia has been associated with poor patient outcomes, including higher rates of morbidity and mortality across a range of conditions. This review discusses options for the effective management of hyperglycemia with a focus on the use of disposable insulin pens in the hospital. Literature, including guidelines for hospital management of hyperglycemia, and information regarding methods of insulin administration were reviewed. Appropriate glucose control via administration of insulin within hospitals has been acknowledged as an important goal and is consistent with achieving patient safety. Insulin may be administered subcutaneously using a pen or vial and syringe or infused intravenously. Levels of patient and provider satisfaction are higher with pen administration than with vial and syringe. Insulin pens have many safety and convenience features including enhanced dose accuracy and autocover/autoshield pen needles. Use of insulin pens instead of vials and syringes can provide several advantages for hospitalized patients, including greater satisfaction among them and health care providers, improved safety, and reduced costs. These advantages can continue following patient discharge.

  5. Review of Insulin Therapy and Pen Use in Hospitalized Patients

    PubMed Central

    Foral, Pamela A.; Dull, Ryan B.; Smith, April N.

    2013-01-01

    Objective: Hyperglycemia is common among hospitalized patients, affecting approximately 40% of patients at the time of hospital admission, despite the fact that 1 in every 8 patients has no previous diagnosis of diabetes. Hyperglycemia has been associated with poor patient outcomes, including higher rates of morbidity and mortality across a range of conditions. This review discusses options for the effective management of hyperglycemia with a focus on the use of disposable insulin pens in the hospital. Methods: Literature, including guidelines for hospital management of hyperglycemia, and information regarding methods of insulin administration were reviewed Results: Appropriate glucose control via administration of insulin within hospitals has been acknowledged as an important goal and is consistent with achieving patient safety. Insulin may be administered subcutaneously using a pen or vial and syringe or infused intravenously. Levels of patient and provider satisfaction are higher with pen administration than with vial and syringe. Insulin pens have many safety and convenience features including enhanced dose accuracy and autocover/autoshield pen needles. Conclusion: Use of insulin pens instead of vials and syringes can provide several advantages for hospitalized patients, including greater satisfaction among them and health care providers, improved safety, and reduced costs. These advantages can continue following patient discharge. PMID:24421496

  6. "Best practice" for patient-centered communication: a narrative review.

    PubMed

    King, Ann; Hoppe, Ruth B

    2013-09-01

    Communicating with patients has long been identified as an important physician competency. More recently, there is a growing consensus regarding the components that define physician-patient communication. There continues to be emphasis on both the need to teach and to assess the communication skills of physicians. This narrative review aims to summarize the work that has been conducted in physician-patient communication that supports the efficacy of good communications skills. This work may also help to define the physician-patient communication skills that need to be taught and assessed. A review of the literature shows it contains impressive evidence supporting positive associations between physician communication behaviors and positive patient outcomes, such as patient recall, patient understanding, and patient adherence to therapy. There is a consensus about what constitutes "best practice" for physician communication in medical encounters: (1) fostering the relationship, (2) gathering information, (3) providing information, (4) making decisions, (5) responding to emotions, and (6) enabling disease- and treatment-related behavior. Evidence supports the importance of communication skills as a dimension of physician competence. Effort to enhance teaching of communication skills to medical trainees likely will require significant changes in instruction at undergraduate and graduate levels, as well as changes in assessing the developing communication skills of physicians. An added critical dimension is faculty understanding of the importance of communication skills, and their commitment to helping trainees develop those skills.

  7. 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…

  8. 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…

  9. Acknowledging patient heterogeneity in economic evaluation : a systematic literature review.

    PubMed

    Grutters, Janneke P C; Sculpher, Mark; Briggs, Andrew H; Severens, Johan L; Candel, Math J; Stahl, James E; De Ruysscher, Dirk; Boer, Albert; Ramaekers, Bram L T; Joore, Manuela A

    2013-02-01

    Patient heterogeneity is the part of variability that can be explained by certain patient characteristics (e.g. age, disease stage). Population reimbursement decisions that acknowledge patient heterogeneity could potentially save money and increase population health. To date, however, economic evaluations pay only limited attention to patient heterogeneity. The objective of the present paper is to provide a comprehensive overview of the current knowledge regarding patient heterogeneity within economic evaluation of healthcare programmes. A systematic literature review was performed to identify methodological papers on the topic of patient heterogeneity in economic evaluation. Data were obtained using a keyword search of the PubMed database and manual searches. Handbooks were also included. Relevant data were extracted regarding potential sources of patient heterogeneity, in which of the input parameters of an economic evaluation these occur, methods to acknowledge patient heterogeneity and specific concerns associated with this acknowledgement. A total of 20 articles and five handbooks were included. The relevant sources of patient heterogeneity (demographics, preferences and clinical characteristics) and the input parameters where they occurred (baseline risk, treatment effect, health state utility and resource utilization) were combined in a framework. Methods were derived for the design, analysis and presentation phases of an economic evaluation. Concerns related mainly to the danger of false-positive results and equity issues. By systematically reviewing current knowledge regarding patient heterogeneity within economic evaluations of healthcare programmes, we provide guidance for future economic evaluations. Guidance is provided on which sources of patient heterogeneity to consider, how to acknowledge them in economic evaluation and potential concerns. The improved acknowledgement of patient heterogeneity in future economic evaluations may well improve the

  10. Robotic assisted hysterectomy in obese patients: a systematic review.

    PubMed

    Iavazzo, Christos; Gkegkes, Ioannis D

    2016-06-01

    Robotic hysterectomy is an alternative approach to the management of female genital tract pathology. A systematic literature review was performed to evaluate the till now available literature evidence on robotic assisted hysterectomy in obese and morbidly obese patients. In total, robotic assisted hysterectomy was performed on 2769 patients. The most frequent indication for robotic hysterectomy was endometrial carcinoma (1832 out of 2769 patients, 66.2 %). Hypertension, diabetes mellitus, obstructive sleep apnea, chronic obstructive pulmonary disease and venous thromboembolism were the most common comorbidities reported. The conversion rate to laparotomy was 92 out of 2226 patients (4.1 %). The most frequent intraoperative complications for robotic hysterectomy were gastrointestinal injury (17 out of 2769 patients, 0.6 %), haemorrhage (five out of 2769 patients, 0.2 %) and bladder injury (five out of 2769 patients, 0.2 %). Wound infections/dehiscence (66 out of 2769 patients, 2.4 %), fever (56 out of 2769 patients, 2 %), pulmonary complications (55 out of 2769 patients, 1.9 %), urogenital complications (36 out of 2769 patients, 1.3 %) and postoperative ileus (28 out of 2769 patients, 1 %) were the most common postoperative complications. Death was reported in three out of 2769 patients (0.1 %). The ICU admitted patients were eight of 2226 patients (0.4 %). The robotic technique, especially in obese, can optimize the surgical approach and recovery of such patients with equally if not better outcomes compared to open and/or laparoscopic techniques.

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

    PubMed

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

    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.

  12. 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…

  13. 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…

  14. Cimetidine in elderly patients: review of uses and risks.

    PubMed

    Jenike, M A

    1982-03-01

    Cimetidine is widely prescribed but has numerous potential side effects, especially in elder patients, who require a lower dosage, e.g., 300 mg twice daily. Antacids may be more effective than cimetidine in preventing acute gastrointestinal bleeding in critically ill elderly patients. Cimetidine increases the risk of toxicity of other commonly used drugs such as phenytoin, diazepam, chlordiazepoxide, propranolol, theophylline, warfarin, and carbamazepine. Elderly patients taking cimetidine are at risk for neuropsychiatric changes, which may be temporarily reversed by physostigmine. Other side effects and indications for use are reviewed.

  15. Communicating with the unresponsive patient: a student review.

    PubMed

    Munger, Amanda; Rios, Yesenia; Ignowski, Crizelle; Nelson, Megan; Gass, Susie; Festa, Colina

    2012-01-01

    Providing patient care for the unconscious population in the intensive care unit can be very challenging. Over time, some nurses may face barriers that prevent them from providing caring behaviors, such as communication. Review of the literature found the attitude of a nurse, hospital technology, and the working environment are barriers that prevent therapeutic nurse-patient communication with a patient who is unconscious or sedated and ventilated. Becoming more knowledgeable about how communication can help and what can be done if such barriers present themselves in the hospital setting is beneficial to improving nurses' care in the intensive care unit.

  16. Acute coronary syndrome among older patients: a review.

    PubMed

    Veerasamy, Murugapathy; Edwards, Richard; Ford, Gary; Kirkwood, Tom; Newton, Julia; Jones, Dave; Kunadian, Vijay

    2015-01-01

    Ischemic heart disease is the leading cause of mortality worldwide. Due to advances in medicine in the past few decades, life expectancy has increased resulting in an aging population in developed and developing countries. Acute coronary syndrome causes greater morbidity and mortality in this group of older patients, which appears to be due to age-related comorbidities. This review examines the incidence and prevalence of acute coronary syndrome among older patients, examines current treatment strategies, and evaluates the predictors of adverse outcomes. In particular, the impact of frailty on outcomes and the need for frailty assessment in developing future research and management strategies among older patients are discussed.

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

    PubMed Central

    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

  18. 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.

  19. 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

  20. 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

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. Compendium of Dental Residents’ Research Project and Literature Reviews - 1991.

    DTIC Science & Technology

    1992-04-01

    AD-A250 354 COMPENDIUM OF DENTAL RESIDENTS’ RESEARCH PROJECTS VO AND LITERATURE REVIEWS 5 1991 SE ,S M Am KECTE 0 0 ’ SS Samuel P. Davis, Ueutenant...2:I Armstrong Laboratory N Aerospace Medicine Directorate USAF Dental Investigation Service Brooks Air Force Base, TX 78235-5000 NOTICES This report...for publication. SAMUEL P. DAVIS, Lt Col, USAF, DC ARL W. HAVEMAN, Colonel, USAF, DC Proje Scientist Chief, USAF Dental Investigation Service /z S

  7. Compendium of Dental Residents’ Research Projects and Literature Reviews - 1990

    DTIC Science & Technology

    1991-03-01

    AL-SR-1991-0001 AD-A236 272 COMPENDIUM OF DENTAL RESIDENTS’ RESEARCH PROJECTS AND LITERATURE REVIEWS 1990 CDTIC JNO 6INSi3 Samuel P. Davis...USAF Dental Investigation Service Armstrong Laboratory Human Systems Division (AFSC) 91-01146 Brooks Air Force Base, TX 78235-5000 .,....,,.,,.l. ltfl 91...L, / 041 4li NOTICES This interim special report was submitted by personnel of the Dental Investigation Service, Clinical Sciences Division

  8. Interpersonal Continuity of Care and Patient Satisfaction: A Critical Review

    PubMed Central

    Saultz, John W.; Albedaiwi, Waleed

    2004-01-01

    PURPOSE We wanted to review the medical literature regarding the relationship between interpersonal continuity of care and patient satisfaction and suggest future strategies for research on this topic. METHODS A search of the MEDLINE database from 1966 through April 2002 was conducted to find articles focusing on interpersonal continuity of patient care. The resulting articles were screened to select those focusing on the relationship between interpersonal continuity in the doctor-patient relationship and patient satisfaction. These articles were systematically reviewed and analyzed for study method, measurement technique, and the quality of evidence. RESULTS Thirty articles were found that addressed the relationship between interpersonal continuity and patient satisfaction with medical care. Twenty-two of these articles were reports of original research. Nineteen of the 22, including 4 clinical trials, reported significantly higher satisfaction when interpersonal continuity was present. CONCLUSIONS Although the available literature reflects persistent methodologic problems, a consistent and significant positive relationship exists between interpersonal continuity of care and patient satisfaction. Future research in this area should address whether the same is true for all patients or only for those who seek ongoing relationships with physicians in primary care. PMID:15506579

  9. 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.

  10. [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

  11. Pediatric morphea (localized scleroderma): review of 136 patients.

    PubMed

    Christen-Zaech, Stéphanie; Hakim, Miriam D; Afsar, F Sule; Paller, Amy S

    2008-09-01

    Morphea is an autoimmune inflammatory sclerosing disorder that may cause permanent functional disability and disfigurement. We sought to determine the clinical features of morphea in a large pediatric cohort. We conducted a retrospective chart review of 136 pediatric patients with morphea from one center, 1989 to 2006. Most children showed linear morphea, with a disproportionately high number of Caucasian and female patients. Two patients with rapidly progressing generalized or extensive linear morphea and arthralgias developed restrictive pulmonary disease. Initial oral corticosteroid treatment and long-term methotrexate administration stabilized and/or led to disease improvement in most patients with aggressive disease. Retrospective analysis, relatively small sample size, and risk of a selected referral population to the single site are limitations. These data suggest an increased prevalence of morphea in Caucasian girls, and support methotrexate as treatment for problematic forms. Visceral manifestations rarely occur; the presence of progressive problematic cutaneous disease and arthralgias should trigger closer patient monitoring.

  12. [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.

  13. Clinical Problems in the Hospitalized Parkinson's Disease Patient: Systematic Review

    PubMed Central

    Gerlach, Oliver HH; Winogrodzka, Ania; Weber, Wim EJ

    2011-01-01

    The problems Parkinson's disease (PD) patients encounter when admitted to a hospital, are known to be numerous and serious. These problems have been inventoried through a systematic review of literature on reasons for emergency and hospital admissions in PD patients, problems encountered during hospitalization, and possible solutions for the encountered problems using the Pubmed database. PD patients are hospitalized in frequencies ranging from 7 to 28% per year. PD/parkinsonism patients are approximately one and a half times more frequently and generally 2 to 14 days longer hospitalized than non-PD patients. Acute events occurring during hospitalization were mainly urinary infection, confusion, and pressure ulcers. Medication errors were also frequent adverse events. During and after surgery PD patients had an increased incidence of infections, confusion, falls, and decubitus, and 31% of patients was dissatisfied in the way their PD was managed. There are only two studies on medication continuation during surgery and one analyzing the effect of an early postoperative neurologic consultation, and numerous case reports, and opinionated views and reviews including other substitutes for dopaminergic medication intraoperatively. In conclusion, most studies were retrospective on small numbers of patients. The major clinical problems are injuries, infections, poor control of PD, and complications of PD treatment. There are many (un-researched) proposals for improvement. A substantial number of PD patients' admissions might be prevented. There should be guidelines concerning the hospitalized PD patients, with accent on early neurological consultation and team work between different specialities, and incorporating nonoral dopaminergic replacement therapy when necessary. © 2011 Movement Disorder Society PMID:21284037

  14. Patient-centred hand hygiene information in orthopaedics units: an evidence-based implementation project.

    PubMed

    Ong, Arielle Yi Jia; Tan, Joanne; Yeo, Hui Ling; Goh, Mien Li

    2017-03-01

    This project aimed to improve patients' knowledge on the importance of hand hygiene. It involved providing patients with a patient and family education on the importance of hand hygiene using a patient information leaflet that introduces the rationale of hand hygiene, possible consequences of poor hand hygiene, and the seven steps of hand hygiene. This projected used a preimplementation and postimplementation audit strategy using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research Into Practice programs. The implementation occurred in three phases over a period of 6 months from January 2014 to June 2014. The audits took place in two orthopaedic wards in a large acute care setting tertiary hospital in Singapore and involved a sample size of 54 patients. It involved going through the medical records of the cases, assessment of patient knowledge based on the audit criteria, and checking if the patients received the patient information leaflet on hand hygiene. The postimplementation audit found significant improvements in all three audit criteria. The percentage of patients who demonstrated knowledge in the importance of hand hygiene saw an improvement of 48.1%. There was an improvement of 44.5% in nurses' compliance to the documentation of patient education being carried out. The percentage of patients who received a patient information leaflet on hand hygiene saw an increase of 36.1%. This project demonstrated that a preimplementation and postimplementation audit is a viable method to implement change and translate evidence into practice. Through this project, patients gained an understanding on the importance of hand hygiene and could take better ownership of their well being. This may potentially improve hospitalization experience and benefit health outcomes. The positive results of this project are contributed by the enthusiastic involvement of all the stakeholders, from patients and their caregivers to the bedside

  15. Using Patient-Reported Outcome Measures (PROMs) to promote quality of care and safety in the management of patients with Advanced Chronic Kidney disease (PRO-trACK project): a mixed-methods project protocol.

    PubMed

    Aiyegbusi, Olalekan Lee; Kyte, Derek; Cockwell, Paul; Marshall, Tom; Dutton, Mary; Slade, Anita; Marklew, Neil; Price, Gary; Verdi, Rav; Waters, Judi; Sharpe, Keeley; Calvert, Melanie

    2017-06-30

    Advanced chronic kidney disease (CKD) has a major effect on the quality of life and health status of patients and requires accurate and responsive management. The use of electronic patient-reported outcome measures (ePROMs) could assist patients with advanced pre-dialysis CKD, and the clinicians responsible for their care, by identifying important changes in symptom burden in real time. We report the protocol for 'Using Patient-Reported Outcome measures (PROMs) to promote quality of care and safety in the management of patients with Advanced Chronic Kidney Disease' (PRO-trACK) project, which will explore the feasibility and validity of an ePROM system for use in patients with advanced CKD. The project will use a mixed-methods approach in three studies: (1) usability testing of the ePROM system involving up to 30 patients and focusing on acceptability and technical performance/stability; (2) ascertaining the views of patient and clinician stakeholders on the optimal use and administration of the CKD ePROM system-this will involve qualitative face-to-face/telephone interviewing with up to 30 patients or until saturation is achieved, focus groups with up to 15 clinical staff, management and IT team members; (3) psychometric assessment of the system, within a cohort of at least 180 patients with advanced CKD, to establish the measurement properties of the ePROM. This project was approved by the West Midlands Edgbaston Research Ethics Committee (Reference 17/WM/0010) and received Health Research Authority (HRA) approval on 24 February 2017.The findings from this project will be provided to clinicians at the Department of Renal Medicine, Queen Elizabeth Hospitals, Birmingham (QEHB), NHS England, presented at conferences and to the Kidney Patients' Association, British Kidney Patient Association and the British Renal Society. Articles based on the findings will be written and submitted for publication in peer-reviewed journals. © Article author(s) (or their employer

  16. Quantitative Assessment of Statistical Reviews of Patient Safety Research Articles.

    PubMed

    Daniels, Jeffrey R; Dexter, Franklin; Espy, Jennifer L; Brull, Sorin J

    2017-06-06

    For 8.5 consecutive years, all patient safety articles of a journal underwent statistical review before publication. We sought to establish the prevalence of statistical themes in the statistical reviews, consideration of contemporary statistical methods, and their associations with time to journal receipt of authors' revision. An initial set of statistical themes was created using the statistical editor's notes. For example, for the statistical theme of "CONSORT checklist," the search term needed was "CONSORT." A complete (exhaustive) list of additional themes was obtained inductively. Among the 273 subsequent reviews for manuscripts that were ultimately accepted, the number of paragraphs that included a theme of a statistical method was only weakly associated with longer revision times (Kendall τ = 0.139 ± 0.039, P = 0.0004). Among the total 3274 paragraphs of statistical reviews, 72.2% did not include a theme of a statistical method (e.g., the editor instead asked the authors to clarify what statistical method had been used) (95% confidence interval [CI] = 70.6%-73.7%, P < 0.0001 versus 50%).Among the 207 manuscripts with a review that included a statistical method, 47.3% included a contemporary topic (e.g., generalized pivotal methods) (95% CI = 40.4%-54.4%). However, among the 911 corresponding paragraphs of statistical review comments, only 16.0% included a contemporary theme (95% CI = 13.7%-18.6%). The revised versions of patient safety articles, which are eventually to be accepted for publication, have many statistical limitations especially in the reporting (writing) of basic statistical methods and results. The results suggest a need for education of patient safety investigators to include statistical writing.

  17. Patient Outcomes at 26 Months in the Patient-Centered Medical Home National Demonstration Project

    PubMed Central

    Jaén, Carlos Roberto; Ferrer, Robert L.; Miller, William L.; Palmer, Raymond F.; Wood, Robert; Davila, Marivel; Stewart, Elizabeth E.; Crabtree, Benjamin F.; Nutting, Paul A.; Stange, Kurt C.

    2010-01-01

    PURPOSE The purpose of this study was to evaluate patient outcomes in the National Demonstration Project (NDP) of practices’ transition to patient-centered medical homes (PCMHs). METHODS In 2006, a total of 36 family practices were randomized to facilitated or self-directed intervention groups. Progress toward the PCMH was measured by independent assessments of how many of 39 predominantly technological NDP model components the practices adopted. We evaluated 2 types of patient outcomes with repeated cross-sectional surveys and medical record audits at baseline, 9 months, and 26 months: patient-rated outcomes and condition-specific quality of care outcomes. Patient-rated outcomes included core primary care attributes, patient empowerment, general health status, and satisfaction with the service relationship. Condition-specific outcomes were measures of the quality of care from the Ambulatory Care Quality Alliance (ACQA) Starter Set and measures of delivery of clinical preventive services and chronic disease care. RESULTS Practices adopted substantial numbers of NDP components over 26 months. Facilitated practices adopted more new components on average than self-directed practices (10.7 components vs 7.7 components, P=.005). ACQA scores improved over time in both groups (by 8.3% in the facilitated group and by 9.1% in the self-directed group, P <.0001) as did chronic care scores (by 5.2% in the facilitated group and by 5.0% in the self-directed group, P=.002), with no significant differences between groups. There were no improvements in patient-rated outcomes. Adoption of PCMH components was associated with improved access (standardized beta [Sβ]=0.32, P = .04) and better prevention scores (Sβ=0.42, P=.001), ACQA scores (Sβ=0.45, P = .007), and chronic care scores (Sβ=0.25, P =.08). CONCLUSIONS After slightly more than 2 years, implementation of PCMH components, whether by facilitation or practice self-direction, was associated with small improvements in

  18. A Clinical Network Project Improves Care of Patients with Atrial Fibrillation with Rapid Ventricular Response in Victorian Emergency Departments.

    PubMed

    Kelly, Anne-Maree; Pannifex, Jan

    2016-03-01

    Atrial fibrillation with rapid ventricular response is a common condition in emergency departments (ED) and despite published guidelines, variation in practice is common. The aim of this nine-month evidence-based care improvement project was improving the management of atrial fibrillation with rapid ventricular response (AFRVR). This was a quality improvement project, evaluated using before and after chart review methodology. The outcomes of interest were the proportion of patients managed according to a local treatment pathway, the proportion with duration of symptoms documented, the proportion with rate control versus rhythm control strategy documented and the proportion with a CHADS2 score (or equivalent) documented. Ten ED participated. Management according to a local treatment pathway increased from 8% (27/326) of patients to 68% (191/281); p<0.0001. The proportion of patients with symptom duration documented increased from 62% (201/326) to 81% (227/281); p<0.0001. The proportion of patients with CHADS2 score (similar) documented increased from 16% (49/310) to 47% (126/268); p<0.0001. This project has led to clinically and statistically significant improvements in management of AFRVR across a health system, although there is still room for improvement. Work continues to embed these gains and make further improvements. Crown Copyright © 2015. Published by Elsevier B.V. All rights reserved.

  19. 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.

  20. Pharmacists as Care Providers for Stroke Patients: A Systematic Review.

    PubMed

    Basaraba, Jade E; Picard, Michelle; George-Phillips, Kirsten; Mysak, Tania

    2017-09-20

    Pharmacists have become an integral member of the multidisciplinary team providing clinical patient care in various healthcare settings. Although evidence supporting their role in the care of patients with other disease states is well-established, minimal literature has been published evaluating pharmacist interventions in stroke patients. The purpose of this systematic review is to summarize the evidence evaluating the impact of pharmacist interventions on stroke patient outcomes. Study abstracts and full-text articles evaluating the impact of a pharmacist intervention on outcomes in patients with an acute stroke/transient ischemic attack (TIA) or a history of an acute stroke/TIA were identified and a qualitative analysis performed. A total of 20 abstracts and full-text studies were included. The included studies provided evidence supporting pharmacist interventions in multiple settings, including emergency departments, inpatient, outpatient, and community pharmacy settings. In a significant proportion of the studies, pharmacist care was collaborative with other healthcare professionals. Some of the pharmacist interventions included participation in a stroke response team, assessment for thrombolytic use, medication reconciliation, participation in patient rounds, identification and resolution of drug therapy problems, risk-factor reduction, and patient education. Pharmacist involvement was associated with increased use of evidence-based therapies, medication adherence, risk-factor target achievement, and maintenance of health-related quality of life. Available evidence suggests that a variety of pharmacist interventions can have a positive impact on stroke patient outcomes. Pharmacists should be considered an integral member of the stroke patient care team.

  1. Evaluation of dialysis adequacy in hemodialysis patients: A systematic review.

    PubMed

    Barzegar, Hengameh; Moosazadeh, Mahmoud; Jafari, Hedayat; Esmaeili, Ravanbakhsh

    2016-08-25

    Hemodialysis is the common kidney replacement therapy in Iran. Doing an adequate and effective dialysis can improve patients' quality of life and reduce kidney failure complications. Additionally, dialysis quality is an important factor in reducing mortality in patients with chronic kidney failure. This systematic review has investigated the adequacy of dialysis in studies done on hemodialysis patients of Iran. All articles related to the dialysis adequacy in hemodialysis patients in English and Farsi (contemporary Persian) were identified by searching the related keywords in various electronic databases. According to the inclusion criteria 21 studies were identified. The results were analyzed using Stata software version 11. A number of 6677 patients had been enrolled in 21 studies that were chosen for this systematic review. Based on the random effects model, the overall dialysis adequacy (KT/V) (K: clearance of urea, T: duration of dialysis, V: distribution of urea) more than 1.2 and confidence interval were 36.3% and 46.2-26.4, respectively. Also, based on random effects model more than 65% urea reduction ratio in all studies was 28.8% and the confidence interval was 43.3-14.4. KT/V and urea reduction ratio were much less desirable in hemodialysis patients and the dialysis quality was also undesirable. It seems that inadequate dialysis prescription, use of inappropriate filters, low pump speed (blood flow speed), and the short duration and few times of dialysis are the major causes of this inadequacy. .

  2. Prevalence of whiplash trauma in TMD patients: a systematic review.

    PubMed

    Häggman-Henrikson, B; Rezvani, M; List, T

    2014-01-01

    The purpose of this systematic review was to describe the prevalence of whiplash trauma in patients with temporomandibular disorders (TMDs) and to describe clinical signs and symptoms in comorbid TMD/whiplash compared with TMD localised to the facial region. A systematic literature search of the PubMed, Cochrane Library and Bandolier databases was carried out for articles published from 1 January 1966 to 31 December 2012. The systematic search identified 129 articles. After the initial screening of abstracts, 32 articles were reviewed in full text applying inclusion and exclusion criteria. Six studies on the prevalence of neck trauma in patients with TMD met the inclusion criteria and were included in the review. Two of the authors evaluated the methodological quality of the included studies. The reported prevalence of whiplash trauma ranged from 8·4% to 70% (median 35%) in TMD populations, compared with 1·7-13% in the non-TMD control groups. Compared with patients with TMD localised to the facial region, TMD patients with a history of whiplash trauma reported more TMD symptoms, such as limited jaw opening and more TMD pain, and also more headaches and stress symptoms. In conclusion, the prevalence of whiplash trauma is higher in patients with TMD compared with non-TMD controls. Furthermore, patients with comorbid TMD/whiplash present with more jaw pain and more severe jaw dysfunction compared with TMD patients without a history of head-neck trauma. These results suggest that whiplash trauma might be an initiating and/or aggravating factor as well as a comorbid condition for TMD.

  3. 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

  4. Readability of Written Materials for CKD Patients: A Systematic Review.

    PubMed

    Morony, Suzanne; Flynn, Michaela; McCaffery, Kirsten J; Jansen, Jesse; Webster, Angela C

    2015-06-01

    The "average" patient has a literacy level of US grade 8 (age 13-14 years), but this may be lower for people with chronic kidney disease (CKD). Current guidelines suggest that patient education materials should be pitched at a literacy level of around 5th grade (age 10-11 years). This study aims to evaluate the readability of written materials targeted at patients with CKD. Systematic review. Patient information materials aimed at adults with CKD and written in English. Patient education materials designed to be printed and read, sourced from practices in Australia and online at all known websites run by relevant international CKD organizations during March 2014. Quantitative analysis of readability using Lexile Analyzer and Flesch-Kincaid tools. We analyzed 80 materials. Both Lexile Analyzer and Flesch-Kincaid analyses suggested that most materials required a minimum of grade 9 (age 14-15 years) schooling to read them. Only 5% of materials were pitched at the recommended level (grade 5). Readability formulas have inherent limitations and do not account for visual information. We did not consider other media through which patients with CKD may access information. Although the study covered materials from the United States, United Kingdom, and Australia, all non-Internet materials were sourced locally, and it is possible that some international paper-based materials were missed. Generalizability may be limited due to exclusion of non-English materials. These findings suggest that patient information materials aimed at patients with CKD are pitched above the average patient's literacy level. This issue is compounded by cognitive decline in patients with CKD, who may have lower literacy than the average patient. It suggests that information providers need to consider their audience more carefully when preparing patient information materials, including user testing with a low-literacy patient population. Copyright © 2015 National Kidney Foundation, Inc. Published by

  5. Clinical review: The critical care management of the burn patient

    PubMed Central

    2013-01-01

    Between 4 and 22% of burn patients presenting to the emergency department are admitted to critical care. Burn injury is characterised by a hypermetabolic response with physiologic, catabolic and immune effects. Burn care has seen renewed interest in colloid resuscitation, a change in transfusion practice and the development of anti-catabolic therapies. A literature search was conducted with priority given to review articles, meta-analyses and well-designed large trials; paediatric studies were included where adult studies were lacking with the aim to review the advances in adult intensive care burn management and place them in the general context of day-to-day practical burn management. PMID:24093225

  6. 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.

  7. 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

  8. 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

  9. Systematic review of patient safety interventions in dentistry.

    PubMed

    Bailey, Edmund; Tickle, Martin; Campbell, Stephen; O'Malley, Lucy

    2015-11-28

    The concept of patient safety in dentistry is in its infancy, with little knowledge about the effectiveness of tools or interventions developed to improve patient safety or to minimise the occurrence of adverse events. The aim of this qualitative systematic review was to search the academic and grey literature to identify and assess tools or interventions used in dental care settings to maintain or improve patient safety. All study designs were included from all dental care settings. Outcome measures were: patient safety, harm prevention, risk minimization, patient satisfaction and patient acceptability, professional acceptability, efficacy, cost-effectiveness and efficiency. Quality assessments were performed on the included studies based on CASP tools. Further analysis was undertaken to discover whether any of the tools had been trialled or verified by the authors, or by subsequent authors. Following abstract screening, and initial qualitative synthesis, nine studies were found to meet the inclusion criteria with 31 being excluded following initial analysis. Tools identified included: checklists (4 studies), reporting systems (3), the use of electronic notes (1) and trigger tools (1). Grey literature searching did not identify any further appropriate studies. In terms of study design, there were observational studies including audit cycles (5 studies), epidemiological studies (3) and prospective cluster randomised clinical trials (1). The quality of the studies varied and none of their outcomes were verified by other researchers. The tools identified have the potential to be used for measuring and improving patient safety in dentistry, with two surgical safety checklists demonstrating a reduction in erroneous dental extractions to nil following their introduction. Reporting systems provide epidemiological data, however, it is not known whether they lead to any improvement in patient safety. The one study on trigger tools demonstrates a 50 % positive predictive

  10. Summary of the National Demonstration Project and Recommendations for the Patient-Centered Medical Home

    PubMed Central

    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

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

    PubMed

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

    2014-01-01

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

  12. The development of biodiversity conservation measures in China's hydro projects: A review.

    PubMed

    Bai, Ruiqiao; Liu, Xuehua; Liu, Xiaofei; Liu, Lanmei; Wang, Jianping; Liao, Sihui; Zhu, Annah; Li, Zhouyuan

    2017-11-01

    The hydropower capacity of China ranks first in the world and accounts for approximately 20% of the total energy production in the country. While hydropower has substantially contributed to meeting China's renewable energy targets and providing clean energy to rural areas, the development of hydropower in China has been met with significant controversy. Ecologically, hydro projects alter the landscape, with potential impacts to the country's aquatic biodiversity. Over the past four decades in China, various mainstream opinions and misunderstandings have been presented concerning how to alleviate the negative impacts of hydro projects on aquatic ecosystems. This article reviews research concerning potential mitigation measures to enhance aquatic biodiversity conservation in hydro projects in China. Based on the academic attention such research has attracted, three technical measures for aquatic biodiversity conservation are considered: (1) fish passages, (2) restocking efforts and (3) river and lake renovations. This article provides a historical comparison of these three practices in China to demonstrate the advantages and disadvantages of each method. The article also reviews the relevant legislation, regulations and technical guidelines concerning China's hydro projects dating back to 1979. The dynamics in research, publications, and patents concerning these three mitigation measures are summarized to demonstrate their technological developments in the context of legislative and policy advances. Data were gathered through the China Knowledge Resource Integrated Database and the State Intellectual Property Office of the People's Republic of China. Based on the analysis provided, the article recommends an expansion of China's environmental certification system for hydro projects, more robust regional legislation to bolster the national framework, the cooperation between upstream and downstream conservation mechanisms, and better monitoring to determine the efficacy

  13. The relationship between nursing leadership and patient outcomes: a systematic review update.

    PubMed

    Wong, Carol A; Cummings, Greta G; Ducharme, Lisa

    2013-07-01

    Our aim was to describe the findings of a systematic review of studies that examine the relationship between nursing leadership practices and patient outcomes. As healthcare faces an economic downturn, stressful work environments, upcoming retirements of leaders and projected workforce shortages, implementing strategies to ensure effective leadership and optimal patient outcomes are paramount. However, a gap still exists in what is known about the association between nursing leadership and patient outcomes. Published English-only research articles that examined leadership practices of nurses in formal leadership positions and patient outcomes were selected from eight online bibliographic databases. Quality assessments, data extraction and analysis were completed on all included studies. A total of 20 studies satisfied our inclusion criteria and were retained. Current evidence suggests relationships between positive relational leadership styles and higher patient satisfaction and lower patient mortality, medication errors, restraint use and hospital-acquired infections. The findings document evidence of a positive relationship between relational leadership and a variety of patient outcomes, although future testing of leadership models that examine the mechanisms of influence on outcomes is warranted. Efforts by organisations and individuals to develop transformational and relational leadership reinforces organisational strategies to improve patient outcomes. © 2013 John Wiley & Sons Ltd.

  14. Beard alopecia areata: a multicentre review of 55 patients.

    PubMed

    Saceda-Corralo, D; Grimalt, R; Fernández-Crehuet, P; Clemente, A; Bernárdez, C; García-Hernandez, M J; Arias-Santiago, S; Rodrigues-Barata, A R; Rodríguez-Pichardo, A; García-Lora, E; Jaén, P; Camacho, F M; Vañó-Galván, S

    2017-01-01

    Alopecia areata on the beard area (BAA) is a common clinical manifestation, but there are no studies about its characteristics. To describe the epidemiology, comorbidities, clinical presentation, evolution, diagnostic findings and therapeutic choices in a series of patients with BAA. This retrospective multicentre review included patients diagnosed with BAA as the first and unique clinical manifestation with at least 12 months of follow-up. Diagnosis was performed based on the typical clinical features. Extra-beard involvement was monitored in all cases. Overall, 55 male patients with a mean age of 39.1 years (range 20-74) were included. Twenty-five patients (45.5%) developed alopecia of the scalp during follow-up and more than 80% of cases appeared in the first 12.4 months. Clinical presentation of AA on the scalp was patchy AA (less than 5 patches) (52%), multifocal AA (28%), AA totalis (12%) and AA universalis (8%). Multivariate analysis revealed a trend of association between scalp involvement and family history of AA without statistical significance. According to this study, BAA may progress to scalp AA in a significant number of patients (45.5% of the patients with a follow-up interval of at least 12 months). In the group of patients who developed scalp AA, 80% of them did it within the first 12 months, so follow-up of patients with BAA is highly encouraged. © 2016 European Academy of Dermatology and Venereology.

  15. Patient satisfaction in pediatric surgical care: a systematic review.

    PubMed

    Espinel, Alexandra G; Shah, Rahul K; McCormick, Michael E; Krakovitz, Paul R; Boss, Emily F

    2014-05-01

    This study seeks to synthesize evidence-based findings related to patient satisfaction as a process measure in pediatric surgical care. PubMed, CINAHL, Scopus, and the Cochrane Central Register of Controlled Trials. We queried 4 standard search engines (1992-2013) for studies specific to pediatric surgical fields in which patient or parent satisfaction or experience of care was a primary outcome measure. Data were systematically analyzed to determine study characteristics, setting, parent or patient focus, measure of experience, and bias. Two independent investigators independently reviewed all articles. The initial search yielded 4748 publications (1503 duplicates), of which 170 underwent full-text review. Thirty-five were included for analysis; the majority (24/35,77%) were published in the last 5 years. Studies examined experience of the child (3/35), parent (23/35), or both (9/35). Experience and satisfaction were evaluated either by validated self-assessment instruments (8), by satisfaction tools (8), or by nonstandard institutional or author-developed tools (19). Experience was measured in the outpatient (7), preoperative (11), operative (14), and postoperative (3) care settings. Specific findings were unique to setting; however, in many studies higher satisfaction correlated with education/information giving, health care provider interpersonal behaviors, and facile/efficient care processes. The patient experience of care is a valuable quality measure that is being more frequently evaluated as a mechanism to improve pediatric surgical care processes. Findings related to patient satisfaction and experience of care may be limited due to lack of measurement using validated tools. Findings from this review may bear significance as patient experience measures become routinely integrated with quality and reimbursement.

  16. Family caregivers of patients with frontotemporal dementia: An integrative review.

    PubMed

    Caceres, Billy A; Frank, Mayu O; Jun, Jin; Martelly, Melissa T; Sadarangani, Tina; de Sales, Paloma Cesar

    2016-03-01

    The purpose of this integrative review is to: (1) identify the characteristics of family caregivers of patients with frontotemporal dementia, (2) explore the impact of providing care on family caregivers' health and well-being, and (3) identify coping strategies used by family caregivers. Frontotemporal dementia is thought to be the second most common form of dementia after Alzheimer's disease. Family caregivers of patients with frontotemporal dementia face unique challenges due to its early onset, behavioral symptoms, and slow progression of decline. However, there is a dearth of research evaluating the health and wellbeing of family caregivers of patients with frontotemporal dementia. An integrative review was conducted using the Whittemore and Knafl methodology. An electronic search of the literature was conducted using four electronic databases: PubMed, Embase, CINAHL, and Web of Science. The Crowe Critical Appraisal tool was used to evaluate the quality of the selected articles. Findings of 11 articles informed this integrative review. Family caregivers of patients with frontotemporal dementia identify behavioral disturbances as most troubling. Spouses and female caregivers experience greater caregiver burden, distress, increased rates of depression, as well as decreased sleep related to behavior disturbances. Though less explored, providing care to those with behavioral disturbances may also impact caregiver physical health. Additionally, female caregivers are most likely to employ coping strategies, most commonly, adaptation and reframing. Effective interventions to reduce family caregiver burden are poorly understood but family caregivers suggest education and internet-based support groups are most helpful. Family caregivers of patients with frontotemporal dementia experience significant distress, which impacts their health and wellbeing. It is important for healthcare providers who care for patients with frontotemporal dementia to recognize the unique

  17. Multidisciplinary care for tracheostomy patients: a systematic review

    PubMed Central

    2009-01-01

    Introduction Appropriate care for patients with tracheostomies in hospital settings is an important issue. Each year more than 7000 patients receive tracheostomies in Australia and New Zealand alone. Many of these tracheostomy patients commence their care in the intensive care unit (ICU) and once stabilised are then transferred to a general ward. Insufficient skills and experience of staff caring for tracheostomy patients may lead to sub-optimal care and increased morbidity. The purpose of this review was to identify whether multidisciplinary tracheostomy outreach teams enable the reduction in time to decannulation and length of stay in acute and sub-acute settings, improve quality of care or decrease adverse events for patients with a tracheostomy. Methods We included all relevant trials published in English. We searched Medline, CINAHL, All EBM and EMBASE in June 2009. Studies were selected and appraised by two reviewers in consultation with colleagues, using inclusion, exclusion and appraisal criteria established a priori. Results Three studies were identified which met the study selection criteria. All were cohort studies with historical controls. All studies included adult patients with tracheostomies. One study was conducted in the UK and the other two in Australia. Risk of bias was moderate to high in all studies. All papers concluded that the introduction of multidisciplinary care reduces the average time to decannulation for tracheostomy patients discharged from the ICU. Two papers also reported that multidisciplinary care reduced the overall length of stay in hospital as well as the length of stay following ICU discharge. Conclusions In the papers we appraised, patients with a tracheostomy tube in situ discharged from an ICU to a general ward who received care from a dedicated multidisciplinary team as compared with standard care showed reductions in time to decannulation, length of stay and adverse events. Impacts on quality of care were not reported

  18. Dental management in patients with antiplatelet therapy: A systematic review

    PubMed Central

    Sola-Martín, Cristina; Molinero-Mourelle, Pedro; Paredes-Rodríguez, Victor; Zarrias-Caballero, Carmen; Hernández-Vallejo, Gonzalo

    2017-01-01

    Introduction Cardiovascular diseases are the most frequent cause of death in the Western world. Its treatment frequently needs therapy with antiplatelet agents, which increases the haemorrhage risk after oral surgical procedures. The aim of this study is to present a review on the dental management of the patients under antiplatelet treatment. Material and Methods A systematic review was carried out following PRISMA recommendations including studies searched in Pubmed-Medline, Embase and Cochrane databases. Results The current trend is to maintain the treatment during the surgical procedure, assuring a good control of the haemorrhage with local haemostatic measures. However, new antiplatelet drugs protocols are not firmly established. Conclusions In spite of the existing recommendations, it is always advisable to consult with the internist or cardiologist of every patient before any intervention. Key words:Antiplatelet, Oral Surgery, Exodontia, Dental Management. PMID:28936297

  19. Massage modalities and symptoms reported by cancer patients: narrative review.

    PubMed

    Myers, Cynthia D; Walton, Tracy; Bratsman, Lindsay; Wilson, Jennifer; Small, Brent

    2008-01-01

    The results of several studies on the use of massage therapies for cancer patients have been published in the peer-reviewed literature over the past 20 years. The current article provides a summary and critique of published studies in which patient-reported symptom ratings were assessed in relation to massage. Twenty-two studies are discussed. Most studies were on Swedish massage, followed by aromatherapy massage, foot reflexology, and acupressure. Symptoms assessed as outcomes included pain, fatigue, anxiety, nausea, and depression. Study designs included uncontrolled observational studies, crossover designs, and quasiexperimental and randomized controlled studies. Several studies included methodologic limitations such as small sample sizes, lack of blinded assessment, lack of accounting for subject attrition in statistical analyses, and other limitations. The results of the studies reviewed are mixed and vary as a function of several study characteristics. The most consistent symptom reduction was anxiety reduction. Additional well-designed studies are needed. Several recommendations are offered for future studies.

  20. Cognitive functioning in meningioma patients: a systematic review.

    PubMed

    Meskal, Ikram; Gehring, Karin; Rutten, Geert-Jan M; Sitskoorn, Margriet M

    2016-06-01

    This systematic review evaluates relevant findings and methodologic aspects of studies on cognitive functioning in meningioma patients prior to and/or following surgery with or without adjuvant radiotherapy. PubMed and Web of Science electronic databases were searched until December 2015. From 1012 initially identified articles, 11 met the inclusion criteria for this review. Multiple methodological limitations were identified which include the lack of pre-treatment assessments, variations in the number and types of neuropsychological tests used, the normative data used to identify patients with cognitive deficits, and the variety of definitions for cognitive impairment. Study results suggest that most of meningioma patients are faced with cognitive deficits in several cognitive domains prior to surgery. Following surgery, most of these patients seem to improve in cognitive functioning. However, they still have impairments in a wide range of cognitive functions compared to healthy controls. Suggestions are given for future research. Adequate diagnosis and treatment of cognitive deficits may ultimately lead to improved outcome and quality of life in meningioma patients.

  1. Management of the dental patient on anticoagulant medication: a review.

    PubMed

    Agarwal, Manoj; Mittal, Sankalp; Vijay, Sharmistha; Yadav, Pooja; Panwar, Vasim Raja; Gupta, Neha

    2014-01-01

    Patients taking anticoagulant medication pose a challenge for the clinician. Dentists are often required to manage bleeding as part of routine oral surgery or dental procedures, and altered hemostasis can lead to complications. Nevertheless, use of these medications is generally important for the patient's health and any alteration in the anticoagulant regimen may have untoward sequelae. In addition, several medications can affect the clotting mechanism, potentially compromising hemostasis. This article will review a variety of anticoagulant medications and the medical conditions that necessitate their use.

  2. The impact on healthcare, policy and practice from 36 multi-project research programmes: findings from two reviews.

    PubMed

    Hanney, Steve; Greenhalgh, Trisha; Blatch-Jones, Amanda; Glover, Matthew; Raftery, James

    2017-03-28

    We sought to analyse the impacts found, and the methods used, in a series of assessments of programmes and portfolios of health research consisting of multiple projects. We analysed a sample of 36 impact studies of multi-project research programmes, selected from a wider sample of impact studies included in two narrative systematic reviews published in 2007 and 2016. We included impact studies in which the individual projects in a programme had been assessed for wider impact, especially on policy or practice, and where findings had been described in such a way that allowed them to be collated and compared. Included programmes were highly diverse in terms of location (11 different countries plus two multi-country ones), number of component projects (8 to 178), nature of the programme, research field, mode of funding, time between completion and impact assessment, methods used to assess impact, and level of impact identified. Thirty-one studies reported on policy impact, 17 on clinician behaviour or informing clinical practice, three on a combined category such as policy and clinician impact, and 12 on wider elements of impact (health gain, patient benefit, improved care or other benefits to the healthcare system). In those multi-programme projects that assessed the respective categories, the percentage of projects that reported some impact was policy 35% (range 5-100%), practice 32% (10-69%), combined category 64% (60-67%), and health gain/health services 27% (6-48%). Variations in levels of impact achieved partly reflected differences in the types of programme, levels of collaboration with users, and methods and timing of impact assessment. Most commonly, principal investigators were surveyed; some studies involved desk research and some interviews with investigators and/or stakeholders. Most studies used a conceptual framework such as the Payback Framework. One study attempted to assess the monetary value of a research programme's health gain. The widespread

  3. Airway management in patients with pituitary disease: a review of 746 patients.

    PubMed

    Nemergut, Edward C; Zuo, Zhiyi

    2006-01-01

    Difficulties in airway management are observed among patients with pituitary disease. The purpose of this study was to better characterize the relationship between disease factors such as tumor characteristics on difficult endotracheal intubation. The perioperative records of 746 patients that underwent transsphenoidal microsurgery at the University of Virginia between January 1995 and June 2001 were reviewed. Among the 746 patients studied, difficulty with endotracheal intubation was encountered in 28 patients (3.8%). Patient gender and tumor size were not associated with a difference in the incidence of unanticipated airway management difficulty. Unanticipated difficulty with airway management was more than three times more common in acromegalic patients (n = 121) than in patients with nonfunctioning pituitary tumors (9.1% [5.8-14%] vs 2.6% [1.5-4.5%], P = 0.007). Patients with Cushing disease (n = 182) and patients with a prolactinoma (n = 87) were no more difficult to intubate than patients with nonfunctioning tumors. Among patients with acromegaly, neither tumor size nor patient gender has any impact on the incidence of intubation difficulty. Among all patients, when difficulty was encountered, intubation assisted by the gum elastic bougie was successful 100% of the time. The incidence of difficulty in intubation is not higher among patients with pituitary disease than in the general surgical population; however, patients with acromegaly have difficult intubations three times more often.

  4. Using qualitative methods to understand factors contributing to patient satisfaction among dermatology patients: a systematic review.

    PubMed

    Gibbons, Caitlin; Singh, Sanminder; Gibbons, Brittany; Clark, Caitlin; Torres, Josefina; Cheng, Michelle Y; Wang, Elizabeth A; Armstrong, April W

    2017-09-11

    In this systematic review, we aimed to synthesize data that identify factors contributing to patient satisfaction in dermatology care using qualitative methods. We performed a comprehensive search of the literature using the PubMed database for articles published between January 1, 2000 and February 9, 2015. The initial search yielded 186 articles, of which 13 were included after applying inclusion and exclusion criteria. The systematic review of 13 articles included a total of 330 patients. Using in-field observations and semistructured interviews, studies found that qualitative methods and analysis increased the provider's sensitivity to patient needs and enhanced patient care. Analyses using qualitative methods found increased patient satisfaction in their healthcare provider is associated with (1) confidence in the provider's diagnosis, (2) perception of patient-centered, individualized recommendations and (3) quality of patient education and provider explanation during a visit. Patient satisfaction is measured using either quantitative or qualitative methods. Quantitative methods result in standardized data that often does not capture the nuances of patient experience. In contrast, qualitative methodology is integral to gathering patient perspectives on patient care and satisfaction and should be included in future research models.

  5. Patient satisfaction with colonoscopy: A literature review and pilot study

    PubMed Central

    Chartier, Lucas; Arthurs, Erin; Sewitch, Maida J

    2009-01-01

    BACKGROUND: Current guidelines recommend that colonoscopic colorectal cancer screening be undertaken every 10 years after the age of 50 years. However, because the procedure does not meet criteria that promote screening uptake, patient satisfaction with colonoscopy may encourage repeat screening. OBJECTIVE: To systematically review the literature and conduct a pilot study of patient satisfaction with the colonoscopy experience. METHODS: All cohort studies from January 1997 to August 2008 in the MEDLINE database that measured either patient satisfaction with colonoscopy, patient willingness to return for colonoscopy under the same conditions or patient preference for colonoscopy compared with other large bowel procedures were identified. The search was supplemented by journal citation lists in the retrieved articles. RESULTS: Of the 29 studies identified, 15 met the inclusion criteria. Consistently, the vast majority of patients (approximately 95%) were very satisfied with their colonoscopy experience. Patient satisfaction was similar for screening and nonscreening colonoscopy. Patient willingness to return for the procedure ranged from 73% to 100%. Of the five studies that examined modality preference, three studies reported the majority of patients preferred colonography to colonoscopy and two studies reported the reverse. Our pilot study findings mirrored those of other studies that were conducted in the United States. The major limitation of the included studies was that patients who were most dissatisfied may have gone elsewhere to have their colonoscopy. CONCLUSIONS: Patients were very satisfied with colonoscopy. The majority were willing to return for repeat testing under the same conditions, and colonoscopy was not preferred over other modalities. However, studies were limited by methodological shortcomings. PMID:19319384

  6. Neurosurgical procedures in patients with liver cirrhosis: A review

    PubMed Central

    Chen, Ching-Chang; Huang, Yin-Cheng; Yeh, Chun-Nan

    2015-01-01

    Liver cirrhosis, a devastating liver fibrosis caused by hepatitis/inflammation or tumors, is a major comorbid factor in known surgery fields, such as cardiovascular and abdominal surgeries. It is important to review possible comorbid results in neurosurgical procedures in cirrhotic patients. In the reviewed literature, Child-Pugh and model for end-stage liver disease scores are commonly used in the assessment of surgical risks for cirrhotic patients undergoing abdominal, cardiovascular or neurosurgical procedures. The major categories of neurosurgery are traumatic brain injury (TBI), spontaneous intracranial hemorrhage (SICH), brain tumors, and spinal instrumentation procedures. TBI was reported with surgical mortality as high as 34.5% and a complication rate of 87.2%. For SICH, mortality ranged from 22.7% to 47.0%, while complications were reported to be 43.2%. Less is discussed in brain tumor patients; still the postoperative hemorrhage rate approached 26.7%. In spinal fusion instrumentation procedures, the complication rate was as high as 41.0%. Preoperative assessment and correction could possibly decrease complications such as hemorrhage, wound infection and other cirrhosis-related complications (renal, pulmonary, ascites and encephalopathy). In this study, we reviewed the neurosurgical-related literature with regard to liver cirrhosis as a prognostic factor influencing neurosurgical outcomes. PMID:26413225

  7. Neurosurgical procedures in patients with liver cirrhosis: A review.

    PubMed

    Chen, Ching-Chang; Huang, Yin-Cheng; Yeh, Chun-Nan

    2015-09-28

    Liver cirrhosis, a devastating liver fibrosis caused by hepatitis/inflammation or tumors, is a major comorbid factor in known surgery fields, such as cardiovascular and abdominal surgeries. It is important to review possible comorbid results in neurosurgical procedures in cirrhotic patients. In the reviewed literature, Child-Pugh and model for end-stage liver disease scores are commonly used in the assessment of surgical risks for cirrhotic patients undergoing abdominal, cardiovascular or neurosurgical procedures. The major categories of neurosurgery are traumatic brain injury (TBI), spontaneous intracranial hemorrhage (SICH), brain tumors, and spinal instrumentation procedures. TBI was reported with surgical mortality as high as 34.5% and a complication rate of 87.2%. For SICH, mortality ranged from 22.7% to 47.0%, while complications were reported to be 43.2%. Less is discussed in brain tumor patients; still the postoperative hemorrhage rate approached 26.7%. In spinal fusion instrumentation procedures, the complication rate was as high as 41.0%. Preoperative assessment and correction could possibly decrease complications such as hemorrhage, wound infection and other cirrhosis-related complications (renal, pulmonary, ascites and encephalopathy). In this study, we reviewed the neurosurgical-related literature with regard to liver cirrhosis as a prognostic factor influencing neurosurgical outcomes.

  8. How technology is empowering patients? A literature review.

    PubMed

    Calvillo, Jorge; Román, Isabel; Roa, Laura M

    2015-10-01

    The term 'Patient Empowerment' (PE) is a growing concept – so in popularity as in application – covering situations where citizens are encouraged to take an active role in the management of their own health. This concept is serving as engine power for increasing the quality of health systems, but a question is still unanswered, 'how PE will be effectively achieved?' Beyond psychological implications, empowerment of patients in daily practice relies on technology and the way it is used. Unfortunately, the heterogeneity of approaches and technologies makes difficult to have a global vision of how PE is being performed. To clarify how technology is being applied for enhancing patient empowerment as well as to identify current (and future) trends and milestones in this issue. Searches for relevant English language articles using Medline, Scopus, ACM Digital Library, Springer Link, EBSCO host and ScienceDirect databases from the year 2000 until October 2012 were conducted. Among others, a selection criterion was to review articles including terms 'patient' and 'empowerment' in title, abstract or as keywords. Results state that practical approaches to empower patients vary in scope, aim and technology. Health literacy of patients, remote access to health services, and self-care mechanisms are the most valued ways to accomplish PE. Current technology already allows establishing the first steps in the road ahead, but a change of attitude by all stakeholders (i.e. professionals, patients, policy makers, etc.) is required. © 2013 John Wiley & Sons Ltd.

  9. 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.

  10. Bariatric surgery in elderly patients: a systematic review.

    PubMed

    Giordano, Salvatore; Victorzon, Mikael

    2015-01-01

    Controversy exists regarding the effectiveness and safety of bariatric/metabolic surgery in elderly patients. We performed a systematic review on this issue in patients aged 60 years or older. MEDLINE, Cochrane Library, Embase, Scopus, and Google Scholar were searched until August 2015 for studies on outcomes of bariatric surgery in elderly patients. The results were expressed as pooled proportions (%) with 95% confidence intervals. Heterogeneity across the studies was evaluated by the I (2) test, and a random-effects model was used. Twenty-six articles encompassing 8,149 patients were pertinent with this issue and included data on bariatric surgery outcomes in elderly population. Fourteen patients died during the 30-day postoperative period, with a pooled mortality of 0.01%. Pooled overall complication rate was 14.7%. At 1-year follow-up, pooled mean excess weight loss was 53.77%, pooled diabetes resolution was 54.5%, and pooled hypertension resolution was 42.5%, while pooled lipid disorder resolution was 41.2%. Outcomes and complication rates of bariatric surgery in patients older than 60 years are comparable to those in a younger population, independent of the type of procedure performed. Patients should not be denied bariatric surgery because of their age alone.

  11. 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

  12. Reviews on current carbon emission reduction technologies and projects and their feasibilities on ships

    NASA Astrophysics Data System (ADS)

    Wang, Haibin; Zhou, Peilin; Wang, Zhongcheng

    2017-06-01

    Concern about global climate change is growing, and many projects and researchers are committed to reducing greenhouse gases from all possible sources. International Maritime (IMO) has set a target of 20% CO2 reduction from shipping by 2020 and also presented a series of carbon emission reduction methods, which are known as Energy Efficiency Design Index (EEDI) and Energy Efficiency Operation Indicator (EEOI). Reviews on carbon emission reduction from all industries indicate that, Carbon Capture and Storage (CCS) is an excellent solution to global warming. In this paper, a comprehensive literature review of EEDI and EEOI and CCS is conducted and involves reviewing current policies, introducing common technologies, and considering their feasibilities for marine activities, mainly shipping. Current projects are also presented in this paper, thereby illustrating that carbon emission reduction has been the subject of attention from all over the world. Two case ship studies indicate the economic feasibility of carbon emission reduction and provide a guide for CCS system application and practical installation on ships.

  13. Massage for symptom relief in patients with cancer: systematic review.

    PubMed

    Wilkinson, Susie; Barnes, Kelly; Storey, Lesley

    2008-09-01

    This paper is a report of a review to assess evidence of the effectiveness of massage for patients with cancer, in terms of reducing physical or psychological symptoms, improving quality of life, or producing unwanted side effects. Patients with cancer may use complementary therapies, including massage and aromatherapy massage. However, their use and provision by state-financed healthcare services is controversial. A systematic review was carried out, using the Cochrane principles. No meta-analysis was appropriate. An initial comprehensive search of electronic databases search was carried out in 2003 and updated in 2006. Eligible trials were randomized controlled trials, controlled before-and-after (pre-post) studies and interrupted time-series studies. Participants were adults with a diagnosis of cancer and receiving care in any healthcare setting. Interventions were limited to massage and/or aromatherapy massage carried out by a qualified therapist. Outcome measures to be included were patient-reported levels of physical and psychological indices of symptom distress and quality of life (measured using validated assessment tools). In the review, 1325 papers were considered. Ten trials met the inclusion criteria and their results suggest that massage might reduce anxiety in patients with cancer in the short term and may have a beneficial effect on physical symptoms of cancer, such as pain and nausea. However, the lack of rigorous research evidence precludes drawing definitive conclusions. Further well-designed large trials with longer follow-up periods are needed to be able to draw firm conclusions about the efficacy and effectiveness of massage for cancer patients.

  14. A Depression Screening Protocol for Patients With Acute Stroke: A Quality Improvement Project.

    PubMed

    McIntosh, Celia

    2017-02-01

    Depression after stroke is common and is associated with poor functional recovery, suicidal ideation, decreased quality of life, and increased mortality. Despite this knowledge, poststroke depression (PSD) is often underdetected and thus undertreated. PSD is clinically important for the caregiver, the family, and the stroke survivor. Inconsistencies in screening and treatment practices may further contribute to these negative outcomes. The purposes of this evidence-based clinical scholarship project were to (1) determine the efficacy of an evidence-based depression screening protocol in improving early detection and treatment of PSD and (2) identify if there were any relationships between the protocol interventions, depression scores, and diagnosis. A retrospective chart review was conducted in a convenience sample of 79 hospitalized patients with acute stroke. Depression was assessed using the Patient Health Questionnaire-9. Demographic data and medical and protocol variables were also collected. Descriptive statistics, chi-square test, and Pearson correlation test were used for data analysis. Of the 79 participants, 56% were men, 65% were White, 77% were admitted with ischemic stroke, and 48% were identified as being depressed (Patient Health Questionnaire-9 depression scale > 4). Individuals with a history of depression (χ = 17.09, p = .002) were also more likely to have higher levels of depression severity as compared with patients who did not have a history of depression. After the intervention, patients screening positive were more likely to receive an educational booklet on stroke and depression (χ = 30.0, p = .000) and be medically treated for PSD before discharge (χ = 5.57, p = .018). Nurses' documentation of screening results also improved (χ = 9.19, p = .002). Implementation of the Evidence Based Depression Screening and Treatment (EBDST) protocol improved early detection and treatment of PSD in the hospitalized patients with acute stroke before

  15. 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

  16. A review of malaria vaccine clinical projects based on the WHO rainbow table

    PubMed Central

    2012-01-01

    Development and Phase 3 testing of the most advanced malaria vaccine, RTS,S/AS01, indicates that malaria vaccine R&D is moving into a new phase. Field trials of several research malaria vaccines have also confirmed that it is possible to impact the host-parasite relationship through vaccine-induced immune responses to multiple antigenic targets using different platforms. Other approaches have been appropriately tested but turned out to be disappointing after clinical evaluation. As the malaria community considers the potential role of a first-generation malaria vaccine in malaria control efforts, it is an apposite time to carefully document terminated and ongoing malaria vaccine research projects so that lessons learned can be applied to increase the chances of success for second-generation malaria vaccines over the next 10 years. The most comprehensive resource of malaria vaccine projects is a spreadsheet compiled by WHO thanks to the input from funding agencies, sponsors and investigators worldwide. This spreadsheet, available from WHO's website, is known as "the rainbow table". By summarizing the published and some unpublished information available for each project on the rainbow table, the most comprehensive review of malaria vaccine projects to be published in the last several years is provided below. PMID:22230255

  17. Operational research on malaria control and elimination: a review of projects published between 2008 and 2013.

    PubMed

    Zhou, Shui-sen; Rietveld, Aafje E C; Velarde-Rodriguez, Mar; Ramsay, Andrew R; Zhang, Shao-sen; Zhou, Xiao-nong; Cibulskis, Richard E

    2014-12-04

    A literature review for operational research on malaria control and elimination was conducted using the term 'malaria' and the definition of operational research (OR). A total of 15 886 articles related to malaria were searched between January 2008 and June 2013. Of these, 582 (3.7%) met the definition of operational research. These OR projects had been carried out in 83 different countries. Most OR studies (77%) were implemented in Africa south of the Sahara. Only 5 (1%) of the OR studies were implemented in countries in the pre-elimination or elimination phase. The vast majority of OR projects (92%) were led by international or local research institutions, while projects led by National Malaria Control Programmes (NMCP) accounted for 7.8%. With regards to the topic under investigation, the largest percentage of papers was related to vector control (25%), followed by epidemiology/transmission (16.5%) and treatment (16.3%). Only 19 (3.8%) of the OR projects were related to malaria surveillance. Strengthening the capacity of NMCPs to conduct operational research and publish its findings, and improving linkages between NMCPs and research institutes may aid progress towards malaria elimination and eventual eradication world-wide.

  18. 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

  19. 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

  20. A Systematic Review of Emergency Department Use Among Cancer Patients

    PubMed Central

    Lash, Rebecca S.; Bell, Janice F.; Reed, Sarah C.; Poghosyan, Hermine; Rodgers, James; Kim, Katherine K.; Bold, Richard J.; Joseph, Jill G.

    2016-01-01

    Background Recent reports call for reductions in costly and potentially avoidable services such as emergency department (ED) visits. Providing high-quality and safe care for oncology patients remains challenging for ED providers given the diversity of patients seeking care and the unpredictable clinical environment. While ED use by oncology patients is appropriate for acute health concerns, some ED visits may be preventable with well-coordinated care and adequate symptom management. Objective The aim of this study was to summarize available evidence regarding the incidence, predictors of, and reasons for ED visits among oncology patients. Methods Keyword/MeSH term searches were conducted using 4 online databases. Inclusion criteria were publication date between April 1, 2003, and December 5, 2014; sample size of 50 or more; and report of the incidence or predictors of ED use among oncology patients. Results The 15 studies that met criteria varied in study aim, design, and time frames for calculating ED utilization rates. The incidence of ED visits among oncology patients ranged from 1% to 83%. The 30-day standardized visit rate incidence ranged from 1% to 12%. Collectively, the studies lack population-based estimates for all cancers combined. Conclusions The studies included in this review suggest that rates of ED use among cancer patients exceed those of the general population. However, the extent of ED use by oncology patients and the reasons for ED visits remain understudied. Implications for Practice Nurses are involved in the treatment of cancer, patient education, and symptom management. Nurses are well positioned to develop patient-centered treatment and care coordination plans to improve quality of care and reduce ED visits. PMID:26925998

  1. The effectiveness of patient navigation programs for adult cancer patients undergoing treatment: a systematic review.

    PubMed

    Tho, Poh Chi; Ang, Emily

    2016-02-01

    Advancements in technology and medical treatment have made cancer care treatment more complex. With the current trend of sub-specialization in health care, cancer patients commonly receive care from multiple specialists and have wider treatment options. In view of this, there is a need to coordinate care and integrate information to enhance care and quality of outcomes for patients. Since the successful implementation of programs for increasing the survival rate of breast cancer patients at Harlem Hospital Center, New York, USA, patient navigation programs have been widely introduced in healthcare settings. Some literature has identified nurses as a primary candidate in assuming the role of a navigator. However, there is a need to further explore the effectiveness of patient navigation programs for their effectiveness in improving quality of life, and patient satisfaction and outcomes during the commencement of cancer treatment. The objective of this review was to synthesize the best available evidence on the effectiveness of patient navigation programs in adult cancer patients undergoing treatments such as radiotherapy and/or chemotherapy. This review considered studies that included adults aged 18 years and over, diagnosed with any type of cancer and undergoing treatment in an acute care hospital setting, including inpatient and outpatient/ambulatory care.This review considered studies that evaluated nurse-led patient navigation programs versus no patient navigation program or non-structured care coordination.A patient navigation program includes patient education, psychosocial support, and care coordination.This review considered randomized controlled trials and quasi-experimental studies.The review focused on the effects of patient navigator program clinical/patient outcomes. The review included studies on patient wellbeing and clinical outcomes, but excluded studies that had examined the impact of these programs on efficiency-related outcomes, such as length

  2. FASTING ABBREVIATION AMONG PATIENTS SUBMITTED TO ONCOLOGIC SURGERY: SYSTEMATIC REVIEW

    PubMed Central

    PINTO, Andressa dos Santos; GRIGOLETTI, Shana Souza; MARCADENTI, Aline

    2015-01-01

    Introduction The abbreviation of perioperative fasting among candidates to elective surgery have been associated with shorter hospital stay and decreased postoperative complications. Objective To conduct a systematic review from randomized controlled trials to detect whether the abbreviation of fasting is beneficial to patients undergoing cancer surgery compared to traditional fasting protocols. Method A literature search was performed in electronic databases: MEDLINE (PubMed), SciELO, EMBASE and Cochrane, without time restriction. Were used the descriptors: "preoperative fasting", "cancer", "diet restriction" and "perioperative period". Randomized trials were included in adults of both sexes, with diagnosis of cancer. Exclusion criteria were: use of parenteral nutrition and publications in duplicate. All analyzes, selections and data extraction were done blinded manner by independent evaluators. Results Four studies were included, with a total of 150 patients, 128 with colorectal cancer and 22 gastric cancer. The articles were published from 2006 to 2013. The main outcome measures were heterogeneous, which impaired the unification of the results by means of meta-analysis. Compared to traditional protocols, patients undergoing fasting abbreviation with the administration of fluids containing carbohydrates had improvements in glycemic parameters (fasting glucose and insulin resistance), inflammatory markers (interleukin 6 and 10) and indicators of malnutrition (grip strength hand and CRP/albumin ratio), and shorter hospital stay. The methodological quality of the reviewed articles, however, suggests that the results should be interpreted with caution. Conclusions The abbreviation of perioperative fasting in patients with neoplasm appears to be beneficial. PMID:25861075

  3. [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.

  4. Review: Biological relevance of disseminated tumor cells in cancer patients.

    PubMed

    Riethdorf, Sabine; Wikman, Harriet; Pantel, Klaus

    2008-11-01

    The prognosis of cancer patients is largely determined by the occurrence of distant metastases. In patients with primary tumors, this relapse is mainly due to clinically occult micrometastasis present in secondary organs at primary diagnosis but not detectable even with high resolution imaging procedures. Sensitive and specific immunocytochemical and molecular assays enable the detection and characterization of disseminated tumor cells (DTC) at the single cell level in bone marrow (BM) as the common homing site of DTC and circulating tumor cells (CTC) in peripheral blood. Because of the high variability of results in DTC and CTC detection, there is an urgent need for standardized methods. In this review, we will focus on BM and present currently available methods for the detection and characterization of DTC. Furthermore, we will discuss data on the biology of DTC and the clinical relevance of DTC detection. While the prognostic impact of DTC in BM has clearly been shown for primary breast cancer patients, less is known about the clinical relevance of DTC in patients with other carcinomas. Current findings suggest that DTC are capable to survive chemotherapy and persist in a dormant nonproliferating state over years. To what extent these DTC have stem cell properties is subject of ongoing investigations. Further characterization is required to understand the biology of DTC and to identify new targets for improved risk prevention and tailoring of therapy. Our review will focus on breast, colon, lung, and prostate cancer as the main tumor entities in Europe and the United States.

  5. The prevalence of onychomycosis in psoriatic patients: a systematic review.

    PubMed

    Klaassen, K M G; Dulak, M G; van de Kerkhof, P C M; Pasch, M C

    2014-05-01

    We systematically reviewed all available literature concerning the prevalence of onychomycosis in patients with nail psoriasis and the distribution of pathogens causing onychomycosis in this specific group of patients. Databases searched were Pubmed, EMBASE and the Cochrane Controlled Clinical Trial Register. All studies reporting on the prevalence of onychomycosis in nail psoriasis were obtained, and quality assessment was determined by the STrengthening the Reporting of OBservational studies in Epidemiology checklist. Literature search revealed 720 studies, of which 10 studies met the inclusion criteria. The major limitation of the review was the heterogeneity of the included studies, which prevented the possibility to conduct a meta analysis. However, the average prevalence of 18.0% of onychomycosis in psoriatic patients seems to be increased when compared with control groups and literature on healthy population, even though the ultimate evidence remains lacking. As in the literature hypothesized shift in causative agents from dermatophytes to yeasts and/or moulds could not be confirmed. The clinical consequence of the relatively high prevalence of onychomycosis in psoriasis may be a general advice to rule out onychomycosis or concomitant onychomycosis in these patients with (suspected) nail psoriasis. This advice is stressed by the relative simplicity of treating the contribution of onychomycosis in the nail dystrophy but also the fact that nail psoriasis mostly is treated by immunosuppressive drugs, like steroids, methotrexate or biologics which may aggravate mycotic nail infections.

  6. A systems development life cycle approach to patient journey modeling projects.

    PubMed

    Curry, Joanne M; McGregor, Carolyn; Tracy, Sally

    2007-01-01

    Patient Journey Modeling, a relatively recent innovation in healthcare quality improvement, models the patient's movement through a Health Care Organisation (HCO) by viewing it from a patient centric perspective. A Systems Development Life Cycle (SDLC) provides a standard project management framework that can improve the quality of information systems. The concept of following a consistent project management framework to boost quality outcomes can be applied equally to healthcare improvement. This paper describes a SDLC designed specifically for the health care domain and in particular patient journey modeling projects. It goes on to suggest that such a framework can be used to compliment the dominant healthcare improvement method, the Model for Improvement. The key contribution of this paper is the introduction of a project management framework in the form of an SDLC that can be used by non-professional computer developers (ie: health care staff), to improve the consistency and quality of outcomes for patient journey redesign projects. Experiences of applying the SDLC in a midwife-led primary-care maternity services environment are discussed. The project team found the steps logical and easy to follow and produced demonstrable improvement results along with ongoing goal-focused action plans.

  7. [Patients with gastric cancer submitted to gastrectomy: an integrative review].

    PubMed

    Mello, Bruna Schroeder; Lucena, Amália de Fátima; Echer, Isabel Cristina; Luzia, Melissa de Freitas

    2010-12-01

    This study aims to analyze the scientific production about patients with gastric cancer submitted to gastrectomy and describe important aspects of nursing guidelines for these patients. An integrative review was carried out using Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and Medical Literature Analysis and Retrieval System Online (MEDLINE) databases; twenty two articles were analyzed. Retrospective cross-sectional studies were the most frequent. The scientific production of nursing is numerically small in relation to the medical area. The results show that approaches related to pre and post-operative in gastrectomy for gastric cancer resection subsidize the knowledge of issues essential for nurses to promote efficient intervention for the recovery of such patients. There is still the need for further research on the practice of nursing in the guidelines of this kind of surgery.

  8. Caring for critically ill oldest old patients: a clinical review.

    PubMed

    Vargas, Nicola; Tibullo, Loredana; Landi, Emanuela; Carifi, Giovanni; Pirone, Alfonso; Pippo, Antonio; Alviggi, Immacolata; Tizzano, Renato; Salsano, Elisa; Di Grezia, Francesco; Vargas, Maria

    2016-10-19

    Despite technological advances, the mortality rate for critically ill oldest old patients remains high. The intensive caring should be able to combine technology and a deep humanity considering that the patients are living the last part of their lives. In addition to the traditional goals of ICU of reducing morbidity and mortality, of maintaining organ functions and restoring health, caring for seriously oldest old patients should take into account their end-of-life preferences, the advance or proxy directives if available, the prognosis, the communication, their life expectancy and the impact of multimorbidity. The aim of this review was to focus on all these aspects with an emphasis on some intensive procedures such as mechanical ventilation, noninvasive mechanical ventilation, cardiopulmonary resuscitation, renal replacement therapy, hemodynamic support, evaluation of delirium and malnutrition in this heterogeneous frail ICU population.

  9. Efficacy of Memantine in Schizophrenic Patients: A Systematic Review

    PubMed Central

    Baroni, Gaia; Lorusso, Marco; Montemitro, Chiara; di Giannantonio, Massimo

    2017-01-01

    Several evidences support the hypothesis that glutamatergic dysfunction may be implicated in the pathogenesis of schizophrenia and in the last few years great interest has been focused on the role of the N-methyl-D-aspartate receptor (NMDAR). Glutamate is the main excitatory neurotransmitter in human CNS and it plays a prominent role in synaptic plasticity, learning, and memory and other cognitive functions. Increasing interest in memantine add-on therapy in schizophrenic patients with negative and cognitive symptoms may suggest that memantine could be a new promising treatment in schizophrenia. The aim of this update was to evaluate clinical data about the memantine effectiveness in schizophrenic patients. Our systematic review of the literature highlights that memantine therapy in schizophrenic patients seems to improve mainly negative symptoms while positive symptoms and cognitive symptoms did not improve significantly. PMID:28243470

  10. IV access in bleeding trauma patients: a performance review.

    PubMed

    Engels, Paul T; Passos, Edward; Beckett, Andrew N; Doyle, Jeffrey D; Tien, Homer C

    2014-01-01

    Exsanguinating haemorrhage is a leading cause of death in severely injured trauma patients. Management includes achieving haemostasis, replacing lost intravascular volume with fluids and blood, and treating coagulopathy. The provision of fluids and blood products is contingent on obtaining adequate vascular access to the patient's venous system. We sought to examine the nature and timing of achieving adequate intravenous (IV) access in trauma patients requiring uncrossmatched blood in the trauma bay. We performed a retrospective chart review of all patients admitted to our trauma centre from 2005 to 2009 who were transfused uncrossmatched blood in the trauma bay. We examined the impact of IV access on prehospital times and time to first PRBC transfusion. Of 208 study patients, 168 (81%) received prehospital IV access, and the on-scene time for these patients was 5 min longer (16.1 vs 11.4, p<0.01). Time to achieving adequate IV access in those without any prehospital IVs occurred on average 21 min (6.6-30.5) after arrival to the trauma bay. A central venous catheter was placed in 92 (44%) of patients. Time to first blood transfusion correlated most strongly with time to achieving central venous access (Pearson correlation coefficient 0.94, p<0.001) as opposed to time to achieving adequate peripheral IV access (Pearson correlation coefficient 0.19, p=0.12). We found that most bleeding patients received a prehospital IV; however, we also found that obtaining prehospital IVs was associated with longer EMS on-scene times and longer prehospital times. Interestingly, we found that obtaining a prehospital IV was not associated with more rapid initiation of blood product transfusion. Obtaining optimal IV access and subsequent blood transfusion in severely injured patients continues to present a challenge. Copyright © 2013 Elsevier Ltd. All rights reserved.

  11. Measurement of physician-patient communication--a systematic review.

    PubMed

    Zill, Jördis M; Christalle, Eva; Müller, Evamaria; Härter, Martin; Dirmaier, Jörg; Scholl, Isabelle

    2014-01-01

    Effective communication with health care providers has been found as relevant for physical and psychological health outcomes as well as the patients' adherence. However, the validity of the findings depends on the quality of the applied measures. This study aimed to provide an overview of measures of physician-patient communication and to evaluate the methodological quality of psychometric studies and the quality of psychometric properties of the identified measures. A systematic review was performed to identify psychometrically tested instruments which measure physician-patient communication. The search strategy included three databases (EMBASE, PsycINFO, PubMed), reference and citation tracking and personal knowledge. Studies that report the psychometric properties of physician-patient communication measures were included. Two independent raters assessed the methodological quality of the selected studies with the COSMIN (COnsensus based Standards for the selection of health status Measurement INtruments) checklist. The quality of psychometric properties was evaluated with the quality criteria of Terwee and colleagues. Data of 25 studies on 20 measures of physician-patient communication were extracted, mainly from primary care samples in Europe and the USA. Included studies reported a median of 3 out of the nine COSMIN criteria. Scores for internal consistency and content validity were mainly fair or poor. Reliability and structural validity were rated mainly of fair quality. Hypothesis testing scored mostly poor. The quality of psychometric properties of measures evaluated with Terwee et al.'s criteria was rated mainly intermediate or positive. This systematic review identified a number of measures of physician-patient communication. However, further psychometric evaluation of the measures is strongly recommended. The application of quality criteria like the COSMIN checklist could improve the methodological quality of psychometric property studies as well as the

  12. Measurement of Physician-Patient Communication—A Systematic Review

    PubMed Central

    Zill, Jördis M.; Christalle, Eva; Müller, Evamaria; Härter, Martin; Dirmaier, Jörg; Scholl, Isabelle

    2014-01-01

    Background Effective communication with health care providers has been found as relevant for physical and psychological health outcomes as well as the patients' adherence. However, the validity of the findings depends on the quality of the applied measures. This study aimed to provide an overview of measures of physician-patient communication and to evaluate the methodological quality of psychometric studies and the quality of psychometric properties of the identified measures. Methods A systematic review was performed to identify psychometrically tested instruments which measure physician-patient communication. The search strategy included three databases (EMBASE, PsycINFO, PubMed), reference and citation tracking and personal knowledge. Studies that report the psychometric properties of physician-patient communication measures were included. Two independent raters assessed the methodological quality of the selected studies with the COSMIN (COnsensus based Standards for the selection of health status Measurement INtruments) checklist. The quality of psychometric properties was evaluated with the quality criteria of Terwee and colleagues. Results Data of 25 studies on 20 measures of physician-patient communication were extracted, mainly from primary care samples in Europe and the USA. Included studies reported a median of 3 out of the nine COSMIN criteria. Scores for internal consistency and content validity were mainly fair or poor. Reliability and structural validity were rated mainly of fair quality. Hypothesis testing scored mostly poor. The quality of psychometric properties of measures evaluated with Terwee et al.'s criteria was rated mainly intermediate or positive. Discussion This systematic review identified a number of measures of physician-patient communication. However, further psychometric evaluation of the measures is strongly recommended. The application of quality criteria like the COSMIN checklist could improve the methodological quality of

  13. Determinants of patient loyalty to healthcare providers: An integrative review.

    PubMed

    Zhou, Wei-Jiao; Wan, Qiao-Qin; Liu, Cong-Ying; Feng, Xiao-Lin; Shang, Shao-Mei

    2017-08-01

    Patient loyalty is key to business success for healthcare providers and also for patient health outcomes. This study aims to identify determinants influencing patient loyalty to healthcare providers and propose an integrative conceptual model of the influencing factors. PubMed, CINAHL, OVID, ProQuest and Elsevier Science Direct databases were searched. Publications about determinants of patient loyalty to health providers were screened, and 13 articles were included. Date of publication, location of the research, sample details, objectives and findings/conclusions were extracted for 13 articles. Thirteen studies explored eight determinants: satisfaction, quality, value, hospital brand image, trust, commitment, organizational citizenship behavior and customer complaints. The integrated conceptual model comprising all the determinants demonstrated the significant positive direct impact of quality on satisfaction and value, satisfaction on trust and commitment, trust on commitment and loyalty, and brand image on quality and loyalty. This review identifies and models the determinants of patient loyalty to healthcare providers. Further studies are needed to explore the influence of trust, commitment, and switching barriers on patient loyalty.

  14. Retrospective review of 99 patients with secondary alveolar cleft repair.

    PubMed

    Miller, Lisa L; Kauffmann, Daniel; St John, Dane; Wang, Deli; Grant, John H; Waite, Peter D

    2010-06-01

    The purpose of the present review was to evaluate the protocol and technique used in a large population of patients with cleft lip and palate when secondary grafting is performed during the early mixed dentition stage, as determined by eruption of the central incisor. In the United States, most investigators have recommended alveolar grafting at the 9- to 11-year age range or before eruption of the permanent canines. An institutional review board-approved chart review of 99 patients undergoing alveolar cleft bone grafting during a 7-year period at a single institution was performed. Data were collected regarding demographics, operative time, length of hospitalization, follow-up time, complications, and additional procedures performed. The cases were divided by patient age into 2 groups: group 1, aged 6 to 8 years (n = 61); and group 2, aged 9 years and older (n = 38). Statistical analysis was performed for various comparisons in the study. The average operative time for groups 1 and 2 was 86 and 103 minutes, respectively. The complication rate, length of stay, and follow-up time between the 2 groups was not statistically significant at the P = .05 significance level. We recommend earlier bone grafting at or before the eruption of the central incisor, rather than delaying until the cuspid tooth root is 25% formed. We believe this will provide better bone support for the dentition, a decreased burden of treatment for the patient, and improved quality of life. Performing the procedure at this time can lead to decreased operative times, with comparable postoperative outcomes. Published by Elsevier Inc.

  15. 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.

  16. 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.

  17. 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.

  18. Helicobacter pylori gastritis in HIV-infected patients: a review.

    PubMed

    Nevin, Daniel T; Morgan, Christopher J; Graham, David Y; Genta, Robert M

    2014-10-01

    The risk factors for acquiring Helicobacter pylori and Human Immunodeficiency Virus (HIV) infections are different: H. pylori is transmitted by gastro- or fecal-oral routes and is associated with low socioeconomic conditions, while HIV is transmitted through sexual intercourse, infected body fluids, and transplacentally. If the host responses to these infections were independent, the prevalence of H. pylori should be similar in HIV-infected and non-infected patients. Yet, several studies have detected a lower prevalence of H. pylori in patients with HIV infection, whereas other studies found either no differences or greater rates of H. pylori infection in HIV-positive subjects. To review studies that addressed the issue of these two simultaneous infections and attempt to determine whether reliable conclusions can be drawn from this corpus of often contrasting evidence. Electronic literature search for relevant publications, followed by manual search of additional citations from extracted articles. The initial search yielded 44 publications; after excluding case reports, reviews, narrowly focused articles, and duplicate reports, there remained 29 articles, which are the corpus of this review. With one exception, all studies reported higher rates of H. pylori infection in HIV-negative subjects. Five studies also examined the CD4 lymphocyte counts and found an inverse correlation between the degree of immunosuppression and the prevalence of active H. pylori infection. Current evidence suggests that it is likely that H. pylori needs a functional immune system to successfully and persistently colonize the human gastric mucosa. © 2014 John Wiley & Sons Ltd.

  19. Systematic reviews of therapeutic interventions frequently consider patient-important outcomes.

    PubMed

    Ameur, Hayet; Ravaud, Philippe; Fayard, Florence; Riveros, Carolina; Dechartres, Agnes

    2017-04-01

    To determine whether recently published and ongoing systematic reviews of therapeutic interventions assess patient-important outcomes. For this methodological review, we searched MEDLINE via PubMed for recently published systematic reviews and online registry of systematic reviews (PROSPERO) for ongoing systematic reviews. We selected systematic reviews with meta-analyses of randomized controlled trials. We extracted all outcomes defined in the methods section and categorized them. Mortality, other clinical events, pain, quality of life, function, and therapeutic decisions were considered patient-important outcomes. We included 420 systematic reviews: 90 Cochrane reviews, 200 other published reviews, and 130 registered ongoing reviews. Primary outcomes were defined in 85 Cochrane reviews (95%), 98 (49%) other published reviews and all ongoing reviews. At least one patient-important outcome was defined as a primary outcome in 81/85 Cochrane reviews (95%), 78/98 other published reviews (80%), and 117/130 ongoing reviews (90%). Considering all outcomes assessed, at least one patient-important outcome was evaluated in 90/90 Cochrane reviews (100%), 189/200 other published reviews (95%), and 121/130 ongoing reviews (93%). Most recent systematic reviews aim to assess patient-important outcomes, which contrasts with RCTs. These results suggest some important gaps between primary and secondary research. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Patient Safety Learning Systems: A Systematic Review and Qualitative Synthesis

    PubMed Central

    Lambrinos, Anna; Holubowich, Corinne

    2017-01-01

    Background A patient safety learning system (sometimes called a critical incident reporting system) refers to structured reporting, collation, and analysis of critical incidents. To inform a provincial working group's recommendations for an Ontario Patient Safety Event Learning System, a systematic review was undertaken to determine design features that would optimize its adoption into the health care system and would inform implementation strategies. Methods The objective of this review was to address two research questions: (a) what are the barriers to and facilitators of successful adoption of a patient safety learning system reported by health professionals and (b) what design components maximize successful adoption and implementation? To answer the first question, we used a published systematic review. To answer the second question, we used scoping study methodology. Results Common barriers reported in the literature by health care professionals included fear of blame, legal penalties, the perception that incident reporting does not improve patient safety, lack of organizational support, inadequate feedback, lack of knowledge about incident reporting systems, and lack of understanding about what constitutes an error. Common facilitators included a non-accusatory environment, the perception that incident reporting improves safety, clarification of the route of reporting and of how the system uses reports, enhanced feedback, role models (such as managers) using and promoting reporting, legislated protection of those who report, ability to report anonymously, education and training opportunities, and clear guidelines on what to report. Components of a patient safety learning system that increased successful adoption and implementation were emphasis on a blame-free culture that encourages reporting and learning, clear guidelines on how and what to report, making sure the system is user-friendly, organizational development support for data analysis to generate

  1. 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.

  2. The Use of Life Review to Enhance Spiritual Wellbeing in Patients with Terminal Illnesses: An Integrative Review.

    PubMed

    Kwan, Cecilia W M; Ng, Marques S N; Chan, Carmen W H

    2017-07-26

    An integrative review of the current literature on using life review as an intervention to address the spiritual need of patients with terminal illnesses. Palliative care highlights the holistic approach of care including the spiritual aspect. Life review has been used in palliative nursing intending to enhance patients' emotional and spiritual wellbeing, and quality of life. However, there is a lack of publications that provide a structured overview on life review programs and their effectiveness. Integrative review. The Whittmore and Knafl integrative review method was used. Five major online databases were included in our literature search. The keywords used were 'life review' and 'palliative care, terminal care, terminally ill, death & dying, hospice, spiritual wellbeing, spirituality'. Seven primary papers were identified, critically appraised and synthesized in the final review. There are limited clinical studies on life review programs for patients with terminal illness. The research design of these studies is too widely varied for meta-analysis. Here, we identified two major programs of life review as an intervention to address the spiritual wellbeing of patients with terminal illness. However, repeated studies on the effectiveness of these two programs are lacking. The shorter program of life review is more likely to be applicable and effective for terminal patients. Further research in this area is required to provide strong evidence on the effectiveness and applicability of life review in patients receiving palliative care. This review adds weight to the need of a better understanding on the use of life review in addressing the spiritual needs of patients with terminal illness. Such understanding would provide evidence for the use of life review as an alternative approach in palliative care delivery. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  3. 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

  4. 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.

  5. 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

  6. 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.

  7. Standardizing the initial resuscitation of the trauma patient with the Primary Assessment Completion Tool using video review.

    PubMed

    Wurster, Lee Ann; Thakkar, Rajan K; Haley, Kathy J; Wheeler, Krista K; Larson, Jeremy; Stoner, Michael; Gewirtz, Yaffa; Holman, Todd; Buckingham, Don; Groner, Jonathan I

    2017-06-01

    Major trauma resuscitations at pediatric trauma centers have an elevated risk for error because of their high acuity and relatively low frequency. The Advanced Trauma Life Support (ATLS) treatment paradigm was established to improve the management of trauma patients during the initial resuscitation phase and has been shown to improve outcomes through a standardized approach. The goal of this quality improvement project was to decrease assessment physician variability and improve the compliance with the ATLS primary assessment for major resuscitations. A video review tool was developed to score the assessment physician on completion of the primary survey components using ATLS format. Interrater reliability and content validity were established for the tool. Data were collected through video review of the trauma response team in the emergency department for all Level 1 trauma alert activations with general consent. Chi-square and regression analyses were used to evaluate the data at 30 days, 6 months, and 1 year from the baseline period. A total of 142 patient videos were scored between July 28, 2015, and August 1, 2016. Eleven patients were reviewed during the baseline period, and only 9.1% of the total scores were ≥85. Thirty days following project implementation, 37.5% were ≥ 85. Six months following project implementation, 64.4% scored ≥85. One year following project implementation, 91.5% scored ≥85. These were statistically significant changes (p < .0001) with less variability over time. Effective leadership using a standardized approach during the trauma resuscitation has been found to have a positive effect on task completion and the overall functioning of the trauma team. This focused quality improvement project improved compliance with ATLS format and decreased variability by the assessment physician, potentially improving patient safety and outcomes. Therapeutic/care management study, level IV.

  8. 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 to...

  9. 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…

  10. 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

  11. Dyspnea in lung cancer patients: a systematic review

    PubMed Central

    Kathiresan, Ganesan; Clement, Reynold F; Sankaranarayanan, Meera T

    2010-01-01

    Dyspnea is a common and distressing symptom experienced by 19%–51% of patients with advanced cancer. Higher incidences are reported in patients approaching end of life. While the prevalence of dyspnea has been reported to be as frequent as pain in people with lung cancer, less attention has been paid to the distress associated with dyspnea. This review of the literature was undertaken to investigate how dyspnea has been assessed and whether breathlessness in people with lung cancer is distressing. Using a predetermined search strategy and inclusion criteria, 31 primary studies were identified and included in this review. Different outcome measures were used to assess the experience of dyspnea, with domains including intensity, distress, quality of life, qualitative sensation, and prevalence. Overall, the studies report a high prevalence of dyspnea in lung cancer patients, with subjects experiencing a moderate level of dyspnea intensity and interference with activities of daily living. Distress associated with breathing appears to be variable, with some studies reporting dyspnea to be the most distressing sensation, and others reporting lower levels of distress. However, taking into account the prevalence, intensity, and distress of dyspnea, the general consensus appears to be that the experience of dyspnea in people with lung cancer is common, with varying degrees of intensity, but involves considerable unpleasantness. Thus, if dyspnea and pain are both distressing sensations for people with lung cancer, this has potential implications for both clinical and academic areas with regards to both management strategies and further research. PMID:28210113

  12. 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

  13. Review of information technology for surgical patient care.

    PubMed

    Robinson, Jamie R; Huth, Hannah; Jackson, Gretchen P

    2016-06-01

    Electronic health records (EHRs), computerized provider order entry (CPOE), and patient portals have experienced increased adoption by health care systems. The objective of this study was to review evidence regarding the impact of such health information technologies (HIT) on surgical practice. A search of Medline, EMBASE, CINAHL, and the Cochrane Library was performed to identify data-driven, nonsurvey studies about the effects of HIT on surgical care. Domain experts were queried for relevant articles. Two authors independently reviewed abstracts for inclusion criteria and analyzed full text of eligible articles. A total of 2890 citations were identified. Of them, 32 observational studies and two randomized controlled trials met eligibility criteria. EHR or CPOE improved appropriate antibiotic administration for surgical procedures in 13 comparative observational studies. Five comparative observational studies indicated that electronically generated operative notes had increased accuracy, completeness, and availability in the medical record. The Internet as an information resource about surgical procedures was generally inadequate. Surgical patients and providers demonstrated rapid adoption of patient portals, with increasing proportions of online versus inperson outpatient surgical encounters. The overall quality of evidence about the effects of HIT in surgical practice was low. Current data suggest an improvement in appropriate perioperative antibiotic administration and accuracy of operative reports from CPOE and EHR applications. Online consumer health educational resources and patient portals are popular among patients and families, but their impact has not been studied well in surgical populations. With increasing adoption of HIT, further research is needed to optimize the efficacy of such tools in surgical care. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. 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

  15. A Review of metabolic staging in severely injured patients

    PubMed Central

    2010-01-01

    An interpretation of the metabolic response to injury in patients with severe accidental or surgical trauma is made. In the last century, various authors attributed a meaning to the post-traumatic inflammatory response by using teleological arguments. Their interpretations of this response, not only facilitates integrating the knowledge, but also the flow from the bench to the bedside, which is the main objective of modern translational research. The goal of the current review is to correlate the metabolic changes with the three phenotypes -ischemia-reperfusion, leukocytic and angiogenic- that the patients express during the evolution of the systemic inflammatory response. The sequence in the expression of multiple metabolic systems that becomes progressively more elaborate and complex in severe injured patients urges for more detailed knowledge in order to establish the most adequate metabolic support according to the evolutive phase. Thus, clinicians must employ different treatment strategies based on the different metabolic phases when caring for this challenging patient population. Perhaps, the best therapeutic option would be to favor early hypometabolism during the ischemia-reperfusion phase, to boost the antienzymatic metabolism and to reduce hypermetabolism during the leukocytic phase through the early administration of enteral nutrition and the modulation of the acute phase response. Lastly, the early epithelial regeneration of the injured organs and tissues by means of an oxidative metabolism would reduce the fibrotic sequelae in these severely injured patients. PMID:20478066

  16. 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

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

    PubMed

    van der Jagt, Mathieu

    2016-05-31

    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.

  18. Review of Management Options for Patients With Atypical Peyronie's Disease.

    PubMed

    Yafi, Faysal A; Hatzichristodoulou, Georgios; DeLay, Kenneth J; Hellstrom, Wayne J G

    2017-04-01

    Peyronie's disease (PD) is a wound-healing disorder of the tunica albuginea often associated with penile deformity. Less commonly, patients with PD might display atypical presentations such as ventral curvature, hourglass deformity, significantly shortened penis, and/or multiplanar curvature. To review the available literature on the prevalence of and management options for atypical PD. A literature review was performed through PubMed from 1982 through 2016 regarding atypical PD. Keywords used for the search were Peyronie's disease, atypical Peyronie's disease, ventral Peyronie's disease, ventral plaque, hourglass deformity, penile indentation, penile notching, short penis, shortened penis, shrunken penis, biplanar curvature, and multiplanar curvature. To assess the various surgical and non-surgical techniques used for the management of atypical PD. Collagenase Clostridium histolyticum is contraindicated for patients with ventral plaques and/or hourglass deformities. Patients with maintained erectile function and ventral PD plaques are best treated with intralesional injections of interferon alpha-2b or tunica plication. Patients with maintained erectile function with PD associated with hourglass deformity and/or multiplanar curvature are best treated with plaque incision or partial excision and grafting. Patients with a shortened penis could attempt conservative measures such as penile traction therapy and medical management. When erectile function is compromised, insertion of an inflatable penile prosthesis with or without ancillary straightening procedures should be recommended. Lengthening procedures can be attempted in very special circumstances by expert surgeons. There is a paucity of data regarding atypical PD. Ventral plaques can be treated with intralesional injections or surgery, hourglass deformity and multiplanar curvatures are best managed surgically, and a shortened penis should be treated with non-invasive approaches. When concomitant erectile

  19. Patient Portals and Patient Engagement: A State of the Science Review

    PubMed Central

    DeVito Dabbs, Annette; Curran, Christine R

    2015-01-01

    Background Patient portals (ie, electronic personal health records tethered to institutional electronic health records) are recognized as a promising mechanism to support greater patient engagement, yet questions remain about how health care leaders, policy makers, and designers can encourage adoption of patient portals and what factors might contribute to sustained utilization. Objective The purposes of this state of the science review are to (1) present the definition, background, and how current literature addresses the encouragement and support of patient engagement through the patient portal, and (2) provide a summary of future directions for patient portal research and development to meaningfully impact patient engagement. Methods We reviewed literature from 2006 through 2014 in PubMed, Ovid Medline, and PsycInfo using the search terms “patient portal” OR “personal health record” OR “electronic personal health record”. Final inclusion criterion dictated that studies report on the patient experience and/or ways that patients may be supported to make competent health care decisions and act on those decisions using patient portal functionality. Results We found 120 studies that met the inclusion criteria. Based on the research questions, explicit and implicit aims of the studies, and related measures addressed, the studies were grouped into five major topics (patient adoption, provider endorsement, health literacy, usability, and utility). We discuss the findings and conclusions of studies that address the five topical areas. Conclusions Current research has demonstrated that patients’ interest and ability to use patient portals is strongly influenced by personal factors such age, ethnicity, education level, health literacy, health status, and role as a caregiver. Health care delivery factors, mainly provider endorsement and patient portal usability also contribute to patient’s ability to engage through and with the patient portal. Future

  20. Challenges in achieving patient participation: A review of how patient participation is addressed in empirical studies.

    PubMed

    Angel, Sanne; Frederiksen, Kirsten Norup

    2015-09-01

    For decades, it has been an ideal in western countries that individuals should participate in society as self-governing and autonomous subjects; however, this ideal does not always correspond to the actual experiences of individuals in their encounters with health professionals. This review identifies how empirical studies address challenges in achieving patient participation in clinical nursing. We conducted a literature search for studies of patient participation in PubMed, Cinahl, PsychInfo and Scopus. In a systematic review using Garrard's matrix method, we selected empirical studies that focused on patients' participation in health services. The empirical studies we investigated addressed the relationship between patient and nurse, knowledge, contact time with the patient, severity of illness and the effect of age on the degree of patient involvement. Every study thus investigated assessed patient participation as being achievable. None of the studies questioned the foundation for patient participation, which has been described in theoretical articles. The main explanation for difficulties in achieving patient participation was that expectations concerning the extent and quality of participation could be unrealistic and lead to dissatisfaction. Studies on patient participation identify challenges due to the nature of the relationship between laypersons and professionals, and the embedded difference in situation and knowledge. This difference may be reduced by time and a mutually positive attitude. But participation in its ideal form cannot be achieved because of this fundamental difference. Therefore, the optimal level of patient participation can only be achieved within a framework which provides both patients and health professionals with adequate time to build relationships and shared knowledge. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Should we involve terminally ill patients in teaching medical students? A systematic review of patient's views.

    PubMed

    Harris, Dylan Gareth; Coles, Bernadette; Willoughby, Hannah May

    2015-12-01

    To review available published research that has explored how terminally ill patients feel about being involved in undergraduate medical teaching. A systematic review using narrative synthesis. Qualitative or quantitative publications were included if they directly explored the views of adult patients, with a terminal diagnosis, about their involvement in undergraduate clinical teaching. Seven publications met the inclusion criteria: one case report, one qualitative study and five questionnaire-based studies. A total of 269 patients were included across all studies. Patients were predominantly studied in a hospice or hospice day care setting. Both patients who had, and who had not, previously been involved in student teaching were captured by the included publications. In general, the views of patients were highly positive: overall 85%-100% were in favour of involvement in teaching. There were also some negative aspects, such as: concerns about being physically examined by a student; finding involvement in teaching tiring; feeling unable to decline consent to participate. An assumption that clinical undergraduate medical teaching involving terminally ill patients may be too burdensome is not reflected overall in studies that have sought the views of the patients themselves. Understanding the patient's perspective provides a number of practical points in relation to how clinical teaching should be adapted in this patient group; for example, using smaller student group sizes; direct supervision if physical examination performed; short encounters with multiple patients rather than a longer encounter with one patient; adequate informed consent beforehand and without the students automatically being present. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  2. Review of Postoperative Delirium in Geriatric Patients Undergoing Hip Surgery.

    PubMed

    Rizk, Paul; Morris, William; Oladeji, Philip; Huo, Michael

    2016-06-01

    Postoperative delirium is a serious complication following hip surgery in elderly patients that can adversely affect outcomes in both hip fracture and arthroplasty surgery. Recently, the incidence of hip fracture in the Medicare population was estimated at approximately 500 000 patients per year, with the majority treated surgically. The annual volume of total hip arthroplasty is nearly 450 000 patients and is projected to increase over the next 15 to 20 years. Subsequently, the incidence of postoperative delirium will rise. The incidence of postoperative delirium after hip surgery in the elderly patients ranges between 4% and 53%, and it is identified as the most common surgical complication of older patients. The most common risk factors include advanced age, hip fracture surgery (vs elective hip surgery), and preoperative delirium/cognitive impairment. Exact pathophysiology has not been fully defined. It is hypothesized that imbalances in cortical neurotransmitters or inflammatory cytokine pathway mechanisms contribute to delirium. Development of postoperative delirium is associated with longer hospital stay, increased medical complications, and poorer short-term functional outcome. Patients who develop postoperative delirium are also at increased risk for cognitive decline beyond the acute phase. Following acute care, postoperative delirium is associated with the need for a higher level of care, an additional cost. Management of postoperative delirium centers on prevention and early recognition. Medical prophylaxis has been demonstrated to have limited utility. Utilization of delirium detection methods contributed to early recognition. The most effective means of prevention involved a multidisciplinary team focused on adequate hydration, optimization of analgesia, reduction in polypharmacy, aggressive physiotherapy, and early recognition of the delirium symptoms.

  3. Review of Postoperative Delirium in Geriatric Patients Undergoing Hip Surgery

    PubMed Central

    Morris, William; Oladeji, Philip; Huo, Michael

    2016-01-01

    Postoperative delirium is a serious complication following hip surgery in elderly patients that can adversely affect outcomes in both hip fracture and arthroplasty surgery. Recently, the incidence of hip fracture in the Medicare population was estimated at approximately 500 000 patients per year, with the majority treated surgically. The annual volume of total hip arthroplasty is nearly 450 000 patients and is projected to increase over the next 15 to 20 years. Subsequently, the incidence of postoperative delirium will rise. The incidence of postoperative delirium after hip surgery in the elderly patients ranges between 4% and 53%, and it is identified as the most common surgical complication of older patients. The most common risk factors include advanced age, hip fracture surgery (vs elective hip surgery), and preoperative delirium/cognitive impairment. Exact pathophysiology has not been fully defined. It is hypothesized that imbalances in cortical neurotransmitters or inflammatory cytokine pathway mechanisms contribute to delirium. Development of postoperative delirium is associated with longer hospital stay, increased medical complications, and poorer short-term functional outcome. Patients who develop postoperative delirium are also at increased risk for cognitive decline beyond the acute phase. Following acute care, postoperative delirium is associated with the need for a higher level of care, an additional cost. Management of postoperative delirium centers on prevention and early recognition. Medical prophylaxis has been demonstrated to have limited utility. Utilization of delirium detection methods contributed to early recognition. The most effective means of prevention involved a multidisciplinary team focused on adequate hydration, optimization of analgesia, reduction in polypharmacy, aggressive physiotherapy, and early recognition of the delirium symptoms. PMID:27239384

  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. Improving patient participation in a challenging context: a 2-year evaluation study of an implementation project.

    PubMed

    Jangland, Eva; Gunningberg, Lena

    2017-05-01

    To evaluate an implementation project on patient participation. Patient participation is one of the cornerstones of person-centred care. A previous intervention study resulted in improved patient participation in a surgical department in a large university hospital in Sweden. A subsequent implementation project was guided by the PARiSH framework and included several strategies over 2 years. Patients (n = 198) in five units completed a questionnaire and nurse managers (n = 5) were interviewed. Although the long-term implementation project did not improve patient participation in the units, the nurse managers described a changing culture in which staff grew to accept patients' involvement in their own care. Several barriers to change and sustainability were acknowledged. Improving patient participation in a busy environment is challenging. The framework was useful in the different steps of the project. In the future, the interrelationship of the core elements needs to be analysed in an ongoing and deeper way to allow both prediction and prevention of barriers to improvement. A dedicated leadership together with skilled facilitators should encourage and support staff to reflect on their attitudes and ways of working to increase person-centred care. © 2017 John Wiley & Sons Ltd.

  6. 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.

  7. Patient empowerment: a systematic review of questionnaires measuring empowerment in cancer patients.

    PubMed

    Eskildsen, Nanna Bjerg; Joergensen, Clara Ruebner; Thomsen, Thora Grothe; Ross, Lone; Dietz, Susanne Malchau; Groenvold, Mogens; Johnsen, Anna Thit

    2017-02-01

    There is an increased attention to and demand for patient empowerment in cancer treatment and follow-up programs. Patient empowerment has been defined as feeling in control of or having mastery in relation to cancer and cancer care. This calls for properly developed questionnaires assessing empowerment from the user perspective. The aim of this review was to identify questionnaires and subscales measuring empowerment and manifestations of empowerment among cancer patients. We conducted a systematic search of the PubMed, PsycINFO and CINAHL databases. Empowerment and multiple search terms associated with empowerment were included. We included peer-reviewed articles published in English, which described questionnaires measuring empowerment or manifestations of empowerment in a cancer setting. In addition, the questionnaire had to be a patient-reported outcome measure for adult cancer patients. Database searches identified 831 records. Title and abstract screening resulted in 482 records being excluded. The remaining 349 full text articles were retrieved and assessed for eligibility. This led to the inclusion of 33 individual instruments measuring empowerment and manifestations of empowerment. Of these, only four were specifically developed to measure empowerment, and two were originally developed for the cancer setting, whereas the remaining two were developed elsewhere, but adapted to the cancer setting. The other 29 questionnaires were not intended to measure the concept of empowerment, but focused on patient-centered care, patient competence, self-efficacy, etc. However, they were included because part of the instrument (at least five items) was considered to measure empowerment or manifestations of empowerment. Our study provides an overview of the available questionnaires, which can be used by researchers and practitioners who wish to measure the concept of empowerment among cancer patients. Very few questionnaires were explicitly developed to explore

  8. 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.

  9. Is Project Towards No Drug Abuse (Project TND) an evidence-based drug and violence prevention program? A review and reappraisal of the evaluation studies.

    PubMed

    Gorman, Dennis M

    2014-08-01

    This paper critically reviews the published evidence pertaining to Project Towards No Drug Abuse (Project TND). Publications from seven evaluation studies of Project TND are reviewed, and the results from these are discussed as related to the following outcomes: main effects on the use of cigarettes, alcohol and marijuana; main effects on the use of "hard drugs," defined in the evaluations as cocaine, hallucinogens, stimulants, inhalants, ecstasy and other drugs (e.g., depressants, PCP, steroids and heroin); subgroup and interaction analyses of drug use; and violence-related behaviors. Very few main effects have been found for cigarette, alcohol and marijuana use in the Project TND evaluations. While studies do report main effects for hard drug use, these findings are subject to numerous threats to validity and may be attributable to the data analyses employed. Similarly, while isolated subgroup and interaction effects were found for alcohol use among baseline nonusers and some violence-related behaviors in the early Project TND evaluations, these findings have not been replicated in more recent studies and may result from multiple comparisons between study conditions. In conclusion, there is little evidence to support the assertion that Project TND is an effective drug or violence prevention program. The broader implications of these findings for prevention science are discussed and suggestions are made as to how the quality of research in the field might be improved.

  10. Systematic Review of Psychosocial Outcomes for Patients with Advanced Melanoma.

    PubMed

    Dunn, Jeff; Watson, Maggie; Aitken, Joanne F; Hyde, Melissa K

    2016-10-03

    New advanced melanoma therapies are associated with improved survival however quality of survivorship, particularly psychosocial outcomes, for patients overall and those treated with newer therapies is unclear. Synthesise qualitative and quantitative evidence about psychosocial outcomes for advanced (stage III/IV) melanoma patients. Five databases were searched (01/01/1980 to 31/01/2016). advanced melanoma patients or sub-group analysis; assessed psychosocial outcomes; English language. 52 studies met review criteria (4 qualitative, 48 quantitative). Trials comprise mostly medical not psychosocial interventions, with psychosocial outcomes assessed within broader quality of life measures. Patients receiving chemotherapy or IFN-alpha showed decreased emotional and social function and increased distress. Five trials of newer therapies appeared to show improvements in emotional and social function. Descriptive studies suggest that patients with advanced, versus localised disease, had decreased emotional and social function and increased distress. Contributors to distress were largely unexplored and no clear framework described coping/adjustment trajectories. Patients with advanced versus localised disease had more supportive care needs, particularly amount, quality, and timing of melanoma-related information, communication with and emotional support from clinicians. Limitations included: lack of theoretical underpinnings guiding study design; inconsistent measurement approaches; small sample sizes; non-representative sampling; and cross-sectional design. Quality trial evidence is needed to clarify the impact of treatment innovations for advanced melanoma on patients' psychosocial wellbeing. Survivorship research and subsequent translation of that knowledge into programs and services currently lags behind gains in the medical treatment of advanced melanoma, a troubling circumstance that requires immediate and focussed attention. This article is protected by copyright

  11. A psychological study of spinal cord injured patients involved in the Madras Paraplegia Project.

    PubMed

    Somasundaram, O; Balakrishnan, S; Ravindran, O S; Shanmugasundaram, T K

    1992-11-01

    The psychological features of spinal cord injured (SCI) patients involved in the Madras Paraplegia Project are described. Three hundred and twenty-eight patients were studied. Based on personality tests, 11% were extroverts, 14% were introverts and 76% were neither extroverts nor introverts. Twenty-four percent of the subjects were neurotic, 11% had a depressive illness, and 26% had pathological anxiety. The study has highlighted the psychological status of SCI patients, and the usefulness of a psychiatric team in the multidisciplinary care of such patients. This is probably the first large psychological study of SCI patients from a developing country.

  12. Basic Neuroangiography: Review of Technique and Perioperative Patient Care

    PubMed Central

    Ahn, Sun Ho; Prince, Ethan A.; Dubel, Gregory J.

    2013-01-01

    Neuroangiography (NA) is an important part of diagnosis and treatment of patients with neurological disease. Although NA may be performed for diagnostic purposes, in many instances NA is performed with the intent to treat. Indications for NA range from extracranial diseases (vertebrobasilar insufficiency from subclavian steal, extracranial carotid stenosis, cavernous-carotid fistula, neck trauma, epistaxis, tumor invasion of the carotid artery, and tumor embolization) to intracranial diseases (nontraumatic subarachnoid hemorrhage, cerebral aneurysms, cerebral arteriovenous malformations, cerebral vasospasm, acute stroke, tumor embolization, and WADA test). Similar to peripheral angiography, appropriate preprocedural assessment and postprocedural care, along with understanding of anatomy, catheter technique, and disease processes, are vital to successful outcomes. This article will review the basic technique, equipment, and patient management in NA. With appropriate skill and knowledge, interventional radiologists can perform NA with safe and successful results. PMID:24436543

  13. Blood transfusion indications in neurosurgical patients: A systematic review.

    PubMed

    Bagwe, Shefali; Chung, Lawrance K; Lagman, Carlito; Voth, Brittany L; Barnette, Natalie E; Elhajjmoussa, Lekaa; Yang, Isaac

    2017-04-01

    Neurosurgical procedures can be complicated by significant blood losses that have the potential to decrease tissue perfusion to critical brain tissue. Red blood cell transfusion is used in a variety of capacities both inside, and outside, of the operating room to prevent untoward neurologic damage. However, evidence-based guidelines concerning thresholds and indications for transfusion in neurosurgery remain limited. Consequently, transfusion practices in neurosurgical patients are highly variable and based on institutional experiences. Recently, a paradigm shift has occurred in neurocritical intensive care units, whereby restrictive transfusion is increasingly favored over liberal transfusion but the ideal strategy remains in clinical equipoise. The authors of this study perform a systematic review of the literature with the objective of capturing the changing landscape of blood transfusion indications in neurosurgical patients.

  14. 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

  15. Amplifying Each Patient's Voice: A Systematic Review of Multi-criteria Decision Analyses Involving Patients.

    PubMed

    Marsh, Kevin; Caro, J Jaime; Hamed, Alaa; Zaiser, Erica

    2017-04-01

    Qualitative methods tend to be used to incorporate patient preferences into healthcare decision making. However, for patient preferences to be given adequate consideration by decision makers they need to be quantified. Multi-criteria decision analysis (MCDA) is one way to quantify and capture the patient voice. The objective of this review was to report on existing MCDAs involving patients to support the future use of MCDA to capture the patient voice. MEDLINE and EMBASE were searched in June 2014 for English-language papers with no date restriction. The following search terms were used: 'multi-criteria decision*', 'multiple criteria decision*', 'MCDA', 'benefit risk assessment*', 'risk benefit assessment*', 'multicriteri* decision*', 'MCDM', 'multi-criteri* decision*'. Abstracts were included if they reported the application of MCDA to assess healthcare interventions where patients were the source of weights. Abstracts were excluded if they did not apply MCDA, such as discussions of how MCDA could be used; or did not evaluate healthcare interventions, such as MCDAs to assess the level of health need in a locality. Data were extracted on weighting method, variation in patient and expert preferences, and discussion on different weighting techniques. The review identified ten English-language studies that reported an MCDA to assess healthcare interventions and involved patients as a source of weights. These studies reported 12 applications of MCDA. Different methods of preference elicitation were employed: direct weighting in workshops; discrete choice experiment surveys; and the analytical hierarchy process using both workshops and surveys. There was significant heterogeneity in patient responses and differences between patients, who put greater weight on disease characteristics and treatment convenience, and experts, who put more weight on efficacy. The studies highlighted cognitive challenges associated with some weighting methods, though patients' views on their

  16. [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.

  17. Understanding meaning in life interventions in patients with advanced disease: A systematic review and realist synthesis.

    PubMed

    Guerrero-Torrelles, Mariona; Monforte-Royo, Cristina; Rodríguez-Prat, Andrea; Porta-Sales, Josep; Balaguer, Albert

    2017-02-01

    Among patients with advanced disease, meaning in life is thought to enhance well-being, promote coping and improve the tolerance of physical symptoms. It may also act as a buffer against depression and hopelessness. As yet, there has been no synthesis of meaning in life interventions in which contextual factors, procedures and outcomes are described and evaluated. To identify meaning in life interventions implemented in patients with advanced disease and to describe their context, mechanisms and outcomes. Systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and realist synthesis of meaning in life interventions using criteria from the Realist And Meta-narrative Evidence Syntheses: Evolving Standards project. The CINAHL, PsycINFO, PubMed and Web of Science databases were searched. A total of 12 articles were included in the systematic review, corresponding to nine different interventions. Five articles described randomized controlled trials, two were qualitative studies, two were commentaries or reflections, and there was one pre-post evaluation, one exploratory study and one description of a model of care. Analysis of context, mechanisms and outcomes configurations showed that a core component of all the interventions was the interpersonal encounter between patient and therapist, in which sources of meaning were explored and a sense of connectedness was re-established. Meaning in life interventions were associated with clinical benefits on measures of purpose-in-life, quality of life, spiritual well-being, self-efficacy, optimism, distress, hopelessness, anxiety, depression and wish to hasten death. This review provides an explanatory model of the contextual factors and mechanisms that may be involved in promoting meaning in life. These approaches could provide useful tools for relieving existential suffering at the end of life.

  18. Non-Adherence in Patients on Peritoneal Dialysis: A Systematic Review

    PubMed Central

    Griva, Konstadina; Lai, Alden Yuanhong; Lim, Haikel Asyraf; Yu, Zhenli; Foo, Marjorie Wai Yin; Newman, Stanton P.

    2014-01-01

    Background It has been increasingly recognized that non-adherence is an important factor that determines the outcome of peritoneal dialysis (PD) therapy. There is therefore a need to establish the levels of non-adherence to different aspects of the PD regimen (dialysis procedures, medications, and dietary/fluid restrictions). Methods A systematic review of peer-reviewed literature was performed in PubMed, PsycINFO and CINAHL databases using PRISMA guidelines in May 2013. Publications on non-adherence in PD were selected by two reviewers independently according to predefined inclusion and exclusion criteria. Relevant data on patient characteristics, measures, rates and factors associated with non-adherence were extracted. The quality of studies was also evaluated independently by two reviewers according to a revised version of the Effective Public Health Practice Project assessment tool. Results The search retrieved 204 studies, of which a total of 25 studies met inclusion criteria. Reported rates of non-adherence varied across studies: 2.6–53% for dialysis exchanges, 3.9–85% for medication, and 14.4–67% for diet/fluid restrictions. Methodological differences in measurement and definition of non-adherence underlie the observed variation. Factors associated with non-adherence that showed a degree of consistency were mostly socio-demographical, such as age, employment status, ethnicity, sex, and time period on PD treatment. Conclusion Non-adherence to different dimensions of the dialysis regimen appears to be prevalent in PD patients. There is a need for further, high-quality research to explore these factors in more detail, with the aim of informing intervention designs to facilitate adherence in this patient population. PMID:24586478

  19. Development of a core outcome set for medication review in older patients with multimorbidity and polypharmacy: a study protocol

    PubMed Central

    Beuscart, Jean-Baptiste; Dalleur, Olivia; Boland, Benoit; Thevelin, Stefanie; Knol, Wilma; Cullinan, Shane; Schneider, Claudio; O’Mahony, Denis; Rodondi, Nicolas; Spinewine, Anne

    2017-01-01

    Background Medication review has been advocated to address the challenge of polypharmacy in older patients, yet there is no consensus on how best to evaluate its efficacy. Heterogeneity of outcomes reported in clinical trials can hinder the comparison of clinical trial findings in systematic reviews. Moreover, the outcomes that matter most to older patients might be under-reported or disregarded altogether. A core outcome set can address this issue as it defines a minimum set of outcomes that should be reported in all clinical trials in any particular field of research. As part of the European Commission-funded project, called OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly, this paper describes the methods used to develop a core outcome set for clinical trials of medication review in older patients with multimorbidity. Methods/design The study was designed in several steps. First, a systematic review established which outcomes were measured in published and ongoing clinical trials of medication review in older patients. Second, we undertook semistructured interviews with older patients and carers aimed at identifying additional relevant outcomes. Then, a multilanguage European Delphi survey adapted to older patients was designed. The international Delphi survey was conducted with older patients, health care professionals, researchers, and clinical experts in geriatric pharmacotherapy to validate outcomes to be included in the core outcome set. Consensus meetings were conducted to validate the results. Discussion We present the method for developing a core outcome set for medication review in older patients with multimorbidity. This study protocol could be used as a basis to develop core outcome sets in other fields of geriatric research. PMID:28919724

  20. Development of a core outcome set for medication review in older patients with multimorbidity and polypharmacy: a study protocol.

    PubMed

    Beuscart, Jean-Baptiste; Dalleur, Olivia; Boland, Benoit; Thevelin, Stefanie; Knol, Wilma; Cullinan, Shane; Schneider, Claudio; O'Mahony, Denis; Rodondi, Nicolas; Spinewine, Anne

    2017-01-01

    Medication review has been advocated to address the challenge of polypharmacy in older patients, yet there is no consensus on how best to evaluate its efficacy. Heterogeneity of outcomes reported in clinical trials can hinder the comparison of clinical trial findings in systematic reviews. Moreover, the outcomes that matter most to older patients might be under-reported or disregarded altogether. A core outcome set can address this issue as it defines a minimum set of outcomes that should be reported in all clinical trials in any particular field of research. As part of the European Commission-funded project, called OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly, this paper describes the methods used to develop a core outcome set for clinical trials of medication review in older patients with multimorbidity. The study was designed in several steps. First, a systematic review established which outcomes were measured in published and ongoing clinical trials of medication review in older patients. Second, we undertook semistructured interviews with older patients and carers aimed at identifying additional relevant outcomes. Then, a multilanguage European Delphi survey adapted to older patients was designed. The international Delphi survey was conducted with older patients, health care professionals, researchers, and clinical experts in geriatric pharmacotherapy to validate outcomes to be included in the core outcome set. Consensus meetings were conducted to validate the results. We present the method for developing a core outcome set for medication review in older patients with multimorbidity. This study protocol could be used as a basis to develop core outcome sets in other fields of geriatric research.

  1. 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.

  2. "Christmas Balls": a Christmas carol by the adolescent cancer patients of the Milan Youth Project.

    PubMed

    Ferrari, Andrea; Signoroni, Stefano; Silva, Matteo; Gaggiotti, Paola; Veneroni, Laura; Magni, Chiara; Casanova, Michela; Chiaravalli, Stefano; Capelletti, Mirko; Lapidari, Pietro; Clerici, Carlo Alfredo; Massimino, Maura

    2017-03-24

    The Youth Project is a program developed at the Pediatric Oncology Unit at the Istituto Nazionale Tumori in Milan, dedicated to adolescents and young adults with cancer. Among its various goals, the Youth Project organizes structured creative activities with the support of professionals, with the objective of offering young people a new way to express their hopes and fears. This article describes a project centered around music: patients created a Christmas carol with the help of musicians and authors. The adolescents explained with their own words the meaning of the lyrics, telling the story of a Christmas spent in a cancer hospital ward.

  3. Promoting Patient- and Family-Centered Care in the Intensive Care Unit: A Dissemination Project.

    PubMed

    Kleinpell, Ruth; Buchman, Timothy G; Harmon, Lori; Nielsen, Melissa

    2017-01-01

    Awareness of patient-centered and family-centered care research can assist clinicians to promote patient and family engagement in the intensive care unit. Project Dispatch (Disseminating Patient-Centered Outcomes Research to Healthcare Professionals) was developed to disseminate patient- and family-centered care research and encourage its application in clinical practice. The 3-year project involved the development of an interactive website platform, online educational programming, social media channels, a podcast and webcast series, and electronic and print media. The project's webpages received more than 5200 page views with over 4000 unique visitors from 36 countries. The podcast series has download numbers ranging from 35 596 for "Family Presence in the ICU" to 25 843 for "Improving Patient and Family satisfaction in the ICU" and 22 148 for "Family Satisfaction in the ICU." The project therefore successfully developed resources for critical care health care professionals to promote the patient- and family-centric perspective. ©2017 American Association of Critical-Care Nurses.

  4. Managing multiple projects: a literature review of setting priorities and a pilot survey of healthcare researchers in an academic setting.

    PubMed

    Hopkins, Robert Borden; Campbell, Kaitryn; O'Reilly, Daria; Tarride, Jean-Eric; Bowen, Jim; Blackhouse, Gord; Goerre, Ron

    2007-05-16

    To summarize and then assess with a pilot study the use of published best practice recommendations for priority setting during management of multiple healthcare research projects, in a resource-constrained environment. Medical, economic, business, and operations literature was reviewed to summarize and develop a survey to assess best practices for managing multiple projects. Fifteen senior healthcare research project managers, directors, and faculty at an urban academic institution were surveyed to determine most commonly used priority rules, ranking of rules, characteristics of their projects, and availability of resources. Survey results were compared to literature recommendations to determine use of best practices. Seven priority-setting rules were identified for managing multiple projects. Recommendations on assigning priorities by project characteristics are presented. In the pilot study, a large majority of survey respondents follow best practice recommendations identified in the research literature. However, priority rules such as Most Total Successors (MTS) and Resource Scheduling Method (RSM) were used "very often" by half of the respondents when better performing priority rules were available. Through experience, project managers learn to manage multiple projects under resource constraints. Best practice literature can assist project managers in priority setting by recommending the most appropriate priority given resource constraints and project characteristics. There is room for improvement in managing multiple projects.

  5. Managing Multiple Projects: A Literature Review of Setting Priorities and a Pilot Survey of Healthcare Researchers in an Academic Setting

    PubMed Central

    Hopkins, Robert Borden; Campbell, Kaitryn; O'Reilly, Daria; Tarride, Jean-Eric; Bowen, Jim; Blackhouse, Gord; Goerre, Ron

    2007-01-01

    Objectives To summarize and then assess with a pilot study the use of published best practice recommendations for priority setting during management of multiple healthcare research projects, in a resource-constrained environment. Methods Medical, economic, business, and operations literature was reviewed to summarize and develop a survey to assess best practices for managing multiple projects. Fifteen senior healthcare research project managers, directors, and faculty at an urban academic institution were surveyed to determine most commonly used priority rules, ranking of rules, characteristics of their projects, and availability of resources. Survey results were compared to literature recommendations to determine use of best practices. Results Seven priority-setting rules were identified for managing multiple projects. Recommendations on assigning priorities by project characteristics are presented. In the pilot study, a large majority of survey respondents follow best practice recommendations identified in the research literature. However, priority rules such as Most Total Successors (MTS) and Resource Scheduling Method (RSM) were used “very often” by half of the respondents when better performing priority rules were available. Conclusions Through experience, project managers learn to manage multiple projects under resource constraints. Best practice literature can assist project managers in priority setting by recommending the most appropriate priority given resource constraints and project characteristics. There is room for improvement in managing multiple projects. PMID:18066354

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

    PubMed

    Ching, William; Robinson, John; McEntee, Mark

    2014-09-01

    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.

  7. 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.

  8. Clinical review: Early patient mobilization in the ICU

    PubMed Central

    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

  9. 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.

  10. The Impact of Electronic Patient Portals on Patient Care: A Systematic Review of Controlled Trials

    PubMed Central

    Ammenwerth, Elske; Schnell-Inderst, Petra

    2012-01-01

    Background Modern information technology is changing and provides new challenges to health care. The emergence of the Internet and the electronic health record (EHR) has brought new opportunities for patients to play a more active role in his/her care. Although in many countries patients have the right to access their clinical information, access to clinical records electronically is not common. Patient portals consist of provider-tethered applications that allow patients to electronically access health information that are documented and managed by a health care institution. Although patient portals are already being implemented, it is still unclear in which ways these technologies can influence patient care. Objective To systematically review the available evidence on the impact of electronic patient portals on patient care. Methods A systematic search was conducted using PubMed and other sources to identify controlled experimental or quasi-experimental studies on the impact of patient portals that were published between 1990 and 2011. A total of 1,306 references from all the publication hits were screened, and 13 papers were retrieved for full text analysis. Results We identified 5 papers presenting 4 distinct studies. There were no statistically significant changes between intervention and control group in the 2 randomized controlled trials investigating the effect of patient portals on health outcomes. Significant changes in the patient portal group, compared to a control group, could be observed for the following parameters: quicker decrease in office visit rates and slower increase in telephone contacts; increase in number of messages sent; changes of the medication regimen; and better adherence to treatment. Conclusions The number of available controlled studies with regard to patient portals is low. Even when patient portals are often discussed as a way to empower patients and improve quality of care, there is insufficient evidence to support this

  11. 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.

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

    SciTech Connect

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

    2016-03-15

    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.

  13. The role of health professionals in informing cancer patients: findings from The Teamwork Project (phase one)

    PubMed Central

    Smith

    2001-01-01

    Background The Teamwork Project is managed by the National Cancer Alliance (NCA) and funded jointly by the National Lottery Charities Board and the Department of Health. The aim of the Project is to produce a Personal Information File to help people with cancer work in partnership with health professionals. Phase one was carried out between September 1998 and April 2000. The Teamwork Project arose as a direct result of the NCA report, ‘Patient‐Centred Cancer Services’? – What Patients Say, 1 one of a number of studies that found people with cancer want to be involved in decisions about their treatment and care. The study also found that, for this involvement to be successful, health professionals need to support patients in accessing information relevant to their individual needs and help them understand and apply that information. The focus of The Teamwork Project is to help provide a practical solution to meeting this information need. Approach The Teamwork Project has used a wide‐range of methods including literature appraisal; patient questionnaires; focus groups; semi‐structured interviews and a consultation exercise. Throughout the Project there has been on‐going involvement from both patients and professionals. Conclusions There may be a divergence of views among health professionals in cancer services regarding their role as providers of patient information. Consequently, there may also be a significant variance in how their patients are informed in practice. This finding needs to be validated and the reasons for this understood if the full potential of the forthcoming National Health Service (NHS) Cancer Information Strategy is to be realised. PMID:11281931

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

    PubMed

    Aranda-Jan, Clara B; Mohutsiwa-Dibe, Neo; Loukanova, Svetla

    2014-02-21

    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. 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. 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 lack of resources. mHealth in Africa is an innovative approach

  15. A systematic review of dental disease management in cancer patients.

    PubMed

    Hong, Catherine H L; Hu, Shijia; Haverman, Thijs; Stokman, Monique; Napeñas, Joel J; Braber, Jacolien Bos-den; Gerber, Erich; Geuke, Margot; Vardas, Emmanouil; Waltimo, Tuomas; Jensen, Siri Beier; Saunders, Deborah P

    2017-07-22

    This systematic review aims to update on the prevalence of odontogenic-related infections and the efficacy of dental strategies in preventing dental-related complications in cancer patients since the 2010 systematic review. A literature search was conducted in the databases MEDLINE/PubMed and EMBASE for articles published between 1 January 2009 and 30 June 2016. Each study was assessed by 2 reviewers and the body of evidence for each intervention was assigned an evidence level. After examination of the abstracts and full-text articles, 59 articles satisfied the inclusion criteria. The weighted prevalence of dental infections and pericoronitis during cancer therapy was 5.4 and 5.3%, respectively. The frequency of dental-related infections during intensive chemotherapy after complete, partial, and minimal pre-cancer dental evaluation/treatment protocols ranged from 0 to 4%. Protocols involving third molars extractions had the highest complications (40%). In view of the low prevalence of infections and the potential for complications after third molar extractions, it is suggested that partial dental evaluation/treatment protocols prior to intensive chemotherapy; whereby minor caries (within dentin), asymptomatic third molars or asymptomatic teeth without excessive probing depth (<8 mm), mobility (mobility I or II) or with periapical lesions of <5 mm were observed; is a viable option when there is insufficient time for complete dental evaluation/treatment protocols. The use of chlorhexidine, fluoride mouth rinses as well as composite resin, resin-modified glass ionomer cement (GIC), and amalgam restorations over conventional GIC in post head and neck radiation patients who are compliant fluoride users is recommended.

  16. Outcome of the Joint Council of Thoracic Surgery Education's Early Review Course Project.

    PubMed

    Allen, Mark S; Calhoon, John H; Fullerton, David; Shemin, Richard; Naunheim, Keith; Verrier, Edward; Doty, John; Mathisen, Douglas J

    2016-04-01

    The Joint Council on Thoracic Surgical Education was formed in 2008 to improve cardiothoracic education. Resident learning has been a concern as reflected in declining passing rates on the American Board of Thoracic Surgery examinations. The Joint Council on Thoracic Surgical Education piloted a program to determine whether early exposure to a cardiothoracic curriculum through participation in a board review course would improve learning. The purpose of this paper is to report the results of this project. Residents from the incoming classes of traditional 5-2 or 5-3 cardiothoracic training programs were randomly selected to attend a 3-day board review course (University of Utah) in September of their first year. For the 2012 and 2013 classes of cardiothoracic residents, we asked all incoming residents to take the prior spring in-training examination in July of their first year and then take the in-training examination in the spring of their first year. We combined the results of the incoming class of 2012 and 2013 and analyzed the results. There were 171 residents who participated in either 2012 or 2013. There were 38 residents (78.9% were men) who attended the board review course and 133 (79.7% men) who did not. Questionnaires completed by the program directors and the residents who took the review course showed a favorable opinion of the program. The number of correct answers on the in-training examination, the percentage correct, and the percentile rank score increased more for the residents who took the review course, but was not statistically significant. When only the general thoracic surgery questions were analyzed, there was a statistically significant increase in the rank change between residents who attended the review course and residents who did not (8.4% increase versus 2.0% decrease, respectively; p = 0.042, Student t test). This pilot study established for the first time the baseline level of knowledge of incoming residents assessed by the in

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

    PubMed

    Hanskamp-Sebregts, M; Zegers, M; van Gurp, P J; de Vet, H C W; Wollersheim, H

    2017-01-01

    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. A systematic review of the literature. 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. 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-raterreliability 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. 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 methods that can be used to test concurrent validity.

  18. 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

  19. Sutureless onlay hernia repair: a review of 97 patients.

    PubMed

    Shahan, Charles P; Stoikes, Nathaniel F; Webb, David L; Voeller, Guy R

    2016-08-01

    Repair of large ventral/incisional (V/I) hernias is a common problem. Outside of recurrence, other factors such as wound complications and mesh infection can create significant morbidity. Chevrel described the premuscular repair and later modified it by using glue over the midline closure. We previously described our onlay technique using fibrin glue alone in a small case series. The aim of this study is to review the largest case series of sutureless onlay V/I hernia repair whereby mesh is fixated with fibrin glue alone for complex ventral hernias, and how the technique has evolved. All patients who underwent onlay V/I hernia repair over a 3-year period were reviewed. Patient demographics, operative details, complications, and follow-up were reviewed. In total, 97 patients were included. 54.6 % were female, with a mean age of 57.3 years. Mean BMI was 32.2. 23(23.7 %) patients had diabetes. 90 (92.8 %) of the operations were for incisional hernias, 3 (3.1 %) primary ventral hernias, 2 (2.1 %) flank hernias, and 2 (2 %) complex abdominal wall reconstruction. 88 (90.7 %) of the cases were performed on an elective basis. 77 (77.3 %) cases were classified as clean, 21 (21.6 %) clean-contaminated, and 1 (1.0 %) contaminated. The mean defect size was 150 cm(2). Mean follow-up was 386 days, and maximum was 3.1 years. There were 21 (21.6 %) seromas, 4 (4.1 %) wound infections, 7 (7.4 %) had skin necrosis, and 9 (9.3 %) required re-operation due to a complication. At 3 years, there have been no recurrences or mesh explants. The sutureless onlay V/I hernia repair with fibrin glue fixation has proven to be durable with a comparable complication profile to other techniques. The most common sequela, seroma, is easily managed in the outpatient setting. This sutureless technique is an effective option for onlay hernia repair that may provide several advantages over traditional suture techniques.

  20. Effects of life review on mental health and well-being among cancer patients: A systematic review.

    PubMed

    Zhang, Xiaoling; Xiao, Huimin; Chen, Ying

    2017-06-23

    Cancer patients often experience psychological distress. Life review has increasingly been used to enhance their mental health and well-being. However, no systematic review has synthesized the evidence, and its effects remain unclear. To examine and synthesize the best available evidence on the effects of life review on mental health and well-being among cancer patients. Systematic review of randomized controlled trials and clinical controlled trials. Twelve electronic databases were searched for published studies reported in English or Chinese, from inception to September 2016. Other supplementary sources, such as related websites, professional books, reference lists, and author contacts were also used for published or unpublished studies. A comprehensive literature search was conducted to identify eligible randomized controlled trials or clinical controlled trials about the effects of life review on cancer patients. Study selection, quality assessment, and data extraction were independently performed by two reviewers. The results were synthesized without meta-analysis in this review. Fifteen studies (899 participants) were identified; of that total, nine studies were rated as strong in quality, while six studies were of moderate quality. In addition to structured life review interviews, other elements such as memory prompts and a legacy product were integrated into life review programs. A majority of studies indicated that life review programs benefited cancer patients by reducing depression and anxiety, as well as improving their sense of hope, self-esteem and quality of life. Life review can improve mental health and well-being among cancer patients. This suggests that life review can be integrated into typical cancer treatment to enhance patients' mental health and well-being. More research with rigorous design is necessary to further explore the effects of life review. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Nurse-patient ratios as a patient safety strategy: a systematic review.

    PubMed

    Shekelle, Paul G

    2013-03-05

    A small percentage of patients die during hospitalization or shortly thereafter, and it is widely believed that more or better nursing care could prevent some of these deaths. The author systematically reviewed the evidence about nurse staffing ratios and in-hospital death through September 2012. From 550 titles, 87 articles were reviewed and 15 new studies that augmented the 2 existing reviews were selected. The strongest evidence supporting a causal relationship between higher nurse staffing levels and decreased inpatient mortality comes from a longitudinal study in a single hospital that carefully accounted for nurse staffing and patient comorbid conditions and a meta-analysis that found a "dose-response relationship" in observational studies of nurse staffing and death. No studies reported any serious harms associated with an increase in nurse staffing. Limiting any stronger conclusions is the lack of an evaluation of an intervention to increase nurse staffing ratios. The formal costs of increasing the nurse-patient ratio cannot be calculated because there has been no evaluation of an intentional change in nurse staffing to improve patient outcomes.

  2. [Integration of hospital social services in the rehabilitation of accident patients by the statutory accident insurance. Results of a one-year model project].

    PubMed

    Lukasczik, M; Geyer, S; Neuderth, S; Gerlich, C; Weis, I; Raiber, I; Weber-Falkensammer, H; Vogel, H

    2008-02-01

    In accident patient care, there is a substantial overlap between the scope of duties of hospital social services and tasks fulfilled by the German statutory accident insurances' visiting staff that regularly takes care of accident patients. Therefore, a project on the integration of hospital social services into the organizational structures of the German statutory accident insurance was initiated which aimed at optimising communication and realising synergy effects. A formative evaluation of the project was conducted that provided process- and outcome-related data for a comprehensive evaluation of the strengths and potentials of the project. Report forms containing patient-related information were completed by hospital social services. Forms were evaluated in terms of their utility for case management by accident insurance administrators using a checklist. Project implementation and procedures were documented and evaluated using semi-structured interviews with social services staff and accident insurance employees. Through the model, a comprehensive care for accident patients could be reached. In one third of all cases reviewed, rehabilitation management could be improved by including hospital social services. Moreover, in one third of all cases, care-related activities initiated by accident insurance funds could be reduced by involving local hospital social services. The report form used by hospital social services was evaluated as a useful tool in the context of patient care and rehabilitation management. The model was evaluated by interview participants as a highly targeted approach in accident patients' care management. Implications of the study for improving health care are discussed.

  3. 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.

  4. 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…

  5. 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…

  6. Clinical review: Traumatic brain injury in patients receiving antiplatelet medication

    PubMed Central

    2012-01-01

    As the population ages, emergency physicians are confronted with a growing number of trauma patients receiving antithrombotic and antiplatelet medication prior to injury. In cases of traumatic brain injury, pre-injury treatment with anticoagulants has been associated with an increased risk of posttraumatic intracranial haemorrhage. Since high age itself is a well-recognised risk factor in traumatic brain injury, this population is at special risk for increased morbidity and mortality. The effects of antiplatelet medication on coagulation pathways in posttraumatic intracranial haemorrhage are not well understood, but available data suggest that the use of these agents increases the risk of an unfavourable outcome, especially in cases of severe traumatic brain injury. Standard laboratory investigations are insufficient to evaluate platelet activity, but new assays for monitoring platelet activity have been developed. Commonly used interventions to restore platelet activity include platelet transfusion and application of haemostatic drugs. Nevertheless, controlled clinical trials have not been carried out and, therefore, clinical practice guidelines are not available. In addition to the risks of the acute trauma, patients are at risk for cardiac events such as life-threatening stent thrombosis if antiplatelet therapy is withdrawn. In this review article, we summarize the pathophysiologic mechanisms of the most commonly used antiplatelet agents and analyse results of studies on the effects of this treatment on patients with traumatic brain injury. Additionally, we focus on opportunities to counteract antiplatelet effects in those patients as well as on considerations regarding the withdrawal of antiplatelet therapy. In those chronically ill patients, an interdisciplinary approach involving intensivists, neurosurgeons as well as cardiologists is often mandatory. PMID:22839302

  7. Multidisciplinary in-hospital teams improve patient outcomes: A review

    PubMed Central

    Epstein, Nancy E.

    2014-01-01

    Background: The use of multidisciplinary in-hospital teams limits adverse events (AE), improves outcomes, and adds to patient and employee satisfaction. Methods: Acting like “well-oiled machines,” multidisciplinary in-hospital teams include “staff” from different levels of the treatment pyramid (e.g. staff including nurses’ aids, surgical technicians, nurses, anesthesiologists, attending physicians, and others). Their enhanced teamwork counters the “silo effect” by enhancing communication between the different levels of healthcare workers and thus reduces AE (e.g. morbidity/mortality) while improving patient and healthcare worker satisfaction. Results: Multiple articles across diverse disciplines incorporate a variety of concepts of “teamwork” for staff covering emergency rooms (ERs), hospital wards, intensive care units (ICUs), and most critically, operating rooms (ORs). Cohesive teamwork improved communication between different levels of healthcare workers, and limited adverse events, improved outcomes, decreased the length of stay (LOS), and yielded greater patient “staff” satisfaction. Conclusion: Within hospitals, delivering the best medical/surgical care is a “team sport.” The goals include: Maximizing patient safety (e.g. limiting AE) and satisfaction, decreasing the LOS, and increasing the quality of outcomes. Added benefits include optimizing healthcare workers’ performance, reducing hospital costs/complications, and increasing job satisfaction. This review should remind hospital administrators of the critical need to keep multidisciplinary teams together, so that they can continue to operate their “well-oiled machines” enhancing the quality/safety of patient care, while enabling “staff” to optimize their performance and enhance their job satisfaction. PMID:25289149

  8. Isokinetic testing in patients with neuromuscular diseases: a focused review.

    PubMed

    El Mhandi, Lhassan; Bethoux, François

    2013-02-01

    This literature review aimed to study the use of isokinetic testing in patients with neuromuscular diseases (NMDs) and to identify directions for future research of isokinetic testing. The MEDLINE (January 1, 1965, to July 1, 2010), Cumulative Index to Nursing and Allied Health (1980 to May 2010), and Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2009) electronic databases were searched. The literature search was conducted using the keywords muscle assessment, muscle strength, evaluation, isokinetic, neuromuscular diseases, muscle fatigue, functional test, rehabilitation, and literature search. Relevant references cited in the selected articles were also considered, regardless of the year of publication. The search strategy yielded 13 articles involving a variety of patients with known NMDs. All studies demonstrated that isokinetic dynamometry is appropriate and safe for ambulatory patients with NMDs. Isokinetic testing has proven to be reliable (intratest/intertest correlation coefficient ranged from 0.65 to 0.98), with the proximal muscles having the highest reliability, and sensitive to disease progression and to the effects of various therapeutic interventions. However, isokinetic testing has never gained wide acceptance, partly because of concerns about stabilizing the dynamometer and the subject during the test and of the lack of standardized protocols for isokinetic strength measurement. Isokinetic testing is an important part of the comprehensive evaluation and rehabilitation of patients with NMD. Research has demonstrated its efficacy in providing clinically relevant information. When integrated with a complete history, physical examination, and functional evaluation, isokinetic testing and exercise can be a valuable tool for the clinician in the assessment, rehabilitation, and performance enhancement of patients with NMD. Such equipment, however, has several disadvantages, rendering it usually impractical in the clinical

  9. Improving Health of At-Risk Rural Patients project: A collaborative care model.

    PubMed

    Matzke, Gary R; Czar, Michael J; Lee, William T; Moczygemba, Leticia R; Harlow, L David

    2016-11-01

    The design elements of the Improving Health of At-Risk Rural Patients (IHARP) care model are described. The IHARP project evaluated the clinical, economic, and humanistic outcomes associated with the collaborative care model relative to usual care in the community. The care model was initiated in 22 level 3- certified patient-centered medical homes. The primary outcomes are the absolute change in all relevant clinical and laboratory values of patients with hypertension, hyperlipidemia, and diabetes within and between the intervention and comparator groups; the change in the absolute number of emergency department visits and hospitalizations; and the change in the cost of care among the Medicare and Medicaid intervention patients. The lessons learned during the implementation and conduction of this project over the past three years are also presented. Patient enrollment ended in December 2014, final patient care visits were concluded in the fall of 2015, and results are expected in late 2016 or early 2017. This project will provide information from patients, physicians, and midlevel providers regarding their perceptions of clinical pharmacists as collaborative care team members. Data on health outcomes, health services utilization, and costs of care drawn from over 1600 Medicare beneficiaries will provide a robust assessment of the value of the IHARP care delivery model. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  10. 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.

  11. 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.; hide

    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.

  12. Mindfulness meditation for oncology patients: a discussion and critical review.

    PubMed

    Ott, Mary Jane; Norris, Rebecca L; Bauer-Wu, Susan M

    2006-06-01

    The purpose of this article is to (1) provide a comprehensive over view and discussion of mindfulness meditation and its clinical applicability in oncology and (2) report and critically evaluate the existing and emerging research on mindfulness meditation as an intervention for cancer patients. Using relevant keywords, a comprehensive search of MEDLINE, PsycInfo, and Ovid was completed along with a review of published abstracts from the annual conferences sponsored by the Center for Mindfulness in Medicine, Health Care, and Society and the American Psychosocial Oncology Society. Each article and abstract was critiqued and systematically assessed for purpose statement or research questions, The search produced 9 research articles published in the past 5 years and 5 conference abstracts published in 2004. Most studies were conducted with breast and prostate cancer patients, and the mindfulness intervention was done in a clinic-based group setting. Consistent benefits--improved psychological functioning, reduction of stress symptoms, enhanced coping and well-being in cancer outpatients--were found. More research in this area is warranted: using randomized, controlled designs, rigorous methods, and different cancer diagnoses and treatment settings; expanding outcomes to include quality of life, physiological, health care use, and health-related outcomes; exploring mediating factors; and discerning dose effects and optimal frequency and length of home practice. Mindfulness meditation has clinically relevant implications to alleviate psychological and physical suffering of persons living with cancer. Use of this behavioral intervention for oncology patients is an area of burgeoning interest to clinicians and researchers.

  13. Nasogastric tube insertion in anaesthetized patients: a comprehensive review.

    PubMed

    Sanaie, Sarvin; Mahmoodpoor, Ata; Najafi, Mahdi

    2017-01-01

    Nasogastric tubes (NGT) still remain the easiest and the best way for gastrointestinal tract access. There are various indications for the insertion of a nasogastric tube in anaesthetized and critically ill patients. Although many techniques have been introduced to facilitate nasogastric tube insertion using anatomic landmarks and a group of devices, there is no consensus on a standard method. Moreover, there are different methods for the assessment of the correct placement of a nasogastric tube. In addition to these challenges in insertion and assessment methods, there are varieties of major life-threatening and minor complications to be addressed. Thus, selecting the most appropriate approach requires enough knowledge in this area, considering patient condition and clinical factors, as well as the practitioners' sufficient education and experience, along with skill in performance. This is a comprehensive review of the literature evidence on different methods for nasogastric tube insertion, on the assessment of correct placement and the evaluation of complications, in addition to an approach to the effect of education on the quality of routine practice and patients' outcome.  .

  14. [Neuraxial anesthesia in patients with multiple sclerosis - a systematic review].

    PubMed

    Bornemann-Cimenti, Helmar; Sivro, Nikki; Toft, Frederike; Halb, Larissa; Sandner-Kiesling, Andreas

    Current guidelines for neuraxial analgesia in patients with multiple sclerosis are ambiguous and offer the clinician only a limited basis for decision making. This systematic review examines the number of cases in which multiple sclerosis has been exacerbated after central neuraxial analgesia in order to rationally evaluate the safety of these procedures. A systematic literature search with the keywords "anesthesia or analgesia" and "epidural, peridural, caudal, spinal, subarachnoid or intrathecal" in combination with "multiple sclerosis" was performed in the databases PubMed and Embase, looking for clinical data on the effect of central neuraxial analgesia on the course of multiple sclerosis. Over a period of 65 years, our search resulted in 37 reports with a total of 231 patients. In 10 patients multiple sclerosis was worsened and nine multiple sclerosis or neuromyelitis optica was first diagnosed in a timely context with central neuraxial analgesia. None of the cases showed a clear relation between cause and effect. Current clinical evidence does not support the theory that central neuraxial analgesia negatively affects the course of multiple sclerosis. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  15. Medical librarians supporting information systems project lifecycles toward improved patient safety. Medical librarians possess expertise to navigate various search resources and can investigate inquiries during IS project lifecycles.

    PubMed

    Saimbert, Marie K; Zhang, Yingting; Pierce, Jenny; Moncrief, Erica S; O'Hagan, Keydi Boss; Cole, Peter

    2010-01-01

    Health information systems (HIS) have progressed from being used to manage billing to impacting patient safety and health professionals' job satisfaction. Many decisions are made during project management and the information system lifecycle of a HIS. Medical librarians are underutilized in HIS lifecycles; it may not be clear to stakeholders what they can provide and where their services fit. Medical librarians possess expertise to navigate various search resources and can investigate inquiries during information systems project lifecycles. Librarians can market specific skills to project lifecycle teams such as those involved in computerized provider order entry (CPOE), electronic medication administration record (eMAR) and root cause analysis (RCA). HIS project personnel, including patient safety team members, should make use of medical librarians in phases of health information systems project management. This will help them meet institutional and global objectives for evidence-based use of technology towards improved patient safety.

  16. TOPICAL REVIEW: Separable nonlinear least squares: the variable projection method and its applications

    NASA Astrophysics Data System (ADS)

    Golub, Gene; Pereyra, Victor

    2003-04-01

    In this paper we review 30 years of developments and applications of the variable projection method for solving separable nonlinear least-squares problems. These are problems for which the model function is a linear combination of nonlinear functions. Taking advantage of this special structure, the method of variable projections eliminates the linear variables obtaining a somewhat more complicated function that involves only the nonlinear parameters. This procedure not only reduces the dimension of the parameter space but also results in a better-conditioned problem. The same optimization method applied to the original and reduced problems will always converge faster for the latter. We present first a historical account of the basic theoretical work and its various computer implementations, and then report on a variety of applications from electrical engineering, medical and biological imaging, chemistry, robotics, vision, and environmental sciences. An extensive bibliography is included. The method is particularly well suited for solving real and complex exponential model fitting problems, which are pervasive in their applications and are notoriously hard to solve.

  17. 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.

  18. 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.

  19. 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

  20. 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

  1. Social networks of patients with psychosis: a systematic review.

    PubMed

    Palumbo, Claudia; Volpe, Umberto; Matanov, Aleksandra; Priebe, Stefan; Giacco, Domenico

    2015-10-12

    Social networks are important for mental health outcomes as they can mobilise resources and help individuals to cope with social stressors. Individuals with psychosis may have specific difficulties in establishing and maintaining social relationships which impacts on their well-being and quality of life. There has been a growing interest in developing social network interventions for patients with psychotic disorders. A systematic literature review was conducted to investigate the size of social networks of patients with psychotic disorders, as well as their friendship networks. A systematic electronic search was carried out in MEDLINE, EMBASE and PsychINFO databases using a combination of search terms relating to 'social network', 'friendship' and 'psychotic disorder'. The search identified 23 relevant papers. Out of them, 20 reported patient social network size. Four papers reported the mean number of friends in addition to whole network size, while three further papers focused exclusively on the number of friends. Findings varied substantially across the studies, with a weighted mean size of 11.7 individuals for whole social networks and 3.4 individuals for friendship networks. On average, 43.1 % of the whole social network was composed of family members, while friends accounted for 26.5 %. Studies assessing whole social network size and friendship networks of people with psychosis are difficult to compare as different concepts and methods of assessment were applied. The extent of the overlap between different social roles assessed in the networks was not always clear. Greater conceptual and methodological clarity is needed in order to help the development of effective strategies to increase social resources of patients with psychosis.

  2. [Depression among older nursing home patients. A review].

    PubMed

    Jongenelis, K; Pot, A M; Eisses, A M H; Beekman, A T F; Kluiter, H; van Tilburg, W; Ribbe, M W

    2003-04-01

    Depression is a common disorder in later life. The prevalence of depression in aged nursing home patients in 36 studies in various countries was reviewed. Results show prevalence rates ranging from 2% to 61%. Average prevalences were calculated for depressive symptoms, minor depression and major depression each. The averages thus found are 43.9% for depressive symptoms, 25.7% for minor depression and 15.5% for major depression. In order to find an explanation for the variation in occurrence of depression in nursing homes, factors that may have influenced the results are described. Both the definition of depression and the kind of instrument used in measuring depression appear to be highly responsible for the variations found.

  3. Oral health of patients with intellectual disabilities: a systematic review.

    PubMed

    Anders, Patrick L; Davis, Elaine L

    2010-01-01

    A systematic review of original studies was conducted to determine if differences in oral health exist between adults who have intellectual disabilities (ID) and the general population. Electronic searching identified 27 studies that met the inclusion criteria. These studies were assessed for strength of evidence. People with ID have poorer oral hygiene and higher prevalence and greater severity of periodontal disease. Caries rates in people with ID are the same as or lower than the general population. However, the rates of untreated caries are consistently higher in people with ID. Two subgroups at especially high risk for oral health problems are people with Down syndrome and people unable to cooperate for routine dental care. Evidence supports the need to develop strategies to increase patient acceptance for routine care, additional training for dentists to provide this care, and the development of more effective preventive strategies to minimize the need for this care.

  4. 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

  5. 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…

  6. 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…

  7. 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…

  8. 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…

  9. 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

  10. Nutritional screening in hospitalized pediatric patients: a systematic review.

    PubMed

    Teixeira, Adriana Fonseca; Viana, Kátia Danielle Araújo Lourenço

    2016-01-01

    This systematic review aimed to verify the available scientific evidence on the clinical performance and diagnostic accuracy of nutritional screening tools in hospitalized pediatric patients. A search was performed in the Medline (National Library of Medicine United States), LILACS (Latin American and Caribbean Health Sciences), PubMed (US National Library of Medicine National Institutes of Health), in the SCIELO (Scientific Electronic Library Online), through CAPES portal (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior), bases Scopus e Web of Science. The descriptors used in accordance with the Descriptors in Health Sciences (DeCS)/Medical Subject Headings (MeSH) list were "malnutrition", "screening", and "pediatrics", as well as the equivalent words in Portuguese. The authors identified 270 articles published between 2004 and 2014. After applying the selection criteria, 35 were analyzed in full and eight articles were included in the systematic review. We evaluated the methodological quality of the studies using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS). Five nutritional screening tools in pediatrics were identified. Among these, the Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP) showed high sensitivity, almost perfect inter-rater agreement and between the screening and the reference standard; the Screening Tool Risk on Nutritional Status and Growth (STRONGkids) showed high sensitivity, lower percentage of specificity, substantial intra-rater agreement, and ease of use in clinical practice. The studies included in this systematic review showed good performance of the nutritional screening tools in pediatrics, especially STRONGkids and STAMP. The authors emphasize the need to perform for more studies in this area. Only one tool was translated and adapted to the Brazilian pediatric population, and it is essential to carry out studies of tool adaptation and validation for this population. Copyright

  11. Localized cutaneous argyria: Report of two patients and literature review.

    PubMed

    Beutler, Bryce David; Lee, Robert A; Cohen, Philip R

    2016-11-15

    BackgroundLocalized cutaneous argyria is a rare skin condition caused by direct contact with silver or silver particles. It presents as asymptomatic gray or blue-gray macules that appear similar to blue nevi. Histologic features include brown-colored or black-colored silver granules in the basement membrane and dermis, most commonly surrounding eccrine glands, elastic fibers, and collagen fibrils. The condition is most frequently observed in individuals who are regularly exposed to small silver particles, such as silversmiths and welders. However, localized cutaneous argyria has also been associated with acupuncture needles, silver earrings, and topical medications containing silver nitrate. Although the condition is benign, patients who are concerned about the cosmetic features of localized cutaneous argyria may benefit from laser therapy.PurposeWe describe the clinical and pathologic findings of two women who developed localized cutaneous argyria. We also review the characteristics of other patients with localized cutaneous argyria and summarize the differential diagnosis and treatment options for this condition.Materials and methodsThe features of two women with localized cutaneous argyria are presented. Using PubMed, the following terms were searched and relevant citations assessed: acquired localized argyria, acupuncture, argyria, argyrosis, colloidal silver, cutaneous argyria, and localized cutaneous argyria. In addition, the literature on localized cutaneous argyria is reviewed.ResultsTwo women presented with small, asymptomatic blue-gray macules appearing at sites directly adjacent to ear piercings. A punch biopsy was performed on one woman. Microscopic examination revealed a yellowish-brown colored granular material found adjacent to elastic fibers. Based on correlation of the clinical presentation and histopathologic findings, a diagnosis of localized cutaneous argyria was established. The second woman did not undergo a biopsy. However, the clinical

  12. Human herpes viruses in burn patients: A systematic review.

    PubMed

    Wurzer, Paul; Guillory, Ashley; Parvizi, Daryousch; Clayton, Robert P; Branski, Ludwik K; Kamolz, Lars-P; Finnerty, Celeste C; Herndon, David N; Lee, Jong O

    2017-02-01

    The contribution of human herpes viruses, including herpes simplex virus (HSV), cytomegalovirus (CMV), and varicella zoster virus (VZV) to morbidity and mortality after burns remains controversial. This systematic review was undertaken to assess evidence of herpes virus-related morbidity and mortality in burns. PubMed, Ovid, and Web of Science were searched to identify studies of HSV, CMV, or VZV infections in burn patients. Exclusion criteria included: A level of evidence (LoE) of IV or V; nonhuman in vivo studies; and non-English articles. There was no limitation by publication date. Fifty articles were subjected to full-text analysis. Of these, 18 had LoE between I-III and were included in the final review (2 LoE I, 16 LoE II-III). Eight had a prospective study design, 9 had a retrospective study design, and 1 included both. No direct evidence linked CMV and HSV infection with increased morbidity and mortality in burns. Following burn, CMV reactivation was more common than a primary CMV infection. Active HSV infection impaired wound healing but was not directly correlated to mortality. Infections with VZV are rare after burns but when they occur, VZV infections were associated with severe complications including mortality. The therapeutic effect of antiviral agents administered after burns warrants investigation via prospective randomized controlled trials. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  13. Patient education after amputation: systematic review and experts' opinions.

    PubMed

    Pantera, E; Pourtier-Piotte, C; Bensoussan, L; Coudeyre, E

    2014-04-01

    To perform a systematic review of the literature regarding amputee self-care, and analyze current experts' opinions. The research in Medline and Cochrane Library databases was performed using the keywords "amputee self-care", "amputee health care", "amputee education", and "amputee health management". The methodological quality of the articles was assessed using four levels of evidence and three guideline grades (A: strong; B: moderate; C: poor). One prospective randomized controlled study confirm the level of evidence of self-care amputee persons with grade B, which is similar others chronic diseases self-care. Self-care of amputee persons contributes to improve functional status, depressive syndrome, and also health-related quality of life. A review of the patients' needs and expectations in self-care amputee persons has been established thanks to the presence of qualitative focus group study. A multidisciplinary self-care of amputee persons can be recommended. Regarding literature date, the level of evidence of self-care amputee persons is moderate (grade B). Experts groups are currently working on a self-care amputee persons guideline book in order to standardize practicing and programs in the physical medicine and rehabilitation departments. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  14. Patient and Stakeholder Engagement in the PCORI Pilot Projects: Description and Lessons Learned.

    PubMed

    Forsythe, Laura P; Ellis, Lauren E; Edmundson, Lauren; Sabharwal, Raj; Rein, Alison; Konopka, Kristen; Frank, Lori

    2016-01-01

    Patients and healthcare stakeholders are increasingly becoming engaged in the planning and conduct of biomedical research. However, limited research characterizes this process or its impact. We aimed to characterize patient and stakeholder engagement in the 50 Pilot Projects funded by the Patient-Centered Outcomes Research Institute (PCORI), and identify early contributions and lessons learned. A self-report instrument was completed by researchers between 6 and 12 months following project initiation. Forty-seven principal investigators or their designees (94 % response rate) participated in the study. MAIN MEASURES Self-report of types of stakeholders engaged, stages and levels of engagement, facilitators and barriers to engagement, lessons learned, and contributions from engagement were measured. Most (83 %) reported engaging more than one stakeholder in their project. Among those, the most commonly reported groups were patients (90 %), clinicians (87 %), health system representatives (44 %), caregivers (41 %), and advocacy organizations (41 %). Stakeholders were commonly involved in topic solicitation, question development, study design, and data collection. Many projects engaged stakeholders in data analysis, results interpretation, and dissemination. Commonly reported contributions included changes to project methods, outcomes or goals; improvement of measurement tools; and interpretation of qualitative data. Investigators often identified communication and shared leadership strategies as "critically important" facilitators (53 and 44 % respectively); lack of stakeholder time was the most commonly reported challenge (46 %). Most challenges were only partially resolved. Early lessons learned included the importance of continuous and genuine partnerships, strategic selection of stakeholders, and accommodation of stakeholders' practical needs. PCORI Pilot Projects investigators report engaging a variety of stakeholders across many stages of research, with specific

  15. Promoting patient-centred palliative care: a scoping review of the patient dignity question.

    PubMed

    Arantzamendi, María; Belar, Alazne; Martínez, Marina

    2016-12-01

    In recent years, there has been a growing interest in promoting dignity in care, and specific interventions have been developed to include it at the end of life. The patient dignity question (PDQ) is a recent, novel and simple intervention that healthcare professionals can implement; however, little information is known about its impact. This scoping review aims to examine and map out the PDQ literature. Studies suggest that patients, families and professionals have a positive view of the PDQ in that it helps to get to know patients and provide them with the best care possible. The PDQ seems to promote an environment of care focused on the person and the prevalence of more human aspects in clinical encounters between professionals and patients. This is especially so in situations in which human aspects of the healthcare relationship at baseline received lower marks. Healthcare professionals thought that performing the PDQ to determine what is important to the patient is a feasible and effective exercise. The published literature suggests that PDQ is a beneficial intervention for approaching and getting to know a patient as a person. More studies are needed that measure pre-post-PDQ changes and that demonstrate their impact on patient care.

  16. Project ADAPT (Report Number 2): Review and Assessment of Post-Orientation Careers of Project Participants. Aerospace Employment Project. Final Report.

    ERIC Educational Resources Information Center

    Massachusetts Inst. of Tech., Cambridge. Dept. of Urban Studies and Planning.

    The careers of 185 previously unemployed aerospace and defense industry professionals are documented, following completion in August 1971 of a 1-month orientation to urban affairs entitled Project ADAPT (Aerospace and Defense Adaptation to Public Technology). Funded by the Labor Department and by the Housing and Urban Development Project to…

  17. Project PRISM: Project Manual.

    ERIC Educational Resources Information Center

    Cunnion, Maryellen; And Others

    The first of three volumes of Project PRISM, a program designed to help classroom teachers (grades 6 through 8) provide for the needs of their gifted and talented students without removing those students from the mainstream of education, outlines the project's background and achievements. Sections review the following project aspects (sample…

  18. Medical complications of achondroplasia: a multicentre patient review.

    PubMed Central

    Hunter, A G; Bankier, A; Rogers, J G; Sillence, D; Scott, C I

    1998-01-01

    Achondroplasia is the most prevalent chondrodysplasia and numerous authors have documented the varied social and medical complications that may compromise a full and productive life. Complications include cervicomedullary compression, spinal stenosis, restrictive and obstructive lung disease, otitis media, and tibial bowing, among others. These known complications have led to recommendations for the anticipatory management of such patients. There are relatively few data on the actual rates and timing of these problems. This paper reports data on the rates and age of occurrence of several of these complications based on a review of recorded chart information of 193 patients ascertained from several well established genetic centres with a known interest in the chondrodysplasias. The length of follow up varied and the rates of occurrence at specific age intervals were used to estimate the cumulative percentage affected for each complication. The report includes information on otitis media, ventilation tubes, hearing loss, tonsillectomy, speech problems, tibial bowing and osteotomy, ventricular shunting, apnoea, cervicomedullary decompression, and neurological signs attributable to spinal stenosis. Images PMID:9733026

  19. Acoustic rhinometry in mouth breathing patients: a systematic review.

    PubMed

    Melo, Ana Carolina Cardoso de; Gomes, Adriana de Oliveira de Camargo; Cavalcanti, Arlene Santos; Silva, Hilton Justino da

    2015-01-01

    When there is a change in the physiological pattern of nasal breathing, mouth breathing may already be present. The diagnosis of mouth breathing is related to nasal patency. One way to access nasal patency is by acoustic rhinometry. To systematically review the effectiveness of acoustic rhinometry for the diagnosis of patients with mouth breathing. Electronic databases LILACS, MEDLINE via PubMed and Bireme, SciELO, Web of Science, Scopus, PsycInfo, CINAHL, and Science Direct, from August to December 2013, were consulted. 11,439 articles were found: 30 from LILACS, 54 from MEDLINE via Bireme, 5558 from MEDLINE via PubMed, 11 from SciELO, 2056 from Web of Science, 1734 from Scopus, 13 from PsycInfo, 1108 from CINAHL, and 875 from Science Direct. Of these, two articles were selected. The heterogeneity in the use of equipment and materials for the assessment of respiratory mode in these studies reveals that there is not yet consensus in the assessment and diagnosis of patients with mouth breathing. According to the articles, acoustic rhinometry has been used for almost twenty years, but controlled studies attesting to the efficacy of measuring the geometry of nasal cavities for complementary diagnosis of respiratory mode are warranted. Copyright © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  20. Physicians' intention to leave direct patient care: an integrative review.

    PubMed

    Degen, Christiane; Li, Jian; Angerer, Peter

    2015-09-08

    In light of the growing shortage of physicians worldwide, the problem of physicians who intend to leave direct patient care has become more acute, particularly in terms of quality of care and health-care costs. A literature search was carried out following Cooper's five-stage model for conducting an integrative literature review. Database searches were made in MEDLINE, PsycINFO and Web of Science in May 2014. A total of 17 studies from five countries were identified and the study results synthesized. Measures and percentages of physicians' intention to leave varied between the studies. Variables associated with intention to leave were demographics, with age- and gender-specific findings, family or personal domain, working time and psychosocial working conditions, job-related well-being and other career-related aspects. Gender differences were identified in several risk clusters. Factors such as long working hours and work-family conflict were particularly relevant for female physicians' intention to leave. Health-care managers and policy-makers should take action to improve physicians' working hours and psychosocial working conditions in order to prevent a high rate of intention to leave and limit the number of physicians actually leaving direct patient care. Further research is needed on gender-specific needs in the workplace, the connection between intention to leave and actually leaving and measures of intention to leave as well as using qualitative methods to gain a deeper understanding and developing validated questionnaires.

  1. 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

  2. Questionnaires Measuring Patients' Spiritual Needs: A Narrative Literature Review.

    PubMed

    Seddigh, Ruohollah; Keshavarz-Akhlaghi, Amir-Abbas; Azarnik, Somayeh

    2016-03-01

    The objective of the present review was to collect published spiritual needs questionnaires and to present a clear image of the research condition of this domain. First, an electronic search was conducted with no limits on time span (until June 2015) or language in the following databases: PubMed, Scopus, Ovid, ProQuest and Google Scholar. All derivations of the keywords religion and spiritual alongside need and its synonyms were included in the search. Researches that introduced new tools was then selected and included in the study. Due to the limited quantity of questionnaires in this domain and with no consideration given to the existence or lack of exact standardization information, all of the questionnaires were included in the final report. Eight questionnaires were found: patients spiritual needs assessment scale (PSNAS), spiritual needs inventory (SNI), spiritual interests related to illness tool (SpIRIT), spiritual needs questionnaire (SpNQ), spiritual needs assessment for patients (SNAP), spiritual needs scale (SNS), spiritual care needs inventory (SCNI), and spiritual needs questionnaire for palliative care. These questionnaires have been designed from a limited medical perspective and often involve cultural concepts which complicate their cross-cultural applicability.

  3. Clinical and histopathological characteristics of patients with prostate cancer in the BioBank Japan project.

    PubMed

    Ukawa, Shigekazu; Nakamura, Koshi; Okada, Emiko; Hirata, Makoto; Nagai, Akiko; Yamagata, Zentaro; Muto, Kaori; Matsuda, Koichi; Ninomiya, Toshiharu; Kiyohara, Yutaka; Kamatani, Yoichiro; Kubo, Michiaki; Nakamura, Yusuke; Tamakoshi, Akiko

    2017-03-01

    Prostate cancer is the sixth leading cause of cancer-related deaths in Japan. We aimed to elucidate the clinical and histopathological characteristics of patients with prostate cancer in the BioBank Japan (BBJ) project. Four thousand, seven hundred and ninety-three patients diagnosed with prostate cancer in the BBJ project were included. Clinical and histopathological data, including causes of death, were analyzed. Relative survival (RS) rates of prostate cancer were calculated. Four thousand, one hundred and seventy-one prostate cancer patients with available histological data had adenocarcinoma. The mean age of the patients was 72.5 years. The proportion of patients who were non-smokers, non-drinkers, had a normal body mass index, did not exercise, had a normal prostate-specific antigen level, and had a family history of prostate cancer were 30.7%, 28.0%, 66.6%, 58.1%, 67.6%, and 6.5%, respectively. The proportion of patients with Stage II, III, and IV disease were 24.4%, 7.3%, and 4.4%, respectively. After limiting to patients with a time from the initial diagnosis of prostate cancer to entry into the study cohort of ≤90 days (n = 869), the 5- and 10-year RS rates were 96.3% and 100.5%, respectively, although we were unable to consider management strategies due to a plenty of data missing. We provide an overview of patients with prostate cancer in the BBJ project. Our findings, coupled with those from various high throughput "omics" technologies, will contribute to the implementation of prevention interventions and medical management of prostate cancer patients. Copyright © 2017 The Authors. Production and hosting by Elsevier B.V. All rights reserved.

  4. Measuring patients' experiences with individual primary care physicians. Results of a statewide demonstration project.

    PubMed

    Safran, Dana Gelb; Karp, Melinda; Coltin, Kathryn; Chang, Hong; Li, Angela; Ogren, John; Rogers, William H

    2006-01-01

    Measuring and reporting patients' experiences with health plans has been routine for several years. There is now substantial interest in measuring patients' experiences with individual physicians, but numerous concerns remain. The Massachusetts Ambulatory Care Experiences Survey Project was a statewide demonstration project designed to test the feasibility and value of measuring patients' experiences with individual primary care physicians and their practices. Cross-sectional survey administered to a statewide sample by mail and telephone (May-August 2002). Adult patients from 5 commerical health plans and Medicaid sampled from the panels of 215 generalist physicians at 67 practice sites (n=9,625). Ambulatory Care Experiences Survey produces 11 summary measures of patients' experiences across 2 domains: quality of physician-patient interactions and organizational features of care. Physician-level reliability was computed for all measures, and variance components analysis was used to determine the influence of each level of the system (physician, site, network organization, plan) on each measure. Risk of misclassifying individual physicians was evaluated under varying reporting frameworks. All measures except 2 achieved physician-level reliability of at least 0.70 with samples of 45 patients per physician, and several exceeded 0.80. Physicians and sites accounted for the majority of system-related variance on all measures, with physicians accounting for the majority on all "interaction quality" measures (range: 61.7% to 83.9%) and sites accounting for the largest share on "organizational" measures (range: 44.8% to 81.1%). Health plans accounted for neglible variance (<3%) on all measures. Reporting frameworks and principles for assuring misclassification risk < or =2.5% were identified. With considerable national attention on the importance of patient-centered care, this project demonstrates the feasibility of obtaining highly reliable measures of patients

  5. Patient-Reported Outcome Instruments for Physical Symptoms Among Patients Receiving Maintenance Dialysis: A Systematic Review

    PubMed Central

    Flythe, Jennifer E.; Powell, Jill D.; Poulton, Caroline J.; Westreich, Katherine D.; Handler, Lara; Reeve, Bryce B.; Carey, Timothy S.

    2015-01-01

    Background Patients with end-stage renal disease (ESRD) receiving dialysis have poor health-related quality of life (HRQoL). Physical symptoms are highly prevalent among dialysis-dependent patients and play important roles in HRQoL. A range of symptom assessment tools have been used in dialysis-dependent patients, but there has been no previous systematic assessment of the existing symptom measures’ content, validity, and reliability. Study Design systematic review of the literature Settings & Population ESRD patients on maintenance dialysis Selection Criteria for Studies instruments with ≥3 physical symptoms previously used in dialysis-dependent patients and evidence of validity or reliability testing Intervention patient-reported physical symptom assessment instrument Outcomes instrument symptom-related content, validity, and reliability Results From 3,148 screened abstracts, 89 full-text articles were eligible for review. After article exclusion and further article identification via reference reviews, 58 articles on 23 symptom assessment instruments with documented reliability or validity testing were identified. Of the assessment instruments, 43.5% were generic and 56.5% were ESRD-specific. Symptoms most frequently assessed were fatigue, shortness of breath, insomnia, nausea and vomiting, and appetite. The instruments varied widely in respondent time burden, recall period, and symptom attributes. Few instruments considered recall periods less than 2 weeks and few assessed a range of symptom attributes. Psychometric testing was completed for congruent validity (70%), known group validity (25%), responsiveness (30%), internal consistency (78%), and test-retest reliability (65%). Content validity was assessed in dialysis populations in 57% of the 23 instruments. Limitations Consideration of physical symptoms only and exclusion of single symptom-focused instruments Conclusions The number of available instruments focused exclusively on physical symptoms in

  6. Patient-Reported Outcome Instruments for Physical Symptoms Among Patients Receiving Maintenance Dialysis: A Systematic Review.

    PubMed

    Flythe, Jennifer E; Powell, Jill D; Poulton, Caroline J; Westreich, Katherine D; Handler, Lara; Reeve, Bryce B; Carey, Timothy S

    2015-12-01

    Patients with end-stage renal disease (ESRD) receiving dialysis have poor health-related quality of life. Physical symptoms are highly prevalent among dialysis-dependent patients and play important roles in health-related quality of life. A range of symptom assessment tools have been used in dialysis-dependent patients, but there has been no previous systematic assessment of the existing symptom measures' content, validity, and reliability. Systematic review of the literature. Patients with ESRD on maintenance dialysis therapy. Instruments with 3 or more physical symptoms previously used in dialysis-dependent patients and evidence of validity or reliability testing. Patient-reported physical symptom assessment instrument. Instrument symptom-related content, validity, and reliability. From 3,148 screened abstracts, 89 full-text articles were eligible for review. After article exclusion and further article identification by reference reviews, 58 articles on 23 symptom assessment instruments with documented reliability or validity testing were identified. Of the assessment instruments, 43.5% were generic and 56.5% were ESRD specific. Symptoms most frequently assessed were fatigue, shortness of breath, insomnia, nausea and vomiting, and appetite. Instruments varied widely in respondent time burden, recall period, and symptom attributes. Few instruments considered recall periods less than 2 weeks and few assessed a range of symptom attributes. Psychometric testing was completed for congruent validity (70%), known-group validity (25%), responsiveness (30%), internal consistency (78%), and test-retest reliability (65%). Content validity was assessed in dialysis populations in 57% of the 23 instruments. Consideration of physical symptoms only and exclusion of single symptom-focused instruments. The number of available instruments focused exclusively on physical symptoms in dialysis patients is limited. Few symptom-containing instruments have short recall periods, assess

  7. 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.

  8. Melatonin in elderly patients with insomnia. A systematic review.

    PubMed

    Olde Rikkert, M G; Rigaud, A S

    2001-12-01

    Melatonin is a hormone and antioxidant produced by the pineal gland of which four neurobiological roles have been claimed in the aged population: anti-ageing agent; free-radical scavenger; regulator of circadian rhythm; endogeneous sleep-inducer. The "melatonin replacement" hypothesis states that 1) the well-evidenced age-related decline contributes to insomnia and that 2) replacement with physiological doses of melatonin improves sleep. The aim of this review was to determine the evidence for the efficacy of melatonin in elderly insomniacs. MEDLINE's database from 1990-2000 was searched with "melatonin", "geriatrics" and "(frail)-elderly" as major sub-headings. This resulted in 78 articles: only studies with empirical treatment data were reviewed (N = 12). Six reports (abstract, research letter, retrospective case study, 3 open label studies) showed a trend towards efficacy of melatonin: sleep quality improved and in patients with Alzheimer's disease sundowning was reduced. In 6 double blind, randomised crossover trials, a total number of 95 patients (mean ages: 65-79 yrs) were treated. Melatonin doses ranged from 0.5 mg to 6 mg; most took a single dose 30-120 min before bedtime. In 3 studies a slow release form was used. Sleep quality was objectively measured by wrist actigraphy (n = 4) and polysomnography (n = 2), and additionally subjective sleep quality was assessed (n = 2). Sleep latency decreased significantly in 4 studies. In 3 studies other measures of sleep quality (sleep efficiency, total sleep time and wake time during sleep) improved. Subjective sleep quality did not improve. No early-morning sleepiness occurred. Comparison of the studies suggests that melatonin is most effective in elderly insomniacs who chronically use benzodiazepines and/or with documented low melatonin levels during sleep. There is sufficient evidence that low doses of melatonin improve initial sleep quality in selected elderly insomniacs. However, larger randomized controlled

  9. 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

  10. [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.

  11. Patient preferences for cardiovascular preventive medication: a systematic review.

    PubMed

    Albarqouni, Loai; Doust, Jenny; Glasziou, Paul

    2017-10-01

    To systematically review current evidence regarding the minimum acceptable risk reduction of a cardiovascular event that patients feel would justify daily intake of a preventive medication. We used the Web of Science to track the forward and backward citations of a set of five key articles until 15 November 2016. Studies were eligible if they quantitatively assessed the minimum acceptable benefit-in absolute values-of a cardiovascular disease preventive medication among a sample of the general population and required participants to choose if they would consider taking the medication. Of 341 studies screened, we included 22, involving a total of 17 751 participants: 6 studied prolongation of life (POL), 12 studied absolute risk reduction (ARR) and 14 studied number needed to treat (NNT) as measures of risk reduction communicated to the patients. In studies framed using POL, 39%-54% (average: 48%) of participants would consider taking a medication if it prolonged life by <8 months and 56%-73% (average: 64%) if it prolonged life by ≥8 months. In studies framed using ARR, 42%-72% (average: 54%) of participants would consider taking a medication that reduces their 5-year cardiovascular disease (CVD) risk by <3% and 50%-89% (average: 77%) would consider taking a medication that reduces their 5-year CVD risk by ≥3%. In studies framed using 5-year NNT, 31%-81% (average: 60%) of participants would consider taking a medication with an NNT of >30 and 46%-87% (average: 71%) with an NNT of ≤30. Many patients require a substantial risk reduction before they consider taking a daily medication worthwhile, even when the medication is described as being side effect free and costless. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  12. Prognostic Tools in Patients With Advanced Cancer: A Systematic Review.

    PubMed

    Simmons, Claribel P L; McMillan, Donald C; McWilliams, Kerry; Sande, Tonje A; Fearon, Kenneth C; Tuck, Sharon; Fallon, Marie T; Laird, Barry J

    2017-05-01

    In 2005, the European Association for Palliative Care made recommendations for prognostic markers in advanced cancer. Since then, prognostic tools have been developed, evolved, and validated. The aim of this systematic review was to examine the progress in the development and validation of prognostic tools. Medline, Embase Classic and Embase were searched. Eligible studies met the following criteria: patients with incurable cancer, >18 years, original studies, population n ≥100, and published after 2003. Descriptive and quantitative statistical analyses were performed. Forty-nine studies were eligible, assessing seven prognostic tools across different care settings, primary cancer types, and statistically assessed survival prediction. The Palliative Performance Scale was the most studied (n = 21,082), comprising six parameters (six subjective), was externally validated, and predicted survival. The Palliative Prognostic Score composed of six parameters (four subjective and two objective), the Palliative Prognostic Index composed of nine parameters (nine subjective), and the Glasgow Prognostic Score composed of two parameters (two objective) and were all externally validated in more than 2000 patients with advanced cancer and predicted survival. Various prognostic tools have been validated but vary in their complexity, subjectivity, and therefore clinical utility. The Glasgow Prognostic Score would seem the most favorable as it uses only two parameters (both objective) and has prognostic value complementary to the gold standard measure, which is performance status. Further studies comparing all proved prognostic markers in a single cohort of patients with advanced cancer are needed to determine the optimal prognostic tool. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  13. Non-invasive ventilation in postoperative patients: a systematic review.

    PubMed

    Chiumello, D; Chevallard, G; Gregoretti, C

    2011-06-01

    Postoperative pulmonary complications, generally defined as any pulmonary abnormality occurring in the postoperative period, are still a significant issue in clinical practice increasing hospital length of stay, morbidity and mortality. Non-invasive ventilation (NIV), primarily applied in cardiogenic pulmonary edema, decompensated COPD and hypoxemic pulmonary failure, is nowadays also used in perioperative settings. Investigate the application and results of preventive and therapeutic NIV in postsurgical patients. A systematic review. Medical literature databases were searched for articles about "clinical trials," "randomized controlled trials" and "meta-analyses." The keywords "cardiac surgery," "thoracic surgery," "lung surgery," "abdominal surgery," "solid organ transplantation," "thoraco-abdominal surgery" and "bariatric surgery" were combined with any of these: "non-invasive positive pressure ventilation," "continuous positive airway pressure," "bilevel ventilation," "postoperative complications," "postoperative care," "respiratory care," "acute respiratory failure," "acute lung injury" and "acute respiratory distress syndrome." Twenty-nine articles (N=2,279 patients) met the inclusion criteria. Nine studies evaluated NIV in post-abdominal surgery, three in thoracic surgery, eight in cardiac surgery, three in thoraco-abdominal surgery, four in bariatric surgery and two in post solid organ transplantation used both for prophylactic and therapeutic purposes. NIV improved arterial blood gases in 15 of the 22 prophylactic and in 4 of the 7 therapeutic studies, respectively. NIV reduced the intubation rate in 11 of the 29 studies and improved outcome in only 1. Despite these limited data and the necessity of new randomized trials, NIV could be considered as a prophylactic and therapeutic tool to improve gas exchange in postoperative patients. © Copyright jointly held by Springer and ESICM 2011

  14. 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

  15. Patient-experienced burden of treatment in patients with multimorbidity - A systematic review of qualitative data.

    PubMed

    Rosbach, Michael; Andersen, John Sahl

    2017-01-01

    . Findings in this review suggest that the weight of the burden needs to be established in the individual patient and components of the burden must be identified.

  16. Patient education interventions for colorectal cancer patients with stoma: A systematic review.

    PubMed

    Faury, Stéphane; Koleck, Michèle; Foucaud, Jérôme; M'Bailara, Katia; Quintard, Bruno

    2017-10-01

    To describe the various types of patient education interventions for colorectal cancer patients with stoma and to examine their effects on quality of life, psychosocial skills and self-management skills. A systematic review was performed. Six electronic databases were searched. Inclusion criteria were: studies about patient education applying quantitative methods including digestive stoma adults with colorectal cancer. The primary outcome was quality of life. Secondary outcomes were psychosocial and self-management skills. Thirteen studies were identified and included. Five studies examined quality of life and three reported improvements. Patient education improved some psychosocial and self-management skills. Contrasting findings were reported for specific-disease quality of life, emotional distress, length of hospital stay, stoma complications and readmission rate. Patient education has a positive impact on some psychosocial and self-management skills, indicating that this area should be developed. Contrasting findings were reported for quality of life. Methodologies are heterogeneous making it difficult to produce evidence-based guidelines. This article proposes tools to carry out further studies on this subject and to improve understanding. Further education intervention for stoma patients with colorectal cancer should be standardized in terms of intervention, duration and outcome measures to compare intervention and determine best practice. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Feeding the critically ill obese patient: a systematic review protocol.

    PubMed

    Secombe, Paul; Harley, Simon; Chapman, Marianne; Aromataris, Edoardo

    2015-10-01

    The objective of this review is to identify effective enteral nutritional regimens targeting protein and calorie delivery for the critically ill obese patient on morbidity and mortality.More specifically, the review question is:In the critically ill obese patient, what is the optimal enteral protein and calorie target that improves mortality and morbidity? The World Health Organization (WHO) defines obesity as abnormal or excessive fat accumulation that may impair health, or, empirically, as a body mass index (BMI) ≥ 30 kg/m. Twenty-eight percent of the Australian population is obese with the prevalence rising to 44% in rural areas, and there is evidence that rates of obesity are increasing. The prevalence of obese patients in intensive care largely mirrors that of the general population. There is concern, however, that this may also be rising. A recently published multi-center nutritional study of critically ill patients reported a mean BMI of 29 in their sample, suggesting that just under 50% of their intensive care population is obese. It is inevitable, therefore, that the intensivist will care for the critically ill obese patient.Managing the critically ill obese patient is challenging, not least due to the co-morbid diseases frequently associated with obesity, including diabetes mellitus, cardiovascular disease, dyslipidaemia, sleep disordered breathing and respiratory insufficiency, hepatic steatohepatitis, chronic kidney disease and hypertension. There is also evidence that metabolic processes differ in the obese patient, particularly those with underlying insulin resistance, itself a marker of the metabolic syndrome, which may predispose to futile cycling, altered fuel utilization and protein catabolism. These issues are compounded by altered drug pharmacokinetics, and the additional logistical issues associated with prophylactic, therapeutic and diagnostic interventions.It is entirely plausible that the altered metabolic processes observed in the obese

  18. Identifying the most important outcomes for systematic reviews of interventions for rhinosinusitis in adults: working with Patients, Public and Practitioners.

    PubMed

    Hopkins, Claire; Philpott, Carl; Crowe, Sally; Regan, Ssndra; Degun, Aneeka; Papachristou, Iliatha; Schilder, Anne G M

    2016-03-01

    Promoting the assessment of health interventions using outcomes that matter to patients and practitioners is a key principle of Cochrane. Cochrane UK therefore commissioned the OMIPP project: Outcomes that are Most Important for Patients, Public and Practitioners to identify the outcomes they felt most important and should be evaluated in Cochrane reviews of health interventions for Chronic Rhinosinusitis (CRS). Using direct emailing, social media and printed cards, an online survey was distributed to a wide range of people involved in the care of patients with CRS. Patients and practitioners were asked to list the 3 outcomes from treatments most important to them. Responses were analysed through development of a thematic framework based on the data. Two hundred and thirty-five people completed the survey; 155 practitioners and 80 patients. Respondents provided 653 suggestions of important outcomes. 73% concerned symptoms of CRS, (nasal discharge or drip, facial pain, nasal blockage, headache, impaired sense of smell, congestion and breathing difficulties); 9% concerned quality of life, 4% reducing the need for further treatment and 4% side effects of treatment. Objective measurements of disease formed only 3% of responses. There was high level of agreement between patients and practitioners. Of 10 current Cochrane reviews on CRS, 9 include symptomatic outcomes identified by our survey as most important to patients and healthcare practitioners. We have identified outcomes that both patients and their doctors consider should be included in reviews evaluating treatments of rhinosinusitis. We recommend that primary outcomes in future reviews focus on symptom-based outcomes. The ability to extract these data from relevant trials is dependent upon their inclusion in trials, and so it is important that building on this work a core outcome set for rhinosinusitis research is developed.

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

    PubMed

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

    2017-01-01

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

  20. Value versus Use for Patients: Findings from an ICT supported Cystic Fibrosis Self-Management Project.

    PubMed

    Roehrer, Erin; Cummings, Elizabeth; Ellis, Leonie; Turner, Paul

    2015-01-01

    This paper presents findings from the implementation of an online symptom monitoring diary that was part of a broader project aimed to support self-management of cystic fibrosis and the development of an online community of practice (CoP). The findings challenge conventional perspectives on how value is acquired by patients and their families from electronic tools designed to provide them with support. Additionally, the findings highlight complex relationships between user needs and subsequent tool use that challenge approaches to the measurement of value from ehealth projects.

  1. A review of the LATEX project: mesoscale to submesoscale processes in a coastal environment

    NASA Astrophysics Data System (ADS)

    Petrenko, Anne A.; Doglioli, Andrea M.; Nencioli, Francesco; Kersalé, Marion; Hu, Ziyuan; d'Ovidio, Francesco

    2017-03-01

    The main objective of the LAgrangian Transport EXperiment (LATEX) project was to study the influence of coastal mesoscale and submesoscale physical processes on circulation dynamics, cross-shelf exchanges, and biogeochemistry in the western continental shelf of the Gulf of Lion, Northwestern Mediterranean Sea. LATEX was a five-year multidisciplinary project based on the combined analysis of numerical model simulations and multi-platform field experiments. The model component included a ten-year realistic 3D numerical simulation, with a 1 km horizontal resolution over the gulf, nested in a coarser 3 km resolution model. The in situ component involved four cruises, including a large-scale multidisciplinary campaign with two research vessels in 2010. This review concentrates on the physics results of LATEX, addressing three main subjects: (1) the investigation of the mesoscale to submesoscale processes. The eddies are elliptic, baroclinic, and anticyclonic; the strong thermal and saline front is density compensated. Their generation processes are studied; (2) the development of sampling strategies for their direct observations. LATEX has implemented an adaptive strategy Lagrangian tool, with a reference software available on the web, to perform offshore campaigns in a Lagrangian framework; (3) the quantification of horizontal mixing and cross-shelf exchanges. Lateral diffusivity coefficients, calculated in various ways including a novel technique, are in the range classically encountered for their associated scales. Cross-shelf fluxes have been calculated, after retrieving the near-inertial oscillation contribution. Further perspectives are discussed, especially for the ongoing challenge of studying submesoscale features remotely and from in situ data.

  2. A review of the LATEX project: mesoscale to submesoscale processes in a coastal environment

    NASA Astrophysics Data System (ADS)

    Petrenko, Anne A.; Doglioli, Andrea M.; Nencioli, Francesco; Kersalé, Marion; Hu, Ziyuan; d'Ovidio, Francesco

    2017-04-01

    The main objective of the LAgrangian Transport EXperiment (LATEX) project was to study the influence of coastal mesoscale and submesoscale physical processes on circulation dynamics, cross-shelf exchanges, and biogeochemistry in the western continental shelf of the Gulf of Lion, Northwestern Mediterranean Sea. LATEX was a five-year multidisciplinary project based on the combined analysis of numerical model simulations and multi-platform field experiments. The model component included a ten-year realistic 3D numerical simulation, with a 1 km horizontal resolution over the gulf, nested in a coarser 3 km resolution model. The in situ component involved four cruises, including a large-scale multidisciplinary campaign with two research vessels in 2010. This review concentrates on the physics results of LATEX, addressing three main subjects: (1) the investigation of the mesoscale to submesoscale processes. The eddies are elliptic, baroclinic, and anticyclonic; the strong thermal and saline front is density compensated. Their generation processes are studied; (2) the development of sampling strategies for their direct observations. LATEX has implemented an adaptive strategy Lagrangian tool, with a reference software available on the web, to perform offshore campaigns in a Lagrangian framework; (3) the quantification of horizontal mixing and cross-shelf exchanges. Lateral diffusivity coefficients, calculated in various ways including a novel technique, are in the range classically encountered for their associated scales. Cross-shelf fluxes have been calculated, after retrieving the near-inertial oscillation contribution. Further perspectives are discussed, especially for the ongoing challenge of studying submesoscale features remotely and from in situ data.

  3. Additionality and permanence standards in California's Forest Offset Protocol: A review of project and program level implications.

    PubMed

    Ruseva, T; Marland, E; Szymanski, C; Hoyle, J; Marland, G; Kowalczyk, T

    2017-08-01

    A key component of California's cap-and-trade program is the use of carbon offsets as compliance instruments for reducing statewide GHG emissions. Under this program, offsets are tradable credits representing real, verifiable, quantifiable, enforceable, permanent, and additional reductions or removals of GHG emissions. This paper focuses on the permanence and additionality standards for offset credits as defined and operationalized in California's Compliance Offset Protocol for U.S. Forest Projects. Drawing on a review of the protocol, interviews, current offset projects, and existing literature, we discuss how additionality and permanence standards relate to project participation and overall program effectiveness. Specifically, we provide an overview of offset credits as compliance instruments in California's cap-and-trade program, the timeline for a forest offset project, and the factors shaping participation in offset projects. We then discuss the implications of permanence and additionality at both the project and program levels. Largely consistent with previous work, we find that stringent standards for permanent and additional project activities can present barriers to participation, but also, that there may be a trade-off between project quality and quantity (i.e. levels of participation) when considering overall program effectiveness. We summarize what this implies for California's forest offset program and provide suggestions for improvements in light of potential program diffusion and policy learning. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. 18 CFR 401.35 - Classification of projects for review under Section 3.8 of the Compact.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 18 Conservation of Power and Water Resources 2 2010-04-01 2010-04-01 false Classification of projects for review under Section 3.8 of the Compact. 401.35 Section 401.35 Conservation of Power and Water... within the Basin except the Delaware River and tidal portions of tributaries thereto, and streams...

  5. 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

    ... 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 Water... within the Basin except the Delaware River and tidal portions of tributaries thereto, and streams...

  6. 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

    ... 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 Water... within the Basin except the Delaware River and tidal portions of tributaries thereto, and streams...

  7. 18 CFR 401.35 - Classification of projects for review under Section 3.8 of the Compact.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 18 Conservation of Power and Water Resources 2 2011-04-01 2011-04-01 false Classification of projects for review under Section 3.8 of the Compact. 401.35 Section 401.35 Conservation of Power and Water... within the Basin except the Delaware River and tidal portions of tributaries thereto, and streams...

  8. An Evaluative Review of Uses of Computers in Instruction, Project CLUE (Computer Learning Under Evaluation). Final Report.

    ERIC Educational Resources Information Center

    Zinn, Karl L.

    Project CLUE (Computer Learning Under Evaluation) was an extensive review of the state of the art of the instructional uses of computers. Students, laymen, administrators and teachers will find the first volume of the two volume final report directed to their needs. The introduction discusses the scope of computer uses considered and a timetable…

  9. 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…

  10. 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

    ... and approval of project planning and design documents submitted by the Self-Governance Tribe? 137.365... SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES TRIBAL SELF-GOVERNANCE Construction Roles of the...-Governance Tribe? (a) The Secretary shall review and approve planning documents to ensure compliance...

  11. 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

    ... and approval of project planning and design documents submitted by the Self-Governance Tribe? 137.365... SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES TRIBAL SELF-GOVERNANCE Construction Roles of the...-Governance Tribe? (a) The Secretary shall review and approve planning documents to ensure compliance...

  12. 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

    ... and approval of project planning and design documents submitted by the Self-Governance Tribe? 137.365... SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES TRIBAL SELF-GOVERNANCE Construction Roles of the...-Governance Tribe? (a) The Secretary shall review and approve planning documents to ensure compliance...

  13. 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

    ... and approval of project planning and design documents submitted by the Self-Governance Tribe? 137.365... SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES TRIBAL SELF-GOVERNANCE Construction Roles of the...-Governance Tribe? (a) The Secretary shall review and approve planning documents to ensure compliance...

  14. 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

    ... and approval of project planning and design documents submitted by the Self-Governance Tribe? 137.365... SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES TRIBAL SELF-GOVERNANCE Construction Roles of the...-Governance Tribe? (a) The Secretary shall review and approve planning documents to ensure compliance...

  15. Patterns, Processes of Growth, and the Projection of Library Size: A Critical Review of the Literature on Academic Library Growth.

    ERIC Educational Resources Information Center

    Molyneux, Robert E.

    1986-01-01

    Reviews studies done on academic library growth in attempt to clarify three reasons for failure of these analyses to result in usable projections of library size. Highlights include patterns in library growth (hypothetical exponential and arithmetic growth), Fremont Rider's studies of growth, and literature on growth after Rider. (28 references)…

  16. The Hunters Point-Bayview SEED Project: A Diagnostic Review of Reading Achievement in the First Three Grades.

    ERIC Educational Resources Information Center

    Counelis, James Steve

    A diagnostic review of reading achiev