Post-operative fatal blood aspiration after routine lung surgery.

PubMed

Plenzig, Stefanie; Soriano, Mauricio; Held, Hannelore; Verhoff, Marcel A

2017-08-01

A routine question encountered in medicolegal practice is whether the death of a patient in proximity to a surgical procedure is due to medical malpractice. The case of a 62-year-old man who died two weeks after undergoing a VATS sleeve resection of the upper right lung lobe in conjunction with radical lymphadenectomy, a routine surgical procedure, is reported. To address the issue of medical malpractice, a forensic autopsy was ordered by the investigative authority. During the autopsy, the lungs were removed as a whole and fixed in formalin and were later dissected in cooperation with a thoracic surgeon. In the course of this dissection, a bronchovascular fistula, which had led to the occlusion of the bronchial system with clotted blood, was discovered. Bronchovascular fistulas are a rare complication of bronchial sleeve resections. Because this surgical complication is essentially always fatal, it is highly pertinent to medicolegal practice. The presented case report also lists other important complications associated with bronchial anastomosis and elucidates a pragmatic approach to obtaining an expert clinical assessment of possible medical malpractice after operations through the example of a dissection performed in cooperation with a thoracic surgeon. Copyright © 2017 Elsevier B.V. All rights reserved.

Anesthesiologists' and surgeons' perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians' decisions to order pre-operative tests.

PubMed

Patey, Andrea M; Islam, Rafat; Francis, Jill J; Bryson, Gregory L; Grimshaw, Jeremy M

2012-06-09

Routine pre-operative tests for anesthesia management are often ordered by both anesthesiologists and surgeons for healthy patients undergoing low-risk surgery. The Theoretical Domains Framework (TDF) was developed to investigate determinants of behaviour and identify potential behaviour change interventions. In this study, the TDF is used to explore anaesthesiologists' and surgeons' perceptions of ordering routine tests for healthy patients undergoing low-risk surgery. Sixteen clinicians (eleven anesthesiologists and five surgeons) throughout Ontario were recruited. An interview guide based on the TDF was developed to identify beliefs about pre-operative testing practices. Content analysis of physicians' statements into the relevant theoretical domains was performed. Specific beliefs were identified by grouping similar utterances of the interview participants. Relevant domains were identified by noting the frequencies of the beliefs reported, presence of conflicting beliefs, and perceived influence on the performance of the behaviour under investigation. Seven of the twelve domains were identified as likely relevant to changing clinicians' behaviour about pre-operative test ordering for anesthesia management. Key beliefs were identified within these domains including: conflicting comments about who was responsible for the test-ordering (Social/professional role and identity); inability to cancel tests ordered by fellow physicians (Beliefs about capabilities and social influences); and the problem with tests being completed before the anesthesiologists see the patient (Beliefs about capabilities and Environmental context and resources). Often, tests were ordered by an anesthesiologist based on who may be the attending anesthesiologist on the day of surgery while surgeons ordered tests they thought anesthesiologists may need (Social influences). There were also conflicting comments about the potential consequences associated with reducing testing, from negative (delay or cancel patients' surgeries), to indifference (little or no change in patient outcomes), to positive (save money, avoid unnecessary investigations) (Beliefs about consequences). Further, while most agreed that they are motivated to reduce ordering unnecessary tests (Motivation and goals), there was still a report of a gap between their motivation and practice (Behavioural regulation). We identified key factors that anesthesiologists and surgeons believe influence whether they order pre-operative tests routinely for anesthesia management for a healthy adults undergoing low-risk surgery. These beliefs identify potential individual, team, and organisation targets for behaviour change interventions to reduce unnecessary routine test ordering.

What is the value of routinely testing full blood count, electrolytes and urea, and pulmonary function tests before elective surgery in patients with no apparent clinical indication and in subgroups of patients with common comorbidities: a systematic review of the clinical and cost-effective literature.

PubMed

Czoski-Murray, C; Lloyd Jones, M; McCabe, C; Claxton, K; Oluboyede, Y; Roberts, J; Nicholl, J P; Rees, A; Reilly, C S; Young, D; Fleming, T

2012-12-01

The evidence base which supported the National Institute for Health and Clinical Excellence (NICE) published Clinical Guideline 3 was limited and 50% was graded as amber. However, the use of tests as part of pre-operative work-up remains a low-cost but high-volume activity within the NHS, with substantial resource implications. The objective of this study was to identify, evaluate and synthesise the published evidence on the clinical effectiveness and cost-effectiveness of the routine use of three tests, full blood counts (FBCs), urea and electrolytes tests (U&Es) and pulmonary function tests, in the pre-operative work-up of otherwise healthy patients undergoing minor or intermediate surgery in the NHS. The aims of this study were to estimate the clinical effectiveness and cost-effectiveness of routine pre-operative testing of FBC, electrolytes and renal function and pulmonary function in adult patients classified as American Society of Anaesthesiologists (ASA) grades 1 and 2 undergoing elective minor (grade 1) or intermediate (grade 2) surgical procedures; to compare NICE recommendations with current practice; to evaluate the cost-effectiveness of mandating or withdrawing each of these tests in this patient group; and to identify the expected value of information and whether or not it has value to the NHS in commissioning further primary research into the use of these tests in this group of patients. The following electronic bibliographic databases were searched: (1) BIOSIS; (2) Cumulative Index to Nursing and Allied Health Literature; (3) Cochrane Database of Systematic Reviews; (4) Cochrane Central Register of Controlled Trials; (5) EMBASE; (6) MEDLINE; (7) MEDLINE In-Process & Other Non-Indexed Citations; (8) NHS Database of Abstracts of Reviews of Effects; (9) NBS Health Technology Assessment Database; and (10) Science Citation Index. To identify grey and unpublished literature, the Cochrane Register of Controlled Trials, National Research Register Archive, National Institute for Health Research Clinical Research Network Portfolio database and the Copernic Meta-search Engine were searched. A large routine data set which recorded the results of tests was obtained from Leeds Teaching Hospitals Trust. A systematic review of the literature was carried out. The searches were undertaken in March to April 2008 and June 2009. Searches were designed to retrieve studies that evaluated the clinical effectiveness and cost-effectiveness of routine pre-operative testing of FBC, electrolytes and renal function and pulmonary function in the above group of patients. A postal survey of current practice in testing patients in this group pre-operatively was undertaken in 2008. An exemplar cost-effectiveness model was constructed to demonstrate what form this would have taken had there been sufficient data. A large routine data set that recorded the results of tests was obtained from Leeds Teaching Hospitals Trust. This was linked to individual patient data with surgical outcomes, and regression models were estimated. A comprehensive and systematic search of both the clinical effectiveness and cost-effectiveness literature identified a large number of potentially relevant studies. However, when these studies were subjected to detailed review and quality assessment, it became clear that the literature provides no evidence on the clinical effectiveness and cost-effectiveness of these specific tests in the specific patient groups. The postal survey had a 17% response rate. Results reported that in ASA grade 1, patients aged < 40 years with no comorbidities undergoing minor surgery did not have routine tests for FBC, electrolytes and renal function and pulmonary function. The results from the regression model showed that the frequency of test use was not consistent with the hypothesis of their routine use. FBC tests were performed in only 58% of patients in the data set and U&E testing was carried out in only 57%. Systematic searches of the clinical effectiveness and cost-effectiveness literature found that there is no evidence on the clinical effectiveness or cost-effectiveness of these tests in this specific clinical context for the NHS. A survey of NHS hospitals found that respondent trusts were implementing current NICE guidance in relation to pre-operative testing generally, and a de novo analysis of routine data on test utilisation and post-operative outcome found that the tests were not be used in routine practice; rather, use was related to an expectation of a more complex clinical case. The paucity of published evidence is a limitation of this study. The studies included relied on non-UK health-care systems data, which may not be transferable. The inclusion of non-randomised studies is associated with an increased risk of bias and confounding. Scoping work to establish the likely mechanism of action by which tests would impact upon outcomes and resource utilisation established that the cause of an abnormal test result is likely to be a pivotal determinant of the cost-effectiveness of a pre-operative test and therefore evaluations would need to consider tests in the context of the underlying risk of specific clinical problems (i.e. risk guided rather than routine use). The time of universal utilisation of pre-operative tests for all surgical patients is likely to have passed. The evidence we have identified, though weak, indicates that tests are increasingly utilised in patients in whom there is a reason to consider an underlying raised risk of a clinical abnormality that should be taken into account in their clinical management. It is likely that this strategy has led to substantial resource savings for the NHS, although there is not a published evidence base to establish that this is the case. The total expenditure on pre-operative tests across the NHS remains significant. Evidence on current practice indicates that clinical practice has changed to such a degree that the original research question is no longer relevant to UK practice. Future research on the value of these tests in pre-operative work-up should be couched in terms of the clinical effectiveness and cost-effectiveness in the identification of specific clinical abnormalities in patients with a known underlying risk. We suggest that undertaking a multicentre study making use of linked, routinely collected data sets would identify the extent and nature of pre-operative testing in this group of patients. The National Institute for Health Research Health Technology Assessment programme.

Practical Applications of Data Processing to School Purchasing.

ERIC Educational Resources Information Center

California Association of School Business Officials, San Diego. Imperial Section.

Electronic data processing provides a fast and accurate system for handling large volumes of routine data. If properly employed, computers can perform myriad functions for purchasing operations, including purchase order writing; equipment inventory control; vendor inventory; and equipment acquisition, transfer, and retirement. The advantages of…

40 CFR 63.2250 - What are the general requirements?

Code of Federal Regulations, 2012 CFR

2012-07-01

..., except during periods of process unit or control device startup, shutdown, and malfunction; prior to process unit initial startup; and during the routine control device maintenance exemption specified in... practice requirements are not operating, or during periods of startup, shutdown, and malfunction. Startup...

40 CFR 63.2250 - What are the general requirements?

Code of Federal Regulations, 2013 CFR

2013-07-01

..., except during periods of process unit or control device startup, shutdown, and malfunction; prior to process unit initial startup; and during the routine control device maintenance exemption specified in... practice requirements are not operating, or during periods of startup, shutdown, and malfunction. Startup...

40 CFR 63.2250 - What are the general requirements?

Code of Federal Regulations, 2014 CFR

2014-07-01

..., except during periods of process unit or control device startup, shutdown, and malfunction; prior to process unit initial startup; and during the routine control device maintenance exemption specified in... practice requirements are not operating, or during periods of startup, shutdown, and malfunction. Startup...

The impact of routine histopathological examination on cholecystectomy specimens from an Asian demographic

PubMed Central

Chin, KF; Mohammad, AA; Khoo, YY; Krishnasamy, T

2012-01-01

INTRODUCTION Most gallbladder carcinoma cases are suspected pre-operatively or intra-operatively. In Malaysia histopathological examination of cholecystectomy specimens has become routine practice. The aim of this study was to assess the impact of routine histological examinations on cholecystectomy specimens from an Asian demographic, which may differ from a Caucasian demographic. METHODS A retrospective study was performed of all histopathoiogy reports for choiecystectomies (Iaparoscopic and open) undertaken over a period of 12 years (1997-2008) in a single teaching hospital. RESULTS A total of 1,375 gallbladder specimens were sent for histopathological analysis, with 7 (0.5%) being reported as malignant while only three (0.2%) were found to contain primary gallbladder carcinoma. Other premalignant findings included two specimens with dyspiastic changes of the mucosa and one tubuioviiious adenoma with a dyspiastic epithelium. From the ten malignant and premalignant specimens, seven were diagnosed pre-operatively, two were suspected intra-operatively and one was diagnosed with dyspiastic changes on the histopathoiogy report post-operatively. CONCLUSIONS This study supports earlier research carried out in the UK and the demographic difference does not affect the impact of the histology examination on cholecystectomy specimens in diagnosing this disease. A selective policy is recommended in Malaysia. PMID:22507719

Clinical Space Medicine Panel

NASA Technical Reports Server (NTRS)

Baisden, Denise L.; Billica, Roger (Technical Monitor)

2000-01-01

The practice of space medicine is diverse. It includes routine preventive medical care of astronauts and pilots, the development of inflight medical capability and training of flight crews as well as the preflight, inflight, and postflight medical assessment and monitoring. The Johnson Space Center Medical Operations Branch is a leader in the practice of space medicine. The papers presented in this panel will demonstrate some of the unique aspects of space medicine.

Optical-Fiber-Welding Machine

NASA Technical Reports Server (NTRS)

Goss, W. C.; Mann, W. A.; Goldstein, R.

1985-01-01

Technique yields joints with average transmissivity of 91.6 percent. Electric arc passed over butted fiber ends to melt them together. Maximum optical transmissivity of joint achieved with optimum choice of discharge current, translation speed, and axial compression of fibers. Practical welding machine enables delicate and tedious joining operation performed routinely.

Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests

PubMed Central

2012-01-01

Background Routine pre-operative tests for anesthesia management are often ordered by both anesthesiologists and surgeons for healthy patients undergoing low-risk surgery. The Theoretical Domains Framework (TDF) was developed to investigate determinants of behaviour and identify potential behaviour change interventions. In this study, the TDF is used to explore anaesthesiologists’ and surgeons’ perceptions of ordering routine tests for healthy patients undergoing low-risk surgery. Methods Sixteen clinicians (eleven anesthesiologists and five surgeons) throughout Ontario were recruited. An interview guide based on the TDF was developed to identify beliefs about pre-operative testing practices. Content analysis of physicians’ statements into the relevant theoretical domains was performed. Specific beliefs were identified by grouping similar utterances of the interview participants. Relevant domains were identified by noting the frequencies of the beliefs reported, presence of conflicting beliefs, and perceived influence on the performance of the behaviour under investigation. Results Seven of the twelve domains were identified as likely relevant to changing clinicians’ behaviour about pre-operative test ordering for anesthesia management. Key beliefs were identified within these domains including: conflicting comments about who was responsible for the test-ordering (Social/professional role and identity); inability to cancel tests ordered by fellow physicians (Beliefs about capabilities and social influences); and the problem with tests being completed before the anesthesiologists see the patient (Beliefs about capabilities and Environmental context and resources). Often, tests were ordered by an anesthesiologist based on who may be the attending anesthesiologist on the day of surgery while surgeons ordered tests they thought anesthesiologists may need (Social influences). There were also conflicting comments about the potential consequences associated with reducing testing, from negative (delay or cancel patients’ surgeries), to indifference (little or no change in patient outcomes), to positive (save money, avoid unnecessary investigations) (Beliefs about consequences). Further, while most agreed that they are motivated to reduce ordering unnecessary tests (Motivation and goals), there was still a report of a gap between their motivation and practice (Behavioural regulation). Conclusion We identified key factors that anesthesiologists and surgeons believe influence whether they order pre-operative tests routinely for anesthesia management for a healthy adults undergoing low-risk surgery. These beliefs identify potential individual, team, and organisation targets for behaviour change interventions to reduce unnecessary routine test ordering. PMID:22682612

The bacteriology of children prior to 1st stage autologous ear reconstruction.

PubMed

Eley, Karen A; Gault, David T

2010-12-01

In virtually all surgical specialities the use of peri-operative antibiotic prophylaxis to minimise wound site infection is routine practice. Antibiotic selection is targeted towards the pathogens most commonly encountered at the surgical site. The surgical management of microtia is by autologous rib cartilage reconstruction, a process that involves at least two surgical stages. The pits and recesses of the microtia ear are difficult to clean and may shelter unusual pathogens not routinely found as skin commensals, requiring modified prophylaxis. This retrospective review of 37 patients undergoing 1st stage ear reconstruction, examines the pre-operative ear site, nose and throat swabs to determine the common pre-operative bacteria encountered in children prior to ear reconstruction, to aid in appropriate antibiotic selection. Copyright © 2010 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Check radiography after fixation of hip fractures: is it necessary?

PubMed

Mohanty, K; Gupta, S K; Evans, R M

2000-12-01

Technological advances in radiography in the form of image intensification has not only made internal fixation of femoral neck fracture much easier but these high resolution films can be saved as hard copies and can also be reversed into 'positives' at a later date. However, requesting routine post-operative check radiographs for these fractures are still a common practice. A retrospective study was carried out to compare the quality of image intensifier films with conventional post-operative radiographs. 79 sets of films were reviewed with particular reference to adequacy of fixation and possible joint penetration by the screws. No significant difference was noted between the two sets of films. We suggest that routine post-operative radiographs after femoral neck fracture fixation are unnecessary unless there is some clinical indication. This has significant implications in relation to patient discomfort, radiation exposure and cost-effectiveness.

Management of asthma in Australian general practice: care is still not in line with clinical practice guidelines.

PubMed

Barton, Christopher; Proudfoot, Judith; Amoroso, Cheryl; Ramsay, Emmae; Holton, Christine; Bubner, Tanya; Harris, Mark; Beilby, Justin

2009-06-01

We investigated the quality of primary care asthma management in a sample of Australian general practices. 247 general practitioners (GPs) from 97 practices completed a structured interview about management of asthma, diabetes and hypertension/heart disease. A further structured interview with the senior practice principal and practice manager was used to collect information about practice capacity for chronic disease management. Just under half of GPs (47%) had access to an asthma register and the majority (76%) had access to spirometry in their practice. In terms of routine management of asthma, 12% of GPs reported using spirometry routinely, 13% routinely reviewed written asthma action plans, 27% routinely provided education about trigger factors, 30% routinely reviewed inhaler technique, 24% routinely assessed asthma severity, and 29% routinely assessed physical activity. Practice characteristics such as practice size (p=1.0) and locality (rural/metropolitan) (p=0.7) did not predict quality of asthma management nor did indicators of practice capacity including Business maturity, IT/IM maturity, Multidisciplinary teamwork, and Clinical linkages. Gaps remain in the provision of evidence-based care for patients with asthma in general practice. Markers of practice capacity measured here were not associated with guideline-based respiratory care within practices.

Ankle fracture syndesmosis fixation and management: the current practice of orthopedic surgeons.

PubMed

Bava, Eric; Charlton, Timothy; Thordarson, David

2010-05-01

There is a wide variety of treatments for disruption of the syndesmosis. There is also controversy as to which device should be used for fixation of the syndesmosis, how many devices should be used, how many cortices the screws should engage, and whether, when, and where the screws should be removed. We conducted a study to determine how orthopedic surgeons manage these injuries. In a survey, we asked orthopedic trauma and foot and ankle fellowship directors and members of the Orthopaedic Trauma Association and the American Orthopaedic Foot and Ankle Society how they routinely treated the syndesmotic injury component of Danis-Weber type C or Lauge-Hansen pronation-external rotation type IV ankle fractures. The overall response rate was 50% (77/153). Fifty-one percent of respondents routinely used 3.5-mm cortical screws, 24% routinely used 4.5-mm cortical screws, and 14% routinely used a suture fixation device. Forty-four percent of respondents routinely used 1 screw, 44% routinely used 2 screws, and the rest were undecided between 1 and 2 screws. Twenty-nine percent of respondents engaged 3 cortices with syndesmotic screws, and 67% engaged 4 cortices. Syndesmotic screws were routinely removed 65% of the time and left in place 35% of the time. Routine removal of syndesmotic screws was done in the operating room in 95% of cases; it was done at 3 months in 49% of cases, at 4 months in 37%, and at 6 months in 12%. The most common method for treating syndesmotic injuries was through use of 3.5-mm screws engaging 4 cortices routinely removed in the operating room at 3 months. Number of screws used to fix the syndesmosis, either 1 or 2, was evenly split.

The significance of routines in nursing practice.

PubMed

Rytterström, Patrik; Unosson, Mitra; Arman, Maria

2011-12-01

The aim of this study was to illuminate the significance of routines in nursing practice. Clinical nursing is performed under the guidance of routines to varying degrees. In the nursing literature, routine is described as having both negative and positive aspects, but use of the term is inconsistent, and empirical evidence is sparse. In the research on organisational routines, a distinction is made between routine as a rule and routine as action. A qualitative design using a phenomenological-hermeneutic approach. Data collection from three focus groups focused on nurses' experience of routines. Seventeen individual interviews from a previous study focusing on caring culture were also analysed in a secondary qualitative analysis. All participants were employed as 'qualified nursing pool' nurses. Routines are experienced as pragmatic, obstructive and meaningful. The aim of the pragmatic routine was to ensure that daily working life works; this routine is practised more on the basis of rational arguments and obvious intentions. The obstructive routine had negative consequences for nursing practice and was described as nursing losing its humanity and violating the patient's integrity. The meaningful routine involved becoming one with the routine and for the nurses, it felt right and meaningful to adapt to it. Routines become meaningful when the individual action is in harmony with the cultural pattern on which the nursing work is based. Instead of letting contemporary practice passively become routine, routines can be assessed and developed using research and theoretical underpinnings as a starting point for nursing practice. Leaders have a special responsibility to develop and support meaningful routines. One approach could be to let wards examine their routines from a patient perspective on the basis of the themes of pragmatic, meaningful and obstructive routine. © 2010 Blackwell Publishing Ltd.

Prosthetists' perceptions and use of outcome measures in clinical practice: Long-term effects of focused continuing education.

PubMed

Hafner, Brian J; Spaulding, Susan E; Salem, Rana; Morgan, Sara J; Gaunaurd, Ignacio; Gailey, Robert

2017-06-01

Continuing education is intended to facilitate clinicians' skills and knowledge in areas of practice, such as administration and interpretation of outcome measures. To evaluate the long-term effect of continuing education on prosthetists' confidence in administering outcome measures and their perceptions of outcomes measurement in clinical practice. Pretest-posttest survey methods. A total of 66 prosthetists were surveyed before, immediately after, and 2 years after outcomes measurement education and training. Prosthetists were grouped as routine or non-routine outcome measures users, based on experience reported prior to training. On average, prosthetists were just as confident administering measures 1-2 years after continuing education as they were immediately after continuing education. In all, 20% of prosthetists, initially classified as non-routine users, were subsequently classified as routine users at follow-up. Routine and non-routine users' opinions differed on whether outcome measures contributed to efficient patient evaluations (79.3% and 32.4%, respectively). Both routine and non-routine users reported challenges integrating outcome measures into normal clinical routines (20.7% and 45.9%, respectively). Continuing education had a long-term impact on prosthetists' confidence in administering outcome measures and may influence their clinical practices. However, remaining barriers to using standardized measures need to be addressed to keep practitioners current with evolving practice expectations. Clinical relevance Continuing education (CE) had a significant long-term impact on prosthetists' confidence in administering outcome measures and influenced their clinical practices. In all, approximately 20% of prosthetists, who previously were non-routine outcome measure users, became routine users after CE. There remains a need to develop strategies to integrate outcome measurement into routine clinical practice.

Clinical trials finance and operations.

PubMed

O'Brien, Jennifer A

2007-01-01

The National Coverage Decision of 2000 was designed to enhance the participation in clinical trials for both patients and physicians by mandating the governmental coverage for services in a clinical trial that are considered "routine" regardless of the trial. Participation in clinical trials can be a practice builder as well as a contribution to the betterment of medical science. Without proper coverage analysis, study budgeting, accurate time estimates, and effective negotiation prior to signing the contract, participation in clinical trials can cost a practice rather than benefit it.

A case study of field-scale maize irrigation patterns in western Nebraska: implications for water managers and recommendations for hyper-resolution land surface modeling

NASA Astrophysics Data System (ADS)

Gibson, Justin; Franz, Trenton E.; Wang, Tiejun; Gates, John; Grassini, Patricio; Yang, Haishun; Eisenhauer, Dean

2017-02-01

In many agricultural regions, the human use of water for irrigation is often ignored or poorly represented in land surface models (LSMs) and operational forecasts. Because irrigation increases soil moisture, feedback on the surface energy balance, rainfall recycling, and atmospheric dynamics is not represented and may lead to reduced model skill. In this work, we describe four plausible and relatively simple irrigation routines that can be coupled to the next generation of hyper-resolution LSMs operating at scales of 1 km or less. The irrigation output from the four routines (crop model, precipitation delayed, evapotranspiration replacement, and vadose zone model) is compared against a historical field-scale irrigation database (2008-2014) from a 35 km2 study area under maize production and center pivot irrigation in western Nebraska (USA). We find that the most yield-conservative irrigation routine (crop model) produces seasonal totals of irrigation that compare well against the observed irrigation amounts across a range of wet and dry years but with a low bias of 80 mm yr-1. The most aggressive irrigation saving routine (vadose zone model) indicates a potential irrigation savings of 120 mm yr-1 and yield losses of less than 3 % against the crop model benchmark and historical averages. The results of the various irrigation routines and associated yield penalties will be valuable for future consideration by local water managers to be informed about the potential value of irrigation saving technologies and irrigation practices. Moreover, the routines offer the hyper-resolution LSM community a range of irrigation routines to better constrain irrigation decision-making at critical temporal (daily) and spatial scales (< 1 km).

Autoclave performance and practitioner knowledge of autoclave use: a survey of selected UK practices.

PubMed

Burke, F J; Coulter, W A; Cheung, S W; Palenik, C J

1998-04-01

It is essential that the dental surgery autoclave be tested regularly to ensure that it is operating at a temperature and pressure that will kill all microorganisms. The aims of this study were to investigate the knowledge of general dental practitioners on aspects of autoclave use, to examine their autoclaving routines, and to test the effectiveness of the sterilization cycle of their practice's autoclave. A 35-question questionnaire was distributed to 840 dental practitioners in the United Kingdom. They were also sent three spore test ampules with details of their function and instructions on their use. The practitioners were asked to use the spore test ampules in their own practice's autoclave and to return these for testing. Four hundred one questionnaires and associated spore test ampules were returned for analysis, a 47.7% response rate. Eight practice autoclaves (2.0%) failed to sterilize the spores. These practices were offered a retest following counseling. A total of 77.8% of respondents had received formal training in infection control. Of the 71.3% of respondents who stated that they check the performance of their autoclave routinely, 31.5% use a chemical strip every cycle, 17.5% use it once per day, and 30.4% use it once per week. However, only five respondents (1.2%) use a spore test; two of these respondents use it every cycle, one once per day, and two once per week. Further education of practitioners may be necessary to enhance their awareness of the need for routine checking of autoclave effectiveness.

[Basic research in traumatology and its contribution to routine operation].

PubMed

Hausner, T; Redl, H

2017-02-01

Basic research in traumatology supports the clinical outcome of patients in trauma care and tries to find science-based solutions for clinical problems. Furthermore, institutions for basic research in traumatology usually offer training in different skills, such as how to write a scientific paper, or practice in microsurgery or intubation. Two examples of clinically significant research topics are presented.

[Equipment qualification].

PubMed

Le Vacon, F

2005-06-01

The qualification of the equipment is a particularly important stage in the transfusional process. On the one hand, of many standards such as those of certification or that of accreditation require it, just as the good transfusional practices; in addition, the practices of steps of quality assurance develop this aspect. Indeed, the absence of the realization of this qualification of material having an influence on the finished product, can lead to an error in the product. This qualification passes by various stages of which some are major such as the drafting of the schedule of conditions, the drafting of the operational protocol of qualification, the decision made for the setting in routine. Finally so that this qualification takes all its dimensions it is necessary to carry out methods linked to the international system of measurement. Moreover certain questions after reflexions must find response such as which unit to check, and only this one, the equipment is - it a complex one, is there a maintenance contract? Once all these elements taken into account, the questions having found their answer, the operational protocol will then well be built, the decisions of settings in routine could be done and the sets of the finalized stages.

Translation of Real-Time Infectious Disease Modeling into Routine Public Health Practice

PubMed Central

Chughtai, Abrar A.; Heywood, Anita; Gardner, Lauren M.; Heslop, David J.; MacIntyre, C. Raina

2017-01-01

Infectious disease dynamic modeling can support outbreak emergency responses. We conducted a workshop to canvas the needs of stakeholders in Australia for practical, real-time modeling tools for infectious disease emergencies. The workshop was attended by 29 participants who represented government, defense, general practice, and academia stakeholders. We found that modeling is underused in Australia and its potential is poorly understood by practitioners involved in epidemic responses. The development of better modeling tools is desired. Ideal modeling tools for operational use would be easy to use, clearly indicate underlying parameterization and assumptions, and assist with policy and decision making. PMID:28418309

Towards routine measurements of meteorological and aerosol parameters using small unmanned aerial and tethered balloon systems

NASA Astrophysics Data System (ADS)

Mei, F.; Dexheimer, D.; Hubbe, J. M.; deBoer, G.; Schmid, B.; Ivey, M.; Longbottom, C.; Carroll, P.

2017-12-01

The Inaugural Campaigns for ARM Research using Unmanned Systems (ICARUS) had been launched in 2016 and then the effort has been continued in 2017. ICARUS centered on Oliktok Point, Alaska focusses on developing routine operations of Unmanned Aerial Systems (UAS) and Tethered Balloon Systems (TBS). The operation routine practiced during ICARUS 2016 provided valuable guidance for the ICARUS 2017 deployment. During two intensive operation periods in 2017, a small DataHawk II UAS has been deployed to collect data for two weeks each in May and August. Coordinated with DataHawk flights, the TBS has been launched with meteorology sensors such as iMet and Tethersondes, therefore vertical profiles of the basic atmospheric state (temperature, humidity, and horizontal wind) were observed simultaneously by UAS and TBS. In addition, an aerosol payload was attached and launched with 2 TBS flights in April and 7 TBS flights in May, which include a condensation particle counter (CPC, TSI 3007) and two printed optical particle spectrometers (POPS, Handix TBS version). The two POPS were operated at different inlet temperatures. This approach provided potential measurements for aerosol optical closure in future. Measured aerosol properties include total particle number concentrations, particle size distribution, at different ambient temperature and relative humidity. Vertical profiles of atmospheric state and aerosol properties will be discussed based on the coordinated flights. Monthly variation will be assessed with data from the upcoming August flights.

The use of fixed appliances in the UK: a survey of specialist orthodontists.

PubMed

Banks, Phil; Elton, Victoria; Jones, Yvonne; Rice, Peter; Derwent, Serena; Odondi, Lang'o

2010-03-01

To investigate the use of fixed appliances in the UK. Prospective postal questionnaire. UK. All members of the General Dental Council Specialist List in Orthodontics still in active practice and not in training posts. A preemptive letter of explanation was sent inviting orthodontists to participate in the survey. The questionnaire was subsequently posted to 935 specialists. Data analysis investigated differences in clinical practice related to varying provider groups, level of operator experience and geographical region. The response rate achieved was 66.3%. A majority of orthodontists routinely used the 0.022 inch pre-adjusted edgewise system, standard size Siamese pattern stainless steel brackets, conventionally ligated and bonded using standard etch and light cured composite. Nickel titanium and stainless steel were the most popular archwire materials. Anchorage was supported routinely by palatal and lingual arches in up to 25% and by headgear in over a third of respondents. Newer innovations showed variable popularity. Self-etching primer was used routinely by one-third of respondents with 11% use of self-ligating brackets. Banding of first molars was preferred by over 60% of clinicians. Bone screw implants were used by only 0.2% of respondents. Clinicians with less than 10 years experience used more headgear, light curing, MBT prescription and molar bonding. Operators with over 20 years experience used more chemically cured bonding, Roth prescription, banded first molars, 0.018 inch slot size and Tip-Edge(TM), with less use of headgear. Fixed appliance use differed from that reported in the US with lower use in the UK of standard edgewise and Roth systems, aesthetic, miniaturised and 0.018 inch slot brackets and rapid maxillary expansion. Most UK orthodontic specialists routinely used the 0.022 inch pre-adjusted edgewise system with standard size Siamese steel brackets bonded using standard etch and light cured composite with conventional ligation. Variations were seen between different provider groups, types of treatment funding, levels of operator seniority and geographical regions. Differences were noted particularly in the use of bracket prescription and design, types of molar attachment and anchorage control.

Chest radiography practice in critically ill patients: a postal survey in the Netherlands

PubMed Central

Graat, Marleen E; Hendrikse, Karin A; Spronk, Peter E; Korevaar, Johanna C; Stoker, Jaap; Schultz, Marcus J

2006-01-01

Background To ascertain current chest radiography practice in intensive care units (ICUs) in the Netherlands. Methods Postal survey: a questionnaire was sent to all ICUs with > 5 beds suitable for mechanical ventilation; pediatric ICUs were excluded. When an ICU performed daily-routine chest radiographs in any group of patients it was considered to be a "daily-routine chest radiography" ICU. Results From the number of ICUs responding, 63% practice a daily-routine strategy, in which chest radiographs are obtained on a daily basis without any specific reason. A daily-routine chest radiography strategy is practiced less frequently in university-affiliated ICUs (50%) as compared to other ICUs (68%), as well as in larger ICUs (> 20 beds, 50%) as compared to smaller ICUs (< 20 beds, 65%) (P > 0.05). Remarkably, physicians that practice a daily-routine strategy consider daily-routine radiographs helpful in guiding daily practice in less than 30% of all performed radiographs. Chest radiographs are considered essential for verification of the position of invasive devices (81%) and for diagnosing pneumothorax, pneumonia or acute respiratory distress syndrome (82%, 74% and 69%, respectively). On demand chest radiographs are obtained after introduction of thoracic drains, central venous lines and endotracheal tubes in 98%, 84% and 75% of responding ICUs, respectively. Chest films are also obtained in case of ventilatory deterioration (49% of responding ICUs), and after cardiopulmonary resuscitation (59%), tracheotomy (58%) and mini-tracheotomy (23%). Conclusion There is notable lack of consensus on chest radiography practice in the Netherlands. This survey suggests that a large number of intensivists may doubt the value of daily-routine chest radiography, but still practice a daily-routine strategy. PMID:16848892

Sugammadex compared with neostigmine/glycopyrrolate for routine reversal of neuromuscular block: a systematic review and economic evaluation†

PubMed Central

Paton, F.; Paulden, M.; Chambers, D.; Heirs, M.; Duffy, S.; Hunter, J. M.; Sculpher, M.; Woolacott, N.

2010-01-01

Summary The cost-effectiveness of sugammadex for the routine reversal of muscle relaxation produced by rocuronium or vecuronium in UK practice is uncertain. We performed a systematic review of randomized controlled trials of sugammadex compared with neostigmine/glycopyrrolate and an economic assessment of sugammadex for the reversal of moderate or profound neuromuscular block (NMB) produced by rocuronium or vecuronium. The economic assessment aimed to establish the reduction in recovery time and the ‘value of time saved’ which would be necessary for sugammadex to be potentially cost-effective compared with existing practice. Three trials indicated that sugammadex 2 mg kg−1 (4 mg kg−1) produces more rapid recovery from moderate (profound) NMB than neostigmine/glycopyrrolate. The economic assessment indicated that if the reductions in recovery time associated with sugammadex in the trials are replicated in routine practice, sugammadex would be cost-effective if those reductions are achieved in the operating theatre (assumed value of staff time, £4.44 per minute), but not if they are achieved in the recovery room (assumed value of staff time, £0.33 per minute). However, there is considerable uncertainty in these results. Sugammadex has the potential to be cost-effective compared with neostigmine/glycopyrrolate for the reversal of rocuronium-induced moderate or profound NMB, provided that the time savings observed in trials can be achieved and put to productive use in clinical practice. Further research is required to evaluate the effects of sugammadex on patient safety, predictability of recovery from NMB, patient outcomes, and efficient use of resources. PMID:20935005

12 CFR 225.171 - What are the limitations on managing or operating a portfolio company held as a merchant banking...

Code of Federal Regulations, 2013 CFR

2013-01-01

... banking investment? (a) May a financial holding company routinely manage or operate a portfolio company... manage or operate any portfolio company. (b) When does a financial holding company routinely manage or... portfolio company. A financial holding company routinely manages or operates a portfolio company if any...

12 CFR 225.171 - What are the limitations on managing or operating a portfolio company held as a merchant banking...

Code of Federal Regulations, 2014 CFR

2014-01-01

... banking investment? (a) May a financial holding company routinely manage or operate a portfolio company... manage or operate any portfolio company. (b) When does a financial holding company routinely manage or... portfolio company. A financial holding company routinely manages or operates a portfolio company if any...

Eating routines: Embedded, value based, modifiable, and reflective

PubMed Central

Jastran, Margaret; Bisogni, Carole A.; Sobal, Jeffery; Blake, Christine; Devine, Carol M.

2009-01-01

Eating routines are a compelling issue because recurring eating behaviors influence nutrition and health. As non-traditional and individualized eating patterns have become more common, new ways of thinking about routine eating practices are needed. This study sought to gain conceptual understanding of working adults' eating routines. Forty-two purposively sampled US adults reported food intake and contextual details about eating episodes in qualitative 24-hour dietary recalls conducted over 7 consecutive days. Using the constant comparative method, researchers analyzed interview transcripts for recurrent ways of eating that were either explicitly reported by study participants as “routines” or emergent in the data. Participants' eating routines included repetition in food consumption as well as eating context, and also involved sequences of eating episodes. Eating routines were embedded in daily schedules for work, family, and recreation. Participants maintained purposeful routines that helped balance tension between demands and values, but they modified routines as circumstances changed. Participants monitored and reflected upon their eating practices and tended to assess their practices in light of their personal identities. These findings provide conceptual insights for food choice researchers and present a perspective from which practitioners who work with individuals seeking to adopt healthful eating practices might usefully approach their tasks. PMID:18835305

Routines for change: how managers can use absorptive capacity to adopt and implement evidence-based practice.

PubMed

Innis, Jennifer; Berta, Whitney

2016-09-01

This paper uses the construct of absorptive capacity to understand how nurse managers can facilitate the adoption and use of evidence-based practice within health-care organisations. How health-care organisations adopt and implement innovations such as new evidence-based practices will depend on their absorptive, or learning, capacity. Absorptive capacity manifests as routines, which are the practices, procedures and customs that organisational members use to carry out work and to make work-related decisions. Using the construct of absorptive capacity as well as a recent literature review of how health-care organisations take on best practices, we illustrate how the uptake and use of new knowledge, such as evidence-based practices, can be facilitated through the use of routines. This paper highlights routines that nurse managers can use to foster environments where evidence-based practices can be readily identified, and strategies for facilitating their adoption and implementation. The construct of absorptive capacity and the use of routines can be used to examine the ways in which nurse managers can adopt, implement and evaluate the use of evidence-based practices. © 2016 John Wiley & Sons Ltd.

Huddle up!: The adoption and use of structured team communication for VA medical home implementation.

PubMed

Rodriguez, Hector P; Meredith, Lisa S; Hamilton, Alison B; Yano, Elizabeth M; Rubenstein, Lisa V

2015-01-01

Daily clinical team meetings (i.e., "huddles") may be helpful in implementing new roles and responsibilities for patient care because they provide a regular opportunity for member learning and feedback. We examined how huddles were implemented in the context of the VA patient-centered medical home (PCMH) transformation, including assessing barriers and facilitators to regular huddling among small teams ("teamlets"). We assessed the extent to which teamlet members that huddled had higher self-efficacy for PCMH changes, reported better teamwork experiences, and perceived more supportive practice environments. We used a convergent mixed-methods approach to analyze 79 teamlet member interviews from six VA primary care practices and 418 clinician and staff PCMH survey responses from the six interviewed practices and 13 additional practices in the same region. Most members reported participating in teamlet huddles when asked in surveys (85%). A minority of interview participants, however, described routine huddling focused on previsit planning that included all members. When members reported routine teamlet huddling, activities included (a) previsit planning, (b) strategizing treatment plans for patients with special or complex needs, (c) addressing daily workflow and communication issues through collective problem solving, and (d) ensuring awareness of what team members do and what actions are happening on the teamlet and in the practice. Primary care providers (PCPs) were least likely to report routine huddling. PCP huddlers reported greater self-efficacy for implementing PCMH changes. All huddlers, irrespective of role, reported better teamwork and more supportive practice climates. The most common barriers to teamlet huddling were limited time and operational constraints. In order to improve the impact of huddles on patient care, practice leaders should clearly communicate the goals, requirements, and benefits of huddling and provide adequate time and resources to ensure that frontline teams use huddle time to improve patient care.

SAMOS - A Decade of High-Quality, Underway Meteorological and Oceanographic Data from Research Vessels

NASA Astrophysics Data System (ADS)

Smith, S. R.; Rolph, J.; Briggs, K.; Elya, J. L.; Bourassa, M. A.

2016-02-01

The authors will describe the successes and lessons learned from the Shipboard Automated Meteorological and Oceanographic System (SAMOS) initiative. Over the past decade, SAMOS has acquired, quality controlled, and distributed underway surface meteorological and oceanographic observations from nearly 40 oceanographic research vessels. Research vessels provide underway observations at high-temporal frequency (1-minute sampling interval) that include navigational (position, course, heading, and speed), meteorological (air temperature, humidity, wind, surface pressure, radiation, rainfall), and oceanographic (surface sea temperature and salinity) samples. Vessels recruited to the SAMOS initiative collect a high concentration of data within the U.S. continental shelf, around Hawaii and the islands of the tropical Pacific, and frequently operate well outside routine shipping lanes, capturing observations in extreme ocean environments (Southern, Arctic, South Atlantic, and South Pacific oceans) desired by the air-sea exchange, modeling, and satellite remote sensing communities. The presentation will highlight the data stewardship practices of the SAMOS initiative. Activities include routine automated and visual data quality evaluation, feedback to vessel technicians and operators regarding instrumentation errors, best practices for instrument siting and exposure on research vessels, and professional development activities for research vessel technicians. Best practices for data, metadata, and quality evaluation will be presented. We will discuss ongoing efforts to expand data services to enhance interoperability between marine data centers. Data access and archival protocols will also be presented, including how these data may be referenced and accessed via NCEI.

Principles and practice of external digital photography in ophthalmology

PubMed Central

Mukherjee, Bipasha; Nair, Akshay Gopinathan

2012-01-01

It is mandatory to incorporate clinical photography in an ophthalmic practice. Patient photographs are routinely used in teaching, presentations, documenting surgical outcomes and marketing. Standardized clinical photographs are part of an armamentarium for any ophthalmologist interested in enhancing his or her practice. Unfortunately, many clinicians still avoid taking patient photographs for want of basic knowledge or inclination. The ubiquitous presence of the digital camera and digital technology has made it extremely easy and affordable to take high-quality images. It is not compulsory to employ a professional photographer or invest in expensive equipment any longer for this purpose. Any ophthalmologist should be able to take clinical photographs in his/her office settings with minimal technical skill. The purpose of this article is to provide an ophthalmic surgeon with guidelines to achieve standardized photographic views for specific procedures, to achieve consistency, to help in pre-operative planning and to produce accurate pre-operative and post-operative comparisons, which will aid in self-improvement, patient education, medicolegal documentation and publications. This review also discusses editing, storage, patient consent, medicolegal issues and importance of maintenance of patient confidentiality. PMID:22446907

Principles and practice of external digital photography in ophthalmology.

PubMed

Mukherjee, Bipasha; Nair, Akshay Gopinathan

2012-01-01

It is mandatory to incorporate clinical photography in an ophthalmic practice. Patient photographs are routinely used in teaching, presentations, documenting surgical outcomes and marketing. Standardized clinical photographs are part of an armamentarium for any ophthalmologist interested in enhancing his or her practice. Unfortunately, many clinicians still avoid taking patient photographs for want of basic knowledge or inclination. The ubiquitous presence of the digital camera and digital technology has made it extremely easy and affordable to take high-quality images. It is not compulsory to employ a professional photographer or invest in expensive equipment any longer for this purpose. Any ophthalmologist should be able to take clinical photographs in his/her office settings with minimal technical skill. The purpose of this article is to provide an ophthalmic surgeon with guidelines to achieve standardized photographic views for specific procedures, to achieve consistency, to help in pre-operative planning and to produce accurate pre-operative and post-operative comparisons, which will aid in self-improvement, patient education, medicolegal documentation and publications. This review also discusses editing, storage, patient consent, medicolegal issues and importance of maintenance of patient confidentiality.

12 CFR 1500.2 - What are the limitations on managing or operating a portfolio company held as a merchant banking...

Code of Federal Regulations, 2014 CFR

2014-01-01

... financial holding company routinely manage or operate a portfolio company? Except as permitted in paragraph (e) of this section, a financial holding company may not routinely manage or operate any portfolio company. (b) When does a financial holding company routinely manage or operate a company?—(1) Examples of...

12 CFR 225.171 - What are the limitations on managing or operating a portfolio company held as a merchant banking...

Code of Federal Regulations, 2012 CFR

2012-01-01

...? (a) May a financial holding company routinely manage or operate a portfolio company? Except as permitted in paragraph (e) of this section, a financial holding company may not routinely manage or operate any portfolio company. (b) When does a financial holding company routinely manage or operate a company...

12 CFR 1500.2 - What are the limitations on managing or operating a portfolio company held as a merchant banking...

Code of Federal Regulations, 2012 CFR

2012-01-01

... financial holding company routinely manage or operate a portfolio company? Except as permitted in paragraph (e) of this section, a financial holding company may not routinely manage or operate any portfolio company. (b) When does a financial holding company routinely manage or operate a company?—(1) Examples of...

12 CFR 1500.2 - What are the limitations on managing or operating a portfolio company held as a merchant banking...

Code of Federal Regulations, 2013 CFR

2013-01-01

... financial holding company routinely manage or operate a portfolio company? Except as permitted in paragraph (e) of this section, a financial holding company may not routinely manage or operate any portfolio company. (b) When does a financial holding company routinely manage or operate a company?—(1) Examples of...

The acceptability of computer applications to group practices.

PubMed

Zimmerman, J; Gordon, R S; Tao, D K; Boxerman, S B

1978-01-01

Of the 72 identified group practices in a midwest urban environment, 39 were found to use computers. The practices had been influenced strongly by vendors in their selection of an automated system or service, and had usually spent less than a work-month analyzing their needs and reviewing alternate ways in which those needs could be met. Ninety-seven percent of the practices had some financial applications and 64% had administrative applications, but only 2.5% had medical applications. For half the practices at least 2 months elapsed from the time the automated applications were put into operation until they were considered to be integrated into the office routine. Advantages experienced by at least a third of the practices using computers were that the work was done faster, information was more readily available, and costs were reduced. The most common disadvantage was inflexibility. Most (89%) of the practices believed that automation was preferable to their previous manual system.

Integration of robotic surgery into routine practice and impacts on communication, collaboration, and decision making: a realist process evaluation protocol.

PubMed

Randell, Rebecca; Greenhalgh, Joanne; Hindmarsh, Jon; Dowding, Dawn; Jayne, David; Pearman, Alan; Gardner, Peter; Croft, Julie; Kotze, Alwyn

2014-05-02

Robotic surgery offers many potential benefits for patients. While an increasing number of healthcare providers are purchasing surgical robots, there are reports that the technology is failing to be introduced into routine practice. Additionally, in robotic surgery, the surgeon is physically separated from the patient and the rest of the team, with the potential to negatively impact teamwork in the operating theatre. The aim of this study is to ascertain: how and under what circumstances robotic surgery is effectively introduced into routine practice; and how and under what circumstances robotic surgery impacts teamwork, communication and decision making, and subsequent patient outcomes. We will undertake a process evaluation alongside a randomised controlled trial comparing laparoscopic and robotic surgery for the curative treatment of rectal cancer. Realist evaluation provides an overall framework for the study. The study will be in three phases. In Phase I, grey literature will be reviewed to identify stakeholders' theories concerning how robotic surgery becomes embedded into surgical practice and its impacts. These theories will be refined and added to through interviews conducted across English hospitals that are using robotic surgery for rectal cancer resection with staff at different levels of the organisation, along with a review of documentation associated with the introduction of robotic surgery. In Phase II, a multi-site case study will be conducted across four English hospitals to test and refine the candidate theories. Data will be collected using multiple methods: the structured observation tool OTAS (Observational Teamwork Assessment for Surgery); video recordings of operations; ethnographic observation; and interviews. In Phase III, interviews will be conducted at the four case sites with staff representing a range of surgical disciplines, to assess the extent to which the results of Phase II are generalisable and to refine the resulting theories to reflect the experience of a broader range of surgical disciplines. The study will provide (i) guidance to healthcare organisations on factors likely to facilitate successful implementation and integration of robotic surgery, and (ii) guidance on how to ensure effective communication and teamwork when undertaking robotic surgery.

Integration of robotic surgery into routine practice and impacts on communication, collaboration, and decision making: a realist process evaluation protocol

PubMed Central

2014-01-01

Background Robotic surgery offers many potential benefits for patients. While an increasing number of healthcare providers are purchasing surgical robots, there are reports that the technology is failing to be introduced into routine practice. Additionally, in robotic surgery, the surgeon is physically separated from the patient and the rest of the team, with the potential to negatively impact teamwork in the operating theatre. The aim of this study is to ascertain: how and under what circumstances robotic surgery is effectively introduced into routine practice; and how and under what circumstances robotic surgery impacts teamwork, communication and decision making, and subsequent patient outcomes. Methods and design We will undertake a process evaluation alongside a randomised controlled trial comparing laparoscopic and robotic surgery for the curative treatment of rectal cancer. Realist evaluation provides an overall framework for the study. The study will be in three phases. In Phase I, grey literature will be reviewed to identify stakeholders’ theories concerning how robotic surgery becomes embedded into surgical practice and its impacts. These theories will be refined and added to through interviews conducted across English hospitals that are using robotic surgery for rectal cancer resection with staff at different levels of the organisation, along with a review of documentation associated with the introduction of robotic surgery. In Phase II, a multi-site case study will be conducted across four English hospitals to test and refine the candidate theories. Data will be collected using multiple methods: the structured observation tool OTAS (Observational Teamwork Assessment for Surgery); video recordings of operations; ethnographic observation; and interviews. In Phase III, interviews will be conducted at the four case sites with staff representing a range of surgical disciplines, to assess the extent to which the results of Phase II are generalisable and to refine the resulting theories to reflect the experience of a broader range of surgical disciplines. The study will provide (i) guidance to healthcare organisations on factors likely to facilitate successful implementation and integration of robotic surgery, and (ii) guidance on how to ensure effective communication and teamwork when undertaking robotic surgery. PMID:24885669

Developing practical knowledge content of emergency nursing professionals.

PubMed

Chu, Wen; Hsu, Li-Ling

2011-06-01

There is a paucity of published research on clinical or practical nursing knowledge. The ways that nurses acquire, develop, and maintain emergency room (ER) nursing care skills is a research area, in particular, that deserves further investigation. This study examined clinical setting learning processes to better understand the practical knowledge content of ER nurses. This study used a phenomenological approach and in-depth interviews of 10 nurses. Each participant had at least 3 years of ER experience. Researchers used Moustakas' method to analyze interview data. Findings were checked for credibility, transferability, dependability, and confirmability. The authors identified four major practical knowledge themes for ER professionals. These were (a) basic emergency treatment procedure routines and symptom management; (b) disease mechanisms, pharmacodynamics, and treatment responses; (c) newly identified diseases, updated emergency treatments and techniques, and medical treatment discussions; and (d) identifying nursing values including nursing attitudes and continuing patient care. Participants in this study had experience with the first three themes and successfully combined various types of nursing knowledge in their nursing care duties. Only few participants indicated experience with the fourth theme. Findings clarify that clinical or practical knowledge in ER nurses evolves first from declarative knowledge (e.g., basic emergency treatment routines and operating procedures) to procedural knowledge (e.g., instructions from supervisors, actual practice, and drills) to conditional knowledge (e.g., observation and treatment involving direct interactions with patients). Nurses should combine and apply the various knowledge types in their nursing practice to assess comprehensively each patient's condition and administer effective treatment and service.

Effects of the Practiced Routines Parent Training Program on Behavioral Strategy Use, Parental Well-Being, and Child Challenging Behavior in Parents of Children with Autism Spectrum Disorder

ERIC Educational Resources Information Center

Raulston, Tracy Jane

2017-01-01

In this study, a concurrent randomized multiple baseline across three parent-child dyads single-case design was employed to evaluate the effects of a brief three-week parent training program, titled Practiced Routines. The Practiced Routines parent training program included positive behavior supports (PBS) and mindfulness strategies within the…

Series: Pragmatic trials and real world evidence: Paper 1. Introduction.

PubMed

Zuidgeest, Mira G P; Goetz, Iris; Groenwold, Rolf H H; Irving, Elaine; van Thiel, Ghislaine J M W; Grobbee, Diederick E

2017-08-01

This is the introductory paper in a series of eight papers. In this series, we integrate the theoretical design options with the practice of conducting pragmatic trials. For most new market-approved treatments, the clinical evidence is insufficient to fully guide physicians and policy makers in choosing the optimal treatment for their patients. Pragmatic trials can fill this gap, by providing evidence on the relative effectiveness of a treatment strategy in routine clinical practice, already in an early phase of development, while maintaining the strength of randomized controlled trials. Selecting the setting, study population, mode of intervention, comparator, and outcome are crucial in designing pragmatic trials. In combination with monitoring and data collection that does not change routine care, this will enable appropriate generalization to the target patient group in clinical practice. To benefit from the full potential of pragmatic trials, there is a need for guidance and tools in designing these studies while ensuring operational feasibility. This paper introduces the concept of pragmatic trial design. The complex interplay between pragmatic design options, feasibility, stakeholder acceptability, validity, precision, and generalizability will be clarified. In this way, balanced design choices can be made in pragmatic trials with an optimal chance of success in practice. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Preoperative Hand Decontamination in Ophthalmic Surgery: A Comparison of the Removal of Bacteria from Surgeons' Hands by Routine Antimicrobial Scrub versus an Alcoholic Hand Rub.

PubMed

Forer, Yaara; Block, Colin; Frenkel, Shahar

2017-09-01

The goal of this experiment was to evaluate and compare the antimicrobial efficacy of routine preoperative hand washing using commercial medicated sponge brushes versus an alcoholic hand rub, by comparing bacterial growth on ophthalmic surgeons' hands after application of each of these methods. Twenty ophthalmic surgeons were recruited at the Hadassah-Hebrew University Medical Center in Jerusalem, Israel. Samples were collected twice from the hands of each surgeon after hand decontamination using two different protocols during routine surgical practice. The routine preparation consisted of a 3-minute surgical scrub using commercial brush-sponges incorporating either 4% chlorhexidine gluconate (CHG) or 1% povidone-iodine (PVP-I) formulations with detergent, followed by drying the hands with a sterile towel, while the 70% ethanol solution was applied for 60-seconds and allowed to air dry. Half of the group was randomly assigned to provide samples first after the routine method and the alcoholic solution a week later, and the other half of the group was sampled in the reverse order. Viable counts of bacteria were evaluated using a modified glove juice method. Bacterial colonies were enumerated after incubation for 24 hours and expressed as colony forming units (CFU)/mL for each pair of hands. Geometric mean counts were 1310 and 39 CFU/mL, in the routine and alcohol rub groups, respectively, representing a mean log 10 reduction in 1.53. The difference between the paired bacterial counts for the routine versus the alcohol rub was statistically significant (p < 0.0001). There was no statistically significant difference between log 10 reductions for CHG and PVP-I (p = 0.97). This study provides evidence that an alcohol rub protocol is more effective in reducing bacterial counts on hands than routine surgical hand preparation with PVP-I and CHG in a population of practicing ophthalmic surgeons in the operative clinical setting. Thus, it provides a safe alternative as a preoperative hand disinfection method.

Initial Clinical Trial of Robot of Endovascular Treatment with Force Feedback and Cooperating of Catheter and Guidewire.

PubMed

Jiang, Yuhua; Liu, Keyun; Li, Youxiang

2018-01-01

To evaluate the feasibility and safety of the robot of endovascular treatment (RobEnt) in clinical practice, we carried out a cerebral angiography using this robot system. We evaluated the performance of application of the robot system to clinical practice through using this robotic system to perform the digital subtraction angiography for a patient who was suspected of suffering intracranial aneurysm. At the same time, through comparing the postoperative head nuclear magnetic and blood routine with the preoperative examination, we evaluated the safety of application of the robot system to clinical practice. We performed the robot system to complete the bilateral carotid artery and bilateral vertebral arteriography. The results indicate that there was no obvious abnormality in the patient's cerebral artery. No obvious abnormality was observed in the examination of patients' check-up, head nuclear magnetism, and blood routine after the digital subtraction angiography. From this clinical trial, it can be observed that the robot system can perform the operation of cerebral angiography. The robot system can basically complete the related observation indexes, and its accuracy, effectiveness, stability, and safety basically meet the requirements of clinical application in neurointerventional surgery.

An Element of Practical Knowledge in Education: Professional Routines

ERIC Educational Resources Information Center

Lacourse, France

2011-01-01

The question of practical knowledge and its teaching has arisen more perceptibly since the appearance of the aim to professionalize teachers. How can imperceptible knowledge such as professional routines be taught? To establish a social fabric and effective class management, it is essential to call on creative and adaptive professional routines.…

Routine histological analysis of a macroscopically normal gallbladder--a review of the literature.

PubMed

Jamal, K; Ratansingham, K; Siddique, M; Nehra, D

2014-01-01

70,000 cholecystectomies were performed in the United Kingdom in 2011-2012. Currently it is standard practice to submit all gallbladder specimens for routine histology to exclude malignancy. The aim of this systematic review was to establish whether a normal macroscopic appearance to the gallbladder at the time of cholecystectomy is sufficient to rule out malignancy and therefore negate the need for routine histology. Relevant articles that were published between 1966 and January 2013 were identified through electronic databases. 21 studies reported on 34,499 histologically analysed specimens. 172/187 (92%) of gallbladder cancers demonstrated intra-operative macroscopic abnormality. Studies that opened the specimens intra-operatively identified all cancers, whereas gross macroscopic visualization resulted in 15 potentially missed cancers (p = 0.10). In patients of European ethnicity, gallbladder cancer in a macroscopically normal looking gallbladder was identified in only one study; however all of these patients were above the age of 60. The incidence of gallbladder cancer was significantly raised in ethnic groups from high risk areas (p = 0.0001). A macroscopically normal gallbladder in patients of European ethnicity under the age of 60 may not require formal histopathology. The best method for intra-operative examination may involve opening the specimen to allow inspection of the mucosa and wall, however this needs further investigation. In the context of the volume of gallbladder surgery being performed there is the potential for significant cost and time savings. Copyright © 2014 Surgical Associates Ltd. All rights reserved.

Preoperative Site Marking: Are We Adhering to Good Surgical Practice?

PubMed

Bathla, Sonia; Chadwick, Michael; Nevins, Edward J; Seward, Joanna

2017-06-29

Wrong-site surgery is a never event and a serious, preventable patient safety incident. Within the United Kingdom, national guidance has been issued to minimize the risk of such events. The mandate includes preoperative marking of all surgical patients. This study aimed to quantify regional variation in practice within general surgery and opinions of the surgeons, to help guide the formulation and implementation of a regional general surgery preoperative marking protocol. A SurveyMonkey questionnaire was designed and distributed to 120 surgeons within the Mersey region, United Kingdom. This included all surgical trainees in Mersey (47 registrars, 56 core trainees), 15 consultants, and 2 surgical care practitioners. This sought to ascertain their routine practice and how they would choose to mark for 12 index procedures in general surgery, if mandated to do so. A total of 72 responses (60%) were obtained to the SurveyMonkey questionnaire. Only 26 (36.1%) said that they routinely marked all of their patients preoperatively. The operating surgeon marked the patient in 69% of responses, with the remainder delegating this task. Markings were visible after draping in only 55.6% of marked cases. Based on our findings, surgeons may not be adhering to "Good Surgical Practice"; practice is widely variable and surgeons are largely opposed and resistant to marking patients unless laterality is involved. We suggest that all surgeons need to be actively engaged in the design of local marking protocols to gain support, change practice, and reduce errors.

Comparison between two portal laparoscopy and open surgery for ovariectomy in dogs.

PubMed

Shariati, Elnaz; Bakhtiari, Jalal; Khalaj, Alireza; Niasari-Naslaji, Amir

2014-01-01

Ovariectomy (OVE) is a routine surgical procedure for neutering in small animal practice. Laparoscopy is a new surgical technique which contains advantages such as less trauma, smaller incision and excellent visualization than traditional open surgery. The present study was conducted to examine the feasibility and safety of laparoscopic procedure through two portal comparing with the conventional open surgery for OVE in healthy female bitches (n=16). Dogs were divided in two equal groups. In laparoscopic group, two 5 and 10 mm portals were inserted; First in the umbilicus for introducing the camera and the second, caudal to the umbilicus for inserting the forceps. Laparoscopic procedure involved grasping and tacking the ovary to the abdominal wall, followed by electrocautery, resection and removal of the ovary. In open surgery, routine OVE was conducted through an incision from umbilicus to caudal midline. Mean operative time, total length of scar, blood loss, clinical and blood parameters and all intra and post-operative complications were recorded in both groups. Mean operative time, total length of scar, blood loss and post-operative adhesions were significantly less in laparoscopic group compared with open surgery. In conclusion, laparoscopic OVE is an acceptable procedure due to more advantages in comparison with traditional OVE.

Reporting guidelines for implementation and operational research.

PubMed

Hales, Simon; Lesher-Trevino, Ana; Ford, Nathan; Maher, Dermot; Ramsay, Andrew; Tran, Nhan

2016-01-01

In public health, implementation research is done to improve access to interventions that have been shown to work but have not reached many of the people who could benefit from them. Researchers identify practical problems facing public health programmes and aim to find solutions that improve health outcomes. In operational research, routinely-collected programme data are used to uncover ways of delivering more effective, efficient and equitable health care. As implementation research can address many types of questions, many research designs may be appropriate. Existing reporting guidelines partially cover the methods used in implementation and operational research, so we ran a consultation through the World Health Organization (WHO), the Alliance for Health Policy & Systems Research (AHPSR) and the Special Programme for Research and Training in Tropical Diseases (TDR) and developed guidelines to facilitate the funding, conduct, review and publishing of such studies. Our intention is to provide a practical reference for funders, researchers, policymakers, implementers, reviewers and editors working with implementation and operational research. This is an evolving field, so we plan to monitor the use of these guidelines and develop future versions as required.

DEVELOPING AND INSTRUCTING PRE-PERFORMANCE ROUTINES FOR TENPIN BOWLING COMPETITIONS (1).

PubMed

Lee, Seungmin; Lee, Keunchul; Kwon, Sungho

2015-06-01

This preliminary study developed pre-performance routines for tenpin bowlers and instructed them. To develop the routine, the situations before throwing the ball were divided into four phases; participants were examined through interviews and observations. This study used an A-B design; the A stage included the development of the routines for 3 wk., while the B stage included the instruction and two evaluations of the routine consistency. Practice was implemented for 4 hr. per day for 9 wk. The participants noted they understood the developed routine easily and experienced an atmosphere similar to that of a competition during training through the routines. They found it difficult to practice the relaxation phase, but emphasized that the relaxation phase was helpful. Consistent routines were associated with an improved mental state and performance in a competition. This study suggests that pre-performance routines stabilize the mental state of the athletes, apparently giving them a competitive advantage.

The role of informal dimensions of safety in high-volume organisational routines: an ethnographic study of test results handling in UK general practice.

PubMed

Grant, Suzanne; Checkland, Katherine; Bowie, Paul; Guthrie, Bruce

2017-04-27

The handling of laboratory, imaging and other test results in UK general practice is a high-volume organisational routine that is both complex and high risk. Previous research in this area has focused on errors and harm, but a complementary approach is to better understand how safety is achieved in everyday practice. This paper ethnographically examines the role of informal dimensions of test results handling routines in the achievement of safety in UK general practice and how these findings can best be developed for wider application by policymakers and practitioners. Non-participant observation was conducted of high-volume organisational routines across eight UK general practices with diverse organisational characteristics. Sixty-two semi-structured interviews were also conducted with the key practice staff alongside the analysis of relevant documents. While formal results handling routines were described similarly across the eight study practices, the everyday structure of how the routine should be enacted in practice was informally understood. Results handling safety took a range of local forms depending on how different aspects of safety were prioritised, with practices varying in terms of how they balanced thoroughness (i.e. ensuring the high-quality management of results by the most appropriate clinician) and efficiency (i.e. timely management of results) depending on a range of factors (e.g. practice history, team composition). Each approach adopted created its own potential risks, with demands for thoroughness reducing productivity and demands for efficiency reducing handling quality. Irrespective of the practice-level approach adopted, staff also regularly varied what they did for individual patients depending on the specific context (e.g. type of result, patient circumstances). General practices variably prioritised a legitimate range of results handling safety processes and outcomes, each with differing strengths and trade-offs. Future safety improvement interventions should focus on how to maximise practice-level knowledge and understanding of the range of context-specific approaches available and the safeties and risks inherent in each within the context of wider complex system conditions and interactions. This in turn has the potential to inform new kinds of proactive, contextually appropriate approaches to intervention development and implementation focusing on the enhanced deliberation of the safety of existing high-volume routines.

Recommendations for Practice: Justifying Claims of Generalizability

ERIC Educational Resources Information Center

Hedges, Larry V.

2013-01-01

Recommendations for practice are routinely included in articles that report educational research. Robinson et al. suggest that reports of primary research should not routinely do so. They argue that single primary research studies seldom have sufficient external validity to support claims about practice policy. In this article, I draw on recent…

Environmental Assessment for Routine and Recurring Unmanned Aerial Vehicle Flight Operations at Edwards Air Force Base, California

DTIC Science & Technology

2006-11-01

grounds, spawning 28 sites, feeding sites, seasonal wetlands or drylands, water quality or quantity, host species or plant 29 pollinators , geological...cycles, and biotic interactions . As a 28 practical matter the guidance suggests that [environmental] assessments should focus on ecological 29...potential impacts were compared to the ten ecological 17 processes identified by the U.S. EPA and were found to be less than significant because of the

Best Practices During Hip Arthroscopy: Aggregate Recommendations of High-Volume Surgeons.

PubMed

Gupta, Asheesh; Suarez-Ahedo, Carlos; Redmond, John M; Gerhardt, Michael B; Hanypsiak, Bryan; Stake, Christine E; Finch, Nathan A; Domb, Benjamin G

2015-09-01

To survey surgeons who perform a high volume of hip arthroscopy procedures regarding their operative technique, type of procedure, and postoperative management. We conducted a cross-sectional survey of 27 high-volume orthopaedic surgeons specializing in hip arthroscopy to report their preferences and practices related to their operative practice and postoperative rehabilitation protocol. All participants completed the survey in person in an anonymous fashion during a meeting of the American Hip Institute. All surgeons perform hip arthroscopy with the patient in the supine position, accessing the central compartment of the hip initially, using intraoperative fluoroscopy. All surgeons perform labral repair (100%), with the majority performing labral reconstructions (77.8%) and gluteus medius repairs (81.5%). There is variability in the type of anchors used during labral repair. Most surgeons perform capsular closure in most cases (88.9%), inject either intra-articular cortisone or platelet-rich plasma at the conclusion of the procedure (59%), and prescribe a postoperative hip brace for some or all patients (59%). There is considerable variability in rehabilitation protocols. All surgeons routinely prescribe postoperative heterotopic ossification prophylaxis to their patients, with most surgeons (88.9%) prescribing a nonsteroidal anti-inflammatory medication for 3 weeks. Forty percent of the respondents use the modified Harris Hip Score as the most important outcome measure. Consistent practices such as use of intraoperative fluoroscopy, heterotopic ossification prophylaxis, and labral repair skills were identified by surveying 27 hip arthroscopy surgeons at high-volume centers. Most of the surgeons performed routine capsular closure unless underlying conditions precluded capsular release or plication. The survey identified higher variability between surgeons regarding postoperative rehabilitation protocols and use of intra-articular pharmacologic injections at the end of the procedure. These data may provide surgeons with a set of aggregate trends that may help guide training, clinical practice, and research in the evolving field of hip arthroscopy. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

PubMed Central

Baum, S.; Sillem, M.; Ney, J. T.; Baum, A.; Friedrich, M.; Radosa, J.; Kramer, K. M.; Gronwald, B.; Gottschling, S.; Solomayer, E. F.; Rody, A.; Joukhadar, R.

2017-01-01

Introduction Minimally invasive operative techniques are being used increasingly in gynaecological surgery. The expansion of the laparoscopic operation spectrum is in part the result of improved imaging. This study investigates the practical advantages of using 3D cameras in routine surgical practice. Materials and Methods Two different 3-dimensional camera systems were compared with a 2-dimensional HD system; the operating surgeonʼs experiences were documented immediately postoperatively using a questionnaire. Results Significant advantages were reported for suturing and cutting of anatomical structures when using the 3D compared to 2D camera systems. There was only a slight advantage for coagulating. The use of 3D cameras significantly improved the general operative visibility and in particular the representation of spacial depth compared to 2-dimensional images. There was not a significant advantage for image width. Depiction of adhesions and retroperitoneal neural structures was significantly improved by the stereoscopic cameras, though this did not apply to blood vessels, ureter, uterus or ovaries. Conclusion 3-dimensional cameras were particularly advantageous for the depiction of fine anatomical structures due to improved spacial depth representation compared to 2D systems. 3D cameras provide the operating surgeon with a monitor image that more closely resembles actual anatomy, thus simplifying laparoscopic procedures. PMID:28190888

How much guidance is given in the operating room? Factors influencing faculty self-reports, resident perceptions, and faculty/resident agreement.

PubMed

Torbeck, Laura; Williams, Reed G; Choi, Jennifer; Schmitz, Connie C; Chipman, Jeffrey G; Dunnington, Gary L

2014-10-01

Guidance in the operating room impacts resident confidence and ability to function independently. The purpose of this study was to explore attending surgeon guidance practices in the operating room as reported by faculty members themselves and by junior and senior residents. This was an exploratory, cross-sectional survey research study involving 91 categorical residents and 82 clinical faculty members at two academic general surgery training programs. A series of analyses of variance along with descriptive statistics were performed to understand the impact of resident training year, program, and surgeon characteristics (sex and type of surgery performed routinely) on guidance practices. Resident level (junior versus senior) significantly impacted the amount of guidance given as reported by faculty and as perceived by residents. Within each program, junior residents perceived less guidance than faculty reported giving. For senior guidance practices, however, the differences between faculty and resident practices varied by program. In terms of the effects of surgeon practice type (mostly general versus mostly complex cases), residents at both institutions felt they were more supervised closely by the faculty who perform mostly complex cases. More autonomy is given to senior than to junior residents. Additionally, faculty report a greater amount of change in their guidance practices over the training period than residents perceive. Faculty and resident agreement about the need for guidance and for autonomy are important for achieving the goals of residency training. Copyright © 2014 Elsevier Inc. All rights reserved.

Routine versus selective contrast imaging to identify the need for early re-intervention following laparoscopic fundoplication: A retrospective cohort study.

PubMed

Shahzad, Khalid; Menon, Ashok; Turner, Paul; Ward, Jeremy; Pursnani, Kishore; Alkhaffaf, Bilal

2015-08-01

The prompt recognition of complications is essential in reducing morbidity following anti-reflux surgery. Consequently, many centres employ a policy of routine post-operative contrast studies. The study aimed to examine whether routine contrast studies more effectively recognised early post-operative complications following anti-reflux surgery compared with selective use. This was a retrospective analysis of 240 adults who had undergone primary anti-reflux surgery. Selective use of water-soluble contrast swallows was employed for 115 patients (Group 1) while 125 patients (Group 2) had routine studies. 10 (0.9%) patients from Group 1 underwent contrast studies, four (40%) of which were abnormal. Routine studies in Group 2 identified thirty-two abnormalities (27%) however the inter-group difference was not significant (p = 0.32). Only one case from group 2 required immediate re-intervention. This was not statistically significant (p = 0.78). Multivariate analysis found no significant association between selective or routine imaging and re-intervention rates. One patient from group 2 presented three days following discharge with wrap migration requiring reoperation despite a normal post-operative study. Routine use of contrast imaging following anti-reflux and hiatus hernia surgery is not necessary. It does not identify a significantly greater number of post-operative complications in comparison to selective use. Additionally, routine use of contrast studies does not ensure the diagnosis of all complications in the post-operative period. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

Routine Digital Pathology Workflow: The Catania Experience

PubMed Central

Fraggetta, Filippo; Garozzo, Salvatore; Zannoni, Gian Franco; Pantanowitz, Liron; Rossi, Esther Diana

2017-01-01

Introduction: Successful implementation of whole slide imaging (WSI) for routine clinical practice has been accomplished in only a few pathology laboratories worldwide. We report the transition to an effective and complete digital surgical pathology workflow in the pathology laboratory at Cannizzaro Hospital in Catania, Italy. Methods: All (100%) permanent histopathology glass slides were digitized at ×20 using Aperio AT2 scanners. Compatible stain and scanning slide racks were employed to streamline operations. eSlide Manager software was bidirectionally interfaced with the anatomic pathology laboratory information system. Virtual slide trays connected to the two-dimensional (2D) barcode tracking system allowed pathologists to confirm that they were correctly assigned slides and that all tissues on these glass slides were scanned. Results: Over 115,000 glass slides were digitized with a scan fail rate of around 1%. Drying glass slides before scanning minimized them sticking to scanner racks. Implementation required introduction of a 2D barcode tracking system and modification of histology workflow processes. Conclusion: Our experience indicates that effective adoption of WSI for primary diagnostic use was more dependent on optimizing preimaging variables and integration with the laboratory information system than on information technology infrastructure and ensuring pathologist buy-in. Implementation of digital pathology for routine practice not only leveraged the benefits of digital imaging but also creates an opportunity for establishing standardization of workflow processes in the pathology laboratory. PMID:29416914

Routine Digital Pathology Workflow: The Catania Experience.

PubMed

Fraggetta, Filippo; Garozzo, Salvatore; Zannoni, Gian Franco; Pantanowitz, Liron; Rossi, Esther Diana

2017-01-01

Successful implementation of whole slide imaging (WSI) for routine clinical practice has been accomplished in only a few pathology laboratories worldwide. We report the transition to an effective and complete digital surgical pathology workflow in the pathology laboratory at Cannizzaro Hospital in Catania, Italy. All (100%) permanent histopathology glass slides were digitized at ×20 using Aperio AT2 scanners. Compatible stain and scanning slide racks were employed to streamline operations. eSlide Manager software was bidirectionally interfaced with the anatomic pathology laboratory information system. Virtual slide trays connected to the two-dimensional (2D) barcode tracking system allowed pathologists to confirm that they were correctly assigned slides and that all tissues on these glass slides were scanned. Over 115,000 glass slides were digitized with a scan fail rate of around 1%. Drying glass slides before scanning minimized them sticking to scanner racks. Implementation required introduction of a 2D barcode tracking system and modification of histology workflow processes. Our experience indicates that effective adoption of WSI for primary diagnostic use was more dependent on optimizing preimaging variables and integration with the laboratory information system than on information technology infrastructure and ensuring pathologist buy-in. Implementation of digital pathology for routine practice not only leveraged the benefits of digital imaging but also creates an opportunity for establishing standardization of workflow processes in the pathology laboratory.

75 FR 12815 - Endangered and Threatened Wildlife and Plants; Revised Designation of Critical Habitat for the...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-17

... would outweigh the benefits of designation for the following reasons: (1) Routine grazing practices benefit the California red-legged frog, and designation would increase the liabilities on such practices... the 4(d) special rule includes an expanded definition of routine ranching practices and incorporates...

Rolling Deck to Repository I: Designing a Database Infrastructure

NASA Astrophysics Data System (ADS)

Arko, R. A.; Miller, S. P.; Chandler, C. L.; Ferrini, V. L.; O'Hara, S. H.

2008-12-01

The NSF-supported academic research fleet collectively produces a large and diverse volume of scientific data, which are increasingly being shared across disciplines and contributed to regional and global syntheses. As both Internet connectivity and storage technology improve, it becomes practical for ships to routinely deliver data and documentation for a standard suite of underway instruments to a central shoreside repository. Routine delivery will facilitate data discovery and integration, quality assessment, cruise planning, compliance with funding agency and clearance requirements, and long-term data preservation. We are working collaboratively with ship operators and data managers to develop a prototype "data discovery system" for NSF-supported research vessels. Our goal is to establish infrastructure for a central shoreside repository, and to develop and test procedures for the routine delivery of standard data products and documentation to the repository. Related efforts are underway to identify tools and criteria for quality control of standard data products, and to develop standard interfaces and procedures for maintaining an underway event log. Development of a shoreside repository infrastructure will include: 1. Deployment and testing of a central catalog that holds cruise summaries and vessel profiles. A cruise summary will capture the essential details of a research expedition (operating institution, ports/dates, personnel, data inventory, etc.), as well as related documentation such as event logs and technical reports. A vessel profile will capture the essential details of a ship's installed instruments (manufacturer, model, serial number, reference location, etc.), with version control as the profile changes through time. The catalog's relational database schema will be based on the UNOLS Data Best Practices Committee's recommendations, and published as a formal XML specification. 2. Deployment and testing of a central repository that holds navigation and routine underway data. Based on discussion with ship operators and data managers at a workgroup meeting in September 2008, we anticipate that a subset of underway data could be delivered from ships to the central repository in near- realtime - enabling the integrated display of ship tracks at a public Web portal, for example - and a full data package could be delivered post-cruise by network transfer or disk shipment. Once ashore, data sets could be distributed to assembly centers such as the Shipboard Automated Meteorological and Oceanographic System (SAMOS) for routine processing, quality assessment, and synthesis efforts - as well as transmitted to national data centers such as NODC and NGDC for permanent archival. 3. Deployment and testing of a basic suite of Web services to make cruise summaries, vessel profiles, event logs, and navigation data easily available. A standard set of catalog records, maps, and navigation features will be published via the Open Archives Initiative (OAI) and Open Geospatial Consortium (OGC) protocols, which can then be harvested by partner data centers and/or embedded in client applications.

The Development and Deployment of a Maintenance Operations Safety Survey.

PubMed

Langer, Marie; Braithwaite, Graham R

2016-11-01

Based on the line operations safety audit (LOSA), two studies were conducted to develop and deploy an equivalent tool for aircraft maintenance: the maintenance operations safety survey (MOSS). Safety in aircraft maintenance is currently measured reactively, based on the number of audit findings, reportable events, incidents, or accidents. Proactive safety tools designed for monitoring routine operations, such as flight data monitoring and LOSA, have been developed predominantly for flight operations. In Study 1, development of MOSS, 12 test peer-to-peer observations were collected to investigate the practicalities of this approach. In Study 2, deployment of MOSS, seven expert observers collected 56 peer-to-peer observations of line maintenance checks at four stations. Narrative data were coded and analyzed according to the threat and error management (TEM) framework. In Study 1, a line check was identified as a suitable unit of observation. Communication and third-party data management were the key factors in gaining maintainer trust. Study 2 identified that on average, maintainers experienced 7.8 threats (operational complexities) and committed 2.5 errors per observation. The majority of threats and errors were inconsequential. Links between specific threats and errors leading to 36 undesired states were established. This research demonstrates that observations of routine maintenance operations are feasible. TEM-based results highlight successful management strategies that maintainers employ on a day-to-day basis. MOSS is a novel approach for safety data collection and analysis. It helps practitioners understand the nature of maintenance errors, promote an informed culture, and support safety management systems in the maintenance domain. © 2016, Human Factors and Ergonomics Society.

The Development and Deployment of a Maintenance Operations Safety Survey

PubMed Central

Langer, Marie; Braithwaite, Graham R.

2016-01-01

Objective: Based on the line operations safety audit (LOSA), two studies were conducted to develop and deploy an equivalent tool for aircraft maintenance: the maintenance operations safety survey (MOSS). Background: Safety in aircraft maintenance is currently measured reactively, based on the number of audit findings, reportable events, incidents, or accidents. Proactive safety tools designed for monitoring routine operations, such as flight data monitoring and LOSA, have been developed predominantly for flight operations. Method: In Study 1, development of MOSS, 12 test peer-to-peer observations were collected to investigate the practicalities of this approach. In Study 2, deployment of MOSS, seven expert observers collected 56 peer-to-peer observations of line maintenance checks at four stations. Narrative data were coded and analyzed according to the threat and error management (TEM) framework. Results: In Study 1, a line check was identified as a suitable unit of observation. Communication and third-party data management were the key factors in gaining maintainer trust. Study 2 identified that on average, maintainers experienced 7.8 threats (operational complexities) and committed 2.5 errors per observation. The majority of threats and errors were inconsequential. Links between specific threats and errors leading to 36 undesired states were established. Conclusion: This research demonstrates that observations of routine maintenance operations are feasible. TEM-based results highlight successful management strategies that maintainers employ on a day-to-day basis. Application: MOSS is a novel approach for safety data collection and analysis. It helps practitioners understand the nature of maintenance errors, promote an informed culture, and support safety management systems in the maintenance domain. PMID:27411354

Solving constant-coefficient differential equations with dielectric metamaterials

NASA Astrophysics Data System (ADS)

Zhang, Weixuan; Qu, Che; Zhang, Xiangdong

2016-07-01

Recently, the concept of metamaterial analog computing has been proposed (Silva et al 2014 Science 343 160-3). Some mathematical operations such as spatial differentiation, integration, and convolution, have been performed by using designed metamaterial blocks. Motivated by this work, we propose a practical approach based on dielectric metamaterial to solve differential equations. The ordinary differential equation can be solved accurately by the correctly designed metamaterial system. The numerical simulations using well-established numerical routines have been performed to successfully verify all theoretical analyses.

Prescriptive Package. Improving Patrol Productivity. Volume I. Routine Patrol.

ERIC Educational Resources Information Center

Gay, William G.; Schack, Stephen

Designed to assist police departments in improving the productivity of their patrol operations, this volume on routine patrol and a companion volume on specialized patrol operations are intended for use by various sizes of departments. The volume on routine patrol focuses on the major issues of patrol productivity and recommends a number of…

[Use of PubMed to improve evidence-based medicine in routine urological practice].

PubMed

Rink, M; Kluth, L A; Shariat, S F; Chun, F K; Fisch, M; Dahm, P

2013-03-01

Applying evidence-based medicine in daily clinical practice is the basis of patient-centered medicine and knowledge of accurate literature acquisition skills is necessary for informed clinical decision-making. PubMed is an easy accessible, free bibliographic database comprising over 21 million citations from the medical field, life-science journals and online books. The article summarizes the effective use of PubMed in routine urological clinical practice based on a common case scenario. This article explains the simple use of PubMed to obtain the best search results with the highest evidence. Accurate knowledge about the use of PubMed in routine clinical practice can improve evidence-based medicine and also patient treatment.

WHAT WE DON’T TALK ABOUT WHEN WE DON’T TALK ABOUT SEX1: RESULTS OF A NATIONAL SURVEY OF UNITED STATES OBSTETRICIAN/GYNECOLOGISTS

PubMed Central

SOBECKI, Janelle N.; CURLIN, Farr A.; RASINSKI, Kenneth A.; LINDAU, Stacy Tessler

2012-01-01

Introduction Sexuality is a key aspect of women’s physical and psychological health. Research shows both patients and physicians face barriers to communication about sexuality. Given their expertise and training in addressing conditions of the female genital tract across the female life course, obstetrician/gynecologists (ob/gyns) are well-positioned among all physicians to address sexuality issues with female patients. New practice guidelines for management of female sexual dysfunction and the importance of female sexual behavior and function to virtually all aspects of ob/gyn care, and to women’s health more broadly, warrant up-to-date information regarding ob/gyns’ sexual history-taking routine. Aims To determine obstetrician/gynecologists’ practices of communication with patients about sexuality, and to examine the individual and practice-level correlates of such communication. Methods A population-based sample of 1154 practicing U.S. obstetrician/gynecologists (53% male; mean age 48 years) was surveyed regarding their practices of communication with patients about sex. Main Outcome Measures Self-reported frequency measures of ob/gyns’ communication practices with patients including whether or not ob/gyns discuss patients’ sexual activities, sexual orientation, satisfaction with sexual life, pleasure with sexual activity, and sexual problems or dysfunction, as well as whether or not one ever expresses disapproval of or disagreement with patients’ sexual practices. Multivariable analysis was used to correlate physicians’ personal and practice characteristics with these communication practices. Results Survey response rate was 65.6%. Sixty-three percent of ob/gyns reported routinely assessing patients’ sexual activities; 40% routinely asked about sexual problems. Fewer asked about sexual satisfaction (28.5%), sexual orientation/identity (27.7%), or pleasure with sexual activity (13.8%). A quarter of ob/gyns reported they had expressed disapproval of patients’ sexual practices. Ob/gyns practicing predominately gynecology were significantly more likely than other ob/gyns to routinely ask about each of the five outcomes investigated. Conclusion The majority of U.S. ob/gyns report routinely asking patients about their sexual activities, but most other areas of patients’ sexuality are not routinely discussed. PMID:22443146

The impact of telemedicine in the postoperative care of the neurosurgery patient in an outpatient clinic: a unique perspective of this valuable resource in the developing world--an experience of more than 3000 teleconsultations.

PubMed

Dadlani, Ravi; Mani, Subramaniyan; A U, Jai Ganesh; Mohan, Dilip; Rajgopalan, Niranjana; Thakar, Sumit; Aryan, Saritha; Hegde, Alangar S

2014-01-01

Telemedicine has always been used as a teleconsultation tool in neurological emergencies (e.g., triage in head injuries, stroke, and cerebrovascular accidents). At Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India, we have been operating two teleconsultation sessions per week for the postoperative patient population, addressing routine follow-up and semiemergent conditions in this cohort of patients. At our center more than 80% of the neurosurgical procedures are conducted in patients traveling more than 1500 km. Telemedicine as a routine tool in clinical medicine has significant financial and psychosocial benefits versus routine outpatient clinics. There are very few reports of telemedicine use in routine outpatient teleconsultations in the available neurosurgical literature; those that are present do not differentiate or analyze the use in routine versus emergency neurosurgery. We discuss the role of this underused resource in the developing countries and retrospectively analyze the clinical data in more than 1500 patients and 3000 teleconsultations during a period of 6 years. We address the financial implications, psychosocial factors, and several other factors that could make this relatively modest technology an indispensible tool in current neurosurgical practice, especially in a developing country like India. Copyright © 2014 Elsevier Inc. All rights reserved.

Risk factors and monitoring for water quality to determine best management practices for splash parks.

PubMed

de Man, H; Leenen, E J T M; van Knapen, F; de Roda Husman, A M

2014-09-01

Splash parks have been associated with infectious disease outbreaks as a result of exposure to poor water quality. To be able to protect public health, risk factors were identified that determine poor water quality. Samples were taken at seven splash parks where operators were willing to participate in the study. Higher concentrations of Escherichia coli were measured in water of splash parks filled with rainwater or surface water as compared with sites filled with tap water, independent of routine inspection intervals and employed disinfection. Management practices to prevent fecal contamination and guarantee maintaining good water quality at splash parks should include selection of source water of acceptable quality.

Routine road maintenance water quality and habitat guide : best management practices

DOT National Transportation Integrated Search

2009-01-01

Since June 9, 1999 the Oregon Department of Transportation (ODOT) has implemented the Routine Road Maintenance: Water Quality and Habitat Guide Best Management Practices (the Guide), and is considered the cornerstone of the ODOT'd Office of Maintenan...

Ultrasound Fissure Observation: Assessment of Lung by Pleural-Hub Affiliates.

PubMed

Zanforlin, Alessandro; Livi, Vanina; Santoriello, Carlo; Ceruti, Paolo; Trigiani, Marco; Valerio, Manlio; Perani, Cristiano; Carlucci, Paolo; Palmiotti, Antonio; Marchetti, Giampietro

2018-02-22

Lung ultrasound examination is becoming an even more important part of pulmonologists' clinical routine. As indicated in the literature, the coordinates of any findings on lung parenchyma are based on surface landmarks or conventional quadrants. In our experience we have noticed that lung fissures are clearly detectable as interruptions of the pleural line, but this has never been investigated previously. The aim of this study was to evaluate whether lung fissures are detectable under normal conditions in routine clinical practice. Ten operators were enrolled from Pleural-Hub, a scientific discussion group. After compiling a prestudy survey to investigate whether they had observed fissures previously, they were asked to note if the following fissures were detectable: posterior right (PR) and left (PL), lateral right (LR) and left (LL), anterior right (AR), and anterolateral left (AL). Enrollment was competitive, aiming to reach 100 case subjects. We found that general fissure detection was 61.3%, in particular: PR, 59%; LR, 75%; AR, 69%; PL, 45%; LL, 64%; AL, 56%. Single operators yielded different detection rates ranging from 90% to 25%, showing strong operator dependency. Before being made aware of general results operators indicated operator's skill and rib shadow artifacts as the principal factors affecting fissure detection. Lung fissures may be detected with ultrasound once adequate training is provided. This may allow the clinician a more precise anatomical delineation of pathology identified by lung ultrasound. Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

[Decision-making process and administrative practice: managing the State Health Secretariat in Bahia, Brazil].

PubMed

Coelho, Thereza Christina Bahia; Paim, Jairnilson Silva

2005-01-01

This case study is based on research performed by the Bahia State Health Secretariat (SESAB), aimed at analyzing management practices during the implementation of a State government administrative reform. The institutional agenda shows evidence of limited participation by civil society and technical and operational staff in problem selection and prioritization, resulting from a work process pressured by high-level executive government staff. Decisions regarding "output" (projects, services, and activities) were made under the responsibility of subordinate operational levels and did not appear as issues in the institutional routine. Concerns related to "input" (financial and human resources) consumed most of the high-level efforts, with internal and external negotiations and compromises to assure access to them. Meanwhile the possible "outcome", namely public health status, represents the "occult subject" of the institutional discourse. Information emerges in institutional disputes as a technical "power resource" in its medical, epidemiological, health, and administrative dimensions. The issue of government "representation" and allied interests is based on ideological dispositions and authoritarian practices, thus contradicting the need for management transparency and modernization.

40 CFR 141.806 - Reporting requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... development of the coliform sampling plan, the operations and maintenance plan, and the disinfection and... operations and maintenance plan required by § 141.804 and report the frequency for routine disinfection and... frequency for routine disinfection and flushing within the first calendar quarter of initial operation of...

40 CFR 141.806 - Reporting requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... development of the coliform sampling plan, the operations and maintenance plan, and the disinfection and... operations and maintenance plan required by § 141.804 and report the frequency for routine disinfection and... frequency for routine disinfection and flushing within the first calendar quarter of initial operation of...

Computer Program For Linear Algebra

NASA Technical Reports Server (NTRS)

Krogh, F. T.; Hanson, R. J.

1987-01-01

Collection of routines provided for basic vector operations. Basic Linear Algebra Subprogram (BLAS) library is collection from FORTRAN-callable routines for employing standard techniques to perform basic operations of numerical linear algebra.

Clinical utility of routine pre-operative axillary ultrasound and fine needle aspiration cytology in patient selection for sentinel lymph node biopsy.

PubMed

Rattay, T; Muttalib, M; Khalifa, E; Duncan, A; Parker, S J

2012-04-01

In patients with operable breast cancer, pre-operative evaluation of the axilla may be of use in the selection of appropriate axillary surgery. Pre-operative axillary ultrasound (US) and fine needle aspiration cytology (FNAC) assessments have become routine practice in many breast units, although the evidence base is still gathering. This study assessed the clinical utility of US+/-FNAC in patient selection for either axillary node clearance (ANC) or sentinel lymph node biopsy (SLNB) in patients undergoing surgery for operable breast cancer. Over a two-year period, 348 patients with a clinically negative axilla underwent axillary US. 67 patients with suspicious nodes on US also underwent FNAC. The sensitivity and specificity of axillary investigations to determine nodal involvement were 56% (confidence interval: 47-64%) and 90% (84-93%) for US alone, and 76% (61-87%) and 100% (65-100%) for FNAC combined with US, respectively. With a positive US, the post-test probability was 78%. A negative US carried a post-test probability of 25%. When FNAC was positive, the post-test probability was greater than unity. A negative FNAC yielded a post-test probability of 52%. All patients with positive FNAC and most patients with suspicious US were listed for axillary node clearance (ANC) after consideration at the multi-disciplinary team (MDT) meeting. With pre-operative axillary US+/-FNAC, 20% of patients were saved a potential second axillary procedure, facilitating a reduction in the overall re-operation rate to 12%. In this study, a positive pre-operative US+/-FNAC directs patients towards ANC. When the result is negative, other clinico-pathological factors need to be taken into account in the selection of the appropriate axillary procedure. Copyright © 2011 Elsevier Ltd. All rights reserved.

Demand-based provision of housing, welfare and care services to elderly clients: from policy to daily practice through operations management.

PubMed

de Blok, Carolien; Meijboom, Bert; Luijkx, Katrien; Schols, Jos

2009-03-01

Practical implementation of notions such as patient-orientation, client-centredness, and demand-driven care is far from straightforward in care and service supply to elderly clients living independently. This paper aims to provide preliminary insights into how it is possible to bridge the gap between policy intent, which reflects an increasing client orientation, and actual practice of care and service provision. Differences in personal objectives and characteristics generate different sets of needs among elderly clients that must have an appropriate response in the daily routines of care and service providers. From a study of the available literature and by conceptual reasoning, we identify several important operational implications of client-oriented care and service provision. To deal with these implications the authors turn to the field of operations management. This field has deepened the understanding of translating an organisation's policy into daily activities and working methods. More specifically, we elaborate on the concept of modularity, which stems from the field of operations management. With respect to elderly people who live independently, this concept, among others, seems to be particularly useful in providing options and variation in individual care and service packages. Based on our line of reasoning, we propose that modularity provides possibilities to enhance the provision of demand-based care and services. Furthermore, our findings offer direction on how organisations in housing, welfare and care can be guided in translating demand-based care to their operational processes.

How we eat what we eat: identifying meal routines and practices most strongly associated with healthy and unhealthy dietary factors among young adults.

PubMed

Laska, Melissa N; Hearst, Mary O; Lust, Katherine; Lytle, Leslie A; Story, Mary

2015-08-01

(i) To examine associations between young adults' meal routines and practices (e.g. food preparation, meal skipping, eating on the run) and key dietary indicators (fruit/vegetable, fast-food and sugar-sweetened beverage intakes) and (ii) to develop indices of protective and risky meal practices most strongly associated with diet. Cross-sectional survey. Minneapolis/St. Paul metropolitan area, Minnesota (USA). A diverse sample of community college and public university students (n 1013). Meal routines and practices most strongly associated with healthy dietary patterns were related to home food preparation (i.e. preparing meals at home, preparing meals with vegetables) and meal regularity (i.e. routine consumption of evening meals and breakfast). In contrast, factors most strongly associated with poor dietary patterns included eating on the run, using media while eating and purchasing foods/beverages on campus. A Protective Factors Index, summing selected protective meal routines and practices, was positively associated with fruit/vegetable consumption and negatively associated with fast-food and sugar-sweetened beverage consumption (P<0·001). A Risky Factors Index yielded significant, positive associations with fast-food and sugar-sweetened beverage consumption (P<0·001). The probability test for the association between the Risky Factors Index and fruit/vegetable intake was P=0·05. Meal routines and practices were significantly associated with young adults' dietary patterns, suggesting that ways in which individuals structure mealtimes and contextual characteristics of eating likely influence food choice. Thus, in addition to considering specific food choices, it also may be important to consider the context of mealtimes in developing dietary messaging and guidelines.

How we eat what we eat: Identifying meal routines and practices most strongly associated with healthy and unhealthy dietary factors among young adults

PubMed Central

Laska, Melissa N.; Hearst, Mary O.; Lust, Katherine; Lytle, Leslie; Story, Mary

2017-01-01

Objectives (a) To examine associations between young adult meal routines and practices (e.g., food preparation, meal skipping, eating on the run) and key dietary indicators (fruit/vegetable, fast food and sugar-sweetened beverage intake), and (b) to develop indices of protective and risky meal practices most strongly associated with diet. Design Cross-sectional survey. Setting Minneapolis/St. Paul metropolitan area, Minnesota (USA). Subjects A diverse sample of community college and public university (n=1,013) students. Results Meal routines and practices most strongly associated with healthy dietary patterns were related to home food preparation (i.e., preparing meals at home, preparing meals with vegetables) and meal regularity (i.e., routine consumption of evening meals and breakfast). In contrast, factors most strongly associated with poor dietary patterns included eating on the run, using media while eating, and purchasing foods/beverages on campus. A Protective Factors Index, summing selected protective meal routines and practices, was positively associated with fruit/vegetable consumption, and negatively associated with fast food and sugar-sweetened beverage consumption (p<0.001). A Risky Factors Index yielded significant, positive associations with fast food and sugar sweetened beverage (p<0.001) consumption. The probability test for the association between the Risky Factors Index and fruit/vegetable intake was p=0.05. Conclusions Meal routines and practices were significantly associated with young adult dietary patterns, suggesting that ways in which individuals structure mealtimes and contextual characteristics of eating likely influence food choice. Thus, in addition to considering specific food choices, it also may be important to consider the context of mealtimes in developing dietary messaging and guidelines. PMID:25439511

Airline return-on-investment model for technology evaluation. [computer program to measure economic value of advanced technology applied to passenger aircraft

NASA Technical Reports Server (NTRS)

1974-01-01

This report presents the derivation, description, and operating instructions for a computer program (TEKVAL) which measures the economic value of advanced technology features applied to long range commercial passenger aircraft. The program consists of three modules; and airplane sizing routine, a direct operating cost routine, and an airline return-on-investment routine. These modules are linked such that they may be operated sequentially or individually, with one routine generating the input for the next or with the option of externally specifying the input for either of the economic routines. A very simple airplane sizing technique was previously developed, based on the Brequet range equation. For this program, that sizing technique has been greatly expanded and combined with the formerly separate DOC and ROI programs to produce TEKVAL.

Explanation, motivation and question posing routines in university mathematics teachers' pedagogical discourse: a commognitive analysis

NASA Astrophysics Data System (ADS)

Viirman, Olov

2015-11-01

This paper investigates the teaching practices used by university mathematics teachers when lecturing, a topic within university mathematics education research which is gaining an increasing interest. In the study, a view of mathematics teaching as a discursive practice is taken, and Sfard's commognitive framework is used to investigate the teaching practices of seven Swedish university mathematics teachers on the topic of functions. The present paper looks at the discourse of mathematics teaching, presenting a categorization of the didactical routines into three categories - explanation, motivation and question posing routines. All of these are present in the discourses of all seven teachers, but within these general categories, a number of different sub-categories of routines are found, used in different ways and to different extent by the various teachers. The explanation routines include known mathematical facts, summary and repetition, different representations, everyday language, and concretization and metaphor; the motivation routines include reference to utility, the nature of mathematics, humour and result focus; and the question posing routines include control questions, asking for facts, enquiries and rhetorical questions. This categorization of question posing routines, for instance, complements those already found in the literature. In addition to providing a valuable insight into the teaching of functions at the university level, the categorizations presented in the study can also be useful for investigating the teaching of other mathematical topics.

Clinical Outcome of Degenerative Mitral Regurgitation: Critical Importance of Echocardiographic Quantitative Assessment in Routine Practice.

PubMed

Antoine, Clemence; Benfari, Giovanni; Michelena, Hector I; Malouf, Joseph F; Nkomo, Vuyisile T; Thapa, Prabin; Enriquez-Sarano, Maurice

2018-05-31

Background -Echocardiographic quantitation of degenerative mitral regurgitation (DMR) is recommended whenever possible in clinical guidelines but is criticized and its scalability to routine clinical practice doubted. We hypothesized that echocardiographic DMR quantitation, performed in routine clinical practice by multiple practitioners predicts independently long-term survival, and thus is essential to DMR management. Methods -We included patients diagnosed with isolated mitral-valve-prolapse 2003-2011 and any degree of MR quantified by any physician/sonographer in routine clinical practice. Clinical/echocardiographic data acquired at diagnosis were retrieved electronically. Endpoint was mortality under medical treatment analyzed by Kaplan-Meir method and Proportional-Hazard models. Results -The cohort included 3914 patients (55% male) aged 62±17 years, with left ventricular ejection fraction (LVEF) 63±8% and routinely measured effective regurgitant orifice area (EROA) 19[0-40] mm 2 During follow-up (6.7±3.1 years) 696 patients died under medical management and 1263 underwent mitral surgery. In multivariate analysis, routinely measured EROA was associated with mortality (adjusted-hazard-ratio 1.19[1.13-1.24] p<0.0001 per-10mm 2 ) independently of LVEF and end-systolic diameter, symptoms and age/comorbidities. The association between routinely measured EROA and mortality persisted with competitive risk modeling (adjusted hazard-ratio 1.15[1.10-1.20] per 10mm 2 p<0.0001), or in patients without guideline-based Class I/II surgical triggers (adjusted hazard ratio 1.19[1.10-1.28] per 10mm 2 p<0.0001) and in all subgroups examined (all p<0.01). Spline curve analysis showed that, compared with general population mortality, excess mortality appears for moderate DMR (EROA ≥20mm 2 ) becomes notable ≥EROA 30mm 2 and steadily increases with higher EROA levels, > 40 mm 2 threshold. Conclusions -Echocardiographic DMR quantitation is scalable to routine practice and is independently associated with clinical outcome. Routinely measured EROA is strongly associated with long-term survival under medical treatment. Excess mortality vs. the general population appears in the "moderate" DMR range and steadily increases with higher EROA. Hence, individual EROA values should be integrated into therapeutic considerations, additionally to categorical DMR grading.

Navigating towards improved surgical safety using aviation-based strategies.

PubMed

Kao, Lillian S; Thomas, Eric J

2008-04-01

Safety practices in the aviation industry are being increasingly adapted to healthcare in an effort to reduce medical errors and patient harm. However, caution should be applied in embracing these practices because of limited experience in surgical disciplines, lack of rigorous research linking these practices to outcome, and fundamental differences between the two industries. Surgeons should have an in-depth understanding of the principles and data supporting aviation-based safety strategies before routinely adopting them. This paper serves as a review of strategies adapted to improve surgical safety, including the following: implementation of crew resource management in training operative teams; incorporation of simulation in training of technical and nontechnical skills; and analysis of contributory factors to errors using surveys, behavioral marker systems, human factors analysis, and incident reporting. Avenues and challenges for future research are also discussed.

Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain.

PubMed

Sugrue, Conor M; McInerney, Niall; Joyce, Cormac W; Jones, Deidre; Hussey, Alan J; Kelly, Jack L; Kerin, Michael J; Regan, Padraic J

2015-01-01

Bilateral breast reduction (BBR) is one of the most frequently performed female breast operations. Despite no evidence supporting efficacy of drain usage in BBRs, postoperative insertion is common. Recent high quality evidence demonstrating potential harm from drain use has subsequently challenged this traditional practice. The aim of this study is to assess the current practice patterns of drains usage by Plastic & Reconstructive and Breast Surgeons in UK and Ireland performing BBRs. An 18 question survey was created evaluating various aspects of BBR practice. UK and Irish Plastic & Reconstructive and Breast Surgeons were invited to participate by an email containing a link to a web-based survey. Statistical analysis was performed with student t-test and chi-square test. Two hundred and eleven responding surgeons were analysed, including 80.1% (171/211) Plastic Surgeons and 18.9% (40/211) Breast Surgeons. Of the responding surgeons, 71.6% (151/211) routinely inserted postoperative drains, for a mean of 1.32 days. Drains were used significantly less by surgeons performing ≥20 BBRs (p = 0.02). With the majority of BBRs performed as an inpatient procedure, there was a trend towards less drain usage in surgeons performing this procedure as an outpatient; however, this was not statistically significant (p = 0.07). Even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilised. In an era of evidence- based medicine, surgeons performing breast reductions must adopt the results from scientific research into their clinical practice.

Improving Implementation of eMental Health for Mood Disorders in Routine Practice: Systematic Review of Barriers and Facilitating Factors

PubMed Central

Mol, Mayke; Kleiboer, Annet; Bührmann, Leah; Finch, Tracy; Smit, Jan; Riper, Heleen

2018-01-01

Background Electronic mental health interventions (eMental health or eMH) can be used to increase accessibility of mental health services for mood disorders, with indications of comparable clinical outcomes as face-to-face psychotherapy. However, the actual use of eMH in routine mental health care lags behind expectations. Identifying the factors that might promote or inhibit implementation of eMH in routine care may help to overcome this gap between effectiveness studies and routine care. Objective This paper reports the results of a systematic review of the scientific literature identifying those determinants of practices relevant to implementing eMH for mood disorders in routine practice. Methods A broad search strategy was developed with high sensitivity to four key terms: implementation, mental health care practice, mood disorder, and eMH. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework was applied to guide the review and structure the results. Thematic analysis was applied to identify the most important determinants that facilitate or hinder implementation of eMH in routine practice. Results A total of 13,147 articles were screened, of which 48 studies were included in the review. Most studies addressed aspects of the reach (n=33) of eMH, followed by intervention adoption (n=19), implementation of eMH (n=6), and maintenance (n=4) of eMH in routine care. More than half of the studies investigated the provision of mental health services through videoconferencing technologies (n=26), followed by Internet-based interventions (n=20). The majority (n=44) of the studies were of a descriptive nature. Across all RE-AIM domains, we identified 37 determinants clustered in six main themes: acceptance, appropriateness, engagement, resources, work processes, and leadership. The determinants of practices are expressed at different levels, including patients, mental health staff, organizations, and health care system level. Depending on the context, these determinants hinder or facilitate successful implementation of eMH. Conclusions Of the 37 determinants, three were reported most frequently: (1) the acceptance of eMH concerning expectations and preferences of patients and professionals about receiving and providing eMH in routine care, (2) the appropriateness of eMH in addressing patients’ mental health disorders, and (3) the availability, reliability, and interoperability with other existing technologies such as the electronic health records are important factors for mental health care professionals to remain engaged in providing eMH to their patients in routine care. On the basis of the taxonomy of determinants of practices developed in this review, implementation-enhancing interventions can be designed and applied to achieve better implementation outcomes. Suggestions for future research and implementation practice are provided. PMID:29549072

Working at the nexus between public health policy, practice and research. Dynamics of knowledge sharing in the Netherlands

PubMed Central

2012-01-01

Background Joining the domains of practice, research and policy is an important aspect of boosting the quality performance required to tackle complex public health problems. “Joining domains” implies a departure from the linear and technocratic knowledge-translation approach. Integrating the practice, research and policy triangle means knowing its elements, appreciating the barriers, identifying possible cooperation strategies and studying strategy effectiveness under specified conditions. This article examines the dynamic process of developing an Academic Collaborative Centre for Public Health in the Netherlands, with the objective of achieving that the three domains of policy, practice and research become working partners on an equal footing. Method An interpretative hermeneutic approach was used to interpret the phenomenon of collaboration at the nexus between the three domains. The project was explicitly grounded in current organizational culture and routines, applied to nexus action. In the process of examination, we used both quantitative (e.g. records) and qualitative data (e.g., interviews and observations). The data were interpreted using the Actor-Network, Institutional Re-Design and Blurring the Boundaries theories. Results Results show commitment at strategic level. At the tactical level, however, managers were inclined to prioritize daily routine, while the policy domain remained absent. At the operational level, practitioners learned to do PhD research in real-life practice and researchers became acquainted with problems of practice and policy, resulting in new research initiatives. Conclusion We conclude that working at the nexus is an ongoing process of formation and reformation. Strategies based on Institutional Re-Design theories in particular might help to more actively stimulate managers’ involvement to establish mutually supportive networks. PMID:23075375

Working at the nexus between public health policy, practice and research. Dynamics of knowledge sharing in The Netherlands.

PubMed

Jansen, Maria W; De Leeuw, Evelyne; Hoeijmakers, Marjan; De Vries, Nanne K

2012-10-17

Joining the domains of practice, research and policy is an important aspect of boosting the quality performance required to tackle complex public health problems. "Joining domains" implies a departure from the linear and technocratic knowledge-translation approach. Integrating the practice, research and policy triangle means knowing its elements, appreciating the barriers, identifying possible cooperation strategies and studying strategy effectiveness under specified conditions.This article examines the dynamic process of developing an Academic Collaborative Centre for Public Health in the Netherlands, with the objective of achieving that the three domains of policy, practice and research become working partners on an equal footing. An interpretative hermeneutic approach was used to interpret the phenomenon of collaboration at the nexus between the three domains. The project was explicitly grounded in current organizational culture and routines, applied to nexus action. In the process of examination, we used both quantitative (e.g. records) and qualitative data (e.g., interviews and observations). The data were interpreted using the Actor-Network, Institutional Re-Design and Blurring the Boundaries theories. Results show commitment at strategic level. At the tactical level, however, managers were inclined to prioritize daily routine, while the policy domain remained absent. At the operational level, practitioners learned to do PhD research in real-life practice and researchers became acquainted with problems of practice and policy, resulting in new research initiatives. We conclude that working at the nexus is an ongoing process of formation and reformation. Strategies based on Institutional Re-Design theories in particular might help to more actively stimulate managers' involvement to establish mutually supportive networks.

Can a theoretical framework help to embed alcohol screening and brief interventions in an endoscopy day-unit?

PubMed

O'Neill, G; Masson, S; Bewick, L; Doyle, J; McGovern, R; Stoker, E; Wright, H; Newbury-Birch, D

2016-01-01

The National Institute for Health Care and Excellence recommend that alcohol screening and brief intervention (ASBI) should be routinely implemented in secondary care. This study used theoretical frameworks to understand how health professionals can be supported to adapt their behaviour and clinical practice. Staff training and support was conducted using theoretical frameworks. A 12-week study, delivering ASBI was carried out as part of routine practice in an endoscopy day-unit. Anonymised patient data were collected using the Alcohol Use Disorders Identification Tool (AUDIT) and whether patients received a brief intervention. Staff completed the Shortened Alcohol and Alcohol Problems Perceptions Questionnaire at three time points and took part in a focus group both pre and post study. For staff, levels or role adequacy, role legitimacy, motivation to discuss alcohol, security in their role, job satisfaction and commitment to working with patients who drink increased during the time of the study. 1598 individual patients were seen in the department in the timeframe. Of these, 1180 patients were approached (74%); 18% (n=207) of patients were AUDIT positive. This study has shown that it is possible to reach a high number of patients in a busy hospital out-patient department and deliver ASBI by working with staff using theoretical frameworks for training. Embedding evidence-based public health interventions into routine clinical environments is complex. The social system in which professionals operate requires consideration alongside individual professionals' real and perceived barriers and facilitators to change.

A methodological protocol for selecting and quantifying low-value prescribing practices in routinely collected data: an Australian case study.

PubMed

Brett, Jonathan; Elshaug, Adam G; Bhatia, R Sacha; Chalmers, Kelsey; Badgery-Parker, Tim; Pearson, Sallie-Anne

2017-05-03

Growing imperatives for safety, quality and responsible resource allocation have prompted renewed efforts to identify and quantify harmful or wasteful (low-value) medical practices such as test ordering, procedures and prescribing. Quantifying these practices at a population level using routinely collected health data allows us to understand the scale of low-value medical practices, measure practice change following specific interventions and prioritise policy decisions. To date, almost all research examining health care through the low-value lens has focused on medical services (tests and procedures) rather than on prescribing. The protocol described herein outlines a program of research funded by Australia's National Health and Medical Research Council to select and quantify low-value prescribing practices within Australian routinely collected health data. We start by describing our process for identifying and cataloguing international low-value prescribing practices. We then outline our approach to translate these prescribing practices into indicators that can be applied to Australian routinely collected health data. Next, we detail methods of using Australian health data to quantify these prescribing practices (e.g. prevalence of low-value prescribing and related costs) and their downstream health consequences. We have approval from the necessary Australian state and commonwealth human research ethics and data access committees to undertake this work. The lack of systematic and transparent approaches to quantification of low-value practices in routinely collected data has been noted in recent reviews. Here, we present a methodology applied in the Australian context with the aim of demonstrating principles that can be applied across jurisdictions in order to harmonise international efforts to measure low-value prescribing. The outcomes of this research will be submitted to international peer-reviewed journals. Results will also be presented at national and international pharmacoepidemiology and health policy forums such that other jurisdictions have guidance to adapt this methodology.

Turning Routine Exercises into Activities That Teach Inquiry: A Practical Guide

ERIC Educational Resources Information Center

Dorée, Suzanne Ingrid

2017-01-01

How can we teach inquiry? In this paper, I offer practical techniques for teaching inquiry effectively using activities built from routine textbook exercises with minimal advanced preparation, including rephrasing exercises as questions, creating activities that inspire students to make conjectures, and asking for counterexamples to reasonable,…

Space shuttle environmental control/life support systems

NASA Technical Reports Server (NTRS)

1972-01-01

This study analyzes and defines a baseline Environmental Control/Life Support System (EC/LSS) for a four-man, seven-day orbital shuttle. In addition, the impact of various mission parameters, crew size, mission length, etc. are examined for their influence on the selected system. Pacing technology items are identified to serve as a guide for application of effort to enhance the total system optimization. A fail safe-fail operation philosophy was utilized in designing the system. This has resulted in a system that requires only one daily routine operation. All other critical item malfunctions are automatically resolved by switching to redundant modes of operation. As a result of this study, it is evident that a practical, flexible, simple and long life, EC/LSS can be designed and manufactured for the shuttle orbiter within the time phase required.

Real-Time Ultrasound-Guided Spinal Anaesthesia: A Prospective Observational Study of a New Approach

PubMed Central

Conroy, P. H.; Luyet, C.; McCartney, C. J.; McHardy, P. G.

2013-01-01

Identification of the subarachnoid space has traditionally been achieved by either a blind landmark-guided approach or using prepuncture ultrasound assistance. To assess the feasibility of performing spinal anaesthesia under real-time ultrasound guidance in routine clinical practice we conducted a single center prospective observational study among patients undergoing lower limb orthopaedic surgery. A spinal needle was inserted unassisted within the ultrasound transducer imaging plane using a paramedian approach (i.e., the operator held the transducer in one hand and the spinal needle in the other). The primary outcome measure was the success rate of CSF acquisition under real-time ultrasound guidance with CSF being located in 97 out of 100 consecutive patients within median three needle passes (IQR 1–6). CSF was not acquired in three patients. Subsequent attempts combining landmark palpation and pre-puncture ultrasound scanning resulted in successful spinal anaesthesia in two of these patients with the third patient requiring general anaesthesia. Median time from spinal needle insertion until intrathecal injection completion was 1.2 minutes (IQR 0.83–4.1) demonstrating the feasibility of this technique in routine clinical practice. PMID:23365568

Parents with Intellectual Disabilities Experiencing Challenging Child Routines: A Pilot Study Using Embedded Self-Determination Practices.

PubMed

Knowles, Christen; Blakely, Allison; Hansen, Sarah; Machalicek, Wendy

2017-05-01

Practices to facilitate self-determination have not received appropriate attention in research concerning parents with intellectual disabilities (ID). Likewise, parenting interventions for adults with intellectual disabilities have seldom observed both parent and child behavioural outcomes. This study evaluated the effectiveness of a parenting intervention embedded with self-determination facilitation practices for two dyads of a parent with intellectual disabilities and their young child. The interventions focused on increasing parents' ability to correctly implement steps of a parenting routine while reducing occurrence of challenging child behaviour. The results of the study demonstrated two basic effects of correctly completed steps of the parenting routine and a reduction of challenging child behaviour. Parents also reported decreased feelings of stress during the routine following completion of the intervention. Implications for future research and replication of this pilot study are discussed. © 2016 John Wiley & Sons Ltd.

NASA Space Program experience in hydrogen transportation and handling

NASA Technical Reports Server (NTRS)

Bain, A. L.

1976-01-01

This paper portrays the experience gained in the transportation and handling of hydrogen in support of the Apollo launch site at Kennedy Space Center (KSC), Fla., one of NASA's prime hydrogen users in the Space Program. The objective of the paper is basically to reveal the types of systems involved in handling hydrogen, safety practices, operational techniques, other general experience information, and primarily to convey the routinism by which this potential fuel of the future has already been handled in significant quantities for a number of years.

Commander Naval Air Forces (CNAF) Flight Hour Program: Budgeting and Execution Response to the Implementation of the Fleet Response Plan and OP-20 Pricing Model Changes

DTIC Science & Technology

2005-06-01

seat ratio ( CSR ). The wartime CSR is the result of wartime manning levels divided by Primary Aircraft Authorized (PAA). The Aircrew Manning Factor...justifies the FHP.59 As ADM Mallon suggested, let us look at two simple examples of today’s best business practices with Starbucks and Southwest Airlines...focusing on efforts to achieve optimal efficiency in routine tasks of their operation. The Starbucks example involves redesigning ice scoops and

Public attitudes to the storage of blood left over from routine general practice tests and its use in research.

PubMed

Treweek, Shaun; Doney, Alex; Leiman, David

2009-01-01

There is increasing international interest in DNA biobanks but relatively little evidence concerning appropriate recruitment methods for these repositories of genetic information linked to patient-specific phenotypic data. To this end, our study aimed to investigate the attitudes of members of the public recruited through general practices to the donation and storage of blood left over from routine clinical tests in general practice. A questionnaire was mailed to 2600 individuals randomly selected from two general practice patient lists in Dundee, Scotland. Using a 7-point Likert scale, respondents rated their attitudes toward DNA biobanks in general, and procurement of blood samples specifically. Overall, 841 (34%) of 2471 delivered questionnaires were returned. Compared with patients on the practice lists, respondents were older and more likely to be women. A majority of respondents (61%) were unequivocally positive about storing blood left over from routine tests. Despite general support for this collection method, when asked about open-ended consent, respondents expressed concern about future uses. Respondents' increasing age and level of deprivation had significant adverse effects on attitudes towards making leftover routine biological samples available for research (P = 0.013 and P = 0.034, respectively). The study had three main limitations: there was a low response rate (34%) such that respondents were not entirely respresentative of the survey population; some respondents had difficulty with the questionnaire; and the study was somewhat underpowered for some comparisons. Despite its limitations, this first survey of a general practice population suggests that the majority would be willing to consider giving open-ended consent for the use of blood left over from routine clinical tests in general practice to be stored and used later for medical research.

Predictors of routine episiotomy in primigravida women in Oman.

PubMed

Al-Ghammari, Khadija; Al-Riyami, Zainab; Al-Moqbali, Moza; Al-Marjabi, Fatma; Al-Mahrouqi, Basma; Al-Khatri, Amal; Al-Khasawneh, Esra M

2016-02-01

Episiotomy is still the most common surgical procedure performed on women, despite the evidence against its routine use. This cross-sectional study was conducted to determine the practice and predictors of routine episiotomy on primigravidae in Oman. Demographic data, reasons for and rate of performing routine episiotomies, and perceptions of 269 obstetricians, midwives and nurses from 11 hospitals in Oman regarding the procedure were recorded and analyzed. The rate of episiotomies was 66%. In terms of performing routine episiotomies (p<0.05): non-Omanis were 4.49 times more likely than Omanis; bachelor's degree-holders were 2.26 more likely than diploma-holders; and regional hospitals were 2.36 times more likely than tertiary hospitals. The majority perceived episiotomies "reduce spontaneous perineal tearing risk", "reduce shoulder dystocia complications", and allow for "easier suturing". The rate of episiotomies was higher than other similar contexts. An urgent intervention is necessary to curb this excessive practice, and create a culture of evidence-based practice to deal with misleading perceptions. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Learning management by self-employed occupational therapists in private practice.

PubMed

Millsteed, Jeannine; Redmond, Janice; Walker, Elizabeth

2017-04-01

This study explored how occupational therapists in private practice developed the business skills needed to operate a successful private practice. The literature shows that many small-business owner-managers have poorly developed business skills, and some experience high rates of failure. This indicates that to be successful in private practice, occupational therapists need to gain mastery of management competencies in addition to their professional clinical competencies. A qualitative study, using in-depth interviews, collected data from twenty-six self-employed occupational therapists on their experiences of becoming a small-business owner-manager. A narrative analysis built an understanding about how these therapists developed their business competencies. Analysis revealed the factors affecting the development of business competencies were interactions between the initial motivations for start-up, growth aspirations and engagement with external business environments. Business competencies developed through a combination of formal learning prior to starting their businesses, and informal learning once their businesses were in operation. Lower level learning occurred in the routine and operational processes, with higher level learning through discontinuous events resulting in a transformation in the therapists' understanding about themselves as business owner-managers. Findings led to a proposition that occupational therapists make the transition to becoming successful small-business owner-manager through management learning that includes elements of self-reflection, identifying environmental opportunities and risks, developing capabilities, and strategic planning for growth and development. It provides insights on what occupational therapists need to consider to become successful small-business owner-managers. © 2016 Occupational Therapy Australia.

Child Routines and Self-Regulation Serially Mediate Parenting Practices and Externalizing Problems in Preschool Children

ERIC Educational Resources Information Center

Bater, Lovina Rose; Jordan, Sara Sytsma

2017-01-01

Background: Studies clearly indicate that parenting practices relate to child externalizing behaviors, although the mechanisms underlying this relation are less well understood. There has been limited evaluation of child routines and self-regulation in relation to these variables, and no known studies have evaluated all of these variables…

Ethnographic study of ICT-supported collaborative work routines in general practice.

PubMed

Swinglehurst, Deborah; Greenhalgh, Trisha; Myall, Michelle; Russell, Jill

2010-12-29

Health informatics research has traditionally been dominated by experimental and quasi-experimental designs. An emerging area of study in organisational sociology is routinisation (how collaborative work practices become business-as-usual). There is growing interest in the use of ethnography and other in-depth qualitative approaches to explore how collaborative work routines are enacted and develop over time, and how electronic patient records (EPRs) are used to support collaborative work practices within organisations. Following Feldman and Pentland, we will use 'the organisational routine' as our unit of analysis. In a sample of four UK general practices, we will collect narratives, ethnographic observations, multi-modal (video and screen capture) data, documents and other artefacts, and analyse these to map and compare the different understandings and enactments of three common routines (repeat prescribing, coding and summarising, and chronic disease surveillance) which span clinical and administrative spaces and which, though 'mundane', have an important bearing on quality and safety of care. In a detailed qualitative analysis informed by sociological theory, we aim to generate insights about how complex collaborative work is achieved through the process of routinisation in healthcare organisations. Our study offers the potential not only to identify potential quality failures (poor performance, errors, failures of coordination) in collaborative work routines but also to reveal the hidden work and workarounds by front-line staff which bridge the model-reality gap in EPR technologies and via which "automated" safety features have an impact in practice.

Ethnographic study of ICT-supported collaborative work routines in general practice

PubMed Central

2010-01-01

Background Health informatics research has traditionally been dominated by experimental and quasi-experimental designs. An emerging area of study in organisational sociology is routinisation (how collaborative work practices become business-as-usual). There is growing interest in the use of ethnography and other in-depth qualitative approaches to explore how collaborative work routines are enacted and develop over time, and how electronic patient records (EPRs) are used to support collaborative work practices within organisations. Methods/design Following Feldman and Pentland, we will use 'the organisational routine' as our unit of analysis. In a sample of four UK general practices, we will collect narratives, ethnographic observations, multi-modal (video and screen capture) data, documents and other artefacts, and analyse these to map and compare the different understandings and enactments of three common routines (repeat prescribing, coding and summarising, and chronic disease surveillance) which span clinical and administrative spaces and which, though 'mundane', have an important bearing on quality and safety of care. In a detailed qualitative analysis informed by sociological theory, we aim to generate insights about how complex collaborative work is achieved through the process of routinisation in healthcare organisations. Discussion Our study offers the potential not only to identify potential quality failures (poor performance, errors, failures of coordination) in collaborative work routines but also to reveal the hidden work and workarounds by front-line staff which bridge the model-reality gap in EPR technologies and via which "automated" safety features have an impact in practice. PMID:21190583

Managing cows: an ethnography of breeding practices and uses of reproductive technology in contemporary dairy farming in Lombardy (Italy).

PubMed

Grasseni, Cristina

2007-06-01

The aim of this article is to contribute detailed ethnographic material to broaden the scope of what we mean by reproductive technology. Technology can be defined not only by a series of laboratory techniques (such as artificial insemination and embryo transfer) that are drafted into the daily management of the animal body, but also by a range of on-farm management strategies and working routines, as well as the cultural dispositions, social networks and tacit knowledge of the actors involved. RT is communicated to lay operators and disseminated amongst semi-professional figures such as breed experts, herd inspectors and technical consultants. The practical contexts in which reproductive knowledge is popularized and applied provide ample scope for local negotiations, resistance and conflict. Professional knowledge about breed-improvement is personalised and appropriated by operators and plays a role in power relations and the exercise of personal charisma as well as being specific to context, in particular the nuances of pre-existing relationships of trust, friendship, kinship or hierarchy. No wonder then that many ambivalences and compromises coexist in the practice of applying 'reproductive knowledge' to breed selection.

A risk-management approach for effective integration of biomarkers in clinical trials: perspectives of an NCI, NCRI, and EORTC working group.

PubMed

Hall, Jacqueline Anne; Salgado, Roberto; Lively, Tracy; Sweep, Fred; Schuh, Anna

2014-04-01

Clinical cancer research today often includes testing the value of biomarkers to direct treatment and for drug development. However, the practical challenges of integration of molecular information into clinical trial protocols are increasingly appreciated. Inherent difficulties include evidence gaps in available biomarker data, a paucity of robust assay methods, and the design of appropriate studies within the constraints of feasible trial operations, and finite resources. Scalable and proportionate approaches are needed to systematically cope with these challenges. Therefore, we assembled international experts from three clinical trials organisations to identify the common challenges and common solutions. We present a practical risk-assessment framework allowing targeting of scarce resources to crucial issues coupled with a library of useful resources and a simple actionable checklist of recommendations. We hope that these practical methods will be useful for running biomarker-driven trials and ultimately help to develop biomarkers that are ready for integration in routine practice. Copyright © 2014 Elsevier Ltd. All rights reserved.

Laboratory safety handbook

USGS Publications Warehouse

Skinner, E.L.; Watterson, C.A.; Chemerys, J.C.

1983-01-01

Safety, defined as 'freedom from danger, risk, or injury,' is difficult to achieve in a laboratory environment. Inherent dangers, associated with water analysis and research laboratories where hazardous samples, materials, and equipment are used, must be minimized to protect workers, buildings, and equipment. Managers, supervisors, analysts, and laboratory support personnel each have specific responsibilities to reduce hazards by maintaining a safe work environment. General rules of conduct and safety practices that involve personal protection, laboratory practices, chemical handling, compressed gases handling, use of equipment, and overall security must be practiced by everyone at all levels. Routine and extensive inspections of all laboratories must be made regularly by qualified people. Personnel should be trained thoroughly and repetitively. Special hazards that may involve exposure to carcinogens, cryogenics, or radiation must be given special attention, and specific rules and operational procedures must be established to deal with them. Safety data, reference materials, and texts must be kept available if prudent safety is to be practiced and accidents prevented or minimized.

Introducing guidelines into clinical practice.

PubMed

Fowkes, F G; Roberts, C J

1984-04-01

The impetus for guidelines of practice has been accelerated by a worldwide trend towards insurance based systems of health care. In the past it has been the tradition for the clinician to order all the diagnostic procedures that conceivably might help to clarify what is wrong with a patient, or what course of treatment should be followed. This traditional view ignores the stubborn economic reality that resources are finite and that it is no longer possible to be both endlessly generous and continually fair. Making judgements about the need for, and value of, services now forms an important part of coping with this problem. Clinical practice has to strive to be as safe as possible and to produce a given benefit at a socially acceptable cost. Guidelines are recommendations, preferably developed by clinicians themselves, which describe how and when individual clinical activities should be offered in order to achieve these objectives. Utilisation review of current practice is a valuable source of information for the development of guidelines. In the United Kingdom the Royal College of Radiologists attempted to do this in connection with the use of pre-operative chest X-rays. In 1979 they published the findings of a multicentre review of 10,619 consecutive cases of elective non-cardiopulmonary surgery undertaken in 8 centres throughout the United Kingdom. Substantial variations were found in national practice. Use of pre-operative chest X-rays varied from 11.5% of patients in one centre to 54.2% of patients in another centre. The study also found that the chest X-ray report did not seem to have much influence on the decision to operate nor on the decision to use inhalation anaesthesia. The College study failed to find "any evidence at all for the effectiveness of pre-operative chest X-ray when used routinely" and it was estimated that even if the procedure was 10% effective the costs of avoiding one death would be approximately 1 million pounds. These findings provided the impetus for the College to develop guidelines for the use of pre-operative chest X-rays in hospitals in the United Kingdom. Creating a change in clinical practice through the introduction of guidelines is a three stage process: Stage I: introducing the idea of a change in practice. Stage II: introduction of guidelines into clinical practice. Stage III: sustained implementation of guidelines in clinical practice.(ABSTRACT TRUNCATED AT 400 WORDS)

Ultrasound guidance for central venous catheter placement in Australasian emergency departments: potential barriers to more widespread use.

PubMed

Matera, Jakub T; Egerton-Warburton, Diana; Meek, Robert

2010-12-01

To survey Fellows of the Australasian College for Emergency Medicine (FACEMs) in order to describe current ultrasound (US) usage during central venous catheter (CVC) placement and to compare practice and opinions between FACEMs routinely using US and those not. Descriptive and analytical cross-sectional electronic survey of all FACEMs. Baseline variables including hospital type, US availability, frequency of CVC insertion, US usage and technique are presented descriptively. US practice and opinions on usage are compared between routine and non-routine users. Responses were obtained from 486 (42.4%) of 1146 FACEMs emailed. Whereas 88.5% of respondents had US available and 70% had done an US course, only 37% routinely used US for CVC placement. Completion of an US course and performance of >11 CVC per year were strongly associated with routine US use (odds ratio 10.0 [5.5-18.4] and 2.6 [1.7-3.9], respectively). Common barriers to more frequent US use were not having completed an US course (20%) and US-guided CVC placement taking too long (18%). Eighty-five per cent of FACEMs agreed that there should be ED access to US and US training but only 34% thought its use should be mandatory. We found that only 37% of FACEM respondents routinely used US to guide placement of CVCs and a number of barriers to more frequent use are identified. Practices and opinions regarding US use differed significantly between routine and non-routine users. © 2010 The Authors. EMA © 2010 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

How does routinely delivered cognitive-behavioural therapy for gambling disorder compare to "gold standard" clinical trial?

PubMed

Smith, David P; Fairweather-Schmidt, A Kate; Harvey, Peter W; Battersby, Malcolm W

2018-03-01

Currently, it is unknown whether treatment outcomes derived from randomized controlled trials (RCTs) of cognitive-behavioural therapy (CBT) for problem gamblers still hold when applied to patients seen in routine practice. Thus, data from an RCT of cognitive therapy versus exposure therapy for problem gambling versus patients of a gambling help service were compared. Assessments of problem gambling severity, psychosocial impairment, and alcohol use were undertaken at baseline and post-treatment and evaluated within a counterfactual framework. Findings showed that the contrast between routine CBT for pokies and horse betting had a significant effect, indicative of a 62% lower gambling urge score if routine CBT recipients had all been horse/track betters opposed to gambling with "pokies." However, the majority of contrasts indicated therapeutic outcomes achieved in routine CBT treatments were of equivalent robustness relative to RCT conditions. The present findings infer routine practice treatment outcomes are as efficacious as those generated in RCT contexts. Copyright © 2017 John Wiley & Sons, Ltd.

Measuring Teaching Best Practice in the Induction Years: Development and Validation of an Item-Level Assessment

ERIC Educational Resources Information Center

Kingsley, Laurie; Romine, William

2014-01-01

Schools and teacher induction programs around the world routinely assess teaching best practice to inform accreditation, tenure/promotion, and professional development decisions. Routine assessment is also necessary to ensure that teachers entering the profession get the assistance they need to develop and succeed. We introduce the Item-Level…

THE PROS AND CONS OF ROUTINE CIRCUMCISION

PubMed Central

Hovsepian, Deron

1951-01-01

The origin of the practice of circumcision is an ancient one having a ritual significance in most cases, but the operation is done primarily for hygienic purposes amongst English-speaking people. Critical evaluation of the indication for circumcision suggests that the hygienic principles are probably overrated. If it were understood that the anatomy of the prepuce and glans has a morphological development which in most cases removes the possibility of phimosis after the third year, less emphasis would be placed on the necessity for the operation. On the other hand, the feeling exists that boys who will require circumcision because of phimosis, balanitis, etc., should not be subjected to the operation at the age when psychological trauma can result. Convention and conformity demand the continuation of the procedure in many areas. The decision to circumcise remains a matter of individual preference as prescribed in the doctor-patient relationship. PMID:14886736

An Overview of Dynamic Contact Resistance Measurement of HV Circuit Breakers

NASA Astrophysics Data System (ADS)

Bhole, A. A.; Gandhare, W. Z.

2016-06-01

With the deregulation of the electrical power industry, utilities and service companies are operating in a changing business environment. High voltage circuit breakers are extremely important for the function of modern electric power supply systems. The need to predict the proper function of circuit breaker grew over the years as the transmission networks expanded. The maintenance of circuit breakers deserves special consideration because of their importance for routine switching and for protection of other equipments. Electric transmission system breakups and equipment destruction can occur if a circuit breaker fails to operate because of a lack of preventive maintenance. Dynamic Contact Resistance Measurement (DCRM) is known as an effective technique for assessing the condition of power circuit breakers contacts and operating mechanism. This paper gives a general review about DCRM. It discusses the practical case studies on use of DCRM for condition assessment of high voltage circuit breakers.

A simulation system for Space Station extravehicular activity

NASA Technical Reports Server (NTRS)

Marmolejo, Jose A.; Shepherd, Chip

1993-01-01

America's next major step into space will be the construction of a permanently manned Space Station which is currently under development and scheduled for full operation in the mid-1990's. Most of the construction of the Space Station will be performed over several flights by suited crew members during an extravehicular activity (EVA) from the Space Shuttle. Once fully operational, EVA's will be performed from the Space Station on a routine basis to provide, among other services, maintenance and repair operations of satellites currently in Earth orbit. Both voice recognition and helmet-mounted display technologies can improve the productivity of workers in space by potentially reducing the time, risk, and cost involved in performing EVA. NASA has recognized this potential and is currently developing a voice-controlled information system for Space Station EVA. Two bench-model helmet-mounted displays and an EVA simulation program have been developed to demonstrate the functionality and practicality of the system.

SPIRIT: Systematic Planning of Intelligent Reuse of Integrated Clinical Routine Data. A Conceptual Best-practice Framework and Procedure Model.

PubMed

Hackl, W O; Ammenwerth, E

2016-01-01

Secondary use of clinical routine data is receiving an increasing amount of attention in biomedicine and healthcare. However, building and analysing integrated clinical routine data repositories are nontrivial, challenging tasks. As in most evolving fields, recognized standards, well-proven methodological frameworks, or accurately described best-practice approaches for the systematic planning of solutions for secondary use of routine medical record data are missing. We propose a conceptual best-practice framework and procedure model for the systematic planning of intelligent reuse of integrated clinical routine data (SPIRIT). SPIRIT was developed based on a broad literature overview and further refined in two case studies with different kinds of clinical routine data, including process-oriented nursing data from a large hospital group and high-volume multimodal clinical data from a neurologic intensive care unit. SPIRIT aims at tailoring secondary use solutions to specific needs of single departments without losing sight of the institution as a whole. It provides a general conceptual best-practice framework consisting of three parts: First, a secondary use strategy for the whole organization is determined. Second, comprehensive analyses are conducted from two different viewpoints to define the requirements regarding a clinical routine data reuse solution at the system level from the data perspective (BOTTOM UP) and at the strategic level from the future users perspective (TOP DOWN). An obligatory clinical context analysis (IN BETWEEN) facilitates refinement, combination, and integration of the different requirements. The third part of SPIRIT is dedicated to implementation, which comprises design and realization of clinical data integration and management as well as data analysis solutions. The SPIRIT framework is intended to be used to systematically plan the intelligent reuse of clinical routine data for multiple purposes, which often was not intended when the primary clinical documentation systems were implemented. SPIRIT helps to overcome this gap. It can be applied in healthcare institutions of any size or specialization and allows a stepwise setup and evolution of holistic clinical routine data reuse solutions.

Colon cleansing protocol in children: research conditions vs. clinical practice.

PubMed

Elitsur, Yoram; Balfaqih, Yaslam; Preston, Deborah

2018-04-01

 Colon preparation rates are the limiting factor for a successful diagnostic colonoscopy in children. Different colon cleansing protocols have been published for use in children. Unfortunately, the applicability of those published research protocols has not been formally evaluated in routine clinical practice. We investigated the success rate of our previously published colon cleansing protocol as utilized in our clinical practice.  This was a retrospective study. In the clinical practice, the colon cleansing protocol included PEG-3350 at a dose of 2 g/kg/day plus Dulcolax (Bisacodyl, Boehringer Ingelheim, TX USA) 5 mg/day for 2 days. Adequate colon preparation was graded between 1 - 5, as previously described, and grade ≥ 4.0 was considered an adequate preparation. Patients were instructed to complete a questionnaire that included PEG-3350 dose, number of stools per day, consistency of each stool, and side effects (vomiting, abdominal pain). Clinical and endoscopic results were compared between the protocol under research conditions and routine practice.  The success rate of the colon preparation in our clinical practice was similar to the results observed under our research protocol (75 % vs. 73.6 %). Moreover, the total number of stools, stool consistency, and the intubation rate of the terminal ileum were also similar. We concluded, that in our experience, the colon cleansing protocol used under research conditions was effective and appropriate for use in routine clinical practice.  We recommend testing each new protocol under the routine conditions of clinical practice to confirm its applicability for general practitioners.

Methods for synchronizing a countdown routine of a timer key and electronic device

DOEpatents

Condit, Reston A.; Daniels, Michael A.; Clemens, Gregory P.; Tomberlin, Eric S.; Johnson, Joel A.

2015-06-02

A timer key relating to monitoring a countdown time of a countdown routine of an electronic device is disclosed. The timer key comprises a processor configured to respond to a countdown time associated with operation of the electronic device, a display operably coupled with the processor, and a housing configured to house at least the processor. The housing has an associated structure configured to engage with the electronic device to share the countdown time between the electronic device and the timer key. The processor is configured to begin a countdown routine based at least in part on the countdown time, wherein the countdown routine is at least substantially synchronized with a countdown routine of the electronic device when the timer key is removed from the electronic device. A system and method for synchronizing countdown routines of a timer key and an electronic device are also disclosed.

Thinking Routines: Replicating Classroom Practices within Museum Settings

ERIC Educational Resources Information Center

Wolberg, Rochelle Ibanez; Goff, Allison

2012-01-01

This article describes thinking routines as tools to guide and support young children's thinking. These learning strategies, developed by Harvard University's Project Zero Classroom, actively engage students in constructing meaning while also understanding their own thinking process. The authors discuss how thinking routines can be used in both…

Receptionist input to quality and safety in repeat prescribing in UK general practice: ethnographic case study

PubMed Central

Greenhalgh, Trisha; Russell, Jill; Myall, Michelle

2011-01-01

Objective To describe, explore, and compare organisational routines for repeat prescribing in general practice to identify contributors and barriers to safety and quality. Design Ethnographic case study. Setting Four urban UK general practices with diverse organisational characteristics using electronic patient records that supported semi-automation of repeat prescribing. Participants 395 hours of ethnographic observation of staff (25 doctors, 16 nurses, 4 healthcare assistants, 6 managers, and 56 reception or administrative staff), and 28 documents and other artefacts relating to repeat prescribing locally and nationally. Main outcome measures Potential threats to patient safety and characteristics of good practice. Methods Observation of how doctors, receptionists, and other administrative staff contributed to, and collaborated on, the repeat prescribing routine. Analysis included mapping prescribing routines, building a rich description of organisational practices, and drawing these together through narrative synthesis. This was informed by a sociological model of how organisational routines shape and are shaped by information and communications technologies. Results Repeat prescribing was a complex, technology-supported social practice requiring collaboration between clinical and administrative staff, with important implications for patient safety. More than half of requests for repeat prescriptions were classed as “exceptions” by receptionists (most commonly because the drug, dose, or timing differed from what was on the electronic repeat list). They managed these exceptions by making situated judgments that enabled them (sometimes but not always) to bridge the gap between the idealised assumptions about tasks, roles, and interactions that were built into the electronic patient record and formal protocols, and the actual repeat prescribing routine as it played out in practice. This work was creative and demanded both explicit and tacit knowledge. Clinicians were often unaware of this input and it did not feature in policy documents or previous research. Yet it was sometimes critical to getting the job done and contributed in subtle ways to safeguarding patients. Conclusion Receptionists and administrative staff make important “hidden” contributions to quality and safety in repeat prescribing in general practice, regarding themselves accountable to patients for these contributions. Studying technology-supported work routines that seem mundane, standardised, and automated, but which in reality require a high degree of local tailoring and judgment from frontline staff, opens up a new agenda for the study of patient safety. PMID:22053317

Receptionist input to quality and safety in repeat prescribing in UK general practice: ethnographic case study.

PubMed

Swinglehurst, Deborah; Greenhalgh, Trisha; Russell, Jill; Myall, Michelle

2011-11-03

To describe, explore, and compare organisational routines for repeat prescribing in general practice to identify contributors and barriers to safety and quality. Ethnographic case study. Four urban UK general practices with diverse organisational characteristics using electronic patient records that supported semi-automation of repeat prescribing. 395 hours of ethnographic observation of staff (25 doctors, 16 nurses, 4 healthcare assistants, 6 managers, and 56 reception or administrative staff), and 28 documents and other artefacts relating to repeat prescribing locally and nationally. Potential threats to patient safety and characteristics of good practice. Observation of how doctors, receptionists, and other administrative staff contributed to, and collaborated on, the repeat prescribing routine. Analysis included mapping prescribing routines, building a rich description of organisational practices, and drawing these together through narrative synthesis. This was informed by a sociological model of how organisational routines shape and are shaped by information and communications technologies. Results Repeat prescribing was a complex, technology-supported social practice requiring collaboration between clinical and administrative staff, with important implications for patient safety. More than half of requests for repeat prescriptions were classed as "exceptions" by receptionists (most commonly because the drug, dose, or timing differed from what was on the electronic repeat list). They managed these exceptions by making situated judgments that enabled them (sometimes but not always) to bridge the gap between the idealised assumptions about tasks, roles, and interactions that were built into the electronic patient record and formal protocols, and the actual repeat prescribing routine as it played out in practice. This work was creative and demanded both explicit and tacit knowledge. Clinicians were often unaware of this input and it did not feature in policy documents or previous research. Yet it was sometimes critical to getting the job done and contributed in subtle ways to safeguarding patients. Conclusion Receptionists and administrative staff make important "hidden" contributions to quality and safety in repeat prescribing in general practice, regarding themselves accountable to patients for these contributions. Studying technology-supported work routines that seem mundane, standardised, and automated, but which in reality require a high degree of local tailoring and judgment from frontline staff, opens up a new agenda for the study of patient safety.

The art and science of using routine outcome measurement in mental health benchmarking.

PubMed

McKay, Roderick; Coombs, Tim; Duerden, David

2014-02-01

To report and critique the application of routine outcome measurement data when benchmarking Australian mental health services. The experience of the authors as participants and facilitators of benchmarking activities is augmented by a review of the literature regarding mental health benchmarking in Australia. Although the published literature is limited, in practice, routine outcome measures, in particular the Health of the National Outcomes Scales (HoNOS) family of measures, are used in a variety of benchmarking activities. Use in exploring similarities and differences in consumers between services and the outcomes of care are illustrated. This requires the rigour of science in data management and interpretation, supplemented by the art that comes from clinical experience, a desire to reflect on clinical practice and the flexibility to use incomplete data to explore clinical practice. Routine outcome measurement data can be used in a variety of ways to support mental health benchmarking. With the increasing sophistication of information development in mental health, the opportunity to become involved in benchmarking will continue to increase. The techniques used during benchmarking and the insights gathered may prove useful to support reflection on practice by psychiatrists and other senior mental health clinicians.

Variations in achievement of evidence-based, high-impact quality indicators in general practice: An observational study

PubMed Central

West, Robert; Rushforth, Bruno; Stokes, Tim; Glidewell, Liz; Carder, Paul; Faulkner, Simon; Foy, Robbie

2017-01-01

Background There are widely recognised variations in the delivery and outcomes of healthcare but an incomplete understanding of their causes. There is a growing interest in using routinely collected ‘big data’ in the evaluation of healthcare. We developed a set of evidence-based ‘high impact’ quality indicators (QIs) for primary care and examined variations in achievement of these indicators using routinely collected data in the United Kingdom (UK). Methods Cross-sectional analysis of routinely collected, electronic primary care data from a sample of general practices in West Yorkshire, UK (n = 89). The QIs covered aspects of care (including processes and intermediate clinical outcomes) in relation to diabetes, hypertension, atrial fibrillation, myocardial infarction, chronic kidney disease (CKD) and ‘risky’ prescribing combinations. Regression models explored the impact of practice and patient characteristics. Clustering within practice was accounted for by including a random intercept for practice. Results Median practice achievement of the QIs ranged from 43.2% (diabetes control) to 72.2% (blood pressure control in CKD). Considerable between-practice variation existed for all indicators: the difference between the highest and lowest performing practices was 26.3 percentage points for risky prescribing and 100 percentage points for anticoagulation in atrial fibrillation. Odds ratios associated with the random effects for practices emphasised this; there was a greater than ten-fold difference in the likelihood of achieving the hypertension indicator between the lowest and highest performing practices. Patient characteristics, in particular age, gender and comorbidity, were consistently but modestly associated with indicator achievement. Statistically significant practice characteristics were identified less frequently in adjusted models. Conclusions Despite various policy and improvement initiatives, there are enduring inappropriate variations in the delivery of evidence-based care. Much of this variation is not explained by routinely collected patient or practice variables, and is likely to be attributable to differences in clinical and organisational behaviour. PMID:28704407

An efficient, maintenance free and approved method for spectroscopic control and monitoring of blend uniformity: The moving F-test.

PubMed

Besseling, Rut; Damen, Michiel; Tran, Thanh; Nguyen, Thanh; van den Dries, Kaspar; Oostra, Wim; Gerich, Ad

2015-10-10

Dry powder mixing is a wide spread Unit Operation in the Pharmaceutical industry. With the advent of in-line Near Infrared (NIR) Spectroscopy and Quality by Design principles, application of Process Analytical Technology to monitor Blend Uniformity (BU) is taking a more prominent role. Yet routine use of NIR for monitoring, let alone control of blending processes is not common in the industry, despite the improved process understanding and (cost) efficiency that it may offer. Method maintenance, robustness and translation to regulatory requirements have been important barriers to implement the method. This paper presents a qualitative NIR-BU method offering a convenient and compliant approach to apply BU control for routine operation and process understanding, without extensive calibration and method maintenance requirements. The method employs a moving F-test to detect the steady state of measured spectral variances and the endpoint of mixing. The fundamentals and performance characteristics of the method are first presented, followed by a description of the link to regulatory BU criteria, the method sensitivity and practical considerations. Applications in upscaling, tech transfer and commercial production are described, along with evaluation of the method performance by comparison with results from quantitative calibration models. A full application, in which end-point detection via the F-test controls the blending process of a low dose product, was successfully filed in Europe and Australia, implemented in commercial production and routinely used for about five years and more than 100 batches. Copyright © 2015 Elsevier B.V. All rights reserved.

Stress and dress: investigating the relationship between social anxiety and appearance management among gay and straight men.

PubMed

Reilly, Andrew; Rudd, Nancy Ann

2007-01-01

This research project explores the relationship between social anxiety and appearance management behaviors (AMB), including both routine and non-routine, among gay and straight men and women. Prior research had found links between AMB and stress (Reilly & Rudd, 2002), stress and (perceived) discrimination (Lee, 1997; Savin-Williams, 1994), and sexual orientation and weight (Brand, Rothblum, & Solom, 1992). An argument is made that links stress with AMB using the foundation of Social Comparison Theory (Festinger, 1954) as a guide. Research questions investigated were: (1) Is there a correlation between stress and AMB; (2) Is there a significant difference between body mass indices of men and women of differing sexual orientations; (3) How do AMB differ between those with gay and straight orientations; and (4) How do AMB differ between men and women? Using a survey design, a questionnaire was posted on the Internet. Measures included the Rudd/Lennon Appearance Management Scale of Routine and Risky Behaviors and the Liebowitz Social Anxiety Scale. A total of 365 usable forms were completed. Results show that social anxiety is positively correlated with non-routine AMB, or behaviors that carry some risk. Gay and straight participants differed on the routine AMB they practiced. Men and women differed on the non-routine or risky AMB they practiced or would consider practicing. Implications are discussed and further research is suggested.

Surgical Management of Common Disorders of Feedlot Calves.

PubMed

Miesner, Matt D; Anderson, David E

2015-11-01

Procedures to improve animal and handler safety, shape production parameters, and directly address the prosperity of individuals in need of assistance are performed routinely. Techniques to accomplish these tasks have been described in many venues. Painful procedures are expected in feedlot practice. Assessing and managing pain and welfare for these procedures has strengthened significantly over the past decade to address increased public concerns and also to support the desires of the operators/managers to progress. Methods to perform common procedures are described, including evidence and techniques for managing the pain and distress while performing them. Published by Elsevier Inc.

Could quantitative longitudinal peak systolic strain help in the detection of left ventricular wall motion abnormalities in our daily echocardiographic practice?

PubMed

Benyounes, Nadia; Lang, Sylvie; Gout, Olivier; Ancédy, Yann; Etienney, Arnaud; Cohen, Ariel

2016-10-01

Transthoracic echocardiography is the most commonly used tool for the detection of left ventricular wall motion (LVWM) abnormalities using "naked eye evaluation". This subjective and operator-dependent technique requires a high level of clinical training and experience. Two-dimensional speckle-tracking echocardiography (2D-STE), which is less operator-dependent, has been proposed for this purpose. However, the role of on-line segmental longitudinal peak systolic strain (LPSS) values in the prediction of LVWM has not been fully evaluated. To test segmental LPSS for predicting LVWM abnormalities in routine echocardiography laboratory practice. LVWM was evaluated by an experienced cardiologist, during routine practice, in 620 patients; segmental LPSS values were then calculated. In this work, reflecting real life, 99.6% of segments were successfully tracked. Mean (95% confidence interval [CI]) segmental LPSS values for normal basal (n=3409), mid (n=3468) and apical (n=3466) segments were -16.7% (-16.9% to -16.5%), -18.2% (-18.3% to -18.0%) and -21.1% (-21.3% to -20.9%), respectively. Mean (95% CI) segmental LPSS values for hypokinetic basal (n=114), mid (n=116) and apical (n=90) segments were -7.7% (-9.0% to -6.3%), -10.1% (-11.1% to -9.0%) and -9.3% (-10.5% to -8.1%), respectively. Mean (95% CI) segmental LPSS values for akinetic basal (n=128), mid (n=95) and apical (n=91) segments were -6.6% (-8.0% to -5.1%), -6.1% (-7.7% to -4.6%) and -4.2% (-5.4% to -3.0%), respectively. LPSS allowed the differentiation between normal and abnormal segments at basal, mid and apical levels. An LPSS value≥-12% detected abnormal segmental motion with a sensitivity of 78% for basal, 70% for mid and 82% for apical segments. Segmental LPSS values may help to differentiate between normal and abnormal left ventricular segments. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Suspected retinopathies in Norwegian optometric practice with emphasis on patients with diabetes: a cross-sectional study

PubMed Central

Sundling, Vibeke; Gulbrandsen, Pål; Bragadottir, Ragnheiður; Bakketeig, Leiv S; Jervell, Jak; Straand, Jørund

2008-01-01

Background The scope of optometry differs worldwide. In Norway the vast majority of optometrists perform ophthalmoscopy as part of their routine examinations. The aim of this study was to describe the frequency of suspected retinopathies in patients seen for routine optometric examination and to determine how optometrists deal with these patients. Methods 212 optometrists participated in a questionnaire survey and a practice registration during November 2004 – May 2005. In the practice registration, details for 20 consecutive patient encounters were recorded. Data were analysed by chi-square tests and multiple logistic regression. Results All optometrist stated that ocular history taking was an integrated part of their routine examination, while general health and diabetes history were routinely addressed by 59% and 42% of the optometrists, respectively. During the practice registration 4,052 patient encounters were recorded. Ophthalmoscopy was performed in 88% of the patients, of which 2% were dilated fundus examinations. Retinopathy was suspected in 106 patients, of whom 31 did not report a previous history of ocular or systemic disease. Old age (75+), hypertension and diabetes strongly predicted retinopathy with odds ratio (95% CI) of 6.4 (4.2 to 9.9), 3.8 (2.4 to 6.0) and 2.5 (1.4 to 4.7), respectively. Diabetic retinopathy was seen in 10% of diabetic patients and suspected in 0.2% of patients with no established history of diabetes. Retinopathy was not confirmed in 9 out 18 patients with a history of diabetic retinopathy; seven of these had undergone laser treatment. Out of the 106 patients with findings of retinopathy, 28 were referred to an ophthalmologist or a general practitioner (GP), written reports were sent to a GP in 16 cases, ten patients were urged to contact their GP for further follow up, while 52 were considered in need of routine optometric follow up only. Conclusion Optometric practice provides a low threshold setting for detecting cases of ocular disease and retinal manifestations of systemic disease in the population. At present diagnosis of retinopathy in Norwegian optometric practice is unreliable. There are potentials for improving the optometrists' routine examination, their patient management patterns and collaboration routines with medical doctors. PMID:18261204

Predicting the evolution of low back pain patients in routine clinical practice: results from a registry within the Spanish National Health Service.

PubMed

Kovacs, Francisco M; Seco, Jesús; Royuela, Ana; Corcoll Reixach, Josep; Abraira, Víctor

2012-11-01

The Spanish National Health Service (SNHS) is a tax-funded public organization that provides free health care to every resident in Spain. To develop models for predicting the evolution of low back pain (LBP) in routine clinical practice within SNHS. Analysis of a prospective registry in routine clinical practice, in 17 centers across SNHS. Patient sample includes 4,477 acute and chronic LBP patients treated in primary and hospital care. Pain and disability, measured through validated instruments. Patients treated for LBP were assessed at baseline and 3 months later. Data gathered were the following: sex, age, employment status, duration of pain, severity of LBP, pain down to the leg (LP) and disability, history of lumbar surgery, diagnostic procedures undertaken, imaging findings, and treatments used throughout the study period. Three separate multivariate logistic regression models were developed for predicting a clinically relevant improvement in LBP, LP, and disability at 3 months. In total, 4,261 patients (95.2%) attended follow-up. For all the models, calibration was reasonable and the area under the receiver operating characteristic curve was ≥0.640. For LBP, LP, and disability, factors associated with a higher probability of improvement at 3 months were the following: not having undergone lumbar surgery, higher baseline scores for the corresponding variable, lower ones for the rest, and being treated with neuroreflexotherapy. Additional factors were the following: for LBP, shorter pain duration; for LP, not undergoing electromyography; and for disability, shorter pain duration, not being diagnosed with disc degeneration, and being treated with muscle relaxants and not opioids. A prospective registry can be used for developing predictive models to quantify the odds that a given LBP patient will experience a clinically relevant improvement. This may empower patients for an informed shared decision making. Copyright © 2012 Elsevier Inc. All rights reserved.

Barium swallow for hiatal hernia detection is unnecessary prior to primary sleeve gastrectomy.

PubMed

Goitein, David; Sakran, Nasser; Rayman, Shlomi; Szold, Amir; Goitein, Orly; Raziel, Asnat

2017-02-01

Hiatal hernia (HH) is common in the bariatric population. Its presence imposes various degrees of difficulty in performing laparoscopic sleeve gastrectomy (LSG). Preoperative upper gastrointestinal evaluation consists of fluoroscopic and or endoscopic studies OBJECTIVES: To evaluate the efficacy of routine, preoperative barium swallow in identifying HH in patients undergoing LSG, and determine if such foreknowledge changes operative and immediate postoperative course regarding operative time, intraoperative adverse events, and length of hospital stay (LOS). In addition, to quantify HH prevalence in these patients and correlate preoperative patient characteristics with its presence. High-volume bariatric practice in a private hospital in Israel METHODS: Retrospective analysis of prospectively collected data between October 2010 and March 2015: anthropometrics, co-morbidities, previous barium swallow, preoperative HH workup (type and result), operative and immediate postoperative course. Primary LSG was performed in 2417 patients. The overall prevalence of HH was 7.3%. Preoperative diagnosis of gastroesophageal reflux disease and female gender were independent risk factors for HH presence. Operative times were significantly longer when HH was concomitantly repaired but "foreknowledge" thereof did not assist in shortening this time. Looking for an HH that was suggested in preoperative upper gastrointestinal evaluation slightly prolonged surgery. LOS was not changed in a significant fashion by HH presence and repair, whether suspected or incidentally found. Routine, pre-LSG barium swallow does not seem to offer an advantage over selective intraoperative hiatal exploration, in the discovery and management of HH. Conversely, when preoperative workup yields a false-positive result, surgery is slightly prolonged. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Use of perioperative dialogues with children undergoing day surgery.

PubMed

Wennström, Berith; Hallberg, Lillemor R-M; Bergh, Ingrid

2008-04-01

This paper is a report of a study to explore what it means for children to attend hospital for day surgery. Hospitalization is a major stressor for children. Fear of separation, unfamiliar routines, anaesthetic/operation expectations/experiences and pain and needles are sources of children's negative reactions. A grounded theory study was carried out during 2005-2006 with 15 boys and five girls (aged 6-9 years) scheduled for elective day surgery. Data were collected using tape-recorded interviews that included a perioperative dialogue, participant observations and pre- and postoperative drawings. A conceptual model was generated on the basis of the core category 'enduring inflicted hospital distress', showing that the main problem for children having day surgery is that they are forced into an unpredictable and distressful situation. Pre-operatively, the children do not know what to expect, as described in the category 'facing an unknown reality'. Additional categories show that they perceive a 'breaking away from daily routines' and that they are 'trying to gain control' over the situation. During the perioperative period, the categories 'losing control' and 'co-operating despite fear and pain' are present and intertwined. Post-operatively, the categories 'breathing a sigh of relief' and 'regaining normality in life' emerged. The perioperative dialogue used in our study, if translated into clinical practice, might therefore minimize distress and prepare children for the 'unknown' stressor that hospital care often presents. Further research is needed to compare anxiety and stress levels in children undergoing day surgery involving the perioperative dialogue and those having 'traditional' anaesthetic care.

77 FR 42796 - Privacy Act of 1974; System of Records; Statement of General Routine Uses; Notice of...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-20

..., organization, or individual for the purpose of performing audit or oversight operations related to this system...; System of Records; Statement of General Routine Uses; Notice of Establishment of Three New General... systems of records. Comment is invited on the three new routine uses. The three new routine uses are...

Developing and piloting an expert system for better routine voluntary HIV counseling and testing in China: preliminary results and lessons.

PubMed

Chai, Jing; Wang, DeBin; Zhou, Meng; Xu, WangQuan; Liang, Guojun; Shen, Yi Fang

2012-01-01

This study aims at developing and testing a pragmatic expert system for HIV voluntary counseling (VCT-ES) that leverages best practices. The VCT-ES was developed via evolutionary prototyping and piloted in 10 voluntary HIV counseling and testing (VCT) clinics from Anhui and Beijing representative of prefecture and county level VCT clinics in China. All counselors with the clinics and the clients to the clinics within selected two weeks at baseline and the end of study were invited to participate. Assessment measures included essential counseling procedures (ECPs); clients' satisfaction, knowledge, and behavior efficacy. VCT-ES was developed which tries to model and facilitate standard VCT operation procedures and best practices. One hundred and eighty-two (96 at baseline vs. 86 after intervention) cases recordings, 172 (96 vs. 76) client questionnaires, 10 counselor, and 2 expert rating instruments were collected; and 17 clients and 8 counselors participated in qualitative interviews. VCT-ES increased delivery of ECPs from 18.94% to 66.39% on average; increased clients' knowledge from 40.51% to 86.34% and self-efficacy by 22.42%. The VCT-ES applications listed were rated 9.1 on average (maximum = 10). The VCT-ES could be an easy and effective solution to better routine VCT and merits further research.

Making innovations accessible to the poor through implementation research.

PubMed

Squire, S B; Ramsay, A R C; van den Hof, S; Millington, K A; Langley, I; Bello, G; Kritski, A; Detjen, A; Thomson, R; Cobelens, F; Mann, G H

2011-07-01

Within countries, poorer populations have greater health needs and less access to good medical care than better-off populations. This is particularly true for tuberculosis (TB), the archetypal disease of poverty. Innovations also tend to become available to better-off populations well before they become available to those who need them the most. In a new era of innovations for TB diagnosis and treatment, it is increasingly important not only to be sure that these innovations can work in terms of accuracy and efficacy, but also that they will work, especially for the poor. We argue that after an innovation or a group of innovations has been endorsed, based on demonstrated accuracy and/or efficacy, introduction into routine practice should proceed through implementation by research. Cluster-randomised pragmatic trials are suited to this approach, and permit the prospective collection of evidence needed for full impact assessment according to a previously published framework. The novel approach of linking transmission modelling with operational modelling provides a methodology for expanding and enhancing the range of evidence, and can be used alongside evidence from pragmatic implementation trials. This evidence from routine practice should then be used to ensure that innovations in TB control are used for positive action for all, and particularly the poor.

Routine intra-operative trans-oesophageal echocardiography yields better outcomes in surgical repair of CHD.

PubMed

Madriago, Erin J; Punn, Rajesh; Geeter, Natalie; Silverman, Norman H

2016-02-01

Trans-oesophageal echocardiographic imaging is valuable in the pre- and post-operative evaluation of children and adults with CHD; however, the frequency by which trans-oesophageal echocardiography guides the intra-operative course of patients is unknown. We retrospectively reviewed 1748 intra-operative trans-oesophageal echocardiograms performed between 1 October, 2005 and 31 December, 2010, and found 99 cases (5.7%) that required return to bypass, based in part upon the intra-operative echocardiographic findings. The diagnoses most commonly requiring further repair and subsequent imaging were mitral valve disease (20.9%), tricuspid valve disease (16.0%), atrioventricular canal defects (12.0%), and pulmonary valve disease (14.1%). The vast majority of those requiring immediate return to bypass benefited by avoiding subsequent operations and longer lengths of hospital stay. A total of 14 patients (0.8%) who received routine imaging required further surgical repair within 1 week, usually due to disease that developed over ensuing days. Patients who had second post-operative trans-oesophageal echocardiograms in the operating room rarely required re-operations, confirming the benefit of routine intra-operative imaging. This study represents a large single institutional review of intra-operative trans-oesophageal echocardiography, and confirms its applicability in the surgical repair of patients with CHD. Routine imaging accurately identifies patients requiring further intervention, does not confer additional risk of mortality or prolonged length of hospital stay, and prevents subsequent operations and associated sequelae in a substantial subset of patients. This study demonstrates the utility of echocardiography in intra-operative monitoring of surgical repair and highlights patients who are most likely to require return to bypass, as well as the co-morbidities of such manipulations.

Arthroscopic hip preservation surgery practice patterns: an international survey

PubMed Central

Smith, Kevin M.; Gerrie, Brayden J.; McCulloch, Patrick C.; Lewis, Brian D.; Mather, R. Chad; Van Thiel, Geoffrey; Nho, Shane J.

2017-01-01

Abstract To design and conduct a survey analyzing pre-, intra- and post- hip arthroscopy practice patterns among hip arthroscopists worldwide. A 21-question, IRB-exempt, HIPAA-compliant, cross-sectional survey was conducted via email using SurveyMonkey to examine pre-operative evaluation, intra-operative techniques and post-operative management. The survey was administered internationally to 151 hip arthroscopists identified from publicly available sources. Seventy-five respondents completed the survey (151 ± 116 hip arthroscopy procedures per year; 8.6 ± 7.1 years hip arthroscopy experience). Standing AP pelvis, false profile and Dunn 45 were the most common radiographs utilized. CT scans were utilized by 54% of surgeons at least some of the time. Only 56% of participants recommended an arthrogram with MRI. Nearly all surgeons either never (40%) or infrequently (58%) performed arthroscopy in Tönnis grade-2 or grade-3 osteoarthritis. Surgeons rarely performed hip arthroscopy on patients with dysplasia (51% never; 44% infrequently). Only 25% of participants perform a routine ‘T’ capsulotomy and 41% close the capsule if the patient is at risk for post-operative instability. Post-operatively, 52% never use a brace, 39% never use a continuous passive motion, 11% never recommended heterotopic ossification prophylaxis and 30% never recommended formal thromboembolic disease prophylaxis. Among a large number of high-volume experienced hip arthroscopists worldwide, pre-, intra- and post- hip arthroscopy practice patterns have been established and reported. Within this cohort of respondents, several areas of patient evaluation and management remain discordant and controversial without universal agreement. Future research should move beyond expert opinion level V evidence towards high-quality appropriately designed and conducted investigations. PMID:28630717

Cultural Responsiveness and Routines: When Center and Home Don't Match

ERIC Educational Resources Information Center

Gonzalez-Mena, Janet

2010-01-01

This article discusses cultural responsiveness and routines of child care centers that do not match what families are accustomed to at home. It can be difficult to discuss cultural differences in some routine caregiving activities because of the standards, rules, regulations, best practices, and health concerns that those trained in early…

Between demarcation and discretion: The medical-administrative boundary as a locus of safety in high-volume organisational routines.

PubMed

Grant, Suzanne; Guthrie, Bruce

2018-04-01

Patient safety is an increasing concern for health systems internationally. The majority of administrative work in UK general practice takes place in the context of organisational routines such as repeat prescribing and test results handling, where high workloads and increased clinician dependency on administrative staff have been identified as an emerging safety issue. Despite this trend, most research to date has focused on the redistribution of the clinical workload between doctors, nurses and allied health professionals within individual care settings. Drawing on Strauss's negotiated order perspective, we examine ethnographically the achievement of safety across the medical-administrative boundary in key high-volume routines in UK general practice. We focus on two main issues. First, GPs engaged in strategies of demarcation by defining receptionist work as routine, unspecialised and dependent upon GP clinical knowledge and oversight as the safety net to deal with complexity and risk. Receptionists consented to this 'social closure' when describing their role, thus reinforcing the underlying inter-occupational relationship of medical domination. Second, in everyday practice, GPs and receptionists engaged in informal boundary-blurring to safely accommodate the complexity of everyday high-volume routine work. This comprised additional informal discretionary spaces for receptionist decision-making and action that went beyond the routine safety work formally assigned to them. New restratified intra-occupational hierarchies were also being created between receptionists based on the complexity of the safety work that they were authorised to do at practice level, with specialised roles constituting a new form of administrative 'professional project'. The article advances negotiated order theory by providing an in-depth examination of the ways in which medical-administrative boundary-making and boundary-blurring constitute distinct modes of safety in high-volume routines. It also provides the basis for further research and safety improvement to maximise team-level understandings of the pivotal role of medical-administrative negotiations in achieving safety and mitigating risk. Copyright © 2018 Elsevier Ltd. All rights reserved.

Routine operation of an Elliott 903 computer in a clinical chemistry laboratory

PubMed Central

Whitby, L. G.; Simpson, D.

1973-01-01

Experience gained in the last four years concerning the capabilities and limitations of an 8K Elliott 903 (18-bit word) computer with magnetic tape backing store in the routine operation of a clinical chemistry laboratory is described. Designed as a total system, routine operation has latterly had to be confined to data acquisition and process control functions, due primarily to limitations imposed by the choice of hardware early in the project. In this final report of a partially successful experiment the opportunity is taken to review mistakes made, especially at the start of the project, to warn potential computer users of pitfalls to be avoided. PMID:4580240

The self-reported clinical practice behaviors of Australian optometrists as related to smoking, diet and nutritional supplementation.

PubMed

Downie, Laura Elizabeth; Keller, Peter Richard

2015-01-01

The primary aim of this study was to examine the self-reported, routine clinical practice behaviors of Australian optometrists with respect to advice regarding smoking, diet and nutritional supplementation. The study also sought to assess the potential influence of practitioner age, gender, practice location (major city versus regional), therapeutic-endorsement status and personal nutritional supplementation habits upon management practices in these areas. A survey was electronically distributed to Australian optometrists (n = 4,242). Respondents anonymously provided information about their personal demographics and lifestyle behaviors (i.e., age, gender, practice location, therapeutic-endorsement status, smoking status, nutritional supplement intake) and routine patient management practices with respect to advice across three domains: smoking, diet and nutritional supplementation. Multivariate logistic regression analyses were performed to assess for potential effects of the listed factors on practitioner behavior. A total of 283 completed surveys were received (completed survey response rate: 6.7%). Fewer than half of respondents indicated routinely asking their patients about smoking status. Younger practitioners were significantly (p < 0.05) less likely to enquire about patients' smoking behaviors, but this did not extend to counseling for smoking cessation. Almost two-thirds of respondents indicated routinely counseling patients about diet. About half of practitioners specified routinely asking their patients about nutritional supplement intake; this form of questioning was significantly more likely if the respondent was female (p < 0.05). Practitioners who recommended nutritional supplements most commonly did so for age-related macular degeneration (91.2%) and dry eye disease (63.9%). The primary source of evidence used to guide practitioners' nutrition-related patient management was reported to be peer-reviewed publications. These findings demonstrate that there are no clear predictors of practitioner behavior across the three domains. Overall, this study suggests that there is scope for Australian optometrists to improve their routine engagement by questioning patients, as well as providing evidence-based clinical advice, about smoking status, diet and nutritional supplement behaviors, being key modifiable lifestyle risk factors with long-term implications for eye health.

The Self-Reported Clinical Practice Behaviors of Australian Optometrists as Related to Smoking, Diet and Nutritional Supplementation

PubMed Central

Downie, Laura Elizabeth; Keller, Peter Richard

2015-01-01

Objective The primary aim of this study was to examine the self-reported, routine clinical practice behaviors of Australian optometrists with respect to advice regarding smoking, diet and nutritional supplementation. The study also sought to assess the potential influence of practitioner age, gender, practice location (major city versus regional), therapeutic-endorsement status and personal nutritional supplementation habits upon management practices in these areas. Methods A survey was electronically distributed to Australian optometrists (n = 4,242). Respondents anonymously provided information about their personal demographics and lifestyle behaviors (i.e., age, gender, practice location, therapeutic-endorsement status, smoking status, nutritional supplement intake) and routine patient management practices with respect to advice across three domains: smoking, diet and nutritional supplementation. Multivariate logistic regression analyses were performed to assess for potential effects of the listed factors on practitioner behavior. Results A total of 283 completed surveys were received (completed survey response rate: 6.7%). Fewer than half of respondents indicated routinely asking their patients about smoking status. Younger practitioners were significantly (p < 0.05) less likely to enquire about patients’ smoking behaviors, but this did not extend to counseling for smoking cessation. Almost two-thirds of respondents indicated routinely counseling patients about diet. About half of practitioners specified routinely asking their patients about nutritional supplement intake; this form of questioning was significantly more likely if the respondent was female (p < 0.05). Practitioners who recommended nutritional supplements most commonly did so for age-related macular degeneration (91.2%) and dry eye disease (63.9%). The primary source of evidence used to guide practitioners’ nutrition-related patient management was reported to be peer-reviewed publications. Conclusions These findings demonstrate that there are no clear predictors of practitioner behavior across the three domains. Overall, this study suggests that there is scope for Australian optometrists to improve their routine engagement by questioning patients, as well as providing evidence-based clinical advice, about smoking status, diet and nutritional supplement behaviors, being key modifiable lifestyle risk factors with long-term implications for eye health. PMID:25886641

Management of occiput posterior position in the second stage of labor: a survey of midwifery practice in Australia.

PubMed

Phipps, Hala; de Vries, Brad; Jagadish, Ujvala; Hyett, Jon

2014-03-01

The management of the occiput posterior (OP) position has been controversial for many years. Manual rotation can be performed by midwives and could reduce cesarean sections and instrumental births. We aimed to determine current midwifery views, knowledge, and practice of manual rotation. A de-identified, self-reported questionnaire was e-mailed to all Australian College of Midwives full members (n = 3,997). Of 3,182 surveyed, 57 percent (1,817) responded, of whom 51 percent (920) were currently practicing midwifery. Seventy-seven percent of midwives thought that manual rotation at full dilatation was a valid intervention. Sixty-four percent stated the procedure was acceptable before instrumental delivery, but 30 percent were unsure. Most practicing midwives (93%) had heard of manual rotation, but only 18 percent had performed one in the last year. Midwives would support the routine performance of manual rotation for OP position if it reduced operative births from 68 to 50 percent and would support manual rotation for occiput transverse (OT) position if it reduced operative births from 39 to 25 percent. This study indicates that manual rotation is considered acceptable by most midwives in Australia, yet is only performed by a minority. Midwives would be willing to perform prophylactic manual rotation if it was known to facilitate normal vaginal births suggesting a scope to introduce this procedure into widespread clinical practice. © 2014, Copyright the Authors Journal compilation © 2014, Wiley Periodicals, Inc.

Self-injurious behaviour in people with intellectual disability and autism spectrum disorder.

PubMed

Oliver, Chris; Licence, Lucy; Richards, Caroline

2017-03-01

This review summarises the recent trends in research in the field of self-injurious behaviour in people with intellectual disability and autism spectrum disorder. New data on incidence, persistence and severity add to studies of prevalence to indicate the large scale of the clinical need. A number of person characteristics have been repeatedly identified in prevalence and cohort studies that: can be considered as risk markers (e.g. stereotyped behaviour, autism spectrum disorder) and indicate possible causal mechanisms (e.g. sleep disorder, anxiety). Studies have started to integrate traditional operant learning paradigms with known person characteristics and reviews and meta-analyses of applied behaviour analytic procedures can now inform practice. Despite these positive developments interventions and appropriate support falls far short of the required need. Expansions in applied research are warranted to develop and evaluate innovative service delivery models that can translate knowledge of risk markers and operant learning paradigms into widespread, low cost routine clinical practice. Alongside this, further pure research is needed to elucidate the direction of causality of implicated risk factors, in order to understand and intervene more effectively in self-injury.

Operational Research: Evaluating Multimodel Implementations for 24/7 Runtime Environments

NASA Astrophysics Data System (ADS)

Burkhart, J. F.; Helset, S.; Abdella, Y. S.; Lappegard, G.

2016-12-01

We present a new open source framework for operational hydrologic rainfall-runoff modeling. The Statkraft Hydrologic Forecasting Toolbox (Shyft) is unique from existing frameworks in that two primary goals are to provide: i) modern, professionally developed source code, and ii) a platform that is robust and ready for operational deployment. Developed jointly between Statkraft AS and The University of Oslo, the framework is currently in operation in both private and academic environments. The hydrology presently available in the distribution is simple and proven. Shyft provides a platform for distributed hydrologic modeling in a highly efficient manner. In it's current operational deployment at Statkraft, Shyft is used to provide daily 10-day forecasts for critical reservoirs. In a research setting, we have developed a novel implementation of the SNICAR model to assess the impact of aerosol deposition on snow packs. Several well known rainfall-runoff algorithms are available for use, allowing for intercomparing different approaches based on available data and the geographical environment. The well known HBV model is a default option, and other routines with more localized methods handling snow and evapotranspiration, or simplifications of catchment scale processes are included. For the latter, we have implemented the Kirchner response routine. Being developed in Norway, a variety snow-melt routines, including simplified degree day models or more advanced energy balance models, may be selected. Ensemble forecasts, multi-model implementations, and statistical post-processing routines enable a robust toolbox for investigating optimal model configurations in an operational setting. The Shyft core is written in modern templated C++ and has Python wrappers developed for easy access to module sub-routines. The code is developed such that the modules that make up a "method stack" are easy to modify and customize, allowing one to create new methods and test them rapidly. Due to the simple architecture and ease of access to the module routines, we see Shyft as an optimal choice to evaluate new hydrologic routines in an environment requiring robust, professionally developed software and welcome further community participation.

12 CFR 1500.2 - What are the limitations on managing or operating a portfolio company held as a merchant banking...

Code of Federal Regulations, 2010 CFR

2010-01-01

... routine management or operation—(i) Executive officer interlocks at the portfolio company. A financial... other than executive officers. (2) Presumptions of routine management or operation. A financial holding... paragraph (e) of this section. (2) Covenants or other provisions regarding extraordinary events. A financial...

Factors influencing identification of and response to intimate partner violence: a survey of physicians and nurses

PubMed Central

Gutmanis, Iris; Beynon, Charlene; Tutty, Leslie; Wathen, C Nadine; MacMillan, Harriet L

2007-01-01

Background Intimate partner violence against women (IPV) has been identified as a serious public health problem. Although the health care system is an important site for identification and intervention, there have been challenges in determining how health care professionals can best address this issue in practice. We surveyed nurses and physicians in 2004 regarding their attitudes and behaviours with respect to IPV, including whether they routinely inquire about IPV, as well as potentially relevant barriers, facilitators, experiential, and practice-related factors. Methods A modified Dillman Tailored Design approach was used to survey 1000 nurses and 1000 physicians by mail in Ontario, Canada. Respondents were randomly selected from professional directories and represented practice areas pre-identified from the literature as those most likely to care for women at the point of initial IPV disclosure: family practice, obstetrics and gynecology, emergency care, maternal/newborn care, and public health. The survey instrument had a case-based scenario followed by 43 questions asking about behaviours and resources specific to woman abuse. Results In total, 931 questionnaires were returned; 597 by nurses (59.7% response rate) and 328 by physicians (32.8% response rate). Overall, 32% of nurses and 42% of physicians reported routinely initiating the topic of IPV in practice. Principal components analysis identified eight constructs related to whether routine inquiry was conducted: preparedness, self-confidence, professional supports, abuse inquiry, practitioner consequences of asking, comfort following disclosure, practitioner lack of control, and practice pressures. Each construct was analyzed according to a number of related issues, including clinician training and experience with woman abuse, area of practice, and type of health care provider. Preparedness emerged as a key construct related to whether respondents routinely initiated the topic of IPV. Conclusion The present study provides new insight into the factors that facilitate and impede clinicians' decisions to address the issue of IPV with their female patients. Inadequate preparation, both educational and experiential, emerged as a key barrier to routine inquiry, as did the importance of the "real world" pressures associated with the daily context of primary care practice. PMID:17250771

Prevalence of Chronic Gastritis or Helicobacter pylori Infection in Adolescent Sleeve Gastrectomy Patients Does Not Correlate with Symptoms or Surgical Outcomes.

PubMed

Franklin, Ashanti L; Koeck, Emily S; Hamrick, Miller C; Qureshi, Faisal G; Nadler, Evan P

2015-08-01

In adults undergoing gastric bypass surgery, it is routine practice to perform pre-operative testing for Helicobacter pylori infection. Evidence suggests that infection impairs anastomotic healing and contributes to complications. There currently are no data for adolescents undergoing bariatric procedures. Despite few patients with pre-operative symptoms, we noted occasional patients with H. pylori detected after sleeve gastrectomy. We reviewed our experience with our adolescent sleeve gastrectomy cohort to determine the prevalence of H. pylori infection, its predictive factors, and association with outcomes. We hypothesized that H. pylori infection would be associated with pre-operative symptoms, but not surgical outcomes. All patients undergoing sleeve gastrectomy at our hospital were included. We conducted a chart review to determine pre- or post-operative symptoms of gastroesophageal reflux disease GERD or gastritis, operative complications, and long-term anti-reflux therapy after surgery. Pathology reports were reviewed for evidence of gastritis and H. pylori infection. 78 adolescents had laparoscopic sleeve gastrectomy from January 2010 through July 2014. The prevalence of chronic gastritis was 44.9% (35/78) and 11.4% of those patients had H. pylori (4/35). Only one patient with H. pylori had pre-operative symptoms, and only 25.7% (9/35) of patients with pathology-proven gastritis had symptoms. One staple line leak occurred but this patient did not have H. pylori or gastritis. Mean patient follow-up was 10 (3-26) mos. There is a moderate prevalence of gastritis among adolescents undergoing sleeve gastrectomy, but only a small number of these patients had H. pylori infection. Neither the presence of chronic gastritis nor H. pylori infection correlated with symptoms or outcomes. Thus, in the absence of predictive symptomology or adverse outcome in those who are infected, we advocate for continued routine pathologic evaluation without the required need for pre-operative determination unless or until H. pylori infection is associated with adverse surgical outcomes.

Practical experience with graphical user interfaces and object-oriented design in the clinical laboratory.

PubMed

Wells, I G; Cartwright, R Y; Farnan, L P

1993-12-15

The computing strategy in our laboratories evolved from research in Artificial Intelligence, and is based on powerful software tools running on high performance desktop computers with a graphical user interface. This allows most tasks to be regarded as design problems rather than implementation projects, and both rapid prototyping and an object-oriented approach to be employed during the in-house development and enhancement of the laboratory information systems. The practical application of this strategy is discussed, with particular reference to the system designer, the laboratory user and the laboratory customer. Routine operation covers five departments, and the systems are stable, flexible and well accepted by the users. Client-server computing, currently undergoing final trials, is seen as the key to further development, and this approach to Pathology computing has considerable potential for the future.

Analysis of good practice of public health Emergency Operations Centers.

PubMed

Xu, Min; Li, Shi-Xue

2015-08-01

To study the public health Emergency Operations Centers (EOCs)in the US, the European Union, the UK and Australia, and summarize the good practice for the improvement of National Health Emergency Response Command Center in Chinese National Health and Family Planning Commission. Literature review was conducted to explore the EOCs of selected countries. The study focused on EOC function, organizational structure, human resources and information management. The selected EOCs had the basic EOC functions of coordinating and commanding as well as the public health related functions such as monitoring the situation, risk assessment, and epidemiological briefings. The organizational structures of the EOCs were standardized, scalable and flexible. Incident Command System was the widely applied organizational structure with a strong preference. The EOCs were managed by a unit of emergency management during routine time and surge staff were engaged upon emergencies. The selected EOCs had clear information management framework including information collection, assessment and dissemination. The performance of National Health Emergency Response Command Center can be improved by learning from the good practice of the selected EOCs, including setting clear functions, standardizing the organizational structure, enhancing the human resource capacity and strengthening information management. Copyright © 2015 Hainan Medical College. Production and hosting by Elsevier B.V. All rights reserved.

Evidence-based Practices Addressed in Community-based Children’s Mental Health Clinical Supervision

PubMed Central

Accurso, Erin C.; Taylor, Robin M.; Garland, Ann F.

2013-01-01

Context Clinical supervision is the principal method of training for psychotherapeutic practice, however there is virtually no research on supervision practice in community settings. Of particular interest is the role supervision might play in facilitating implementation of evidence-based (EB) care in routine care settings. Objective This study examines the format and functions of clinical supervision sessions in routine care, as well as the extent to which supervision addresses psychotherapeutic practice elements common to EB care for children with disruptive behavior problems, who represent the majority of patients served in publicly-funded routine care settings. Methods Supervisors (n=7) and supervisees (n=12) from four publicly-funded community-based child mental health clinics reported on 130 supervision sessions. Results Supervision sessions were primarily individual in-person meetings lasting one hour. The most common functions included case conceptualization and therapy interventions. Coverage of practice elements common to EB treatments was brief. Discussion Despite the fact that most children presenting to public mental health services are referred for disruptive behavior problems, supervision sessions are infrequently focused on practice elements consistent with EB treatments for this population. Supervision is a promising avenue through which training in EB practices could be supported to improve the quality of care for children in community-based “usual care” clinics. PMID:24761163

A multicentre randomized controlled trial of gentle assisted pushing in the upright posture (GAP) or upright posture alone compared with routine practice to reduce prolonged second stage of labour (the Gentle Assisted Pushing study): study protocol.

PubMed

Hofmeyr, G Justus; Singata, Mandisa; Lawrie, Theresa; Vogel, Joshua P; Landoulsi, Sihem; Seuc, Armando H; Gülmezoglu, A Metin

2015-12-16

Fundal pressure (pushing on the upper part of the uterus in the direction of the birth canal) is often performed in routine practice, however the benefit and indications for its use are unclear and vigorous pressure is potentially harmful. There is some evidence that it may be applied routinely or to expedite delivery in some situations (e.g. fetal distress or maternal exhaustion), particularly in settings where other methods of achieving delivery (forceps, vacuum) are not available. Gentle assisted pushing (GAP) is an innovative method of applying gentle but steady pressure to the uterine fundus with the woman in an upright posture. This trial aims to evaluate the use of GAP in an upright posture, or upright posture alone, on reducing the mean time of delivery and the associated maternal and neonatal complications in women not having delivered following 15-30 min in the second stage of labour. We will conduct a multicentre, randomized, unblinded, controlled trial with three parallel arms (1:1:1). 1,145 women will be randomized at three hospitals in South Africa. Women will be eligible for inclusion if they are ≥18 years old, nulliparous, gestational age ≥ 35 weeks, have a singleton pregnancy in cephalic presentation and vaginal delivery anticipated. Women with chronic medical conditions or obstetric complications are not eligible. If eligible women are undelivered following 15-30 min in the second stage of labour, they will be randomly assigned to: 1) GAP in the upright posture, 2) upright posture only and 3) routine practice (recumbent/supine posture). The primary outcome is the mean time from randomization to complete delivery. Secondary outcomes include operative delivery, adverse neonatal outcomes, maternal adverse events and discomfort. This trial will establish whether upright posture and/or a controlled method of applying fundal pressure (GAP) can improve labour outcomes for women and their babies. If fundal pressure is found to have a measurable beneficial effect, this gentle approach can be promoted as a replacement for the uncontrolled methods currently in use. If it is not found to be useful, fundal pressure can be discouraged.

Apparatus, system, and method for synchronizing a timer key

DOEpatents

Condit, Reston A; Daniels, Michael A; Clemens, Gregory P; Tomberlin, Eric S; Johnson, Joel A

2014-04-22

A timer key relating to monitoring a countdown time of a countdown routine of an electronic device is disclosed. The timer key comprises a processor configured to respond to a countdown time associated with operation of the electronic device, a display operably coupled with the processor, and a housing configured to house at least the processor. The housing has an associated structure configured to engage with the electronic device to share the countdown time between the electronic device and the timer key. The processor is configured to begin a countdown routine based at least in part on the countdown time, wherein the countdown routine is at least substantially synchronized with a countdown routine of the electronic device when the timer key is removed from the electronic device. A system and method for synchronizing countdown routines of a timer key and an electronic device are also disclosed.

Brief sexual histories and routine HIV/STD testing by medical providers.

PubMed

Lanier, Yzette; Castellanos, Ted; Barrow, Roxanne Y; Jordan, Wilbert C; Caine, Virginia; Sutton, Madeline Y

2014-03-01

Clinicians who routinely take patient sexual histories have the opportunity to assess patient risk for sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV), and make appropriate recommendations for routine HIV/STD screenings. However, less than 40% of providers conduct sexual histories with patients, and many do not receive formal sexual history training in school. After partnering with a national professional organization of physicians, we trained 26 (US and US territory-based) practicing physicians (58% female; median age=48 years) regarding sexual history taking using both in-person and webinar methods. Trainings occurred during either a 6-h onsite or 2-h webinar session. We evaluated their post-training experiences integrating sexual histories during routine medical visits. We assessed use of sexual histories and routine HIV/STD screenings. All participating physicians reported improved sexual history taking and increases in documented sexual histories and routine HIV/STD screenings. Four themes emerged from the qualitative evaluations: (1) the need for more sexual history training; (2) the importance of providing a gender-neutral sexual history tool; (3) the existence of barriers to routine sexual histories/testing; and (4) unintended benefits for providers who were conducting routine sexual histories. These findings were used to develop a brief, gender-neutral sexual history tool for clinical use. This pilot evaluation demonstrates that providers were willing to utilize a sexual history tool in clinical practice in support of HIV/STD prevention efforts.

Analysis of routine pilot-controller communication

NASA Technical Reports Server (NTRS)

Morrow, Daniel G.; Lee, Alfred; Rodvold, Michelle

1990-01-01

Although pilot-controller communication is central to aviation safety, this area of aviation human factors has not been extensively researched. Most research has focused on what kinds of communication problems occur. A more complete picture of communication problems requires understanding how communication usually works in routine operations. A sample of routine pilot-controller communication in the TRACON environment is described. After describing several dimensions of routine communication, three kinds of communication problems are treated: inaccuracies such as incorrect readbacks, procedural deviations such as missing callsigns and readbacks, and nonroutine transactions where pilot and controller must deal with misunderstandings or other communication problems. Preliminary results suggest these problems are not frequent events in daily operations. However, analysis of the problems that do occur suggest some factors that may cause them.

Navigation within the heart and vessels in clinical practice.

PubMed

Beyar, Rafael

2010-02-01

The field of interventional cardiology has developed at an unprecedented pace on account of the visual and imaging power provided by constantly improving biomedical technologies. Transcatheter-based technology is now routinely used for coronary revascularization and noncoronary interventions using balloon angioplasty, stents, and many other devices. In the early days of interventional practice, the operating physician had to manually navigate catheters and devices under fluoroscopic imaging and was exposed to radiation, with its comcomitant necessity for wearing heavy lead aprons for protection. Until recently, very little has changed in the way procedures have been carried out in the catheterization laboratory. The technological capacity to remotely manipulate devices, using robotic arms and computational tools, has been developed for surgery and other medical procedures. This has brought to practice the powerful combination of the abilities afforded by imaging, navigational tools, and remote control manipulation. This review covers recent developments in navigational tools for catheter positioning, electromagnetic mapping, magnetic resonance imaging (MRI)-based cardiac electrophysiological interventions, and navigation tools through coronary arteries.

Creating financial transparency in public health: examining best practices of system partners.

PubMed

Honoré, Peggy A; Clarke, Richard L; Mead, Dean Michael; Menditto, Susan M

2007-01-01

Financial transparency is based on concepts for valid, standardized information that is readily accessible and routinely disseminated to stakeholders. While Congress and others continuously ask for an accounting of public health investments, transparency remains an ignored concept. The objective of this study was to examine financial transparency practices in other industries considered as part of the public health system. Key informants, regarded as financial experts on the operations of hospitals, school systems, and higher education, were a primary source of information. Principal findings were that system partners have espoused some concepts for financial transparency beginning in the early 20th century--signifying an 80-year implementation gap for public health. Critical features that promote accountability included standardized data collection methods and infrastructures, uniform practices for quantitative analysis of financial performance, and credentialing of the financial management workforce. Recommendations are offered on the basis of these findings to aid public health to close this gap by framing a movement toward transparency.

Can we make sense of multidisciplinary co-operation in primary care by considering routines and rules?

PubMed

Elissen, Arianne M J; van Raak, Arno J A; Paulus, Aggie T G

2011-01-01

Although it is widely acknowledged that the complex health problems of chronically ill and elderly persons require care provision across organisational and professional boundaries, achieving widespread multidisciplinary co-operation in primary care has proven problematic. We developed an explanation for this on the basis of the concepts of routines (patterns of behaviour) and rules, which form a relatively new yet promising perspective for studying co-operation in health-care. We used data about primary care providers situated in the Dutch region of Limburg, a region that, despite high numbers of chronically and elderly persons, has traditionally few healthcare centres and where multidisciplinary co-operation is limited. A qualitative study design was used, in which interviews and documents were the main data sources. Semi-structured interviews were conducted with providers from six primary care professions in the Dutch region of Limburg; relevant documents included co-operation agreements, annual reports and internal memos. To analyse the evidence, several data matrices were developed and all data were structured according to the main concepts under study, i.e. routines and rules. Although more research is needed, our study suggests that the emergence of more extensive multidisciplinary co-operation in primary care is hampered by the organisational rules and regulations prevailing in the sector. By emphasising individual care delivery rather than co-operation, these rules stimulate the perseverance of diversity between the routines by which providers perform their solo care delivery activities, rather than the creation of the amount of compatibility between those routines that is necessary for the current, rather limited shape of multidisciplinary co-operation to expand. Further research should attempt to validate this explanation by utilising a larger research population and systematically operationalising the rules existing in the legal and--more importantly--organisational environment of primary care. © 2010 Blackwell Publishing Ltd.

Circumcision of preschool boys in Baghdad, Iraq: prevalence, current practice and complications.

PubMed

Naji, Hussein; Mustafa, Rajaa

2013-03-01

Circumcision is probably one of the most ancient surgical operations and has been performed more than any other operation. The aim of this study is to assess the prevalence of circumcision in preschool boys and to present an overview of the current practices and complications in Baghdad, Iraq. A statistical survey was conducted at the Central Teaching Hospital for Children in Baghdad, Iraq during the period April 2003 to October 2004. The survey consisted of structured interviews with the accompanying parents while waiting for their children's routine appointments. A total of 4000 boys were included. 2443 (61%) were circumcised and the prevalence of circumcision increased from 18% at 6 months of age to reach 92% at 6 years. Only 180 (7.4%) boys had a medical reason while the rest were circumcised for religious reasons. Parents were the only determinant in deciding the time and place of religious circumcision. Circumcision was performed by a doctor in 732 (30%) boys, by a nurse in 1276 (52%) and by a traditional circumciser in 435 (18%). Post-operative complications were encountered in 209 (8.5%) boys. Circumcision is an important surgical procedure that should be performed by trained medical staff in medical institutions. Circumcision performed by medical professionals caused significantly less complications.

Chronic Subdural Hematoma: A Questionnaire Survey of Management Practice in India and Review of Literature.

PubMed

Avanali, Raghunath; Bhadran, Biju; Krishna Kumar, P; Vijayan, Abhishek; Arun, S; Musthafa, Aneeze M; Panchal, Sunil; Gopal, Vinu V

2016-12-01

To identify the current management modalities practiced by neurosurgeons in India for chronic subdural hematoma. A questionnaire was prepared for the survey and sent via e-mail to neurosurgeons. It covered the following aspects of managing chronic subdural hematoma: 1) demographic and institutional details; 2) choice of surgical procedure; 3) surgical adjutants such as placing a subdural drain; 4) pre- and postoperative care; and 5) recurrences and management. Responses obtained were entered in a SPSS data sheet and analyzed. Response rate of the survey was 9.3%. The majority of neurosurgeons (75%) preferred to do burr whole drainage for primary chronic subdural hematoma and also for recurrences. Only one third of routinely placed a subdural drain. Considerable practice variations exist for medical and perioperative management. Bedside twist drill drainage, which is effective and less costly than operative room procedures, has not gained popularity in practice. The present survey points towards the importance of making management guidelines for this common neurosurgical entity. Copyright © 2016 Elsevier Inc. All rights reserved.

On-demand rather than daily-routine chest radiography prescription may change neither the number nor the impact of chest computed tomography and ultrasound studies in a multidisciplinary intensive care unit.

PubMed

Kröner, Anke; Binnekade, Jan M; Graat, Marleen E; Vroom, Margreeth B; Stoker, Jaap; Spronk, Peter E; Schultz, Marcus J

2008-01-01

Elimination of daily-routine chest radiographs (CXRs) may influence chest computed tomography (CT) and ultrasound practice in critically ill patients. This was a retrospective cohort study including all patients admitted to a university-affiliated intensive care unit during two consecutive periods of 5 months, one before and one after elimination of daily-routine CXR. Chest CT and ultrasound studies were identified retrospectively by using the radiology department information system. Indications for and the diagnostic/therapeutic yield of chest CT and ultrasound studies were collected. Elimination of daily-routine CXR resulted in a decrease of CXRs per patient day from 1.1 +/- 0.3 to 0.6 +/- 0.4 (P < 0.05). Elimination did not affect duration of stay or mortality rates. Neither the number of chest CT studies nor the ratio of chest CT studies per patient day changed with the intervention: Before elimination of daily-routine CXR, 52 chest CT studies were obtained from 747 patients; after elimination, 54 CT studies were obtained from 743 patients. Similarly, chest ultrasound practice was not affected by the change of CXR strategy: Before and after elimination, 21 and 27 chest ultrasound studies were performed, respectively. Also, timing of chest CT and ultrasound studies was not different between the two study periods. During the two periods, 40 of 106 chest CT studies (38%) and 18 of 48 chest ultrasound studies (38%) resulted in a change in therapy. The combined therapeutic yield of chest CT and ultrasound studies did not change with elimination of daily-routine CXR. Elimination of daily-routine CXRs may not affect chest CT and ultrasound practice in a multidisciplinary intensive care unit.

Anatomy of a public health agency turnaround: the case of the general health district in Mahoning County.

PubMed

Honoré, Peggy A; Stefanak, Matthew; Dessens, Scott

2012-01-01

A turnaround describes an organization's ability to recover from successive periods of decline. Current and projected declines in US economic conditions continue to place local public health departments at risk of fiscal exigency. This examination focused on turnaround methodologies used by a local public health department to reverse successive periods of operational and financial declines. Illustrations are provided on the value added by implementing financial ratio and trend analysis in addition to using evidence-based private sector turnaround strategies of retrenchment, repositioning, and reorganization. Evidence has shown how the financial analysis and strategies aided in identifying operational weakness and set in motion corrective measures. The Public Health Uniform Data System is introduced along with a list of standards offered for mainstreaming these and other routine stewardship practices to diagnose, predict, and prevent agency declines.

Cutaneous adenocarcinoma of sebaceous gland in a captive male jaguar Panthera onca: a case report.

PubMed

Majie, Arnab K; Mondal, Parswanath; Ghosh, Swapan K; Banerjee, Dayanarayan

2014-02-24

High incidence of neoplasia in captive jaguar (Panthera onca) has been recorded but there have been no reports of cutaneous adenocarcinoma of the sebaceous gland. A high incidence of neoplasia has been detected in captive jaguars, possibly associated with longevity and husbandry practices in captivity. Neoplasm is a major cause of mortality in jaguar. Tumours of sebaceous gland are common in older domestic felids. A case of cutaneous adenocarcinoma of the sebaceous gland was diagnosed in a male captive jaguar in the Zoological Garden, Alipore, Kolkata, India and was managed successfully. The tumour was observed as a superficial, ulcerated, multilobulated intradermal mass. After preoperative haematological evaluation the tumour was excised through routine surgical procedure under chemical immobilisation. Post-operative management was uneventful. Local tumour recurrence was not noticed till one year after post-operation.

Software fault tolerance in computer operating systems

NASA Technical Reports Server (NTRS)

Iyer, Ravishankar K.; Lee, Inhwan

1994-01-01

This chapter provides data and analysis of the dependability and fault tolerance for three operating systems: the Tandem/GUARDIAN fault-tolerant system, the VAX/VMS distributed system, and the IBM/MVS system. Based on measurements from these systems, basic software error characteristics are investigated. Fault tolerance in operating systems resulting from the use of process pairs and recovery routines is evaluated. Two levels of models are developed to analyze error and recovery processes inside an operating system and interactions among multiple instances of an operating system running in a distributed environment. The measurements show that the use of process pairs in Tandem systems, which was originally intended for tolerating hardware faults, allows the system to tolerate about 70% of defects in system software that result in processor failures. The loose coupling between processors which results in the backup execution (the processor state and the sequence of events occurring) being different from the original execution is a major reason for the measured software fault tolerance. The IBM/MVS system fault tolerance almost doubles when recovery routines are provided, in comparison to the case in which no recovery routines are available. However, even when recovery routines are provided, there is almost a 50% chance of system failure when critical system jobs are involved.

Learning, Dynamic Capabilities and Operating Routines: A Consumer Package Goods Company

ERIC Educational Resources Information Center

Swift, Peter E.; Hwang, Alvin

2008-01-01

Purpose: This paper seeks to present organizational learning processes of knowledge accumulation, articulation, codification and subsequent routine development in a marketing services organization where judgment and rules of thumb were more the norm than codified knowledge and explicit routines. The case illustrates how organizational learning…

Assessment of routine elimination of postoperative nasogastric decompression after Roux-en-Y gastric bypass.

PubMed

Huerta, Sergio; Arteaga, James R; Sawicki, Mark P; Liu, Carson D; Livingston, Edward H

2002-11-01

Anastomotic disruption after surgical intervention is an infrequent complication, but may lead to severe morbidity and mortality when it occurs. Of the various gastric procedures, the Roux-en-Y gastric bypass (RYGB) has one of the highest risks for anastomotic leakage. Consequently, a nasogastric tube (NGT) is frequently placed when these operations are performed. Most studies examining the outcomes for patients without postoperative NGTs have been relatively small with groups of patients undergoing a variety of operations. Assessing the incidence of anastomotic leaks by routine elimination of postoperative NGTs requires a large number of patients. In this study, we assessed the safety and efficacy of routine elimination of NGTs in a large cohort of patients undergoing a single operation. We reviewed our experience with 1067 patients who underwent RYGB at the UCLA medical center. Fifty-six patients had NGTs routinely placed before the implementation of a standard protocol, which eliminated postoperative NGT decompression. The complication rate for the RYGB patient cohort with and without postoperative NGT was compared. We found no difference in the complication rates between the 2 groups (Fisher exact test; P =.21). Our findings suggest that routine placement of an NGT after RYGB is unnecessary.

Use of structured musculoskeletal examination routines in undergraduate medical education and postgraduate clinical practice - a UK survey.

PubMed

Baker, Kenneth F; Jandial, Sharmila; Thompson, Ben; Walker, David; Taylor, Ken; Foster, Helen E

2016-10-21

Structured examination routines have been developed as educational resources for musculoskeletal clinical skills teaching, including Gait-Arms-Legs-Spine (GALS), Regional Examination of the Musculoskeletal System (REMS) and paediatric GALS (pGALS). In this study, we aimed to assess the awareness and use of these examination routines in undergraduate medical teaching in UK medical schools and UK postgraduate clinical practice. Electronic questionnaires were distributed to adult and paediatric musculoskeletal teaching leads at UK medical schools and current UK doctors in training. Responses were received from 67 tutors representing teaching at 22/33 [67 %] of all UK medical schools, and 70 trainee doctors across a range of postgraduate training specialities. There was widespread adoption, at responding medical schools, of the adult examination routines within musculoskeletal teaching (GALS: 14/16 [88 %]; REMS: 12/16 [75 %]) and assessment (GALS: 13/16 [81 %]; REMS: 12/16 [75 %]). More trainees were aware of GALS (64/70 [91 %]) than REMS (14/67 [21 %]). Of the 39 trainees who used GALS in their clinical practice, 35/39 [90 %] reported that it had improved their confidence in musculoskeletal examination. Of the 17/22 responding medical schools that included paediatric musculoskeletal examination within their curricula, 15/17 [88 %] used the pGALS approach and this was included within student assessment at 4 medical schools. We demonstrate the widespread adoption of these examination routines in undergraduate education and significant uptake in postgraduate clinical practice. Further study is required to understand their impact upon clinical performance.

Enhancing systematic implementation of skills training modules for persons with schizophrenia: three steps forward and two steps back?

PubMed

van Erp, Nicole H J; van Vugt, Maaike; Verhoeven, Dorien; Kroon, Hans

2009-01-01

This brief report addresses the systematic implementation of skills training modules for persons with schizophrenia or related disorders in three Dutch mental health agencies. Information on barriers, strategies and integration into routine daily practice was gathered at 0, 12 and 24 months through interviews with managers, program leaders, trainers, practitioners and clients. Overall implementation of the skills training modules for 74% of the persons with schizophrenia or related disorders was not feasible. Implementation was impeded by an incapable program leader, organizational changes, disappointing referrals and loss of trainers. The agencies made important steps forward to integrate the modules into routine daily practice. A reach percentage of 74% in two years time is too ambitious and needs to be adjusted. Systematic integration of the modules into routine daily practice is feasible, but requires solid program management and continuous effort to involve clients and practitioners.

Routine Sub-hepatic Drainage versus No Drainage after Laparoscopic Cholecystectomy: Open, Randomized, Clinical Trial.

PubMed

Shamim, Muhammad

2013-02-01

Surgeons are still following the old habit of routine subhepatic drainage following laparoscopic cholecystectomy (LC). This study aims to compare the outcome of subhepatic drainage with no drainage after LC. This prospective study was conducted in two phases. Phase I was open, randomized controlled trial (RCT), conducted in Civil Hospital Karachi, from August 2004 to June 2005. Phase II was descriptive case series, conducted in author's practice hospitals of Karachi, from July 2005 to December 2009. In phase I, 170 patients with chronic calculous cholecystitis underwent LC. Patients were divided into two groups, subhepatic drainage (group A: 79 patients) or no drainage (group B: 76 patients). The rest 15 patients were excluded either due to conversion or elective subhepatic drainage. In phase II, 218 consecutive patients were enrolled, who underwent LC with no subhepatic drainage. Duration of operation, character, and amount of drain fluid (if placed), postoperative ultrasound for subhepatic collection, postoperative chest X-ray for the measurement of subdiaphragmatic air, postoperative pain, postoperative nausea/vomiting, duration of hospital stay, and preoperative or postoperative complications were noted and analyzed. Duration of operation and hospital stay was slightly longer in group A patients (P values 0.002 and 0.029, respectively); postoperative pain perception, nausea/vomiting, and postoperative complications were nearly same in both groups (P value 0.064, 0.078, and 0.003, respectively). Subhepatic fluid collection was more in group A (P = 0.002), whereas subdiaphragmatic air collection was more in group B (P = 0.003). Phase II results were nearly similar to group B patients in phase I. Routine subhepatic drainage after LC is not necessary in uncomplicated cases.

Comprehensive self management and routine monitoring in chronic obstructive pulmonary disease patients in general practice: randomised controlled trial.

PubMed

Bischoff, Erik W M A; Akkermans, Reinier; Bourbeau, Jean; van Weel, Chris; Vercoulen, Jan H; Schermer, Tjard R J

2012-11-28

To assess the long term effects of two different modes of disease management (comprehensive self management and routine monitoring) on quality of life (primary objective), frequency and patients' management of exacerbations, and self efficacy (secondary objectives) in patients with chronic obstructive pulmonary disease (COPD) in general practice. 24 month, multicentre, investigator blinded, three arm, pragmatic, randomised controlled trial. 15 general practices in the eastern part of the Netherlands. Patients with COPD confirmed by spirometry and treated in general practice. Patients with very severe COPD or treated by a respiratory physician were excluded. A comprehensive self management programme as an adjunct to usual care, consisting of four tailored sessions with ongoing telephone support by a practice nurse; routine monitoring as an adjunct to usual care, consisting of 2-4 structured consultations a year with a practice nurse; or usual care alone (contacts with the general practitioner at the patients' own initiative). The primary outcome was the change in COPD specific quality of life at 24 months as measured with the chronic respiratory questionnaire total score. Secondary outcomes were chronic respiratory questionnaire domain scores, frequency and patients' management of exacerbations measured with the Nijmegen telephonic exacerbation assessment system, and self efficacy measured with the COPD self-efficacy scale. 165 patients were allocated to self management (n=55), routine monitoring (n=55), or usual care alone (n=55). At 24 months, adjusted treatment differences between the three groups in mean chronic respiratory questionnaire total score were not significant. Secondary outcomes did not differ, except for exacerbation management. Compared with usual care, more exacerbations in the self management group were managed with bronchodilators (odds ratio 2.81, 95% confidence interval 1.16 to 6.82) and with prednisolone, antibiotics, or both (3.98, 1.10 to 15.58). Comprehensive self management or routine monitoring did not show long term benefits in terms of quality of life or self efficacy over usual care alone in COPD patients in general practice. Patients in the self management group seemed to be more capable of appropriately managing exacerbations than did those in the usual care group. Clinical trials NCT00128765.

Landsat: a global land imaging program

USGS Publications Warehouse

Byrnes, Raymond A.

2012-01-01

Landsat satellites have continuously acquired space-based images of the Earth's land surface, coastal shallows, and coral reefs across four decades. The Landsat Program, a joint effort of the U.S. Geological Survey (USGS) and the National Aeronautics and Space Administration (NASA), was established to routinely gather land imagery from space. In practice, NASA develops remote-sensing instruments and spacecraft, launches satellites, and validates their performance. The USGS then assumes ownership and operation of the satellites, in addition to managing all ground-data reception, archiving, product generation, and distribution. The result of this program is a visible, long-term record of natural and human-induced changes on the global landscape.

Novel Method for Detection of Air Pollution using Cellular Communication Networks

NASA Astrophysics Data System (ADS)

David, N.; Gao, O. H.

2016-12-01

Air pollution can lead to a wide spectrum of severe and chronic health impacts. Conventional tools for monitoring the phenomenon do not provide a sufficient monitoring solution in a global scale since they are, for example, not representative of the larger space or due to limited deployment as a result of practical limitations, such as: acquisition, installation, and ongoing maintenance costs. Near ground temperature inversions are directly identified with air pollution events since they suppress vertical atmospheric movement and trap pollutants near the ground. Wireless telecommunication links that comprise the data transfer infrastructure in cellular communication networks operate at frequencies of tens of GHz and are affected by different atmospheric phenomena. These systems are deployed near ground level across the globe, including in developing countries such as India, countries in Africa, etc. Many cellular providers routinely store data regarding the received signal levels in the network for quality assurance needs. Temperature inversions cause atmospheric layering, and change the refractive index of the air when compared to standard conditions. As a result, the ducts that are formed can operate, in essence, as atmospheric wave guides, and cause interference (signal amplification / attenuation) in the microwaves measured by the wireless network. Thus, this network is in effect, an existing system of environmental sensors for monitoring temperature inversions and the episodes of air pollution identified with them. This work presents the novel idea, and demonstrates it, in operation, over several events of air pollution which were detected by a standard cellular communication network during routine operation. Reference: David, N. and Gao, H.O. Using cellular communication networks to detect air pollution, Environmental Science & Technology, 2016 (accepted).

Nurse teachers' knowledge in curriculum planning and implementation.

PubMed

Thomas, Eiddwen; Davies, Brian

2006-10-01

Nurses are required to base care on research evidence but research findings on nursing practice often suggest that the linkage is poor and ritualistic routines often prevail. The study explored the origin and nature of knowledge utilised by nurse teachers when developing and implementing a curriculum. In a single, ethnographic case study data were collected from two curriculum development and two curriculum implementation groups, using interviews, participant observation and documents. The study drew directly on Bernstein's theory of the pedagogic device and cultural reproduction. Findings suggested that even though nurse education appears to be dominated by policies and guidelines produced by state agencies, it was teachers operating at institutional and classroom levels who determined what was delivered to student nurses as they relied upon their experience of teaching and clinical practice to plan and implement curriculum. Notwithstanding both national and local aspirations to the contrary, teaching and assessment practices were mostly teacher- rather than student-centred, with heavy reliance on propositional knowledge. The practices identified within this study may induce approaches to learning that may be antithetical to delivering research based care within a prevailing climate that advocates evidence-based practice, clinical effectiveness and governance.

20. VIEW OF THE INCINERATOR. DURING ROUTINE BUILDING OPERATIONS IN ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

20. VIEW OF THE INCINERATOR. DURING ROUTINE BUILDING OPERATIONS IN DECEMBER 1988, A HEAT PLUME WAS GENERATED THAT WAS REGISTERED ON FILM BY A PASSING AIRCRAFT. OFFICIALS WITH THE UNITED STATES ENVIRONMENTAL PROTECTION AGENCY (USEPA) BELIEVED THAT ILLEGAL OPERATIONS WERE BEING CONDUCTED. THE USEPA USED THIS OPPORTUNITY TO CONVINCE AUTHORITIES TO ISSUE A WARRANT TO ENTER THE ROCKY FLATS PLANT AND INVESTIGATE THE ALLEGATION. (4/98) - Rocky Flats Plant, Plutonium Recovery & Fabrication Facility, North-central section of plant, Golden, Jefferson County, CO

Addressing Unconscious Bias: Steps toward an Inclusive Scientific Culture

NASA Astrophysics Data System (ADS)

Stewart, Abigail

2011-01-01

In this talk I will outline the nature of unconscious bias, as it operates to exclude or marginalize some participants in the scientific community. I will show how bias results from non-conscious expectations about certain groups of people, including scientists and astronomers. I will outline scientific research in psychology, sociology and economics that has identified the impact these expectations have on interpersonal judgments that are at the heart of assessment of individuals' qualifications. This research helps us understand not only how bias operates within a single instance of evaluation, but how evaluation bias can accumulate over a career if not checked, creating an appearance of confirmation of biased expectations. Some research has focused on how best to interrupt and mitigate unconscious bias, and many institutions--including the University of Michigan--have identified strategic interventions at key points of institutional decision-making (particularly hiring, annual review, and promotion) that can make a difference. The NSF ADVANCE Institutional Transformation program encouraged institutions to draw on the social science literature to create experimental approaches to addressing unconscious bias. I will outline four approaches to intervention that have arisen through the ADVANCE program: (1) systematic education that increases awareness among decisionmakers of how evaluation bias operates; (2) development of practices that mitigate the operation of bias even when it is out of conscious awareness; (3) creation of institutional policies that routinize and sanction these practices; and (4) holding leaders accountable for these implementation of these new practices and policies. Although I will focus on ways to address unconscious bias within scientific institutions (colleges and universities, laboratories and research centers, etc.), I will close by considering how scientific organizations can address unconscious bias and contribute to creating an inclusive scientific culture.

A Scoping Review of Maternal and Child Health Clinicians Attitudes, Beliefs, Practice, Training and Perceived Self-Competence in Environmental Health.

PubMed

Massaquoi, Lamin Daddy; Edwards, Nancy Christine

2015-12-10

Clinicians regularly assess, diagnose and manage illnesses which are directly or indirectly linked to environmental exposures. Yet, various studies have identified gaps in environmental assessment in routine clinical practice. This review assessed clinicians' environmental health practices, attitudes and beliefs, and competencies and training. Relevant articles were sought using a systematic search strategy using five databases, grey literature and a hand search. Search strategies and protocols were developed using tailored mesh terms and keywords. 43 out of 11,291 articles were eligible for inclusion. Clinicians' attitudes and beliefs towards environmental health and routine clinical practice were generally positive, with most clinicians believing that environmental hazards affect human health. However, with the exception of tobacco smoke exposure, environmental health assessment was infrequently part of routine clinical practice. Clinicians' self-competence in environmental assessment was reported to be inadequate. Major challenges were the time required to complete an assessment, inadequate training and concerns about negative patients' responses. Clinicians have strong positive attitudes and beliefs about the importance of environmental health assessments. However, more concerted and robust strategies will be needed to support clinicians in assuming their assessment and counselling roles related to a wider range of environmental hazards.

Longitudinal evaluation of a training program to promote routine antenatal enquiry for domestic violence by midwives.

PubMed

Baird, Kathleen; Creedy, Debra K; Saito, Amornrat S; Eustace, Jennifer

2018-01-15

Routine enquiry about domestic violence during pregnancy is accepted best practice. Training is essential to improve knowledge and practice. Few studies have undertaken a comprehensive evaluation of training impact over time. To evaluate the longitudinal impact of a domestic violence training and support program to promote midwives' routine antenatal enquiry for domestic violence using a mixed methods design. Data sources included (1) surveys of midwives at 6 months post-training, (2) interviews with key stakeholders at 12 months, (3) chart audit data of screening, risk, and disclosure rates (for 16 months). Measures included midwives' knowledge, preparation for routine enquiry, knowledge of domestic violence and perceptions of impact of the training and support for practice change. Forty (out of 83) participant surveys could be matched and responses compared to baseline and post-training scores. Wilcoxon signed-rank test identified that all 6-month follow-up scores were significantly higher than those at baseline. Level of preparedness increased from 42.3 to 51.05 (Z=4.88, p<.001); and knowledge scores increased from a mean of 21.15 to 24.65 (Z=4.9, p<.001). Most participants (>90%) reported improved confidence to undertake routine inquiry. A chart audit of screening rates revealed that of the 6671 women presenting for antenatal care, nearly 90% were screened. Disclosure of domestic violence was low (<2%) with most women at risk or experiencing violence declining referral. Training, support processes, and referral pathways, contributed to midwives' sustained preparedness and knowledge to conduct routine enquiry and support women disclosing domestic violence. Copyright © 2018. Published by Elsevier Ltd.

Time Projection Compton Spectrometer (TPCS). User`s guide

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

Landron, C.O.; Baldwin, G.T.

1994-04-01

The Time Projection Compton Spectrometer (TPCS) is a radiation diagnostic designed to determine the time-integrated energy spectrum between 100 keV -- 2 MeV of flash x-ray sources. This guide is intended as a reference for the routine operator of the TPCS. Contents include a brief overview of the principle of operation, detailed component descriptions, detailed assembly and disassembly procedures, guide to routine operations, and troubleshooting flowcharts. Detailed principle of operation, signal analysis and spectrum unfold algorithms are beyond the scope of this guide; however, the guide makes reference to sources containing this information.

Predictors of Treatment Response to Fluoxetine in PTSD Following a Recent History of War Zone Stress Exposure

DTIC Science & Technology

2010-07-01

routinely prescribed for acute stress disorder and early PTSD and recommended in the VA-DoD best practice guidelines, the efficacy of SSRIs as an early...selective serotonin reuptake inhibitors (SSRIs) are routinely prescribed for acute stress disorder and early PTSD and recommended in the VA-DoD best practice...1-0283 TITLE: Predictors of Treatment Response to Fluoxetine in PTSD Following a Recent History of War Zone Stress Exposure

Elaboration of the Gothenburg model of person-centred care.

PubMed

Britten, Nicky; Moore, Lucy; Lydahl, Doris; Naldemirci, Oncel; Elam, Mark; Wolf, Axel

2017-06-01

Person-centred care (PCC) is increasingly advocated as a new way of delivering health care, but there is little evidence that it is widely practised. The University of Gothenburg Centre for Person-Centred Care (GPCC) was set up in 2010 to develop and implement person-centred care in clinical practice on the basis of three routines. These routines are based on eliciting the patient's narrative to initiate a partnership; working the partnership to achieve commonly agreed goals; and using documentation to safeguard the partnership and record the person's narrative and shared goals. In this paper, we aimed to explore professionals' understanding of PCC routines as they implement the GPCC model in a range of different settings. We conducted a qualitative study and interviewed 18 clinician-researchers from five health-care professions who were working in seven diverse GPCC projects. Interviewees' accounts of PCC emphasized the ways in which persons are seen as different from patients; the variable emphasis placed on the person's goals; and the role of the person's own resources in building partnerships. This study illustrates what is needed for health-care professionals to implement PCC in everyday practice: the recognition of the person is as important as the specific practical routines. Interviewees described the need to change the clinical mindset and to develop the ways of integrating people's narratives with clinical practice. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

Oblique Chest Views as a Routine Part of Skeletal Surveys Performed for Possible Physical Abuse--Is This Practice Worthwhile?

ERIC Educational Resources Information Center

Hansen, Karen Kirhofer; Prince, Jeffrey S.; Nixon, G. William

2008-01-01

Objective: To evaluate the utility of oblique chest views in the diagnosis of rib fractures when used as a routine part of the skeletal survey performed for possible physical abuse. Methods: Oblique chest views have been part of the routine skeletal survey protocol at Primary Children's Medical Center since October 2002. Dictated radiology reports…

Effects of a psychoeducation intervention on fear and anxiety about surgery: randomized trial in patients undergoing coronary artery bypass grafting.

PubMed

Shahmansouri, Nazilla; Janghorbani, Mohsen; Salehi Omran, Abbas; Karimi, Abbas Ali; Noorbala, Ahmad Ali; Arjmandi, Akram; Nikfam, Sepideh

2014-01-01

The aim of this study was to examine the impact of a brief psychoeducation group intervention on fear and anxiety in patients undergoing the coronary artery bypass grafting (CABG). Sixty consecutive patients undergoing CABG for the first time were recruited for a clinical trial and randomized into two groups. The control group received routine care. The study group received a brief psychoeducation group intervention combined with routine care. The psychoeducation session consisted of a discussion of fear and anxiety in a psychotherapeutic atmosphere and relaxation techniques. Fear was scored with the Bypass Grafting Fear Scale (BGFS) and anxiety was scored with the Spielberger State Inventory (STAI) Questionnaire. The BGFS and the STAI were given to the patients the day after hospital admission and a day before the operation to measure fear and anxiety. Fear scores decreased in the psychoeducation group. Of the 29 patients treated with psychoeducation, the mean (SD) fear score decreased from 4.6 (1.7) at baseline to 2.8 (1.2) before the operation (p < .001). In the 31 patients who received routine care, there was a nonsignificant trend from 3.7 (1.9) to 4.1 (2.1) (p > .05). The mean difference in fear score before the operation was significantly lower in the psychoeducation group than the routine care group (mean difference -1.3; 95% CI, -2.1, -.2; p < .05). There were no differences in anxiety scores before the operation between the psychoeducation and routine care groups. In patients undergoing CABG, adding psychoeducation to routine care had a significant positive effect on fear but not on anxiety scores. A larger study of psychoeducation in these patients is warranted to assess the efficacy of this intervention in greater detail.

Brief Sexual Histories and Routine HIV/STD Testing by Medical Providers

PubMed Central

Lanier, Yzette; Castellanos, Ted; Barrow, Roxanne Y.; Jordan, Wilbert C.; Caine, Virginia

2014-01-01

Abstract Clinicians who routinely take patient sexual histories have the opportunity to assess patient risk for sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV), and make appropriate recommendations for routine HIV/STD screenings. However, less than 40% of providers conduct sexual histories with patients, and many do not receive formal sexual history training in school. After partnering with a national professional organization of physicians, we trained 26 (US and US territory-based) practicing physicians (58% female; median age=48 years) regarding sexual history taking using both in-person and webinar methods. Trainings occurred during either a 6-h onsite or 2-h webinar session. We evaluated their post-training experiences integrating sexual histories during routine medical visits. We assessed use of sexual histories and routine HIV/STD screenings. All participating physicians reported improved sexual history taking and increases in documented sexual histories and routine HIV/STD screenings. Four themes emerged from the qualitative evaluations: (1) the need for more sexual history training; (2) the importance of providing a gender-neutral sexual history tool; (3) the existence of barriers to routine sexual histories/testing; and (4) unintended benefits for providers who were conducting routine sexual histories. These findings were used to develop a brief, gender-neutral sexual history tool for clinical use. This pilot evaluation demonstrates that providers were willing to utilize a sexual history tool in clinical practice in support of HIV/STD prevention efforts. PMID:24564387

Driving CT developments the last mile: case examples of successful and somewhat less successful translations into clinical practice

NASA Astrophysics Data System (ADS)

Sodickson, Aaron D.

2017-03-01

CT technology has advanced rapidly in recent years, yet not all innovations translate readily into clinical practice. Technology advances must meet certain key requirements to make it into routine use: They must provide a well-defined clinical benefit. They must be easy to use and integrate readily into existing workflows, or better still, further streamline these workflows. These requirements heavily favor fully integrated or automated solutions that remove the human factor and provide a reproducible output independent of operator skill level. Further, to achieve these aims, collaboration with the ultimate end users is needed as early as possible in the development cycle, not just at the point of product testing. Technology innovators are encouraged to engage such collaborators even at early stages of feature or product definition. This manuscript highlights these concepts through exploration of challenging areas in CT imaging in an Emergency Department setting. Technique optimization for pulmonary embolus CT is described as an example of successful integration of multiple advances in radiation dose reduction and imaging speed. The typical workflow of a trauma "pan-scan" (incorporating scans from head through pelvis) is described to highlight workflow challenges and opportunities for improvement. Finally, Dual Energy CT is discussed to highlight the undeniable clinical value of the material characterization it provides, yet also its surprisingly slow integration into routine use beyond early adopters.

Management of adult pancreatic injuries: A practice management guideline from the Eastern Association for the Surgery of Trauma.

PubMed

Ho, Vanessa Phillis; Patel, Nimitt J; Bokhari, Faran; Madbak, Firas G; Hambley, Jana E; Yon, James R; Robinson, Bryce R H; Nagy, Kimberly; Armen, Scott B; Kingsley, Samuel; Gupta, Sameer; Starr, Frederic L; Moore, Henry R; Oliphant, Uretz J; Haut, Elliott R; Como, John J

2017-01-01

Traumatic injury to the pancreas is rare but is associated with significant morbidity and mortality, including fistula, sepsis, and death. There are currently no practice management guidelines for the medical and surgical management of traumatic pancreatic injuries. The overall objective of this article is to provide evidence-based recommendations for the physician who is presented with traumatic injury to the pancreas. The MEDLINE database using PubMed was searched to identify English language articles published from January 1965 to December 2014 regarding adult patients with pancreatic injuries. A systematic review of the literature was performed, and the Grading of Recommendations Assessment, Development and Evaluation framework was used to formulate evidence-based recommendations. Three hundred nineteen articles were identified. Of these, 52 articles underwent full text review, and 37 were selected for guideline construction. Patients with grade I/II injuries tend to have fewer complications; for these, we conditionally recommend nonoperative or nonresectional management. For grade III/IV injuries identified on computed tomography or at operation, we conditionally recommend pancreatic resection. We conditionally recommend against the routine use of octreotide for postoperative pancreatic fistula prophylaxis. No recommendations could be made regarding the following two topics: optimal surgical management of grade V injuries, and the need for routine splenectomy with distal pancreatectomy. Systematic review, level III.

Evidence and resources to implement Pharmacogenetic Knowledge for Precision Medicine

PubMed Central

Caudle, Kelly E.; Gammal, Roseann S.; Whirl-Carrillo, Michelle; Hoffman, James M.; Relling, Mary V.; Klein, Teri E.

2016-01-01

Purpose Implementation of pharmacogenetics into clinical practice has been relatively slow despite substantial scientific progress over the last decade. One barrier that inhibits uptake of pharmacogenetics into routine clinical practice is the lack of knowledge of how to translate a genetic test into a clinical action based on current evidence. The purpose of this paper is to describe the current state of pharmacogenetic evidence and evidence-based resources that facilitate the uptake of pharmacogenetics into clinical practice. Summary Controversy exists over the required evidence threshold needed for routine clinical implementation of pharmacogenetics. Large randomized controlled trials are not clinically feasible or necessary for many pharmacogenetic applications. Online resources exist like the Clinical Pharmacogenetics Implementation Consortium (CPIC) and the Pharmacogenomics Knowledgebase (PharmGKB) that provide freely available, evidence-based resources that facilitate the translation of genetic laboratory test results into actionable prescribing recommendations for specific drugs. Conclusion Resources provided by organizations such as CPIC and PharmGKB that use standardized approaches to evaluate the literature and provide clinical guidance are essential for the implementation of pharmacogenetics into routine clinical practice. PMID:27864205

Portable device technology in organ donation: new "app" for procurement coordinators.

PubMed

Cavallin, M; Bertini, P; Lopane, P; Guarracino, F

2014-09-01

Portable devices are commonly used at bedside in everyday practice. Transplant procurement coordinators routinely have to deal with protocols and flow charts and need to assess the donor condition several times. In our experience, a great part of the organ procurement management work is provided by nurses "on call." We developed an application for iOS devices to facilitate their approach to relatives and procedures for organ donation. The application, which includes algorithms, tutorials, and simple calculators, has been designed by transplant procurement coordinators to speed up the process of organ donation and at the same time to be as accurate as possible for the process. It can be used alongside all of the procedures for procurement in the emergency room, intensive care unit, operating room, and morgue in both brainstem-dead and cadaver organ donors. The application could be effective in organ procurement management for everyday practice. Copyright © 2014 Elsevier Inc. All rights reserved.

Functional Requirements Document for HALE UAS Operations in the NAS: Step 1. Version 3

NASA Technical Reports Server (NTRS)

2006-01-01

The purpose of this Functional Requirements Document (FRD) is to compile the functional requirements needed to achieve the Access 5 Vision of "operating High Altitude, Long Endurance (HALE) Unmanned Aircraft Systems (UAS) routinely, safely, and reliably in the national airspace system (NAS)" for Step 1. These functional requirements could support the development of a minimum set of policies, procedures and standards by the Federal Aviation Administration (FAA) and various standards organizations. It is envisioned that this comprehensive body of work will enable the FAA to establish and approve regulations to govern safe operation of UAS in the NAS on a routine or daily "file and fly" basis. The approach used to derive the functional requirements found within this FRD was to decompose the operational requirements and objectives identified within the Access 5 Concept of Operations (CONOPS) into the functions needed to routinely and safely operate a HALE UAS in the NAS. As a result, four major functional areas evolved to enable routine and safe UAS operations for an on-demand basis in the NAS. These four major functions are: Aviate, Navigate, Communicate, and Avoid Hazards. All of the functional requirements within this document can be directly traceable to one of these four major functions. Some functions, however, are traceable to several, or even all, of these four major functions. These cross-cutting functional requirements support the "Command / Control: function as well as the "Manage Contingencies" function. The requirements associated to these high-level functions and all of their supporting low-level functions are addressed in subsequent sections of this document.

75 FR 11435 - Airworthiness Directives; Airbus Model A300 B4-2C, B4-103, and B4-203 Airplanes; and Model A300...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-11

... operator reported that, during a routine inspection, the Right Hand frame 40 forward fitting between... result in a deterioration of the structural integrity of the frame. * * * * * We are issuing this AD to... operator reported that, during a routine inspection, the Right Hand frame 40 forward fitting between...

Autoclave performance and operator knowledge of autoclave use in primary care: a survey of UK practices.

PubMed

Coulter, W A; Chew-Graham, C A; Cheung, S W; Burke, F J

2001-07-01

Changes in the delivery of health care have increased the demand for minor surgical and screening procedures in general practice. This has increased the risk of cross-infection with blood-borne viruses and the demand for sterile instruments. The aim of this study was to investigate the knowledge and training of medical personnel in England and Wales on aspects of autoclave use, and to test the effectiveness of their practice autoclaves. An anonymous postal questionnaire and autoclave performance survey using biological indicators was made of 700 general medical practitioners selected at random from FHSA lists from 12 Health Authorities in England and Wales. The overall response rate was 53.1% (N= 372) comprising 10% general practitioners and 90% practice nurses. Eighty-two percent of respondents used autoclaves with a mean age of 2.5 years, of which 91% had been serviced in the past year. While 35% of respondents made daily observation of gauges, 19% did not routinely monitor autoclave effectiveness. Six autoclaves failed to sterilize the spore test ampoules. Fourteen percent of respondents did not autoclave instruments after every patient. Only 33.1% reported wearing gloves during minor operations. Fifty five percent had training in cross-infection prevention. It was concluded that although there has been improvement in instrument decontamination procedures in general practice compared with previous surveys, further education of medical practitioners and practice nurses in the use of autoclaves and infection prevention and control is indicated. The failure of 2% of the autoclaves to kill spores suggests the need for increased monitoring of autoclave performance. Two-thirds of practitioners exposed themselves to increased risk of infection by carrying out minor surgery without the protection of gloves. Copyright 2001 The Hospital Infection Society.

External evaluation of the Dimension Vista 1500® intelligent lab system.

PubMed

Bruneel, Arnaud; Dehoux, Monique; Barnier, Anne; Boutten, Anne

2012-09-01

Dimension Vista® analyzer combines four technologies (photometry, nephelometry, V-LYTE® integrated multisensor potentiometry, and LOCI® chemiluminescence) into one high-throughput system. We assessed analytical performance of assays routinely performed in our emergency laboratory according to the VALTEC protocol, and practicability. Precision was good for most parameters. Analytical domain was large and suitable for undiluted analysis in most clinical settings encountered in our hospital. Data were comparable and correlated to our routine analyzers (Roche Modular DP®, Abbott AXSYM®, Siemens Dimension® RxL, and BN ProSpec®). Performance of nephelometric and LOCI modules was excellent. Functional sensitivity of high-sensitivity C-reactive protein and cardiac troponin I were 0.165 mg/l and 0.03 ng/ml, respectively (coefficient of variation; CV < 10%). The influence of interfering substances (i.e., hemoglobin, bilirubin, or lipids) was moderate, and Dimension Vista® specifically alerted for interference according to HIL (hemolysis, icterus, lipemia) indices. Good instrument performance and full functionality (no reagent or sample carryover in the conditions evaluated, effective sample-volume detection, and clot detection) were confirmed. Simulated routine testing demonstrated excellent practicability, throughput, ease of use of software and security. Performance and practicability of Dimension Vista® are highly suitable for both routine and emergency use. Since no volume detection and thus no warning is available on limited sample racks, pediatric samples require special caution to the Siemens protocol to be analyzed in secured conditions. Our experience in routine practice is also discussed, i.e., the impact of daily workload, "manual" steps resulting from dilutions and pediatric samples, maintenances, flex hydration on instrument's performance on throughput and turnaround time. © 2012 Wiley Periodicals, Inc.

Current practice of usual clinic blood pressure measurement in people with and without diabetes: a survey and prospective ‘mystery shopper’ study in UK primary care

PubMed Central

2018-01-01

Objectives Hypertension trials and epidemiological studies use multiple clinic blood pressure (BP) measurements at each visit. Repeat measurement is also recommended in international guidance; however, little is known about how BP is measured routinely. This is important for individual patient management and because routinely recorded readings form part of research databases. We aimed to determine the current practice of BP measurement during routine general practice appointments. Design (1) An online cross-sectional survey and (2) a prospective ‘mystery shopper’ study where patients agreed to report how BP was measured during their next appointment. Setting Primary care. Participants Patient charity/involvement group members completing an online survey between July 2015 and January 2016. 334 participants completed the prospective study (51.5% male, mean age=59.3 years) of which 279 (83.5%) had diabetes. Primary outcome Proportion of patients having BP measured according to guidelines. Results 217 participants with (183) and without diabetes (34) had their BP measured at their last appointment. BP was measured in line with UK guidance in 63.7% and 60.0% of participants with and without diabetes, respectively. Initial pressures were significantly higher in those who had their BP measured more than once compared with only once (p=0.016/0.089 systolic and p<0.001/p=0.022 diastolic, in patients with/without diabetes, respectively). Conclusions Current practice of routine BP measurement in UK primary care is often concordant with guidelines for repeat measurement. Further studies are required to confirm findings in broader populations, to confirm when a third repeat reading is obtained routinely and to assess adherence to other aspects of BP measurement guidance. PMID:29654037

Implementation and spread of interventions into the multilevel context of routine practice and policy: implications for the cancer care continuum.

PubMed

Yano, Elizabeth M; Green, Lawrence W; Glanz, Karen; Ayanian, John Z; Mittman, Brian S; Chollette, Veronica; Rubenstein, Lisa V

2012-05-01

The promise of widespread implementation of efficacious interventions across the cancer continuum into routine practice and policy has yet to be realized. Multilevel influences, such as communities and families surrounding patients or health-care policies and organizations surrounding provider teams, may determine whether effective interventions are successfully implemented. Greater recognition of the importance of these influences in advancing (or hindering) the impact of single-level interventions has motivated the design and testing of multilevel interventions designed to address them. However, implementing research evidence from single- or multilevel interventions into sustainable routine practice and policy presents substantive challenges. Furthermore, relatively few multilevel interventions have been conducted along the cancer care continuum, and fewer still have been implemented, disseminated, or sustained in practice. The purpose of this chapter is, therefore, to illustrate and examine the concepts underlying the implementation and spread of multilevel interventions into routine practice and policy. We accomplish this goal by using a series of cancer and noncancer examples that have been successfully implemented and, in some cases, spread widely. Key concepts across these examples include the importance of phased implementation, recognizing the need for pilot testing, explicit engagement of key stakeholders within and between each intervention level; visible and consistent leadership and organizational support, including financial and human resources; better understanding of the policy context, fiscal climate, and incentives underlying implementation; explication of handoffs from researchers to accountable individuals within and across levels; ample integration of multilevel theories guiding implementation and evaluation; and strategies for long-term monitoring and sustainability.

Implementation and Spread of Interventions Into the Multilevel Context of Routine Practice and Policy: Implications for the Cancer Care Continuum

PubMed Central

Green, Lawrence W.; Glanz, Karen; Ayanian, John Z.; Mittman, Brian S.; Chollette, Veronica; Rubenstein, Lisa V.

2012-01-01

The promise of widespread implementation of efficacious interventions across the cancer continuum into routine practice and policy has yet to be realized. Multilevel influences, such as communities and families surrounding patients or health-care policies and organizations surrounding provider teams, may determine whether effective interventions are successfully implemented. Greater recognition of the importance of these influences in advancing (or hindering) the impact of single-level interventions has motivated the design and testing of multilevel interventions designed to address them. However, implementing research evidence from single- or multilevel interventions into sustainable routine practice and policy presents substantive challenges. Furthermore, relatively few multilevel interventions have been conducted along the cancer care continuum, and fewer still have been implemented, disseminated, or sustained in practice. The purpose of this chapter is, therefore, to illustrate and examine the concepts underlying the implementation and spread of multilevel interventions into routine practice and policy. We accomplish this goal by using a series of cancer and noncancer examples that have been successfully implemented and, in some cases, spread widely. Key concepts across these examples include the importance of phased implementation, recognizing the need for pilot testing, explicit engagement of key stakeholders within and between each intervention level; visible and consistent leadership and organizational support, including financial and human resources; better understanding of the policy context, fiscal climate, and incentives underlying implementation; explication of handoffs from researchers to accountable individuals within and across levels; ample integration of multilevel theories guiding implementation and evaluation; and strategies for long-term monitoring and sustainability. PMID:22623601

Do Modern Spectacles Endanger Surgeons?

PubMed Central

Chong, Simon J.; Smith, Charlotte; Bialostocki, Adam; McEwan, Christopher N.

2007-01-01

Background: Despite documented cases of infectious disease transmission to medical staff via conjunctival contamination and widespread recommendation of protective eyewear use during surgical procedures, a large number of surgeons rely on their prescription spectacles as sole eye protection. Modern fashion spectacles, being of increasingly slim design, may no longer be adequate in this role. Methods: A survey was conducted among the surgeons at Waikato Hospital from December 7, 2004 to February 1, 2005, to assess current operating theater eyewear practices and attitudes. Those who wore prescription spectacles were asked to assume a standardized “operating position” from which anatomic measurements were obtained. These data were mathematically analyzed to determine the degree of palebral fissure protection conferred by their spectacles. Results: Of 71 surgical practitioners surveyed, 45.1% required prescription lenses for operating, the mean spectacle age being 2.45 years; 84.5% had experienced prior periorbital blood splashes; 2.8% had previously contracted an illness attributed to such an event; 78.8% participants routinely used eye protection, but of the 27 requiring spectacles, 68.0% used these as their sole eye protection. Chief complaints about safety glasses and facial shields were of fogging, poor comfort, inability to wear spectacles underneath, and unavailability. Our model predicted that 100%, 92.6%, 77.8%, and 0% of our population were protected by their spectacles laterally, medially, inferiorly, and superiorly, respectively. Conclusions: Prescription spectacles of contemporary styling do not provide adequate protection against conjunctival blood splash injuries. Our model predicts the design adequacy of currently available purpose-designed protective eyewear, which should be used routinely. PMID:17435558

Do modern spectacles endanger surgeons? The Waikato Eye Protection Study.

PubMed

Chong, Simon J; Smith, Charlotte; Bialostocki, Adam; McEwan, Christopher N

2007-03-01

Despite documented cases of infectious disease transmission to medical staff via conjunctival contamination and widespread recommendation of protective eyewear use during surgical procedures, a large number of surgeons rely on their prescription spectacles as sole eye protection. Modern fashion spectacles, being of increasingly slim design, may no longer be adequate in this role. A survey was conducted among the surgeons at Waikato Hospital from December 7, 2004 to February 1, 2005, to assess current operating theater eyewear practices and attitudes. Those who wore prescription spectacles were asked to assume a standardized "operating position" from which anatomic measurements were obtained. These data were mathematically analyzed to determine the degree of palebral fissure protection conferred by their spectacles. Of 71 surgical practitioners surveyed, 45.1% required prescription lenses for operating, the mean spectacle age being 2.45 years; 84.5% had experienced prior periorbital blood splashes; 2.8% had previously contracted an illness attributed to such an event; 78.8% participants routinely used eye protection, but of the 27 requiring spectacles, 68.0% used these as their sole eye protection. Chief complaints about safety glasses and facial shields were of fogging, poor comfort, inability to wear spectacles underneath, and unavailability. Our model predicted that 100%, 92.6%, 77.8%, and 0% of our population were protected by their spectacles laterally, medially, inferiorly, and superiorly, respectively. Prescription spectacles of contemporary styling do not provide adequate protection against conjunctival blood splash injuries. Our model predicts the design adequacy of currently available purpose-designed protective eyewear, which should be used routinely.

Nurse staffing levels and outcomes - mining the UK national data sets for insight.

PubMed

Leary, Alison; Tomai, Barbara; Swift, Adrian; Woodward, Andrew; Hurst, Keith

2017-04-18

Purpose Despite the generation of mass data by the nursing workforce, determining the impact of the contribution to patient safety remains challenging. Several cross-sectional studies have indicated a relationship between staffing and safety. The purpose of this paper is to uncover possible associations and explore if a deeper understanding of relationships between staffing and other factors such as safety could be revealed within routinely collected national data sets. Design/methodology/approach Two longitudinal routinely collected data sets consisting of 30 years of UK nurse staffing data and seven years of National Health Service (NHS) benchmark data such as survey results, safety and other indicators were used. A correlation matrix was built and a linear correlation operation was applied (Pearson product-moment correlation coefficient). Findings A number of associations were revealed within both the UK staffing data set and the NHS benchmarking data set. However, the challenges of using these data sets soon became apparent. Practical implications Staff time and effort are required to collect these data. The limitations of these data sets include inconsistent data collection and quality. The mode of data collection and the itemset collected should be reviewed to generate a data set with robust clinical application. Originality/value This paper revealed that relationships are likely to be complex and non-linear; however, the main contribution of the paper is the identification of the limitations of routinely collected data. Much time and effort is expended in collecting this data; however, its validity, usefulness and method of routine national data collection appear to require re-examination.

CPU timing routines for a CONVEX C220 computer system

NASA Technical Reports Server (NTRS)

Bynum, Mary Ann

1989-01-01

The timing routines available on the CONVEX C220 computer system in the Structural Mechanics Division (SMD) at NASA Langley Research Center are examined. The function of the timing routines, the use of the timing routines in sequential, parallel, and vector code, and the interpretation of the results from the timing routines with respect to the CONVEX model of computing are described. The timing routines available on the SMD CONVEX fall into two groups. The first group includes standard timing routines generally available with UNIX 4.3 BSD operating systems, while the second group includes routines unique to the SMD CONVEX. The standard timing routines described in this report are /bin/csh time,/bin/time, etime, and ctime. The routines unique to the SMD CONVEX are getinfo, second, cputime, toc, and a parallel profiling package made up of palprof, palinit, and palsum.

Paediatric day-case neurosurgery in a resource challenged setting: Pattern and practice

PubMed Central

Owojuyigbe, Afolabi Muyiwa; Komolafe, Edward O.; Adenekan, Anthony T.; Dada, Muyiwa A.; Onyia, Chiazor U.; Ogunbameru, Ibironke O.; Owagbemi, Oluwafemi F.; Talabi, Ademola O.; Faponle, Fola A.

2016-01-01

Background: It has been generally observed that children achieve better convalescence in the home environment especially if discharged same day after surgery. This is probably due to the fact that children generally tend to feel more at ease in the home environment than in the hospital setting. Only few tertiary health institutions provide routine day-case surgery for paediatric neurosurgical patients in our sub-region. Objective: To review the pattern and practice of paediatric neurosurgical day-cases at our hospital. Patients and Methods: A prospective study of all paediatric day-case neurosurgeries carried out between June 2011 and June 2014. Results: A total of 53 patients (34 males and 19 females) with age ranging from 2 days to 14 years were seen. Majority of the patients (77.4%) presented with congenital lesions, and the most common procedure carried out was spina bifida repair (32%) followed by ventriculoperitoneal shunt insertion (26.4%) for hydrocephalus. Sixty-eight percentage belonged to the American Society of Anesthesiologists physical status class 2, whereas the rest (32%) belonged to class 1. General anaesthesia was employed in 83% of cases. Parenteral paracetamol was used for intra-operative analgesia for most of the patients. Two patients had post-operative nausea and vomiting and were successfully managed. There was no case of emergency re-operation, unplanned admission, cancellation or mortality. Conclusion: Paediatric day-case neurosurgery is feasible in our environment. With careful patient selection and adequate pre-operative preparation, good outcome can be achieved. PMID:27251657

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

McKenzie-Carter, M.A.; Lyon, R.E.

This report contains information to support the Environmental Assessment for the Compact Ignition Tokamak Project (CIT) proposed for Princeton Plasma Physics Laboratory (PPPL). The assumptions and methodology used to assess the impact to members of the public from operational and accidental releases of radioactive material from the proposed CIT during the operational period of the project are described. A description of the tracer release tests conducted at PPPL by NOAA is included; dispersion values from these tests are used in the dose calculation. Radiological releases, doses, and resulting health risks are calculated. The computer code AIRDOS-EPA is used to calculatemore » the individual and population doses for routine releases; FUSCRAC3 is used to calculate doses resulting from off-normal releases where direct application of the NOAA tracer test data is not practical. Where applicable, doses are compared to regulatory limits and guidelines values. 44 refs., 5 figs., 18 tabs.« less

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

McKenzie-Carter, M.A.; Lyon, R.E.; Rope, S.K.

This report contains information to support the Environmental Assessment for the Burning Plasma Experiment (BPX) Project proposed for the Princeton Plasma Physics Laboratory (PPPL). The assumptions and methodology used to assess the impact to members of the public from operational and accidental releases of radioactive material from the proposed BPX during the operational period of the project are described. A description of the tracer release tests conducted at PPPL by NOAA is included; dispersion values from these tests are used in the dose calculations. Radiological releases, doses, and resulting health risks are calculated and summarized. The computer code AIRDOS- EPA,more » which is part of the computer code system CAP-88, is used to calculate the individual and population doses for routine releases; FUSCRAC3 is used to calculate doses resulting from off-normal releases where direct application of the NOAA tracer test data is not practical. Where applicable, doses are compared to regulatory limits and guideline values. 48 refs., 16 tabs.« less

Assessment of infection control practices in maternity units in Southern Nigeria.

PubMed

Friday, Okonofua; Edoja, Okpokunu; Osasu, Aigbogun; Chinenye, Nwandu; Cyril, Mokwenye; Lovney, Kanguru; Julia, Hussein

2012-12-01

Puerperal sepsis accounts for 12% of maternal deaths in Nigeria. To date, little is known about the background hospital factors that predispose pregnant women to puerperal infection that leads to mortality. The objective of this study was to investigate the nature and pattern of existing policies and practices relating to infection control in maternity care centres in Edo state, South-South Nigeria. Cross-sectional study consisting of in-depth interviews with service providers, observation of clinical practices and examination of medical records. Public and private health-care facilities in eight local government areas (LGAs) selected from the three senatorial districts of Edo State, Nigeria. Health providers from 63 primary, secondary and tertiary maternity care centres. Sixty-three health-care facilities were sampled from eight LGAs from the three senatorial districts in Edo State. Three pre-tested tools were adapted to the local setting and used to interview key informants in the health facilities and to observe for practices and records relating to infection control. Of the 63 health facilities, 68% (43) reported that they had infection control procedures in place, while only 25% (16) reported that they documented these as manuals or charts. Only 13% (8) of facilities had infection control committees; 11% (7) routinely carried out audits of maternal deaths, while 33% (21) reported that they had an ongoing programme for staff training on infection control. A high proportion of the health facilities reported that staff routinely wash their hands before and after sterile procedures, but only half of the facilities were observed to have 24-h running water and only two-thirds had soap and antiseptic solutions in delivery and operating theatre areas. Although more than 90% (57) of the health facilities reported that they use sterile gloves routinely, unused sterile gloves were found in only 60% (38) of these facilities, and recycled gloves in 11.1% (7). The results of this study suggest the need for improved record-keeping procedures, the development of appropriate policies and protocols for infection control and staff training on infection control in maternity care facilities in Edo State. A public health education and advocacy programme to create awareness on clean delivery places as an approach for reducing maternal morbidity and mortality and to build political will for implementing related activities is also urgently needed.

What’s So Different about Big Data?. A Primer for Clinicians Trained to Think Epidemiologically

PubMed Central

Liu, Vincent

2014-01-01

The Big Data movement in computer science has brought dramatic changes in what counts as data, how those data are analyzed, and what can be done with those data. Although increasingly pervasive in the business world, it has only recently begun to influence clinical research and practice. As Big Data draws from different intellectual traditions than clinical epidemiology, the ideas may be less familiar to practicing clinicians. There is an increasing role of Big Data in health care, and it has tremendous potential. This Demystifying Data Seminar identifies four main strands in Big Data relevant to health care. The first is the inclusion of many new kinds of data elements into clinical research and operations, in a volume not previously routinely used. Second, Big Data asks different kinds of questions of data and emphasizes the usefulness of analyses that are explicitly associational but not causal. Third, Big Data brings new analytic approaches to bear on these questions. And fourth, Big Data embodies a new set of aspirations for a breaking down of distinctions between research data and operational data and their merging into a continuously learning health system. PMID:25102315

What's so different about big data?. A primer for clinicians trained to think epidemiologically.

PubMed

Iwashyna, Theodore J; Liu, Vincent

2014-09-01

The Big Data movement in computer science has brought dramatic changes in what counts as data, how those data are analyzed, and what can be done with those data. Although increasingly pervasive in the business world, it has only recently begun to influence clinical research and practice. As Big Data draws from different intellectual traditions than clinical epidemiology, the ideas may be less familiar to practicing clinicians. There is an increasing role of Big Data in health care, and it has tremendous potential. This Demystifying Data Seminar identifies four main strands in Big Data relevant to health care. The first is the inclusion of many new kinds of data elements into clinical research and operations, in a volume not previously routinely used. Second, Big Data asks different kinds of questions of data and emphasizes the usefulness of analyses that are explicitly associational but not causal. Third, Big Data brings new analytic approaches to bear on these questions. And fourth, Big Data embodies a new set of aspirations for a breaking down of distinctions between research data and operational data and their merging into a continuously learning health system.

Implementation of molecular intra-operative assessment of sentinel lymph node in breast cancer.

PubMed

Khaddage, Abir; Berremila, Sid-Ali; Forest, Fabien; Clemenson, Alix; Bouteille, Catherine; Seffert, Pierre; Peoc'h, Michel

2011-02-01

Sentinel lymph node (SLN) biopsy is used as a staging procedure in early breast cancer, however, histology based intra-operative assessment of the SLN status has a low sensitivity. The one-step nucleic acid amplification (OSNA) method was developed to detect metastases by amplification of cytokeratin (CK) 19 mRNA. Experience with OSNA during a French multi-centric prospective study, as well as intra-operative clinical routine use, is reported. For the clinical study 80 SLNs from 46 patients were assessed. During routine use, the central slice of the SLN from 197 patients was investigated by permanent histology and the remainder was assessed by OSNA. During the clinical study, OSNA detected 15/17 metastases, including all the macrometastases, reaching a 96.3% concordance rate, 88.2% sensitivity and 98.4% specificity. During routine use, both OSNA and histology detected 25 patients with metastasis. OSNA is an accurate tool for intra-operative assessment of SLN status and could reduce the need for second surgery.

Robotic assembly and maintenance of future space stations based on the ISS mission operations experience

NASA Astrophysics Data System (ADS)

Rembala, Richard; Ower, Cameron

2009-10-01

MDA has provided 25 years of real-time engineering support to Shuttle (Canadarm) and ISS (Canadarm2) robotic operations beginning with the second shuttle flight STS-2 in 1981. In this capacity, our engineering support teams have become familiar with the evolution of mission planning and flight support practices for robotic assembly and support operations at mission control. This paper presents observations on existing practices and ideas to achieve reduced operational overhead to present programs. It also identifies areas where robotic assembly and maintenance of future space stations and space-based facilities could be accomplished more effectively and efficiently. Specifically, our experience shows that past and current space Shuttle and ISS assembly and maintenance operations have used the approach of extensive preflight mission planning and training to prepare the flight crews for the entire mission. This has been driven by the overall communication latency between the earth and remote location of the space station/vehicle as well as the lack of consistent robotic and interface standards. While the early Shuttle and ISS architectures included robotics, their eventual benefits on the overall assembly and maintenance operations could have been greater through incorporating them as a major design driver from the beginning of the system design. Lessons learned from the ISS highlight the potential benefits of real-time health monitoring systems, consistent standards for robotic interfaces and procedures and automated script-driven ground control in future space station assembly and logistics architectures. In addition, advances in computer vision systems and remote operation, supervised autonomous command and control systems offer the potential to adjust the balance between assembly and maintenance tasks performed using extra vehicular activity (EVA), extra vehicular robotics (EVR) and EVR controlled from the ground, offloading the EVA astronaut and even the robotic operator on-orbit of some of the more routine tasks. Overall these proposed approaches when used effectively offer the potential to drive down operations overhead and allow more efficient and productive robotic operations.

Short communication: Snapshot of industry milk hauling practices in the western United States.

PubMed

Kuhn, Eva; Meunier-Goddik, Lisbeth; Waite-Cusic, Joy G

2018-03-01

The Pasteurized Milk Ordinance (PMO) mandates milk hauling sanitation and operational practices; however, the use of vague language (i.e., "as needed") and gaps in processes lead to variability in industry practices. Our aim was to characterize industry milk hauling practices and identify areas that may be an unexplained source of contamination in the dairy processing continuum, and communicate this information with industry to cultivate best practices. The objectives of this study were to (1) survey industry hauling sanitation and operation practices in the Pacific Northwest region of the United States, and (2) quantify microbial populations [aerobic plate count (APC), lactic acid bacteria, coliforms] on the internal surfaces of transfer hoses (tanker and receiving bay) to determine their potential contribution to the microbiological quality of raw milk. Eleven facilities (78% response rate) participated in our survey. All facilities surveyed were compliant with the PMO; however, overall milk reception layout, sanitation practices, and routine maintenance greatly varied between facilities. Farm hose samples (n = 115) had significantly higher microbial loads (APC: mean 4.7 log cfu/100 cm 2 ; median 5.1 log cfu/cm 2 ) than receiving hose samples (n = 57; APC: mean: 2.1 log cfu/100 cm 2 ; median 1.9 log cfu/100 cm 2 ). Microbial populations on transfer hose surfaces did not correlate with time since last cleaning for either tanker or receiving bay hoses. Microbial content of farm hoses is likely to reflect the microbial quality of the previous milk transferred through the hose, making on-farm management practices the primary consideration to maintain low microbiological counts downstream. Upon arrival at the processor, 10% of farm hoses were missing caps. Although this did not correlate with elevated microbiological counts, uncapped farm hoses are exposed to the farm environment, provide opportunity for contamination, and are in violation of the PMO. Through observations made during our studies, manual cleaning procedures appear to be a major weakness in hauling practices and need more attention. Recognizing and communicating variability and areas of weakness allows industry to elevate their hauling sanitation and operational practices to maintain optimum milk microbiological quality. Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Scenario-based design: A method for connecting information system design with public health operations and emergency management

PubMed Central

Reeder, Blaine; Turner, Anne M

2011-01-01

Responding to public health emergencies requires rapid and accurate assessment of workforce availability under adverse and changing circumstances. However, public health information systems to support resource management during both routine and emergency operations are currently lacking. We applied scenario-based design as an approach to engage public health practitioners in the creation and validation of an information design to support routine and emergency public health activities. Methods: Using semi-structured interviews we identified the information needs and activities of senior public health managers of a large municipal health department during routine and emergency operations. Results: Interview analysis identified twenty-five information needs for public health operations management. The identified information needs were used in conjunction with scenario-based design to create twenty-five scenarios of use and a public health manager persona. Scenarios of use and persona were validated and modified based on follow-up surveys with study participants. Scenarios were used to test and gain feedback on a pilot information system. Conclusion: The method of scenario-based design was applied to represent the resource management needs of senior-level public health managers under routine and disaster settings. Scenario-based design can be a useful tool for engaging public health practitioners in the design process and to validate an information system design. PMID:21807120

Effectiveness of training to promote routine enquiry for domestic violence by midwives and nurses: A pre-post evaluation study.

PubMed

Baird, Kathleen M; Saito, Amornrat S; Eustace, Jennifer; Creedy, Debra K

2017-11-01

Asking women about experiences of domestic violence in the perinatal period is accepted best practice. However, midwives and nurses may be reluctant to engage with, or effectively respond to disclosures of domestic violence due a lack of knowledge and skills. To evaluate the impact of training on knowledge and preparedness of midwives and nurses to conduct routine enquiry about domestic violence with women during the perinatal period. A pre-post intervention design was used. Midwives and nurses (n=154) attended a full day workshop. Of these, 149 completed pre-post workshop measures of knowledge and preparedness. Additional questions at post-training explored participants' perceptions of organisational barriers to routine enquiry, as well as anticipated impact of training on their practice. Training occurred between July 2015 and October 2016. Using the Wilcoxon signed-rank test, all post intervention scores were significantly higher than pre intervention scores. Knowledge scores increased from a pre-training mean of 21.5-25.6 (Z=-9.56, p<0.001) and level of preparedness increased from 40.8 to 53.2 (Z=-10.12, p<0.001). Most participants (93%) reported improved preparedness to undertake routine enquiry after training. Only a quarter (24.9%) felt their workplace allowed adequate time to respond to disclosures of DV. Brief training can improve knowledge, preparedness, and confidence of midwives and nurses to conduct routine enquiry and support women during the perinatal period. Training can assist midwives and nurses to recognise signs of DV, ask women about what would be helpful to them, and address perceived organisational barriers to routine enquiry. Practice guidelines and clear referral pathways following DV disclosure need to be implemented to support gains made through training. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

An overview of systematic reviews of normal labor and delivery management

PubMed Central

Iravani, Mina; Janghorbani, Mohsen; Zarean, Elahe; Bahrami, Masoud

2015-01-01

Background: Despite the scientific and medical advances for management of complicated health issues, the current maternity care setting has increased risks for healthy women and their babies. The aim of this study was to conduct an overview of published systematic reviews on the interventions used most commonly for management of normal labor and delivery in the first stage of labor. Materials and Methods: The online databases through March 2013, limited to systematic reviews of clinical trials were searched. An updated search was performed in April 2014. Two reviewers independently assessed data inclusion, extraction, and quality of methodology. Results: Twenty-three reviews (16 Cochrane, 7 non-Cochrane), relating to the most common care practices for management of normal labor and delivery in the first stage of labor, were included. Evidence does not support routine enemas, routine perineal shaving, continuous electronic fetal heart rate monitoring, routine early amniotomy, and restriction of fluids and food during labor. Evidence supports continuity of midwifery care and support, encouragement to non-supine position, and freedom in movement throughout labor. There is insufficient evidence to support routine administration of intravenous fluids and antispasmodics during labor. More evidence is needed regarding delayed admission until active labor and use of partograph. Conclusions: Evidence-based maternity care emphasizes on the practices that increase safety for mother and baby. If policymakers and healthcare providers wish to promote obstetric care quality successfully, it is important that they implement evidence-based clinical practices in routine midwifery care. PMID:26120327

An overview of systematic reviews of normal labor and delivery management.

PubMed

Iravani, Mina; Janghorbani, Mohsen; Zarean, Elahe; Bahrami, Masoud

2015-01-01

Despite the scientific and medical advances for management of complicated health issues, the current maternity care setting has increased risks for healthy women and their babies. The aim of this study was to conduct an overview of published systematic reviews on the interventions used most commonly for management of normal labor and delivery in the first stage of labor. The online databases through March 2013, limited to systematic reviews of clinical trials were searched. An updated search was performed in April 2014. Two reviewers independently assessed data inclusion, extraction, and quality of methodology. Twenty-three reviews (16 Cochrane, 7 non-Cochrane), relating to the most common care practices for management of normal labor and delivery in the first stage of labor, were included. Evidence does not support routine enemas, routine perineal shaving, continuous electronic fetal heart rate monitoring, routine early amniotomy, and restriction of fluids and food during labor. Evidence supports continuity of midwifery care and support, encouragement to non-supine position, and freedom in movement throughout labor. There is insufficient evidence to support routine administration of intravenous fluids and antispasmodics during labor. More evidence is needed regarding delayed admission until active labor and use of partograph. Evidence-based maternity care emphasizes on the practices that increase safety for mother and baby. If policymakers and healthcare providers wish to promote obstetric care quality successfully, it is important that they implement evidence-based clinical practices in routine midwifery care.

Transitioning to routine breast cancer risk assessment and management in primary care: what can we learn from cardiovascular disease?

PubMed

Phillips, Kelly-Anne; Steel, Emma J; Collins, Ian; Emery, Jon; Pirotta, Marie; Mann, G Bruce; Butow, Phyllis; Hopper, John L; Trainer, Alison; Moreton, Jane; Antoniou, Antonis C; Cuzick, Jack; Keogh, Louise

2016-01-01

To capitalise on advances in breast cancer prevention, all women would need to have their breast cancer risk formally assessed. With ~85% of Australians attending primary care clinics at least once a year, primary care is an opportune location for formal breast cancer risk assessment and management. This study assessed the current practice and needs of primary care clinicians regarding assessment and management of breast cancer risk. Two facilitated focus group discussions were held with 17 primary care clinicians (12 GPs and 5 practice nurses (PNs)) as part of a larger needs assessment. Primary care clinicians viewed assessment and management of cardiovascular risk as an intrinsic, expected part of their role, often triggered by practice software prompts and facilitated by use of an online tool. Conversely, assessment of breast cancer risk was not routine and was generally patient- (not clinician-) initiated, and risk management (apart from routine screening) was considered outside the primary care domain. Clinicians suggested that routine assessment and management of breast cancer risk might be achieved if it were widely endorsed as within the remit of primary care and supported by an online risk-assessment and decision aid tool that was integrated into primary care software. This study identified several key issues that would need to be addressed to facilitate the transition to routine assessment and management of breast cancer risk in primary care, based largely on the model used for cardiovascular disease.

Review of wireless and wearable electroencephalogram systems and brain-computer interfaces--a mini-review.

PubMed

Lin, Chin-Teng; Ko, Li-Wei; Chang, Meng-Hsiu; Duann, Jeng-Ren; Chen, Jing-Ying; Su, Tung-Ping; Jung, Tzyy-Ping

2010-01-01

Biomedical signal monitoring systems have rapidly advanced in recent years, propelled by significant advances in electronic and information technologies. Brain-computer interface (BCI) is one of the important research branches and has become a hot topic in the study of neural engineering, rehabilitation, and brain science. Traditionally, most BCI systems use bulky, wired laboratory-oriented sensing equipments to measure brain activity under well-controlled conditions within a confined space. Using bulky sensing equipments not only is uncomfortable and inconvenient for users, but also impedes their ability to perform routine tasks in daily operational environments. Furthermore, owing to large data volumes, signal processing of BCI systems is often performed off-line using high-end personal computers, hindering the applications of BCI in real-world environments. To be practical for routine use by unconstrained, freely-moving users, BCI systems must be noninvasive, nonintrusive, lightweight and capable of online signal processing. This work reviews recent online BCI systems, focusing especially on wearable, wireless and real-time systems. Copyright 2009 S. Karger AG, Basel.

A funding model for a psychological service to plastic and reconstructive surgery in UK practice.

PubMed

Clarke, A; Lester, K J; Withey, S J; Butler, P E M

2005-07-01

Appearance related distress in both clinical and general populations is associated with the increasing identification of surgery as a solution, leading to referrals for cosmetic surgery and pressure on NHS resources. Cosmetic surgery guidelines are designed to control this growing demand, but lack a sound evidence base. Where exceptions are provided on the basis of psychological need, this may recruit patients inappropriately into a surgical pathway, and creates a demand for psychological assessment which transfers the resource problem from one service to another. The model described below evaluates the impact of a designated psychology service to a plastic surgery unit. Developing an operational framework for delivering cosmetic guidelines, which assesses patients using clearly defined and measurable outcomes, has significantly reduced numbers of patients proceeding to the NHS waiting list and provided a systematic audit process. The associated cost savings have provided a way of funding a psychologist within the plastic surgery service so that psychological assessment becomes routine, alternative methods of treatment are easily available and all patients have access to psychological input as part of the routine standard of care.

Management of patients with herpes simplex virus eye disease having cataract surgery in the United Kingdom.

PubMed

Sykakis, Evripidis; Karim, Rushmia; Parmar, Dipak N

2013-08-01

To standardize the management of patients with herpetic eye disease scheduled for cataract surgery, a questionnaire was sent to each fellow of the Royal College of Ophthalmologists registered as a consultant with a subspecialty interest in cornea. Most respondents agreed that disease stability was required before cataract surgery was offered; 62.3% would operate on patients in whom the disease had been quiescent for 3 to 6 months. The decision to prescribe prophylactic antivirals divided the respondents, with 58.8% in favor of starting antiviral treatment. Most respondents (72.46%) did not start topical antiviral treatment. In regard to changing topical steroid use postoperatively, 80.9% would not change their routine regimen. Oral acyclovir was the first line of treatment for 92.5%. The conclusions were that a significant period of inactivity should be considered before cataract surgery is performed in patients with herpes simplex virus eye disease. Oral antiviral prophylaxis is common clinical practice, but no change in routine postoperative steroid use is needed. Copyright © 2013 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

A non-interventional comparative study of the 20:1 combination of cafedrine/theodrenaline versus ephedrine for the treatment of intra-operative arterial hypotension: the 'HYPOTENS' study design and rationale.

PubMed

Eberhart, Leopold; Geldner, Götz; Huljic, Susanne; Marggraf, Kerstin; Keller, Thomas; Koch, Tilo; Kranke, Peter

2018-06-01

To compare the effectiveness of 20:1 cafedrine/theodrenaline approved for use in Germany to ephedrine in the restoration of arterial blood pressure and on post-operative outcomes in patients with intra-operative arterial hypotension of any origin under standard clinical practice conditions. 'HYPOTENS' is a national, multi-center, prospective, open-label, two-armed, non-interventional study. Effectiveness and post-operative outcome following cafedrine/theodrenaline or ephedrine therapy will be evaluated in two cohorts of hypotensive patients. Cohort A includes patients aged ≥50 years with ASA-classification 2-4 undergoing non-emergency surgical procedures under general anesthesia. Cohort B comprises patients undergoing Cesarean section under spinal anesthesia. Participating surgical departments will be assigned to a treatment arm by routinely used anti-hypotensive agent. To minimize bias, matched department pairs will be compared in a stratified selection process. The composite primary end-point is the lower absolute deviation from individually determined target blood pressure (IDTBP) and the incidence of heart rate ≥100 beats/min in the first 15 min. Secondary end-points include incidence and degree of early post-operative delirium (cohort A), severity of fetal acidosis in the newborn (cohort B), upper absolute deviation from IDTBP, percentage increase in systolic blood pressure, and time to IDTBP. This open-label, non-interventional study design mirrors daily practice in the treatment of patients with intra-operative hypotension and ensures full treatment decision autonomy with respect to each patient's individual condition. Selection of participating sites by a randomization process addresses bias without interfering with the non-interventional nature of the study. First results are expected in 2018. ClinicalTrials.gov identifier: NCT02893241; DRKS identifier: DRKS00010740.

Routines, roles, and responsibilities for aligning scientific and classroom practices

NASA Astrophysics Data System (ADS)

Ford, Michael J.; Wargo, Brian M.

2007-01-01

Reform efforts in science education have focused on engaging students in authentic scientific practices. For these efforts to succeed, detailed articulations of scientific practice need to be linked to understandings of classroom practice. Here we characterize engagement in practice generally in terms of 3Rs: routines, roles, and responsibilities. We argue that there is a misalignment between the 3Rs of scientific practice and the practices common in classrooms, and that this misalignment poses a considerable obstacle for beginning teachers who attempt to implement reform pedagogy. As part of a secondary methods course, 16 preservice teachers (PSTs) participated in two exemplar activities designed to engage them in scientific practices. The PST performances suggest that at least initially, they did not consider authentic scientific practices appropriate for classroom activities, implying a pedagogical repertoire dominated by the 3Rs of traditional classrooms. PST performances, however, evidenced a shift in the 3Rs from those common in classrooms to those required by these activities, suggesting that their visions for classrooms are malleable and underlining the importance of aligning the 3Rs of scientific and classroom practices during teacher preparation.

Embryo transfer practices in the United States: a survey of clinics registered with the Society for Assisted Reproductive Technology.

PubMed

Jungheim, Emily S; Ryan, Ginny L; Levens, Eric D; Cunningham, Alexandra F; Macones, George A; Carson, Kenneth R; Beltsos, Angeline N; Odem, Randall R

2010-09-01

To gain a better understanding of factors influencing clinicians' embryo transfer practices. Cross-sectional survey. Web-based survey conducted in December 2008 of individuals practicing IVF in centers registered with the Society for Assisted Reproductive Technology (SART). None. None. Prevalence of clinicians reporting following embryo transfer guidelines recommended by the American Society for Reproductive Medicine (ASRM), prevalence among these clinicians to deviate from ASRM guidelines in commonly encountered clinical scenarios, and practice patterns related to single embryo transfer. Six percent of respondents reported following their own, independent guidelines for the number of embryos to transfer after IVF. Of the 94% of respondents who reported routinely following ASRM embryo transfer guidelines, 52% would deviate from these guidelines for patient request, 51% for cycles involving the transfer of frozen embryos, and 70% for patients with previously failed IVF cycles. All respondents reported routinely discussing the risks of multiple gestations associated with standard embryo transfer practices, whereas only 34% reported routinely discussing single embryo transfer with all patients. Although the majority of clinicians responding to our survey reported following ASRM embryo transfer guidelines, at least half would deviate from these guidelines in a number of different situations. Copyright (c) 2010 American Society for Reproductive Medicine. All rights reserved.

System design of a remotely operated, program controlled measurement table for the calibration of the Egret experiment. Part A: Program control

NASA Technical Reports Server (NTRS)

1984-01-01

The structure of the program, the five priority levels, the drive routines, the stepwise drive plan, the figure routines, meander X and y, the range of measurement table, the optimization of figure drive, the figure drive plan, dialogue routines, stack processing, the drive for the main terminal, the protocol routines, the drive for the microterminal, the drive for the experiment computer, and the main program are discussed.

Manualized cognitive therapy versus cognitive-behavioral treatment-as-usual for social anxiety disorder in routine practice: A cluster-randomized controlled trial.

PubMed

Hoyer, Jürgen; Čolić, Jasmin; Pittig, Andre; Crawcour, Stephen; Moeser, Manuela; Ginzburg, Denise; Lin, Jihong; Wiltink, Joerg; Leibing, Eric; Stangier, Ulrich

2017-08-01

This study examined the effectiveness of manualized cognitive therapy (mCT) following the Clark-Wells approach versus non-manualized cognitive-behavioral treatment-as-usual (CBTAU) for social anxiety disorder (SAD) in routine practice. Forty-eight private practitioners were recruited within a multi-center trial and either received training in manualized CT for SAD or no such training. Practitioners treated 162 patients with SAD in routine practice (N = 107 completers, n = 57 for mCT, n = 50 for CBTAU). Social anxiety symptoms (Liebowitz Social Anxiety Scale; LSAS) and secondary measures were assessed before treatment, at treatment-hour 8, 15, and 25, at end of treatment, as well as 6 and 12 months after treatment. Patients in both groups showed significant reductions of SAD severity after treatment (d = 1.91 [mCT] and d = 1.80 [CBTAU], within-group effect sizes, intent-to-treat analyses, LSAS observer ratings), which remained stable at follow-up. There were no differences between groups in terms of symptom reduction and treatment duration. The present trial confirms the high effectiveness of CBTAU and mCT for SAD when practitioners conduct the treatments in routine practice. Additional training in the CT manual did not result in significant between-group effects on therapy outcome. Explanations for this unexpected result are discussed. Copyright © 2017 Elsevier Ltd. All rights reserved.

Innovative telemonitoring system for cardiology: from science to routine operation.

PubMed

Kastner, P; Morak, J; Modre, R; Kollmann, A; Ebner, C; Fruhwald, Fm; Schreier, G

2010-01-01

Results of the Austrian MOBITEL (MOBIle phone based TELemonitoring for heart failure patients) trial indicate that home-based telemonitoring improves outcome of chronic heart failure (CHF) patients and reduces both frequency and duration of hospitalizations. Based on lessons learned, we assessed the weak points to clear the way for routine operations. We analyzed the system with respect to recommendations of the ESC Guidelines and experiences gained throughout the trial to identify potential improvements. The following components have been identified: a patient terminal with highest usability, integrated way to document drug-intake and well-being, and automated event detection for worsening of CHF. As a consequence the system was extended by Near Field Communication (NFC) technology and by an event management tool. Usability evaluation with 30 adults (14f, median 51y. IQR[45-65]) showed that 21 (8f) were able to immediately operate the system after reading a step-by-step manual. Eight (6f) needed one time demonstration and one man (80y) failed to operate the blood pressure meter. Routine operation of the revised system started in March 2009. Within 9 months, 15 patients (4f, median 74y. IQR[71-83], all NYHA-III) transmitted 17,149 items. 43 events were detected because of body weight gain of more then 2kg within 2 days. 49 therapy adjustments were documented. Three patients stopped using the system, two (1f) because of non-compliance and one (m, 82y) because of death. Overall, the rate of adherence to daily data transfer was 78%. First results confirm the applicability of the revised telemonitoring system in routine operation.

Clinician Telephone Training to Reduce Family Tobacco Use: Analysis of Transcribed Recordings

PubMed Central

Walters, Bethany Hipple; Ossip, Deborah J.; Drehmer, Jeremy E.; Nabi-Burza, Emara; Whitmore, Regina; Gorzkowski, Julie; Winickoff, Jonathan P.

2018-01-01

Background Family tobacco use and exposure are significant threats to the health of children and their families. However, few pediatric clinicians address family tobacco use and exposure in a routine and effective manner. The Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention was developed to tackle this gap between clinical need and clinical practice. Objective To review the main considerations and questions that clinicians and office staff expressed during telephone training to participate in CEASE. Methods This study was conducted in pediatric practices in 5 US states. Practices were recruited by the American Academy of Pediatrics (10 intervention, 10 control). Ten training calls were recorded and transcribed. The data was then coded inductively based on themes found in the transcripts. Results The data revealed that clinicians and staff were concerned about prescribing, dosing, and insurance coverage of nicotine replacement therapy; motivation for and methods to help families become tobacco-free; and the impact of the intervention on practice operations. Conclusion While the majority of clinicians and office staff were interested and enthusiastic about helping families become tobacco-free, they expressed concerns that could threaten implementation of family tobacco control strategies. PMID:29497272

Pregnancy Options Counseling and Abortion Referrals Among US Primary Care Physicians: Results From a National Survey.

PubMed

Holt, Kelsey; Janiak, Elizabeth; McCormick, Marie C; Lieberman, Ellice; Dehlendorf, Christine; Kajeepeta, Sandhya; Caglia, Jacquelyn M; Langer, Ana

2017-07-01

Primary care physicians (PCPs) can play a critical role in addressing unintended pregnancy through high-quality options counseling and referrals. We surveyed a nationally representative sample of 3,000 PCPs in general, family, and internal medicine on practices and opinions related to options counseling for unintended pregnancy. We assessed predictors of physician practices using multivariable logistic regression weighted for sampling design and differential non-response. Response rate was 29%. Seventy-one percent believed residency training in options counseling should be required, and 69% believed PCPs have an obligation to provide abortion referrals even in the presence of a personal objection to abortion. However, only 26% reported routine options counseling when caring for women with unintended pregnancy compared to 60% who routinely discuss prenatal care. Among physicians who see women seeking abortion, 62% routinely provide referrals, while 14% routinely attempt to dissuade women. Family physicians were more likely to provide routine options counseling when seeing patients with unintended pregnancy than internal medicine physicians (32% vs 21%, P=0.002). In multivariable analyses, factors associated with higher odds of routine abortion referrals were more years in practice (OR=1.03 for each additional year, 95% CI: 1.00-1.05), identifying as a woman vs a man (OR=2.11, 95% CI: 1.31-3.40), practicing in a hospital vs private primary care/multispecialty setting (OR=3.17, 95% CI: 1.10-9.15), and no religious affiliation of practice vs religious affiliation (OR for Catholic affiliation=0.27, 95% CI: 0.11-0.66; OR for other religious affiliation=0.36, 95% CI: 0.15-0.83). Personal Christian religious affiliation among physicians who regularly attend religious services vs no religious affiliation was associated with lower odds of counseling (OR=0.48, 95% CI: 0.26-0.90) and referrals (OR=0.31, 95% CI: 0.15-0.62), and higher odds of abortion dissuasion (OR=4.03, 95% CI: 1.46-11.14). Findings reveal the need to support fuller integration of options counseling and abortion referrals in primary care, particularly through institutional and professional society guidelines and training opportunities to impart skills and highlight the professional obligation to provide non-directive information and support to women with unintended pregnancy.

ISS Expedition 42 / 43 Crew Training Resource Reel (JSC-2641)

NASA Image and Video Library

2014-11-14

Media resource reel of ISS Expedition 42 / 43 Crew training activities. Includes footage of crew photo shots with Samantha Cristoforetti, Anton Shkaplerov and Terry Virts; Routine shots with Virts, ISS Expedition 43 crewmember Scott Kelly, Cristoforetti, ISS Expedition 41 / 42 crewmember Barry Wilmore; and Shklaplerov; T-38 Operations with Virts; Routine operations with Cristoforetti, Shkaplerov and Virts; Neutral Buoyancy Lab (NBL) with Cristoforetti and Kelly; and Emergency Scenatios with Virts, Cristoforetti and Shkaplerov.

Developing a weather observation routine during ICARUS

NASA Astrophysics Data System (ADS)

Mei, F.; Hubbe, J. M.; de Boer, G.; Lawrence, D.; Shupe, M.; Ivey, M.; Dexheimer, D.; Schmid, B.

2016-12-01

Starting in 2014, the Atmospheric Radiation Measurement (ARM) program began a major reconfiguration to more tightly link measurements and atmospheric models. As part of this the reconfiguration, ARM's North Slope of Alaska (NSA) site is being upgraded to include additional observations to support modeling and process studies. The Inaugural Campaigns for ARM Research using Unmanned Systems (ICARUS) have been launched in 2016. This internal initiative at Oliktok Point, Alaska focus on developing routine operations of Unmanned Aerial Systems (UAS) and Tethered Balloon Systems (TBS). The main purpose of ICARUS is to collect spatial data about surface radiation, heat fluxes, and vertical profiles of the basic atmospheric state (temperature, humidity, and horizontal wind). Based on the data collected during ICARUS, we will develop the operation routines for each atmospheric state measurement, and then optimize the operation schedule to maximize the data collection capacity. The statistical representation of important atmospheric state parameters will be discussed.

Do People with a Mental Handicap Have Rights?

ERIC Educational Resources Information Center

Hudson, Bob

1988-01-01

Rights for people with mental handicaps include claim rights and moral rights, which are associated with routine discrimination and fundamental discrimination, respectively. In Britain, people with mental handicaps are routinely denied both types of rights. Greater protection would be offered through a "Code of Practice" and consistent…

Identifying factors that predict the choice and success rate of radial artery catheterisation in contemporary real world cardiology practice: a sub-analysis of the PREVAIL study data.

PubMed

Pristipino, Christian; Roncella, Adriana; Trani, Carlo; Nazzaro, Marco S; Berni, Andrea; Di Sciascio, Germano; Sciahbasi, Alessandro; Musarò, Salvatore Donato; Mazzarotto, Pietro; Gioffrè, Gaetano; Speciale, Giulio

2010-06-01

To assess: the reasons behind an operator choosing to perform radial artery catheterisation (RAC) as against femoral arterial catheterisation, and to explore why RAC may fail in the real world. A pre-determined analysis of PREVAIL study database was performed. Relevant data were collected in a prospective, observational survey of 1,052 consecutive patients undergoing invasive cardiovascular procedures at nine Italian hospitals over a one month observation period. By multivariate analysis, the independent predictors of RAC choice were having the procedure performed: (1) at a high procedural volume centre; and (2) by an operator who performs a high volume of radial procedures; clinical variables played no statistically significant role. RAC failure was predicted independently by (1) a lower operator propensity to use RAC; and (2) the presence of obstructive peripheral artery disease. A 10-fold lower rate of RAC failure was observed among operators who perform RAC for > 85% of their personal caseload than among those who use RAC < 25% of the time (3.8% vs. 33.0%, respectively); by receiver operator characteristic (ROC) analysis, no threshold value for operator RAC volume predicted RAC failure. A routine RAC in all-comers is superior to a selective strategy in terms of feasibility and success rate.

Bootstrap-based procedures for inference in nonparametric receiver-operating characteristic curve regression analysis.

PubMed

Rodríguez-Álvarez, María Xosé; Roca-Pardiñas, Javier; Cadarso-Suárez, Carmen; Tahoces, Pablo G

2018-03-01

Prior to using a diagnostic test in a routine clinical setting, the rigorous evaluation of its diagnostic accuracy is essential. The receiver-operating characteristic curve is the measure of accuracy most widely used for continuous diagnostic tests. However, the possible impact of extra information about the patient (or even the environment) on diagnostic accuracy also needs to be assessed. In this paper, we focus on an estimator for the covariate-specific receiver-operating characteristic curve based on direct regression modelling and nonparametric smoothing techniques. This approach defines the class of generalised additive models for the receiver-operating characteristic curve. The main aim of the paper is to offer new inferential procedures for testing the effect of covariates on the conditional receiver-operating characteristic curve within the above-mentioned class. Specifically, two different bootstrap-based tests are suggested to check (a) the possible effect of continuous covariates on the receiver-operating characteristic curve and (b) the presence of factor-by-curve interaction terms. The validity of the proposed bootstrap-based procedures is supported by simulations. To facilitate the application of these new procedures in practice, an R-package, known as npROCRegression, is provided and briefly described. Finally, data derived from a computer-aided diagnostic system for the automatic detection of tumour masses in breast cancer is analysed.

Guidance on validation and qualification of processes and operations involving radiopharmaceuticals.

PubMed

Todde, S; Peitl, P Kolenc; Elsinga, P; Koziorowski, J; Ferrari, V; Ocak, E M; Hjelstuen, O; Patt, M; Mindt, T L; Behe, M

2017-01-01

Validation and qualification activities are nowadays an integral part of the day by day routine work in a radiopharmacy. This document is meant as an Appendix of Part B of the EANM "Guidelines on Good Radiopharmacy Practice (GRPP)" issued by the Radiopharmacy Committee of the EANM, covering the qualification and validation aspects related to the small-scale "in house" preparation of radiopharmaceuticals. The aim is to provide more detailed and practice-oriented guidance to those who are involved in the small-scale preparation of radiopharmaceuticals which are not intended for commercial purposes or distribution. The present guideline covers the validation and qualification activities following the well-known "validation chain", that begins with editing the general Validation Master Plan document, includes all the required documentation (e.g. User Requirement Specification, Qualification protocols, etc.), and leads to the qualification of the equipment used in the preparation and quality control of radiopharmaceuticals, until the final step of Process Validation. A specific guidance to the qualification and validation activities specifically addressed to small-scale hospital/academia radiopharmacies is here provided. Additional information, including practical examples, are also available.

Patterns of care analysis for head & neck cancer of unknown primary site: a survey inside the German society of radiation oncology (DEGRO).

PubMed

Müller von der Grün, Jens; Bon, Dimitra; Rödel, Claus; Balermpas, Panagiotis

2018-05-14

Due to the absence of randomized trials, the optimal management for squamous cell cancer of unknown primary in the head and neck region (SCCHN CUP) remains controversial. Current strategies are based on retrospective studies, clinical experience, and institutional policies. An anonymous questionnaire with a total of 24 questions was created and distributed by the use of an online version (Google Forms®, Google, Mountain View, CA, USA) as well as a printout version as equivalent option. An email with a link to the survey and the questionnaire as attachment was sent to 361 DEGRO(German Society of Radiation Oncology)-associated departments. Frequency distributions of responses for each question were calculated. The data were also analyzed by type of practice. Representativity of the sample size for the DEGRO was also evaluated. 66 responses were received including answers from 20 (30%) university departments, 16 (24%) non-university institutions, and 30 (46%) radiation oncology practices. 95% of the participants routinely present these cases in an interdisciplinary tumor board and use intensity modulated radiotherapy (IMRT) techniques for SCCHN CUP treatment. Surgery includes neck dissection in 83% and tonsillectomy in 73% of the cases. Human papilloma virus (HPV) status is routinely determined in 82% of the departments. Statistically significant differences between universities and institutions and clinics and practices could be found with respect to positron emission tomography-computed tomography (PET-CT) utilization, indications for chemotherapy, radiotherapy volumes, and cumulative doses. Diagnostics and treatment for SCCHN CUP within the DEGRO remain heterogeneous. A prospective register trial with standard operation procedures is warranted to homogenize and possibly improve management.

Students' understandings of electrochemistry

NASA Astrophysics Data System (ADS)

O'Grady-Morris, Kathryn

Electrochemistry is considered by students to be a difficult topic in chemistry. This research was a mixed methods study guided by the research question: At the end of a unit of study, what are students' understandings of electrochemistry? The framework of analysis used for the qualitative and quantitative data collected in this study was comprised of three categories: types of knowledge used in problem solving, levels of representation of knowledge in chemistry (macroscopic, symbolic, and particulate), and alternative conceptions. Although individually each of the three categories has been reported in previous studies, the contribution of this study is the inter-relationships among them. Semi-structured, task-based interviews were conducted while students were setting up and operating electrochemical cells in the laboratory, and a two-tiered, multiple-choice diagnostic instrument was designed to identify alternative conceptions that students held at the end of the unit. For familiar problems, those involving routine voltaic cells, students used a working-forwards problem-solving strategy, two or three levels of representation of knowledge during explanations, scored higher on both procedural and conceptual knowledge questions in the diagnostic instrument, and held fewer alternative conceptions related to the operation of these cells. For less familiar problems, those involving non-routine voltaic cells and electrolytic cells, students approached problem-solving with procedural knowledge, used only one level of representation of knowledge when explaining the operation of these cells, scored higher on procedural knowledge than conceptual knowledge questions in the diagnostic instrument, and held a greater number of alternative conceptions. Decision routines that involved memorized formulas and procedures were used to solve both quantitative and qualitative problems and the main source of alternative conceptions in this study was the overgeneralization of theory related to the particulate level of representation of knowledge. The findings from this study may contribute further to our understanding of students' conceptions in electrochemistry. Furthermore, understanding the influence of the three categories in the framework of analysis and their inter-relationships on how students make sense of this field may result in a better understanding of classroom practice that could promote the acquisition of conceptual knowledge --- knowledge that is "rich in relationships".

Systematic review of discharge coding accuracy

PubMed Central

Burns, E.M.; Rigby, E.; Mamidanna, R.; Bottle, A.; Aylin, P.; Ziprin, P.; Faiz, O.D.

2012-01-01

Introduction Routinely collected data sets are increasingly used for research, financial reimbursement and health service planning. High quality data are necessary for reliable analysis. This study aims to assess the published accuracy of routinely collected data sets in Great Britain. Methods Systematic searches of the EMBASE, PUBMED, OVID and Cochrane databases were performed from 1989 to present using defined search terms. Included studies were those that compared routinely collected data sets with case or operative note review and those that compared routinely collected data with clinical registries. Results Thirty-two studies were included. Twenty-five studies compared routinely collected data with case or operation notes. Seven studies compared routinely collected data with clinical registries. The overall median accuracy (routinely collected data sets versus case notes) was 83.2% (IQR: 67.3–92.1%). The median diagnostic accuracy was 80.3% (IQR: 63.3–94.1%) with a median procedure accuracy of 84.2% (IQR: 68.7–88.7%). There was considerable variation in accuracy rates between studies (50.5–97.8%). Since the 2002 introduction of Payment by Results, accuracy has improved in some respects, for example primary diagnoses accuracy has improved from 73.8% (IQR: 59.3–92.1%) to 96.0% (IQR: 89.3–96.3), P= 0.020. Conclusion Accuracy rates are improving. Current levels of reported accuracy suggest that routinely collected data are sufficiently robust to support their use for research and managerial decision-making. PMID:21795302

A survey of contemporary opinions and practices of surgical and intensive care specialists towards peri-operative venous thromboembolism prophylaxis in Asia.

PubMed

Lee, L; Liew, N C; Gee, T

2012-12-01

This survey was conducted to determine the opinions and practices of peri-operative venous thromboembolism (VTE) prophylaxis among surgical and intensive care specialists in Asia. A set of questionnaire was distributed to surgeons and intensivists from different countries in Asia. The specialties included were general surgery and its sub-specialties, orthopaedic surgery, gynaecological surgery and intensive care unit. This survey involved teaching institutions, general hospitals and private hospitals. To gauge if the respondents were from hospitals that would likely encounter VTE cases, the hospital's bed-strength, intensive care facility and sub-specialty services were recorded. Over a period of six months, questionnaires and feedbacks were collected and analyzed. One hundred and ninety-one responses were received from 8 countries throughout Asia. Fifty-six percent of these were from large hospitals (800 bedded or more) and 62% of these hospitals have large intensive care facility (20 or more beds). Only half of the respondents practice routine thromboprophylaxis in moderate and high risk surgeries. Thirty six percent of them practices selective thromboprophylaxis and only 3% do not believe in any thromboprophylaxis. A third prescribed thromboprophylaxis for 3 to 5 days; another third extended it until patient is mobile. About 48.6% of the respondents do not have VTE guidelines in their institutions. Majority of the respondents agreed that more evidence is needed in the form of multi-centre randomized controlled trials to influence their decision on thromboprophylaxis. Despite the availability of strong epidemiological data, randomized controlled trials and multicentre case-controlled studies, perioperative VTE prophylactic practices are still suboptimal in Asia.

48 CFR 9.501 - Definition.

Code of Federal Regulations, 2010 CFR

2010-10-01

... consultant when rendering— (1) Services excluded in subpart 37.2; (2) Routine engineering and technical services (such as installation, operation, or maintenance of systems, equipment, software, components, or facilities); (3) Routine legal, actuarial, auditing, and accounting services; and (4) Training services. [55...

Episodic Contributions to Sequential Control: Learning from a Typist's Touch

ERIC Educational Resources Information Center

Crump, Matthew J. C.; Logan, Gordon D.

2010-01-01

Sequential control over routine action is widely assumed to be controlled by stable, highly practiced representations. Our findings demonstrate that the processes controlling routine actions in the domain of skilled typing can be flexibly manipulated by memory processes coding recent experience with typing particular words and letters. In two…

Ecological Congruence Assessment for Classroom Activities and Routines: Identifying Goals and Intervention Practices in Childcare.

ERIC Educational Resources Information Center

Wolery, Mark; Brashers, Margaret Sigalove; Neitzel, Jennifer C.

2002-01-01

This article explains how educators can use the ecological congruence assessment process for identifying functional goals for young children with disabilities. Process steps include: teacher collects information about functioning in usual classroom activities, routines, and transitions; summarizes the collected information; and shares the…

Self-Care through Self-Compassion: A Balm for Burnout

ERIC Educational Resources Information Center

Coaston, Susannah C.

2017-01-01

Counselors are routinely exposed to painful situations and overwhelming emotions that can, over time, result in burnout. Although counselors routinely promote self-care, many struggle to practice such wellness regularly, putting themselves at increased risk for burning out. Compassion is essential to the helper's role, as it allows counselors to…

Statistical Measurements of Contact Conditions of 478 Transport-airplane Landings During Routine Daytime Operations

NASA Technical Reports Server (NTRS)

Silsby, Norman S

1955-01-01

Statistical measurements of contact conditions have been obtained, by means of a special photographic technique, of 478 landings of present-day transport airplanes made during routine daylight operations in clear air at the Washington National Airport. From the measurements, sinking speeds, rolling velocities, bank angles, and horizontal speeds at the instant before contact have been evaluated and a limited statistical analysis of the results has been made and is reported in this report.

Scenario-based design: a method for connecting information system design with public health operations and emergency management.

PubMed

Reeder, Blaine; Turner, Anne M

2011-12-01

Responding to public health emergencies requires rapid and accurate assessment of workforce availability under adverse and changing circumstances. However, public health information systems to support resource management during both routine and emergency operations are currently lacking. We applied scenario-based design as an approach to engage public health practitioners in the creation and validation of an information design to support routine and emergency public health activities. Using semi-structured interviews we identified the information needs and activities of senior public health managers of a large municipal health department during routine and emergency operations. Interview analysis identified 25 information needs for public health operations management. The identified information needs were used in conjunction with scenario-based design to create 25 scenarios of use and a public health manager persona. Scenarios of use and persona were validated and modified based on follow-up surveys with study participants. Scenarios were used to test and gain feedback on a pilot information system. The method of scenario-based design was applied to represent the resource management needs of senior-level public health managers under routine and disaster settings. Scenario-based design can be a useful tool for engaging public health practitioners in the design process and to validate an information system design. Copyright © 2011 Elsevier Inc. All rights reserved.

Comparison of smartphone application-based vital sign monitors without external hardware versus those used in clinical practice: a prospective trial.

PubMed

Alexander, John C; Minhajuddin, Abu; Joshi, Girish P

2017-08-01

Use of healthcare-related smartphone applications is common. However, there is concern that inaccurate information from these applications may lead patients to make erroneous healthcare decisions. The objective of this study is to study smartphone applications purporting to measure vital sign data using only onboard technology compared with monitors used routinely in clinical practice. This is a prospective trial comparing correlation between a clinically utilized vital sign monitor (Propaq CS, WelchAllyn, Skaneateles Falls, NY, USA) and four smartphone application-based monitors Instant Blood Pressure, Instant Blood Pressure Pro, Pulse Oximeter, and Pulse Oximeter Pro. We performed measurements of heart rate (HR), systolic blood pressures (SBP), diastolic blood pressure (DBP), and oxygen saturation (SpO 2 ) using standard monitor and four smartphone applications. Analysis of variance was used to compare measurements from the applications to the routine monitor. The study was completed on 100 healthy volunteers. Comparison of routine monitor with the smartphone applications shows significant differences in terms of HR, SpO 2 and DBP. The SBP values from the applications were not significantly different from those from the routine monitor, but had wide limits of agreement signifying a large degree of variation in the compared values. The degree of correlation between monitors routinely used in clinical practice and the smartphone-based applications studied is insufficient to recommend clinical utilization. This lack of correlation suggests that the applications evaluated do not provide clinically meaningful data. The inaccurate data provided by these applications can potentially contribute to patient harm.

Cost-effectiveness of molecular testing for thyroid nodules with atypia of undetermined significance cytology.

PubMed

Lee, Lawrence; How, Jacques; Tabah, Roger J; Mitmaker, Elliot J

2014-08-01

Novel molecular diagnostics, such as the gene expression classifier (GEC) and gene mutation panel (GMP) testing, may improve the management for thyroid nodules with atypia of undetermined significance (AUS) cytology. The cost-effectiveness of an approach combining both tests in different practice settings in North America is unknown. The aim of the study was to determine the cost-effectiveness of two diagnostic molecular tests, singly or in combination, for AUS thyroid nodules. We constructed a microsimulation model to investigate cost-effectiveness from US (Medicare) and Canadian healthcare system perspectives. Low-risk patients with AUS thyroid nodules were simulated. We examined five management strategies: 1) routine GEC; 2) routine GEC + selective GMP; 3) routine GMP; 4) routine GMP + selective GEC; and 5) standard management. Lifetime costs and quality-adjusted life-years were measured. From the US perspective, the routine GEC + selective GMP strategy was the dominant strategy. From the Canadian perspective, routine GEC + selective GMP cost and additional CAN$24 030 per quality-adjusted life-year gained over standard management, and was dominant over the other strategies. Sensitivity analyses reported that the decisions from both perspectives were sensitive to variations in the probability of malignancy in the nodule and the costs of the GEC and GMP. The probability of cost-effectiveness for routine GEC + selective GMP was low. In the US setting, the most cost-effective strategy was routine GEC + selective GMP. In the Canadian setting, standard management was most likely to be cost effective. The cost of these molecular diagnostics will need to be reduced to increase their cost-effectiveness for practice settings outside the United States.

40 CFR 160.63 - Maintenance and calibration of equipment.

Code of Federal Regulations, 2012 CFR

2012-07-01

.... (b) The written standard operating procedures required under § 160.81(b)(11) shall set forth in... maintenance operations were routine and followed the written standard operating procedures. Written records... operating procedures shall designate the person responsible for the performance of each operation. (c...

40 CFR 160.63 - Maintenance and calibration of equipment.

Code of Federal Regulations, 2013 CFR

2013-07-01

.... (b) The written standard operating procedures required under § 160.81(b)(11) shall set forth in... maintenance operations were routine and followed the written standard operating procedures. Written records... operating procedures shall designate the person responsible for the performance of each operation. (c...

40 CFR 160.63 - Maintenance and calibration of equipment.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... (b) The written standard operating procedures required under § 160.81(b)(11) shall set forth in... maintenance operations were routine and followed the written standard operating procedures. Written records... operating procedures shall designate the person responsible for the performance of each operation. (c...

40 CFR 160.63 - Maintenance and calibration of equipment.

Code of Federal Regulations, 2011 CFR

2011-07-01

.... (b) The written standard operating procedures required under § 160.81(b)(11) shall set forth in... maintenance operations were routine and followed the written standard operating procedures. Written records... operating procedures shall designate the person responsible for the performance of each operation. (c...

40 CFR 160.63 - Maintenance and calibration of equipment.

Code of Federal Regulations, 2014 CFR

2014-07-01

.... (b) The written standard operating procedures required under § 160.81(b)(11) shall set forth in... maintenance operations were routine and followed the written standard operating procedures. Written records... operating procedures shall designate the person responsible for the performance of each operation. (c...

As accessible as a book on a library shelf: the imperative of routine simulation in modern health care.

PubMed

Gordon, James A

2012-01-01

Technology-enhanced patient simulation has emerged as an important new modality for teaching and learning in medicine. In particular, immersive simulation platforms that replicate the clinical environment promise to revolutionize medical education by enabling an enhanced level of safety, standardization, and efficiency across health-care training. Such an experiential approach seems unique in reliably catalyzing a level of emotional engagement that fosters immediate and indelible learning and allows for increasingly reliable levels of performance evaluation-all in a completely risk-free environment. As such, medical simulation is poised to emerge as a critical component of training and certification throughout health care, promising to fundamentally enhance quality and safety across disciplines. To encourage routine simulation-based practice as part of its core quality and safety mission, Massachusetts General Hospital now incorporates simulation resources within its historic medical library (est. 1847), located at the center of the campus. In this new model, learners go to the library not only to read about a patient's illness, but also to take care of their "patient." Such an approach redefines and advances the central role of the library on the campus and ensures that simulation-based practice is centrally available as part of everyday hospital operations. This article describes the reasons for identifying simulation as an institutional priority leading up to the Massachusetts General Hospital Bicentennial Celebration (1811-2011) and for creating a simulation-based learning laboratory within a hospital library.

Error mapping controller: a closed loop neuroprosthesis controlled by artificial neural networks.

PubMed

Pedrocchi, Alessandra; Ferrante, Simona; De Momi, Elena; Ferrigno, Giancarlo

2006-10-09

The design of an optimal neuroprostheses controller and its clinical use presents several challenges. First, the physiological system is characterized by highly inter-subjects varying properties and also by non stationary behaviour with time, due to conditioning level and fatigue. Secondly, the easiness to use in routine clinical practice requires experienced operators. Therefore, feedback controllers, avoiding long setting procedures, are required. The error mapping controller (EMC) here proposed uses artificial neural networks (ANNs) both for the design of an inverse model and of a feedback controller. A neuromuscular model is used to validate the performance of the controllers in simulations. The EMC performance is compared to a Proportional Integral Derivative (PID) included in an anti wind-up scheme (called PIDAW) and to a controller with an ANN as inverse model and a PID in the feedback loop (NEUROPID). In addition tests on the EMC robustness in response to variations of the Plant parameters and to mechanical disturbances are carried out. The EMC shows improvements with respect to the other controllers in tracking accuracy, capability to prolong exercise managing fatigue, robustness to parameter variations and resistance to mechanical disturbances. Different from the other controllers, the EMC is capable of balancing between tracking accuracy and mapping of fatigue during the exercise. In this way, it avoids overstressing muscles and allows a considerable prolongation of the movement. The collection of the training sets does not require any particular experimental setting and can be introduced in routine clinical practice.

Error mapping controller: a closed loop neuroprosthesis controlled by artificial neural networks

PubMed Central

Pedrocchi, Alessandra; Ferrante, Simona; De Momi, Elena; Ferrigno, Giancarlo

2006-01-01

Background The design of an optimal neuroprostheses controller and its clinical use presents several challenges. First, the physiological system is characterized by highly inter-subjects varying properties and also by non stationary behaviour with time, due to conditioning level and fatigue. Secondly, the easiness to use in routine clinical practice requires experienced operators. Therefore, feedback controllers, avoiding long setting procedures, are required. Methods The error mapping controller (EMC) here proposed uses artificial neural networks (ANNs) both for the design of an inverse model and of a feedback controller. A neuromuscular model is used to validate the performance of the controllers in simulations. The EMC performance is compared to a Proportional Integral Derivative (PID) included in an anti wind-up scheme (called PIDAW) and to a controller with an ANN as inverse model and a PID in the feedback loop (NEUROPID). In addition tests on the EMC robustness in response to variations of the Plant parameters and to mechanical disturbances are carried out. Results The EMC shows improvements with respect to the other controllers in tracking accuracy, capability to prolong exercise managing fatigue, robustness to parameter variations and resistance to mechanical disturbances. Conclusion Different from the other controllers, the EMC is capable of balancing between tracking accuracy and mapping of fatigue during the exercise. In this way, it avoids overstressing muscles and allows a considerable prolongation of the movement. The collection of the training sets does not require any particular experimental setting and can be introduced in routine clinical practice. PMID:17029636

Predicting hepatic steatosis and liver fat content in obese children based on biochemical parameters and anthropometry.

PubMed

Zhang, H-X; Xu, X-Q; Fu, J-F; Lai, C; Chen, X-F

2015-04-01

Predictors of quantitative evaluation of hepatic steatosis and liver fat content (LFC) using clinical and laboratory variables available in the general practice in the obese children are poorly identified. To build predictive models of hepatic steatosis and LFC in obese children based on biochemical parameters and anthropometry. Hepatic steatosis and LFC were determined using proton magnetic resonance spectroscopy in 171 obese children aged 5.5-18.0 years. Routine clinical and laboratory parameters were also measured in all subjects. Group analysis, univariable correlation analysis, and multivariate logistic and linear regression analysis were used to develop a liver fat score to identify hepatic steatosis and a liver fat equation to predict LFC in each subject. The predictive model of hepatic steatosis in our participants based on waist circumference and alanine aminotransferase had an area under the receiver operating characteristic curve of 0.959 (95% confidence interval: 0.927-0.990). The optimal cut-off value of 0.525 for determining hepatic steatosis had sensitivity of 93% and specificity of 90%. A liver fat equation was also developed based on the same parameters of hepatic steatosis liver fat score, which would be used to calculate the LFC in each individual. The liver fat score and liver fat equation, consisting of routinely available variables, may help paediatricians to accurately determine hepatic steatosis and LFC in clinical practice, but external validation is needed before it can be employed for this purpose. © 2014 The Authors. Pediatric Obesity © 2014 World Obesity.

Doubling immunochemistry laboratory testing efficiency with the cobas e 801 module while maintaining consistency in analytical performance.

PubMed

Findeisen, P; Zahn, I; Fiedler, G M; Leichtle, A B; Wang, S; Soria, G; Johnson, P; Henzell, J; Hegel, J K; Bendavid, C; Collet, N; McGovern, M; Klopprogge, K

2018-06-04

The new immunochemistry cobas e 801 module (Roche Diagnostics) was developed to meet increasing demands on routine laboratories to further improve testing efficiency, while maintaining high quality and reliable data. During a non-interventional multicenter evaluation study, the overall performance, functionality and reliability of the new module was investigated under routine-like conditions. It was tested as a dedicated immunochemistry system at four sites and as a consolidator combined with clinical chemistry at three sites. We report on testing efficiency and analytical performance of the new module. Evaluation of sample workloads with site-specific routine request patterns demonstrated increased speed and almost doubled throughput (maximal 300 tests per h), thus revealing that one cobas e 801 module can replace two cobas e 602 modules while saving up to 44% floor space. Result stability was demonstrated by QC analysis per assay throughout the study. Precision testing over 21 days yielded excellent results within and between labs, and, method comparison performed versus the cobas e 602 module routine results showed high consistency of results for all assays under study. In a practicability assessment related to performance and handling, 99% of graded features met (44%) or even exceeded (55%) laboratory expectations, with enhanced reagent management and loading during operation being highlighted. By nearly doubling immunochemistry testing efficiency on the same footprint as a cobas e 602 module, the new module has a great potential to further consolidate and enhance laboratory testing while maintaining high quality analytical performance with Roche platforms. Copyright © 2018 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Design and Validation of a Radio-Frequency Identification-Based Device for Routinely Assessing Gait Speed in a Geriatrics Clinic.

PubMed

Barry, Lisa C; Hatchman, Laura; Fan, Zhaoyan; Guralnik, Jack M; Gao, Robert X; Kuchel, George A

2018-05-01

To evaluate the feasibility, acceptability, and validity of a radio-frequency identification (RFID)-based system to measure gait speed in a clinical setting as a first step to using unobtrusive gait speed assessment in routine clinical care. Feasibility study comparing gait speed assessed using an RFID-based system with gait speed assessed using handheld stopwatch, the criterion standard. Outpatient geriatrics clinic at a Connecticut-based academic medical center. Clinic attendees who could walk independently with or without an assistive device (N=50) and healthcare providers (N=9). Gait speed was measured in twice using 2 methods each time before participants entered an examination room. Participants walked at their usual pace while gait speed was recorded simultaneously using the RFID-based system and a handheld stopwatch operated by a trained study investigator. After 2 trials, participants completed a brief survey regarding their experience. At the end of the study period, clinic healthcare providers completed a separate survey. Test-retest reliability of the RFID-based system was high (intraclass correlation coefficient = 0.953). The mean difference ± standard deviation in gait speed between the RFID-based system and the stopwatch was -0.003±0.035 m/s (p=.53) and did not differ significantly according to age, sex, or use of an assistive walking aid. Acceptability of the device was high, and 8 of 9 providers indicated that measuring gait speed using the RFID-based system should be a part of routine clinical care. RFID technology may offer a practical means of overcoming barriers to routine measurement of gait speed in real-world outpatient clinical settings. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

Epidural analgesia during labour, routinely or on request: a cost-effectiveness analysis.

PubMed

Bonouvrié, Kimberley; van den Bosch, Anouk; Roumen, Frans J M E; van Kuijk, Sander M; Nijhuis, Jan G; Evers, Silvia M A A; Wassen, Martine M L H

2016-12-01

To assess the cost-effectiveness of routine labour epidural analgesia (EA), from a societal perspective, as compared with labour analgesia on request. Women delivering of a singleton in cephalic presentation beyond 36+0 weeks' gestation were randomly allocated to routine labour EA or analgesia on request in one university and one non-university teaching hospital in the Netherlands. Costs included all medical, non-medical and indirect costs from randomisation to 6 weeks postpartum. Effectiveness was defined as a non-operative, spontaneous vaginal delivery without EA-related maternal adverse effects. Incremental cost-effectiveness ratio (ICER) was defined as the ratio of the difference in costs and the difference in effectiveness between both groups. Data were analysed according to intention to treat and divided into a base case analysis and a sensitivity analysis. Total delivery costs in the routine EA group (n=233) were higher than in the labour on request group (n=255) (difference -€ 322, 95% CI -€ 60 to € 355) due to more medication costs (including EA), a longer stay in the labour ward, and more operations including caesarean sections. Total postpartum hospital costs in the routine EA group were lower (difference -€ 344, 95% CI -€ 1338 to € 621) mainly due to less neonatal admissions (difference -€ 472, 95% CI -€ 1297 to € 331), whereas total postpartum home and others costs were comparable (difference -€ 20, 95% CI -€ 267 to € 248, and -€ 1, 95% CI -€ 67 to € 284, respectively). As a result, the overall mean costs per woman were comparable between the routine EA group and the analgesia on request group (€ 8.708 and € 8.710, respectively, mean difference -€ 2, 95% CI -€ 1.012 to € 916). Routine labour EA resulted in more deliveries with maternal adverse effects, nevertheless the ICER remained low (€ 8; bootstrap 95% CI -€ 6.120 to € 8.659). The cost-effectiveness acceptability curve indicated a low probability that routine EA is cost-effective. Routine labour EA generates comparable costs as analgesia on request, but results in more operative deliveries and more EA-related maternal adverse effects. Based on cost-effectiveness, no preference can be given to routine labour EA as compared with analgesia on request. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Geospace monitoring for space weather research and operation

NASA Astrophysics Data System (ADS)

Nagatsuma, Tsutomu

2017-10-01

Geospace, a space surrounding the Earth, is one of the key area for space weather. Because geospace environment dynamically varies depending on the solar wind conditions. Many kinds of space assets are operating in geospace for practical purposes. Anomalies of space assets are sometimes happened because of space weather disturbances in geospace. Therefore, monitoring and forecasting of geospace environment is very important tasks for NICT's space weather research and development. To monitor and to improve forecasting model, fluxgate magnetometers and HF radars are operated by our laboratory, and its data are used for our research work, too. We also operate real-time data acquisition system for satellite data, such as DSCOVR, STEREO, and routinely received high energy particle data from Himawari-8. Based on these data, we are monitoring current condition of geomagnetic disturbances, and that of radiation belt. Using these data, we have developed empirical models for relativistic electron flux at GEO and inner magnetosphere. To provide userfriendly information , we are trying to develop individual spacecraft anomaly risk estimation tool based on combining models of space weather and those of spacecraft charging, Current status of geospace monitoring, forecasting, and research activities are introduced.

Laparoscopic Pediatric Inguinal Hernia Repair: Overview of "True Herniotomy" Technique and Review of Current Evidence.

PubMed

Feehan, Brendan P; Fromm, David S

2017-05-01

Inguinal hernia repair is one of the most commonly performed operations in the pediatric population. While the majority of pediatric surgeons routinely use laparoscopy in their practices, a relatively small number prefer a laparoscopic inguinal hernia repair over the traditional open repair. This article provides an overview of the three port laparoscopic technique for inguinal hernia repair, as well as a review of the current evidence with respect to visualization and identification of hernias, recurrence rates, operative times, complication rates, postoperative pain, and cosmesis. The laparoscopic repair presents a viable alternative to open repair and offers a number of benefits over the traditional approach. These include superior visualization of the relevant anatomy, ability to assess and repair a contralateral hernia, lower rates of metachronous hernia, shorter operative times in bilateral hernia, and the potential for lower complication rates and improved cosmesis. This is accomplished without increasing recurrence rates or postoperative pain. Further research comparing the different approaches, including standardization of techniques and large randomized controlled trials, will be needed to definitively determine which is superior. Copyright© South Dakota State Medical Association.

Understanding Care Integration from the Ground Up: Five Organizing Constructs that Shape Integrated Practices.

PubMed

Cohen, Deborah J; Balasubramanian, Bijal A; Davis, Melinda; Hall, Jennifer; Gunn, Rose; Stange, Kurt C; Green, Larry A; Miller, William L; Crabtree, Benjamin F; England, Mary Jane; Clark, Khaya; Miller, Benjamin F

2015-01-01

To provide empirical evidence on key organizing constructs shaping practical, real-world integration of behavior health and primary care to comprehensively address patients' medical, emotional, and behavioral health needs. In a comparative case study using an immersion-crystallization approach, a multidisciplinary team analyzed data from observations of practice operations, interviews, and surveys of practice members, and implementation diaries. Practices were drawn from 2 studies of practices attempting to integrate behavioral health and primary care: Advancing Care Together, a demonstration project of 11 practices located in Colorado, and the Integration Workforce Study, a study of 8 practices across the United States. We identified 5 key organizing constructs influencing integration of primary care and behavioral health: 1) Integration REACH (the extent to which the integration program was delivered to the identified target population), 2) establishment of continuum of care pathways addressing the location of care across the range of patient's severity of illness, 3) approach to patient transitions: referrals or warm handoffs, 4) location of the integration workforce, and 5) participants' mental model for integration. These constructs intertwine within an organization's historic and social context to produce locally adapted approaches to integrating care. Contextual factors, particularly practice type, influenced whether specialty mental health and substance use services were colocated within an organization. Interaction among 5 organizing constructs and practice context produces diverse expressions of integrated care. These constructs provide a framework for understanding how primary care and behavioral health services can be integrated in routine practice. © Copyright 2015 by the American Board of Family Medicine.

Guidelines for Mountain Stream Relocations in North Carolina

DOT National Transportation Integrated Search

1979-03-01

Relocations of North Carolina's mountain trout streams traditionally have been : a routine practice during road construction. This practice has been extremely : destructive to the state's fishery, wildlife and recreational sources, because proper env...

Factors influencing how senior nurses and midwives acquire and integrate coaching skills into routine practice: a grounded theory study.

PubMed

Rafferty, Rae; Fairbrother, Greg

2015-06-01

To introduce a theory which describes the process of and explicates the factors moderating, the acquisition and integration of leadership coaching skills into the routine practice of senior nurses and midwives. Organizations invest significant resources in leadership coaching programs to ensure that coaching is embedded as a core function of the manager's role. However, even after training, many managers remain unable to undertake this role successfully. The process by which health professionals translate 'manager as coach' training into successful practice outcomes, has remained largely unexplored. A grounded theory study design. Data, collected between February 2012-May 2013, included in-depth interviews with 20 senior nurses and midwives who had attended a leadership coaching program and analysis of nine reflective practice journals. Multiple researchers coded and analysed the data using constant comparative techniques. The outcomes of coaching training ranged from inappropriate use of the coaching skills through to transformed managerial practice. These outcomes were influenced by the dynamic interaction of three central domains of the emergent theoretical model: pre-existing individual perceptions, program elements and contemporaneous experiences. Interactions occurred within the domains and between them, impacting on activators such as courage, motivation, commitment and confidence. The study offers new insights into how senior nurses and midwives acquire and integrate coaching skills into their routine practice. The process is described as multifactorial and dynamic and has implications for the training design, delivery and organizational support of future leadership coaching programs. © 2015 John Wiley & Sons Ltd.

A tool box for operational mosquito larval control: preliminary results and early lessons from the Urban Malaria Control Programme in Dar es Salaam, Tanzania

PubMed Central

Fillinger, Ulrike; Kannady, Khadija; William, George; Vanek, Michael J; Dongus, Stefan; Nyika, Dickson; Geissbühler, Yvonne; Chaki, Prosper P; Govella, Nico J; Mathenge, Evan M; Singer, Burton H; Mshinda, Hassan; Lindsay, Steven W; Tanner, Marcel; Mtasiwa, Deo; de Castro, Marcia C; Killeen, Gerry F

2008-01-01

Background As the population of Africa rapidly urbanizes, large populations could be protected from malaria by controlling aquatic stages of mosquitoes if cost-effective and scalable implementation systems can be designed. Methods A recently initiated Urban Malaria Control Programme in Dar es Salaam delegates responsibility for routine mosquito control and surveillance to modestly-paid community members, known as Community-Owned Resource Persons (CORPs). New vector surveillance, larviciding and management systems were designed and evaluated in 15 city wards to allow timely collection, interpretation and reaction to entomologic monitoring data using practical procedures that rely on minimal technology. After one year of baseline data collection, operational larviciding with Bacillus thuringiensis var. israelensis commenced in March 2006 in three selected wards. Results The procedures and staff management systems described greatly improved standards of larval surveillance relative to that reported at the outset of this programme. In the first year of the programme, over 65,000 potential Anopheles habitats were surveyed by 90 CORPs on a weekly basis. Reaction times to vector surveillance at observations were one day, week and month at ward, municipal and city levels, respectively. One year of community-based larviciding reduced transmission by the primary malaria vector, Anopheles gambiae s.l., by 31% (95% C.I. = 21.6–37.6%; p = 0.04). Conclusion This novel management, monitoring and evaluation system for implementing routine larviciding of malaria vectors in African cities has shown considerable potential for sustained, rapidly responsive, data-driven and affordable application. Nevertheless, the true programmatic value of larviciding in urban Africa can only be established through longer-term programmes which are stably financed and allow the operational teams and management infrastructures to mature by learning from experience. PMID:18218148

Telephone follow-up for cataract surgery: feasibility and patient satisfaction study.

PubMed

Hoffman, Jeremy J S L; Pelosini, Lucia

2016-05-09

Purpose - The purpose of this paper is to investigate the feasibility of telephone follow-up (TFU) after uncomplicated cataract surgery in low-risk patients and patient satisfaction with this alternative clinical pathway. Design/methodology/approach - Prospective, non-randomised cohort study. A ten-point subjective ophthalmic assessment questionnaire and a six-point patient satisfaction questionnaire were administered to patients following routine cataract surgery at two to three weeks post-procedure. All patients were offered a further clinic review if required. Exclusion criteria comprised ophthalmic co-morbidities, hearing/language impairment and high risk of post-operative complications. Patient notes were retrospectively reviewed over the study period to ensure no additional emergency attendances took place. Findings - Over three months, 50 eyes of 50 patients (mean age: 80; age range 60-91; 66 per cent second eye surgery) underwent uncomplicated phacoemulsification surgery received a TFU at 12-24 days (mean: 16 days) post-operatively. Subjective visual acuity was graded as good by 92 per cent of patients; 72 per cent patients reported no pain and 20 per cent reported mild occasional grittiness. Patient satisfaction was graded 8.9 out of 10; 81.6 per cent defined TFU as convenient and 75.5 per cent of patients preferred TFU to routine outpatient review. No additional visits were required. Research limitations/implications - Non-randomised with no control group; small sample size. One patient was unable to be contacted. Practical implications - Post-operative TFU can be suitably targeted to low-risk patients following uncomplicated cataract surgery. This study demonstrated a high patient satisfaction. A larger, randomised study is in progress to assess this further. Originality/value - This is the first study reporting TFU results and patient satisfaction to the usual alternative two-week outpatient review.

Innovative Telemonitoring System for Cardiology: From Science to Routine Operation

PubMed Central

Kastner, P.; Morak, J.; Modre, R.; Kollmann, A.; Ebner, C.; Fruhwald, FM.; Schreier, G.

2010-01-01

Objective Results of the Austrian MOBITEL (MOBIle phone based TELemonitoring for heart failure patients) trial indicate that home-based telemonitoring improves outcome of chronic heart failure (CHF) patients and reduces both frequency and duration of hospitalizations. Based on lessons learned, we assessed the weak points to clear the way for routine operations. Methods We analyzed the system with respect to recommendations of the ESC Guidelines and experiences gained throughout the trial to identify potential improvements. The following components have been identified: a patient terminal with highest usability, integrated way to document drug-intake and well-being, and automated event detection for worsening of CHF. As a consequence the system was extended by Near Field Communication (NFC) technology and by an event management tool. Results Usability evaluation with 30 adults (14f, median 51y. IQR[45-65]) showed that 21 (8f) were able to immediately operate the system after reading a step-by-step manual. Eight (6f) needed one time demonstration and one man (80y) failed to operate the blood pressure meter. Routine operation of the revised system started in March 2009. Within 9 months, 15 patients (4f, median 74y. IQR[71-83], all NYHA-III) transmitted 17,149 items. 43 events were detected because of body weight gain of more then 2kg within 2 days. 49 therapy adjustments were documented. Three patients stopped using the system, two (1f) because of non-compliance and one (m, 82y) because of death. Overall, the rate of adherence to daily data transfer was 78%. Conclusion First results confirm the applicability of the revised telemonitoring system in routine operation. PMID:23616835

Sarah's birth. How the medicalisation of childbirth may be shaped in different settings: Vignette from a study of routine intervention in Jeddah, Saudi Arabia.

PubMed

Scamell, Mandie; Altaweli, Roa; McCourt, Christine

2017-02-01

The expansion of the medicalisation of childbirth has been described in the literature as being a global phenomenon. The vignette described in this paper, selected from an ethnographic study of routine intervention in Saudi Arabian hospitals illustrates how the worldwide spread of the bio-medical model does not take place within a cultural vacuum. To illuminate the ways in which the medicalisation of birth may be understood and practised in different cultural settings, through a vignette of a specific birth, drawn as a typical case from an ethnographic study that investigated clinical decision-making in the second stage of labour in Saudi Arabia. Ethnographic data collection methods, including participant observation and interviews. The data presented in this paper are drawn from ethnographic field notes collected during field work in Saudi Arabia, and informed by analysis of a wider set of field notes and interviews with professionals working in this context. While the medicalisation of care is a universal phenomenon, the ways in which the care of women is managed using routine medical intervention are framed by the local cultural context in which these practices take place. The ethnographic data presented in this paper shows the medicalisation of birth thesis to be incomplete. The evidence presented in this paper illustrates how local belief systems are not so much subsumed by the expansion of the bio-medical model of childbirth, rather they may actively facilitate a process of localised reinterpretation of such universalised and standardised practices. In this case, aspects of the social and cultural context of Jeddah operates to intensify the biomedical model at the expense of respectful maternity care. In this article, field note data on the birth of one Saudi Arabian woman is used as an illustration of how the medicalisation of childbirth has been appropriated and reinterpreted in Jeddah, Saudi Arabia. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Researching routine immunization-do we know what we don't know?

PubMed

Clements, C John; Watkins, Margaret; de Quadros, Ciro; Biellik, Robin; Hadler, James; McFarland, Deborah; Steinglass, Robert; Luman, Elizabeth; Hennessey, Karen; Dietz, Vance

2011-11-03

The Expanded Programme on Immunization (EPI), launched in 1974, has developed and implemented a range of strategies and practices over the last three decades to ensure that children and adults receive the vaccines they need to help protect them against vaccine-preventable diseases. Many of these strategies have been implemented, resulting in immunization coverage exceeding 80% among children one year of age in many countries. Yet millions of infants remain under-immunized or unimmunized, particularly in poorer countries. In November 2009, a panel of external experts met at the United States Centers for Disease Control and Prevention (CDC) to review and identify areas of research required to strengthen routine service delivery in developing countries. Research opportunities were identified utilizing presentations emphasizing existing research, gaps in knowledge and key questions. Panel members prioritized the topics, as did other meeting participants. Several hundred research topics covering a wide range were identified by the panel members and participants. However there were relatively few topics for which there was a consensus that immediate investment in research is warranted. The panel identified 28 topics as priorities. 18 topics were identified as priorities by at least 50% of non-panel participants; of these, five were also identified as priorities by the panel. Research needs included identifying the best ways to increase coverage with existing vaccines and introduce new vaccines, integrate other services with immunizations, and finance immunization programmes. There is an enormous range of research that could be undertaken to support routine immunization. However, implementation of strategic plans, rather than additional research will have the greatest impact on raising immunization coverage and preventing disease, disability, and death from vaccine-preventable diseases. The panel emphasized the importance of tying operational research to programmatic needs, with a focus on efforts to scale up proven best practices in each country, facilitating the full implementation of immunization strategies. Copyright © 2011. Published by Elsevier Ltd.. All rights reserved.

Impact of routine episodic emissions on the expected frequency distribution of emissions from oil and gas production sources.

NASA Astrophysics Data System (ADS)

Smith, N.; Blewitt, D.; Hebert, L. B.

2015-12-01

In coordination with oil and gas operators, we developed a high resolution (< 1 min) simulation of temporal variability in well-pad oil and gas emissions over a year. We include routine emissions from condensate tanks, dehydrators, pneumatic devices, fugitive leaks and liquids unloading. We explore the variability in natural gas emissions from these individual well-pad sources, and find that routine short-term episodic emissions such as tank flashing and liquids unloading result in the appearance of a skewed, or 'fat-tail' distribution of emissions, from an individual well-pad over time. Additionally, we explore the expected variability in emissions from multiple wells with different raw gas composition, gas/liquids production volumes and control equipment. Differences in well-level composition, production volume and control equipment translate into differences in well-level emissions leading to a fat-tail distribution of emissions in the absence of operational upsets. Our results have several implications for recent studies focusing on emissions from oil and gas sources. Time scale of emission estimates are important and have important policy implications. Fat tail distributions may not be entirely driven by avoidable mechanical failures, and are expected to occur under routine operational conditions from short-duration emissions (e.g., tank flashing, liquid unloading). An understanding of the expected distribution of emissions for a particular population of wells is necessary to evaluate whether the observed distribution is more skewed than expected. Temporal variability in well-pad emissions make comparisons to annual average emissions inventories difficult and may complicate the interpretation of long-term ambient fenceline monitoring data. Sophisticated change detection algorithms will be necessary to identify when true operational upsets occur versus routine short-term emissions.

Breast self-examination: resistance to change.

PubMed

Del Giudice, M Elisabeth; Tannenbaum, David; Goodwin, Pamela J

2005-05-01

To investigate whether Canadian family practitioners routinely teach breast self-examination (BSE) after publication of the 2001 Canadian Preventive Health Task Force guideline advising them to exclude teaching BSE from periodic health examinations. Self-administered cross-sectional mailed survey. Canada. A random sample of English-speaking general practitioners and physicians certified by the College of Family Physicians of Canada. Current and past BSE practices and opinions on the value of BSE. Response rate was 47.4%. Most respondents (88%) were aware of the new recommendations, yet only 16% had changed their usual practice of routinely teaching BSE. Most physicians agreed that before the recommendation they almost always taught BSE (74.3%). Only 9.5% agreed that physicians should follow the recommendation and not routinely teach BSE. A few also agreed that they now spend less time discussing BSE (25.7%) and that the recommendation has influenced them to stop teaching (12.4%) and encouraging (12.9%) women to practise BSE. Physicians who had changed their BSE practices were less likely to agree that BSE increases early detection of breast cancer and more likely to agree that BSE increases benign breast biopsies. They were also more likely to agree that screening mammography in women older than 50 decreases mortality from breast cancer. This survey, which assessed routine teaching of BSE, revealed poor adherence by Canadian family physicians to a well publicized evidence-based guideline update. Resistance to change could in part be attributed to a lack of knowledge of the supporting evidence, a lack of confidence in the evidence to date, and personal experiences with patients within their practices.

A mixed methods approach to adapting health-related quality of life measures for use in routine oncology clinical practice.

PubMed

Harley, Clare; Takeuchi, Elena; Taylor, Sally; Keding, Ada; Absolom, Kate; Brown, Julia; Velikova, Galina

2012-04-01

The current study reviewed and adapted existing health-related quality of life (HRQoL) instruments for use in routine clinical practice delivering outpatient chemotherapy for colorectal, breast and gynaecological cancers. 564 (288 gynaecological, 208 breast and 68 colorectal) outpatient consultations of 141 patients were audio-recorded and analysed to identify discussed issues. Issues were ranked from most to least commonly discussed within each disease group. Existing HRQoL instruments were evaluated against these lists and best fitting items entered into cancer-specific item banks. Item banks were evaluated during semi-structured interviews by twenty-one oncologists (13 consultants and 8 specialist registrars), four clinical nurse specialists and thirty patients, from breast, gynaecological and colorectal cancer practices. Pilot questionnaires were completed by 448 (145 breast, 148 gynaecological and 155 colorectal) patients attending outpatient clinics. Item selection and scale reliability was explored using descriptive data and psychometric methods alongside qualitative patient and clinician ratings. Each questionnaire includes five physical and three psychosocial function scales each with good internal consistency reliability (α > 0.70) plus disease-specific individual-symptom items identified as useful in clinical practice. Three cancer-specific health-related quality of life measures were developed for use in routine clinical practice. Initial analyses suggest good clinical utility and acceptable psychometric properties for the new instruments.

Infection Prophylaxis in Peritoneal Dialysis Patients: Results from an Australia/New Zealand Survey.

PubMed

Campbell, Denise J; Mudge, David W; Gallagher, Martin P; Lim, Wai Hon; Ranganathan, Dwaraka; Saweirs, Walaa; Craig, Jonathan C

2017-01-01

♦ BACKGROUND: Clinical practice guidelines aim to reduce the rates of peritoneal dialysis (PD)-related infections, a common complication of PD in end-stage kidney disease patients. We describe the clinical practices used by Australian and New Zealand nephrologists to prevent PD-related infections in PD patients. ♦ METHODS: A survey of PD practices in relation to the use of antibiotic and antifungal prophylaxis in PD patients was conducted of practicing nephrologists identified via the Australia and New Zealand Society of Nephrology (ANZSN) membership in 2013. ♦ RESULTS: Of 333 nephrologists approached, 133 (39.9%) participated. Overall, 127 (95.5%) nephrologists prescribed antibiotics at the time of Tenckhoff catheter insertion, 85 (63.9%) routinely screened for nasal S. aureus carriage, with 76 (88.4%) reporting they treated S. aureus carriers with mupirocin ointment. Following Tenckhoff catheter insertion, 79 (59.4%) prescribed mupirocin ointment at the exit site or intranasally, and 93 (69.9%) nephrologists routinely prescribed a course of oral antifungal agent whenever their PD patients were given a course of antibiotics. ♦ CONCLUSIONS: Although the majority of nephrologists prescribe antibiotics at the time of Tenckhoff catheter insertion, less than 70% routinely prescribe mupirocin ointment and/or prophylactic antifungal therapy. This variation in practice in Australia and New Zealand may contribute to the disparity in PD-related infection rates that is seen between units. Copyright © 2017 International Society for Peritoneal Dialysis.

Current practice of usual clinic blood pressure measurement in people with and without diabetes: a survey and prospective 'mystery shopper' study in UK primary care.

PubMed

Stevens, Sarah L; McManus, Richard J; Stevens, Richard John

2018-04-12

Hypertension trials and epidemiological studies use multiple clinic blood pressure (BP) measurements at each visit. Repeat measurement is also recommended in international guidance; however, little is known about how BP is measured routinely. This is important for individual patient management and because routinely recorded readings form part of research databases. We aimed to determine the current practice of BP measurement during routine general practice appointments. (1) An online cross-sectional survey and (2) a prospective 'mystery shopper' study where patients agreed to report how BP was measured during their next appointment. Primary care. Patient charity/involvement group members completing an online survey between July 2015 and January 2016. 334 participants completed the prospective study (51.5% male, mean age=59.3 years) of which 279 (83.5%) had diabetes. Proportion of patients having BP measured according to guidelines. 217 participants with (183) and without diabetes (34) had their BP measured at their last appointment. BP was measured in line with UK guidance in 63.7% and 60.0% of participants with and without diabetes, respectively. Initial pressures were significantly higher in those who had their BP measured more than once compared with only once (p=0.016/0.089 systolic and p<0.001/p=0.022 diastolic, in patients with/without diabetes, respectively). Current practice of routine BP measurement in UK primary care is often concordant with guidelines for repeat measurement. Further studies are required to confirm findings in broader populations, to confirm when a third repeat reading is obtained routinely and to assess adherence to other aspects of BP measurement guidance. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

NASA UAS Update

NASA Technical Reports Server (NTRS)

Bauer, Jeffrey Ervin; Mulac, Brenda Lynn

2010-01-01

Last year may prove to be a pivotal year for the National Aeronautics and Space Administration (NASA) in the Unmanned Aircraft Systems (UAS) arena, especially in relation to routine UAS access to airspace as NASA accepted an invitation to join the UAS Executive Committee (UAS ExCom). The UAS ExCom is a multi-agency, Federal executive-level committee comprised of the Federal Aviation Administration (FAA), Department of Defense (DoD), Department of Homeland Security (DHS), and NASA with the goals to: 1) Coordinate and align efforts between key Federal Government agencies to achieve routine safe federal public UAS operations in the National Airspace System (NAS); 2) Coordinate and prioritize technical, procedural, regulatory, and policy solutions needed to deliver incremental capabilities; 3) Develop a plan to accommodate the larger stakeholder community at the appropriate time; and 4) Resolve conflicts between Federal Government agencies (FAA, DoD, DHS, and NASA), related to the above goals. The committee was formed in recognition of the need of UAS operated by these agencies to access to the National Airspace System (NAS) to support operational, training, development and research requirements. In order to meet that need, technical, procedural, regulatory, and policy solutions are required to deliver incremental capabilities leading to routine access. The formation of the UAS ExCom is significant in that it represents a tangible commitment by FAA senior leadership to address the UAS access challenge. While the focus of the ExCom is government owned and operated UAS, civil UAS operations are bound to benefit by the progress made in achieving routine access for government UAS. As the UAS ExCom was forming, NASA's Aeronautics Research Mission Directorate began to show renewed interest in UAS, particularly in relation to the future state of the air transportation system under the Next Generation Air Transportation System (NextGen). NASA made funding from the American Recovery and Revitalization Act available in order to continue addressing the issue of routine civil UAS access.

40 CFR 792.63 - Maintenance and calibration of equipment.

Code of Federal Regulations, 2012 CFR

2012-07-01

... standardized. (b) The written standard operating procedures required under § 792.81(b)(11) shall set forth in... maintenance operations were routine and followed the written standard operating procedures. Written records... operating procedures shall designate the person responsible for the performance of each operation. (c...

40 CFR 792.63 - Maintenance and calibration of equipment.

Code of Federal Regulations, 2011 CFR

2011-07-01

... standardized. (b) The written standard operating procedures required under § 792.81(b)(11) shall set forth in... maintenance operations were routine and followed the written standard operating procedures. Written records... operating procedures shall designate the person responsible for the performance of each operation. (c...

21 CFR 58.63 - Maintenance and calibration of equipment.

Code of Federal Regulations, 2013 CFR

2013-04-01

... standardized. (b) The written standard operating procedures required under § 58.81(b)(11) shall set forth in... maintenance operations were routine and followed the written standard operating procedures. Written records... operating procedures shall designate the person responsible for the performance of each operation. (c...

40 CFR 792.63 - Maintenance and calibration of equipment.

Code of Federal Regulations, 2010 CFR

2010-07-01

... standardized. (b) The written standard operating procedures required under § 792.81(b)(11) shall set forth in... maintenance operations were routine and followed the written standard operating procedures. Written records... operating procedures shall designate the person responsible for the performance of each operation. (c...

21 CFR 58.63 - Maintenance and calibration of equipment.

Code of Federal Regulations, 2011 CFR

2011-04-01

... standardized. (b) The written standard operating procedures required under § 58.81(b)(11) shall set forth in... maintenance operations were routine and followed the written standard operating procedures. Written records... operating procedures shall designate the person responsible for the performance of each operation. (c...

21 CFR 58.63 - Maintenance and calibration of equipment.

Code of Federal Regulations, 2012 CFR

2012-04-01

... standardized. (b) The written standard operating procedures required under § 58.81(b)(11) shall set forth in... maintenance operations were routine and followed the written standard operating procedures. Written records... operating procedures shall designate the person responsible for the performance of each operation. (c...

21 CFR 58.63 - Maintenance and calibration of equipment.

Code of Federal Regulations, 2014 CFR

2014-04-01

... standardized. (b) The written standard operating procedures required under § 58.81(b)(11) shall set forth in... maintenance operations were routine and followed the written standard operating procedures. Written records... operating procedures shall designate the person responsible for the performance of each operation. (c...

40 CFR 792.63 - Maintenance and calibration of equipment.

Code of Federal Regulations, 2013 CFR

2013-07-01

... standardized. (b) The written standard operating procedures required under § 792.81(b)(11) shall set forth in... maintenance operations were routine and followed the written standard operating procedures. Written records... operating procedures shall designate the person responsible for the performance of each operation. (c...

40 CFR 792.63 - Maintenance and calibration of equipment.

Code of Federal Regulations, 2014 CFR

2014-07-01

... standardized. (b) The written standard operating procedures required under § 792.81(b)(11) shall set forth in... maintenance operations were routine and followed the written standard operating procedures. Written records... operating procedures shall designate the person responsible for the performance of each operation. (c...

21 CFR 58.63 - Maintenance and calibration of equipment.

Code of Federal Regulations, 2010 CFR

2010-04-01

... standardized. (b) The written standard operating procedures required under § 58.81(b)(11) shall set forth in... maintenance operations were routine and followed the written standard operating procedures. Written records... operating procedures shall designate the person responsible for the performance of each operation. (c...

Assessment of physician performance in Alberta: the Physician Achievement Review

PubMed Central

Hall, W; Violato, C; Lewkonia, R; Lockyer, J; Fidler, H; Toews, J; Jennett, P; Donoff, M; Moores, D

1999-01-01

The College of Physicians and Surgeons of Alberta, in collaboration with the Universities of Calgary and Alberta, has developed a program to routinely assess the performance of physicians, intended primarily for quality improvement in medical practice. The Physician Achievement Review (PAR) provides a multidimensional view of performance through structured feedback to physicians. The program will also provide a new mechanism for identifying physicians for whom more detailed assessment of practice performance or medical competence may be needed. Questionnaires were created to assess an array of performance attributes, and then appropriate assessors were designated--the physician himself or herself (self-evaluation), patients, medical peers, consultants and referring physicians, and non-physician coworkers. A pilot study with 308 physician volunteers was used to evaluate the psychometric and statistical properties of the questionnaires and to develop operating policies. The pilot surveys showed good statistical validity and technical reliability of the PAR questionnaires. For only 28 (9.1%) of the physicians were the PAR results more than one standard deviation from the peer group means for 3 or more of the 5 major domains of assessment (self, patients, peers, consultants and coworkers). In post-survey feedback, two-thirds of the physicians indicated that they were considering or had implemented changes to their medical practice on the basis of their PAR data. The estimated operating cost of the PAR program is approximately $200 per physician. In February 1999, on the basis of the operating experience and the results of the pilot survey, the College of Physicians and Surgeons of Alberta implemented this innovative program, in which all Alberta physicians will be required to participate every 5 years. PMID:10420867

Goal setting practice in services delivering community-based stroke rehabilitation: a United Kingdom (UK) wide survey.

PubMed

Scobbie, Lesley; Duncan, Edward A; Brady, Marian C; Wyke, Sally

2015-01-01

We investigated the nature of services providing community-based stroke rehabilitation across the UK, and goal setting practice used within them, to inform evaluation of a goal setting and action planning (G-AP) framework. We designed, piloted and electronically distributed a survey to health professionals working in community-based stroke rehabilitation settings across the UK. We optimised recruitment using a multi-faceted strategy. Responses were analysed from 437 services. Services size, composition and input was highly variable; however, most were multi-disciplinary (82%; n = 335/407) and provided input to a mixed diagnostic group of patients (71%; n = 312/437). Ninety one percent of services (n = 358/395) reported setting goals with "all" or "most" stroke survivors. Seventeen percent (n = 65/380) reported that no methods were used to guide goal setting practice; 47% (n = 148/315) reported use of informal methods only. Goal setting practice varied, e.g. 98% of services (n = 362/369) reported routinely asking patients about goal priorities; 39% (n = 141/360) reported routinely providing patients with a copy of their goals. Goal setting is embedded within community-based stroke rehabilitation; however, practice varies and is potentially sub-optimal. Further evaluation of the G-AP framework is warranted to inform optimal practice. Evaluation design will take account of the diverse service models that exist. Implications for Rehabilitation Community-based stroke rehabilitation services across the UK are diverse and tend to see a mixed diagnostic group of patients. Goal setting is implemented routinely within community-based stroke rehabilitation services; however, practice is variable and potentially sub-optimal. Further evaluation of the G-AP framework is warranted to assess its effectiveness in practice.

Physical Examination for the Academic Psychiatrist: Primer and Common Clinical Scenarios.

PubMed

Azzam, Pierre N; Gopalan, Priya; Brown, Jennifer R; Aquino, Patrick R

2016-04-01

As clinical psychiatry has evolved to mirror the patient care model followed in other medical specialties, psychiatrists are called upon increasingly to utilize general medical skills in routine practice. Psychiatrists who practice in academic settings are often required to generate broad differential diagnoses that include medical and neurologic conditions and, as a result, benefit from incorporating physical examination into their psychiatric assessments. Physical examination allows psychiatrists to follow and to teach patient-informed clinical practices and comprehensive treatment approaches. In this commentary, the authors encourage routine use of a targeted physical examination and outline common scenarios in which physical examination would be useful for the academic psychiatrist: delirium, toxidromes, and unexplained medical conditions (e.g., somatic symptom disorders).

40 CFR 63.9000 - What emission limitations and work practice standards must I meet?

Code of Federal Regulations, 2010 CFR

2010-07-01

... of Hazardous Waste in Boilers and Industrial Furnaces. (d) The emission limits for HCl storage tanks in table 1 to this subpart do not apply during periods of planned routine maintenance of HCl storage tank control devices. Periods of planned routine maintenance of each HCl storage tank control device...

Evaluation of Sludge Pump Clogging Issue for an Industrial Waste Pretreatment Plant in the Ceres Industrial Park, Vicksburg, MS

DTIC Science & Technology

2018-04-30

operating issue was that the sludge pump routinely clogs. The system operator, Mr. Vick Hasie, was available to answer questions. The ERDC team also...reason for this is that the tank may contain sludge buildup, and at seven feet, entrainment of this sludge could occur. The ERDC team did not review...this time. However, this is cumbersome and potentially dangerous as a routine method since the equalization tank is very high (estimated around 30

40 CFR 63.548 - Monitoring requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

...) You must prepare, and at all times operate according to, a standard operating procedures manual that...) You must submit the standard operating procedures manual for baghouses required by paragraph (a) of... that you specify in the standard operating procedures manual for inspections and routine maintenance...

40 CFR 63.548 - Monitoring requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

...) You must prepare, and at all times operate according to, a standard operating procedures manual that...) You must submit the standard operating procedures manual for baghouses required by paragraph (a) of... that you specify in the standard operating procedures manual for inspections and routine maintenance...

40 CFR 63.548 - Monitoring requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

...) You must prepare, and at all times operate according to, a standard operating procedures manual that...) You must submit the standard operating procedures manual for baghouses required by paragraph (a) of... that you specify in the standard operating procedures manual for inspections and routine maintenance...

Physicians slow to e-mail routinely with patients.

PubMed

Boukus, Ellyn R; Grossman, Joy M; O'Malley, Ann S

2010-10-01

Some experts view e-mail between physicians and patients as a potential tool to improve physician-patient communication and, ultimately, patient care. Despite indications that many patients want to e-mail their physicians, physician adoption and use of e-mail with patients remains uncommon--only 6.7 percent of office-based physicians routinely e-mailed patients in 2008, according to a new national study from the Center for Studying Health System Change (HSC). Overall, about one-third of office-based physicians reported that information technology (IT) was available in their practice for e-mailing patients about clinical issues. Of those, fewer than one in five reported using e-mail with patients routinely; the remaining physicians were roughly evenly split between occasional users and non-users. Physicians in practices with access to electronic medical records and those working in health maintenance organizations (HMOs) or medical school settings were more likely to adopt and use e-mail to communicate with patients compared with other physicians. However, even among the highest users--physicians in group/staff-model HMOs--only 50.6 percent reported routinely e-mailing patients.

The Body of the Text: Literacy's Corporeal Constant.

ERIC Educational Resources Information Center

Marvin, Carolyn

1994-01-01

Considers the role of bodily routines and practices as a component in the study of literacy. Examines a practice by physicians in the late 19th and early 20th centuries of binding fine or rare texts in human skin. Relates this embodied literacy practice to the transformation of medical practice from an oral to a textual discipline. (SR)

Bridging the Research-to-Practice Gap: A Review of the Literature Focusing on Inclusive Education

ERIC Educational Resources Information Center

Grima-Farrell, Christine R.; Bain, Alan; McDonagh, Sarah H.

2011-01-01

Despite advances in our knowledge of evidence-based inclusive educational practice, much of this knowledge does not reach routine classroom practice. There remains a significant gap between our accumulated knowledge about what can work in classrooms and the extent to which evidence-based practice is used in sustainable ways. This inability to…

What can the treatment of Parkinson's disease learn from dementia care; applying a bio-psycho-social approach to Parkinson's disease.

PubMed

Gibson, Grant

2017-12-01

Within contemporary medical practice, Parkinson's disease (PD) is treated using a biomedical, neurological approach, which although bringing numerous benefits can struggle to engage with how people with PD experience the disease. A bio-psycho-social approach has not yet been established in PD; however, bio-psycho-social approaches adopted within dementia care practice could bring significant benefit to PD care. This paper summarises existing bio-psycho-social models of dementia care and explores how these models could also usefully be applied to care for PD. Specifically, this paper adapts the bio-psycho-social model for dementia developed by Spector and Orrell (), to suggest a bio-psycho-social model, which could be used to inform routine care in PD. Drawing on the biopsychosocial model of Dementia put forward by Spector and Orrell (), this paper explores the application of a bio-psycho-social model of PD. This model conceptualises PD as a trajectory, in which several interrelated fixed and tractable factors influence both PD's symptomology and the various biological and psychosocial challenges individuals will face as their disease progresses. Using an individual case study, this paper then illustrates how such a model can assist clinicians in identifying suitable interventions for people living with PD. This model concludes by discussing how a bio-psycho-social model could be used as a tool in PD's routine care. The model also encourages the development of a theoretical and practical framework for the future development of the role of the PD specialist nurse within routine practice. A biopsychosocial approach to Parkinson's Disease provides an opportunity to move towards a holistic model of care practice which addresses a wider range of factors affecting people living with PD. The paper puts forward a framework through which PD care practice can move towards a biopsychosocial perspective. PD specialist nurses are particularly well placed to adopt such a model within routine clinical practice, and should therefore be encouraged within PD services. © 2017 John Wiley & Sons Ltd.

"Control Must Be Maintained": Exploring Teachers' Pedagogical Practice outside the Classroom

ERIC Educational Resources Information Center

Glackin, Melissa

2018-01-01

Drawing on qualitative data, this article presents an analysis of six secondary science teachers' expectations and practices related to teaching outdoors during a professional development programme. Using Foucault's and Bernstein's theories of "space", routines and set practices, I argue that participant teachers' fear of losing control…

Adapted PBL Practical Exercises: Benefits for Apprentices

ERIC Educational Resources Information Center

Monks, Alan

2010-01-01

Use was made of adapted problem-based learning (PBL) practical exercises to address the disengagement of apprentices with the existing assembly-style electronic laboratory programme. Apprentices perceived the traditional routines as having little real-world relevance. This detracted from the value and benefit to them of the practical component of…

Towards the system-wide implementation of the International Classification of Functioning, Disability and Health in routine practice: Lessons from a pilot study in China.

PubMed

Li, Jianan; Prodinger, Birgit; Reinhardt, Jan D; Stucki, Gerold

2016-06-13

In 2011 the Chinese leadership in rehabilitation, in collaboration with the International Classification of Functioning, Disability and Health (ICF) Research Branch, embarked on an effort towards the system-wide implementation of the ICF in the healthcare system in China. We report here on the lessons learned from the pilot phase of testing the ICF Generic Set, a parsimonious set of 7 ICF categories, which have been shown to best describe functioning across the general population and people with various health conditions, for use in routine clinical practice in China. The paper discusses whether classification and measurement are compatible, what number of ICF categories should be included in data collection in routine practice, and the usefulness of a functioning profile and functioning score in clinical practice and health research planning. In addition, the paper reflects on the use of ICF qualifiers in a rating scale and the particularities of certain ICF categories contained in the ICF Generic Set when used as items in the context of Chinese rehabilitation and healthcare. Finally, the steps required to enhance the utility of system-wide implementation of the ICF in rehabilitation and healthcare services are set out.

Community-based telemonitoring for hypertension management: practical challenges and potential solutions.

PubMed

Hovey, Lauren; Kaylor, Mary Beth; Alwan, Majd; Resnick, Helaine E

2011-10-01

Older adults residing in rural areas often lack convenient, patient-centered, community-based approaches to facilitate receipt of routine care to manage common chronic conditions. Without adequate access to appropriate disease management resources, the risk of seniors' experiencing acute events related to these common conditions increases substantially. Further, poorly managed chronic conditions are costly and place seniors at increased risk of institutionalization and permanent loss of independence. Novel, telehealth-based approaches to management of common chronic conditions like hypertension may not only improve the health of older adults, but may also lead to substantial cost savings associated with acute care episodes and institutionalization. The aim of this report is to summarize practical considerations related to operations and logistics of a unique community-based telemonitoring pilot study targeting rural seniors who utilize community-based senior centers. This article reviews the technological challenges encountered during the study and proposes solutions relevant to future research and implementation of telehealth in community-based, congregate settings.

Improvements in sparse matrix operations of NASTRAN

NASA Technical Reports Server (NTRS)

Harano, S.

1980-01-01

A "nontransmit" packing routine was added to NASTRAN to allow matrix data to be refered to directly from the input/output buffer. Use of the packing routine permits various routines for matrix handling to perform a direct reference to the input/output buffer if data addresses have once been received. The packing routine offers a buffer by buffer backspace feature for efficient backspacing in sequential access. Unlike a conventional backspacing that needs twice back record for a single read of one record (one column), this feature omits overlapping of READ operation and back record. It eliminates the necessity of writing, in decomposition of a symmetric matrix, of a portion of the matrix to its upper triangular matrix from the last to the first columns of the symmetric matrix, thus saving time for generating the upper triangular matrix. Only a lower triangular matrix must be written onto the secondary storage device, bringing 10 to 30% reduction in use of the disk space of the storage device.

Icing Frequencies Experienced During Climb and Descent by Fighter-Interceptor Aircraft

NASA Technical Reports Server (NTRS)

Perkins, Porter J.

1958-01-01

Data and analyses are presented on the relative frequencies of occurrence and severity of icing cloud layers encountered by jet aircraft in the climb and descent phases of flights to high altitudes. Fighter-interceptor aircraft operated by the Air Defense Command (USAF) at bases in the Duluth and Seattle areas collected the data with icing meters installed for a l-year period. The project was part of an extensive program conducted by the NACA to collect Icing cloud data for evaluating the icing problem relevant to routine operations. The average frequency of occurrence of icing was found to be about 5 percent of the number of climbs and descents during 1 year of operations The icing encounters were predominantly in the low and middle cloud layers, decreasing above 15,000 feet to practically none above 25,000 feet. The greatest thickness of ice that would accumulate on any aircraft component (as indicated by the accretion on a small object) was measured with the icing meters. The ice thicknesses on a small sensing probe averaged less than 1/32 inch and did not exceed 1/2 inch. Such accumulations are relatively small when compared with those that can form during horizontal flight in icing clouds. The light accretions resulted from relatively steep angles of flight through generally thin cloud layers. Because of the limited statistical reliability of the results, an analysis was made using previous statistics on icing clouds below an altitude of 20,000 feet to determine the general icing severity probabilities. The calculations were made using adiabatic lifting as a basis to establish the liquid-water content. Probabilities of over-all ice accretions on a small object as a function of airspeed and rate of climb were computed from the derived water contents. These results were then combined with the probability of occurrence of icing in order to give the icing severity that can be expected for routine aircraft operations.

Design of a receiver operating characteristic (ROC) study of 10:1 lossy image compression

NASA Astrophysics Data System (ADS)

Collins, Cary A.; Lane, David; Frank, Mark S.; Hardy, Michael E.; Haynor, David R.; Smith, Donald V.; Parker, James E.; Bender, Gregory N.; Kim, Yongmin

1994-04-01

The digital archiving system at Madigan Army Medical Center (MAMC) uses a 10:1 lossy data compression algorithm for most forms of computed radiography. A systematic study on the potential effect of lossy image compression on patient care has been initiated with a series of studies focused on specific diagnostic tasks. The studies are based upon the receiver operating characteristic (ROC) method of analysis for diagnostic systems. The null hypothesis is that observer performance with approximately 10:1 compressed and decompressed images is not different from using original, uncompressed images for detecting subtle pathologic findings seen on computed radiographs of bone, chest, or abdomen, when viewed on a high-resolution monitor. Our design involves collecting cases from eight pathologic categories. Truth is determined by committee using confirmatory studies performed during routine clinical practice whenever possible. Software has been developed to aid in case collection and to allow reading of the cases for the study using stand-alone Siemens Litebox workstations. Data analysis uses two methods, ROC analysis and free-response ROC (FROC) methods. This study will be one of the largest ROC/FROC studies of its kind and could benefit clinical radiology practice using PACS technology. The study design and results from a pilot FROC study are presented.

Appropriate kidney stone size for ureteroscopic lithotripsy: When to switch to a percutaneous approach

PubMed Central

Takazawa, Ryoji; Kitayama, Sachi; Tsujii, Toshihiko

2015-01-01

Flexible ureteroscopy (fURS) has become a more effective and safer treatment for whole upper urinary tract stones. Percutaneous nephrolithotomy (PNL) is currently the first-line recommended treatment for large kidney stones ≥ 20 mm and it has an excellent stone-free rate for large kidney stones. However, its invasiveness is not negligible considering its major complication rates. Staged fURS is a practical treatment for such large kidney stones because fURS has a minimal blood transfusion risk, short hospitalization and few restrictions on daily routines. However, as the stone size becomes larger, the stone-free rate decreases, and the number of operations required increases. Therefore, in our opinion, staged fURS is a practical option for kidney stones 20 to 40 mm. Miniaturized PNL combined with fURS should be considered to be a preferred option for stones larger than 40 mm. Moreover, URS is an effective treatment for multiple upper urinary tract stones. Especially for patients with a stone burden < 20 mm, URS is a favorable option that promises a high stone-free rate after a single session either unilaterally or bilaterally. However, for patients with a stone burden ≥ 20 mm, a staged operation should be considered to achieve stone-free status. PMID:25664253

Operational research in malawi: making a difference with cotrimoxazole preventive therapy in patients with tuberculosis and HIV

PubMed Central

2011-01-01

Background In Malawi, high case fatality rates in patients with tuberculosis, who were also co-infected with HIV, and high early death rates in people living with HIV during the initiation of antiretroviral treatment (ART) adversely impacted on treatment outcomes for the national tuberculosis and ART programmes respectively. This article i) discusses the operational research that was conducted in the country on cotrimoxazole preventive therapy, ii) outlines the steps that were taken to translate these findings into national policy and practice, iii) shows how the implementation of cotrimoxazole preventive therapy for both TB patients and HIV-infected patients starting ART was associated with reduced death rates, and iv) highlights lessons that can be learnt for other settings and interventions. Discussion District and facility-based operational research was undertaken between 1999 and 2005 to assess the effectiveness of cotrimoxazole preventive therapy in reducing death rates in TB patients and subsequently in patients starting ART under routine programme conditions. Studies demonstrated significant reductions in case fatality in HIV-infected TB patients receiving cotrimoxazole and in HIV-infected patients about to start ART. Following the completion of research, the findings were rapidly disseminated nationally at stakeholder meetings convened by the Ministry of Health and internationally through conferences and peer-reviewed scientific publications. The Ministry of Health made policy changes based on the available evidence, following which there was countrywide distribution of the updated policy and guidelines. Policy was rapidly moved to practice with the development of monitoring tools, drug procurement and training packages. National programme performance improved which showed a significant decrease in case fatality rates in TB patients as well as a reduction in early death in people with HIV starting ART. Summary Key lessons for moving this research endeavour through to policy and practice were the importance of placing operational research within the programme, defining relevant questions, obtaining "buy-in" from national programme staff at the beginning of projects and having key actors or "policy entrepreneurs" to push forward the policy-making process. Ultimately, any change in policy and practice has to benefit patients, and the ultimate judge of success is whether treatment outcomes improve or not. PMID:21794154

Reaping the space investment. [Shuttle era geosynchronous satellite based technological trends

NASA Technical Reports Server (NTRS)

Calio, A. J.

1979-01-01

By 1999 operational space systems will be implemented routinely on a worldwide scale in many areas vital to human survival and life quality. Geosynchronous-based monitoring and observation will be extensively used. The Shuttle era will bring in the capability to allow monitoring and identifying pollution sources which fail to stay within required limits. Remotely sensed data over land masses will provide needed facts on renewable and nonrenewable earth resources. New instruments and techniques will have been developed to provide geologists with clues to the declining number of deposits of fuels and minerals. Also, practical methods for predicting earthquakes will have been elaborated by 1999. Communications will see implementation of many of the technological goals of 1978.

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

Heaney, Libby; Jaksch, Dieter; Centre for Quantum Technologies, National University of Singapore

Proposals for Bell-inequality tests on systems restricted by the particle-number-superselection rule often require operations that are difficult to implement in practice. In this article, we derive a Bell inequality, where measurements on pairs of states are used as a method to bypass this superselection rule. In particular, we focus on mode entanglement of an arbitrary number of massive particles and show that our Bell inequality detects the entanglement in an identical pair of states when other inequalities fail. However, as the number of particles in the system increases, the violation of our Bell inequality decreases due to the restriction inmore » the measurement space caused by the superselection rule. This Bell test can be implemented using techniques that are routinely used in current experiments.« less

30 CFR 250.601 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... OPERATIONS IN THE OUTER CONTINENTAL SHELF Oil and Gas Well-Workover Operations § 250.601 Definitions. When... expected surface pressure, you must consider reservoir pressure as well as applied surface pressure. Routine operations mean any of the following operations conducted on a well with the tree installed: (a...

A problem-solving routine for improving hospital operations.

PubMed

Ghosh, Manimay; Sobek Ii, Durward K

2015-01-01

The purpose of this paper is to examine empirically why a systematic problem-solving routine can play an important role in the process improvement efforts of hospitals. Data on 18 process improvement cases were collected through semi-structured interviews, reports and other documents, and artifacts associated with the cases. The data were analyzed using a grounded theory approach. Adherence to all the steps of the problem-solving routine correlated to greater degrees of improvement across the sample. Analysis resulted in two models. The first partially explains why hospital workers tended to enact short-term solutions when faced with process-related problems; and tended not seek longer-term solutions that prevent problems from recurring. The second model highlights a set of self-reinforcing behaviors that are more likely to address problem recurrence and result in sustained process improvement. The study was conducted in one hospital setting. Hospital managers can improve patient care and increase operational efficiency by adopting and diffusing problem-solving routines that embody three key characteristics. This paper offers new insights on why caregivers adopt short-term approaches to problem solving. Three characteristics of an effective problem-solving routine in a healthcare setting are proposed.

Web-based learning resources - new opportunities for competency development.

PubMed

Moen, Anne; Nygård, Kathrine A; Gauperaa, Torunn

2009-01-01

Creating web-based learning environments holds great promise for on the job training and competence development in nursing. The web-based learning environment was designed and customized by four professional development nurses. We interviewed five RNs that pilot tested the web-based resource. Our findings give some insight into how the web-based design tool are perceived and utilized, and how content is represented in the learning environment. From a competency development perspective, practicing authentic tasks in a web-based learning environment can be useful to train skills and keep up important routines. The approach found in this study also needs careful consideration. Emphasizing routines and skills can be important to reduce variation and ensure more streamlined practice from an institution-wide quality improvement efforts. How the emphasis on routines and skills plays out towards the individual's overall professional development needs further careful studies.

Opinions and practices of healthcare professionals on assessment of disease associated malnutrition in children: Results from an international survey.

PubMed

Huysentruyt, Koen; Hulst, Jessie; Bian, Feifei; Shamir, Raanan; White, Melinda; Galera-Martinez, Raphael; Morais-Lopez, Anna; Kansu, Aydan; Gerasimidis, Konstantinos

2018-04-05

Lack of consensus on clinical indicators for the assessment of pediatric disease associated malnutrition (DAM) may explain its under-recognition in clinical practice. This study surveyed the opinions of health professionals (HP) on clinical indicators of DAM and barriers impeding routine nutritional screening in children. Web-based questionnaire survey (April 2013-August 2015) in Australia, Belgium, Israel, Spain, The Netherlands, Turkey and UK. There were 937 questionnaires returned via local professional associations, of which 693 respondents fulfilled the inclusion criteria and were included in the final analysis; 315 pediatric gastroenterologists and 378 pediatric dieticians. The most important clinical indicators of DAM were ongoing weight loss (80.4%), increased energy/nutrient losses (73.0%), suboptimal energy/macronutrient intake (68.6%), a high nutritional risk condition (67.2%) and increased energy/nutrient requirements (66.2%). These findings were consistent across countries and professions. The most common approach to screen for DAM was assessment of weight changes (85%), followed by the usage of growth charts (77-80%). Common perceived barriers for routine nutritional screening/assessment were low staff awareness (47.5%), no local policy or guidelines (33.4%) and lack of time to screen (33.4%). HP who routinely assess and treat children with DAM identified ongoing weight loss, increased losses, increased requirements, low intake and high nutritional risk conditions as the most important clinical indicators of DAM. These clinical indicators should now serve as a basis to form clinical-based criteria for the identification of DAM in routine clinical practice. Low awareness, lack of guidelines or local policy and lack of resources were the most important barriers of routine screening. Copyright © 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Survival of the project: a case study of ICT innovation in health care.

PubMed

Andreassen, Hege K; Kjekshus, Lars Erik; Tjora, Aksel

2015-05-01

From twenty years of information and communication technology (ICT) projects in the health sector, we have learned one thing: most projects remain projects. The problem of pilotism in e-health and telemedicine is a growing concern, both in medical literature and among policy makers, who now ask for large-scale implementation of ICT in routine health service delivery. In this article, we turn the question of failing projects upside down. Instead of investigating the obstacles to implementing ICT and realising permanent changes in health care routines, we ask what makes the temporary ICT project survive, despite an apparent lack of success. Our empirical material is based on Norwegian telemedicine. Through a case study, we take an in-depth look into the history of one particular telemedical initiative and highlight how ICT projects matter on a managerial level. Our analysis reveals how management tasks were delegated to the ICT project, which thus contributed to four processes of organisational control: allocating resources, generating and managing enthusiasm, system correction and aligning local practice and national policies. We argue that the innovation project in itself can be considered an innovation that has become normalised in health care, not in clinical, but in management work. In everyday management, the ICT project appears to be a convenient tool suited to ease the tensions between state regulatory practices and claims of professional autonomy that arise in the wake of new public management reforms. Separating project management and funding from routine practice handles the conceptualised heterogeneity between innovation and routine within contemporary health care delivery. Whilst this separation eases the execution of both normal routines and innovative projects, it also delays expected diffusion of technology. Copyright © 2015 Elsevier Ltd. All rights reserved.

Preliminary Survey of Icing Conditions Measured During Routine Transcontinental Airline Operation

NASA Technical Reports Server (NTRS)

Perkins, Porter J.

1952-01-01

Icing data collected on routine operations by four DC-4-type aircraft equipped with NACA pressure-type icing-rate meters are presented as preliminary information obtained from a statistical icing data program sponsored by the NACA with the cooperation of many airline companies and the United States Air Force. The program is continuing on a much greater scale to provide large quantities of data from many air routes in the United States and overseas. Areas not covered by established air routes are also being included in the survey. The four aircraft which collected the data presented in this report were operated by United Air Lines over a transcontinental route from January through May, 1951. An analysis of the pressure-type icing-rate meter was satisfactory for collecting statistical data during routine operations. Data obtained on routine flight icing encounters from.these four instrumented aircraft, although insufficient for a conclusive statistical analysis, provide a greater quantity and considerably more realistic information than that obtained from random research flights. A summary of statistical data will be published when the information obtained daring the 1951-52 icing season and that to be obtained during the 1952-53 season can be analyzed and assembled. The 1951-52 data already analyzed indicate that the quantity, quality, and range of icing information being provided by this expanded program should afford a sound basis for ice-protection-system design by defining the important meteorological parameters of the icing cloud.

Routine intraoperative completion angiography after coronary artery bypass grafting and 1-stop hybrid revascularization results from a fully integrated hybrid catheterization laboratory/operating room.

PubMed

Zhao, David X; Leacche, Marzia; Balaguer, Jorge M; Boudoulas, Konstantinos D; Damp, Julie A; Greelish, James P; Byrne, John G; Ahmad, Rashid M; Ball, Stephen K; Cleator, John H; Deegan, Robert J; Eagle, Susan S; Fong, Pete P; Fredi, Joseph L; Hoff, Steven J; Jennings, Henry S; McPherson, John A; Piana, Robert N; Pretorius, Mias; Robbins, Mark A; Slosky, David A; Thompson, Annemarie

2009-01-20

This study sought to report our experience with a routine completion angiogram after coronary artery bypass surgery (CABG) and simultaneous (1-stop) percutaneous coronary intervention (PCI) at the time of CABG performed in the hybrid catheterization laboratory/operating room. The value of a routine completion angiogram after CABG and 1-stop hybrid CABG/PCI remains unresolved. Between April 2005 and July 2007, 366 consecutive patients underwent CABG surgery, with (n = 112) or without (n = 254) concomitant 1-stop PCI (hybrid), all with completion angiography before chest closure. Among the 112 1-stop hybrid CABG/PCI patients, 67 (60%) underwent a planned hybrid procedure based on pre-operative assessment, whereas 45 (40%) underwent open-chest PCI (unplanned hybrid) based on intraoperative findings. Among the 796 CABG grafts (345 left internal mammary artery, 12 right internal mammary artery/radial, and 439 veins), 97 (12%) angiographic defects were identified. Defects were repaired with either a minor adjustment of the graft (n = 22, 2.8%), with intraoperative open-chest PCI (unplanned hybrid, n = 48, 6%) or with traditional surgical revision (n = 27, 3.4%). Hybrid patients had clinical outcomes similar to standard CABG patients. Routine completion angiography detected 12% of grafts with important angiographic defects. One-stop hybrid coronary revascularization is reasonable, safe, and feasible. Combining the tools of the catheterization laboratory and operating room greatly enhances the options available to the surgeon and cardiologist for patients with complex coronary artery disease.

Towards the Construction of a Framework to Deal with Routine Problems to Foster Mathematical Inquiry

ERIC Educational Resources Information Center

Santos-Trigo, Manuel; Camacho-Machin, Matias

2009-01-01

To what extent does the process of solving textbook problems help students develop a way of thinking that is consistent with mathematical practice? Can routine problems be transformed into problem solving activities that promote students' mathematical reflection? These questions are used to outline and discuss features of an inquiry framework…

Women who experience domestic violence and women survivors of childhood sexual abuse: a survey of health professionals' attitudes and clinical practice.

PubMed Central

Richardson, J; Feder, G; Eldridge, S; Chung, W S; Coid, J; Moorey, S

2001-01-01

Health professionals do not wish to routinely screen women for a history of domestic violence or childhood sexual abuse. However, over 80% believe that these are significant health care issues. Routine screening should not be prioritised until evidence of benefit has been established. PMID:11407053

Promoting Early Literacy via Practicing Invented Spelling: A Comparison of Different Mediation Routines

ERIC Educational Resources Information Center

Levin, Iris; Aram, Dorit

2013-01-01

The present study compared the effects of different mediation routines provided to kindergartners from families of low socioeconomic status on the students' invented spelling attempts and on their gains obtained on spelling and other early literacy skills (letter naming, sounds of letters, word segmentation, and word decoding). The effects of the…

Leveraging Quiz-Based Multiple-Prize Web Tournaments for Reinforcing Routine Mathematical Skills

ERIC Educational Resources Information Center

Gonzalez-Tablas, Ana I.; de Fuentes, Jose M.; Hernandez-Ardieta, Jorge L.; Ramos, Benjamin

2013-01-01

In Higher Education Engineering studies, there exists the need of engaging students in performing drill and practice activities with the goal of reinforcing routine mathematical skills. The usual optionality of these tasks entails the risk of students not fulfilling them in an effective way. Although competitive approaches are not a trend in…

Robotics in cardiac surgery: the Istanbul experience.

PubMed

Sagbas, Ertan; Akpinar, Belhhan; Sanisoglu, Ilhan; Caynak, Baris; Guden, Mustafa; Ozbek, Ugur; Bayramoglu, Zehra; Bayindir, Osman

2006-06-01

Robots are sensor-based tools capable of performing precise, accurate and versatile actions. Initially designed to spare humans from risky tasks, robots have progressed into revolutionary tools for surgeons. Tele-operated robots, such as the da Vinci (Intuitive Surgical, Mountain View, CA), have allowed cardiac procedures to start benefiting from robotics as an enhancement to traditional minimally invasive surgery. The aim of this text was to discuss our experience with the da Vinci system during a 12 month period in which 61 cardiac patients were operated on. There were 59 coronary bypass patients (CABG) and two atrial septal defect (ASD) closures. Two patients (3.3%) had to be converted to median sternotomy because of pleural adhesions. There were no procedure- or device-related complications. Our experience suggests that robotics can be integrated into routine cardiac surgical practice. Systematic training, team dedication and proper patient selection are important factors that determine the success of a robotic surgery programme. Copyright 2006 John Wiley & Sons, Ltd.

Human Papillomavirus (HPV) Genotyping: Automation and Application in Routine Laboratory Testing

PubMed Central

Torres, M; Fraile, L; Echevarria, JM; Hernandez Novoa, B; Ortiz, M

2012-01-01

A large number of assays designed for genotyping human papillomaviruses (HPV) have been developed in the last years. They perform within a wide range of analytical sensitivity and specificity values for the different viral types, and are used either for diagnosis, epidemiological studies, evaluation of vaccines and implementing and monitoring of vaccination programs. Methods for specific genotyping of HPV-16 and HPV-18 are also useful for the prevention of cervical cancer in screening programs. Some commercial tests are, in addition, fully or partially automated. Automation of HPV genotyping presents advantages such as the simplicity of the testing procedure for the operator, the ability to process a large number of samples in a short time, and the reduction of human errors from manual operations, allowing a better quality assurance and a reduction of cost. The present review collects information about the current HPV genotyping tests, with special attention to practical aspects influencing their use in clinical laboratories. PMID:23248734

Glucose-6-phosphate dehydrogenase deficiency in two returning Operation Iraqi Freedom soldiers who developed hemolytic anemia while receiving primaquine prophylaxis for malaria.

PubMed

Carr, Marcus E; Fandre, Matthew N; Oduwa, Felix O

2005-04-01

Use of antimalarial prophylaxis continues to be routine practice among military personnel returning from areas where malaria is endemic. Primaquine may be used for terminal prophylaxis against Plasmodium ovale and Plasmodium vivax. Serious complications of this regimen are infrequent. We report the occurrence of significant hemolytic anemia for two soldiers returning from Operation Iraqi Freedom. They presented with dark urine, headaches, and classic laboratory findings of hemolysis. Both soldiers were subsequently found to have glucose-6-phosphate dehydrogenase deficiency, and both responded to conservative treatment and cessation of medication. Although this complication is unusual, medical personnel involved in the care of recently returned deployed service members should be alert to its potential occurrence among patients who are receiving antimalarial prophylaxis. This complication could be completely avoided with prescreening of personnel for glucose-6-phosphate dehydrogenase deficiency, as is currently done in the Air Force and Navy, before the use of primaquine.

Big Data and the Future of Radiology Informatics.

PubMed

Kansagra, Akash P; Yu, John-Paul J; Chatterjee, Arindam R; Lenchik, Leon; Chow, Daniel S; Prater, Adam B; Yeh, Jean; Doshi, Ankur M; Hawkins, C Matthew; Heilbrun, Marta E; Smith, Stacy E; Oselkin, Martin; Gupta, Pushpender; Ali, Sayed

2016-01-01

Rapid growth in the amount of data that is electronically recorded as part of routine clinical operations has generated great interest in the use of Big Data methodologies to address clinical and research questions. These methods can efficiently analyze and deliver insights from high-volume, high-variety, and high-growth rate datasets generated across the continuum of care, thereby forgoing the time, cost, and effort of more focused and controlled hypothesis-driven research. By virtue of an existing robust information technology infrastructure and years of archived digital data, radiology departments are particularly well positioned to take advantage of emerging Big Data techniques. In this review, we describe four areas in which Big Data is poised to have an immediate impact on radiology practice, research, and operations. In addition, we provide an overview of the Big Data adoption cycle and describe how academic radiology departments can promote Big Data development. Copyright © 2016 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Trends in qualifying biomarkers in drug safety. Consensus of the 2011 meeting of the spanish society of clinical pharmacology.

PubMed

Agúndez, José A G; Del Barrio, Jaime; Padró, Teresa; Stephens, Camilla; Farré, Magí; Andrade, Raúl J; Badimon, Lina; García-Martín, Elena; Vilahur, Gemma; Lucena, M Isabel

2012-01-01

In this paper we discuss the consensus view on the use of qualifying biomarkers in drug safety, raised within the frame of the XXIV meeting of the Spanish Society of Clinical Pharmacology held in Málaga (Spain) in October, 2011. The widespread use of biomarkers as surrogate endpoints is a goal that scientists have long been pursuing. Thirty years ago, when molecular pharmacogenomics evolved, we anticipated that these genetic biomarkers would soon obviate the routine use of drug therapies in a way that patients should adapt to the therapy rather than the opposite. This expected revolution in routine clinical practice never took place as quickly nor with the intensity as initially expected. The concerted action of operating multicenter networks holds great promise for future studies to identify biomarkers related to drug toxicity and to provide better insight into the underlying pathogenesis. Today some pharmacogenomic advances are already widely accepted, but pharmacogenomics still needs further development to elaborate more precise algorithms and many barriers to implementing individualized medicine exist. We briefly discuss our view about these barriers and we provide suggestions and areas of focus to advance in the field.

Green light for liver function monitoring using indocyanine green? An overview of current clinical applications.

PubMed

Vos, J J; Wietasch, J K G; Absalom, A R; Hendriks, H G D; Scheeren, T W L

2014-12-01

The dye indocyanine green is familiar to anaesthetists, and has been studied for more than half a century for cardiovascular and hepatic function monitoring. It is still, however, not yet in routine clinical use in anaesthesia and critical care, at least in Europe. This review is intended to provide a critical analysis of the available evidence concerning the indications for clinical measurement of indocyanine green elimination as a diagnostic and prognostic tool in two areas: its role in peri-operative liver function monitoring during major hepatic resection and liver transplantation; and its role in critically ill patients on the intensive care unit, where it is used for prediction of mortality, and for assessment of the severity of acute liver failure or that of intra-abdominal hypertension. Although numerous studies have demonstrated that indocyanine green elimination measurements in these patient populations can provide diagnostic or prognostic information to the clinician, 'hard' evidence - i.e. high-quality prospective randomised controlled trials - is lacking, and therefore it is not yet time to give a green light for use of indocyanine green in routine clinical practice. © 2014 The Association of Anaesthetists of Great Britain and Ireland.

Safety of ranibizumab in routine clinical practice: 1-year retrospective pooled analysis of four European neovascular AMD registries within the LUMINOUS programme.

PubMed

Holz, Frank G; Bandello, Francesco; Gillies, Mark; Mitchell, Paul; Osborne, Aaron; Sheidow, Tom; Souied, Eric; Figueroa, Marta S

2013-09-01

Evaluation of 1-year safety profile of intravitreal ranibizumab 0.5 mg in neovascular age-related macular degeneration (NV-AMD) within routine clinical practice. The LUMINOUS programme comprises a prospective observational study assessing ranibizumab 'real-world' safety and clinical effectiveness across licensed indications worldwide and an annual retrospective pooled safety analysis from completed NV-AMD ranibizumab registries. 1-year data from four European registries are available. This retrospective pooled safety analysis assessed 1-year incidence rates for safety events of particular interest (key ocular or systemic events possibly related to the injection procedure or vascular endothelial growth factor inhibition) together with treatment exposure. Patients were treated according to local protocols within the ranibizumab licence. Data of 4444 patients from registries in Germany (n=3470), the Netherlands (n=243), Belgium (n=260) and Sweden (n=471) were retrospectively pooled. Between 70.4% and 84.4% of enrolled patients completed 1 year of follow-up. Most frequent overall ocular events of particular interest were retinal pigment epithelial tears (27 patients; <1%) and intraocular pressure-related events (12 patients; <0.3%). Most frequent non-ocular event of particular interest was stroke (19 patients; 0.4%); annual incidence of stroke was low across all registries (0.0-0.5%). Ranibizumab demonstrated favourable 1-year safety profile for NV-AMD in this routine clinical practice sample, consistent with previous reported trial data. Additional data from a larger patient population are needed to better describe the long-term safety profile of ranibizumab in routine clinical practice and further evaluate risk for infrequent but serious events in 'real-life' settings. The 5-year LUMINOUS prospective observational study will address this need.

Safety of ranibizumab in routine clinical practice: 1-year retrospective pooled analysis of four European neovascular AMD registries within the LUMINOUS programme

PubMed Central

Holz, Frank G; Bandello, Francesco; Gillies, Mark; Mitchell, Paul; Osborne, Aaron; Sheidow, Tom; Souied, Eric; Figueroa, Marta S

2013-01-01

Purpose Evaluation of 1-year safety profile of intravitreal ranibizumab 0.5 mg in neovascular age-related macular degeneration (NV-AMD) within routine clinical practice. Methods The LUMINOUS programme comprises a prospective observational study assessing ranibizumab ‘real-world’ safety and clinical effectiveness across licensed indications worldwide and an annual retrospective pooled safety analysis from completed NV-AMD ranibizumab registries. 1-year data from four European registries are available. This retrospective pooled safety analysis assessed 1-year incidence rates for safety events of particular interest (key ocular or systemic events possibly related to the injection procedure or vascular endothelial growth factor inhibition) together with treatment exposure. Patients were treated according to local protocols within the ranibizumab licence. Results Data of 4444 patients from registries in Germany (n=3470), the Netherlands (n=243), Belgium (n=260) and Sweden (n=471) were retrospectively pooled. Between 70.4% and 84.4% of enrolled patients completed 1 year of follow-up. Most frequent overall ocular events of particular interest were retinal pigment epithelial tears (27 patients; <1%) and intraocular pressure-related events (12 patients; <0.3%). Most frequent non-ocular event of particular interest was stroke (19 patients; 0.4%); annual incidence of stroke was low across all registries (0.0–0.5%). Conclusions Ranibizumab demonstrated favourable 1-year safety profile for NV-AMD in this routine clinical practice sample, consistent with previous reported trial data. Additional data from a larger patient population are needed to better describe the long-term safety profile of ranibizumab in routine clinical practice and further evaluate risk for infrequent but serious events in ‘real-life’ settings. The 5-year LUMINOUS prospective observational study will address this need. PMID:23850682

Lost opportunities to identify and treat HIV-positive patients: results from a baseline assessment of provider-initiated HIV testing and counselling (PITC) in Malawi.

PubMed

Ahmed, Saeed; Schwarz, Monica; Flick, Robert J; Rees, Chris A; Harawa, Mwelura; Simon, Katie; Robison, Jeff A; Kazembe, Peter N; Kim, Maria H

2016-04-01

To assess implementation of provider-initiated testing and counselling (PITC) for HIV in Malawi. A review of PITC practices within 118 departments in 12 Ministry of Health (MoH) facilities across Malawi was conducted. Information on PITC practices was collected via a health facility survey. Data describing patient visits and HIV tests were abstracted from routinely collected programme data. Reported PITC practices were highly variable. Most providers practiced symptom-based PITC. Antenatal clinics and maternity wards reported widespread use of routine opt-out PITC. In 2014, there was approximately 1 HIV test for every 15 clinic visits. HIV status was ascertained in 94.3% (5293/5615) of patients at tuberculosis clinics, 92.6% (30,675/33,142) of patients at antenatal clinics and 49.4% (6871/13,914) of patients at sexually transmitted infection clinics. Reported challenges to delivering PITC included test kit shortages (71/71 providers), insufficient physical space (58/71) and inadequate number of HIV counsellors (32/71) while providers from inpatient units cited the inability to test on weekends. Various models of PITC currently exist at MoH facilities in Malawi. Only antenatal and maternity clinics demonstrated high rates of routine opt-out PITC. The low ratio of facility visits to HIV tests suggests missed opportunities for HIV testing. However, the high proportion of patients at TB and antenatal clinics with known HIV status suggests that routine PITC is feasible. These results underscore the need to develop clear, standardised PITC policy and protocols, and to address obstacles of limited health commodities, infrastructure and human resources. © 2016 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Breast self-examination: Resistance to change

PubMed Central

Del Giudice, M. Elisabeth; Tannenbaum, David; Goodwin, Pamela J.

2005-01-01

OBJECTIVE To investigate whether Canadian family practitioners routinely teach breast self-examination (BSE) after publication of the 2001 Canadian Preventive Health Task Force guideline advising them to exclude teaching BSE from periodic health examinations. DESIGN Self-administered cross-sectional mailed survey. SETTING Canada. PARTICIPANTS A random sample of English-speaking general practitioners and physicians certified by the College of Family Physicians of Canada. MAIN OUTCOME MEASURES Current and past BSE practices and opinions on the value of BSE. RESULTS Response rate was 47.4%. Most respondents (88%) were aware of the new recommendations, yet only 16% had changed their usual practice of routinely teaching BSE. Most physicians agreed that before the recommendation they almost always taught BSE (74.3%). Only 9.5% agreed that physicians should follow the recommendation and not routinely teach BSE. A few also agreed that they now spend less time discussing BSE (25.7%) and that the recommendation has influenced them to stop teaching (12.4%) and encouraging (12.9%) women to practise BSE. Physicians who had changed their BSE practices were less likely to agree that BSE increases early detection of breast cancer and more likely to agree that BSE increases benign breast biopsies. They were also more likely to agree that screening mammography in women older than 50 decreases mortality from breast cancer. CONCLUSION This survey, which assessed routine teaching of BSE, revealed poor adherence by Canadian family physicians to a well publicized evidence-based guideline update. Resistance to change could in part be attributed to a lack of knowledge of the supporting evidence, a lack of confidence in the evidence to date, and personal experiences with patients within their practices. PMID:16926925

A review of the patterns of docetaxel use for hormone-resistant prostate cancer at the Princess Margaret Hospital.

PubMed

Chin, S N; Wang, L; Moore, M; Sridhar, S S

2010-04-01

Based on the TAX 327 phase III trial, docetaxel-based chemotherapy is the standard first-line treatment for hormone-resistant prostate cancer (HRPC); however, there is some heterogeneity in the use of this agent in routine clinical practice. The aim of the present study was to examine the patterns of docetaxel use in routine clinical practice at our institution and to compare them with docetaxel use in the TAX 327 clinical trial. We conducted a retrospective chart review of HRPC patients treated with first-line docetaxel between 2005 and 2007 at the Princess Margaret Hospital. In the first-line setting, 88 patients with HRPC received docetaxel. The main reasons for initiating docetaxel were rising prostate-specific antigen (PSA, 98%) and progressive symptoms (77%). The PSA response rate was 67%; median time to response was 1.5 months, and duration of response was 6.8 months. Median survival was 15.9 months (95% confidence interval: 12.4 to 20.5 months). Patients received a median of 7 cycles of treatment, and the main toxicities were fatigue (35%) and neuropathy (24%). Post docetaxel, 36 patients received second-line treatment with a 22% response rate. In routine clinical practice, HRPC patients received docetaxel mainly because of symptomatic disease progression. Overall response rates and toxicities were comparable to those in the TAX 327 trial. However, our patients received a median of only 7 cycles of treatment versus the 9.5 administered on trial, and survival was slightly shorter in our single-institution study. A larger prospective multicentre analysis, including performance status and quality-of-life parameters, may be warranted to determine if docetaxel performs as well in routine clinical practice as it does in the clinical trial setting.

Dance Class Structure Affects Youth Physical Activity and Sedentary Behavior: A Study of Seven Dance Types.

PubMed

Lopez Castillo, Maria A; Carlson, Jordan A; Cain, Kelli L; Bonilla, Edith A; Chuang, Emmeline; Elder, John P; Sallis, James F

2015-01-01

The study aims were to determine: (a) how class structure varies by dance type, (b) how moderate-to-vigorous physical activity (MVPA) and sedentary behavior vary by dance class segments, and (c) how class structure relates to total MVPA in dance classes. Participants were 291 boys and girls ages 5 to 18 years old enrolled in 58 dance classes at 21 dance studios in Southern California. MVPA and sedentary behavior were assessed with accelerometry, with data aggregated to 15-s epochs. Percent and minutes of MVPA and sedentary behavior during dance class segments and percent of class time and minutes spent in each segment were calculated using Freedson age-specific cut points. Differences in MVPA (Freedson 3 Metabolic Equivalents of Tasks age-specific cut points) and sedentary behavior ( < 100 counts/min) were examined using mixed-effects linear regression. The length of each class segment was fairly consistent across dance types, with the exception that in ballet, more time was spent in technique as compared with private jazz/hip-hop classes and Latin-flamenco and less time was spent in routine/practice as compared with Latin-salsa/ballet folklorico. Segment type accounted for 17% of the variance in the proportion of the segment spent in MVPA. The proportion of the segment in MVPA was higher for routine/practice (44.2%) than for technique (34.7%). The proportion of the segment in sedentary behavior was lowest for routine/practice (22.8%). The structure of dance lessons can impact youths' physical activity. Working with instructors to increase time in routine/practice during dance classes could contribute to physical activity promotion in youth.

HPV Vaccination of Boys in Primary Care Practices

PubMed Central

Allison, Mandy A.; Dunne, Eileen F.; Markowitz, Lauri E.; O’Leary, Sean T.; Crane, Lori A.; Hurley, Laura P.; Stokley, Shannon; Babbel, Christine I.; Brtnikova, Michaela; Beaty, Brenda L.; Kempe, Allison

2018-01-01

OBJECTIVE In October 2011, the Advisory Committee on Immunization Practices (ACIP) recommended the quadrivalent human papillomavirus vaccine (HPV4) for the routine immunization schedule for 11- to 12-year-old boys. Before October 2011, HPV4 was permissively recommended for boys. We conducted a study in 2010 to provide data that could guide efforts to implement routine HPV4 immunization in boys. Our objectives were to describe primary care physicians’: 1) knowledge and attitudes about human papillomavirus (HPV)-related disease and HPV4, 2) recommendation and administration practices regarding HPV vaccine in boys compared to girls, 3) perceived barriers to HPV4 administration in boys, and 4) personal and practice characteristics associated with recommending HPV4 to boys. METHODS We conducted a mail and Internet survey in a nationally representative sample of pediatricians and family medicine physicians from July 2010 to September 2010. RESULTS The response rate was 72% (609 of 842). Most physicians thought that the routine use of HPV4 in boys was justified. Although it was permissively recommended, 33% recommended HPV4 to 11- to 12-year-old boys and recommended it more strongly to older male adolescents. The most common barriers to HPV4 administration were related to vaccine financing. Physicians who reported recommending HPV4 for 11- to 12-year-old boys were more likely to be from urban locations, perceive that HPV4 is efficacious, perceive that HPV-related disease is severe, and routinely discuss sexual health with 11- to 12-year-olds. CONCLUSIONS Although most physicians support HPV4 for boys, physician education and evidence-based tools are needed to improve implementation of a vaccination program for males in primary care settings. PMID:24011749

Academic-practice partnerships to promote evidence-based practice in long-term care: oral hygiene care practices as an exemplar.

PubMed

McConnell, Eleanor Schildwachter; Lekan, Deborah; Hebert, Catherine; Leatherwood, Lisa

2007-01-01

Learning in practice disciplines suffers when gaps exist between classroom instruction and students' observations of routine clinical practices.(1) Academic institutions, therefore, have a strong interest in fostering the rapid and effective translation of evidence-based care techniques into routine practice. Long-term care (LTC) practice sites are particularly vulnerable to gaps between classroom teaching and how daily care is implemented, owing to the recent rapid advances in the scientific bases of care for frail older adults, the relative isolation of most LTC sites from academic settings,(2) and the relatively small number of registered nurses (RNs) available in LTC settings who can facilitate translation of research-based practices into care.(3) The aim of this project was to demonstrate the feasibility and value of an academic practice partnership to implement evidence-based approaches to solving resident care problems in LTC, as many scientifically proven practices hold promise for improving resident outcomes yet adoption is often slow.(4) We developed and implemented a clinical practice improvement process, based on diffusion of innovations theory and research,(5-8) to serve as a new model of academic-practice collaboration between a university school of nursing, LTC facility management and direct-care staff, as a means of developing high quality clinical sites for student rotations. The goal was to implement a sustainable evidence-based oral care program as an exemplar of how scientific evidence can be translated into LTC practice. This project focused on oral hygiene because the staff was dissatisfied with their existing resident oral care program, and an evidence-base for oral care in LTC existed that had not yet been incorporated into care routines. This article describes a systematic, replicable process for linking advanced practice registered nurse expertise with staff insights about care systems to reduce the gap between teaching and practice in long-term care settings. Our experience demonstrates that translation of research on oral care practices into LTC practice through academic-practice partnerships is feasible, is associated with positive resident outcomes, and illustrates a process that has broader applicability to other common problems in LTC, where incomplete implementation of an extant research base for practice may inhibit student learning.

Homework as a Family Literacy Practice: What Counts as Best Practices for Children Deemed as High Risk for Academic Failure Due to Socioeconomic Status

ERIC Educational Resources Information Center

Fox, Kathy R.

2016-01-01

Homework is a constant yet often controversial practice in homes and other settings. This study set out to determine answers to the question: "What practices were used to support children with homework in families deemed as at risk due to low socioeconomic factors?" Homework was examined as a common practice that routinely took place in…

Practicing health promotion in primary care -a reflective enquiry.

PubMed

Pati, S; Chauhan, A S; Mahapatra, S; Sinha, R; Pati, S

2017-12-01

Health promotion is an integral part of routine clinical practice. The physicians' role in improving the health status of the general population, through effective understanding and delivery of health promotion practice, is evident throughout the international literature. Data from India suggest that physicians have limited skills in delivering specific health promotion services. However, the data available on this is scarce. This study was planned to document the current health promotion knowledge, perception and practices of local primary care physicians in Odisha. An exploratory study was planned between the months of January - February 2013 in Odisha among primary care physicians working in government set up. This exploratory study was conducted, using a two-step self-administered questionnaire, thirty physicians practicing under government health system were asked to map their ideal and current health promotion practice, and potential health promotion elements to be worked upon to enhance the practice. The study recorded a significant difference between the mean of current and ideal health promotion practices. The study reported that physicians want to increase their practice on health education. We concluded that inclusion of health promotion practices in routine care is imperative for a strong healthcare system. It should be incorporated as a structured health promotion module in medical curriculum as well.

Coding for effective denial management.

PubMed

Miller, Jackie; Lineberry, Joe

2004-01-01

Nearly everyone will agree that accurate and consistent coding of diagnoses and procedures is the cornerstone for operating a compliant practice. The CPT or HCPCS procedure code tells the payor what service was performed and also (in most cases) determines the amount of payment. The ICD-9-CM diagnosis code, on the other hand, tells the payor why the service was performed. If the diagnosis code does not meet the payor's criteria for medical necessity, all payment for the service will be denied. Implementation of an effective denial management program can help "stop the bleeding." Denial management is a comprehensive process that works in two ways. First, it evaluates the cause of denials and takes steps to prevent them. Second, denial management creates specific procedures for refiling or appealing claims that are initially denied. Accurate, consistent and compliant coding is key to both of these functions. The process of proactively managing claim denials also reveals a practice's administrative strengths and weaknesses, enabling radiology business managers to streamline processes, eliminate duplicated efforts and shift a larger proportion of the staff's focus from paperwork to servicing patients--all of which are sure to enhance operations and improve practice management and office morale. Accurate coding requires a program of ongoing training and education in both CPT and ICD-9-CM coding. Radiology business managers must make education a top priority for their coding staff. Front office staff, technologists and radiologists should also be familiar with the types of information needed for accurate coding. A good staff training program will also cover the proper use of Advance Beneficiary Notices (ABNs). Registration and coding staff should understand how to determine whether the patient's clinical history meets criteria for Medicare coverage, and how to administer an ABN if the exam is likely to be denied. Staff should also understand the restrictions on use of ABNs and the compliance risks associated with improper use. Finally, training programs should include routine audits to monitor coders for competence and precision. Constantly changing codes and guidelines mean that a coder's skills can quickly become obsolete if not reinforced by ongoing training and monitoring. Comprehensive reporting and routine analysis of claim denials is without a doubt one of the greatest assets to a practice that is suffering from excessive claim denials and should be considered an investment capable of providing both short and long term ROIs. Some radiologists may lack the funding or human resources needed to implement truly effective coding programs for their staff members. In these circumstances, radiology business managers should consider outsourcing their coding.

Operative reports: form and function.

PubMed

Stewart, Lygia; Hunter, John G; Wetter, Alberto; Chin, Brian; Way, Lawrence W

2010-09-01

Little is known about how closely operative reports reflect what was actually performed during an operation, nor has the construction of operative reports been adequately studied with the aims of clarifying the objectives of those reports and improving their efficacy. We hypothesized that if more attention is paid to the objectives of operative reports, their content will more predictably contain the most relevant information, which might channel thinking in beneficial directions during performance of the operation. Multivariate analysis of 250 laparoscopic cholecystectomy operative reports (125 uncomplicated and 125 with bile duct injury). Academic research. University (105 cases) and community (145 cases) hospitals. Variations in content and design of operative reports. Cognitive task analysis of laparoscopic cholecystectomy was conducted, and a model operative report was generated and compared with the actual operative reports. Descriptions of key elements in adequate dissection of the Calot triangle were present in 24.8% and 0.0% of operative reports from uncomplicated and bile duct injury cases, respectively. Thorough dissection of the Calot triangle, identification of the cystic duct-infundibulum junction, and lateral retraction of the infundibulum correlated with uncomplicated cases, while irregular cues (eg, perceived anatomic or other deviations) correlated with bile duct injury cases. Current practice generates operative reports that vary widely in content and too often omit important elements. This research suggests that the construction of operative reports should be constrained such that the reports routinely include the fundamental goals of the operation and what was performed to meet them. Cognitive task analysis is based on the ways the mind controls the performance of tasks; it is an excellent method for determining the extra content needed in operative reports. The resulting designs should also serve as mental guidelines to facilitate learning and to enhance the safety of the operation.

STP Position Paper: Recommended Practices for Sampling and Processing the Nervous System (Brain, Spinal Cord, Nerve, and Eye) during Nonclinical General Toxicity Studies

EPA Science Inventory

The Society of Toxicologic Pathology charged a Nervous System Sampling Working Group with devising recommended practices to routinely screen the central and peripheral nervous systems in Good Laboratory Practice-type nonclinical general toxicity studies. Brains should be trimmed ...

Protective Factor Screening for Prevention Practice: Sensitivity and Specificity of the Dessa-Mini

ERIC Educational Resources Information Center

Shapiro, Valerie B.; Kim, B. K. Elizabeth; Robitaille, Jennifer L.; LeBuffe, Paul A.

2017-01-01

The Devereux Student Strengths Assessment Mini (DESSA-Mini; Naglieri, LeBuffe, & Shapiro, 2011/2014) was designed to overcome practical obstacles to universal prevention screening. This article seeks to determine whether an entirely strength-based, 8-item screening instrument achieves technical accuracy in routine practice. Data come from a…

What Is Implementation Research? Rationale, Concepts, and Practices

ERIC Educational Resources Information Center

Bhattacharyya, Onil; Reeves, Scott; Zwarenstein, Merrick

2009-01-01

Despite the growing knowledge base on evidence-based practices in social work and medicine, there is a large gap between what is known and what is consistently done. Implementation research is the study of methods to promote the uptake of research findings into routine practice. In this article, we describe the rationale for implementation…

75 FR 37353 - Endangered and Threatened Wildlife and Plants; Listing the Mountain Plover as Threatened

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-29

... rule proposed to allow the incidental take of mountain plovers during routine farming practices on... agricultural practices in the winter range; (4) Effects of range management on mountain plover habitat; (5... techniques, or changes in cultivation practices could further affect the availability and quality of...

Nurse perspectives on the implementation of routine telemonitoring for high-risk diabetes patients in a primary care setting.

PubMed

Vest, Bonnie M; Hall, Victoria M; Kahn, Linda S; Heider, Arvela R; Maloney, Nancy; Singh, Ranjit

2017-01-01

Aims The purpose of this qualitative evaluation was to explore the experience of implementing routine telemonitoring (TM) in real-world primary care settings from the perspective of those delivering the intervention; namely the TM staff, and report on lessons learned that could inform future projects of this type. Routine TM for high-risk patients within primary care practices may help improve chronic disease control and reduce complications, including unnecessary hospital admissions. However, little is known about how to integrate routine TM in busy primary care practices. A TM pilot for diabetic patients was attempted in six primary care practices as part of the Beacon Community in Western New York. Semi-structured interviews were conducted with representatives of three TM agencies (n=8) participating in the pilot. Interviews were conducted over the phone or in person and lasted ~30 min. Interviews were audio-taped and transcribed. Analysis was conducted using immersion-crystallization to identify themes. Findings TM staff revealed several themes related to the experience of delivering TM in real-world primary care: (1) the nurse-patient relationship is central to a successful TM experience, (2) TM is a useful tool for understanding socio-economic context and its impact on patients' health, (3) TM staff anecdotally report important potential impacts on patient health, and (4) integrating TM into primary care practices needs to be planned carefully. This qualitative study identified challenges and unexpected benefits that might inform future efforts. Communication and integration between the TM agency and the practice, including the designation of a point person within the office to coordinate TM and help address the broader contextual needs of patients, are important considerations for future implementation. The role of the TM nurse in developing trust with patients and uncovering the social and economic context within which patients manage their diabetes was an unexpected benefit.

Has publication of the results of the ORACLE Children Study changed practice in the UK?

PubMed

Kenyon, S; Pike, K; Jones, D; Brocklehurst, P; Marlow, N; Salt, A; Taylor, D

2010-10-01

  To investigate whether publication of the results of the ORACLE Children's Study, a 7-year follow-up of the ORACLE trial, changed practice with regard to the routine prescription of antibiotics to women with preterm rupture of membranes or spontaneous preterm labour (intact membranes).   A comparative questionnaire survey of clinical practice in November 2007 (before publication) and March 2009 (after publication).   Lead obstetricians for labour wards of all maternity units in the UK.   Self-administered questionnaires requested information about the routine prescription of antibiotics to women with either preterm rupture of membranes or spontaneous preterm labour (intact membranes).   Change in practice for prescription of antibiotics.   The response rate was 166/214 (78%) in 2007 and 158/209 (76%) in 2009. In total, 120 maternity units responded on both occasions. For women with preterm rupture of membranes, 162/214 (98%) in 2007 and 151/158 (96%) in 2009 maternity units reported that they prescribed antibiotics, with the majority using erythromycin (98%). For women with spontaneous preterm labour (intact membranes), 35/166 (21%) in 2007 and 25/158 (16%) in 2009 maternity units reported that they routinely prescribed antibiotics. The findings from units who responded on both occasions are similar.   There has been little change in the reported prescription of antibiotics to women with either preterm rupture of membranes or spontaneous preterm labour following publication of the ORACLE Children's Study. This suggests that current practice may require updated guidance.

UAS Integration into the NAS Project

NASA Technical Reports Server (NTRS)

Bauer, Jeff

2010-01-01

The goal of the UAS Integration in the NAS Project is to contribute capabilities that reduce technical barriers related to the safety and operational challenges associated with enabling routine UAS access to the NAS This goal will be accomplished through a two-phased approach of system-level integration of key concepts, technologies and/or procedures, and demonstrations of integrated capabilities in an operationally relevant environment. Technical objectives include: PHASE 1: a) Validating the key technical areas identified by this project. System-level analyses, a State of the Art Analysis (SOAA), and a ConOps will identify the challenges and barriers preventing routine UAS access to the NAS. b) Developing a national roadmap and gap analysis identifying specific deliverables in the area of operations, procedures, and technologies that will impact future policy decisions. PHASE 2: a) Provide regulators with a methodology for developing airworthiness requirements for UAS and data to support development of certifications standards and regulatory guidance. b) Provide systems-level integrated testing of concepts and/or capabilities that address barriers to routine access to the NAS. Through simulation and flight testing, address issues including separation assurance, communications requirements, and Pilot Aircraft Interfaces (PAIs) in operationally relevant environments

Cost-Effective Telemetry and Command Ground Systems Automation Strategy for the Soil Moisture Active Passive (SMAP) Mission

NASA Technical Reports Server (NTRS)

Choi, Josh; Sanders, Antonio

2012-01-01

Soil Moisture Active Passive (SMAP) is an Earth-orbiting, remote-sensing NASA mission slated for launch in 2014. The ground data system (GDS) being developed for SMAP is composed of many heterogeneous subsystems, ranging from those that support planning and sequencing to those used for real-time operations, and even further to those that enable science data exchange. A full end-to-end automation of the GDS may result in cost savings during mission operations, but it would require a significant upfront investment to develop such a comprehensive automation. As demonstrated by the Jason-1 and Wide-field Infrared Survey Explorer (WISE) missions, a measure of "lights-out" automation for routine, orbital pass, ground operations can still reduce mission costs through smaller staffing of operators and limiting their working hours. The challenge, then, for the SMAP GDS engineering team, is to formulate an automated operations strategy--and corresponding system architecture -- to minimize operator intervention during routine operations, while balancing the development costs associated with the scope and complexity of automation. This paper discusses the automated operations approach being developed for the SMAP GDS. The focus is on automating the activities involved in routine passes, which limits the scope to real-time operations. A key subsystem of the SMAP GDS -- NASA's AMMOS Mission Data Processing and Control System (AMPCS) -- provides a set of capabilities that enable such automation. Also discussed are the lights-out pass automations of the Jason-1 and WISE missions and how they informed the automation strategy for SMAP. The paper aims to provide insights into what is necessary in automating the GDS operations for Earth satellite missions.

A pragmatic cluster randomised trial evaluating three implementation interventions.

PubMed

Rycroft-Malone, Jo; Seers, Kate; Crichton, Nicola; Chandler, Jackie; Hawkes, Claire A; Allen, Claire; Bullock, Ian; Strunin, Leo

2012-08-30

Implementation research is concerned with bridging the gap between evidence and practice through the study of methods to promote the uptake of research into routine practice. Good quality evidence has been summarised into guideline recommendations to show that peri-operative fasting times could be considerably shorter than patients currently experience. The objective of this trial was to evaluate the effectiveness of three strategies for the implementation of recommendations about peri-operative fasting. A pragmatic cluster randomised trial underpinned by the PARIHS framework was conducted during 2006 to 2009 with a national sample of UK hospitals using time series with mixed methods process evaluation and cost analysis. Hospitals were randomised to one of three interventions: standard dissemination (SD) of a guideline package, SD plus a web-based resource championed by an opinion leader, and SD plus plan-do-study-act (PDSA). The primary outcome was duration of fluid fast prior to induction of anaesthesia. Secondary outcomes included duration of food fast, patients' experiences, and stakeholders' experiences of implementation, including influences. ANOVA was used to test differences over time and interventions. Nineteen acute NHS hospitals participated. Across timepoints, 3,505 duration of fasting observations were recorded. No significant effect of the interventions was observed for either fluid or food fasting times. The effect size was 0.33 for the web-based intervention compared to SD alone for the change in fluid fasting and was 0.12 for PDSA compared to SD alone. The process evaluation showed different types of impact, including changes to practices, policies, and attitudes. A rich picture of the implementation challenges emerged, including inter-professional tensions and a lack of clarity for decision-making authority and responsibility. This was a large, complex study and one of the first national randomised controlled trials conducted within acute care in implementation research. The evidence base for fasting practice was accepted by those participating in this study and the messages from it simple; however, implementation and practical challenges influenced the interventions' impact. A set of conditions for implementation emerges from the findings of this study, which are presented as theoretically transferable propositions that have international relevance. ISRCTN18046709--Peri-operative Implementation Study Evaluation (POISE).

40 CFR 63.1547 - Monitoring requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... standard operating procedures manual that describes in detail the procedures for inspection, maintenance...) The standard operating procedures manual for baghouses required by paragraph (a) of this section shall... specified in the standard operating procedures manual for inspections and routine maintenance shall, at a...

40 CFR 63.1547 - Monitoring requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... standard operating procedures manual that describes in detail the procedures for inspection, maintenance...) The standard operating procedures manual for baghouses required by paragraph (a) of this section shall... specified in the standard operating procedures manual for inspections and routine maintenance shall, at a...

Modelling-based identification of factors influencing campylobacters in chicken broiler houses and on carcasses sampled after processing and chilling.

PubMed

Hutchison, M L; Taylor, M J; Tchòrzewska, M A; Ford, G; Madden, R H; Knowles, T G

2017-05-01

To identify production and processing practices that might reduce Campylobacter numbers contaminating chicken broiler carcasses. The numbers of campylobacters were determined on carcass neck skins after processing or in broiler house litter samples. Supplementary information that described farm layouts, farming conditions for individual flocks, the slaughterhouse layouts and operating conditions inside plants was collected, matched with each Campylobacter test result. Statistical models predicting the numbers of campylobacters on neck skins and in litter were constructed. Carcass microbial contamination was more strongly influenced by on-farm production practices compared with slaughterhouse activities. We observed correlations between the chilling, washing and defeathering stages of processing and the numbers of campylobacters on carcasses. There were factors on farm that also correlated with numbers of campylobacters in litter. These included bird gender, the exclusion of dogs from houses, beetle presence in the house litter and the materials used to construct the house frame. Changes in farming practices have greater potential for reducing chicken carcass microbial contamination compared with processing interventions. Routine commercial practices were identified that were correlated with lowered numbers of campylobacters. Consequently, these practices are likely to be both cost-effective and suitable for adoption into established farms and commercial processing. © 2017 The Authors. Journal of Applied Microbiology published by John Wiley & Sons Ltd on behalf of Society for Applied Microbiology.

Guidelines for computer security in general practice.

PubMed

Schattner, Peter; Pleteshner, Catherine; Bhend, Heinz; Brouns, Johan

2007-01-01

As general practice becomes increasingly computerised, data security becomes increasingly important for both patient health and the efficient operation of the practice. To develop guidelines for computer security in general practice based on a literature review, an analysis of available information on current practice and a series of key stakeholder interviews. While the guideline was produced in the context of Australian general practice, we have developed a template that is also relevant for other countries. Current data on computer security measures was sought from Australian divisions of general practice. Semi-structured interviews were conducted with general practitioners (GPs), the medical software industry, senior managers within government responsible for health IT (information technology) initiatives, technical IT experts, divisions of general practice and a member of a health information consumer group. The respondents were asked to assess both the likelihood and the consequences of potential risks in computer security being breached. The study suggested that the most important computer security issues in general practice were: the need for a nominated IT security coordinator; having written IT policies, including a practice disaster recovery plan; controlling access to different levels of electronic data; doing and testing backups; protecting against viruses and other malicious codes; installing firewalls; undertaking routine maintenance of hardware and software; and securing electronic communication, for example via encryption. This information led to the production of computer security guidelines, including a one-page summary checklist, which were subsequently distributed to all GPs in Australia. This paper maps out a process for developing computer security guidelines for general practice. The specific content will vary in different countries according to their levels of adoption of IT, and cultural, technical and other health service factors. Making these guidelines relevant to local contexts should help maximise their uptake.

Do Italian surgeons use antibiotic prophylaxis in thyroid surgery? Results from a national study (UEC--Italian Endocrine Surgery Units Association).

PubMed

Gentile, Ivan; Rosato, Lodovico; Avenia, Nicola; Testini, Mario; D'Ajello, Michele; Antonino, Antonio; De Palma, Maurizio

2014-01-01

Thyroid surgery is a clean procedure and therefore antibiotic prophylaxis is not routinely recommended by most international guidelines. However, antibiotics are often used in clinical practice. We enrolled 2926 patients who performed a thyroid surgical operation between the years 2009 and 2011 in the 38 centers of endocrine surgery that joined the UEC--Italian Endocrine Surgery Units Association. Antibiotic prophylaxis was used in 1132 interventions (38.7%). In case of antibiotic prophylaxis, cephalosporins or aminopenicillins ± beta lactamase inhibitors were employed. At logistic regression analysis the use of drainage or device and the presence of malignancy were independent predictors of antibiotic prophylaxis employment. In conclusion our study shows that antibiotic prophylaxis was not rarely used in clinical practice in the setting of thyroid surgery. Drainage apposition, use of device, and malignant disease were independent predictors for antibiotic prophylaxis employment. More data on everyday practice and infection rate in well-designed studies are warranted to provide definitive recommendations on the utility of antibiotic prophylaxis in this setting. According to our experience, we don't consider to be strictly necessary the antibiotic prophylaxis employment in order to reduce infection rate in thyroid surgery.

Learning to doctor: tinkering with visibility in residency training.

PubMed

Wallenburg, Iris; Bont, Antoinette; Heineman, Maas-Jan; Scheele, Fedde; Meurs, Pauline

2013-05-01

Medical doctors in teaching hospitals aim to serve the two central goals of patient care and medical training. Whereas patient care asks for experience, expertise and close supervision, medical training requires space to practise and the 'invisibility' of medical residents. Yet current reforms in postgraduate medical training point to an increasing emphasis on the measurable visibility of residents. Drawing on an ethnographic study of gynaecology training in The Netherlands, this article demonstrates that in daily clinical routines multiple practices of residents' visibility (visibilities) coexist. The article lists four visibilities: staging residents, negotiating supervision, playing the invisibility game and filming surgical operations. The article shows how attending physicians and medical residents tinker with these visibilities in daily clinical work to provide good care while enacting learning space, highlighting the increasing importance of visualising technologies in clinical work. Moreover, the article contributes to traditional sociological accounts on medical education, shifting the focus from medical education as a social institution to the practices of medical training itself. Such a focus on practice helps to gain an understanding of how the current reform challenges clinicians' educational activities. © 2012 The Authors. Sociology of Health & Illness © 2012 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

Unsupervised daily routine and activity discovery in smart homes.

PubMed

Jie Yin; Qing Zhang; Karunanithi, Mohan

2015-08-01

The ability to accurately recognize daily activities of residents is a core premise of smart homes to assist with remote health monitoring. Most of the existing methods rely on a supervised model trained from a preselected and manually labeled set of activities, which are often time-consuming and costly to obtain in practice. In contrast, this paper presents an unsupervised method for discovering daily routines and activities for smart home residents. Our proposed method first uses a Markov chain to model a resident's locomotion patterns at different times of day and discover clusters of daily routines at the macro level. For each routine cluster, it then drills down to further discover room-level activities at the micro level. The automatic identification of daily routines and activities is useful for understanding indicators of functional decline of elderly people and suggesting timely interventions.

Outcomes of Video-Assisted Teaching for Latching in Postpartum Women: A Randomized Controlled Trial.

PubMed

Sroiwatana, Suttikamon; Puapornpong, Pawin

2018-04-25

Latching is an important process of breastfeeding and should be taught and practiced by the postpartum mother. The objective is to compare latching outcomes between video-assisted and routine teaching methods among postpartum women. A randomized controlled trial was conducted. Postpartum women who had deliveries without complications were randomized into two groups: 14 cases in the video-assisted teaching group and 14 cases in a routine teaching group. In the first group, the mothers were taught breastfeeding benefits, latching methods, and breastfeeding positions and practiced breastfeeding in a controlled setting for a 30-minute period and watched a 6-minute video with consistent content. In the second group, the mothers were taught a normal 30-minute period and then practiced breastfeeding. In both groups, Latching on, Audible swallowing, the Type of nipples, Comfort, and Help (LATCH) scores were assessed at 24-32 and 48-56 hours after the breastfeeding teaching modals. Demographic data and LATCH scores were collected and analyzed. There were no statistically significant differences in the mothers' ages, occupations, marital status, religion, education, income, infants' gestational age, body mass index, nipple length, route of delivery, and time to first latching between the video-assisted and routine breastfeeding teaching groups. First and second LATCH score assessments had shown no significant differences between both breastfeeding teaching groups. The video-assisted breastfeeding teaching did not improve latching outcomes when it was compared with routine teaching.

Development of psychiatric risk evaluation checklist and routine for nurses in a general hospital: ethnographic qualitative study.

PubMed

Camargo, Ana Luiza Lourenço Simões; Maluf Neto, Alfredo; Colman, Fátima Tahira; Citero, Vanessa de Albuquerque

2015-01-01

There is high prevalence of mental and behavioral disorders in general hospitals, thus triggering psychiatric risk situations. This study aimed to develop a psychiatric risk assessment checklist and routine for nurses, the Psychiatric Risk Evaluation Check-List (PRE-CL), as an alternative model for early identification and management of these situations in general hospitals. Ethnographic qualitative study in a tertiary-level private hospital. Three hundred general-unit nurses participated in the study. Reports were gathered through open groups conducted by a trained nurse, at shift changes for two months. The questions used were: "Would you consider it helpful to discuss daily practice situations with a psychiatrist? Which situations?" The data were qualitatively analyzed through an ethnographic approach. The nurses considered it useful to discuss daily practice situations relating to mental and behavioral disorders with a psychiatrist. Their reports were used to develop PRE-CL, within the patient overall risk assessment routine for all inpatients within 24 hours after admission and every 48 hours thereafter. Whenever one item was present, the psychosomatic medicine team was notified. They went to the unit, gathered data from the nurses, patient files and, if necessary, attending doctors, and decided on the risk management: guidance, safety measures or mental health consultation. It is possible to develop a model for detecting and intervening in psychiatric and behavioral disorders at general hospitals based on nursing team observations, through a checklist that takes these observations into account and a routine inserted into daily practice.

The 6.5-m MMT Telescope: status and plans for the future

NASA Astrophysics Data System (ADS)

Williams, G. Grant; Ortiz, R.; Goble, W.; Gibson, J. D.

2016-08-01

The MMT Observatory, a joint venture of the Smithsonian Institution and the University of Arizona, operates the 6.5-m MMT telescope on the summit of Mount Hopkins approximately 45 miles south of Tucson, AZ. The upgraded telescope has been in routine operation for nearly fifteen years and, as such, is a very reliable and productive general purpose astronomical instrument. The telescope can be configured with one of three secondary mirrors that feed more than ten instruments at the Cassegrain focus. In this paper we provide an overview of the the telescope, its current capabilities, and its performance. We will review the existing suite of instruments and their different modes of operation. We will describe some of the general operations challenges and strategies for the Observatory. Finally, we will discuss plans for the near-term future including technical upgrades, new instrumentation and routine queue operation of MMIRS and Binospec.

The comprehensive 'Communicate to Vaccinate' taxonomy of communication interventions for childhood vaccination in routine and campaign contexts.

PubMed

Kaufman, Jessica; Ames, Heather; Bosch-Capblanch, Xavier; Cartier, Yuri; Cliff, Julie; Glenton, Claire; Lewin, Simon; Muloliwa, Artur Manuel; Oku, Afiong; Oyo-Ita, Angela; Rada, Gabriel; Hill, Sophie

2017-05-10

Communication can be used to generate demand for vaccination or address vaccine hesitancy, and is crucial to successful childhood vaccination programmes. Research efforts have primarily focused on communication for routine vaccination. However, vaccination campaigns, particularly in low- or middle-income countries (LMICs), also use communication in diverse ways. Without a comprehensive framework integrating communication interventions from routine and campaign contexts, it is not possible to conceptualise the full range of possible vaccination communication interventions. Therefore, vaccine programme managers may be unaware of potential communication options and researchers may not focus on building evidence for interventions used in practice. In this paper, we broaden the scope of our existing taxonomy of communication interventions for routine vaccination to include communication used in campaigns, and integrate these into a comprehensive taxonomy of vaccination communication interventions. Building on our taxonomy of communication for routine vaccination, we identified communication interventions used in vaccination campaigns through a targeted literature search; observation of vaccination activities in Cameroon, Mozambique and Nigeria; and stakeholder consultations. We added these interventions to descriptions of routine vaccination communication and categorised the interventions according to their intended purposes, building from an earlier taxonomy of communication related to routine vaccination. The comprehensive taxonomy groups communication used in campaigns and routine childhood vaccination into seven purpose categories: 'Inform or Educate'; 'Remind or Recall'; 'Enhance Community Ownership'; 'Teach Skills'; 'Provide Support'; 'Facilitate Decision Making' and 'Enable Communication'. Consultations with LMIC stakeholders and experts informed the taxonomy's definitions and structure and established its potential uses. This taxonomy provides a standardised way to think and speak about vaccination communication. It is categorised by purpose to help conceptualise communication interventions as potential solutions to address needs or problems. It can be utilised by programme planners, implementers, researchers and funders to see the range of communication interventions used in practice, facilitate evidence synthesis and identify evidence gaps.

Is heart rate variability better than routine vital signs for prehospital identification of major hemorrhage?

PubMed

Edla, Shwetha; Reisner, Andrew T; Liu, Jianbo; Convertino, Victor A; Carter, Robert; Reifman, Jaques

2015-02-01

During initial assessment of trauma patients, metrics of heart rate variability (HRV) have been associated with high-risk clinical conditions. Yet, despite numerous studies, the potential of HRV to improve clinical outcomes remains unclear. Our objective was to evaluate whether HRV metrics provide additional diagnostic information, beyond routine vital signs, for making a specific clinical assessment: identification of hemorrhaging patients who receive packed red blood cell (PRBC) transfusion. Adult prehospital trauma patients were analyzed retrospectively, excluding those who lacked a complete set of reliable vital signs and a clean electrocardiogram for computation of HRV metrics. We also excluded patients who did not survive to admission. The primary outcome was hemorrhagic injury plus different PRBC transfusion volumes. We performed multivariate regression analysis using HRV metrics and routine vital signs to test the hypothesis that HRV metrics could improve the diagnosis of hemorrhagic injury plus PRBC transfusion vs routine vital signs alone. As univariate predictors, HRV metrics in a data set of 402 subjects had comparable areas under receiver operating characteristic curves compared with routine vital signs. In multivariate regression models containing routine vital signs, HRV parameters were significant (P<.05) but yielded areas under receiver operating characteristic curves with minimal, nonsignificant improvements (+0.00 to +0.05). A novel diagnostic test should improve diagnostic thinking and allow for better decision making in a significant fraction of cases. Our findings do not support that HRV metrics add value over routine vital signs in terms of prehospital identification of hemorrhaging patients who receive PRBC transfusion. Published by Elsevier Inc.

Dose Adjustment for Normal Eating (DAFNE) in routine clinical practice: who benefits?

PubMed

Keen, A J A; Duncan, E; McKillop-Smith, A; Evans, N D; Gold, A E

2012-05-01

To explore the effectiveness of Dose Adjustment for Normal Eating in routine clinical practice in the UK. Participants were 124 adults with Type 1 diabetes who had completed a Dose Adjustment for Normal Eating course. Data were collected before the course and again 1 year later on a variety of biological, psychological and social measures. There were a range of significant benefits consistent with Dose Adjustment for Normal Eating aims, including: better control among those with baseline HbA(1c) ≥ 81 mmol/mol (9.6%) (z = -2.8, P = 0.004); reduced number of participants reporting severe hypoglycaemia (χ² = 4.27, P = 0.039); total eradication of diabetic ketoacidosis (χ² = 4.17, P = 0.041) and lower diabetes-related distress (z = -4.5, P < 0.001). The most deprived of the clinic population were significantly under-represented (χ² = 17.8, P = 0.001) and the levels of clinical depression were unusually low. These results indicate that Dose Adjustment for Normal Eating delivered in routine clinical practice is associated with a range of benefits and that certain clinical and psychosocial characteristics are associated with better outcomes. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.

Evaluation of a hygiene monitor for detection of contamination in dental surgeries.

PubMed

Douglas, C W; Rothwell, P S

1991-05-11

Routines for disinfecting working surfaces in dental surgeries are difficult to monitor without time-consuming and labour-intensive microbiological techniques, yet effective monitoring is a vital part of cross-infection control. Easy to use, on-site methods would be valuable in this context. This study evaluates a portable monitor, the Biotrace Hygiene Monitor, which uses bioluminescence to measure adenosine triphosphate (ATP) on surfaces. Under laboratory conditions, the ability of the monitor to detect whole saliva and Streptococcus sanguis was determined and, in the general practice environment, the level of ATP on surfaces in five dental surgeries was assessed. The minimum amount of saliva detectable was 0.5 microliters and in surgeries, the monitor readily identified numerous surfaces with fairly high levels of ATP. Routine cleaning methods sometimes left ATP on surfaces at levels which represented a cross-infection risk, if it is assumed that the ATP derived from patients' saliva. Modification of cleaning methods resulted in a reduction of ATP levels to within that which could be considered reasonably practicably safe. It is concluded that the Biotrace Hygiene Monitor offers a simple and valuable means of monitoring dental practice cleaning routines.

Variation in routine follow-up care after curative treatment for head-and-neck cancer: a population-based study in Ontario.

PubMed

Brennan, K E; Hall, S F; Owen, T E; Griffiths, R J; Peng, Y

2018-04-01

The actual practices of routine follow-up after curative treatment for head-and-neck cancer are unknown, and existing guidelines are not evidence-based. This retrospective population-based study used administrative data to describe 5 years of routine follow-up care in 3975 head-and-neck cancer patients diagnosed between 2007 and 2012 in Ontario. The mean number of visits per year declined during the follow-up period (from 7.8 to 1.9, p < 0.001). The proportion of patients receiving visits in concordance with guidelines ranged from 80% to 45% depending on the follow-up year. In at least 50% of patients, 1 head, neck, or chest imaging test was performed in the first follow-up year; that proportion subsequently declined ( p < 0.001). Factors associated with follow-up practices included comorbidity, tumour site, treatment, geographic region, and physician specialty ( p < 0.05). Given current practice variation and the absence of an evidence-based standard, the challenge in identifying a single optimal follow-up strategy might be better addressed with a harmonized approach to providing individualized follow-up care.

Governance, Accountability, and Organizational Development: Eldercare Unit Managers' and Local Politicians' Experiences of and Responses to State Supervision of Swedish Eldercare.

PubMed

Andersson, Katarina; Hanberger, Anders; Nygren, Lennart

2018-02-22

This article explores how local politicians and care unit managers in Swedish eldercare experience and respond to state supervision (SSV). Twelve politicians and twelve managers in 15 previously inspected municipalities were interviewed about their experiences of and reactions to SSV in relation to their views of care quality and routines in eldercare practice. The findings indicate that local managers and political chairs perceived SSV in eldercare positively at a superficial level but were critical of and disappointed with specific aspects of it. In terms of (a) governance, chairs and managers said SSV strengthened implementation of national policies via local actors, but they were critical of SSV's narrow focus on control and flaws in eldercare practice. With regard to (b) accountability, SSV was seen as limited to accountability for finances and systemic performance, and regarding (c) organizational development, SSV was seen as limited to improving routines and compliance with legislation, while local definitions of quality are broader than that. In general, local actors regarded SSV as improving administrative aspects and routines in practice but ignoring the relational content of eldercare quality.

Key Lessons Learned from Moffitt's Molecular Tumor Board: The Clinical Genomics Action Committee Experience.

PubMed

Knepper, Todd C; Bell, Gillian C; Hicks, J Kevin; Padron, Eric; Teer, Jamie K; Vo, Teresa T; Gillis, Nancy K; Mason, Neil T; McLeod, Howard L; Walko, Christine M

2017-02-01

The increasing practicality of genomic sequencing technology has led to its incorporation into routine clinical practice. Successful identification and targeting of driver genomic alterations that provide proliferative and survival advantages to tumor cells have led to approval and ongoing development of several targeted cancer therapies. Within many major cancer centers, molecular tumor boards are constituted to shepherd precision medicine into clinical practice. In July 2014, the Clinical Genomics Action Committee (CGAC) was established as the molecular tumor board companion to the Personalized Medicine Clinical Service (PMCS) at Moffitt Cancer Center in Tampa, Florida. The processes and outcomes of the program were assessed in order to help others move into the practice of precision medicine. Through the establishment and initial 1,400 patients of the PMCS and its associated molecular tumor board at a major cancer center, five practical lessons of broad applicability have been learned: transdisciplinary engagement, the use of the molecular report as an aid to clinical management, clinical actionability, getting therapeutic options to patients, and financial considerations. Value to patients includes access to cutting-edge practice merged with individualized preferences in treatment and care. Genomic-driven cancer medicine is increasingly becoming a part of routine clinical practice. For successful implementation of precision cancer medicine, strategically organized molecular tumor boards are critical to provide objective evidence-based translation of observed molecular alterations into patient-centered clinical action. Molecular tumor board implementation models along with clinical and economic outcomes will define future treatment standards. The Oncologist 2017;22:144-151 Implications for Practice: It is clear that the increasing practicality of genetic tumor sequencing technology has led to its incorporation as part of routine clinical practice. Subsequently, many cancer centers are seeking to develop a personalized medicine services and/or molecular tumor board to shepherd precision medicine into clinical practice. This article discusses the key lessons learned through the establishment and development of a molecular tumor board and personalized medicine clinical service. This article highlights practical issues and can serve as an important guide to other centers as they conceive and develop their own personalized medicine services and molecular tumor boards. © AlphaMed Press 2017.

Key Lessons Learned from Moffitt's Molecular Tumor Board: The Clinical Genomics Action Committee Experience

PubMed Central

Knepper, Todd C.; Bell, Gillian C.; Hicks, J. Kevin; Padron, Eric; Teer, Jamie K.; Vo, Teresa T.; Gillis, Nancy K.; Mason, Neil T.; Walko, Christine M.

2017-01-01

Abstract Background. The increasing practicality of genomic sequencing technology has led to its incorporation into routine clinical practice. Successful identification and targeting of driver genomic alterations that provide proliferative and survival advantages to tumor cells have led to approval and ongoing development of several targeted cancer therapies. Within many major cancer centers, molecular tumor boards are constituted to shepherd precision medicine into clinical practice. Materials and Methods. In July 2014, the Clinical Genomics Action Committee (CGAC) was established as the molecular tumor board companion to the Personalized Medicine Clinical Service (PMCS) at Moffitt Cancer Center in Tampa, Florida. The processes and outcomes of the program were assessed in order to help others move into the practice of precision medicine. Results. Through the establishment and initial 1,400 patients of the PMCS and its associated molecular tumor board at a major cancer center, five practical lessons of broad applicability have been learned: transdisciplinary engagement, the use of the molecular report as an aid to clinical management, clinical actionability, getting therapeutic options to patients, and financial considerations. Value to patients includes access to cutting‐edge practice merged with individualized preferences in treatment and care. Conclusions. Genomic‐driven cancer medicine is increasingly becoming a part of routine clinical practice. For successful implementation of precision cancer medicine, strategically organized molecular tumor boards are critical to provide objective evidence‐based translation of observed molecular alterations into patient‐centered clinical action. Molecular tumor board implementation models along with clinical and economic outcomes will define future treatment standards. Implications for Practice. It is clear that the increasing practicality of genetic tumor sequencing technology has led to its incorporation as part of routine clinical practice. Subsequently, many cancer centers are seeking to develop a personalized medicine services and/or molecular tumor board to shepherd precision medicine into clinical practice. This article discusses the key lessons learned through the establishment and development of a molecular tumor board and personalized medicine clinical service. This article highlights practical issues and can serve as an important guide to other centers as they conceive and develop their own personalized medicine services and molecular tumor boards. PMID:28179575

40 CFR 63.1547 - Monitoring requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... according to, a standard operating procedures manual that describes in detail the procedures for inspection...) The standard operating procedures manual for baghouses required by paragraph (a) of this section must... specified in the standard operating procedures manual for inspections and routine maintenance must, at a...

40 CFR 63.1547 - Monitoring requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... according to, a standard operating procedures manual that describes in detail the procedures for inspection...) The standard operating procedures manual for baghouses required by paragraph (a) of this section must... specified in the standard operating procedures manual for inspections and routine maintenance must, at a...

40 CFR 63.1547 - Monitoring requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... according to, a standard operating procedures manual that describes in detail the procedures for inspection...) The standard operating procedures manual for baghouses required by paragraph (a) of this section must... specified in the standard operating procedures manual for inspections and routine maintenance must, at a...

Introduction in IND and recursive partitioning

NASA Technical Reports Server (NTRS)

Buntine, Wray; Caruana, Rich

1991-01-01

This manual describes the IND package for learning tree classifiers from data. The package is an integrated C and C shell re-implementation of tree learning routines such as CART, C4, and various MDL and Bayesian variations. The package includes routines for experiment control, interactive operation, and analysis of tree building. The manual introduces the system and its many options, gives a basic review of tree learning, contains a guide to the literature and a glossary, and lists the manual pages for the routines and instructions on installation.

DB90: A Fortran Callable Relational Database Routine for Scientific and Engineering Computer Programs

NASA Technical Reports Server (NTRS)

Wrenn, Gregory A.

2005-01-01

This report describes a database routine called DB90 which is intended for use with scientific and engineering computer programs. The software is written in the Fortran 90/95 programming language standard with file input and output routines written in the C programming language. These routines should be completely portable to any computing platform and operating system that has Fortran 90/95 and C compilers. DB90 allows a program to supply relation names and up to 5 integer key values to uniquely identify each record of each relation. This permits the user to select records or retrieve data in any desired order.

Taming the Viper: Software Upgrade for VFAUser and Viper

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

DORIN,RANDALL T.; MOSER III,JOHN C.

2000-08-08

This report describes the procedure and properties of the software upgrade for the Vibration Performance Recorder. The upgrade will check the 20 memory cards for proper read/write operation. The upgrade was successfully installed and uploaded into the Viper and the field laptop. The memory checking routine must run overnight to complete the test, although the laptop need only be connected to the Viper unit until the downloading routine is finished. The routine has limited ability to recognize incomplete or corrupt header and footer files. The routine requires 400 Megabytes of free hard disk space. There is one minor technical flawmore » detailed in the conclusion.« less

Factors Predisposing, Enabling and Reinforcing Routine Screening of Patients for Preventing Fetal Alcohol Syndrome: A Survey of New Jersey Physicians.

ERIC Educational Resources Information Center

Donovan, Carole L.

1991-01-01

Survey of 58 physicians revealed that they did not routinely ask their pregnant patients about alcohol consumption for several reasons: physician bias resulting from own abuse, lack of training, poor awareness of problem and effects, denial that Fetal Alcohol Syndrome occurs in private practice, time limitations, disinterest, fear of offending…

Pitfalls in lung cancer molecular pathology: how to limit them in routine practice?

PubMed

Ilie, M; Hofman, P

2012-01-01

New treatment options in advanced non-small cell lung carcinoma (NSCLC) targeting activating epidermal growth factor receptor (EGFR) gene mutations and other genetic alterations demonstrated the clinical significance of the molecular features of specific subsets of tumors. Therefore, the development of personalized medicine has stimulated the routine integration into pathology departments of somatic mutation testing. However, clinical mutation testing must be optimized and standardized with regard to histological profile, type of samples, pre-analytical steps, methodology and result reporting. Routine molecular testing in NSCLC is currently moving beyond EGFR mutational analysis. Recent progress of targeted therapies will require molecular testing for a wide panel of mutations for a personalized molecular diagnosis. As a consequence, efficient testing of multiple molecular abnormalities is an urgent requirement in thoracic oncology. Moreover, increasingly limited tumor sample becomes a major challenge for molecular pathology. Continuous efforts should be made for safe, effective and specific molecular analyses. This must be based on close collaboration between the departments involved in the management of lung cancer. In this review we explored the practical issues and pitfalls surrounding the routine implementation of molecular testing in NSCLC in a pathology laboratory.

A multicenter study of routine versus selective intraoperative leak testing for sleeve gastrectomy.

PubMed

Bingham, Jason; Kaufman, Jedediah; Hata, Kai; Dickerson, James; Beekley, Alec; Wisbach, Gordon; Swann, Jacob; Ahnfeldt, Eric; Hawkins, Devon; Choi, Yong; Lim, Robert; Martin, Matthew

2017-09-01

Staple line leaks after sleeve gastrectomy are dreaded complications. Many surgeons routinely perform an intraoperative leak test (IOLT) despite little evidence to validate the reliability, clinical benefit, and safety of this procedure. To determine the efficacy of IOLT and if routine use has any benefit over selective use. Eight teaching hospitals, including private, university, and military facilities. A multicenter, retrospective analysis over a 5-year period. The efficacy of the IOLT for identifying unsuspected staple line defects and for predicting postoperative leaks was evaluated. An anonymous survey was also collected reflecting surgeons' practices and beliefs regarding IOLT. From January 2010 through December 2014, 4284 patients underwent sleeve gastrectomy. Of these, 37 patients (.9%) developed a postoperative leak, and 2376 patients (55%) received an IOLT. Only 2 patients (0.08%) had a positive finding. Subsequently, 21 patients with a negative IOLT developed a leak. IOLT demonstrated a sensitivity of only 8.7%. There was a nonsignificant trend toward increased leak rates when an IOLT was performed versus when IOLT was not performed. Leak rates were not statistically different between centers that routinely perform IOLT versus those that selectively perform IOLT. Routine IOLT had very poor sensitivity and was negative in 91% of patients who later developed postoperative leaks. The use of IOLT was not associated with a decrease in the incidence of postoperative leaks, and routine IOLT had no benefit over selective leak testing. IOLT should not be used as a quality indicator or "best practice" for bariatric surgery. Published by Elsevier Inc.

Use of the Ion PGM and the GeneReader NGS Systems in Daily Routine Practice for Advanced Lung Adenocarcinoma Patients: A Practical Point of View Reporting a Comparative Study and Assessment of 90 Patients.

PubMed

Heeke, Simon; Hofman, Véronique; Long-Mira, Elodie; Lespinet, Virginie; Lalvée, Salomé; Bordone, Olivier; Ribeyre, Camille; Tanga, Virginie; Benzaquen, Jonathan; Leroy, Sylvie; Cohen, Charlotte; Mouroux, Jérôme; Marquette, Charles Hugo; Ilié, Marius; Hofman, Paul

2018-03-21

Background : With the integration of various targeted therapies into the clinical management of patients with advanced lung adenocarcinoma, next-generation sequencing (NGS) has become the technology of choice and has led to an increase in simultaneously interrogated genes. However, the broader adoption of NGS for routine clinical practice is still hampered by sophisticated workflows, complex bioinformatics analysis and medical interpretation. Therefore, the performance of the novel QIAGEN GeneReader NGS system was compared to an in-house ISO-15189 certified Ion PGM NGS platform. Methods : Clinical samples from 90 patients (60 Retrospectively and 30 Prospectively) with lung adenocarcinoma were sequenced with both systems. Mutations were analyzed and EGFR , KRAS , BRAF , NRAS , ALK , PIK3CA and ERBB2 genes were compared and sampling time and suitability for clinical testing were assessed. Results : Both sequencing systems showed perfect concordance for the overlapping genes. Correlation of allele frequency was r ² = 0.93 for the retrospective patients and r ² = 0.81 for the prospective patients. Hands-on time and total run time were shorter using the PGM system, while the GeneReader platform provided good traceability and up-to-date interpretation of the results. Conclusion : We demonstrated the suitability of the GeneReader NGS system in routine practice in a clinical pathology laboratory setting.

Chapter IX. Bedtime Routines in Toddlerhood: Prevalence, Consistency, and Associations with Nighttime Sleep

PubMed Central

Staples, Angela D.; Bates, John E.; Petersen, Isaac T.

2016-01-01

The ability to transition from wakefulness to sleep is one of the most important tasks in the development of sleep during early childhood. Although establishing regular bedtime routines for children with sleep problems can be clinically effective in reducing the number of signaled night awakenings and increasing amounts of sleep, it is unclear whether a regular bedtime routine would be associated with either the frequency of signaled night awakenings or nightly sleep minutes in a non-clinical sample of children. This study examined the role of a regular bedtime routine on the development of sleep regulation and consolidation in a community sample of young children. Adherence to a bedtime routine was concurrently associated with a greater amount of nightly sleep at 36 and 42 months. In addition, adherence to a bedtime routine predicted an increase in nightly sleep minutes over a six-month period. Finally, this study demonstrated that adherence to a bedtime routine was particularly supportive of developmental gains for children of mothers who used consistent parenting practices during the day. PMID:25704740

A Nursing Intelligence System to Support Secondary Use of Nursing Routine Data

PubMed Central

Rauchegger, F.; Ammenwerth, E.

2015-01-01

Summary Background Nursing care is facing exponential growth of information from nursing documentation. This amount of electronically available data collected routinely opens up new opportunities for secondary use. Objectives To present a case study of a nursing intelligence system for reusing routinely collected nursing documentation data for multiple purposes, including quality management of nursing care. Methods The SPIRIT framework for systematically planning the reuse of clinical routine data was leveraged to design a nursing intelligence system which then was implemented using open source tools in a large university hospital group following the spiral model of software engineering. Results The nursing intelligence system is in routine use now and updated regularly, and includes over 40 million data sets. It allows the outcome and quality analysis of data related to the nursing process. Conclusions Following a systematic approach for planning and designing a solution for reusing routine care data appeared to be successful. The resulting nursing intelligence system is useful in practice now, but remains malleable for future changes. PMID:26171085

0-6775 : NTCIP-based traffic signal evaluation and optimization toolbox.

DOT National Transportation Integrated Search

2014-08-01

Routine maintenance of traffic signals requires : identification and resolution of hardware faults : and operational inefficiencies. Like most : agencies in charge of operating and maintaining : traffic signals scattered over large geographic : regio...

[Clinical application of combined hepatic artery resection and reconstruction in surgical treatment for hilar cholangiocarcinoma].

PubMed

Dai, H S; Bie, P; Wang, S G; He, Y; Li, D J; Tian, F; Zhao, X; Chen, Z Y

2018-01-01

Objective: To clarify whether the surgical treatment for hilar cholangiocarcinoma combined with artery reconstruction is optimistic to the patients with hilar cholangiocarcinoma with hepatic artery invasion. Methods: There were 384 patients who received treatment in the First Affiliated Hospital to Army Medical University from January 2008 to January 2016 analyzed retrospectively. There were 27 patients underwent palliative operation, 245 patients underwent radical operation, radical resection account for 63.8%. Patients were divided into four groups according to different operation method: routine radical resection group( n =174), portal vein reconstruction group ( n =47), hepatic artery reconstruction group ( n =24), palliative group( n =27). General information of patients who underwent radical operation treatment was analyzed by chi-square test and analysis of variance. The period of operation time, blood loss, the length of hospital stay and hospitalization expenses of the radical operation patients were analyzed by one-way ANOVA. Comparison among groups was analyzed by LSD- t test. Results: The follow-up ended up in June first, 2016. Each of patients followed for 6 to 60 months, the median follow-up period was 24 months. 1-, 3-, and 5-year survival rates were 81.3%, 44.9% and 13.5% of routine radical operation group, and were 83.0%, 44.7% and 15.1% of portal vein reconstruction group, and were 70.8%, 27.7% and 6.9% of hepatic artery reconstruction group, respectively. And 1-, 3-, and 5-year survival rates of hepatic artery reconstruction group was lower than routine radical group and portal vein reconstruction group significantly ( P <0.05). However, the rate of postoperative complications of the hepatic artery reconstruction group and the routine radical operation group and the portal vein reconstruction group were 62.5%(15/24), 55.3%(96/174) and 51.5%(24/47), respectively. There was no significant difference among them ( P >0.05). The data shows that the ratio of lymphatic metastasis in hepatic artery reconstruction group (70.8%) is much higher than them in routine radical operation group (20.1%) and portal vein reconstruction group (19.1%) significantly ( P <0.05). The presented data also indicate that hepatic artery resection prolongs survival time comparing with patients undergoing palliative therapy for hilar cholangiocarcinoma. Cox regression analysis indicate that hepatic artery resection and reconstruction is a protective factor compare with palliative therapy ( RR =0.38, 95% CI: 0.22-0.67). The significant reason for shorter survival time is a positive correlation between hepatic artery invasion and lymph node metastasis. Conclusion: Hepatic artery resection and reconstruction has beneficial impact on oncologic long-term outcome in patients with advanced stage hilar cholangiocarcinoma.

Hypothermia and local cold injuries in combat and non-combat situations--the Israeli experience.

PubMed

Moran, Daniel S; Heled, Yuval; Shani, Yoav; Epstein, Yoram

2003-03-01

Cold weather has been recognized in the Israel Defense Forces (IDF) as a potential medical and operational threat to the soldier. Although regulations have been issued to cope with this situation, every year about 20 cases of hypothermia (T(core) < 35 degrees C) and peripheral cold injuries are reported. This study was aimed at following cold weather injuries (CI) in the IDF in the period 1994-2001. 136 cases were reported to our institute during this period. All patients were from the general population of young (20 +/- 2 yr), male soldiers in the IDF. All were classified a priori as healthy, active subjects. Of these patients, 51% were diagnosed with mild hypothermia and 49% with peripheral CI. Among those soldiers who suffered from peripheral CI, less than 5% were diagnosed with frostbite. Most of the cases (76%) occurred in the winter months; however, 10% occurred in the spring, 13% in autumn, and 2 cases (1%) were reported in the summer. The majority of all CI cases occurred during routine scheduled training (51%), and 15% occurred during routine duties. Of the cases, 34% occurred during combat operations (mainly ambushing and surveillance). The present study provides data on CI cases in an army where the awareness of the hazards involved in hostile environments is extensive, and in which detailed regulations aimed to prevent these injuries are common practice. The Israeli experience indicates that CI is preventable in most instances by following a few simple regulations and providing proper education to the soldiers and their commanding officers.

Developing Process Maps as a Tool for a Surgical Infection Prevention Quality Improvement Initiative in Resource-Constrained Settings.

PubMed

Forrester, Jared A; Koritsanszky, Luca A; Amenu, Demisew; Haynes, Alex B; Berry, William R; Alemu, Seifu; Jiru, Fekadu; Weiser, Thomas G

2018-06-01

Surgical infections cause substantial morbidity and mortality in low-and middle-income countries (LMICs). To improve adherence to critical perioperative infection prevention standards, we developed Clean Cut, a checklist-based quality improvement program to improve compliance with best practices. We hypothesized that process mapping infection prevention activities can help clinicians identify strategies for improving surgical safety. We introduced Clean Cut at a tertiary hospital in Ethiopia. Infection prevention standards included skin antisepsis, ensuring a sterile field, instrument decontamination/sterilization, prophylactic antibiotic administration, routine swab/gauze counting, and use of a surgical safety checklist. Processes were mapped by a visiting surgical fellow and local operating theater staff to facilitate the development of contextually relevant solutions; processes were reassessed for improvements. Process mapping helped identify barriers to using alcohol-based hand solution due to skin irritation, inconsistent administration of prophylactic antibiotics due to variable delivery outside of the operating theater, inefficiencies in assuring sterility of surgical instruments through lack of confirmatory measures, and occurrences of retained surgical items through inappropriate guidelines, staffing, and training in proper routine gauze counting. Compliance with most processes improved significantly following organizational changes to align tasks with specific process goals. Enumerating the steps involved in surgical infection prevention using a process mapping technique helped identify opportunities for improving adherence and plotting contextually relevant solutions, resulting in superior compliance with antiseptic standards. Simplifying these process maps into an adaptable tool could be a powerful strategy for improving safe surgery delivery in LMICs. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Provider-initiated testing and counselling programmes in sub-Saharan Africa: a systematic review of their operational implementation.

PubMed

Roura, Maria; Watson-Jones, Deborah; Kahawita, Tanya M; Ferguson, Laura; Ross, David A

2013-02-20

The routine offer of an HIV test during patient-provider encounters is gaining momentum within HIV treatment and prevention programmes. This review examined the operational implementation of provider-initiated testing and counselling (PITC) programmes in sub-Saharan Africa. PUBMED, EMBASE, Global Health, COCHRANE Library and JSTOR databases were searched systematically for articles published in English between January 2000 and November 2010. Grey literature was explored through the websites of international and nongovernmental organizations. Eligibility of studies was based on predetermined criteria applied during independent screening by two researchers. We retained 44 studies out of 5088 references screened. PITC polices have been effective at identifying large numbers of previously undiagnosed individuals. However, the translation of policy guidance into practice has had mixed results, and in several studies of routine programmes the proportion of patients offered an HIV test was disappointingly low. There were wide variations in the rates of acceptance of the test and poor linkage of those testing positive to follow-up assessments and antiretroviral treatment. The challenges encountered encompass a range of areas from logistics, to data systems, human resources and management, reflecting some of the weaknesses of health systems in the region. The widespread adoption of PITC provides an unprecedented opportunity for identifying HIV-positive individuals who are already in contact with health services and should be accompanied by measures aimed at strengthening health systems and fostering the normalization of HIV at community level. The resources and effort needed to do this successfully should not be underestimated.

Verbal autopsy: current practices and challenges.

PubMed Central

Soleman, Nadia; Chandramohan, Daniel; Shibuya, Kenji

2006-01-01

Cause-of-death data derived from verbal autopsy (VA) are increasingly used for health planning, priority setting, monitoring and evaluation in countries with incomplete or no vital registration systems. In some regions of the world it is the only method available to obtain estimates on the distribution of causes of death. Currently, the VA method is routinely used at over 35 sites, mainly in Africa and Asia. In this paper, we present an overview of the VA process and the results of a review of VA tools and operating procedures used at demographic surveillance sites and sample vital registration systems. We asked for information from 36 field sites about field-operating procedures and reviewed 18 verbal autopsy questionnaires and 10 cause-of-death lists used in 13 countries. The format and content of VA questionnaires, field-operating procedures, cause-of-death lists and the procedures to derive causes of death from VA process varied substantially among sites. We discuss the consequences of using varied methods and conclude that the VA tools and procedures must be standardized and reliable in order to make accurate national and international comparisons of VA data. We also highlight further steps needed in the development of a standard VA process. PMID:16583084

Prospective, observational study comparing automated and visual point-of-care urinalysis in general practice

PubMed Central

van Delft, Sanne; Goedhart, Annelijn; Spigt, Mark; van Pinxteren, Bart; de Wit, Niek; Hopstaken, Rogier

2016-01-01

Objective Point-of-care testing (POCT) urinalysis might reduce errors in (subjective) reading, registration and communication of test results, and might also improve diagnostic outcome and optimise patient management. Evidence is lacking. In the present study, we have studied the analytical performance of automated urinalysis and visual urinalysis compared with a reference standard in routine general practice. Setting The study was performed in six general practitioner (GP) group practices in the Netherlands. Automated urinalysis was compared with visual urinalysis in these practices. Reference testing was performed in a primary care laboratory (Saltro, Utrecht, The Netherlands). Primary and secondary outcome measures Analytical performance of automated and visual urinalysis compared with the reference laboratory method was the primary outcome measure, analysed by calculating sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) and Cohen's κ coefficient for agreement. Secondary outcome measure was the user-friendliness of the POCT analyser. Results Automated urinalysis by experienced and routinely trained practice assistants in general practice performs as good as visual urinalysis for nitrite, leucocytes and erythrocytes. Agreement for nitrite is high for automated and visual urinalysis. κ's are 0.824 and 0.803 (ranked as very good and good, respectively). Agreement with the central laboratory reference standard for automated and visual urinalysis for leucocytes is rather poor (0.256 for POCT and 0.197 for visual, respectively, ranked as fair and poor). κ's for erythrocytes are higher: 0.517 (automated) and 0.416 (visual), both ranked as moderate. The Urisys 1100 analyser was easy to use and considered to be not prone to flaws. Conclusions Automated urinalysis performed as good as traditional visual urinalysis on reading of nitrite, leucocytes and erythrocytes in routine general practice. Implementation of automated urinalysis in general practice is justified as automation is expected to reduce human errors in patient identification and transcribing of results. PMID:27503860

Prospective, observational study comparing automated and visual point-of-care urinalysis in general practice.

PubMed

van Delft, Sanne; Goedhart, Annelijn; Spigt, Mark; van Pinxteren, Bart; de Wit, Niek; Hopstaken, Rogier

2016-08-08

Point-of-care testing (POCT) urinalysis might reduce errors in (subjective) reading, registration and communication of test results, and might also improve diagnostic outcome and optimise patient management. Evidence is lacking. In the present study, we have studied the analytical performance of automated urinalysis and visual urinalysis compared with a reference standard in routine general practice. The study was performed in six general practitioner (GP) group practices in the Netherlands. Automated urinalysis was compared with visual urinalysis in these practices. Reference testing was performed in a primary care laboratory (Saltro, Utrecht, The Netherlands). Analytical performance of automated and visual urinalysis compared with the reference laboratory method was the primary outcome measure, analysed by calculating sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) and Cohen's κ coefficient for agreement. Secondary outcome measure was the user-friendliness of the POCT analyser. Automated urinalysis by experienced and routinely trained practice assistants in general practice performs as good as visual urinalysis for nitrite, leucocytes and erythrocytes. Agreement for nitrite is high for automated and visual urinalysis. κ's are 0.824 and 0.803 (ranked as very good and good, respectively). Agreement with the central laboratory reference standard for automated and visual urinalysis for leucocytes is rather poor (0.256 for POCT and 0.197 for visual, respectively, ranked as fair and poor). κ's for erythrocytes are higher: 0.517 (automated) and 0.416 (visual), both ranked as moderate. The Urisys 1100 analyser was easy to use and considered to be not prone to flaws. Automated urinalysis performed as good as traditional visual urinalysis on reading of nitrite, leucocytes and erythrocytes in routine general practice. Implementation of automated urinalysis in general practice is justified as automation is expected to reduce human errors in patient identification and transcribing of results. 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/

Fundamentals of Counting Statistics in Digital PCR: I Just Measured Two Target Copies-What Does It Mean?

PubMed

Tzonev, Svilen

2018-01-01

Current commercially available digital PCR (dPCR) systems and assays are capable of detecting individual target molecules with considerable reliability. As tests are developed and validated for use on clinical samples, the need to understand and develop robust statistical analysis routines increases. This chapter covers the fundamental processes and limitations of detecting and reporting on single molecule detection. We cover the basics of quantification of targets and sources of imprecision. We describe the basic test concepts: sensitivity, specificity, limit of blank, limit of detection, and limit of quantification in the context of dPCR. We provide basic guidelines how to determine those, how to choose and interpret the operating point, and what factors may influence overall test performance in practice.

Case-finding for common mental disorders of anxiety and depression in primary care: an external validation of routinely collected data.

PubMed

John, Ann; McGregor, Joanne; Fone, David; Dunstan, Frank; Cornish, Rosie; Lyons, Ronan A; Lloyd, Keith R

2016-03-15

The robustness of epidemiological research using routinely collected primary care electronic data to support policy and practice for common mental disorders (CMD) anxiety and depression would be greatly enhanced by appropriate validation of diagnostic codes and algorithms for data extraction. We aimed to create a robust research platform for CMD using population-based, routinely collected primary care electronic data. We developed a set of Read code lists (diagnosis, symptoms, treatments) for the identification of anxiety and depression in the General Practice Database (GPD) within the Secure Anonymised Information Linkage Databank at Swansea University, and assessed 12 algorithms for Read codes to define cases according to various criteria. Annual incidence rates were calculated per 1000 person years at risk (PYAR) to assess recording practice for these CMD between January 1(st) 2000 and December 31(st) 2009. We anonymously linked the 2799 MHI-5 Caerphilly Health and Social Needs Survey (CHSNS) respondents aged 18 to 74 years to their routinely collected GP data in SAIL. We estimated the sensitivity, specificity and positive predictive value of the various algorithms using the MHI-5 as the gold standard. The incidence of combined depression/anxiety diagnoses remained stable over the ten-year period in a population of over 500,000 but symptoms increased from 6.5 to 20.7 per 1000 PYAR. A 'historical' GP diagnosis for depression/anxiety currently treated plus a current diagnosis (treated or untreated) resulted in a specificity of 0.96, sensitivity 0.29 and PPV 0.76. Adding current symptom codes improved sensitivity (0.32) with a marginal effect on specificity (0.95) and PPV (0.74). We have developed an algorithm with a high specificity and PPV of detecting cases of anxiety and depression from routine GP data that incorporates symptom codes to reflect GP coding behaviour. We have demonstrated that using diagnosis and current treatment alone to identify cases for depression and anxiety using routinely collected primary care data will miss a number of true cases given changes in GP recording behaviour. The Read code lists plus the developed algorithms will be applicable to other routinely collected primary care datasets, creating a platform for future e-cohort research into these conditions.

[The family in the Pediatric Unit: living with rules and hospital routines].

PubMed

Xavier, Daiani Modernel; Gomes, Giovana Calcagno; Santos, Silvana Sidney Costa; Lunardi, Valéria Lerch; Pintanel, Aline Campelo; Erdmann, Alacoque Lorenzini

2014-01-01

The study aimed to know, in Foucault's view, how the family caregiver of the child deals with the rules and routines in the hospital. Descriptive qualitative study, conducted in the second half of 2011. It had the Grounded Theory as methodological framework. It was developed in the pediatric unit of a university hospital in southern Brazil, with eighteen family caregivers. The data collection was performed by semi-structured interviews and the analysis through open, axial and selective coding. It was noticed that the family tends to conform to such rules and routines in the hospital, but recognizes the importance of its flexibility, exercising endurance, as dialoguing, or as trespassing such rules and routines, in search of autonomy, when they realize that these do not address their needs. It is important to use rules and routines to enable the family practices and spaces of freedom, autonomy and resistance.

Start-up and incremental practice expenses for behavior change interventions in primary care.

PubMed

Dodoo, Martey S; Krist, Alex H; Cifuentes, Maribel; Green, Larry A

2008-11-01

If behavior-change services are to be offered routinely in primary care practices, providers must be appropriately compensated. Estimating what is spent by practices in providing such services is a critical component of establishing appropriate payment and was the objective of this study. In-practice expenditure data were collected for ten different interventions, using a standardized instrument in 29 practices nested in ten practice-based research networks across the U.S. during 2006-2007. The data were analyzed using standard templates to create credible estimates of the expenses incurred for both the start-up period and the implementation phase of the interventions. Average monthly start-up expenses were $1860 per practice (SE=$455). Most start-up expenditures were for staff training. Average monthly incremental costs were $58 ($15 for provision of direct care [SE=$5]; $43 in overhead [SE=$17]) per patient participant. The bulk of the intervention expenditures was spent on the recruitment and screening of patient participants. Primary care practices must spend money to address their patients' unhealthy behaviors--at least $1860 to initiate systematic approaches and $58 monthly per participating patient to implement the approaches routinely. Until primary care payment systems incorporate these expenses, it is unlikely that these services will be readily available.

A Tale of 2 Techniques: Preoperative Biliary Drainage and Routine Surgical Drainage with Pancreaticoduodenectomy.

PubMed

Iskandar, Mazen E; Wayne, Michael G; Steele, Justin G; Cooperman, Avram M

2018-02-01

Preoperative drainage of an obstructed biliary tree before pancreaticoduodenal resection (PDR) and placement of intraabdominal drains following pancreatic resection have been suggested to be both unnecessary and associated with a higher complication rate. The evidence for and against that practice is presented and analyzed to highlight its risks and benefits. A selective approach on an individual basis for preoperative biliary decompression is advocated, based on multiple factors. Additionally, the evidence for routine use of surgical drains after PDR is critically reviewed and the rationale for routine drainage is made. Copyright © 2017 Elsevier Inc. All rights reserved.

A randomized study of two methods of teaching perineal massage: effects on practice rates, episiotomy rates, and lacerations.

PubMed

Mynaugh, P A

1991-09-01

This study examined the effects of two methods of teaching perineal massage on the rates of practice of perineal massage, of episiotomy, and of lacerations in primiparas at birth. Couples in 20 randomly selected sections of four prenatal class series received routine printed and verbal instruction and a 12-minute video demonstration of perineal massage, or only the routine printed and verbal instruction. Women reported their practice rates in daily diary records, which were mailed to the researcher weekly. Hospital records provided delivery data. Of the 83 women, 23 (28%) practiced perineal massage: 16 (35.6%) in the experimental group, 7 (18.4%) controls. Even though the rate of practice almost doubled among experimental group women, the videotape instruction method was statistically nonsignificant. Episiotomy and laceration rates were not affected by teaching method. More severe lacerations occurred among the experimental group; however, the control group had almost four times as many severe (21%) as minor (5.3%) lacerations. The experimental group had twice as many severe (28.9%) as minor (13.3%) lacerations. These results were also nonsignificant.

Heavy Metal Pad Shielding during Fluoroscopic Interventions

PubMed Central

Dromi, Sergio; Wood, Bradford J.; Oberoi, Jay; Neeman, Ziv

2008-01-01

Significant direct and scatter radiation doses to patient and physician may result from routine interventional radiology practice. A lead-free disposable tungsten antimony shielding pad was tested in phantom patients during simulated diagnostic angiography procedures. Although the exact risk of low doses of ionizing radiation is unknown, dramatic dose reductions can be seen with routine use of this simple, sterile pad made from lightweighttungsten antimony material. PMID:16868175

Step 6: Does Not Routinely Employ Practices, Procedures Unsupported by Scientific Evidence

PubMed Central

Goer, Henci; Sagady Leslie, Mayri; Romano, Amy

2007-01-01

Step 6 of the Ten Steps of Mother-Friendly Care addresses two issues: 1) the routine use of interventions (shaving, enemas, intravenous drips, withholding food and fluids, early rupture of membranes, and continuous electronic fetal monitoring; and 2) the optimal rates of induction, episiotomy, cesareans, and vaginal births after cesarean. Rationales for compliance and systematic reviews are presented. PMID:18523680

Refining Pragmatically-Appropriate Oral Communication via Computer-Simulated Conversations

ERIC Educational Resources Information Center

Sydorenko, Tetyana; Daurio, Phoebe; Thorne, Steven L.

2018-01-01

To address the problem of limited opportunities for practicing second language speaking in interaction, especially delicate interactions requiring pragmatic competence, we describe computer simulations designed for the oral practice of extended pragmatic routines and report on the affordances of such simulations for learning pragmatically…

An economic case for early adoption of preventative practices for management of grapevine trunk diseases

USDA-ARS?s Scientific Manuscript database

The trunk diseases Botryosphaeria dieback, Esca, Eutypa dieback, and Phomopsis dieback, significantly decrease yields and vineyard longevity in California. Despite high disease prevalence and substantial yield impacts, most growers routinely wait to adopt preventative practices until vineyards are ...

Aerospace safety advisory panel

NASA Technical Reports Server (NTRS)

1983-01-01

Data acquired on the actual flight experience with the various subsystems are assessed. These subsystems include: flight control and performance, structural integrity, orbiter landing gear, lithium batteries, EVA and prebreathing, and main engines. Improvements for routine operations are recommended. Policy issues for operations and flight safety for aircraft operations are discussed.

Self-Rehabilitation of a Captive American Crow at Binghamton Zoo.

PubMed

Davie, Clara; Clark, Anne B

2017-01-01

The behavioral transition from an entirely unflighted-to-flighted, female yearling American crow (Corvus brachyrhynchos) in captivity in a specially designed exhibit was documented at the Binghamton Zoo at Ross Park in Binghamton, NY. Upon arrival, the focal crow had no complete primary feathers or retrices and had been in captivity since fledging. She apparently had never flown successfully and was using her legs and an abnormal body orientation to cushion her landing on the ground. In a social and physical environment with 3 flying companion crows and staggered perches, she developed and appeared to "practice" routines that ultimately resulted in her recovering normal body posture and flight ability. The crow's practice routine was recorded during daily observations using an ethogram of social and locomotor behaviors. Both enclosure design and the social environment may have provided an ideal setting for the self-motivation of practice and this recovery. Attention to the potential for such practice could facilitate rehabilitation in individuals for whom rehabilitation was not thought possible.

Use of routine interventions in vaginal labor and birth: findings from the Maternity Experiences Survey.

PubMed

Chalmers, Beverley; Kaczorowski, Janusz; Levitt, Cheryl; Dzakpasu, Susie; O'Brien, Beverley; Lee, Lily; Boscoe, Madeline; Young, David

2009-03-01

Intervention rates in maternity practices vary considerably across Canadian provinces and territories. The objective of this study was to describe the use of routine interventions and practices in labor and birth as reported by women in the Maternity Experiences Survey of the Canadian Perinatal Surveillance System. Rates of interventions and practices are considered in the light of current evidence and both Canadian and international recommendations. A sample of 8,244 estimated eligible women was identified from a randomly selected sample of recently born infants drawn from the May 2006 Canadian Census and stratified primarily by province and territory. Birth mothers living with their infants at the time of interview were invited to participate in a computer-assisted telephone interview conducted by Statistics Canada on behalf of the Public Health Agency of Canada. Interviews averaged 45 minutes long and were completed when infants were between 5 and 10 months old (9-14 mo in the territories). Completed responses were obtained from 6,421 women (78%). Women frequently reported electronic fetal monitoring, a health care practitioner starting or speeding up their labor (or trying to do so), epidural anesthesia, episiotomy, and a supine position for birth. Some women also reported pubic or perineal shaves, enemas, and pushing on the top of their abdomen. Several practices and interventions were commonly reported in labor and birth in Canada, although evidence and Canadian and international guidelines recommend against their routine use. Practices not recommended for use at all, such as shaving, were also reported.

The Genetic Counseling Video Project (GCVP): Models of Practice

PubMed Central

Roter, D.; Ellington, L.; Erby, L. Hamby; Larson, S.; W, Dudley

2009-01-01

Genetic counseling is conceptualized as having both “teaching” and “counseling” functions; however, little is known about how these functions are articulated in routine practice. This study addresses the question by documenting, on videotape, the practices of a national sample of prenatal and cancer genetic counselors (GCs) providing routine pretest counseling to simulated clients (SCs). 177 GCs recruited at two annual conferences of the National Society of Genetic Counselors (NSGC) were randomly assigned to counsel one of six female SCs of varying ethnicity, with or without a spouse, in their specialty. 152 videotapes were coded with the Roter Interaction Analysis System (RIAS) and both GCs and SCs completed evaluative questionnaires. Two teaching and two counseling patterns of practice emerged from cluster analysis. The teaching patterns included: (1) Clinical teaching (31%) characterized by low psychosocial, emotional and facilitative talk, high levels of clinical exchange, and high verbal dominance; and (2) Psycho-educational teaching (27%) characterized by high levels of both clinical and psychosocial exchange, low levels of emotional and facilitative talk, and higher verbal dominance. The counseling patterns included: (1) Supportive counseling (33%) characterized by low psychosocial and clinical exchange, high levels of emotional and facilitative talk, and low verbal dominance; and (2) Psychosocial counseling (9%) with high emotional and facilitative talk, low clinical and high psychosocial exchange, and the lowest verbal dominance. SCs ratings of satisfaction with communication, the counselor’s affective demeanor, and the counselor’s use of nonverbal skills were highest for the counseling model sessions. Both the teaching and counseling models seem to be represented in routine practice and predict variation in client satisfaction. PMID:16941666

Oncological screening for Bilateral Breast Reduction: a survey of practice variations in UK Breast and Plastics surgeons 2009.

PubMed

Hennedige, Anusha A; Kong, Tze Yean; Gandhi, Ashu

2011-07-01

Bilateral Breast Reduction (BBR) is a common procedure performed by Breast and Plastic surgeons in the UK. No consensus exists regarding preoperative screening for malignancy or for selective criteria for such screening. Preoperative BBR screening practices among UK Breast and Plastic surgeons are unknown. Ascertain the preoperative and postoperative BBR screening practices of UK Breast and Plastic surgeons. A questionnaire was posted to all 434 Breast and 335 Plastic surgeons in the UK. All results were analysed with relevant statistical methods. 64% of Breast surgeons and 72% of Plastic surgeons responded. 40% of Breast surgeons and 91% of Plastic surgeons perform BBR. Routine radiological screening: 92% Breast 41% Plastic (p < 0.05). Routine breast examination prior to BBR: 98% Breast 91% Plastic. Routine histology for BBR specimens: 96% Breast 90% Plastic. Selective screening of patients aged 30-40 years old: Breast 38% Plastic 10%. Selective screening of patients aged 40-50: Breast 78%, Plastic 53%. Selective screening of patients with strong family history of breast cancer: Breast 72%, Plastic 91%. Selective screening of patients with previous breast cancer: Breast 77%, Plastic 93%. There are significant differences in practice between UK Breast surgeons and Plastic surgeons in preoperative oncological screening for BBR. The large discrepancy in preoperative radiological screening, reflects a ubiquitous pro-screening ideology among Breast surgeons not prevalent among Plastic surgeons. These results will provoke debate towards the direction of consensus to ultimately reflect best practice. Copyright © 2010. Published by Elsevier Ltd.

Physical therapy in preschool classrooms: successful integration of therapy into classroom routines.

PubMed

Sekerak, Darlene Massey; Kirkpatrick, Dana B; Nelson, Kristal C; Propes, June H

2003-01-01

This exploratory investigation identifies factors that contribute to success of physical therapy services delivered in the context of the daily routines in preschool classroom settings. Ten pediatric physical therapists from rural and urban communities across North Carolina served as informants during telephone interviews. Qualitative analysis of the data led to the identification of six major themes: interactions among classroom personnel, impact of the classroom environment, individual characteristics of the child, logistical considerations, administrative policies and practices, and service delivery options. All 10 informants shared the perception that the cooperation and commitment of the teacher was essential for successful incorporation of therapy activities in classroom routines. Furthermore, the informants agreed that multiple models of service delivery were necessary to meet the individual needs of children. These results lead the authors to question the wisdom of promoting any one service delivery model as "best practice" and suggest guidelines for successful integration of physical therapy in the preschool classroom.

Routine pharmacogenetic testing in clinical practice: dream or reality?

PubMed

Grossman, Iris

2007-10-01

Pharmacogenetics (PGx) has become progressively popular in recent years, thanks to growing anticipation among scientists, healthcare providers and the general public for the incorporation of genetic tests into the diagnostic arsenal at the physician's disposal. Indeed, much research has been dedicated to elucidation of genetic determinants underlying interindividual variability in pharmacokinetic parameters, as well as drug safety and efficacy. However, few PGx applications have thus far been realized in healthcare management. This review uses examples from PGx research of psychiatric drugs to illustrate why the current published findings are inadequate and insufficient for utilization as routine clinical predictors of treatment safety, efficacy or dosing. I therefore suggest the necessary steps to demonstrate the validity, utility and cost-effectiveness of PGx. These recommendations include a whole range of aspects, starting from standardization of criteria and assessment of the technical quality of genotyping assays, up to design of prospective PGx studies, providing the basis for reimbursement programs to be recognized in routine clinical practice.

Screwworm Eradication Data System (SEDS) operational manual, part 3

NASA Technical Reports Server (NTRS)

1976-01-01

All phases of SEDS operation as well as utility routines, error messages, and system disk maintenance procedures are described. Display layouts and examples of runs are included as additional explanation to SEDS program procedures.

77 FR 50504 - Clean Air Act Operating Permit Program; Action on Petition for Objection to State Operating...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-21

...) requirements because WDNR erroneously exempted as ``routine maintenance, repair, and replacement'' projects... were triggered through non-exempt fuel switching and WDNR improperly deferred addressing this issue...

The Arctic Lower Troposphere Observed Structure (ALTOS) Campaign

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

Verlinde, J

2010-10-18

The ALTOS campaign focuses on operating a tethered observing system for routine in situ sampling of low-level (< 2 km) Arctic clouds. It has been a long-term hope to fly tethered systems at Barrow, Alaska, but it is clear that the Federal Aviation Administration (FAA) will not permit in-cloud tether systems at Barrow, even if unmanned aerial vehicle (UAV) operations are allowed in the future. We have provided the scientific rationale for long-term, routine in situ measurements of cloud and aerosol properties in the Arctic. The existing restricted air space at Oliktok offers an opportunity to do so.

ATLAS, an integrated structural analysis and design system. Volume 2: System design document

NASA Technical Reports Server (NTRS)

Erickson, W. J. (Editor)

1979-01-01

ATLAS is a structural analysis and design system, operational on the Control Data Corporation 6600/CYBER computers. The overall system design, the design of the individual program modules, and the routines in the ATLAS system library are described. The overall design is discussed in terms of system architecture, executive function, data base structure, user program interfaces and operational procedures. The program module sections include detailed code description, common block usage and random access file usage. The description of the ATLAS program library includes all information needed to use these general purpose routines.

Reliability of shear wave ultrasound elastography for neck lesions identified in routine clinical practice.

PubMed

Bhatia, K; Tong, C S L; Cho, C C M; Yuen, E H Y; Lee, J; Ahuja, A T

2012-10-01

To evaluate the reliability of shear wave ultrasound elastography (SWE) in the neck. 176 neck lesions (40 thyroid, 56 lymph nodes, 46 salivary, 34 miscellaneous) identified in a routine US clinic underwent SWE by one or two blinded radiologists. For this study, SWE required the operator to acquire three 10 second dynamic colour-coded SWE cineloops per lesion, select one static image per cineloop, and place circular regions-of-interest within the entire lesion and stiffest part to generate 3 SWE measurements per static image. For logistical reasons, one radiologist evaluated all 176 lesions and the other evaluated 58 lesions. Both radiologists also reviewed 27 archived cineloops independently to assess SWE excluding practical technique. Reliability was assessed using intraclass correlation coefficients (ICCs) concordance correlation coefficients (CCCs) and coefficients of repeatability (CORs). Test-retest ICCs for the radiologist evaluating 176 lesions were 0.78 - 0.85 (fair-excellent agreement), CCCs were 0.85 - 0.88 (substantial agreement), and CORs were 14.9 - 36.1 kPa. For both radiologists evaluating 58 lesions, intra-rater and inter-rater ICCs were 0.65 - 0.78 and 0.72 - 0.77 respectively. For SWE excluding practical technique, inter-rater ICCs were 0.97 - 0.98 (excellent agreement). ICCs differed according to tissue, being higher in thyroid lesions than lymph nodes (p < 0.001), and higher in benign than malignant lesions (p values < 0.001). Intra- and inter-rater reliability of SWE is fair to excellent according to ICCs. SWE reliability is influenced appreciably by acquisition technique. Nevertheless, CORs for SWE are not negligible. To determine whether these results are acceptable clinically, further research is required to establish SWE stiffness values of normal and pathological tissues in the neck. © Georg Thieme Verlag KG Stuttgart · New York.

Optimizing Water Use and Hydropower Production in Operational Reservoir System Scheduling with RiverWare

NASA Astrophysics Data System (ADS)

Magee, T. M.; Zagona, E. A.

2017-12-01

Practical operational optimization of multipurpose reservoir systems is challenging for several reasons. Each purpose has its own constraints which may conflict with those of other purposes. While hydropower generation typically provides the bulk of the revenue, it is also among the lowest priority purposes. Each river system has important details that are specific to the location such as hydrology, reservoir storage capacity, physical limitations, bottlenecks, and the continuing evolution of operational policy. In addition, reservoir operations models include discrete, nonlinear, and nonconvex physical processes and if-then operating policies. Typically, the forecast horizon for scheduling needs to be extended far into the future to avoid near term (e.g., a few hours or a day) scheduling decisions that result in undesirable future states; this makes the computational effort much larger than may be expected. Put together, these challenges lead to large and customized mathematical optimization problems which must be solved efficiently to be of practical use. In addition, the solution process must be robust in an operational setting. We discuss a unique modeling approach in RiverWare that meets these challenges in an operational setting. The approach combines a Preemptive Linear Goal Programming optimization model to handle prioritized policies complimented by preprocessing and postprocessing with Rulebased Simulation to improve the solution with regard to nonlinearities, discrete issues, and if-then logic. An interactive policy language with a graphical user interface allows modelers to customize both the optimization and simulation based on the unique aspects of the policy for their system while the routine physical aspect of operations are modeled automatically. The modeler is aided by a set of compiled predefined functions and functions shared by other modelers. We illustrate the success of the approach with examples from daily use at the Tennessee Valley Authority, the Bonneville Power Administration, and public utility districts on the Mid-Columbia River. We discuss recent innovations to improve solution quality, robustness, and performance for these systems. We conclude with new modeling challenges to extend the modeling approach to other uses.

Video-assisted feedback in general practice internships using German general practitioner's guidelines

PubMed Central

Bölter, Regine; Freund, Tobias; Ledig, Thomas; Boll, Bernhard; Szecsenyi, Joachim; Roos, Marco

2012-01-01

Introduction: The planned modification of the Medical Licenses Act in Germany will strengthen the specialty of general practice. Therefore, medical students should get to know the daily routine of general practitioners during their academic studies. At least 10% of students should get the possibility to spend one quarter of the internship, in the last year of their academic studies, in a practice of family medicine. The demonstrated teaching method aims at giving feedback to the student based on video recordings of patient consultations (student-patient) with the help of a checklist. Video-feedback is already successful used in medical teaching in Germany and abroad. This feasibility study aims at assessing the practicability of video-assisted feedback as a teaching method during internship in general practice. Teaching method: First of all, the general practice chooses a guideline as the learning objective. Secondly, a subsequent patient – student – consultation is recorded on video. Afterwards, a video-assisted formative feedback is given by the physician. A checklist with learning objectives (communication, medical examination, a structured case report according to the guideline) is used to structure the feedback content. Feasibility: The feasibility was assessed by a semi structured interview in order to gain insight into barriers and challenges for future implementation. The teaching method was performed in one general practice. Afterwards the teaching physician and the trainee intern were interviewed. The following four main categories were identified: feasibility, performance, implementation in daily routine, challenges of the teaching concept. The results of the feasibility study show general practicability of this approach. Installing a video camera in one examination room may solve technical problems. The trainee intern mentioned theoretical and practical benefits using the guideline. The teaching physician noted the challenge to reflect on his daily routines in the light of evidence-based guidelines. Conclusion: This teaching method supports quality control and standardizing of learning objectives during the internship in general practice by using general practice guidelines. The use of a checklist enhances this method in general practice. We consider the presented teaching method in the context of the planned modification of the Medical Licenses Act is part of quality control and standardisation of medical teaching during general practice internships. In order to validate these presumptions, further, evaluation of this method concerning the learning objectives using the guidelines of general practice need to be carried out. PMID:23255963

Video-assisted feedback in general practice internships using German general practitioner's guidelines.

PubMed

Bölter, Regine; Freund, Tobias; Ledig, Thomas; Boll, Bernhard; Szecsenyi, Joachim; Roos, Marco

2012-01-01

The planned modification of the Medical Licenses Act in Germany will strengthen the specialty of general practice. Therefore, medical students should get to know the daily routine of general practitioners during their academic studies. At least 10% of students should get the possibility to spend one quarter of the internship, in the last year of their academic studies, in a practice of family medicine. The demonstrated teaching method aims at giving feedback to the student based on video recordings of patient consultations (student-patient) with the help of a checklist. Video-feedback is already successful used in medical teaching in Germany and abroad. This feasibility study aims at assessing the practicability of video-assisted feedback as a teaching method during internship in general practice. First of all, the general practice chooses a guideline as the learning objective. Secondly, a subsequent patient - student - consultation is recorded on video. Afterwards, a video-assisted formative feedback is given by the physician. A checklist with learning objectives (communication, medical examination, a structured case report according to the guideline) is used to structure the feedback content. The feasibility was assessed by a semi structured interview in order to gain insight into barriers and challenges for future implementation. The teaching method was performed in one general practice. Afterwards the teaching physician and the trainee intern were interviewed. The Following four main categories were identified: feasibility, performance, implementation in daily routine, challenges of the teaching concept.The results of the feasibility study show general practicability of this approach. Installing a video camera in one examination room may solve technical problems. The trainee intern mentioned theoretical and practical benefits using the guideline. The teaching physician noted the challenge to reflect on his daily routines in the light of evidence-based guidelines. This teaching method supports quality control and standardizing of learning objectives during the internship in general practice by using general practice guidelines. The use of a checklist enhances this method in general practice. We consider the presented teaching method in the context of the planned modification of the Medical Licenses Act is part of quality control and standardisation of medical teaching during general practice internships. In order to validate these presumptions, further, evaluation of this method concerning the learning objectives using the guidelines of general practice need to be carried out.

The Necessity for Routine Pre-operative Ultrasound Mapping Before Arteriovenous Fistula Creation: A Meta-analysis.

PubMed

Georgiadis, G S; Charalampidis, D G; Argyriou, C; Georgakarakos, E I; Lazarides, M K

2015-05-01

Existing guidelines suggest routine use of pre-operative color Doppler ultrasound (DUS) vessel mapping before the creation of arteriovenous fistulae (AVF); however, there is controversy about its benefit over traditional clinical examination or selective ultrasound use. This was a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing routine DUS mapping before the creation of AVF with patients for whom the decision for AVF placement was based on clinical examination and selective ultrasound use. A search of MEDLINE/PubMed, SCOPUS, and the Cochrane Library was carried out in June 2014. The analyzed outcome measures were the immediate failure rate and the early/midterm adequacy of the fistula for hemodialysis. Additionally, assessment of the methodological quality of the included studies was carried out. Five studies (574 patients) were analyzed. A random effects model was used to pool the data. The pooled odds ratio (OR) for the immediate failure rate was 0.32 (95% confidence interval [CI] 0.17-0.60; p < .01), which was significantly in favor of the DUS mapping group. The pooled OR for the early/midterm adequacy for hemodialysis was 0.66 (95% CI 0.42-1.03; p = .06), with a trend in favor of the DUS mapping group; however, subgroup analysis revealed that routine DUS mapping was more beneficial than selective DUS (p < .05). The available evidence, based mainly on moderate quality RCTs, suggests that the pre-operative clinical examination should always be supplemented with routine DUS mapping before AVF creation. This policy avoids negative surgical explorations and significantly reduces the immediate AVF failure rate. Copyright © 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Chest physiotherapy and breathing exercises for cardiac surgery patients in Sweden--a national survey of practice.

PubMed

Westerdahl, E; Olsén, M Fagevik

2011-06-01

Various chest physiotherapy techniques are recommended after cardiac surgery around the world. There is limited published data on what breathing exercises actually are recommended to patients after surgery in Europe. The aim of this national survey was to establish the current practice of chest physiotherapy and breathing exercises for adult patients following cardiac surgery in Sweden. A postal questionnaire was sent to a total population sample of 33 Swedish physiotherapists working at the departments of cardiothoracic surgery in December 2007 and January 2008. In total, 29 replies (88%) were received. Seven male and twenty two female physiotherapists completed the questionnaire. All physiotherapists instructed, on a regular basis, the cardiac surgery patients to perform post-operative breathing exercises. Positive expiratory pressure (PEP) breathing was routinely used as the first choice for treatment by 22 (83%) of the physiotherapists. Expiratory pressures used varied between 2 and 20 cm H2O. Recommended frequency and duration of the exercises varied from 4 to 30 breaths hourly during the daytime in the first post-operative days. All physiotherapists provided coughing support to the patients. Recommendations to continue breathing exercises after discharge varied from not at all up to 3 months after surgery. Breathing exercises are regularly prescribed during the initial post-operative days after cardiac surgery in Sweden. Hourly deep breathing exercises performed with or without a PEP device were reported to be first choice treatments during the hospital stay. Instructions concerning how long patients should continue the exercises after discharge varied notably.

Stochastic determination of matrix determinants.

PubMed

Dorn, Sebastian; Ensslin, Torsten A

2015-07-01

Matrix determinants play an important role in data analysis, in particular when Gaussian processes are involved. Due to currently exploding data volumes, linear operations-matrices-acting on the data are often not accessible directly but are only represented indirectly in form of a computer routine. Such a routine implements the transformation a data vector undergoes under matrix multiplication. While efficient probing routines to estimate a matrix's diagonal or trace, based solely on such computationally affordable matrix-vector multiplications, are well known and frequently used in signal inference, there is no stochastic estimate for its determinant. We introduce a probing method for the logarithm of a determinant of a linear operator. Our method rests upon a reformulation of the log-determinant by an integral representation and the transformation of the involved terms into stochastic expressions. This stochastic determinant determination enables large-size applications in Bayesian inference, in particular evidence calculations, model comparison, and posterior determination.

Diagnostic accuracy of routine blood examinations and CSF lactate level for post-neurosurgical bacterial meningitis.

PubMed

Zhang, Yang; Xiao, Xiong; Zhang, Junting; Gao, Zhixian; Ji, Nan; Zhang, Liwei

2017-06-01

To evaluate the diagnostic accuracy of routine blood examinations and Cerebrospinal Fluid (CSF) lactate level for Post-neurosurgical Bacterial Meningitis (PBM) at a large sample-size of post-neurosurgical patients. The diagnostic accuracies of routine blood examinations and CSF lactate level to distinguish between PAM and PBM were evaluated with the values of the Area Under the Curve of the Receiver Operating Characteristic (AUC -ROC ) by retrospectively analyzing the datasets of post-neurosurgical patients in the clinical information databases. The diagnostic accuracy of routine blood examinations was relatively low (AUC -ROC <0.7). The CSF lactate level achieved rather high diagnostic accuracy (AUC -ROC =0.891; CI 95%, 0.852-0.922). The variables of patient age, operation duration, surgical diagnosis and postoperative days (the interval days between the neurosurgery and examinations) were shown to affect the diagnostic accuracy of these examinations. The variables were integrated with routine blood examinations and CSF lactate level by Fisher discriminant analysis to improve their diagnostic accuracy. As a result, the diagnostic accuracy of blood examinations and CSF lactate level was significantly improved with an AUC -ROC value=0.760 (CI 95%, 0.737-0.782) and 0.921 (CI 95%, 0.887-0.948) respectively. The PBM diagnostic accuracy of routine blood examinations was relatively low, whereas the accuracy of CSF lactate level was high. Some variables that are involved in the incidence of PBM can also affect the diagnostic accuracy for PBM. Taking into account the effects of these variables significantly improves the diagnostic accuracies of routine blood examinations and CSF lactate level. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

MR efficiency using automated MRI-desktop eProtocol

NASA Astrophysics Data System (ADS)

Gao, Fei; Xu, Yanzhe; Panda, Anshuman; Zhang, Min; Hanson, James; Su, Congzhe; Wu, Teresa; Pavlicek, William; James, Judy R.

2017-03-01

MRI protocols are instruction sheets that radiology technologists use in routine clinical practice for guidance (e.g., slice position, acquisition parameters etc.). In Mayo Clinic Arizona (MCA), there are over 900 MR protocols (ranging across neuro, body, cardiac, breast etc.) which makes maintaining and updating the protocol instructions a labor intensive effort. The task is even more challenging given different vendors (Siemens, GE etc.). This is a universal problem faced by all the hospitals and/or medical research institutions. To increase the efficiency of the MR practice, we designed and implemented a web-based platform (eProtocol) to automate the management of MRI protocols. It is built upon a database that automatically extracts protocol information from DICOM compliant images and provides a user-friendly interface to the technologists to create, edit and update the protocols. Advanced operations such as protocol migrations from scanner to scanner and capability to upload Multimedia content were also implemented. To the best of our knowledge, eProtocol is the first MR protocol automated management tool used clinically. It is expected that this platform will significantly improve the radiology operations efficiency including better image quality and exam consistency, fewer repeat examinations and less acquisition errors. These protocols instructions will be readily available to the technologists during scans. In addition, this web-based platform can be extended to other imaging modalities such as CT, Mammography, and Interventional Radiology and different vendors for imaging protocol management.

[Guide for the use of jet-ventilation during ENT and oral surgery].

PubMed

Bourgain, J-L; Chollet, M; Fischler, M; Gueret, G; Mayne, A

2010-10-01

The aim of this synthesis was to give recommendations on the use of jet-ventilation during ENT surgical and endoscopy procedures. Literature was collected from PUBMED and analysed by the members of French association of anaesthesiologists in ENT surgery, all skilled in this field. Presentation of these recommendations was given during the general assembly held in Reims, the 15th May 2009. Jet-ventilation is especially indicated during upper airway endoscopy and laryngeal invasive endoscopic surgery. Furthermore, transtracheal jet ventilation is included on most of difficult oxygenation and difficult intubation algorithm. The main risk of jet-ventilation is pulmonary barotrauma when expiration of injected gas is impeded by an upper airway obstruction. Failure and complications of tracheal puncture are rare when performed by experimented operators. Clinical use of jet ventilation requires a dedicated device. Practice of jet ventilation without intubation may be dangerous when applied without control of driving pressure and end expiratory tracheal pressure. Every anaesthetist should be familiar with transtracheal ventilation since they may face a "cannot ventilate cannot intubate" situation. Upper airway endoscopy and laryngeal surgery are the ideal field for training jet ventilation, even more so as this technique offers perfect operative conditions. To apply this project, jet ventilation should be used more frequently in routine practice. To maintain skill, regular use of these techniques is required. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

An evidence-based approach to perioperative nutrition support in the elective surgery patient.

PubMed

Miller, Keith R; Wischmeyer, Paul E; Taylor, Beth; McClave, Stephen A

2013-09-01

In surgical practice, great attention is given to the perioperative management of the elective surgical patient with regard to surgical planning, stratification of cardiopulmonary risk, and postoperative assessment for complication. However, growing evidence supports the beneficial role for implementation of a consistent and literature-based approach to perioperative nutrition therapy. Determining nutrition risk should be a routine component of the preoperative evaluation. As with the above issues, this concept begins with the clinician's first visit with the patient as risk is assessed and the severity of the surgical insult considered. If the patient is an appropriate candidate for benefit from preoperative support, a plan for initiation and reassessment should be implemented. Once appropriate nutrition end points have been achieved, special consideration should be given to beneficial practices the immediate day preceding surgery that may better prepare the patient for the intervention from a metabolic standpoint. In the operating room, consideration should be given to the potential placement of enteral access during the index operation as well as judicious and targeted intraoperative resuscitation. Immediately following the intervention, adequate resuscitation and glycemic control are key concepts, as is an evidence-based approach to the early advancement of an enteral/oral diet in the postoperative patient. Through the implementation of perioperative nutrition therapy plans in the elective surgery setting, outcomes can be improved.

12 CFR 225.171 - What are the limitations on managing or operating a portfolio company held as a merchant banking...

Code of Federal Regulations, 2010 CFR

2010-01-01

...?—(1) Examples of routine management or operation—(i) Executive officer interlocks at the portfolio... hiring officers or employees other than executive officers. (2) Presumptions of routine management or... paragraph (e) of this section. (2) Covenants or other provisions regarding extraordinary events. A financial...

Multitasking scheduler works without OS

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

Howard, D.M.

1982-09-15

Z80 control applications requiring parallel execution of multiple software tasks can use the executive routine described and listed in this article when multitasking is not available via an operating system (OS). Although the routine is not as capable or as transparent to software as the multitasking in a full-scale OS, it is simple to understand and use.

Identifying Human Papillomavirus Vaccination Practices Among Primary Care Providers of Minority, Low-Income and Immigrant Patient Populations

PubMed Central

Bruno, Denise M.; Wilson, Tracey E.; Gany, Francesca; Aragones, Abraham

2014-01-01

Objective Minority populations in the United States are disproportionally affected by Human Papillomavirus (HPV) infection and HPV-related cancer. We sought to understand physician practices, knowledge and beliefs that affect utilization of the HPV vaccine in primary care settings serving large minority populations in areas with increased rates of HPV-related cancer. Study Design Cross-sectional survey of randomly selected primary care providers, including pediatricians, family practice physicians and internists, serving large minority populations in Brooklyn, N.Y. and in areas with higher than average cervical cancer rates. Results Of 156 physicians randomly selected, 121 eligible providers responded to the survey; 64% were pediatricians, 19% were internists and 17% were family practitioners. Thirty-four percent of respondents reported that they routinely offered HPV vaccine to their eligible patients. Seventy percent of physicians reported that the lack of preventive care visits for patients in the eligible age group limited their ability to recommend the HPV vaccine and 70% of those who reported this barrier do not routinely recommend HPV vaccine. The lack of time to educate parents about the HPV vaccine and cost of the vaccine to their patients were two commonly reported barriers that affected whether providers offered the vaccine. Conclusions Our study found that the majority of providers serving the highest risk populations for HPV infection and HPV-related cancers are not routinely recommending the HPV vaccine to their patients. Reasons for providers' failure to recommend the HPV vaccine routinely are identified and possible areas for targeted interventions to increase HPV vaccination rates are discussed. PMID:24886959

Using the mouse grimace scale to assess pain associated with routine ear notching and the effect of analgesia in laboratory mice.

PubMed

Miller, A L; Leach, M C

2015-04-01

Social housing is recommended where possible for laboratory mice. In order to achieve this, mice must be individually identifiable. Although, various methods are available, permanent identification is often required, such as ear notching. This method is likely to be painful and to date there is limited literature on pain assessment and alleviation for this routine husbandry practice. Here we aimed to determine if the mouse grimace scale (MGS) could be used to assess pain in C57BL/6 mice following routine ear notching. Langford et al. found that very acute noxious stimuli (i.e. < 10 min in duration) did not produce a change in MGS score in comparison to baseline. Here, no significant difference was found between MGS scores at baseline and immediately post ear notching, potentially indicating that the pain associated with ear notching is either too acute to assess using the MGS tool or the practice is not painful. Studies in other species indicate that ear notching is painful, therefore, unless we can confidently conclude that the process of ear notching is not painful, we should err on the side of caution and assume it is painful due to the large number of mice ear-notched and potential welfare consequences. Alternative methods of assessing pain following this routine practice should be used in order to assess both the potential pain in mice, and the effectiveness of analgesics or local anaesthetics to relieve any associated pain. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

USAFA/8086 - A State of the Art Microprocessor System. Volume II. Software Documentation.

DTIC Science & Technology

1980-06-01

34 /* THE THREE FOLLOWING STRUCTU2RES APE NECESSARY TO MLLLO ThE OPERATING SYTEM TO HAVE INDIRECT ACCESS TL 41EMOP *. 13- ** _3_ -- - , -- K k"" , PijPL...FILLJ$ ERROR$ ONE IOPB CHECKER LINK$IN$ DIR$IN$ ABM $IN$ DATA$IN$ OUT OUT OUT OUT DisK86 MODUlE FiGuRE 8. DATA TRANSFER UTILITIE.S 62 In addition to...SUPPORT ROUTINES. Table 3 shows the functions of these routines. TABLE 3. SUPPORT PROCEDURES ROUTINE FUNCTION ABM $ZERO Makes a given sector on a

Introduction to IND and recursive partitioning, version 1.0

NASA Technical Reports Server (NTRS)

Buntine, Wray; Caruana, Rich

1991-01-01

This manual describes the IND package for learning tree classifiers from data. The package is an integrated C and C shell re-implementation of tree learning routines such as CART, C4, and various MDL and Bayesian variations. The package includes routines for experiment control, interactive operation, and analysis of tree building. The manual introduces the system and its many options, gives a basic review of tree learning, contains a guide to the literature and a glossary, lists the manual pages for the routines, and instructions on installation.

A survey of the current use of neuromuscular blocking drugs among the Middle Eastern anesthesiologists.

PubMed

Eldawlatly, Abdelazeem; El-Tahan, Mohamed R

2013-04-01

This survey aimed to assess the extent of practice of the Middle Eastern anesthesiologists in the use of neuromuscular blocking agents (NMB) in 2012. We distributed an electronic survey among 577 members of the Triple-M Middle Eastern Yahoo anesthesia group, enquiring about their practice in the use of neuromuscular blocking agents. Questions concerned the routine first choice use of NMB, choice for tracheal intubation, the use of neuromuscular monitoring (NMT), type of NMB used in difficult airway, frequency of using suxamethonium, cisatracurium, rocuronium and sugammadex, observed side effects of rocuronium, residual curarization, and the reversal of residual curarization of rocuronium. A total of 71 responses from 22 Middle Eastern institutions were collected. Most of the Middle Eastern anesthesiologists were using cisatracurium and rocuronium frequently for tracheal intubation (39% and 35%, respectively). From the respondents, 2/3 were using suxamethonium for tracheal intubation in difficult airway, 1/3 were using rocuronium routinely and 17% have observed hypersensitivity reactions to rocuronium, 54% reported residual curarization from rocuronium, 78% were routinely using neostigmine to reverse the rocuronium, 21% used sugammadex occasionally, and 35% were using NMT routinely during the use of NMB. We believe that more could be done to increase the awareness of the Middle Eastern anesthesiologists about the high incidence of PROC (>20%) and the need for routine monitoring of neuromuscular function. This could be accomplished with by developing formal training programs and providing official guidelines.

"Unwalling" the Classroom: Teacher Reaction and Adaptation

ERIC Educational Resources Information Center

Deed, Craig; Lesko, Thomas

2015-01-01

Modern open school architecture abstractly expresses ideas about choice, flexibility and autonomy. While open spaces express and authorise different teaching practice, these versions of school and classrooms present challenges to teaching routines and practice. This paper examines how teachers adapt as they move into new school buildings designed…

Practicing Algebraic Skills: A Conceptual Approach

ERIC Educational Resources Information Center

Friedlander, Alex; Arcavi, Abraham

2012-01-01

Traditionally, a considerable part of teaching and learning algebra has focused on routine practice and the application of rules, procedures, and techniques. Although today's computerized environments may have decreased the need to master algebraic skills, procedural competence is still a central component in any mathematical activity. However,…

Electronic Communities of Practice: Guidelines from a Project

ERIC Educational Resources Information Center

Ho, Kendall; Jarvis-Selinger, Sandra; Norman, Cameron D.; Li, Linda C.; Olatunbosun, Tunde; Cressman, Celine; Nguyen, Anne

2010-01-01

The timely incorporation of health research into the routine practice of individual health practitioners and interprofessional teams is a widely recognized and ongoing challenge. Health professional engagement and learning is an important cog in the wheel of knowledge translation; passive dissemination of evidence through journals and clinical…

Activity-Based Intervention Practices in Special Education

ERIC Educational Resources Information Center

Ozen, Arzu; Ergenekon, Yasemin

2011-01-01

Teaching practices in natural settings such as activity-based intervention (ABI) are suggested as alternatives to be used in effective early childhood education. As a multidisciplinary model, ABI consists of four components, which are choosing activities according to the child's interests; teaching generalizable goals embedded in routines and…

Identifying economic hurdles to early adoption of trunk disease preventative practices in California winegrape vineyards

USDA-ARS?s Scientific Manuscript database

Trunk diseases poses a serious threat to winegrape growers. Despite high prevalence and substantial consequences, growers routinely wait to adopt field-tested, preventative practices (delayed pruning, double pruning, or application of pruning wound protectant) until symptomatic vines appear (~10 yea...

Remote Operations of Laser Guide Star Systems: Gemini Observatory.

NASA Astrophysics Data System (ADS)

Oram, Richard J.; Fesquet, Vincent; Wyman, Robert; D'Orgeville, Celine

2011-03-01

The Gemini North telescope, equipped with a 14W laser, has been providing Laser Guide Star Adaptive Optics (LGS AO) regular science queue observations for worldwide astronomers since February 2007. The new 55W laser system for MCAO was installed on the Gemini South telescope in May 2010. In this paper, we comment on how Gemini Observatory developed regular remote operation of the Laser Guide Star Facility and high-power solid-state laser as routine normal operations. Fully remote operation of the LGSF from the Hilo base facility HBF was initially trialed and then optimized and became the standard operating procedure (SOP) for LGS operation in December 2008. From an engineering perspective remote operation demands stable, well characterized and base-lined equipment sets. In the effort to produce consistent, stable and controlled laser parameters (power, wavelength and beam quality) we completed a failure mode effect analysis of the laser system and sub systems that initiated a campaign of hardware upgrades and procedural improvements to the routine maintenance operations. Finally, we provide an overview of normal operation procedures during LGS runs and present a snapshot of data accumulated over several years that describes the overall LGS AO observing efficiency at the Gemini North telescope.

Organizational routines, innovation, and flexibility: the application of narrative networks to dynamic workflow.

PubMed

Hayes, Gillian R; Lee, Charlotte P; Dourish, Paul

2011-08-01

The purpose of this paper is to demonstrate how current visual representations of organizational and technological processes do not fully account for the variability present in everyday practices. We further demonstrate how narrative networks can augment these representations to indicate potential areas for successful or problematic adoption of new technologies and potential needs for additional training. We conducted a qualitative study of the processes and routines at a major academic medical center slated to be supported by the development and installation of a new comprehensive HIT system. We used qualitative data collection techniques including observations of the activities to be supported by the new system and interviews with department heads, researchers, and both clinical and non-clinical staff. We conducted a narrative network analysis of these data by choosing exemplar processes to be modeled, selecting and analyzing narrative fragments, and developing visual representations of the interconnection of these narratives. Narrative networks enable us to view the variety of ways work has been and can be performed in practice, influencing our ability to design for innovation in use. Narrative networks are a means for analyzing and visualizing organizational routines in concert with more traditional requirements engineering, workflow modeling, and quality improvement outcome measurement. This type of analysis can support a deeper and more nuanced understanding of how and why certain routines continue to exist, change, or stop entirely. At the same time, it can illuminate areas in which adoption may be slow, more training or communication may be needed, and routines preferred by the leadership are subverted by routines preferred by the staff. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Practical issues in implementing whole-genome-sequencing in routine diagnostic microbiology.

PubMed

Rossen, J W A; Friedrich, A W; Moran-Gilad, J

2018-04-01

Next generation sequencing (NGS) is increasingly being used in clinical microbiology. Like every new technology adopted in microbiology, the integration of NGS into clinical and routine workflows must be carefully managed. To review the practical aspects of implementing bacterial whole genome sequencing (WGS) in routine diagnostic laboratories. Review of the literature and expert opinion. In this review, we discuss when and how to integrate whole genome sequencing (WGS) in the routine workflow of the clinical laboratory. In addition, as the microbiology laboratories have to adhere to various national and international regulations and criteria for their accreditation, we deliberate on quality control issues for using WGS in microbiology, including the importance of proficiency testing. Furthermore, the current and future place of this technology in the diagnostic hierarchy of microbiology is described as well as the necessity of maintaining backwards compatibility with already established methods. Finally, we speculate on the question of whether WGS can entirely replace routine microbiology in the future and the tension between the fact that most sequencers are designed to process multiple samples in parallel whereas for optimal diagnosis a one-by-one processing of the samples is preferred. Special reference is made to the cost and turnaround time of WGS in diagnostic laboratories. Further development is required to improve the workflow for WGS, in particular to shorten the turnaround time, reduce costs, and streamline downstream data analyses. Only when these processes reach maturity will reliance on WGS for routine patient management and infection control management become feasible, enabling the transformation of clinical microbiology into a genome-based and personalized diagnostic field. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

What is the yield of routine chest radiography following tube thoracostomy for trauma?

PubMed

Kong, Victor Y; Oosthuizen, George V; Clarke, Damian L

2015-01-01

Routine chest radiography (CXR) following tube thoracostomy (TT) is a standard practice in most trauma centres worldwide. Evidence supporting this routine practice is lacking and the actual yield is unknown. We performed a retrospective review of 1042 patients over a 4-year period who had a routine post-insertion CXR performed in accordance with current ATLS® recommendations. A total 1042 TTs were performed on 1004 patients. Ninety-one per cent of patients (913/1004) were males, and the median age for all patients was 24 years. Seventy-five per cent of all injuries (756/1004) were from penetrating trauma, and the remaining 25% (248/1004) were from blunt. The initial pathologies requiring TT were: haemopneumothorax: 34% (339/1042), haemothroax: 31% (314/1042), simple pneumothorax: 25% (256/1042), tension pneumothorax: 8% (77/1042) and open pneumothorax: 5% (54/1042). One hundred and three patients had TTs performed on clinical grounds alone without a pre-insertion CXR [Group A]. One hundred and ninety-one patients had a pre-insertion CXR but had persistent clinical concerns following insertion [Group B]. Seven hundred and ten patients had pre-insertion CXR but no clinical concerns following insertion [Group C]. Overall, 15% (152/1004) [9 from Group A, 111 from Group B and 32 from Group C] of all patients had their clinical management influenced as a direct result of the post-insertion CXR. Despite the widely accepted practice of routine CXR following tube thoracostomy, the yield is relatively low. In many cases, good clinical examination post tube insertion will provide warnings as to whether problems are likely to result. However, in the more rural setting, and in resource challenged environments, there is a relatively high yield from the CXR, which alters management. Further prospective studies are needed to establish or refute the role of the existing ATLS® guidelines in these specific environments. Copyright © 2014 Elsevier Ltd. All rights reserved.

Optimization of Maneuver Execution for Landsat-7 Routine Operations

NASA Technical Reports Server (NTRS)

Cox, E. Lucien, Jr.; Bauer, Frank H. (Technical Monitor)

2000-01-01

Multiple mission constraints were satisfied during a lengthy, strategic ascent phase. Once routine operations begin, the ongoing concern of maintaining mission requirements becomes an immediate priority. The Landsat-7 mission has tight longitude control box and Earth imaging that requires sub-satellite descending nodal equator crossing times to occur in a narrow 30minute range fifteen (15) times daily. Operationally, spacecraft maneuvers must'be executed properly to maintain mission requirements. The paper will discuss the importance of optimizing the altitude raising and plane change maneuvers, amidst known constraints, to satisfy requirements throughout mission lifetime. Emphasis will be placed not only on maneuver size and frequency but also on changes in orbital elements that impact maneuver execution decisions. Any associated trade-off arising from operations contingencies will be discussed as well. Results of actual altitude and plane change maneuvers are presented to clarify actions taken.

Radiation safety for anaesthesia providers in the orthopaedic operating room.

PubMed

Rhea, E B; Rogers, T H; Riehl, J T

2016-04-01

In many orthopaedic operating rooms, anaesthesia providers routinely wear lead aprons for protection from radiation, but some studies have questioned whether this is needed. We conducted a systematic review to identify studies that measured the amount of radiation that anaesthetists were exposed to in the orthopaedic operating room. Multiple studies have shown that at 1.5 m from the source of radiation, anaesthetists received no radiation, or amounts so small that a person would have to be present in an unreasonable number of operations to receive cumulative doses of any significance. Radiation doses at this distance were often at the limits of the sensitivity of the measuring dosimeter. We question the need to wear lead protection for anaesthesia providers who are routinely at 1.5 m or a greater distance from standard fluoroscopy units. © 2016 The Association of Anaesthetists of Great Britain and Ireland.

Nonpharmacologic approach to fatigue in patients with cancer.

PubMed

Pachman, Deirdre R; Price, Katharine A; Carey, Elise C

2014-01-01

Cancer-related fatigue is a common yet underappreciated problem with a significant impact on functional ability and quality of life. Practice guidelines mandate that all cancer patients and survivors be screened for cancer-related fatigue (CRF) at regular intervals. Comorbidities that could contribute to fatigue should be treated, and patients with moderate to severe fatigue should undergo a comprehensive evaluation. Nonpharmacologic interventions are important tools to combat CRF and should be incorporated into routine practice. Physical activity, educational interventions, and cognitive-behavioral therapy have the most supportive data and can be recommended to patients with confidence. From a practical standpoint, general education on CRF is something that most care providers can readily offer patients as part of routine care. Other interventions that appear promising but are as yet lacking convincing evidence include mindfulness-based stress reduction, yoga, and acupuncture. Reiki, Qigong, hypnosis, and music therapy may be worthy of further investigation.

Medicines optimisation: priorities and challenges.

PubMed

Kaufman, Gerri

2016-03-23

Medicines optimisation is promoted in a guideline published in 2015 by the National Institute for Health and Care Excellence. Four guiding principles underpin medicines optimisation: aim to understand the patient's experience; ensure evidence-based choice of medicines; ensure medicines use is as safe as possible; and make medicines optimisation part of routine practice. Understanding the patient experience is important to improve adherence to medication regimens. This involves communication, shared decision making and respect for patient preferences. Evidence-based choice of medicines is important for clinical and cost effectiveness. Systems and processes for the reporting of medicines-related safety incidents have to be improved if medicines use is to be as safe as possible. Ensuring safe practice in medicines use when patients are transferred between organisations, and managing the complexities of polypharmacy are imperative. A medicines use review can help to ensure that medicines optimisation forms part of routine practice.

Adenoid and tonsil surgeries in children: how relevant is pre-operative blood grouping and cross-matching?

PubMed

Onotai, Lucky; Lilly-Tariah, Opubo da

2013-01-01

As a part of pre-operative evaluation, several otolaryngologists group and cross-match blood routinely for children undergoing adenoid and tonsil surgeries. This practice has generated several debates either in support or against this practice. The aim of this study is to critically evaluate the incidence of post-tonsillectomy (with or without adenoidectomy) bleeding and blood transfusions in otherwise healthy children with adenoid/tonsil pathologies conducted in the University of Port Harcourt Teaching Hospital (UPTH). A descriptive retrospective study of children who underwent adenoid and tonsil surgeries in the Department of Ear, Nose and Throat (ENT) surgery of UPTH from January 2003 to December 2012. Children with family history of bleeding disorders and derangement of clotting profile as well as different co-morbidity like sickle cell disease were excluded from this study. The patients' data were retrieved from the registers of ENT out-patient clinics, theatre registers and patients case notes. Demographic data, indications for surgery, preoperative investigations, complications and management outcomes were recorded and analyzed. Out of 145 children that had adenoid and tonsil surgeries; only 100 met the criteria for this study. The study subjects included 65 males and 35 females (male: female ratio 1.9:1) belonging to 0-16 years age group (mean age: 3.46 ± 2.82 years). The age group of 3-5 years had the highest (n = 40, 40%) number of surgeries. Adenotonsillectomy was the commonest (n = 85, 85%) surgery performed on patients who had obstructive sleep apnea (OSA). The commonest (n = 6, 6%) complication was haemorrhage, and only few (n = 3, 3%) patients had blood transfusion. However, mortality was recorded in some (n = 3, 3%) patients. This study confirms that the incidence of post adenoidectomy/tonsillectomy bleeding in otherwise healthy children is low and rarely requires blood transfusion. We can conclude that routine preoperative blood grouping and cross-matching of blood for all children undergoing elective adenoid and tonsil surgeries seemed irrelevant and not cost effective. However, it could be carried out in only special circumstances.

Cost calculator methods for estimating casework time in child welfare services: A promising approach for use in implementation of evidence-based practices and other service innovations.

PubMed

Holmes, Lisa; Landsverk, John; Ward, Harriet; Rolls-Reutz, Jennifer; Saldana, Lisa; Wulczyn, Fred; Chamberlain, Patricia

2014-04-01

Estimating costs in child welfare services is critical as new service models are incorporated into routine practice. This paper describes a unit costing estimation system developed in England (cost calculator) together with a pilot test of its utility in the United States where unit costs are routinely available for health services but not for child welfare services. The cost calculator approach uses a unified conceptual model that focuses on eight core child welfare processes. Comparison of these core processes in England and in four counties in the United States suggests that the underlying child welfare processes generated from England were perceived as very similar by child welfare staff in California county systems with some exceptions in the review and legal processes. Overall, the adaptation of the cost calculator for use in the United States child welfare systems appears promising. The paper also compares the cost calculator approach to the workload approach widely used in the United States and concludes that there are distinct differences between the two approaches with some possible advantages to the use of the cost calculator approach, especially in the use of this method for estimating child welfare costs in relation to the incorporation of evidence-based interventions into routine practice.

Implementing evidence-based practices in an emergency department: contradictions exposed when prioritising a flow culture.

PubMed

Kirk, Jeanette W; Nilsen, Per

2016-02-01

An emergency department is typically a place of high activity where practitioners care for unanticipated presentations, which yields a flow culture so that actions that secure available beds are prioritised by the practitioners. How does the flow culture in an emergency department influence nurses' use of a research-based clinical guideline and a nutrition screening routine. Ethnographic fieldwork was carried out over three months. The first author followed nurses, medical secretaries and doctors in the emergency department. Data were also collected by means of semi-structured interviews. An activity system analysis, as described in the Cultural Historical Activity Theory, was conducted to identify various contradictions that could exist between different parts of the activity system. The main contradiction identified was that guidelines and screening routines provided a flow stop. Four associated contradictions were identified: insufficient time to implement guidelines; guilty conscience due to perceived nonadherence to evidence-based practices; newcomers having different priorities; and conflicting views of what constituted being a professional. We found that research-supported guidelines and screening routines were not used if they were perceived to stop the patient flow, suggesting that the practice was not fully evidence based. © 2016 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.

Detection of SHOX gene aberrations in routine diagnostic practice and evaluation of phenotype scoring form effectiveness.

PubMed

Hirschfeldova, Katerina; Florianova, Martina; Kebrdlova, Vera; Urbanova, Marketa; Stekrova, Jitka

2017-02-01

Heterozygous aberrations of SHOX gene have been reported to be responsible for Léri-Weill dyschondrosteosis (LWD) and small portion of idiopathic short stature. The study was established to assess effectiveness of using phenotype 'scoring form' in patients indicated for SHOX gene defect analysis. The submitted study is based on a retrospective group of 352 unrelated patients enrolled as a part of the routine diagnostic practice and analyzed for aberrations affecting the SHOX gene. All participants were scanned for deletion/duplication within the main pseudoautosomal region (PAR1) using the multiplex ligation-dependent probe amplification (MLPA) method. The phenotype 'scoring form' is used in our laboratory practice to preselect patients for subsequent mutation analysis of SHOX gene-coding sequences. The overall detection rate was 11.1% but there was a significant increase in frequency of SHOX gene defect positive with increasing achieved score (P<0.0001). The most frequent aberration was a causal deletion within PAR1. In three probands, MLPA analysis indicated a more complex rearrangement. Madelung deformity or co-occurrence of disproportionate short stature, short forearm and muscular hypertrophy had represented the most potent markers to determine the likelihood of SHOX gene defect detection. We conclude that appliance of phenotype 'scoring form' had saved excessive sample analysis and enabled effective routine diagnostic testing.

Domestic violence screening practices of obstetrician-gynecologists.

PubMed

Horan, D L; Chapin, J; Klein, L; Schmidt, L A; Schulkin, J

1998-11-01

To ascertain the current knowledge base and screening practices of obstetrician-gynecologists in the area of domestic violence. We mailed a survey to 189 ACOG Fellows who are members of the Collaborative Ambulatory Research Network. Questionnaires were also mailed to a random sample of 1250 nonmember Fellows. Obstetrician-gynecologists are aware of the nature of domestic violence and are familiar with common symptomatology that may be associated with domestic violence. For pregnant patients, 39% of respondents routinely screen at the first prenatal visit; 27% of respondents routinely screen nonpregnant patients at the initial visit. Screening is most likely to occur when the obstetrician-gynecologist suspects a patient is being abused, both during pregnancy (68%) and when the patient is not pregnant (72%). Only 30% of obstetrician-gynecologists received training on domestic violence during medical school; 37% received such instruction during residency training. The majority (67%) have received continuing education on the subject. Years since training and personal experiences with intimate-partner violence were associated with increased screening practices. Routine screening of all women for domestic violence has been recommended by ACOG for more than a decade. The majority of obstetrician-gynecologists screen both pregnant and nonpregnant patients when they suspect abuse. However, with universal screening, more female victims of violence can be identified and can receive needed services.

Five years' experience in a (really) rural teleradiology practice. Was it worth it? The successes and the failures

NASA Astrophysics Data System (ADS)

Telepak, Robert J.; Freede, Emily; Jaramillo, Richard E.; Alverson, Dale C.

1998-07-01

During the past 5 years (1992 - 1997) the Department of Radiology of the University of New Mexico Health Sciences Center has developed an active teleradiology program. Contracts are in place to provide both routine and emergency image interpretations 24 hours per day, every day of the year. Several rural hospitals are served as well as the Navajo Indian Health Service. Areas of success: include significantly improved radiologic service to the rural sites, specialty consultations to general radiologists, successful teaching of teleradiology practice to radiology residents and staff, good diagnostic quality images, a small but real profit, improved quality assurance for the rural sites, and no significant medical-legal problems. Failures include: significant telecommunications problems, lack of acceptance and utilization by some of the rural sites, poor QA compliance by some sites, a long period of disappointing technical support by equipment vendors, and slow acceptance of DICOM by equipment manufacturers. The successes outweigh the failures. We would do it again -- but somewhat differently. We offer advice to institutions developing a new rural teleradiology operation.

Social and professional influences of the technology of electronic fetal monitoring on obstetrical nursing.

PubMed

Hoerst, B J; Fairman, J

2000-06-01

Electronic fetal monitoring (EFM) is one example of a biomedical technology that rapidly diffused from an experimental innovation into a standard medical practice. First developed in the 1950s, EFM became commercially available in the early 1970s and quickly transformed intrapartum obstetrical practice. Assessments and interventions, which practitioners had previously based primarily on laboring women's subjective reports of bodily sensations, were now being based on quantifiable objective data from uterine activity and fetal heart rate transducers. Despite concerns of over-medicalization of the natural event of birth, iatrogenesis related to the increased incidence of operative deliveries, and escalating costs, EFM became widely accepted as routine and necessary by both practitioners and patients. By presenting the confident expectations and cautious reservations of various practitioners and patients to EFM, this article explores the rapid diffusion of EFM within the social context of the 1970s. A special focus is given to the perspective of intrapartum obstetrical nurses, because they have been the primary users of this perinatal technology since its introduction.

Handling of hazardous drugs - Effect of an innovative teaching session for nursing students.

PubMed

Zimmer, Janine; Hartl, Stefanie; Standfuß, Katrin; Möhn, Till; Bertsche, Astrid; Frontini, Roberto; Neininger, Martina P; Bertsche, Thilo

2017-02-01

Imparting knowledge and practical skills in hazardous drug handling in nursing students' education is essential to prevent hazardous exposure and to preserve nurses' health. This study aimed at comparing routine nursing education with an additional innovative teaching session. A prospective controlled study in nursing students was conducted in two study periods: (i) a status-quo period (routine education on handling hazardous drugs) followed by (ii) an intervention period (additional innovative teaching session on handling hazardous drugs). Nursing students at a vocational school were invited to participate voluntarily. In both study periods (i) and (ii), the following factors were analysed: (a) knowledge of hazardous drug handling by questionnaire, (b) practical skills in hazardous drug handling (e.g. cleaning) by a simulated handling scenario, (c) contamination with drug residuals on the work surface by fluorescent imaging. Fifty-three nursing students were enrolled. (a) Median knowledge improved from status-quo (39% right answers) to intervention (65%, p<0.001), (b) practical skills improved from status-quo (53% of all participants cleaned the work surface) to intervention (92%, p<0.001). (c) Median number of particles/m 2 decreased from status-quo to intervention (932/97, p<0.001). Compared with routine education, knowledge and practical skills in hazardous drug handling were significantly improved after an innovative teaching session. Additionally, the amount of residuals on the work surface decreased. This indicates a lower risk for hazardous drug exposure. Copyright © 2016 Elsevier Ltd. All rights reserved.

Does a web-based feedback training program result in improved reliability in clinicians' ratings of the Global Assessment of Functioning (GAF) Scale?

PubMed

Støre-Valen, Jakob; Ryum, Truls; Pedersen, Geir A F; Pripp, Are H; Jose, Paul E; Karterud, Sigmund

2015-09-01

The Global Assessment of Functioning (GAF) Scale is used in routine clinical practice and research to estimate symptom and functional severity and longitudinal change. Concerns about poor interrater reliability have been raised, and the present study evaluated the effect of a Web-based GAF training program designed to improve interrater reliability in routine clinical practice. Clinicians rated up to 20 vignettes online, and received deviation scores as immediate feedback (i.e., own scores compared with expert raters) after each rating. Growth curves of absolute SD scores across the vignettes were modeled. A linear mixed effects model, using the clinician's deviation scores from expert raters as the dependent variable, indicated an improvement in reliability during training. Moderation by content of scale (symptoms; functioning), scale range (average; extreme), previous experience with GAF rating, profession, and postgraduate training were assessed. Training reduced deviation scores for inexperienced GAF raters, for individuals in clinical professions other than nursing and medicine, and for individuals with no postgraduate specialization. In addition, training was most beneficial for cases with average severity of symptoms compared with cases with extreme severity. The results support the use of Web-based training with feedback routines as a means to improve the reliability of GAF ratings performed by clinicians in mental health practice. These results especially pertain to clinicians in mental health practice who do not have a masters or doctoral degree. (c) 2015 APA, all rights reserved.

Outcome measures in European patients with haemophilia: Survey of implementation in routine clinical practice, perception of relevance and recommendations by European treaters in the EHTSB.

PubMed

Hermans, C; Klamroth, R; Richards, M; de Moerloose, P; Garrido, R P

2017-03-01

This study was conducted to evaluate the current implementation of outcome measures in routine clinical haemophilia practice and to explore and appreciate the perception of the relevance of such measures by treaters. A survey was completed by 19 of the 26 physicians involved in the European Haemophilia Therapy Strategy Board (EHTSB). Employing an extensive inventory of outcome measures used in patients with haemophilia, information was collected about the frequency of data collection and the subjective appreciation of their importance during clinic review. The survey revealed that most treaters currently collect data that are mainly related to the haemostatic treatment (consumption of concentrates) and the bleeding symptoms (number and location of bleeds) in a non-uniform and non-standardized way. By contrast, functional, physical and quality of life scorings are rarely used and show considerable heterogeneity between treaters. Also, many disparities emerged between practice and perception, in particular quality of life data that are perceived as being important but for most of the time are not collected. This survey represents, in our view, the first attempt to evaluate the actual utilization of outcome measures in haemophilia care. While the value of outcome measures is appreciated, they are not assessed regularly. Therefore, there is a need to include appropriate performance indicators (outcome measures) of haemophilia care in routine clinical practice. Consensus recommendations to provide a framework for achieving this aim are provided. © 2016 John Wiley & Sons Ltd.

Identification and treatment of patients with nicotine problems in routine clinical psychiatry practice.

PubMed

Montoya, Ivan D; Herbeck, Diane M; Svikis, Dace S; Pincus, Harold Alan

2005-01-01

The aim of this study is to assess the rates of nicotine problems diagnosed by psychiatrists, the characteristics of psychiatric patients who smoke, and the services provided to them in routine psychiatric practice. Data were obtained by asking psychiatrists participating in the American Psychiatric Institute for Psychiatric Research and Education's Practice Research Network to complete a self-administered questionnaire to provide detailed sociodemographic, clinical, and health plan information on three of their patients seen during routine clinical practice. A total of 615 psychiatrists provided information on 1,843 patients, of which 280 (16.6%) were reported to have a current nicotine problem. Of these, 9.1% were reported to receive treatment for nicotine dependence. Patients with nicotine problems were significantly more likely to be males, divorced or separated, disabled, and uninsured, and have fewer years of education. They also had significantly more co-morbid psychiatric disorders, particularly schizophrenia or alcohol/substance use disorders; a lower Global Assessment Functioning score; and poorer treatment compliance than their counterparts. The results suggest a very low rate of identification and treatment of nicotine problems among patients treated by psychiatrists, even though psychiatric patients who smoke seem to have more clinical and psychosocial stressors and more severe psychiatric problems than those who do not smoke. Programs should be developed to raise the awareness and ability of psychiatrists to diagnose and treat patients with nicotine problems, with a particular emphasis on the increased medical and psychosocial needs of psychiatric patients who smoke.

Counterbalancing clinical supervision and independent practice: case studies in learning thoracic epidural catheter insertion.

PubMed

Johnson, T

2010-12-01

Thoracic epidural catheter placement is an example of a demanding and high-risk clinical skill that junior anaesthetists need to learn by experience and under the supervision of consultants. This learning is known to present challenges that require further study. Ten consultant and 10 trainee anaesthetists in a teaching hospital were interviewed about teaching and learning this skill in the operating theatre, and a phenomenological analysis of their experience was performed. Trainee participation was limited by time pressure, lack of familiarity with consultants, and consultants' own need for clinical experience. There was a particular tension between safe and effective consultant practice and permitting trainees' independence. Three distinct stages of participation and assistance were identified from reports of ideal practice: early (part-task or basic procedure, consultant always present giving instruction and feedback), middle (independent practice with straightforward cases without further instruction), and late (skill extension and transfer). Learning assistance provided by consultants varied, but it was often not matched to the trainees' stages of learning. Negotiation of participation and assistance was recognized as being useful, but it did not happen routinely. There are many obstacles to trainees' participation in thoracic epidural catheter insertion, and learning assistance is not matched to need. A more explicit understanding of stages of learning is required to benefit the learning of this and other advanced clinical skills.

Space Flight Resource Management for ISS Operations

NASA Technical Reports Server (NTRS)

Schmidt, Lacey L.; Slack, Kelley; Holland, Albert; Huning, Therese; O'Keefe, William; Sipes, Walter E.

2010-01-01

Although the astronaut training flow for the International Space Station (ISS) spans 2 years, each astronaut or cosmonaut often spends most of their training alone. Rarely is it operationally feasible for all six ISS crewmembers to train together, even more unlikely that crewmembers can practice living together before launch. Likewise, ISS Flight Controller training spans 18 months of learning to manage incredibly complex systems remotely in plug-and-play ground teams that have little to no exposure to crewmembers before a mission. How then do all of these people quickly become a team - a team that must respond flexibly yet decisively to a variety of situations? The answer implemented at NASA is Space Flight Resource Management (SFRM), the so-called "soft skills" or team performance skills. Based on Crew Resource Management, SFRM was developed first for shuttle astronauts and focused on managing human errors during time-critical events (Rogers, et al. 2002). Given the nature of life on ISS, the scope of SFRM for ISS broadened to include teamwork during prolonged and routine operations (O'Keefe, 2008). The ISS SFRM model resembles a star with one competency for each point: Communication, Cross-Culture, Teamwork, Decision Making, Team Care, Leadership/Followership, Conflict Management, and Situation Awareness. These eight competencies were developed with international participation by the Human Behavior and Performance Training Working Group. Over the last two years, these competencies have been used to build a multi-modal SFRM training flow for astronaut candidates and flight controllers that integrates team performance skills into the practice of technical skills. Preliminary results show trainee skill increases as the flow progresses; and participants find the training invaluable to performing well and staying healthy during ISS operations. Future development of SFRM training will aim to help support indirect handovers as ISS operations evolve further with the retirement of the Space Shuttle Program.

Operating lists are created by rational algorithms and use of power. What can a social scientific view offer surgeons?

PubMed

Engelmann, Carsten; Grote, Gudela; Geyer, Siegfried; Ametowobla, Dzifa

2017-02-01

Algorithms for surgical operation planning are evidence-based. However, choices sometimes have to be made between medically equal solutions e.g. for staffing of sought-after operations. Such decisions are heavily influenced by micropolitics and power. The article examines the array of highly manipulated processes around operation theatre allocation of convenient time slots or staff, which play out in various ways in all of the world's main regional surgical cultures. Essay supported by empiric data from an ethnographic power-analysis targeted to senior executive surgeons. Operations were categorized into "Interesting" (i.e. career-promoting) and "Uninteresting" (i.e. routine) operations. Fifty nine executives responded. Only one respondent contested the categorization of operations into Interesting and Uninteresting. The two categories were staffed according to significantly different criteria (p < 0.05). These were classified as Rational (e.g. "surgical expertise"), Social (e.g. "equity"), and Political (e.g. "status"). For Interesting operations, Rational criteria were deemed most relevant, while for the Uninteresting operations "equity" was ranked top. Moreover, we found significant differences between surgeons' and external observers' (experienced clerical and nursing staff) assessments of staffing decisions, the latter ranking Political motives higher. Decisions were almost exclusively negotiated among surgeons. 33% of respondents said they used subterfuges such as withholding information, incorrect duration-statements, and barter arrangements to defuse possible conflicts. Operating Lists are not merely the product of rational resource optimization. This article demonstrates the methodic feasibility of academic investigation into the typically tacit micro-political mechanisms in List-making. Developing such research further may potentially concern the practice and outcome of surgery.

TargetCOPD: a pragmatic randomised controlled trial of targeted case finding for COPD versus routine practice in primary care: protocol.

PubMed

Jordan, Rachel E; Adab, Peymané; Jowett, Sue; Marsh, Jen L; Riley, Richard D; Enocson, Alexandra; Miller, Martin R; Cooper, Brendan G; Turner, Alice M; Ayres, Jon G; Cheng, Kar Keung; Jolly, Kate; Stockley, Robert A; Greenfield, Sheila; Siebert, Stanley; Daley, Amanda; Fitzmaurice, David A

2014-10-04

Many people with clinically significant chronic obstructive pulmonary disease (COPD) remain undiagnosed worldwide. There are a number of small studies which have examined possible methods of case finding through primary care, but no large RCTs that have adequately assessed the most cost-effective approach. In this study, using a cluster randomised controlled trial (RCT) in 56 general practices in the West Midlands, we plan to investigate the effectiveness and cost-effectiveness of a Targeted approach to case finding for COPD compared with routine practice. Using an individual patient RCT nested in the Targeted arm, we plan also to compare the effectiveness and cost-effectiveness of Active case finding using a postal questionnaire (with supplementary opportunistic questionnaires), and Opportunistic-only case finding during routine surgery consultations.All ever-smoking patients aged 40-79 years, without a current diagnosis of COPD and registered with participating practices will be eligible. Patients in the Targeted arm who report positive respiratory symptoms (chronic cough or phlegm, wheeze or dyspnoea) using a brief questionnaire will be invited for further spirometric assessment to ascertain whether they have COPD or not. Post-bronchodilator spirometry will be conducted to ATS standards using an Easy One spirometer by trained research assistants.The primary outcomes will be new cases of COPD and cost per new case identified, comparing targeted case finding with routine care, and two types of targeted case finding (active versus opportunistic). A multilevel logistic regression model will be used to model the probability of detecting a new case of COPD for each treatment arm, with clustering of patients (by practice and household) accounted for using a multi-level structure.A trial-based analysis will be undertaken using costs and outcomes collected during the trial. Secondary outcomes include the feasibility, efficiency, long-term cost-effectiveness, patient and primary care staff views of each approach. This will be the largest RCT of its kind, and should inform how best to identify undiagnosed patients with COPD in the UK and other similar healthcare systems. Sensitivity analyses will help local policy-makers decide which sub-groups of the population to target first. Current controlled trials ISRCTN14930255.

Oral hygiene practices and dental service utilization among pregnant women.

PubMed

Boggess, Kim A; Urlaub, Diana M; Massey, Katie E; Moos, Merry-K; Matheson, Matthew B; Lorenz, Carol

2010-05-01

Daily oral hygiene and regular dental visits are important components of oral health care. The authors' objective in this study was to examine women's oral hygiene practices and use of dental services during pregnancy. The authors developed a written oral health questionnaire and administered it to 599 pregnant women. They collected demographic information, as well as data on oral hygiene practices and use of dental services during pregnancy. They used chi2 and multivariable logistic regression models to assess associations between oral hygiene practice and dental service use during pregnancy and to identify maternal predictor variables. Of the 599 participants, 83 percent (n=497) reported brushing once or twice per day. Twenty-four percent (n=141) reported flossing at least once daily; Hispanic women were more likely to floss than were white or African American women (28 percent [52 of 183] versus 22 percent [54 of 248] versus 19 percent [23 of 121], respectively, P<.001). Seventy-four percent (n=442) of the participants reported having received no routine dental care during pregnancy. Hispanic women were significantly less likely than were black or white women to receive routine dental care during pregnancy (13 percent versus 21 percent versus 36 percent, respectively, P<.001). The authors found that being older than 36 years, being of Hispanic race or ethnicity, having an annual income of less than $30,000, flossing infrequently and receiving no dental care when not pregnant were significantly associated with lack of routine dental care during pregnancy (adjusted odds ratios, 95 percent confidence intervals: 2.56 [1.33-4.92]; 2.19 [1.11-4.29]; 2.02 [1.12-3.65]; 1.86 [1.13-3.07]; and 4.35 [2.5-7.69], respectively). A woman's lack of receiving routine dental care when not pregnant was the most significant predictor of lack of receiving dental care during pregnancy. Racial, ethnic and economic disparities related to oral hygiene practices and dental service utilization during pregnancy exist. Medical and dental care providers who treat women of reproductive age and pregnant women need to develop policy strategies to address this population's access barriers to, and use of, dental care services.

Parents with Intellectual Disabilities Experiencing Challenging Child Routines: A Pilot Study Using Embedded Self-Determination Practices

ERIC Educational Resources Information Center

Knowles, Christen; Blakely, Allison; Hansen, Sarah; Machalicek, Wendy

2017-01-01

Background: Practices to facilitate self-determination have not received appropriate attention in research concerning parents with intellectual disabilities (ID). Likewise, parenting interventions for adults with intellectual disabilities have seldom observed both parent and child behavioural outcomes. Methods: This study evaluated the…

Children's Intent Participation in a Pediatric Community of Practice

ERIC Educational Resources Information Center

Rindstedt, Camilla; Aronsson, Karin

2012-01-01

This study analyzes informal learning, drawing on video recordings of staff-child interaction in a pediatric unit. It is shown that even very young patients engage in intent community participation, carefully noting fine variations in examination and treatment practices. They orient to everyday routines in successively more complex ways, gradually…

WOMEN IN CANCER THEMATIC REVIEW: Thyroid-stimulating hormone in thyroid cancer: does it matter?

PubMed

Nieto, Hannah; Boelaert, Kristien

2016-11-01

Differentiated thyroid cancer is the most common endocrine malignancy and the incidence is increasing rapidly worldwide. Appropriate diagnosis and post-treatment monitoring of patients with thyroid tumours are critical. Fine needle aspiration cytology remains the gold standard for diagnosing thyroid cancer, and although there have been significant refinements to this technique, diagnostic surgery is often required for patients suspected to have malignancy. Serum thyroid-stimulating hormone (TSH) is higher in patients with malignant thyroid nodules than in those with benign disease, and TSH is proportionally increased in more aggressive tumours. Importantly, we have shown that the pre-operative serum TSH concentration independently predicts the presence of malignancy in subjects presenting with thyroid nodules. Establishing the use of TSH measurements in algorithms identifying high-risk thyroid nodules in routine clinical practice represents an exciting, cost-efficient and non-invasive approach to optimise thyroid cancer diagnosis. Binding of TSH to receptors on thyrocytes stimulates a number of growth promoting pathways both in normal and malignant thyroid cells, and TSH suppression with high doses of levothyroxine is routinely used after thyroidectomy to prevent cancer recurrence, especially in high-risk tumours. This review examines the relationship between serum TSH and thyroid cancer and reflects on the clinical potential of TSH measurements in diagnosis and disease monitoring. © 2016 Society for Endocrinology.

Diagnosing somatisation disorder (P75) in routine general practice using the International Classification of Primary Care.

PubMed

Schaefert, Rainer; Laux, Gunter; Kaufmann, Claudia; Schellberg, Dieter; Bölter, Regine; Szecsenyi, Joachim; Sauer, Nina; Herzog, Wolfgang; Kuehlein, Thomas

2010-09-01

(i) To analyze general practitioners' diagnosis of somatisation disorder (P75) using the International Classification of Primary Care (ICPC)-2-E in routine general practice. (ii) To validate the distinctiveness of the ICD-10 to ICPC-2 conversion rule which maps ICD-10 dissociative/conversion disorder (F44) as well as half of the somatoform categories (F45.0-2) to P75 and codes the other half of these disorders (F45.3-9), including autonomic organ dysfunctions and pain syndromes, as symptom diagnoses plus a psychosocial code in a multiaxial manner. Cross-sectional analysis of routine data from a German research database comprising the electronic patient records of 32 general practitioners from 22 practices. For each P75 patient, control subjects matched for age, gender, and practice were selected from the 2007 yearly contact group (YCG) without a P75 diagnosis using a propensity-score algorithm that resulted in eight controls per P75 patient. Of the 49,423 patients in the YCG, P75 was diagnosed in 0.6% (302) and F45.3-9 in 1.8% (883) of cases; overall, somatisation syndromes were diagnosed in 2.4% of patients. The P75 coding pattern coincided with typical characteristics of severe, persistent medically unexplained symptoms (MUS). F45.3-9 was found to indicate moderate MUS that otherwise showed little clinical difference from P75. Pain syndromes exhibited an unspecific coding pattern. Mild and moderate MUS were predominantly recorded as symptom diagnoses. Psychosocial codes were rarely documented. ICPC-2 P75 was mainly diagnosed in cases of severe MUS. Multiaxial coding appears to be too complicated for routine primary care. Instead of splitting P75 and F45.3-9 diagnoses, it is proposed that the whole MUS spectrum should be conceptualized as a continuum model comprising categorizations of uncomplicated (mild) and complicated (moderate and severe) courses. Psychosocial factors require more attention. Copyright (c) 2010 Elsevier Inc. All rights reserved.

Application of process mapping to understand integration of high risk medicine care bundles within community pharmacy practice.

PubMed

Weir, Natalie M; Newham, Rosemary; Corcoran, Emma D; Ali Atallah Al-Gethami, Ashwag; Mohammed Abd Alridha, Ali; Bowie, Paul; Watson, Anne; Bennie, Marion

2017-11-21

The Scottish Patient Safety Programme - Pharmacy in Primary Care collaborative is a quality improvement initiative adopting the Institute of Healthcare Improvement Breakthrough Series collaborative approach. The programme developed and piloted High Risk Medicine (HRM) Care Bundles (CB), focused on warfarin and non-steroidal anti-inflammatories (NSAIDs), within 27 community pharmacies over 4 NHS Regions. Each CB involves clinical assessment and patient education, although the CB content varies between regions. To support national implementation, this study aims to understand how the pilot pharmacies integrated the HRM CBs into routine practice to inform the development of a generic HRM CB process map. Regional process maps were developed in 4 pharmacies through simulation of the CB process, staff interviews and documentation of resources. Commonalities were collated to develop a process map for each HRM, which were used to explore variation at a national event. A single, generic process map was developed which underwent validation by case study testing. The findings allowed development of a generic process map applicable to warfarin and NSAID CB implementation. Five steps were identified as required for successful CB delivery: patient identification; clinical assessment; pharmacy CB prompt; CB delivery; and documentation. The generic HRM CB process map encompasses the staff and patients' journey and the CB's integration into routine community pharmacy practice. Pharmacist involvement was required only for clinical assessment, indicating suitability for whole-team involvement. Understanding CB integration into routine practice has positive implications for successful implementation. The generic process map can be used to develop targeted resources, and/or be disseminated to facilitate CB delivery and foster whole team involvement. Similar methods could be utilised within other settings, to allow those developing novel services to distil the key processes and consider their integration within routine workflows to effect maximal, efficient implementation and benefit to patient care. Copyright © 2017 Elsevier Inc. All rights reserved.

Neurological surgery: the influence of physical and mental demands on humans performing complex operations.

PubMed

Bourne, Sarah K; Walcott, Brian P; Sheth, Sameer A; Coumans, Jean-Valery C E

2013-03-01

Performing neurological surgery is an inherently demanding task on the human body, both physically and mentally. Neurosurgeons routinely perform "high stakes" operations in the setting of mental and physical fatigue. These conditions may be not only the result of demanding operations, but also influential to their outcome. Similar to other performance-based endurance activities, training is paramount to successful outcomes. The inflection point, where training reaches the point of diminishing returns, is intensely debated. For the neurosurgeon, this point must be exploited to the maximum, as patients require both the best-trained and best-performing surgeon. In this review, we explore the delicate balance of training and performance, as well as some routinely used adjuncts to improve human performance. Copyright © 2012 Elsevier Ltd. All rights reserved.

Optics Recycle Loop Strategy for NIF Operations above UV Laser-Induced Damage Threshold

DOE PAGES

Spaeth, M. L.; Wegner, P. J.; Suratwala, T. I.; ...

2017-03-23

The National Ignition Facility (NIF) at Lawrence Livermore National Laboratory (LLNL) houses the world’s largest laser system, composed of 192 individual, 40-cm-aperture beamlines. The NIF laser routinely operates at ultraviolet (UV) fluences above 8 J/cm 2, more than twice the (3ω only) damage threshold of commercially available UV-grade fused silica. NIF is able to maintain such high fluence operation by using an optics recycling loop strategy. Successful operation of the loop relies on a number of technologies specifically developed for NIF. One of the most important is the capability developed by LLNL and their vendors for producing highly damage-resistant optics.more » Other technologies developed for the optics recycle loop raise the operating point of NIF by keeping damage growth in check. LLNL has demonstrated the capability to sustain UV fused silica optic recycling rates of up to 40 optics per week. The optics are ready for reinstallation after a 3-week trip through a recycle loop where the damage state of each optic is assessed and repaired. The impact of the optics recycle loop has been profound, allowing the experimental program to routinely employ energies and fluences that would otherwise have been unachievable. Without the recycle loop, it is likely that the NIF fluence would need to be kept below the UV threshold for damage growth, ~4 J/cm 2, thus keeping the energy delivered to the target significantly below 1 MJ. With the recycle loop implemented during the National Ignition Campaign, NIF can routinely deliver >1.8 MJ on target, an increase in operational capability of more than 100%. Finally, in this paper, the enabling technological advances, optical performance, and operational capability implications of the optics recycle loop are discussed.« less

Optics Recycle Loop Strategy for NIF Operations above UV Laser-Induced Damage Threshold

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

Spaeth, M. L.; Wegner, P. J.; Suratwala, T. I.

The National Ignition Facility (NIF) at Lawrence Livermore National Laboratory (LLNL) houses the world’s largest laser system, composed of 192 individual, 40-cm-aperture beamlines. The NIF laser routinely operates at ultraviolet (UV) fluences above 8 J/cm 2, more than twice the (3ω only) damage threshold of commercially available UV-grade fused silica. NIF is able to maintain such high fluence operation by using an optics recycling loop strategy. Successful operation of the loop relies on a number of technologies specifically developed for NIF. One of the most important is the capability developed by LLNL and their vendors for producing highly damage-resistant optics.more » Other technologies developed for the optics recycle loop raise the operating point of NIF by keeping damage growth in check. LLNL has demonstrated the capability to sustain UV fused silica optic recycling rates of up to 40 optics per week. The optics are ready for reinstallation after a 3-week trip through a recycle loop where the damage state of each optic is assessed and repaired. The impact of the optics recycle loop has been profound, allowing the experimental program to routinely employ energies and fluences that would otherwise have been unachievable. Without the recycle loop, it is likely that the NIF fluence would need to be kept below the UV threshold for damage growth, ~4 J/cm 2, thus keeping the energy delivered to the target significantly below 1 MJ. With the recycle loop implemented during the National Ignition Campaign, NIF can routinely deliver >1.8 MJ on target, an increase in operational capability of more than 100%. Finally, in this paper, the enabling technological advances, optical performance, and operational capability implications of the optics recycle loop are discussed.« less

Who wears the braces? A practical application of adolescent consent.

PubMed

Williams, J C; Atack, N E; Dhaliwal, R D K

2015-06-12

The presentation of alternative treatment plans and the discussion of these options with the adolescent patient is a routine part of both general dental and specialist orthodontic practice. This article will cover the issues involved in obtaining consent for treatment from the adolescent patient and suggests a practical means, if appropriate, to ensure that these patients can give and withdraw consent for their own treatment.

Stem cell applications and tissue engineering approaches in surgical practice.

PubMed

Khan, Wasim S; Malik, Atif A; Hardingham, Timothy E

2009-04-01

There has been an increasing interest in stem cell applications and tissue engineering approaches in surgical practice to deal with damaged or lost tissue. Although there have been developments in almost all surgical disciplines, the greatest advances are being made in orthopaedics, especially in bone repair. Significant hurdles however remain to be overcome before tissue engineering becomes more routinely used in surgical practice.

Green Infrastructure & Sustainable Urban Land Use Decision Analysis Workshop

EPA Science Inventory

Introduce green infrastructure, concepts and land use alternatives, to City of Cleveland operations staff. Discuss potential of green alternatives to impact daily operations and routine maintenance activities. Tie in sustainability concepts to long-term City planning and discu...

Evidence into practice: evaluating a child-centred intervention for diabetes medicine management The EPIC Project

PubMed Central

2010-01-01

Background There is a lack of high quality, child-centred and effective health information to support development of self-care practices and expertise in children with acute and long-term conditions. In type 1 diabetes, clinical guidelines indicate that high-quality, child-centred information underpins achievement of optimal glycaemic control with the aim of minimising acute readmissions and reducing the risk of complications in later life. This paper describes the development of a range of child-centred diabetes information resources and outlines the study design and protocol for a randomized controlled trial to evaluate the information resources in routine practice. The aim of the diabetes information intervention is to improve children and young people's quality of life by increasing self-efficacy in managing their type 1 diabetes. Methods/Design We used published evidence, undertook qualitative research and consulted with children, young people and key stakeholders to design and produce a range of child-centred, age-appropriate children's diabetes diaries, carbohydrate recording sheets, and assembled child-centred, age-appropriate diabetes information packs containing published information in a folder that can be personalized by children and young people with pens and stickers. Resources have been designed for children/young people 6-10; 11-15; and 16-18 years. To evaluate the information resources, we designed a pragmatic randomized controlled trial to assess the effectiveness, cost effectiveness, and implementation in routine practice of individually tailored, age-appropriate diabetes diaries and information packs for children and young people age 6-18years, compared with currently available standard practice. Children and young people will be stratified by gender, length of time since diagnosis (< 2years and > 2years) and age (6-10; 11-15; and 16-18 years). The following data will be collected at baseline, 3 and 6 months: PedsQL (generic, diabetes and parent versions), and EQ-5 D (parent and child); NHS resource use and process data (questionnaire and interview). Baseline and subsequent HbA1c measurements, blood glucose meter use, readings and insulin dose will be taken from routine test results and hand-held records when attending routine 3-4 monthly clinic visits. The primary outcome measure is diabetes self-efficacy and quality-of-life (Diabetes PedsQL). Secondary outcomes include: HbA1c, generic quality of life, routinely collected NHS/child-held data, costs, service use, acceptability and utility. Trial Registration ISRCTN17551624. PMID:20875112

What makes it so difficult for nurses to coach patients in shared decision making? A process evaluation.

PubMed

Lenzen, Stephanie Anna; Daniëls, Ramon; van Bokhoven, Marloes Amantia; van der Weijden, Trudy; Beurskens, Anna

2018-04-01

Primary care nurses play a crucial role in coaching patients in shared decision making about goals and actions. This presents a challenge to practice nurses, who are frequently used to protocol-based working routines. Therefore, an approach was developed to support nurses to coach patients in shared decision making. To investigate how the approach was implemented and experienced by practice nurses and patients. A process evaluation was conducted using quantitative and qualitative methods. Fifteen female practice nurses (aged between 28 and 55 years), working with people suffering from diabetes, COPD, asthma and/or cardiovascular diseases, participated. Nurses were asked to apply the approach to their chronically ill patients and to recruit patients (n = 10) willing to participate in an interview or an audio-recording of a consultation (n = 13); patients (13 women, 10 men) were aged between 41 and 88 years and suffered from diabetes, COPD or cardiovascular diseases. The approach involved a framework for shared decision making about goals and actions, a tool to explore the patient perspective, a patient profiles model and a training course. Interviews (n = 15) with nurses, a focus group with nurses (n = 9) and interviews with patients (n = 10) were conducted. Nurses filled in a questionnaire about their work routine before, during and after the training course. They were asked to deliver audiotapes of their consultations (n = 13). Overall, nurses felt that the approach supported them to coach patients in shared decision making. Nurses had become more aware of their own attitudes and learning needs and reported to have had more in-depth discussions with patients. The on-the-job coaching was experienced as valuable. However, nurses struggled to integrate the approach in routine care. They experienced the approach as different to their protocol-based routines and expressed the importance of receiving support and the need for integration of the approach into the family physician practice. This study shows that changing practice nurses' role from medical experts to coaches in shared decision making is very complex and requires paying attention to skills and attitudes, as well as to contextual factors. Our results indicate that more time and training might be needed for this role transition. Moreover, it might be worthwhile to focus on organizational learning, in order to increase an organization's capacity to change work routines in a collaborative process. Future research into the development and evaluation of health coaching approaches, focusing on shared decision making, is necessary. Copyright © 2017 Elsevier Ltd. All rights reserved.

Designed for Workarounds: A Qualitative Study of the Causes of Operational Failures in Hospitals

PubMed Central

Tucker, Anita L; Heisler, W Scott; Janisse, Laura D

2014-01-01

Frontline care clinicians and staff in hospitals spend at least 10% of their time working around operational failures: situations in which information, supplies, or equipment needed for patient care are insufficient. However, little is known about underlying causes of operational failures and what hospitals can do to reduce their occurrence. To address this gap, we examined the internal supply chains at 2 hospitals with the aim of discovering organizational factors that contribute to operational failures. We conducted in-depth qualitative research, including observations and interviews of more than 80 individuals from 4 nursing units and the ancillary support departments that provide equipment and supplies needed for patient care. We found that a lack of interconnectedness among interdependent departments’ routines was a major source of operational failures. The low levels of interconnectedness occurred because of how the internal supply chains were designed and managed rather than because of employee error or a shortfall in training. Thus, we propose that the time that hospital staff members spend on workarounds can be reduced through deliberate efforts to increase interconnectedness among hospitals’ internal supply departments. Four dimensions of interconnectedness include: 1) hospital-level—rather than department-level—performance measures; 2) internal supply department routines that respond to specific patients’ needs rather than to predetermined stocking routines; 3) knowledge that is necessary for efficient handoffs of materials that is translated across departmental boundaries; and 4) cross-departmental collaboration mechanisms that enable improvement in the flow of materials across departmental boundaries. PMID:25102517

Designed for workarounds: a qualitative study of the causes of operational failures in hospitals.

PubMed

Tucker, Anita L; Heisler, W Scott; Janisse, Laura D

2014-01-01

Frontline care clinicians and staff in hospitals spend at least 10% of their time working around operational failures: situations in which information, supplies, or equipment needed for patient care are insufficient. However, little is known about underlying causes of operational failures and what hospitals can do to reduce their occurrence. To address this gap, we examined the internal supply chains at 2 hospitals with the aim of discovering organizational factors that contribute to operational failures. We conducted in-depth qualitative research, including observations and interviews of more than 80 individuals from 4 nursing units and the ancillary support departments that provide equipment and supplies needed for patient care. We found that a lack of interconnectedness among interdependent departments' routines was a major source of operational failures. The low levels of interconnectedness occurred because of how the internal supply chains were designed and managed rather than because of employee error or a shortfall in training. Thus, we propose that the time that hospital staff members spend on workarounds can be reduced through deliberate efforts to increase interconnectedness among hospitals' internal supply departments. Four dimensions of interconnectedness include: 1) hospital-level-rather than department-level-performance measures; 2) internal supply department routines that respond to specific patients' needs rather than to predetermined stocking routines; 3) knowledge that is necessary for efficient handoffs of materials that is translated across departmental boundaries; and 4) cross-departmental collaboration mechanisms that enable improvement in the flow of materials across departmental boundaries.

Three-dimensional pin-to-pin analyses of VVER-440 cores by the MOBY-DICK code

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

Lehmann, M.; Mikolas, P.

1994-12-31

Nuclear design for the Dukovany (EDU) VVER-440s nuclear power plant is routinely performed by the MOBY-DICK system. After its implementation on Hewlett Packard series 700 workstations, it is able to perform routinely three-dimensional pin-to-pin core analyses. For purposes of code validation, the benchmark prepared from EDU operational data was solved.

Occupational medical prophylaxis for the musculoskeletal system: A function-oriented system for physical examination of the locomotor system in occupational medicine (fokus(C)).

PubMed

Spallek, Michael; Kuhn, Walter; Schwarze, Sieglinde; Hartmann, Bernd

2007-10-29

Occupational physicians are very often confronted with questions as to the fitness of the postural and locomotor systems, especially the spinal column. Occupational medical assessment and advice can be required by patients with acute symptoms, at routine check-ups, by persons who have problems doing certain jobs, and for expert medical reports as to the fitness of persons with chronic disorders or after operations. Therefore, for occupational medical purposes a physical examination must aim primarily to investigate functions and not structures or radiologic evidence. The physical examination should be structured systematically and according to regions of the body and, together with a specific (pain) anamnesis should provide a basis for the medical assessment.This paper presents a function-oriented system for physical examination of the locomotor system, named fokus(C) (Funktionsorientierte Koerperliche Untersuchungssystematik, also available on DVD). fokus(C) has been developed with a view to its relevance for occupational medical practice and does not aim primarily to provide a precise diagnosis. Decisive for an occupational medical assessment of disorders of the musculoskeletal system is rather information about functional disorders and any impairment of performance or mobility which they can cause. The division of the physical examination into a rapid screening phase and a subsequent more intensive functional diagnostic phase has proved its practicability in many years of day-to-day use. Here, in contrast to the very extensive measures recommended for orthopaedic and manual diagnosis, for reasons of efficiency and usability of the system in routine occupational medical examinations the examination is structured according to the findings. So it is reduced to that which is most necessary and feasible.

Practice patterns of ophthalmologists administering intravitreal injections in Europe: a longitudinal survey.

PubMed

Huang, Kui; Sultan, Marla B; Zhou, Duo; Tressler, Charles S; Mo, Jingping

2016-01-01

This study was performed to understand the practice patterns of ophthalmologists administering intravitreal (IVT) injections in Europe after the procedure became routine. As part of a prospective, multinational, non-interventional cohort study in 13 countries in Europe between 2006 and 2012, ophthalmologists completed the Baseline Questionnaire and the Follow-up Questionnaire 1 year after baseline. Of the 125 ophthalmologists who participated in the study, 113 (90.4%) completed the Baseline Questionnaire. Most of these ophthalmologists were medical retina specialists (43.0%). The median number of IVT injections that the ophthalmologists performed per month during the year prior to completing the Baseline Questionnaire was 20.0. The majority of the ophthalmologists had performed their last IVT injection prior to completing the questionnaire in an operating room or theater (68.4%). When performing IVT injections, a majority of the ophthalmologists reported applying povidone-iodine (90.4%) before IVT injections and topical antibiotics right after IVT injections (89.5%). In addition, 81.6% of the ophthalmologists reported using a sterile adhesive eye drape and 80.7% reported using an eyelid speculum. In all, 95 ophthalmologists (76%) completed the Follow-up Questionnaire. The median number of IVT injections performed per month during the year prior to completing the Follow-up Questionnaire by these ophthalmologists was increased to 35. The results of the Follow-up Questionnaire on administering IVT injections were similar to those of the Baseline Questionnaire. A majority of the ophthalmologists reported applying povidone-iodine (87.4%) before IVT injections, topical antibiotics right after IVT injections (89.5%), and an eyelid speculum (85.3%). The results of this study indicated a good adherence to all aspects of the guidelines on IVT injections. It seemed that ophthalmologists were more experienced in IVT injections after they became a routine treatment procedure.

Semi-automated scar detection in delayed enhanced cardiac magnetic resonance images

NASA Astrophysics Data System (ADS)

Morisi, Rita; Donini, Bruno; Lanconelli, Nico; Rosengarden, James; Morgan, John; Harden, Stephen; Curzen, Nick

2015-06-01

Late enhancement cardiac magnetic resonance images (MRI) has the ability to precisely delineate myocardial scars. We present a semi-automated method for detecting scars in cardiac MRI. This model has the potential to improve routine clinical practice since quantification is not currently offered due to time constraints. A first segmentation step was developed for extracting the target regions for potential scar and determining pre-candidate objects. Pattern recognition methods are then applied to the segmented images in order to detect the position of the myocardial scar. The database of late gadolinium enhancement (LE) cardiac MR images consists of 111 blocks of images acquired from 63 patients at the University Hospital Southampton NHS Foundation Trust (UK). At least one scar was present for each patient, and all the scars were manually annotated by an expert. A group of images (around one third of the entire set) was used for training the system which was subsequently tested on all the remaining images. Four different classifiers were trained (Support Vector Machine (SVM), k-nearest neighbor (KNN), Bayesian and feed-forward neural network) and their performance was evaluated by using Free response Receiver Operating Characteristic (FROC) analysis. Feature selection was implemented for analyzing the importance of the various features. The segmentation method proposed allowed the region affected by the scar to be extracted correctly in 96% of the blocks of images. The SVM was shown to be the best classifier for our task, and our system reached an overall sensitivity of 80% with less than 7 false positives per patient. The method we present provides an effective tool for detection of scars on cardiac MRI. This may be of value in clinical practice by permitting routine reporting of scar quantification.

Undergraduate medical textbooks do not provide adequate information on intravenous fluid therapy: a systematic survey and suggestions for improvement.

PubMed

Powell, Arfon G M T; Paterson-Brown, Simon; Drummond, Gordon B

2014-02-20

Inappropriate prescribing of intravenous (IV) fluid, particularly 0.9% sodium chloride, causes post-operative complications. Fluid prescription is often left to junior medical staff and is frequently poorly managed. One reason for poor intravenous fluid prescribing practices could be inadequate coverage of this topic in the textbooks that are used. We formulated a comprehensive set of topics, related to important common clinical situations involving IV fluid therapy, (routine fluid replacement, fluid loss, fluids overload) to assess the adequacy of textbooks in common use. We assessed 29 medical textbooks widely available to students in the UK, scoring the presence of information provided by each book on each of the topics. The scores indicated how fully the topics were considered: not at all, partly, and adequately. No attempt was made to judge the quality of the information, because there is no consensus on these topics. The maximum score that a book could achieve was 52. Three of the topics we chose were not considered by any of the books. Discounting these topics as "too esoteric", the maximum possible score became 46. One textbook gained a score of 45, but the general score was poor (median 11, quartiles 4, 21). In particular, coverage of routine postoperative management was inadequate. Textbooks for undergraduates cover the topic of intravenous therapy badly, which may partly explain the poor knowledge and performance of junior doctors in this important field. Systematic revision of current textbooks might improve knowledge and practice by junior doctors. Careful definition of the remit and content of textbooks should be applied more widely to ensure quality and "fitness for purpose", and avoid omission of vital knowledge.

Development and evaluation of a brief self-completed family history screening tool for common chronic disease prevention in primary care

PubMed Central

Walter, Fiona M; Prevost, A Toby; Birt, Linda; Grehan, Nicola; Restarick, Kathy; Morris, Helen C; Sutton, Stephen; Rose, Peter; Downing, Sarah; Emery, Jon D

2013-01-01

Background Family history is an important risk factor for many common chronic diseases, but it remains underutilised for diagnostic assessment and disease prevention in routine primary care. Aim To develop and validate a brief self-completed family history questionnaire (FHQ) for systematic primary care assessment for family history of diabetes, ischaemic heart disease, breast cancer, and colorectal cancer. Design and setting Two-stage diagnostic validation study in 10 general practices in eastern England. Method Participants aged 18–50 years were identified via random sampling from electronic searches of general practice records. Participants completed a FHQ then had a three-generational ‘gold standard’ pedigree taken, to determine disease risk category. In stage 1, the FHQ comprised 12 items; in stage 2 the shorter 6-item FHQ was validated against the same ‘gold standard’. Results There were 1147 participants (stage 1: 618; stage 2: 529). Overall, 32% were at increased risk of one or more marker conditions (diabetes 18.9%, ischaemic heart disease 13.3%, breast cancer 6.2%, colorectal cancer 2.2%). The shorter 6-item FHQ performed very well for all four conditions: pooled data from both stages show diabetes, sensitivity = 98%, specificity = 94%; ischaemic heart disease, sensitivity = 93%, specificity = 81%; breast cancer, sensitivity = 81%, specificity = 83%; colorectal cancer, sensitivity = 96%, specificity = 88%, with an area under the receiver operating characteristic curve of 0.90 for males and 0.89 for females. Conclusion This brief self-completed FHQ shows good diagnostic accuracy for identifying people at higher risk of four common chronic diseases. It could be used in routine primary care to identify patients who would be most likely to benefit from a more detailed pedigree and risk assessment, and consequent management strategies. PMID:23735410

Undergraduate medical textbooks do not provide adequate information on intravenous fluid therapy: a systematic survey and suggestions for improvement

PubMed Central

2014-01-01

Background Inappropriate prescribing of intravenous (IV) fluid, particularly 0.9% sodium chloride, causes post-operative complications. Fluid prescription is often left to junior medical staff and is frequently poorly managed. One reason for poor intravenous fluid prescribing practices could be inadequate coverage of this topic in the textbooks that are used. Methods We formulated a comprehensive set of topics, related to important common clinical situations involving IV fluid therapy, (routine fluid replacement, fluid loss, fluids overload) to assess the adequacy of textbooks in common use. We assessed 29 medical textbooks widely available to students in the UK, scoring the presence of information provided by each book on each of the topics. The scores indicated how fully the topics were considered: not at all, partly, and adequately. No attempt was made to judge the quality of the information, because there is no consensus on these topics. Results The maximum score that a book could achieve was 52. Three of the topics we chose were not considered by any of the books. Discounting these topics as “too esoteric”, the maximum possible score became 46. One textbook gained a score of 45, but the general score was poor (median 11, quartiles 4, 21). In particular, coverage of routine postoperative management was inadequate. Conclusions Textbooks for undergraduates cover the topic of intravenous therapy badly, which may partly explain the poor knowledge and performance of junior doctors in this important field. Systematic revision of current textbooks might improve knowledge and practice by junior doctors. Careful definition of the remit and content of textbooks should be applied more widely to ensure quality and “fitness for purpose”, and avoid omission of vital knowledge. PMID:24555812

How to calculate the annual costs of NGO-implemented programmes to support orphans and vulnerable children: a six-step approach

PubMed Central

2011-01-01

Background Information on the costs of implementing programmes designed to provide support of orphans and vulnerable children (OVC) in sub-Saharan Africa and elsewhere is increasingly being requested by donors for programme evaluation purposes. To date, little information exists to document the costs and structure of costs of OVC programmes as actually implemented "on the ground" by local non-governmental organizations (NGOs). This analysis provides a practical, six-step approach that NGOs can incorporate into routine operations to evaluate their costs of implementing their OVC programmes annually. This approach is applied to the Community-Based Care for Orphans and Vulnerable Children (CBCO) Program implemented by BIDII (a Kenyan NGO) in Eastern Province of Kenya. Methods and results The costing methodology involves the following six steps: accessing and organizing the NGO's annual financial report into logical sub-categories; reorganizing the sub-categories into input cost categories to create a financial cost profile; estimating the annual equivalent payment for programme equipment; documenting donations to the NGO for programme implementation; including a portion of NGO organizational costs not attributed to specific programmes; and including the results of Steps 3-5 into an expanded cost profile. Detailed results are provided for the CBCO programme. Conclusions This paper shows through a concrete example how NGOs implementing OVC programmes (and other public health programmes) can organize themselves for data collection and documentation prospectively during the implementation of their OVC programmes so that costing analyses become routine practice to inform programme implementation rather than a painful and flawed retrospective activity. Such information is required if the costs and outcomes achieved by OVC programmes will ever be clearly documented and compared across OVC programmes and other types of programmes (prevention, treatment, etc.). PMID:22182588

How to calculate the annual costs of NGO-implemented programmes to support orphans and vulnerable children: a six-step approach.

PubMed

Larson, Bruce A; Wambua, Nancy

2011-12-19

Information on the costs of implementing programmes designed to provide support of orphans and vulnerable children (OVC) in sub-Saharan Africa and elsewhere is increasingly being requested by donors for programme evaluation purposes. To date, little information exists to document the costs and structure of costs of OVC programmes as actually implemented "on the ground" by local non-governmental organizations (NGOs). This analysis provides a practical, six-step approach that NGOs can incorporate into routine operations to evaluate their costs of implementing their OVC programmes annually. This approach is applied to the Community-Based Care for Orphans and Vulnerable Children (CBCO) Program implemented by BIDII (a Kenyan NGO) in Eastern Province of Kenya. The costing methodology involves the following six steps: accessing and organizing the NGO's annual financial report into logical sub-categories; reorganizing the sub-categories into input cost categories to create a financial cost profile; estimating the annual equivalent payment for programme equipment; documenting donations to the NGO for programme implementation; including a portion of NGO organizational costs not attributed to specific programmes; and including the results of Steps 3-5 into an expanded cost profile. Detailed results are provided for the CBCO programme. This paper shows through a concrete example how NGOs implementing OVC programmes (and other public health programmes) can organize themselves for data collection and documentation prospectively during the implementation of their OVC programmes so that costing analyses become routine practice to inform programme implementation rather than a painful and flawed retrospective activity. Such information is required if the costs and outcomes achieved by OVC programmes will ever be clearly documented and compared across OVC programmes and other types of programmes (prevention, treatment, etc.).

Machine learning: a useful radiological adjunct in determination of a newly diagnosed glioma's grade and IDH status.

PubMed

De Looze, Céline; Beausang, Alan; Cryan, Jane; Loftus, Teresa; Buckley, Patrick G; Farrell, Michael; Looby, Seamus; Reilly, Richard; Brett, Francesca; Kearney, Hugh

2018-05-16

Machine learning methods have been introduced as a computer aided diagnostic tool, with applications to glioma characterisation on MRI. Such an algorithmic approach may provide a useful adjunct for a rapid and accurate diagnosis of a glioma. The aim of this study is to devise a machine learning algorithm that may be used by radiologists in routine practice to aid diagnosis of both: WHO grade and IDH mutation status in de novo gliomas. To evaluate the status quo, we interrogated the accuracy of neuroradiology reports in relation to WHO grade: grade II 96.49% (95% confidence intervals [CI] 0.88, 0.99); III 36.51% (95% CI 0.24, 0.50); IV 72.9% (95% CI 0.67, 0.78). We derived five MRI parameters from the same diagnostic brain scans, in under two minutes per case, and then supplied these data to a random forest algorithm. Machine learning resulted in a high level of accuracy in prediction of tumour grade: grade II/III; area under the receiver operating characteristic curve (AUC) = 98%, sensitivity = 0.82, specificity = 0.94; grade II/IV; AUC = 100%, sensitivity = 1.0, specificity = 1.0; grade III/IV; AUC = 97%, sensitivity = 0.83, specificity = 0.97. Furthermore, machine learning also facilitated the discrimination of IDH status: AUC of 88%, sensitivity = 0.81, specificity = 0.77. These data demonstrate the ability of machine learning to accurately classify diffuse gliomas by both WHO grade and IDH status from routine MRI alone-without significant image processing, which may facilitate usage as a diagnostic adjunct in clinical practice.

Normal pressure hydrocephalus: survey on contemporary diagnostic algorithms and therapeutic decision-making in clinical practice.

PubMed

Krauss, J K; Halve, B

2004-04-01

There is no agreement on the best diagnostic criteria for selecting patients with normal pressure hydrocephalus (NPH) for CSF shunting. The primary objective of the present study was to provide a contemporary survey on diagnostic algorithms and therapeutic decision-making in clinical practice. The secondary objective was to estimate the incidence of NPH. Standardized questionnaires with sections on the incidence of NPH and the frequency of shunting, evaluation of clinical symptoms, and signs, diagnostic studies, therapeutic decision-making and operative techniques, postoperative outcome and complications, and the profiles of different centers, were sent to 82 neurosurgical centers in Germany known to participate in the care of patients with NPH. Data were analyzed from 49 of 53 centers which responded to the survey (65%). The estimated annual incidence of NPH was 1.8 cases/100.000 inhabitants. Gait disturbance was defined as the most important sign of NPH (61%). There was a wide variety in the choice of diagnostic tests. Cisternography was performed routinely only in single centers. Diagnostic CSF removal was used with varying frequency by all centers except one, but the amount of CSF removed by lumbar puncture differed markedly between centers. There was poor agreement on criteria for evaluation of continuous intracranial pressure recordings regarding both the amplitude and the relative frequency of B-waves. Both periventricular and deep white matter lesions were present in about 50% of patients being shunted, indicating that vascular comorbidity in NPH patients has gained more acceptance. Programmable shunts were used by more than half of the centers, and newer valve types such as gravitational valves have become more popular. According to the present survey, new diagnostic and therapeutic concepts on NPH have penetrated daily routine to a certain extent. Wide variability, however, still exists among different neurosurgical centers.

40 CFR 63.5734 - What standards must I meet for resin and gel coat application equipment cleaning operations?

Code of Federal Regulations, 2010 CFR

2010-07-01

...? (a) For routine flushing of resin and gel coat application equipment (e.g., spray guns, flowcoaters... and gel coat application equipment cleaning operations? 63.5734 Section 63.5734 Protection of... Pollutants for Boat Manufacturing Standards for Resin and Gel Coat Application Equipment Cleaning Operations...

[Observation on analgesia effect of electroacupuncture during gynecologic outpatient operation].

PubMed

Wang, Xiao-Hui; Wu, Xue-Lei; Jin, Ping-Lin; Wang, Lu-Dong; Zhao, Zhi-En; Qin, Xue-Yu; Zhang, Zhi-Yan; Hu, Xue-Zhu; Cai, Zhen-Lin

2012-10-01

To verify the feasibility of electroacupuncture analgesia applied to gynecologic outpatient operation. Two hundred patients were randomly divided into an electroacupuncture analgesia group and an intravenous anesthesia group, 100 cases in each group. Operation types included artificial abortion, diagnostic curettage and remove of intrauterine divice. The electroacupuncture analgesia group was treated with electroacupuncture at bilateral Hegu (LI 4) and Neiguan (PC 6), and the routine gynecologic outpatient operation was performed under patients' waking state. The intravenous anesthesia group was treated with routine gynecologic outpatient operation after intravenous injection of fentanyl and propofol. The excellent rate and the effective rate of analgesia were 88.0% (88/100) and 100.0% (100/100) in the electroacupuncture analgesia group, and 94.0% (94/100) and 100.0% (100/100) in the intravenous anesthesia group, with no statistically significant differences between the two groups (all P > 0.05). There was no adverse reaction in the electroacupuncture anesthesia group, but 11 cases of adverse reactions in the intravenous anesthesia group. Electroacupuncture analgesia can effectively alleviate the pain during gynecologic outpatient operation and it is simple and safe without adverse reactions.

Improving the production of applied health research findings: insights from a qualitative study of operational research.

PubMed

Crowe, Sonya; Turner, Simon; Utley, Martin; Fulop, Naomi J

2017-09-08

Knowledge produced through applied health research is often of a form not readily accessible to or actionable by policymakers and practitioners, which hinders its implementation. Our aim was to identify research activities that can support the production of knowledge tailored to inform policy and practice. To do this, we studied an operational research approach to improving the production of applied health research findings. A 2-year qualitative study was conducted of the operational research contribution to a multidisciplinary applied health research project that was successful in rapidly informing national policy. Semi-structured interviews (n = 20) were conducted with all members of the project's research team and advisory group (patient and health professional representatives and academics). These were augmented by participant (> 150 h) and non-participant (> 15 h) observations focusing on the process and experience of attempting to support knowledge production. Data were analysed thematically using QSR NVivo software. Operational research performed a knowledge mediation role shaped by a problem-focused approach and an intent to perform those tasks necessary to producing readily implementable knowledge but outwith the remit of other disciplinary strands of the project. Three characteristics of the role were found to support this: engaging and incorporating different perspectives to improve services by capturing a range of health professional and patient views alongside quantitative and qualitative research evidence; rendering data meaningful by creating and presenting evidence in forms that are accessible to and engage different audiences, enabling them to make sense of it for practical use; and maintaining perceived objectivity and rigour by establishing credibility, perceived neutrality and confidence in the robustness of the research in order to unite diverse professionals in thinking creatively about system-wide service improvement. Our study contributes useful empirical insights about knowledge mediation activities within multidisciplinary applied health research projects that support the generation of accessible, practice-relevant and actionable knowledge. Incorporating such activities, or a dedicated role, for mediating knowledge production within such projects could help to enhance the uptake of research findings into routine healthcare and warrants further consideration.

[The cell phones as devices for the ocular fundus documentation].

PubMed

Němčanský, J; Kopecký, A; Timkovič, J; Mašek, P

2014-12-01

To present our experience with "smart phones" when examining and documenting human eyes. From September to October 2013 fifteen patients (8 men, 7 women) eye fundus was examined, an average age during the examination was 58 year (ranging from 20-65 years). The photo-documentation was performed with dilated pupils (tropicamid hydrochloridum 1% eye drops) with mobile phone Samsung Galaxy Nexus with the operating system Android 4.3 (Google Inc., Mountain View, CA, USA) and iPhone 4 with the operating system 7.0.4 (Apple Inc., Loop Cupertino, CA, USA), and with 20D lens (Volk Optical Inc., Mentor, OH, USA). The images of the retina taken with a mobile phone and the spherical lens are of a very good quality, precise and reproducible. Learning this technique is easy and fast, the learning curve is steep. Photo-documentation of retina with a mobile phone is a safe, time-saving, easy-to-learn technique, which may be used in a routine ophthalmologic practice. The main advantage of this technique is availability, small size and easy portability of the devices.

Anthropogenic and technogenic factors of operational risk at hazardous industrial objects of fuel-power complex

NASA Astrophysics Data System (ADS)

Magid, S. I.; Arkhipova, E. N.; Kulichikhin, V. V.; Zagretdinov, I. Sh.

2016-12-01

Technogenic and anthropogenic accidence at hazardous industrial objects (HIO) in the Russian Federation has been considered. The accidence level at HIO, including power plants and network enterprises, is determined by anthropogenic reasons, so-called "human factor", in 70% of all cases. The analysis of incidents caused by personnel has shown that errors occur most often during accidental situations, launches, holdups, routine switches, and other effects on equipment controls. It has been demonstrated that skills needed to perform type and routine switches can be learned, to certain limits, on real operating equipment, while combating emergency and accidental situations can be learned only with the help of modern training simulators developed based on information technologies. Problems arising during the following processes have been considered: development of mathematical and software support of modern training equipment associated, in one way or another, with adequate power-generating object modeling in accordance with human operator specifics; modeling and/or simulation of the corresponding control and management systems; organization of the education system (functional supply of the instructor, education and methodological resources (EMR)); organization of the program-technical, scalable and adaptable, platform for modeling of the main and secondary functions of the training simulator. It has been concluded that the systemic approach principle on the necessity and sufficiency in the applied methodology allows to reproduce all technological characteristics of the equipment, its topological completeness, as well as to achieve the acceptable counting rate. The initial "rough" models of processes in the equipment are based on the normative techniques and equation coefficients taken from the normative materials as well. Then, the synthesis of "fine" models has been carried out following the global practice in modeling and training simulator building, i.e., verification of "rough" models based on experimental data available to the developer. Finally, the last stage of modeling is adaptation (validation) of "fine" models to the prototype object using experimental data on the power-generating object and tests of these models with operating and maintaining personnel. These stages determine adequacy of the used mathematical model for a particular training simulator and, thus, its compliance with such modern scientific criteria as objectivity and experimental verifiability.

AUTOMATIC GENERATION OF FFT FOR TRANSLATIONS OF MULTIPOLE EXPANSIONS IN SPHERICAL HARMONICS

PubMed Central

Mirkovic, Dragan; Pettitt, B. Montgomery; Johnsson, S. Lennart

2009-01-01

The fast multipole method (FMM) is an efficient algorithm for calculating electrostatic interactions in molecular simulations and a promising alternative to Ewald summation methods. Translation of multipole expansion in spherical harmonics is the most important operation of the fast multipole method and the fast Fourier transform (FFT) acceleration of this operation is among the fastest methods of improving its performance. The technique relies on highly optimized implementation of fast Fourier transform routines for the desired expansion sizes, which need to incorporate the knowledge of symmetries and zero elements in the input arrays. Here a method is presented for automatic generation of such, highly optimized, routines. PMID:19763233

An Electronic Patient-Reported Outcome Measures System in UK Chiropractic Practices: A Feasibility Study of Routine Collection of Outcomes and Costs.

PubMed

Newell, Dave; Diment, Emily; Bolton, Jenni E

2016-01-01

The purpose of this study was to test the feasibility of collecting valid and widely used health outcomes, including information concerning cost of care, using a Web-based patient-driven patient-reported outcome measure (PROM) collection process within a cohort of UK chiropractic practices. A Web-based PROM system (Care Response) was used. Patients with low back and neck pain were recruited from a group of chiropractic practices located in the United Kingdom. Information collected included demographic data, generic and condition-specific PROMs at the initial consultation and 90 days later, patient-reported experience measures, and additional health seeking to estimate costs of care. A group of 33 clinics provided information from a total of 1895 patients who completed baseline questionnaires with 844 (45%) completing the measures at 90-day follow-up. Subsequent outcomes suggest that more than 70% of patients improved over the course of treatment regardless of the outcome used. Using the baseline as a virtual counterfactual with respect to follow-up, we calculated quality-adjusted life years and the cost thereof resulting in a mean quality-adjusted life years gained of 0.8 with an average cost of £895 per quality-adjusted life year. Routine collection of PROMs, including information about cost, is feasible and can be achieved using an online system within a clinical practice environment. We describe a Web-based collection system and discuss the choice of measures leading to a comprehensive understanding of outcomes and costs in routine practice. Copyright © 2016 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

The Genetic Counseling Video Project (GCVP): models of practice.

PubMed

Roter, D; Ellington, L; Erby, L Hamby; Larson, S; Dudley, W

2006-11-15

Genetic counseling is conceptualized as having both "teaching" and "counseling" functions; however, little is known about how these functions are articulated in routine practice. This study addresses the question by documenting, on videotape, the practices of a national sample of prenatal and cancer genetic counselors (GCs) providing routine pre-test counseling to simulated clients (SCs). One hundred and seventy-seven GCs recruited at two annual conferences of the National Society of Genetic Counselors (NSGC) were randomly assigned to counsel one of six female SCs of varying ethnicity, with or without a spouse, in their specialty. One hundred and fifty-two videotapes were coded with the Roter Interaction Analysis System (RIAS) and both GCs and SCs completed evaluative questionnaires. Two teaching and two counseling patterns of practice emerged from cluster analysis. The teaching patterns included: (1) clinical teaching (31%) characterized by low psychosocial, emotional and facilitative talk, high levels of clinical exchange, and high verbal dominance; and (2) psycho-educational teaching (27%) characterized by high levels of both clinical and psychosocial exchange, low levels of emotional and facilitative talk, and higher verbal dominance. The counseling patterns included: (1) supportive counseling (33%) characterized by low psychosocial and clinical exchange, high levels of emotional and facilitative talk, and low verbal dominance; and (2) psychosocial counseling (9%) with high emotional and facilitative talk, low clinical and high psychosocial exchange, and the lowest verbal dominance. SCs ratings of satisfaction with communication, the counselor's affective demeanor, and the counselor's use of non-verbal skills were highest for the counseling model sessions. Both the teaching and counseling models seem to be represented in routine practice and predict variation in client satisfaction, affective demeanor, and nonverbal effectiveness. (c) 2006 Wiley-Liss, Inc.

Management Trends in Prenatally-Detected Hydronephrosis: A National Survey of Pediatrician Practice Patterns and Antibiotic Use

PubMed Central

Yiee, Jenny H.; Tasian, Gregory E.; Copp, Hillary L.

2011-01-01

Objectives Hydronephrosis is the most common abnormality found on prenatal ultrasound. The utility of prophylactic antibiotics in the postnatal management of this condition is controversial. No study has assessed practice patterns of general pediatricians in the management of prenatally-detected hydronephrosis. Methods An 18 question survey was sent to a random cross-sectional national sample of pediatricians from the American Medical Association Masterfile. Participants answered questions regarding practice location and type, practice experience, frequency of cases seen, familiarity with the literature, use of antibiotics, work-up of hydronephrosis, and specialist referral. Multivariate logistic regression identified factors associated with prescribing antibiotics. Results 244 of 461 (53%) subjects responded. 56% routinely prescribe antibiotics for prenatally-detected hydronephrosis. 57% perform postnatal work-up themselves. Of these, 98% routinely order ultrasounds while ~40% routinely order voiding cystourethrograms. 94% have specialists readily available, but only 41% always refer to a specialist. On multivariate logistic regression, those who believe prophylactic antibiotics to be beneficial are significantly more likely to prescribe antibiotics compared with those who have not read the literature (OR 6.1, 95%CI 2–15). Those without specialist consultation readily available have an increased odds of starting prophylactic antibiotics compared with those who have consultation available (OR 7.2, 95%CI 1.3–39). Conclusion Most pediatricians initiate postnatal management of prenatally-detected hydronephrosis, therefore pediatricians truly are gatekeepers to children with this condition. Knowledge of practice patterns is crucial for the dissemination of evidence-based information to the appropriate providers and enables us to learn more about the utility of antibiotic prophylaxis in future studies. PMID:21696811

Eigenvalue routines in NASTRAN: A comparison with the Block Lanczos method

NASA Technical Reports Server (NTRS)

Tischler, V. A.; Venkayya, Vipperla B.

1993-01-01

The NASA STRuctural ANalysis (NASTRAN) program is one of the most extensively used engineering applications software in the world. It contains a wealth of matrix operations and numerical solution techniques, and they were used to construct efficient eigenvalue routines. The purpose of this paper is to examine the current eigenvalue routines in NASTRAN and to make efficiency comparisons with a more recent implementation of the Block Lanczos algorithm by Boeing Computer Services (BCS). This eigenvalue routine is now available in the BCS mathematics library as well as in several commercial versions of NASTRAN. In addition, CRAY maintains a modified version of this routine on their network. Several example problems, with a varying number of degrees of freedom, were selected primarily for efficiency bench-marking. Accuracy is not an issue, because they all gave comparable results. The Block Lanczos algorithm was found to be extremely efficient, in particular, for very large size problems.