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Sample records for sepsis practice survey

  1. A Survey on Current Practice of Management of Early Onset Neonatal Sepsis.

    PubMed

    Dey, A C; Hossain, M I; Afroze, S; Dey, S K; Mannan, M A; Shahidullah, M

    2016-04-01

    It was a survey type of cross sectional study where the participants were from different teaching/referral hospital across the country and was done to gather information regarding current practice of management of neonatal sepsis among paediatricians and neonatologists and was conducted on the spot during a national conference of Bangladesh Perinatal Society in December 2013. Specialists in neonatology, paediatrics, and some other disciplines working in different institutes across the country were requested to respond. Out of 150 physicians, 92 (61.33%) were neonatologists. Physicians suspected early onset neonatal sepsis (EONS) when there is history suggestive of prolonged rupture of membrane (74.77%), prolonged labour (9.33%), chorioamnionitis (7.33%) and maternal fever (2%). Clinical sepsis is found commonly (53.33%) which is later proved by laboratory evidences such as Hb%, TC, DC PBF (peripheral blood film), C-reactive protein, chest X-ray etc. Injection Ampicillin and Gentamycin are still the first choice of antibiotics (61.3%). Preferred route was intravenous (95.3%). Antibiotics were given for 7-10 days by most of the physicians (48.77%). However there is lack of uniformity among the participants in regard to taking decision about antibiotics, the choice of first line and the subsequent options of antibiotics. So, neonatal sepsis is the most important cause of neonatal mortality in the community. Therefore a standard protocolized approach for diagnosis and management of Early Onset Neonatal Sepsis may prove critical which is currently not in practice uniformly. PMID:27277355

  2. A Survey on Current Practice of Management of Early Onset Neonatal Sepsis.

    PubMed

    Dey, A C; Hossain, M I; Afroze, S; Dey, S K; Mannan, M A; Shahidullah, M

    2016-04-01

    It was a survey type of cross sectional study where the participants were from different teaching/referral hospital across the country and was done to gather information regarding current practice of management of neonatal sepsis among paediatricians and neonatologists and was conducted on the spot during a national conference of Bangladesh Perinatal Society in December 2013. Specialists in neonatology, paediatrics, and some other disciplines working in different institutes across the country were requested to respond. Out of 150 physicians, 92 (61.33%) were neonatologists. Physicians suspected early onset neonatal sepsis (EONS) when there is history suggestive of prolonged rupture of membrane (74.77%), prolonged labour (9.33%), chorioamnionitis (7.33%) and maternal fever (2%). Clinical sepsis is found commonly (53.33%) which is later proved by laboratory evidences such as Hb%, TC, DC PBF (peripheral blood film), C-reactive protein, chest X-ray etc. Injection Ampicillin and Gentamycin are still the first choice of antibiotics (61.3%). Preferred route was intravenous (95.3%). Antibiotics were given for 7-10 days by most of the physicians (48.77%). However there is lack of uniformity among the participants in regard to taking decision about antibiotics, the choice of first line and the subsequent options of antibiotics. So, neonatal sepsis is the most important cause of neonatal mortality in the community. Therefore a standard protocolized approach for diagnosis and management of Early Onset Neonatal Sepsis may prove critical which is currently not in practice uniformly.

  3. Systems for Paediatric Sepsis: A Global Survey

    PubMed Central

    Kang, KT; Chandler, HK; Espinosa, V; Kissoon, N

    2014-01-01

    ABSTRACT Objectives: To evaluate the resources available for early diagnosis and treatment of paediatric sepsis at hospitals in developing and developed countries. Methods: This was a voluntary online survey involving 101 hospitals from 41 countries solicited through the World Federation of Pediatric Intensive and Critical Care Societies contact list and website. The survey was designed to assess the spectrum of sepsis epidemiology, patterns of applied therapies, availability of resources and barriers to optimal sepsis treatment. Results: Ninety per cent of respondents represented a tertiary or general hospital with paediatric intensive care facilities, including 63% from developed countries. Adequate triage services were absent in more than 20% of centres. Insufficiently trained personnel and lack of a sepsis protocol was reported in 40% of all sites. While there were specific guidelines for sepsis management in 78% of centres (n = 100), protocols for assessing sepsis patients were not applied in nearly 70% of centres. Lack of parental recognition of sepsis and failure of referring centres to diagnose sepsis were identified as major barriers by more than 50% of respondents. Conclusions: Even among centres with no significant resource constraints and advanced medical systems, significant deficits in sepsis care exist. Early recognition and management remains a key issue and may be addressed through improved triage, augmented support for referring centres and public awareness. Focussed research is necessary at the institutional level to identify and address specific barriers. PMID:25867557

  4. Sepsis

    MedlinePlus

    ... the episode 3 , 4 . What is the economic cost of sepsis? Treatment for sepsis often involves a ... care unit and complex therapies, which incur high costs. The Agency for Healthcare Research and Quality lists ...

  5. Sepsis.

    PubMed

    Dean, Erin

    2016-09-01

    Essential facts Sepsis, a clinical syndrome caused by the body's immune and coagulation systems being switched on by an infection, is believed to cause about 44,000 deaths a year. If not recognised early and treated promptly, sepsis can lead to shock, multiple organ failure and death. Major reports (UK parliamentary and health service ombudsman enquiry in 2013 and the UK National Confidential Enquiry into Patient Outcome and Death in 2015) have highlighted sepsis as being a leading cause of avoidable death that kills more people than breast, bowel and prostate cancer combined. PMID:27581906

  6. Sepsis.

    PubMed

    Dean, Erin

    2016-09-01

    Essential facts [Figure: see text] Sepsis, a clinical syndrome caused by the body's immune and coagulation systems being switched on by an infection, is believed to cause about 44,000 deaths a year. If not recognised early and treated promptly, sepsis can lead to shock, multiple organ failure and death. Major reports (UK parliamentary and health service ombudsman enquiry in 2013 and the UK National Confidential Enquiry into Patient Outcome and Death in 2015) have highlighted sepsis as being a leading cause of avoidable death that kills more people than breast, bowel and prostate cancer combined. PMID:27615338

  7. Early onset neonatal sepsis: diagnostic dilemmas and practical management.

    PubMed

    Bedford Russell, A R; Kumar, R

    2015-07-01

    Early onset neonatal sepsis is persistently associated with poor outcomes, and incites clinical practice based on the fear of missing a treatable infection in a timely fashion. Unnecessary exposure to antibiotics is also hazardous. Diagnostic dilemmas are discussed in this review, and suggestions offered for practical management while awaiting a more rapidly available 'gold standard' test; in an ideal world, this test would be 100% sensitive and 100% specific for the presence of organisms.

  8. Sepsis

    MedlinePlus

    ... oxygen. In severe cases, one or more organs fail. In the worst cases, blood pressure drops and the heart weakens, leading to septic shock. Anyone can get sepsis, but the risk is higher in People with weakened immune systems Infants and children The elderly People with chronic ...

  9. Neutropenic sepsis.

    PubMed

    Jones, Tracie

    2016-09-28

    What was the nature of the CPD activity, practice-related feedback and/or event and/or experience in your practice? The article discussed the causes, signs and symptoms of neutropenic sepsis in adult patients after cancer treatment. It also explored the prevention and management of this condition. PMID:27682569

  10. Severe sepsis and septic shock in pre-hospital emergency medicine: survey results of medical directors of emergency medical services concerning antibiotics, blood cultures and algorithms.

    PubMed

    Casu, Sebastian; Häske, David

    2016-06-01

    Delayed antibiotic treatment for patients in severe sepsis and septic shock decreases the probability of survival. In this survey, medical directors of different emergency medical services (EMS) in Germany were asked if they are prepared for pre-hospital sepsis therapy with antibiotics or special algorithms to evaluate the individual preparations of the different rescue areas for the treatment of patients with this infectious disease. The objective of the survey was to obtain a general picture of the current status of the EMS with respect to rapid antibiotic treatment for sepsis. A total of 166 medical directors were invited to complete a short survey on behalf of the different rescue service districts in Germany via an electronic cover letter. Of the rescue districts, 25.6 % (n = 20) stated that they keep antibiotics on EMS vehicles. In addition, 2.6 % carry blood cultures on the vehicles. The most common antibiotic is ceftriaxone (third generation cephalosporin). In total, 8 (10.3 %) rescue districts use an algorithm for patients with sepsis, severe sepsis or septic shock. Although the German EMS is an emergency physician-based rescue system, special opportunities in the form of antibiotics on emergency physician vehicles are missing. Simultaneously, only 10.3 % of the rescue districts use a special algorithm for sepsis therapy. Sepsis, severe sepsis and septic shock do not appear to be prioritized as highly as these deadly diseases should be in the pre-hospital setting. PMID:26719078

  11. New clinical practice guidelines of the surviving sepsis campaign: a critical appraisal.

    PubMed

    Palencia Herrejón, E; Bueno García, B

    2013-12-01

    In 2004 was published the first edition of the "Surviving sepsis campaign" guidelines for the management of severe sepsis and septic shock, opening a new era in the treatment of this syndrome. The paradox is that guidelines application have produced positive results despite including in some cases treatments proven ineffective. Eight years later has been published the third edition of the guides, which updates the prior in the light of new knowledge, but the quality of evidence remains weak. In this paper the authors express their critical view on the current edition of the guides, pointing out their weaknesses and suggesting how the development of future editions should be.

  12. Implementing sepsis bundles

    PubMed Central

    Jozwiak, Mathieu; Monnet, Xavier

    2016-01-01

    Sepsis bundles represent key elements of care regarding the diagnosis and treatment of patients with septic shock and allow ones to convert complex guidelines into meaningful changes in behavior. Sepsis bundles endorsed the early goal-directed therapy (EGDT) and their implementation resulted in an improved outcome of septic shock patients. They induced more consistent and timely application of evidence-based care and reduced practice variability. These benefits mainly depend on the compliance with sepsis bundles, highlighting the importance of dedicated performance improvement initiatives, such as multifaceted educational programs. Nevertheless, the interest of early goal directed therapy in septic shock patients compared to usual care has recently been questioned, leading to an update of sepsis bundles in 2015. These new sepsis bundles may also exhibit, as the previous bundles, some limits and pitfalls and the effects of their implementation still needs to be evaluated. PMID:27713890

  13. Sepsis biomarkers.

    PubMed

    Prucha, Miroslav; Bellingan, Geoff; Zazula, Roman

    2015-02-01

    Sepsis is the most frequent cause of death in non-coronary intensive care units (ICUs). In the past 10 years, progress has been made in the early identification of septic patients and in their treatment and these improvements in support and therapy mean that the mortality is gradually decreasing but it still remains unacceptably high. Leaving clinical diagnosis aside, the laboratory diagnostics represent a complex range of investigations that can place significant demands on the system given the speed of response required. There are hundreds of biomarkers which could be potentially used for diagnosis and prognosis in septic patients. The main attributes of successful markers would be high sensitivity, specificity, possibility of bed-side monitoring, and financial accessibility. Only a fraction is used in routine clinical practice because many lack sufficient sensitivity or specificity. The following review gives a short overview of the current epidemiology of sepsis, its pathogenesis and state-of-the-art knowledge on the use of specific biochemical, hematological and immunological parameters in its diagnostics. Prospective approaches towards discovery of new diagnostic biomarkers have been shortly mentioned.

  14. Survey of Compensation Practices in Higher Education.

    ERIC Educational Resources Information Center

    Benedict, Forest C.; And Others

    This national survey collected information on the wage and salary management practices in use in institutions of higher education. The survey questionnaire was distributed to approximately 3,000 institutions of higher education in the United States. Characteristics of the over 800 respondents are analyzed. A section on job analysis practices…

  15. A Survey of Psychological Assessment Feedback Practices

    ERIC Educational Resources Information Center

    Smith, Steven R.; Wiggins, Chauntel M.; Gorske, Tad T.

    2007-01-01

    There have been no previous studies on how often psychologists conduct feedback and whether they view this practice as a useful component of assessment. To explore psychologists' feedback practices and their perception of the effects of feedback on their clients, the authors examined survey data from 719 psychologist members of the International…

  16. Medical Simulation Practices 2010 Survey Results

    NASA Technical Reports Server (NTRS)

    McCrindle, Jeffrey J.

    2011-01-01

    Medical Simulation Centers are an essential component of our learning infrastructure to prepare doctors and nurses for their careers. Unlike the military and aerospace simulation industry, very little has been published regarding the best practices currently in use within medical simulation centers. This survey attempts to provide insight into the current simulation practices at medical schools, hospitals, university nursing programs and community college nursing programs. Students within the MBA program at Saint Joseph's University conducted a survey of medical simulation practices during the summer 2010 semester. A total of 115 institutions responded to the survey. The survey resus discuss overall effectiveness of current simulation centers as well as the tools and techniques used to conduct the simulation activity

  17. Feasibility of contact surveys in general practice.

    PubMed Central

    Phillips, A; Mant, D

    1987-01-01

    Surveys to evaluate risk factors for disease in the general population are popular with health authorities for assessing the effectiveness of their preventive measures. A contact survey of the lifestyles of 2000 randomly selected patients aged 25-64 was conducted in five general practices over 18 months; the medical records of the patients selected were tagged, and when the patients first visited the surgery they were given a questionnaire by the receptionists, which they completed in the waiting room. Over the 18 months at least 1400 of these patients visited the practices, of whom 1106 (55%) completed a questionnaire and 20 refused to do so; 896 (81%) completed it within one year. Information on the patients who were not surveyed was obtained by sending the questionnaire by post and by audit of medical records. The population surveyed on contact with the surgeries contained a higher proportion of young women, and possibly a higher proportion of patients from social classes IIIM-V, than the other patients. No important or consistent bias towards unhealthy patients at high risk was identified in the contact survey. A one year contact survey of a random, tagged sample is feasible in estimating the risk factors in a population and may be the method of choice in general practice because of its low cost and adaptability. PMID:3120900

  18. Surviving sepsis in the critical care environment.

    PubMed

    Benedict, Lara

    2015-01-01

    The management of sepsis and septic shock in the intensive care environment is a complex task requiring the cooperation of a multidisciplinary team. The Surviving Sepsis Campaign provides systematic guidelines for the recognition, early intervention, and supportive management of sepsis. Critical care nurses are instrumental in ensuring that these guidelines and other sources of evidence-based practice are used for patients with severe sepsis or septic shock. This article discusses the pathophysiologic processes in severe sepsis and septic shock and discusses the appropriate interventions as recommended by the Surviving Sepsis Campaign. Recommended early treatments are reviewed along with interventions related to hemodynamics, perfusion, and supportive care in the critical care environment.

  19. A practical guide to surveys and questionnaires.

    PubMed

    Slattery, Eric L; Voelker, Courtney C J; Nussenbaum, Brian; Rich, Jason T; Paniello, Randal C; Neely, J Gail

    2011-06-01

    Surveys with questionnaires play a vital role in decision and policy making in society. Within medicine, including otolaryngology, surveys with questionnaires may be the only method for gathering data on rare or unusual events. In addition, questionnaires can be developed and validated to be used as outcome measures in clinical trials and other clinical research architecture. Consequently, it is fundamentally important that such tools be properly developed and validated. Just asking questions that have not gone through rigorous design and development may be misleading and unfair at best; at worst, they can result in under- or overtreatment and unnecessary expense. Furthermore, it is important that consumers of the data produced by these instruments understand the principles of questionnaire design to interpret results in an optimal and meaningful way. This article presents a practical guide for understanding the methodologies of survey and questionnaire design, including the concepts of validity and reliability, how surveys are administered and implemented, and, finally, biases and pitfalls of surveys.

  20. Training for general practice: a national survey.

    PubMed Central

    Crawley, H S; Levin, J B

    1990-01-01

    OBJECTIVES--(a) To compare current vocational training in general practice with that ascertained by a survey in 1980; (b) to compare the training of trainees in formal training schemes with that of trainees arranging their own hospital and general practice posts. DESIGN--National questionnaire survey of United Kingdom and armed services trainees who were in a training practice on 1 April 1989. Questionnaires were distributed by course organisers. SETTING--Research project set up after an ad hoc meeting of trainees at the 1988 national trainee conference. SUBJECTS--2132 Of the 2281 trainees (93%) known to be in a training practice on 1 April 1989. RESULTS--1657 Trainees returned the questionnaires, representing 73% of all trainees known to be in a training practice on 1 April 1989. Between 1980 and 1989 there were significant improvements in the trainee year, and there was also evidence of improvements in general practice study release courses. There was no evidence of improvement in other aspects of training. General practice trainees spent an average of three years in junior hospital posts, which provided very little opportunity for study related to general practice. Training received during tenure of hospital posts differed significantly between trainees in formal schemes and those arranging their own hospital posts. During the trainee year training was almost the same for those in formal schemes and those arranging their own posts. Regions varied significantly in virtually all aspects of general practice training. CONCLUSIONS--The trainee year could be improved further by enforcing the guidelines of the Joint Committee on Postgraduate Training for General Practice. The poor training in junior hospital posts reflected the low priority that training is generally given during tenure of these posts. A higher proportion of general practice trainees should be attached to vocational training schemes. More hospital trainees could attend general practice study release

  1. Family practice clinics. Survey of family practice residents' attitudes.

    PubMed Central

    Rubenstein, H.; Levitt, C.

    1993-01-01

    All residents of McGill University's Department of Family Medicine were surveyed by mail about their family practice clinic experience. Residents were generally satisfied with their training site and their supervision, but noted problems with volume and diversity of patients, learning certain procedures, and knowledge of community resources. They did not want more family medicine clinic time. PMID:8219838

  2. School Practices Survey: User Guide for Practitioners.

    ERIC Educational Resources Information Center

    Lauer, Patricia A.

    To help schools and districts in their efforts to create more productive and effective learning environments, Mid-continent Research for Education and Learning (McREL) researchers developed the School Practices Survey, a tool districts and schools can use to assess teachers, administrators, and others in the school community regarding their…

  3. Sepsis in critical care.

    PubMed

    King, Joan E

    2007-03-01

    Sepsis is a syndrome produced by the accelerated activity of the inflammatory immune response, the clotting cascade, and endothelial damage. It is a systematic process that can progress easily into septic shock and MODS. The chemical mediators or cytokines produce a complex self-perpetuating process that impacts all body systems. It is critical for the nurse first to identify patients at risk for developing sepsis and to assess patients who have SIRS and sepsis continually for signs and symptoms of organ involvement and organ dysfunction. Once sepsis has been diagnosed, evidence-based practice indicates initiation of fluid resuscitation. Vasopressor therapy, positive inotropic support, and appropriate antibiotic therapy should be started within the first hour. Within a 6-hour timeframe the goal is stabilization of the CVP, MAP, and UOP to prevent further organ damage. The challenge for nurses caring for septic patients is to support the treatment goals, to prevent added complications including stress ulcers, DVTs, aspiration pneumonia, and the progression to MODS, and to address the patient's and the family's psychosocial needs. As complex as the pathophysiology of sepsis is, the nursing care is equally complex but also rewarding. Patients who previously might have died now recover as vigilant nursing care combines forces with new drug therapies and evidence-based practice guidelines.

  4. Survey of Oxygen Delivery Practices in UK Paediatric Intensive Care Units

    PubMed Central

    Peters, Mark J.

    2016-01-01

    Purpose. Administration of supplemental oxygen is common in paediatric intensive care. We explored the current practice of oxygen administration using a case vignette in paediatric intensive care units (PICU) in the united kingdom. Methods. We conducted an online survey of Paediatric Intensive Care Society members in the UK. The survey outlined a clinical scenario followed by questions on oxygenation targets for 5 common diagnoses seen in critically ill children. Results. Fifty-three paediatric intensive care unit members from 10 institutions completed the survey. In a child with moderate ventilatory requirements, 21 respondents (42%) did not follow arterial partial pressure of oxygen (PaO2) targets. In acute respiratory distress syndrome, cardiac arrest, and sepsis, there was a trend to aim for lower PaO2 as the fraction of inspired oxygen (FiO2) increased. Conversely, in traumatic brain injury and pulmonary hypertension, respondents aimed for normal PaO2 even as the FiO2 increased. Conclusions. In this sample of clinicians PaO2 targets were not commonly used. Clinicians target lower PaO2 as FiO2 increases in acute respiratory distress syndrome, cardiac arrest, and sepsis whilst targeting normal range irrespective of FiO2 in traumatic brain injury and pulmonary hypertension. PMID:27516901

  5. A collaborative quality improvement model and electronic community of practice to support sepsis management in emergency departments: investigating care harmonization for provincial knowledge translation.

    PubMed

    Ho, Kendall; Marsden, Julian; Jarvis-Selinger, Sandra; Novak Lauscher, Helen; Kamal, Noreen; Stenstrom, Rob; Sweet, David; Goldman, Ran D; Innes, Grant

    2012-01-01

    Emergency medicine departments within several organizations are now advocating the adoption of early intervention guidelines for patients with the signs and symptoms of sepsis. This proposed research will lead to a comprehensive understanding of how diverse emergency department (ED) sites across British Columbia (BC), Canada, engage in a quality improvement collaborative to lead to improvements in time-based process measures and clinical outcomes for septic patients in EDs. To address the challenge of sepsis management, in 2007, the BC Ministry of Health began working with emergency health professionals, including health administrators, to establish a provincial ED collaborative: Evidence to Excellence (E2E). The E2E initiative employs the Institute for Healthcare Improvement (IHI) model and is supported by a Web-based community of practice (CoP) in emergency medicine. It aims to (1) support clinicians in accessing and applying evidence to clinical practice in emergency medicine, (2) support system change and clinical process improvement, and (3) develop resources and strategies to facilitate knowledge translation and process improvement. Improving sepsis management is one of the central foci of the E2E initiative. The primary purpose of our research is to investigate whether the application of sepsis management protocols leads to improved time-based process measures and clinical outcomes for patients presenting to EDs with sepsis. Also, we seek to investigate the implementation of sepsis protocols among different EDs. For example: (1) How can sepsis protocols be harmonized among different EDs? (2) What are health professionals' perspectives on interprofessional collaboration with various EDs? and (3) What are the factors affecting the level of success among EDs? Lastly, working in collaboration with the BC Ministry of Health as our policy-maker partner, the research will investigate how the demonstrated efficacy of this research can be applied on a provincial and

  6. A collaborative quality improvement model and electronic community of practice to support sepsis management in emergency departments: investigating care harmonization for provincial knowledge translation.

    PubMed

    Ho, Kendall; Marsden, Julian; Jarvis-Selinger, Sandra; Novak Lauscher, Helen; Kamal, Noreen; Stenstrom, Rob; Sweet, David; Goldman, Ran D; Innes, Grant

    2012-07-12

    Emergency medicine departments within several organizations are now advocating the adoption of early intervention guidelines for patients with the signs and symptoms of sepsis. This proposed research will lead to a comprehensive understanding of how diverse emergency department (ED) sites across British Columbia (BC), Canada, engage in a quality improvement collaborative to lead to improvements in time-based process measures and clinical outcomes for septic patients in EDs. To address the challenge of sepsis management, in 2007, the BC Ministry of Health began working with emergency health professionals, including health administrators, to establish a provincial ED collaborative: Evidence to Excellence (E2E). The E2E initiative employs the Institute for Healthcare Improvement (IHI) model and is supported by a Web-based community of practice (CoP) in emergency medicine. It aims to (1) support clinicians in accessing and applying evidence to clinical practice in emergency medicine, (2) support system change and clinical process improvement, and (3) develop resources and strategies to facilitate knowledge translation and process improvement. Improving sepsis management is one of the central foci of the E2E initiative. The primary purpose of our research is to investigate whether the application of sepsis management protocols leads to improved time-based process measures and clinical outcomes for patients presenting to EDs with sepsis. Also, we seek to investigate the implementation of sepsis protocols among different EDs. For example: (1) How can sepsis protocols be harmonized among different EDs? (2) What are health professionals' perspectives on interprofessional collaboration with various EDs? and (3) What are the factors affecting the level of success among EDs? Lastly, working in collaboration with the BC Ministry of Health as our policy-maker partner, the research will investigate how the demonstrated efficacy of this research can be applied on a provincial and

  7. 75 FR 72871 - Survey of Information Sharing Practices With Affiliates

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-26

    ... Office of Thrift Supervision Survey of Information Sharing Practices With Affiliates AGENCY: Office of... collection. Title of Proposal: Survey of Information Sharing Practices with Affiliates. OMB Number: 1550-0121... Agencies will gather information by means of a Survey to be completed by financial institutions and...

  8. 76 FR 4750 - Survey of Information Sharing Practices With Affiliates

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-26

    ... Office of Thrift Supervision Survey of Information Sharing Practices With Affiliates AGENCY: Office of... on the following information collection. Title of Proposal: Survey of Information Sharing Practices...-159, 117 Stat. 1952. The OTS will gather information by means of a Survey to be completed by...

  9. Improving management of sepsis in the community.

    PubMed

    Culligan, Fiona

    2016-08-31

    Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Pathological changes in the circulation reduce the blood supply to major organs, causing them to fail. This may lead to death, therefore rapid recognition and treatment of sepsis is vital. Sepsis research has focused on patients in acute hospital settings. However, most cases of sepsis originate in the community, suggesting that the identification of sepsis and delivery of timely care is necessary before hospital admission. Therefore, it is essential that nurses practising in the community are provided with appropriate sepsis guidelines that can be implemented immediately. The UK Sepsis Trust has developed the General Practice Sepsis Decision Support Tool, which has been designed specifically for use in the community. This article provides an overview of how the tool is used in the community and how it works in conjunction with the 'Sepsis Six' care bundle and care bundles for hospital settings. Changes to the terminology used in relation to sepsis and recent guidelines are also explained. PMID:27577313

  10. Practical Guidelines for Evaluating Sampling Designs in Survey Studies.

    ERIC Educational Resources Information Center

    Fan, Xitao; Wang, Lin

    The popularity of sample surveys in evaluation and research makes it necessary for consumers to tell a good survey from a poor one. Several sources were identified that gave advice on how to evaluate a sample design used in a survey study. The sources are either too limited or too extensive to be useful practically. The purpose of this paper is to…

  11. The Need For Ongoing Surveys About Physician Practice Costs.

    PubMed

    Berk, Marc L

    2016-09-01

    Physicians continue to be the subject of many survey efforts asking them about a wide range of issues including training, retirement plans, satisfaction with practice, practice organization, and practice costs. The resources dedicated to the collection of different types of data have changed over time. Collection efforts have both expanded and contracted. Here I discuss this phenomenon for several types of physician surveys, with particular focus on the reduction in ongoing survey efforts about physician practice costs. The diminution of efforts to collect information about these costs represents an important challenge since the lack of timely, high-quality data could impair the correct calculation of reimbursement rates. PMID:27605646

  12. Tennessee advanced practice nurse compensation survey results 2006-2007.

    PubMed

    Arnold, Kimberly

    2007-01-01

    In 2006, representatives from Middle Tennessee Advanced Practice Nurses (MTAPN), Greater Memphis Area Advanced Practice Nurses (GMAAPN), and Northeast Tennessee Nurse Practitioners Association (NETNPA) decided to poll APNs in Tennessee to compare data with the most recent results from the Advance for Nurse Practitioners national NP survey. Every other year, Advance for Nurse Practitioners publishes salary survey results from their survey. Most recently, in January 2006, an average nationwide salary for all APNs was reported at $74,812, with Tennessee's average at $71,068.

  13. Practical microbiology in schools: a survey of UK teachers.

    PubMed

    Redfern, James; Burdass, Dariel; Verran, Joanna

    2013-11-01

    A survey of secondary school teachers investigated practical microbiology in the classroom. The results were heartening (practical microbiology was common), but concerns were expressed regarding equipment, time, cost, and expertise. Microbiologists should engage more with school education to support teachers and maintain the health of microbiology for future generations.

  14. Cognitive Assessment Practices: A Survey of School Psychologists

    ERIC Educational Resources Information Center

    Sotelo-Dynega, Marlene; Dixon, Shauna G.

    2014-01-01

    The present article describes an exploratory study regarding the preferred cognitive assessment practices of current school psychologists. Three hundred and twenty-three school psychologists participated in the survey. The results suggest that the majority of school psychologists endorsed that they base their assessment practices on an underlying…

  15. Sepsis Questions and Answers

    MedlinePlus

    ... has kidney problems, sepsis can lead to kidney failure that requires lifelong dialysis. Top of Page How ... to prevent healthcare-associated infections. Recently, CDC has projects specifically focused on sepsis prevention so that we ...

  16. Faculty Practice: What Do the Data Show? Findings from the NONPF Faculty Practice Survey.

    ERIC Educational Resources Information Center

    Pohl, Joanne M.; Duderstadt, Karen; Tolve-Schoeneberger, Candice; Uphold, Constance R.; Hartig, Margaret Thorman

    2002-01-01

    A survey of 452 nurse practitioner educators (343 in clinical practice) found that 70% have doctorates, but only 37% of those in clinical practice are tenured; 51% reported that practice is not considered in promotion and tenure decisions at their institutions. (SK)

  17. Survey of western Canadian veterinary practices: A demographic profile.

    PubMed

    Jelinski, Murray D; Barth, Katrina K

    2015-12-01

    A mixed-mode survey was used to describe the demographics of the veterinary profession in western Canada and to assess the demand for veterinary practitioners. Data were received from 655 practices (response rate = 52%), providing demographic data on 1636 individual practitioners. Most (60%) respondents self-classified their practices as exclusively small animal, while 25% and 4% were mixed animal or exclusively food animal practices, respectively. Across all practices, 77% of practitioners' time was devoted to small animals and the average mixed animal practice devoted 60% of practitioners' time to small animals. After accounting for practices that did not respond, there were ~300 full-time equivalent (FTE) vacant positions for veterinary associates; however, only 12% of practices were in urgent need of hiring an associate veterinarian. This report informs both prospective employees and employers on the state of the marketplace for veterinary associates, and provides an overview of the demographics of the veterinary profession in western Canada. PMID:26663919

  18. [Sepsis in Emergency Medicine].

    PubMed

    Christ, Michael; Geier, Felicitas; Bertsch, Thomas; Singler, Katrin

    2016-07-01

    Sepsis is defined as "life-threatening organ dysfunction caused by a dysregulated host-response to infection". Presence of organ dysfunction is associated with a mortality of 10% and higher in hospitalized sepsis patients.Introduction of standards in diagnosis and treatment of sepsis in intensive care units has not considerably reduced sepsis mortality. About 80% of patients with sepsis are transferred to intensive care units from usual care wards and emergency departments. Thus, it is tempting to speculate whether opportunities for further improvement of sepsis management exist outside of intensive care units. Performing a "quick sequential organ assessment" (qSOFA; two of following criteria have to be present: respiratory rate >22/min; sytolic blood pressure <100mmHg; altered mental status) supports to identify patients with suspicion of an infection and an increased risk of death within the hospital. Subsequent treatment according to current guidelines on sepsis management will reduce in-hospital mortality of sepsis patients. Indeed, we were able to show a substantial decrease of in-hospital mortality of about 20% in patients presenting with community acquired pneumonia to the emergency department.In summary, decision of further management of sepsis patients has to be done outside intensive care units at the time of initial presentation to professional care givers. Sepsis management in acute care settings should include a structured and standardized protocol to further improve survival in affected patients with even mild organ dysfunction.

  19. 78 FR 36784 - Survey of Nanomaterial Risk Management Practices

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-19

    ...: The National Institute for Occupational Safety and Health (NIOSH) of the Centers for Disease Control... HUMAN SERVICES Centers for Disease Control and Prevention (CDC) Survey of Nanomaterial Risk Management Practices AGENCY: National Institute for Occupational Safety and Health (NIOSH) of the Centers for...

  20. Autism Spectrum Disorder Early Screening Practices: A Survey of Physicians

    ERIC Educational Resources Information Center

    Self, Trisha L.; Parham, Douglas F.; Rajagopalan, Jagadeesh

    2015-01-01

    The American Academy of Pediatrics (AAP) released a policy statement in 2007 urging physicians to screen for autism spectrum disorder (ASD) at 18 and 24 months. This study sought to identify the screening practices of pediatricians and family physicians (FPs) in following the AAP guidelines for ASD. A survey was mailed to 1,500 pediatricians and…

  1. Licensed Practical Nurses in Occupational Health. An Initial Survey.

    ERIC Educational Resources Information Center

    Lee, Jane A.; And Others

    The study, conducted in 1971, assessed characteristics of licensed practical nurses (LPN's) who worked in occupational health nursing. The survey instrument, a questionnaire, was returned by 591 LPN's in occupational health and provided data related to: personal characteristics, work and setting, administrative and professional functioning,…

  2. A Survey of Practices and Strategies for Marketing Communication Majors.

    ERIC Educational Resources Information Center

    Gray, Philip A.; Wilson, Gerald L.

    Fifty college speech departments responded to a survey intended to discover some of the common practices and strategies for marketing undergraduate speech communication majors. The results indicated that the most frequent name for the departments responding was "Communication" rather than "Speech Communication," completely the opposite of what was…

  3. Trip Staff Training Practices: Survey and Discussion Results.

    ERIC Educational Resources Information Center

    Zwaagstra, Lynn

    A discussion group and survey examined trip-staff training practices among outdoor and adventure recreation/education programs. Of the 40 participants, 80 percent worked with university noncredit programs, with the remaining participants representing university for-credit, military recreation, nonprofit, and for-profit programs. Although the…

  4. A Survey of Educational Acceleration Practices in Canada

    ERIC Educational Resources Information Center

    Kanevsky, Lannie

    2011-01-01

    A nationwide survey of Canadian school districts was undertaken to determine the extent to which 18 forms of acceleration were permitted and practiced. Of the high enrollment provinces, BC school districts' participation rates were highest in the most types of acceleration. A surprising number of districts did not allow some forms of acceleration.…

  5. Payment and Pricing Plans: Survey Identifies Most Common Practices.

    ERIC Educational Resources Information Center

    Young, David M.; And Others

    1996-01-01

    A survey of 787 colleges and universities investigated institutions' payment and pricing practices designed to attract and retain students. Issues examined include acceptance of credit cards, cash discounts, prepayment options, differential pricing based on credits or programs, and the rationales for and results of the policies. Results reflect…

  6. Inclusion Classrooms and Teachers: A Survey of Current Practices

    ERIC Educational Resources Information Center

    Kilanowski-Press, Lisa; Foote, Chandra J.; Rinaldo, Vince J.

    2010-01-01

    This study investigates the current state of inclusion practices in general education classrooms via survey of 71 inclusion teachers currently serving as special educators across the state of New York. Specifically, small group instruction, co-teaching, one-to-one instruction, and planning support are explored in relationship to class size, number…

  7. Survey of School Programs and Practices, 1980. NEA Research Memo.

    ERIC Educational Resources Information Center

    National Education Association, Washington, DC. Research Div.

    The National Education Association's 1980 survey of school programs and practices involved sending questionnaires to 805 representative school systems serving 300 or more students. Exactly 508 usable questionnaires were returned. Thirteen topical areas were explored: (1) increases and decreases in student enrollment and numbers of teachers; (2)…

  8. AME evidence series 001—The Society for Translational Medicine: clinical practice guidelines for diagnosis and early identification of sepsis in the hospital

    PubMed Central

    Smischney, Nathan J.; Zhang, Haibo; Van Poucke, Sven; Tsirigotis, Panagiotis; Rello, Jordi; Honore, Patrick M.; Sen Kuan, Win; Ray, Juliet June; Zhou, Jiancang; Shang, You; Yu, Yuetian; Jung, Christian; Robba, Chiara; Taccone, Fabio Silvio; Caironi, Pietro; Grimaldi, David; Hofer, Stefan; Dimopoulos, George; Leone, Marc; Hong, Sang-Bum; Bahloul, Mabrouk; Argaud, Laurent; Kim, Won Young; Spapen, Herbert D.; Rocco, Jose Rodolfo

    2016-01-01

    Sepsis is a heterogeneous disease caused by an infection stimulus that triggers several complex local and systemic immuno-inflammatory reactions, which results in multiple organ dysfunction and significant morbidity and mortality. The diagnosis of sepsis is challenging because there is no gold standard for diagnosis. As a result, the clinical diagnosis of sepsis is ever changing to meet the clinical and research requirements. Moreover, although there are many novel biomarkers and screening tools for predicting the risk of sepsis, the diagnostic performance and effectiveness of these measures are less than satisfactory, and there is insufficient evidence to recommend clinical use of these new techniques. As a consequence, diagnostic criteria for sepsis need regular revision to cope with emerging evidence. This review aims to present the most updated information on diagnosis and early recognition of sepsis. Recommendations for clinical use of different diagnostic tools rely on the Grades of Recommendation Assessment, Development and Evaluation (GRADE) framework. Because most of the studies were observational and did not allow a reliable assessment of these tools, a two-step inference approach was employed. Future trials need to confirm or refute a particular index test and should directly explore relevant patient outcome parameters. PMID:27747021

  9. Practice Management Training in the PGY1 Residency Year: Best Practices From Two Nationwide Surveys

    PubMed Central

    Doligalski, Christina

    2014-01-01

    Abstract Purpose: The development of future pharmacy leaders is vital to the advancement of our profession. Postgraduate year 1 (PGY1) residency training requires residents to exercise leadership and practice management skills. Two national surveys were conducted to describe the current state of practice management experiences and elucidate best practice recommendations. Methods: The surveys, online multiple choice and free response, queried American Society of Health-System Pharmacists (ASHP)–accredited residency program practice management preceptors (survey 1) and PGY1 residents (survey 2) and were distributed via the ASHP residency program directors’ listserv. Responses were reviewed and analyzed by members of the University HealthSystem Consortium Pharmacy Council Strategic Initiatives and Programming Committee. Results: Survey 1, completed by 240 institutions, identified that a combination of concentrated and longitudinal practice management experiences were used most frequently (47%), followed by concentrated alone (33%). Universally noted activities included meeting attendance (98%), projects (94%), and committee involvement (92%). Sixty-seven percent of the programs changed the experience in the previous 3 years, with 43% planning changes in the coming year. Survey 2 was completed by 58 PGY1 residents from 42 programs. Most (80%) residents stated they had enough time with their preceptors, and 55% rated their enjoyment of the rotation as 4 or 5 on a 1 to 5 scale (5 = most enjoyed) Conclusion: Our findings suggest that there is not a best practice for the structure or content of the PGY1 practice management experience. These results highlight key recommendations, including the need for practice management-specific preceptor development, incorporation of longitudinal experiences, and more practice management and leadership activities. PMID:24715744

  10. Control of infection in general practice: a survey and recommendations.

    PubMed Central

    Hoffman, P. N.; Cooke, E. M.; Larkin, D. P.; Southgate, L. J.; Mayon-White, R. T.; Pether, J. V.; Wright, A. E.; Keenlyside, D.

    1988-01-01

    Twenty general practices in four areas in Britain were surveyed to establish their needs for and practices of sterilising and disinfecting equipment. Of the 327 items of equipment and instruments examined in the survey, 190 were satisfactorily decontaminated, 100 were treated in a way judged to result in doubtful decontamination, and in 37 cases treatment was considered unsatisfactory. Decontamination apparatuses (autoclaves, hot air ovens, and hot water disinfectors) were generally in good working order, but the use of chemical disinfectants was often inappropriate. Recommendations were made on appropriate methods of decontamination for various items in common use in general practice. By virtue of the large numbers of patients treated by general practitioners there is a substantial possibility of transmitting infection; having appropriate methods for decontaminating instruments and equipment is therefore imperative. PMID:3408909

  11. Early management of sepsis

    PubMed Central

    Vincent, Jean-Louis; Pereira, Adriano José; Gleeson, James; Backer, Daniel De

    2014-01-01

    Increased awareness of the signs and symptoms of sepsis and an emphasis on the importance of early treatment have helped to improve survival rates from this serious and frequent condition in recent years. With no specific, effective anti-sepsis therapies available, management focuses on early source control with adequate and appropriate antibiotics and removal of any source of infection, rapid resuscitation, hemodynamic stabilization and organ support. Use of dedicated teams to care for patients with sepsis can help optimize early management.

  12. Exogenous arginine in sepsis.

    PubMed

    Luiking, Yvette C; Deutz, Nicolaas E P

    2007-09-01

    Sepsis is a severe condition in critically ill patients and is considered an arginine deficiency state. The rationale for arginine deficiency in sepsis is mainly based on the reduced arginine levels in sepsis that are associated with the specific changes in arginine metabolism related to endothelial dysfunction, severe catabolism, and worse outcome. Exogenous arginine supplementation in sepsis shows controversial results with only limited data in humans and variable results in animal models of sepsis. Since in these studies the severity of sepsis varies but also the route, timing, and dose of arginine, it is difficult to draw a definitive conclusion for sepsis in general without considering the influence of these factors. Enhanced nitric oxide production in sepsis is related to suggested detrimental effects on hemodynamic instability and enhanced oxidative stress. Potential mechanisms for beneficial effects of exogenous arginine in sepsis include enhanced (protein) metabolism, improved microcirculation and organ function, effects on immune function and antibacterial effects, improved gut function, and an antioxidant role of arginine. We recently performed a study indicating that arginine can be given to septic patients without major effects on hemodynamics, suggesting that more studies can be conducted on the effects of arginine supplementation in septic patients.

  13. Decontamination of laryngoscopes: a survey of national practice.

    PubMed

    Esler, M D; Baines, L C; Wilkinson, D J; Langford, R M

    1999-06-01

    We conducted a postal questionnaire to survey methods of laryngoscope cleaning in units throughout Great Britain. We found that there was great variation in practice. Most units autoclave laryngoscope blades at some time, but less than one-quarter do so between each case. A wide range of methods is used to clean the blade in units where autoclaving was not undertaken. Most units had no guidelines relating to laryngoscope treatment between uses.

  14. Sepsis-induced myopathy

    PubMed Central

    Callahan, Leigh Ann; Supinski, Gerald S.

    2014-01-01

    Sepsis is a major cause of morbidity and mortality in critically ill patients, and despite advances in management, mortality remains high. In survivors, sepsis increases the risk for the development of persistent acquired weakness syndromes affecting both the respiratory muscles and the limb muscles. This acquired weakness results in prolonged duration of mechanical ventilation, difficulty weaning, functional impairment, exercise limitation, and poor health-related quality of life. Abundant evidence indicates that sepsis induces a myopathy characterized by reductions in muscle force-generating capacity, atrophy (loss of muscle mass), and altered bioenergetics. Sepsis elicits derangements at multiple subcellular sites involved in excitation contraction coupling, such as decreasing membrane excitability, injuring sarcolemmal membranes, altering calcium homeostasis due to effects on the sarcoplasmic reticulum, and disrupting contractile protein interactions. Muscle wasting occurs later and results from increased proteolytic degradation as well as decreased protein synthesis. In addition, sepsis produces marked abnormalities in muscle mitochondrial functional capacity and when severe, these alterations correlate with increased death. The mechanisms leading to sepsis-induced changes in skeletal muscle are linked to excessive localized elaboration of proinflammatory cytokines, marked increases in free-radical generation, and activation of proteolytic pathways that are upstream of the proteasome including caspase and calpain. Emerging data suggest that targeted inhibition of these pathways may alter the evolution and progression of sepsis-induced myopathy and potentially reduce the occurrence of sepsis-mediated acquired weakness syndromes. PMID:20046121

  15. A survey of surgical draping practices in small-animal practice in the UK.

    PubMed

    Delisser, P J; Sinnett, D E; Parsons, K J; Friend, E J

    2012-09-29

    Veterinary practices in the United Kingdom were surveyed to compare their surgical draping practices with Royal College of Veterinary Surgeons (RCVS) accreditation tier and other surgery-related factors. Using descriptive statistics and logistic or ordinal regression analysis (where appropriate), the relationships between draping material and accreditation tier and other surgery-related factors were assessed. Procedures were categorised as short or long. Two hundred and sixty-nine surveys were completed. Reusable drapes were used in 66 per cent of practices. Antibiotics were administered routinely in 38 per cent of short and 93 per cent of long procedures. Practices accredited as a Veterinary Hospital (VH) were 6.3-7.2 (short and long surgeries, respectively) times more likely to use disposable drapes, when compared with non-accredited practices. Use of dedicated surgical attire, draping the whole animal/table, and routine antibiotic usage were also positively correlated with disposable drape usage. Fifty-one per cent of practices rated infection rate as most important when choosing drape material. 'Best practice' techniques are associated with lower importance given to infection rate, and higher importance given to financial cost, when choosing drape material. Disposable drape use correlates with RCVS accreditation and with other aspects of surgical technique. Importance ratings awarded correlate with best practice procedures. Clinical relevance 'Best practice' draping procedures, that are not governed by RCVS accreditation scheme, are also more frequently performed in accredited VHs.

  16. Practice and career satisfaction among physiatrists. A national survey.

    PubMed

    DeLisa, J A; Kirshblum, S; Jain, S S; Campagnolo, D I; Johnston, M; Wood, K D; Findley, T

    1997-01-01

    To evaluate physiatrist career satisfaction and current practice patterns, a 15-page survey was mailed randomly to 400 fellow members of the American Academy of Physical Medicine and Rehabilitation. The 208 questionnaires (52%) returned revealed respondents' level of satisfaction with career choice, current practice, relationships with other physicians, their own residency training, and problems experienced that impede their practice. Factor analysis identified six areas of satisfaction: time demands, organizational support, current practice, current specialty, profession, and training. Problems with work consisted of four factors: external intrusions into practice, having to deal with non-rehabilitation problems, dealing with PM&R problems, and insufficient time for patients. Results showed that 75% of physiatrists were satisfied with their practice/profession. Satisfaction with current practice was greater with fewer external intrusions into practice, a larger percentage of income from traditional non-managed payment sources (including Medicaid), and less competition. Changes in health care, such as managed care, competition, and increased external regulations, appear to interfere with current practice. Variation in satisfaction was not significantly correlated with size of community, variation in rates of payment denials, workloads of greater than 50 hours per week, and a number of other factors that one might expect to affect satisfaction. Physiatrists had made many changes in their practice in response to the changes in the health care environment but had not cut care for indigent patients. Needs for greater residency training in outpatient clinics, physicians' offices, managed care, and long-term care settings were expressed. This is the first comprehensive published report on physiatric satisfaction in a changing health care environment. Further research in some of the areas will be required. PMID:9129513

  17. Neurology of Sepsis.

    PubMed

    Sweis, Rochelle; Ortiz, Jorge; Biller, José

    2016-03-01

    Sepsis is a systemic inflammatory response syndrome occurring secondary to infection and labeled severe when end organ dysfunction or tissue hypoperfusion transpires. Sepsis-associated mortality remains high among critically ill patients, with chronic disease and immunosuppression being the most common risk factors. Studies demonstrate that early recognition and treatment are vital to decreasing mortality. Some of the least understood effects of sepsis are the associated neurologic complications. The peripheral nervous system (PNS) has gained most consideration and thought, largely due to dependence on mechanical ventilation. Central nervous system (CNS) complications related to sepsis have only more recently gained attention but continue to go unnoticed. Aside from the clinical examination, electroencephalography (EEG) is a sensitive tool for prognostication or uncovering non-convulsive seizures in encephalopathic patients. Further studies are needed to further define the urgency of a prevention and treatment plan for the deleterious effects of sepsis on the PNS and CNS. PMID:26820754

  18. Current clinical practices in stroke rehabilitation: regional pilot survey.

    PubMed

    Natarajan, Pradeep; Oelschlager, Ashley; Agah, Arvin; Pohl, Patricia S; Ahmad, S Omar; Liu, Wen

    2008-01-01

    This study was aimed at understanding the current physical and occupational therapy practices in stroke rehabilitation in the Midwest. The insights gained from this pilot study will be used in a future study aimed at understanding stroke rehabilitation practices across the nation. Researchers and clinicians in the field of stroke rehabilitation were interviewed, and past studies in the literature were analyzed. Through these activities, we developed a 37-item questionnaire that was sent to occupational and physical therapists practicing in Kansas and Missouri who focus on the care of people who have had a stroke (n = 320). A total of 107 respondents returned a com pleted questionnaire, which gives a response rate of about 36%. The majority of respondents had more than 12 years of experience treating patients with stroke. Consensus of 70% or more was found for 80% of the items. The preferred approaches for the rehabilitation of people who have had a stroke are the Bobath and Brunnstrom methods, which are being used by 93% and 85% of the physical and occupational therapists, respectively. Even though some variability existed in certain parts of the survey, in general clinicians agreed on different treatment approaches in issues dealing with muscle tone, weakness, and limited range of motion in stroke rehabilitation. Some newer treatment approaches that have been proven to be effective are practiced only by a minority of clinicians. The uncertainty among clinicians in some sections of the survey reveals that more evidence on clinical approaches is needed to ensure efficacious treatments.

  19. Current clinical practices in stroke rehabilitation: regional pilot survey.

    PubMed

    Natarajan, Pradeep; Oelschlager, Ashley; Agah, Arvin; Pohl, Patricia S; Ahmad, S Omar; Liu, Wen

    2008-01-01

    This study was aimed at understanding the current physical and occupational therapy practices in stroke rehabilitation in the Midwest. The insights gained from this pilot study will be used in a future study aimed at understanding stroke rehabilitation practices across the nation. Researchers and clinicians in the field of stroke rehabilitation were interviewed, and past studies in the literature were analyzed. Through these activities, we developed a 37-item questionnaire that was sent to occupational and physical therapists practicing in Kansas and Missouri who focus on the care of people who have had a stroke (n = 320). A total of 107 respondents returned a com pleted questionnaire, which gives a response rate of about 36%. The majority of respondents had more than 12 years of experience treating patients with stroke. Consensus of 70% or more was found for 80% of the items. The preferred approaches for the rehabilitation of people who have had a stroke are the Bobath and Brunnstrom methods, which are being used by 93% and 85% of the physical and occupational therapists, respectively. Even though some variability existed in certain parts of the survey, in general clinicians agreed on different treatment approaches in issues dealing with muscle tone, weakness, and limited range of motion in stroke rehabilitation. Some newer treatment approaches that have been proven to be effective are practiced only by a minority of clinicians. The uncertainty among clinicians in some sections of the survey reveals that more evidence on clinical approaches is needed to ensure efficacious treatments. PMID:19009470

  20. Identification of adults with sepsis in the prehospital environment: a systematic review

    PubMed Central

    Smyth, Michael A; Brace-McDonnell, Samantha J; Perkins, Gavin D

    2016-01-01

    Objective Early identification of sepsis could enable prompt delivery of key interventions such as fluid resuscitation and antibiotic administration which, in turn, may lead to improved patient outcomes. Limited data indicate that recognition of sepsis by paramedics is often poor. We systematically reviewed the literature on prehospital sepsis screening tools to determine whether they improved sepsis recognition. Design Systematic review. The electronic databases MEDLINE, EMBASE, CINAHL, the Cochrane Library and PubMed were systematically searched up to June 2015. In addition, subject experts were contacted. Setting Prehospital/emergency medical services (EMS). Study selection All studies addressing identification of sepsis (including severe sepsis and septic shock) among adult patients managed by EMS. Outcome measures Recognition of sepsis by EMS clinicians. Results Owing to considerable variation in the methodological approach adopted and outcome measures reported, a narrative approach to data synthesis was adopted. Three studies addressed development of prehospital sepsis screening tools. Six studies addressed paramedic diagnosis of sepsis with or without use of a prehospital sepsis screening tool. Conclusions Recognition of sepsis by ambulance clinicians is poor. The use of screening tools, based on the Surviving Sepsis Campaign diagnostic criteria, improves prehospital sepsis recognition. Screening tools derived from EMS data have been developed, but they have not yet been validated in clinical practice. There is a need to undertake validation studies to determine whether prehospital sepsis screening tools confer any clinical benefit. PMID:27496231

  1. The older adult experiencing sepsis.

    PubMed

    Englert, Nadine C; Ross, Carl

    2015-01-01

    Sepsis is a potentially fatal response to infection affecting patients across the life span. Sepsis can progress from systemic inflammatory response to severe sepsis and septic shock if not recognized promptly and managed effectively. Risk factors for sepsis include age, gender, the presence of invasive devices (eg, urinary catheters), and chronic medical conditions (eg, chronic obstructive pulmonary disease). Sepsis awareness is essential and includes identification of population-focused risk factors, recognition of clinical signs and symptoms, and timely implementation of interventions. The purpose of this article was to examine sepsis in older adults, including prevalence, atypical presentation of the condition, and considerations for sepsis management in the elderly population.

  2. Bioethics consultation practices and procedures: a survey of a large Canadian community of practice.

    PubMed

    Greenberg, R A; Anstey, K W; Macri, R; Heesters, A; Bean, S; Zlotnik Shaul, R

    2014-06-01

    The literature fails to reflect general agreement over the nature of the services and procedures provided by bioethicists, and the training and core competencies this work requires. If bioethicists are to define their activities in a consistent way, it makes sense to look for common ground in shared communities of practice. We report results of a survey of the services and procedures among bioethicists affiliated with the University of Toronto Joint Centre for Bioethics (JCB). This is the largest group of bioethicists working in healthcare organizations in Canada. The results suggest there are many common services and procedures of JCB bioethicists. This survey can serve as a baseline for further exploration of the work of JCB bioethicists. Common practices exist with respect to the domains of practice, individual reporting relationships, service availability within business hours and the education and training of the bioethicist.

  3. Robin sequence: A European survey on current practice patterns.

    PubMed

    van Lieshout, Manouk J S; Joosten, Koen F M; Mathijssen, Irene M J; Koudstaal, Maarten J; Hoeve, Hans L J; van der Schroeff, Marc P; Wolvius, Eppo B

    2015-10-01

    To provide an overview of current practice patterns with regard to Robin sequence (RS) patients in Europe, a survey was conducted among European clinicians. This online survey consisted of different sections assessing characteristics of the respondent and clinic, definition, diagnosis, treatment, and follow-up. In total, surveys from 101 different European clinics were included in the analysis, and 56 different RS definitions were returned. The majority (72%) of the respondents used a sleep study system to determine the severity of the airway obstruction. A total of 63% used flexible endoscopy and 16% used rigid endoscopy in the diagnostic process. Treatment of the airway obstruction differed considerably between the different countries. Prone positioning for mild airway obstruction was the treatment modality used most often (63%). When prone positioning was not successful, a nasopharyngeal airway was used (62%). Surgical therapies varied considerably among countries. For severe obstruction, mandibular distraction was performed most frequently. Three-quarters of the respondents noted the presence of catch-up growth in their patient population. This first European survey study on definition and management of RS shows that there are considerable differences within Europe. Therefore, we would encourage the establishment of national (and international) guidelines to optimize RS patient care. PMID:26315273

  4. Survey of nursing practice related to decanting intravenous solutions.

    PubMed

    Sulzbach, L M; Munro, B H

    1991-11-01

    A survey instrument was mailed to a stratified random sample of 1000 nurses from the membership list of the American Association of Critical-Care Nurses to determine whether there are generally accepted standards for decanting intravenous (IV) solutions before the addition of medication. Four hundred seventy-eight surveys were returned from 47 states and the District of Columbia. Of those, 475 were usable. Seventy-one percent of the respondents did not decant. Of those who did decant (29%), 79% used a needle and syringe to withdraw a volume equal to that of the medication to be added. The results of this study indicate that no generally accepted standards of practice exist for the preparation of IV solutions. Patients may not, therefore, be receiving the dose prescribed by the physician. Nurses need to develop standards for accurate administration of IV solutions.

  5. Survey of Nursing Integration of Genomics Into Nursing Practice

    PubMed Central

    Calzone, Kathleen A.; Jenkins, Jean; Yates, Jan; Cusack, Georgie; Wallen, Gwenyth R.; Liewehr, David J.; Steinberg, Seth M.; McBride, Colleen

    2012-01-01

    Purpose Translating clinically valid genomic discoveries into practice is hinged not only on technologic advances, but also on nurses—the largest global contingent of health providers—acquiring requisite competencies to apply these discoveries in clinical care. The study aim was to assess practicing nurse attitudes, practices, receptivity, confidence, and competency of integrating genomics into nursing practice. Design A convenience sample of practicing nurses was recruited to complete an online survey that assessed domains from Roger’s Diffusion of Innovations Theory and used family history utilization as the basis for competency assessment. Methods Results were tabulated and analyzed using descriptive statistical techniques. Findings Two-hundred-thirty-nine licensed registered nurses, 22 to 72 years of age, with a median of 20 years in practice, responded, for an overall response rate of 28%. Most were White (83%), female (92%), and held baccalaureate degrees (56%). Seventy-one percent considered genetics to be very important to nursing practice; however, 81% rated their understanding of the genetics of common diseases as poor or fair. Per-question response rates varied widely. Instrument assessment indicated that modifications were necessary to decrease respondent burden. Conclusions Respondents’ perceived genomic competency was inadequate, family history was not routinely utilized in care delivery, and the extent of family history varied widely. However, most nurses indicated interest in pursuing continuing genomic education. Clinical Relevance Findings from this study can lead to the development of targeted education that will facilitate optimal workforce preparation for the ongoing influx of genetics and genomics information, technologies, and targeted therapies into the healthcare arena. This pilot study provides a foundation on which to build the next step, which includes a national nursing workforce study. PMID:23205780

  6. U.S. Geological Survey Fundamental Science Practices

    USGS Publications Warehouse

    ,

    2011-01-01

    The USGS has a long and proud tradition of objective, unbiased science in service to the Nation. A reputation for impartiality and excellence is one of our most important assets. To help preserve this vital asset, in 2004 the Executive Leadership Team (ELT) of the USGS was charged by the Director to develop a set of fundamental science practices, philosophical premises, and operational principles as the foundation for all USGS research and monitoring activities. In a concept document, 'Fundamental Science Practices of the U.S. Geological Survey', the ELT proposed 'a set of fundamental principles to underlie USGS science practices.' The document noted that protecting the reputation of USGS science for quality and objectivity requires the following key elements: - Clearly articulated, Bureau-wide fundamental science practices. - A shared understanding at all levels of the organization that the health and future of the USGS depend on following these practices. - The investment of budget, time, and people to ensure that the USGS reputation and high-quality standards are maintained. The USGS Fundamental Science Practices (FSP) encompass all elements of research investigations, including data collection, experimentation, analysis, writing results, peer review, management review, and Bureau approval and publication of information products. The focus of FSP is on how science is carried out and how products are produced and disseminated. FSP is not designed to address the question of what work the USGS should do; that is addressed in USGS science planning handbooks and other documents. Building from longstanding existing USGS policies and the ELT concept document, in May 2006, FSP policies were developed with input from all parts of the organization and were subsequently incorporated into the Bureau's Survey Manual. In developing an implementation plan for FSP policy, the intent was to recognize and incorporate the best of USGS current practices to obtain the optimum

  7. Plasma arginine correlations in trauma and sepsis.

    PubMed

    Chiarla, C; Giovannini, I; Siegel, J H

    2006-02-01

    , transferrin, cholesterol and many AA clearances. These data show that changes in ARG in trauma and sepsis are correlated with changes in other AA and, within these correlations, reconfirm a tendency to lower ARG in trauma compared to sepsis. The strong correlation with lysine warrants a deeper assessment of the practical implications of interdependency between these two AA. The data also suggest that changes in plasma ORN in trauma and sepsis may reflect adequacy of AA substrate to support acute-phase and other synthetic processes.

  8. Animal models of sepsis

    PubMed Central

    Fink, Mitchell P

    2014-01-01

    Sepsis remains a common, serious, and heterogeneous clinical entity that is difficult to define adequately. Despite its importance as a public health problem, efforts to develop and gain regulatory approval for a specific therapeutic agent for the adjuvant treatment of sepsis have been remarkably unsuccessful. One step in the critical pathway for the development of a new agent for adjuvant treatment of sepsis is evaluation in an appropriate animal model of the human condition. Unfortunately, the animal models that have been used for this purpose have often yielded misleading findings. It is likely that there are multiple reasons for the discrepancies between the results obtained in tests of pharmacological agents in animal models of sepsis and the outcomes of human clinical trials. One of important reason may be that the changes in gene expression, which are triggered by trauma or infection, are different in mice, a commonly used species for preclinical testing, and humans. Additionally, many species, including mice and baboons, are remarkably resistant to the toxic effects of bacterial lipopolysaccharide, whereas humans are exquisitely sensitive. New approaches toward the use of animals for sepsis research are being investigated. But, at present, results from preclinical studies of new therapeutic agents for sepsis must be viewed with a degree of skepticism. PMID:24022070

  9. International Survey of Transfusion Practices for Extremely Premature Infants

    PubMed Central

    Guillén, Úrsula; Cummings, James J.; Bell, Edward F.; Hosono, Shigerharu; Frantz, Axel R.; Maier, Rolf F.; Whyte, Robin K.; Boyle, Elaine; Vento, Max; Widness, John A.; Kirpalani, Haresh

    2013-01-01

    Our objective was to survey neonatologists regarding international practice of red cell transfusion thresholds for premature infants with <1000-g birth weight and/or <28-week gestation. An invitation to fill out an 11-question web-based survey was distributed to neonatologists through their professional societies in 22 countries. Physicians were asked about which specific factors, in addition to hemoglobin levels, influenced their decisions about transfusing premature infants. These factors included gestational age, postnatal age, oxygen need, respiratory support, reticulocyte count, and inotropic support. Physicians were presented with 5 scenarios and asked to identify hemoglobin cutoff values for transfusing infants with <1000-g birth weight and/or <28-week gestation. One thousand eighteen neonatologists responded: the majority were from the United States (67.5%), followed by Germany (10.7%), Japan (8.0%), the United Kingdom (4.9%), Spain (3.9%), Italy (2.6%), Colombia (0.6%), Argentina (0.4%), Canada (0.4%), Belgium (0.1%), and the Netherlands (0.1%). Half of the respondents (51.1%) reported having a written policy with specific red cell transfusion guidelines in their unit. Factors considered “very important” regarding the need to administer blood transfusions included degree of oxygen requirement (44.7%) and need for respiratory support (44.1%). Erythropoietin was routinely used to treat anemia by 26.0% of respondents. Delayed cord clamping or cord milking was practiced by 29.1% of respondents. The main finding was of a wide variation in the hemoglobin values used to transfuse infants, regardless of postnatal age. Step-wise increments in the median hemoglobin cutoffs directly paralleled an increase in the need for levels of respiratory support. In the first week of life, there was a wider range in the distribution of hemoglobin transfusion thresholds for infants requiring no respiratory support and full mechanical ventilation compared with the thresholds

  10. Role of immunoglobulins in neonatal sepsis

    PubMed Central

    Capasso, L; Borrelli, AC; Cerullo, J; Pisanti, R; Figliuolo, C; Izzo, F; Paccone, M; Ferrara, T; Lama, S; Raimondi, F

    2015-01-01

    Neonates, especially VLBW, are at high risk for sepsis related morbidity and mortality for immaturity of their immune system and invasive NICU practices. The paucity of immunoglobulins in preterm neonates consequently to the immaturity of immune system contributes to their high risk for systemic infection. The use of intravenous IgM enriched immunoglobulins, with higher antimicrobial activity than standard IgG, has been demonstrated in a retrospective study to reduce short term mortality in VLBW infant with proven sepsis. Larger, randomized prospective trials given the enormous burden of morbidity and mortality imposed by neonatal sepsis should urgently be addressed not only to validate this results but also to tailor the optimal scheme of treatment. PMID:25674546

  11. Improving the care of sepsis: Between system redesign and professional responsibility: A roundtable discussion in the world sepsis day, September 25, 2013, Riyadh, Saudi Arabia.

    PubMed

    Arabi, Yaseen; Alamry, Ahmed; Levy, Mitchell M; Taher, Saadi; Marini, Abdellatif M

    2014-07-01

    This paper summarizes the roundtable discussion in September 25, 2013, Riyadh, Saudi Arabia as part of the World Sepsis Day held in King Abdulaziz Medical City, Riyadh. The objectives of the roundtable discussion were to (1) review the chasm between the current management of sepsis and best practice, (2) discuss system redesign and role of the microsystem in sepsis management, (3) emphasize the multidisciplinary nature of the care of sepsis and that improvement of the care of sepsis is the responsibility of all, (4) discuss the bundle concept in sepsis management, and (5) reflect on the individual responsibility of the health care team toward sepsis with a focus on accountability and the moral agent.

  12. Survey of dairy housing and manure management practices in California.

    PubMed

    Meyer, D; Price, P L; Rossow, H A; Silva-del-Rio, N; Karle, B M; Robinson, P H; DePeters, E J; Fadel, J G

    2011-09-01

    In 2007, a descriptive survey was mailed to all dairies in Glenn (G) and Tulare (T) Counties to identify current and future opportunities of manure management practices on California dairies. The purpose was to provide baseline information for development of outreach curriculum and a decision support tool to quantify potential benefits of various N management options on dairy farms. Such baseline information is valuable to staff regulating dairy facilities (e.g., San Joaquin Valley Unified Air Pollution Control District and Central Valley Regional Water Quality Control Board), dairy trade association representatives, and technology vendors. Response rates for each county were similar at 29.7% (n=19; G) and 26.7% (n=88; T). Mean milking herd size averaged 570 (range 50 to 3,000) cows in G and 1,800 (range 196 to 9,286) cows in T. Survey data are reported by location due to differences between counties in herd size, housing facilities, and climate. Freestalls are common housing facilities (63.2%, G; 38.6%, T) and separated solids and corral scrapings are commonly used as bedding in freestalls (81.8% G and 79.4% T). The most common methods of manure collection were flushing and scraping (18.8%, G; 44.7%, T), only flushing (43.8%, G; 34.1%, T), or only scraping daily or less frequently than daily (37.5%, G; 20.0%, T). Most dairy farms in G (63.2%) and T (70.5%) used some method of separating solids from liquids. However, mechanical separation systems alone were used by 5.3% G and 11.4% T of dairy farms. Storage or treatment ponds were found on 95.9% of dairies. Respondents identified existing manure management practices and did not indicate any new technologies were in use or being considered for manure management. Survey results were used to describe the 2 predominant manure management pathways of manure collection, storage, treatment, and utilization. Survey results will be used to develop and disseminate targeted information on manure treatment technologies, and on

  13. A blueprint for a sepsis protocol.

    PubMed

    Shapiro, Nathan I; Howell, Michael; Talmor, Daniel

    2005-04-01

    viewed. Although complex and challenging, these therapies must be brought to the patient's bedside. We propose and describe the Multiple Urgent Sepsis Therapies (MUST) protocol as a practical way to implement a comprehensive treatment plan using available evidence-based therapies.

  14. Sepsis-Associated Encephalopathy

    PubMed Central

    Cotena, Simona; Piazza, Ornella

    2012-01-01

    Summary Sepsis-associated encephalopathy (SAE) is defined as a diffuse or multifocal cerebral dysfunction induced by the systemic response to the infection without clinical or laboratory evidence of direct brain infection. Its pathogenesis is multifactorial. SAE generally occurs early during severe sepsis and precedes multiple-organ failure. The most common clinical feature of SAE is the consciousness alteration which ranges from mildly reduced awareness to unresponsiveness and coma. Diagnosis of SAE is primarily clinical and depends on the exclusion of other possible causes of brain deterioration. Electroencephalography (EEG) is almost sensitive, but it is not specific for SAE. Computed Tomography (CT) head scan generally is negative in case of SAE, while Magnetic Resonance Imaging (MRI) can show brain abnormalities in case of SAE, but they are not specific for this condition. Somatosensitive Evoked Potentials (SEPs) are sensitive markers of developing cerebral dysfunction in sepsis. Cerebrospinal fluid (CBF) analysis is generally normal, a part an inconstant elevation of proteins concentration. S100B and NSE have been proposed like biomarkers for diagnosis of SAE, but the existing data are controversial. SAE is reversible even if survivors of severe sepsis have often long lasting or irreversible cognitive and behavioral sequel; however the presence of SAE can have a negative influence on survival. A specific therapy of SAE does not exist and the outcome depends on a prompt and appropriate treatment of sepsis as whole. PMID:23905041

  15. Female genital mutilation: Survey of paediatricians' knowledge, attitudes and practice.

    PubMed

    Sureshkumar, Premala; Zurynski, Yvonne; Moloney, Susan; Raman, Shanti; Varol, Nesrin; Elliott, Elizabeth J

    2016-05-01

    The study objective was to determine paediatricians' experience with female genital mutilation (FGM) in Australian children and adolescents. A cross-sectional, pilot-tested national survey of paediatricians practising in Australia and contributing to the Australian Paediatric Surveillance Unit was conducted. Clinicians' knowledge, attitudes and clinical experience with FGM, awareness of clinical guidelines and education/training needs were recorded. Of 1311 paediatricians surveyed, 497 (38%) responded. Fifty-seven percent were aged 50 years or more, and 51.3% were males. Over half believed that FGM was performed in children in Australia and most were aware of its complications, but few asked about or examined for FGM. Fifty (10.3%) had seen at least one case of FGM in girls aged <18 years during their clinical career, including 16 (3.3%) in the past 5 years. Most were aware that FGM is illegal in Australia (93.9%), agreed all types of FGM were harmful (97.4%) and agreed that FGM violated human rights (98.2%). Most (87.6%) perceived FGM as a traditional cultural practice, although 11.6% thought it was required by religion. The majority (81.8%) knew notification of FGM to child protection authorities was mandatory. Over half (62.0%) were aware of the WHO Statement on FGM, but only 22.0% knew the WHO classification of FGM. These novel data indicate a minority of paediatricians in Australia have clinical experience with or education about FGM. Educational programs, best-practice clinical guidelines and policies are required to address knowledge gaps and help paediatricians identify, manage and prevent FGM in children.

  16. Malaria knowledge, attitudes and practices in Malawi: survey population characteristics.

    PubMed

    Ettling, M; Steketee, R W; Macheso, A; Schultz, L J; Nyasulu, Y; Chitsulo, L

    1994-03-01

    A national knowledge, attitudes and practices (KAP) survey was conducted in March-April 1992 to examine malaria illness and the people's response to illness and malaria prevention. Fifty-one households in each of 30 randomly selected communities were sampled and information was recorded from 1,531 households and 7,025 individuals. The population is characterized by low income (average household and per capita income were US $490 and $122, respectively) and low education levels (among adult women, 45% had no formal education and only 3.9% completed more than 8 years of schooling). Characteristics of the population were similar to those found in the 1987 national census, suggesting that the survey population was representative of the larger population of Malawi. Children under 5 years of age made up 15.8% of the population and had the highest rates of fever illness; these children experienced an estimated 9.7 cases/year of fever illness consistent with malaria. Although adults reported fever less frequently, women of reproductive age experienced an estimated 6.9 episodes of fever annually. The burden of malaria morbidity in this population is extremely high and occurs in all age groups.

  17. The Space Science Decadal Surveys:Lessons Learned and Best Practices

    NASA Astrophysics Data System (ADS)

    Boland, S. W.

    2015-12-01

    This presentation highlights key findings from the 2015 National Research Council report The Space Science Decadal Surveys: Lessons Learned and Best Practices. The authoring committee reviewed the history of space science decadal surveys including the most recent decadal surveys and midterm assessments in Earth science, heliophysics, astrophysics, and planetary science. Lessons learned and best practices were identified to guide future survey participants through several key aspects of the decadal survey process including development of the statement of task, survey organization and execution, report preparation, survey implementation, and stewardship.

  18. How to Use the School Survey of Practices Associated with High Performance. REL 2016-162

    ERIC Educational Resources Information Center

    Weinstock, Phyllis; Yumoto, Futoshi; Abe, Yasuyo; Meyers, Coby; Wan, Yinmei

    2016-01-01

    This report describes and explains how to use the School Survey of Practices Associated with High Performance, which measures the degree to which schools are engaging in practices associated with high performance. State education departments and school districts can use the survey results to identify and describe school practices associated with…

  19. A survey of silage management practices on California dairies.

    PubMed

    Heguy, J M; Meyer, D; Silva-del-Río, N

    2016-02-01

    The aim of the present study was to gather baseline information on corn silage-management practices to develop an outreach curriculum for dairy producers and growers. In spring 2013, dairy producers in the San Joaquin Valley (California) were surveyed on their silage-management practices. Response rate was 14.5% (n=160) and herd size averaged 1,512 milking cows. Harvest date was set solely by the dairy producer (53.4%) or with the assistance of the crop manager, custom chopper, or nutritionist (23.3%). On some dairies (23.3%), the dairy producer delegated the harvest date decision. Most dairies (75.0%) estimated crop dry matter before harvest, and the preferred method was milk line evaluation. Dairy producers were mostly unfamiliar with harvest rate but the number [1 (35.9%), 2 (50.3%), or 3 to 5 (13.8%)] and size [6-row (17.7%), 8-row (67.3%), or 10-row (15.0%)] of choppers working simultaneously was reported. Most dairies used a single packing tractor (68.8%) and weighed every load of fresh chopped corn delivered to the silage pit (62%). During harvest, dry matter (66.9%), particle length (80.4%), and kernel processing (92.5%) were monitored. Most dairies completed filling their largest silage structure in less than 3 d (48.5%) or in 4 to 7 d (30.9%). Silage covering was completed no later than 7 2h after structure completion in all dairies, and was often completed within 24 h (68.8%). Packed forage was covered as filled in 19.6% of dairies. Temporary covers were used on some dairies (51.0%), with filling durations of 1 to 60 d. When temporary covers were not used, structures were filled in no more than 15 d. After structure closure, silage feedout started in 1 to 3 wk (44.4%), 4 to 5 wk (31.4%), or 8 or more wk (24.2%). Future considerations included increasing the silage storage area (55.9%), increasing the number of packing tractors (37.0%), planting brown mid-rib varieties (34.4%), buying a defacer to remove silage (33.1%), and creating drive-over piles (32

  20. A survey of silage management practices on California dairies.

    PubMed

    Heguy, J M; Meyer, D; Silva-del-Río, N

    2016-02-01

    The aim of the present study was to gather baseline information on corn silage-management practices to develop an outreach curriculum for dairy producers and growers. In spring 2013, dairy producers in the San Joaquin Valley (California) were surveyed on their silage-management practices. Response rate was 14.5% (n=160) and herd size averaged 1,512 milking cows. Harvest date was set solely by the dairy producer (53.4%) or with the assistance of the crop manager, custom chopper, or nutritionist (23.3%). On some dairies (23.3%), the dairy producer delegated the harvest date decision. Most dairies (75.0%) estimated crop dry matter before harvest, and the preferred method was milk line evaluation. Dairy producers were mostly unfamiliar with harvest rate but the number [1 (35.9%), 2 (50.3%), or 3 to 5 (13.8%)] and size [6-row (17.7%), 8-row (67.3%), or 10-row (15.0%)] of choppers working simultaneously was reported. Most dairies used a single packing tractor (68.8%) and weighed every load of fresh chopped corn delivered to the silage pit (62%). During harvest, dry matter (66.9%), particle length (80.4%), and kernel processing (92.5%) were monitored. Most dairies completed filling their largest silage structure in less than 3 d (48.5%) or in 4 to 7 d (30.9%). Silage covering was completed no later than 7 2h after structure completion in all dairies, and was often completed within 24 h (68.8%). Packed forage was covered as filled in 19.6% of dairies. Temporary covers were used on some dairies (51.0%), with filling durations of 1 to 60 d. When temporary covers were not used, structures were filled in no more than 15 d. After structure closure, silage feedout started in 1 to 3 wk (44.4%), 4 to 5 wk (31.4%), or 8 or more wk (24.2%). Future considerations included increasing the silage storage area (55.9%), increasing the number of packing tractors (37.0%), planting brown mid-rib varieties (34.4%), buying a defacer to remove silage (33.1%), and creating drive-over piles (32

  1. Essentials of sepsis management.

    PubMed

    Green, John M

    2015-04-01

    Despite remarkable advances in the knowledge of infection and human response to it, sepsis continues to be one of the most common challenges surgeons and critical care providers face. Surgeons confront the problem of infection every day, in treating established infections or reacting to a consequence of surgical intervention. Infections after surgery continue to be a problem despite massive efforts to prevent them. Patients rely on the surgeon's ability to recognize infection and treat it. Also, preventing nosocomial infection and antibiotic resistance is a primary responsibility. This article describes diagnostic and therapeutic measures for sepsis in the perioperative surgical patient.

  2. Admissions Policies and Practices: Selected Findings of the AACRAO/CEEB Survey.

    ERIC Educational Resources Information Center

    Conner, J. Douglas

    1983-01-01

    Analyzes survey data obtained from 1,463 institutions of higher education concerning college admissions practices and policies. Factors examined include selectivity, credentials and requirements, recruitment and marketing, and enrollment trends. Nine tables present survey findings. (PGD)

  3. A Survey of Occupational Therapy Practice in Beijing, China.

    PubMed

    Shi, Yun; Howe, Tsu-Hsin

    2016-06-01

    There is an increasing demand for rehabilitation services in China as a result of the growing number of people with physical and mental challenges, as well as the growing population of older adults. The purpose of this study was to explore the current occupational therapy (OT) resources available in Beijing, China, to serve as the first step in planning the response to increasing demand for OT services from the people of China. Specifically, using the snowball sampling survey method, we explored the work practice, including years of working experience, work setting, weekly work hours, annual income and factors related to job satisfaction among occupational therapists in Beijing, China. A total of 44 occupational therapists currently working in the Beijing area responded to our survey. The results demonstrated that most of the therapists working in Beijing area were young and inexperienced. Despite the fact that the participants had an average age of 31 years old and an average of 8 years' working experience, 61.4% of therapists were under 30 years old and more than half of therapists had less than 5 years of OT experiences. Among those included in the study sample, 50% had earned degrees in OT, and the rest of the OT personnel received OT-related on-the-job training in various forms and lengths of time. A majority of the participants worked in hospital settings with adults or children with physical disabilities and used therapeutic activities and therapeutic exercises. Being an occupational therapist is not a high-paying job. Education satisfaction, work experience and annual income are the factors related to job satisfaction for the participants. The majority of occupational therapists expressed the need to receive more support for clinical-related trainings. We plan to expand this pilot study nationwide to gain an in-depth and comprehensive understanding of the OT workforce in China. Copyright © 2016 John Wiley & Sons, Ltd.

  4. The resuscitation package in sepsis.

    PubMed

    Demertzis, Lee M; Kollef, Marin H

    2010-09-01

    Sepsis and its attendant complications are commonly encountered in the intensive care unit. Early recognition of sepsis is critical because it allows for rapid deployment of a multifaceted resuscitation package. The cornerstones of sepsis management are antibiotic therapy, source control, and hemodynamic resuscitation. In select patients, ancillary therapies are indicated, such as activated protein C, corticosteroids, and glycemic control. Given the complexity of sepsis management, optimal care can be delivered as a bundle-a protocol encompassing the above interventions. The evidence behind the various components of sepsis management are reviewed here.

  5. Improving the management of sepsis in a district general hospital by implementing the 'Sepsis Six' recommendations.

    PubMed

    Kumar, Prashant; Jordan, Mark; Caesar, Jenny; Miller, Sarah

    2015-01-01

    Sepsis is a common condition with a major global impact on healthcare resources and expenditure. The Surviving Sepsis Campaign has been vigorous in promoting internationally recognised pathways to improve the management of septic patients and decrease mortality. However, translating recommendations into practice is a challenging and complex task that requires a multi-faceted approach with sustained engagement from local stakeholders. Whilst working at a district general hospital in New Zealand, we were concerned by the seemingly inconsistent management of septic patients, often leading to long delays in the initiation of life-saving measures such as antibiotic, fluid, and oxygen administration. In our hospital there were no clear systems, protocols or guidelines in place for identifying and managing septic patients. We therefore launched the Sepsis Six resuscitation bundle of care in our hospital in an attempt to raise awareness amongst staff and improve the management of septic patients. We introduced a number of simple low-cost interventions that included educational sessions for junior doctors and nursing staff, as well as posters and modifications to phlebotomy trolleys that acted as visual reminders to implement the Sepsis Six bundle. Overall, we found there to a be a steady improvement in the delivery of the Sepsis Six bundle in septic patients with 63% of patients receiving appropriate care within one hour, compared to 29% prior to our interventions. However this did not translate to an improvement in patient mortality. This project forms part of an on going process to instigate a fundamental culture change among local healthcare professionals regarding the management of sepsis. Whilst we have demonstrated improved implementation of the Sepsis Six bundle, the key challenge remains to ensure that momentum of this project continues and forms a platform for sustainable clinical improvement in the long term. PMID:26734403

  6. Revisiting caspases in sepsis.

    PubMed

    Aziz, M; Jacob, A; Wang, P

    2014-01-01

    Sepsis is a life-threatening illness that occurs due to an abnormal host immune network which extends through the initial widespread and overwhelming inflammation, and culminates at the late stage of immunosupression. Recently, interest has been shifted toward therapies aimed at reversing the accompanying periods of immune suppression. Studies in experimental animals and critically ill patients have demonstrated that increased apoptosis of lymphoid organs and some parenchymal tissues contributes to this immune suppression, anergy and organ dysfunction. Immediate to the discoveries of the intracellular proteases, caspases for the induction of apoptosis and inflammation, and their striking roles in sepsis have been focused elaborately in a number of original and review articles. Here we revisited the different aspects of caspases in terms of apoptosis, pyroptosis, necroptosis and inflammation and focused their links in sepsis by reviewing several recent findings. In addition, we have documented striking perspectives which not only rewrite the pathophysiology, but also modernize our understanding for developing novel therapeutics against sepsis. PMID:25412304

  7. Nutrition and sepsis.

    PubMed

    Cohen, Jonathan; Chin, w Dat N

    2013-01-01

    The effect of nutritional support in critically ill patients with sepsis has received much attention in recent years. However, many of the studies have produced conflicting results. As for all critically ill patients, nutritional support, preferably via the enteral route, should be commenced once initial resuscitation and adequate perfusion pressure is achieved. Where enteral feeding is impossible or not tolerated, parenteral nutrition (either as total or complimentary therapy) may safely be administered. Most positive studies relating to nutritional support and sepsis have been in the setting of sepsis prevention. Thus, the administration of standard nutrition formulas to critically ill patients within 24 h of injury or intensive care unit admission may decrease the incidence of pneumonia. Both arginine-supplemented enteral diets, given in the perioperative period, and glutamine-supplemented parenteral nutrition have been shown to decrease infections in surgical patients. Parenteral fish oil lipid emulsions as well as probiotics given in the perioperative period may also reduce infections in patients undergoing major abdominal operations, such as liver transplantation. There is little support at the present time for the positive effect of specific pharmaconutrients, in particular fish oil, probiotics, or antioxidants, in the setting of established sepsis. More studies are clearly required on larger numbers of more homogeneous groups of patients. PMID:23075593

  8. Revisiting caspases in sepsis

    PubMed Central

    Aziz, M; Jacob, A; Wang, P

    2014-01-01

    Sepsis is a life-threatening illness that occurs due to an abnormal host immune network which extends through the initial widespread and overwhelming inflammation, and culminates at the late stage of immunosupression. Recently, interest has been shifted toward therapies aimed at reversing the accompanying periods of immune suppression. Studies in experimental animals and critically ill patients have demonstrated that increased apoptosis of lymphoid organs and some parenchymal tissues contributes to this immune suppression, anergy and organ dysfunction. Immediate to the discoveries of the intracellular proteases, caspases for the induction of apoptosis and inflammation, and their striking roles in sepsis have been focused elaborately in a number of original and review articles. Here we revisited the different aspects of caspases in terms of apoptosis, pyroptosis, necroptosis and inflammation and focused their links in sepsis by reviewing several recent findings. In addition, we have documented striking perspectives which not only rewrite the pathophysiology, but also modernize our understanding for developing novel therapeutics against sepsis. PMID:25412304

  9. Nutrition and sepsis.

    PubMed

    Cohen, Jonathan; Chin, w Dat N

    2013-01-01

    The effect of nutritional support in critically ill patients with sepsis has received much attention in recent years. However, many of the studies have produced conflicting results. As for all critically ill patients, nutritional support, preferably via the enteral route, should be commenced once initial resuscitation and adequate perfusion pressure is achieved. Where enteral feeding is impossible or not tolerated, parenteral nutrition (either as total or complimentary therapy) may safely be administered. Most positive studies relating to nutritional support and sepsis have been in the setting of sepsis prevention. Thus, the administration of standard nutrition formulas to critically ill patients within 24 h of injury or intensive care unit admission may decrease the incidence of pneumonia. Both arginine-supplemented enteral diets, given in the perioperative period, and glutamine-supplemented parenteral nutrition have been shown to decrease infections in surgical patients. Parenteral fish oil lipid emulsions as well as probiotics given in the perioperative period may also reduce infections in patients undergoing major abdominal operations, such as liver transplantation. There is little support at the present time for the positive effect of specific pharmaconutrients, in particular fish oil, probiotics, or antioxidants, in the setting of established sepsis. More studies are clearly required on larger numbers of more homogeneous groups of patients.

  10. Sepsis Associated Encephalopathy.

    PubMed

    Chaudhry, Neera; Duggal, Ashish Kumar

    2014-01-01

    Sepsis associated encephalopathy (SAE) is a common but poorly understood neurological complication of sepsis. It is characterized by diffuse brain dysfunction secondary to infection elsewhere in the body without overt CNS infection. The pathophysiology of SAE is complex and multifactorial including a number of intertwined mechanisms such as vascular damage, endothelial activation, breakdown of the blood brain barrier, altered brain signaling, brain inflammation, and apoptosis. Clinical presentation of SAE may range from mild symptoms such as malaise and concentration deficits to deep coma. The evaluation of cognitive dysfunction is made difficult by the absence of any specific investigations or biomarkers and the common use of sedation in critically ill patients. SAE thus remains diagnosis of exclusion which can only be made after ruling out other causes of altered mentation in a febrile, critically ill patient by appropriate investigations. In spite of high mortality rate, management of SAE is limited to treatment of the underlying infection and symptomatic treatment for delirium and seizures. It is important to be aware of this condition because SAE may present in early stages of sepsis, even before the diagnostic criteria for sepsis can be met. This review discusses the diagnostic approach to patients with SAE along with its epidemiology, pathophysiology, clinical presentation, and differential diagnosis.

  11. [Sepsis management -- antibiotic therapy].

    PubMed

    Welte, T

    2004-11-26

    Sepsis is one of the most frequent infectious problems at Intensive Care Units, and sepsis is associated with significant mortality. The latter could not be markedly reduced in the last years, despite a number of advances in the field of volume substitution, catecholamines, and endocrinologic therapy. The reason might be that important steps towards overcoming of sepsis are the surgical resection of infectious foci and an adequate antibiotic treatment. A critical role plays the growing resistance of pathogens against the common antibiotics. Since no major progress in the development of new antibiotics can be expected for the next years, sepsis treatment must be focused on prevention of infection, and on an optimised application of current antibiotic substances. The key factors are a broad and high dose initial treatment, a de-escalation strategy according to the clinical course, and -with exceptions- a limitation of treatment to 7 to 10 days. Rotation of antibiotics should be performed, if problems with resistances exist or no specialist for infectious diseases is available on the Intensive Care Unit.

  12. Cultural competence in health visiting practice: a baseline survey.

    PubMed

    Jackson, Angela Knight

    2007-02-01

    The aim of this research study is to explore health visitors' beliefs, knowledge and practice in cultural competence. A baseline survey was undertaken with all health visitors working within a West Midlands primary care trust (PCT) which served a significant population of minority ethnic communities. The results show that half the respondents were themselves members of a minority ethnic community. Caribbean origins predominated, with little representation from those of Asian descent. Non-parametric testing indicated that respondents showed there was a significant difference in their ability to meet the needs of minority ethnic communites as opposed to their ability to meet the white population needs. Respondents were able to identify factors which promote, and barriers which hamper use of health visiting services by minority ethnic communities, for example, the standard yet important factors of language and culture. However, racism was not recognised as a significant issue. The need for cultural competence training was seen as a key outcome.This training must reflect the diverse cultural needs of staff and service users.

  13. Neonatal sepsis: progress towards improved outcomes.

    PubMed

    Shane, Andi L; Stoll, Barbara J

    2014-01-01

    Neonates are predisposed to infections during the perinatal period due to multiple exposures and a relatively compromised immune system. The burden of disease attributed to neonatal infections varies by geographic region and maternal and neonatal risk factors. Worldwide, it is estimated that more than 1.4 million neonatal deaths annually are the consequence of invasive infections. Risk factors for early-onset neonatal sepsis (EOS) include prematurity, immunologic immaturity, maternal Group B streptococcal colonization, prolonged rupture of membranes, and maternal intra-amniotic infection. Intrapartum antimicrobial prophylaxis administered to GBS-colonized women has reduced the burden of disease associated with early onset GBS invasive infections. Active surveillance has identified Gram-negative pathogens as an emerging etiology of early-onset invasive infections. Late-onset neonatal sepsis (LOS) attributable to Gram-positive organisms, including coagulase negative Staphylococci and Staphylococcus aureus, is associated with increased morbidity and mortality among premature infants. Invasive candidiasis is an emerging cause of late-onset sepsis, especially among infants who receive broad spectrum antimicrobial agents. Prophylactic fluconazole administration to very low birthweight (VLBW) neonates during the first 6 weeks of life reduces invasive candidiasis in neonatal intensive care units with high rates of fungal infection. Prevention of healthcare associated infections through antimicrobial stewardship, limited steroid use, early enteral feeding, limited use of invasive devices and standardization of catheter care practices, and meticulous hand hygiene are important and cost-effective strategies for reducing the burden of late-onset neonatal sepsis.

  14. Role of biomarkers in sepsis care.

    PubMed

    Samraj, Ravi S; Zingarelli, Basilia; Wong, Hector R

    2013-11-01

    Sepsis is one of the leading causes of mortality and morbidity, even with the current availability of extended-spectrum antibiotics and advanced medical care. Biomarkers offer a tool in facilitating early diagnosis, in identifying patient populations at high risk of complications, and in monitoring progression of the disease, which are critical assessments for appropriate therapy and improvement in patient outcomes. Several biomarkers are already available for clinical use in sepsis; however, their effectiveness in many instances is limited by the lack of specificity and sensitivity to characterize the presence of an infection and the complexity of the inflammatory and immune processes and to stratify patients into homogenous groups for specific treatments. Current advances in molecular techniques have provided new tools facilitating the discovery of novel biomarkers, which can vary from metabolites and chemical products present in body fluids to genes and proteins in circulating blood cells. The purpose of this review was to examine the current status of sepsis biomarkers, with special emphasis on emerging markers, which are undergoing validation and may transition into clinical practice for their informative value in diagnosis, prognosis, or response to therapy. We will also discuss the new concept of combination biomarkers and biomarker risk models, their existing challenges, and their potential use in the daily management of patients with sepsis.

  15. Practical Tools for Designing and Weighting Survey Samples

    ERIC Educational Resources Information Center

    Valliant, Richard; Dever, Jill A.; Kreuter, Frauke

    2013-01-01

    Survey sampling is fundamentally an applied field. The goal in this book is to put an array of tools at the fingertips of practitioners by explaining approaches long used by survey statisticians, illustrating how existing software can be used to solve survey problems, and developing some specialized software where needed. This book serves at least…

  16. A Glass Ceiling Survey: Benchmarking Barriers and Practices.

    ERIC Educational Resources Information Center

    Morrison, Ann M.; And Others

    This handbook presents findings of a survey that asked human-resources managers to identify current barriers preventing women and people of color from reaching senior management. The survey was sent to 902 human-resources managers at various organizations. A total of 304 surveys were returned, a 34 percent response rate. The managers gave support…

  17. Credit for Prior Learning Practices: Results of the AACRAO December 2014 60 Second Survey

    ERIC Educational Resources Information Center

    American Association of Collegiate Registrars and Admissions Officers (AACRAO), 2015

    2015-01-01

    The American Association of Collegiate Registrars and Admissions Officers (AACRAO) initiated a series of surveys designed to capture member institutional practice snapshots in 60 seconds or less. The December 2014 "AACRAO 60 Second Survey" asked respondents to indicate their institutions' credit for prior learning practices (CPL). To…

  18. Practical applications of genotypic surveys for forensic STR testing.

    PubMed

    Holt, C L; Stauffer, C; Wallin, J M; Lazaruk, K D; Nguyen, T; Budowle, B; Walsh, P S

    2000-08-14

    Legitimate genotype frequency estimation for multiallelic loci relies on component allele frequencies, as population surveys represent only a fraction of possible DNA profiles. Multilocus genotypes from two ethnic human populations, African American (n=195) and U.S. Caucasian (n=200), were compiled at 13 STR loci that are used worldwide in forensic investigation (D3S1358, vWA, FGA, D16S539, TH01, TPOX, CSF1PO, D8S1179, D21S11, D18S51, D5S818, D13S317, and D7S820). Sex-specific AmpFlSTR multiplexes provided stringent PCR-based STR typing specifically optimized for multicolor fluorescence detection. Heterozygosity at each STR locus ranged from 0.57 to 0.89 and encompassed from seven (TH01) to twenty-one (D21S11) alleles. Homozygosity tests, tests based on the distinct numbers of observed homozygous and heterozygous classes, log likelihood ratio tests, and exact tests assessed that the degree of divergence from theoretical Hardy-Weinberg proportions for all 13 STRs does not have practical consequence in genotype frequency estimation. Departures from linkage equilibrium, between loci, that imposed significance to forensic calculations were not indicated by observed variance of the number of heterozygous loci or Karlin interclass correlation tests. For forensic casework, reliable multilocus profile estimates may be obtained from the product of component genotype frequencies, each calculated through application of the Hardy-Weinberg equation to population database allele frequency estimates reported here. The average probability that two randomly selected, unrelated individuals possess an identical thirteen-locus DNA profile was one in 1.8x10(15) African Americans and one in 3.8x10(14) U.S. Caucasians. PMID:10940595

  19. Challenges in College Admissions. A Report of a Survey of Undergraduate Admissions Policies, Practices, and Procedures.

    ERIC Educational Resources Information Center

    Breland, Hunter M.; And Others

    The report summarizes undergraduate admissions policies, practices, and procedures at two- and four-year colleges and universities as of 1992. Information was drawn from a national survey, the third of a series conducted since 1979. A total of 2,024 institutions responded to the survey. An introductory chapter describes the surveys, their…

  20. The encephalopathy of sepsis.

    PubMed

    Jackson, A C; Gilbert, J J; Young, G B; Bolton, C F

    1985-11-01

    Twelve fatal cases of encephalopathy associated with sepsis were examined in a ten-year retrospective study. The sources of infection and organisms isolated were variable. Six of the patients had focal neurologic signs; five had seizures. The level of consciousness varied from drowsiness to deep coma, and electroencephalograms revealed diffuse or multifocal abnormalities. Computed tomographic head scans and cerebrospinal fluid examinations were usually unremarkable. Eight patients had disseminated microabscesses in the brain at autopsy. Four patients had proliferation of astrocytes and microglia in the cerebral cortex, a feature associated with metabolic encephalopathies. Additional findings included cerebral infarcts, brain purpura, multiple small white matter hemorrhages, and central pontine myelinolysis. Although sepsis may cause encephalopathy by producing disturbances in cerebral synaptic transmission and cerebral energy production through a toxic mechanism, bacterial invasion of the brain with the formation of disseminated microabscesses is also an important cause.

  1. Sepsis-induced Cardiomyopathy

    PubMed Central

    Romero-Bermejo, Francisco J; Ruiz-Bailen, Manuel; Gil-Cebrian, Julián; Huertos-Ranchal, María J

    2011-01-01

    Myocardial dysfunction is one of the main predictors of poor outcome in septic patients, with mortality rates next to 70%. During the sepsis-induced myocardial dysfunction, both ventricles can dilate and diminish its ejection fraction, having less response to fluid resuscitation and catecholamines, but typically is assumed to be reversible within 7-10 days. In the last 30 years, It´s being subject of substantial research; however no explanation of its etiopathogenesis or effective treatment have been proved yet. The aim of this manuscript is to review on the most relevant aspects of the sepsis-induced myocardial dysfunction, discuss its clinical presentation, pathophysiology, etiopathogenesis, diagnostic tools and therapeutic strategies proposed in recent years. PMID:22758615

  2. Sepsis-associated hyperlactatemia.

    PubMed

    Garcia-Alvarez, Mercedes; Marik, Paul; Bellomo, Rinaldo

    2014-01-01

    There is overwhelming evidence that sepsis and septic shock are associated with hyperlactatemia (sepsis-associated hyperlactatemia (SAHL)). SAHL is a strong independent predictor of mortality and its presence and progression are widely appreciated by clinicians to define a very high-risk population. Until recently, the dominant paradigm has been that SAHL is a marker of tissue hypoxia. Accordingly, SAHL has been interpreted to indicate the presence of an 'oxygen debt' or 'hypoperfusion', which leads to increased lactate generation via anaerobic glycolysis. In light of such interpretation of the meaning of SAHL, maneuvers to increase oxygen delivery have been proposed as its treatment. Moreover, lactate levels have been proposed as a method to evaluate the adequacy of resuscitation and the nature of the response to the initial treatment for sepsis. However, a large body of evidence has accumulated that strongly challenges such notions. Much evidence now supports the view that SAHL is not due only to tissue hypoxia or anaerobic glycolysis. Experimental and human studies all consistently support the view that SAHL is more logically explained by increased aerobic glycolysis secondary to activation of the stress response (adrenergic stimulation). More importantly, new evidence suggests that SAHL may actually serve to facilitate bioenergetic efficiency through an increase in lactate oxidation. In this sense, the characteristics of lactate production best fit the notion of an adaptive survival response that grows in intensity as disease severity increases. Clinicians need to be aware of these developments in our understanding of SAHL in order to approach patient management according to biological principles and to interpret lactate concentrations during sepsis resuscitation according to current best knowledge. PMID:25394679

  3. The Surviving Sepsis Campaign: Where have we been and where are we going?

    PubMed

    Dellinger, R Phillip

    2015-04-01

    The Surviving Sepsis Campaign develops and promotes evidence-based guidelines and performance-improvement practices aimed at reducing deaths from sepsis worldwide. The most recent guidelines, published in 2013, provide detailed management strategies for acute care, fluid resuscitation, and vasopressor use. In addition, the campaign has developed simple, short protocols for what to do within 3 and 6 hours of recognition of sepsis. These protocols are associated with reduced mortality rates.

  4. Development of an e-learning package for sepsis care.

    PubMed

    Davis, Anna; Henderson, James; Langmack, Gill

    Severe sepsis is a major cause of morbidity and mortality in the UK. This article describes the collaborative development and implementation of an interactive online learning package to understand the key role nurses have in recognising and then starting to apply the Sepsis Six care bundle in clinical practice. The e-learning package, developed in a UK teaching hospital, uses a case study approach to address the knowledge that is required to be able to recognise sepsis, to understand the processes that occur and the ongoing care and treatment required. The package is relevant to final-year student nurses, newly registered nurses in preceptorship and other health professionals involved in assessing and treating patients who may be developing sepsis.

  5. Surviving Sepsis: Taming a Deadly Immune Response

    MedlinePlus

    ... disclaimer . Subscribe Surviving Sepsis Taming a Deadly Immune Response Many people have never heard of sepsis, or ... tract infection) and then a powerful and harmful response by your body’s own immune system . “With sepsis, ...

  6. A survey on clinical practice of interstitial cystitis in Japan

    PubMed Central

    Yamada, Yukio; Nomiya, Akira; Niimi, Aya; Igawa, Yasuhiko; Ito, Takaaki; Tomoe, Hikaru; Takei, Mineo; Ueda, Tomohiro

    2015-01-01

    Background To explore the real-life practice of clinical management of interstitial cystitis (IC) in Japan. Methods A questionnaire on the number of IC patients, cystoscopic findings, diagnostic methods, and the treatment modalities was sent via e-mail to 114 medical institutions belonging to the Society of Interstitial Cystitis of Japan (SICJ). Results Completed questionnaires were returned from 62 institutions (20 university hospitals, 26 general hospitals and 16 clinics), with a response rate of 54%. The median of patient number per institution was 20 and the national number of IC patients was counted as 4,531 in Japan. The number of new patients in 2013 was 7 (median) per institution and calculated as 1,214 in total. The case volume per institution distributed broadly and skewed to a lower volume. The patients were categorized according to cystoscopic findings as either Hunner type IC with Hunner lesions (n=2,066, 45%), non-Hunner type IC with glomerulations on hydrodistension (n=1,720, 38%) or hypersensitive bladder without endoscopic abnormalities (n=304, 7%), excluding unknown (n=441, 10%). The proportion of Hunner type IC was highly variable among the institutions, ranging from 0% to 100% with a median of 29%. As for evaluation, symptom and quality of life (QOL) assessment by questionnaires, frequency volume chart, urinalysis, urine cytology, urine culture, post-void residual measurement, uroflowmetry, ultrasound and cystoscopy were widely adapted. Administration of oral medicines and intravesical instillation therapy were undertaken at 98% and 63% of institutions, respectively. Hydrodistension was commonly performed, totaling in 812 procedures at 53 institutions, while only five cystectomies were reported from four institutions. Conclusions The survey estimated about 4,500 IC patients and 2,000 Hunner type IC patients in Japan. It also revealed a wide range of case volume, acceptable adherence to clinical guidelines, and high variability in the proportion

  7. NPACE nurse practitioner practice characteristics, salary, and benefits survey: 1999. Nurse Practitioner Associates for Continuing Education.

    PubMed

    Pulcini, J; Vampola, D

    2000-11-01

    The purpose of this article is to present the results of a practice characteristics, salary, and benefits survey of 1,557 nurse practitioners from the United States who attended national nurse practitioner conferences in Las Vegas, Nevada, Orlando, Florida, Chicago, Illinois, and Boston, Massachusetts, in 1999. Specific data are presented on the demographics of the population, practice characteristics and responsibilities, benefits for full- and part-time employees, and salary by region, years of practice, type of certification, and location of the practice. The salary data were compared with the 1995-1996 and 1996-1997 NPACE practice characteristics, salary, and benefits surveys (Pulcini & Fitzgerald, 1997; Pulcini, Vampola, & Fitzgerald, 1998).

  8. Association of the immature platelet fraction with sepsis diagnosis and severity

    PubMed Central

    Hubert, Rodolfo Monteiro Enz; Rodrigues, Melina Veiga; Andreguetto, Bruna Dolci; Santos, Thiago M.; de Fátima Pereira Gilberti, Maria; de Castro, Vagner; Annichino-Bizzacchi, Joyce M.; Dragosavac, Desanka; Carvalho-Filho, Marco Antonio; De Paula, Erich Vinicius

    2015-01-01

    Management of Sepsis would greatly benefit from the incorporation of simple and informative new biomarkers in clinical practice. Ideally, a sepsis biomarker should segregate infected from non-infected patients, provide information about prognosis and organ-specific damage, and be accessible to most healthcare services. The immature platelet fraction (IPF) and immature reticulocyte fraction (IRF) are new analytical parameters of the complete blood count, that have been studied as biomarkers of several inflammatory conditions. Recently, a study performed in critically-ill patients suggested that IPF could be a more accurate sepsis biomarker than C-reactive protein (CRP) and procalcitonin. In this retrospective study we evaluated the performance of IPF and IRF as biomarkers of sepsis diagnosis and severity. 41 patients admitted to two intensive care units were evaluated, 12 of which with severe sepsis or septic shock, and 11 with non-complicated sepsis. Significantly higher IPF levels were observed in patients with severe sepsis/septic shock. IPF correlated with sepsis severity scores and presented the highest diagnostic accuracy for the presence of sepsis of all studied clinical and laboratory parameters. No significant differences were observed in IRF levels. Our results suggest that IPF levels could be used as a biomarker of sepsis diagnosis and severity. PMID:25620275

  9. Association of the immature platelet fraction with sepsis diagnosis and severity.

    PubMed

    Enz Hubert, Rodolfo Monteiro; Rodrigues, Melina Veiga; Andreguetto, Bruna Dolci; Santos, Thiago M; de Fátima Pereira Gilberti, Maria; de Castro, Vagner; Annichino-Bizzacchi, Joyce M; Dragosavac, Desanka; Carvalho-Filho, Marco Antonio; De Paula, Erich Vinicius

    2015-01-26

    Management of Sepsis would greatly benefit from the incorporation of simple and informative new biomarkers in clinical practice. Ideally, a sepsis biomarker should segregate infected from non-infected patients, provide information about prognosis and organ-specific damage, and be accessible to most healthcare services. The immature platelet fraction (IPF) and immature reticulocyte fraction (IRF) are new analytical parameters of the complete blood count, that have been studied as biomarkers of several inflammatory conditions. Recently, a study performed in critically-ill patients suggested that IPF could be a more accurate sepsis biomarker than C-reactive protein (CRP) and procalcitonin. In this retrospective study we evaluated the performance of IPF and IRF as biomarkers of sepsis diagnosis and severity. 41 patients admitted to two intensive care units were evaluated, 12 of which with severe sepsis or septic shock, and 11 with non-complicated sepsis. Significantly higher IPF levels were observed in patients with severe sepsis/septic shock. IPF correlated with sepsis severity scores and presented the highest diagnostic accuracy for the presence of sepsis of all studied clinical and laboratory parameters. No significant differences were observed in IRF levels. Our results suggest that IPF levels could be used as a biomarker of sepsis diagnosis and severity.

  10. Sepsis management: An evidence-based approach.

    PubMed

    Baig, Muhammad Akbar; Shahzad, Hira; Jamil, Bushra; Hussain, Erfan

    2016-03-01

    The Surviving Sepsis Campaign (SSC) guidelines have outlined an early goal directed therapy (EGDT) which demonstrates a standardized approach to ensure prompt and effective management of sepsis. Having said that, there are barriers associated with the application of evidence-based practice, which often lead to an overall poorer adherence to guidelines. Considering the global burden of disease, data from low- to middle-income countries is scarce. Asia is the largest continent but most Asian countries do not have a well-developed healthcare system and compliance rates to resuscitation and management bundles are as low as 7.6% and 3.5%, respectively. Intensive care units are not adequately equipped and financial concerns limit implementation of expensive treatment strategies. Healthcare policy-makers should be notified in order to alleviate financial restrictions and ensure delivery of standard care to septic patients.

  11. A Survey of Optometry Graduates to Determine Practice Patterns.

    ERIC Educational Resources Information Center

    Bleimann, Robert L.; Smith, Lee W.

    1984-01-01

    A summary of a study of optometry graduates conducted by the Association of Schools and Colleges of Optometry (ASCO) is provided. The data covered aspects of recently graduated O.D.s' experience in obtaining a state license, becoming established in practice, and their practice characteristics. (Author/MLW)

  12. Muscle regeneration after sepsis.

    PubMed

    Bouglé, Adrien; Rocheteau, Pierre; Sharshar, Tarek; Chrétien, Fabrice

    2016-01-01

    Severe critical illness is often complicated by intensive care unit-acquired weakness (ICU-AW), which is associated with increased ICU and post-ICU mortality, delayed weaning from mechanical ventilation and long-term functional disability. Several mechanisms have been implicated in the pathophysiology of ICU-AW, but muscle regeneration has not been investigated to any extent in this context, even though its involvement is suggested by the protracted functional consequences of ICU-AW. Recent data suggest that muscle regeneration could be impaired after sepsis, and that mesenchymal stem cell treatment could improve the post-injury muscle recovery. PMID:27193340

  13. A Virtual Community of Practice for General Practice Training: A Preimplementation Survey

    PubMed Central

    Jones, Sandra C; Bennett, Sue; Iverson, Don; Robinson, Laura

    2016-01-01

    Background Professional isolation is an important factor in low rural health workforce retention. Objective The aim of this study was to gain insights to inform the development of an implementation plan for a virtual community of practice (VCoP) for general practice (GP) training in regional Australia. The study also aimed to assess the applicability of the findings of an existing framework in developing this plan. This included ascertaining the main drivers of usage, or usefulness, of the VCoP for users and establishing the different priorities between user groups. Methods A survey study, based on the seven-step health VCoP framework, was conducted with general practice supervisors and registrars—133 usable responses; 40% estimated response rate. Data was analyzed using the t test and the chi-square test for comparisons between groups. Factor analysis and generalized linear regression modeling were used to ascertain factors which may independently predict intention to use the VCoP. Results In establishing a VCoP, facilitation was seen as important. Regarding stakeholders, the GP training provider was an important sponsor. Factor analysis showed a single goal of usefulness. Registrars had a higher intention to use the VCoP (P<.001) and to perceive it as useful (P<.001) than supervisors. Usefulness independently predicted intention to actively use the VCoP (P<.001). Regarding engagement of a broad church of users, registrars were more likely than supervisors to want allied health professional and specialist involvement (P<.001). A supportive environment was deemed important, but most important was the quality of the content. Participants wanted regular feedback about site activity. Regarding technology and community, training can be online, but trust is better built face-to-face. Supervisors were significantly more likely than registrars to perceive that registrars needed help with knowledge (P=.01) and implementation of knowledge (P<.001). Conclusions Important

  14. Exploring the Icebergs of Adult Learning: Findings of the First Canadian Survey of Informal Learning Practices.

    ERIC Educational Resources Information Center

    Livingstone, D. W.

    1999-01-01

    A survey of 1,562 Canadian adults found that most are spending more time in learning, especially informal learning through employment, community service, and household work. Findings should be used to shape education policy and practice. (SK)

  15. Substance Use and Its Prevention: A Survey of Classroom Practices.

    ERIC Educational Resources Information Center

    Genaux, Melisa; And Others

    1995-01-01

    A nationwide survey of 109 teachers of students with behavioral disorders found little programming concerning prevention of substance abuse. Teachers differed in their priority assignment of substance abuse prevention and reported the absence of parental involvement in such efforts. Lack of time, curriculum materials, and adequate funding were…

  16. Collaborative Evaluation: Survey of Practice in North America.

    ERIC Educational Resources Information Center

    Cousins, J. Bradley; Donohue, John J.; Bloom, Gordon A.

    Forms of evaluation that involve evaluators working collaboratively with practitioners on applied social research projects are becoming increasingly common, but a body of empirical literature that warrants firm conclusions about collaborative evaluation has not yet been accumulated. This survey studies the views of evaluators and program…

  17. A National Survey of Revising Practices in the Primary Classroom

    ERIC Educational Resources Information Center

    Saddler, Bruce; Saddler, Kristie; Befoorhooz, Bita; Cuccio-Slichko, Julie

    2014-01-01

    A random national sampling of primary grade teachers in the United States were surveyed to determine how they teach revising to writers in the elementary grades. Our findings suggest that in our sample of teachers, little time is dedicated in the school day to writing and especially revising. The teachers believed that more time spent revising did…

  18. Survey of Prior Learning Assessment Practices in Pharmacy Education.

    ERIC Educational Resources Information Center

    Fjortoft, Nancy F.; Zgarrick, David P.

    2001-01-01

    Surveyed nontraditional Pharm.D (NTPD) program directors to determine use of prior learning assessment (PLA). Eighty-four percent of respondents reported using PLA for one or more purposes, including the admissions process and awarding of advanced standing for didactic and experiential courses. Transcript review, faculty-developed exams, and…

  19. School Leadership Preparation and Practice Survey Instruments and Their Uses

    ERIC Educational Resources Information Center

    Pounder, Diana

    2012-01-01

    This article addresses the leadership preparation line of inquiry developed in the past decade by the University Council for Educational Administration/Learning and Teaching in Educational Leadership Special Interest Group Taskforce on Evaluating Leadership Preparation Programs, and it particularly addresses the series of survey instruments…

  20. Pressure ulcer prevention and care: a survey of current practice.

    PubMed

    Sharp, C; Burr, G; Broadbent, M; Cummins, M; Casey, H; Merriman, A

    2000-12-01

    The incidence and management of pressure ulcers in hospitalised patients is an ongoing concern for nurses. Efforts to prevent pressure ulcer development are plagued with inconsistencies and a general lack of best practice guidelines. Establishing current practice approaches to the assessment, prevention and management of pressure ulcers is a necessary first step in the implementation of evidence-based/best practice guidelines. Anecdotal evidence suggested a range of different approaches were being used in a Sydney metropolitan area health service (AHS) to assess patients to identify those at risk, to prevent pressure ulcers and to treat existing ulcers. A collaborative research project was undertaken to examine current practice and to explore the apparent clinical variance. It involved the distribution of a questionnaire to registered nurses working within the AHS (n = 2113) and a review of nursing policy documents in the various hospitals in the health service area. While the overall response rate was satisfactory (40%) many of the returned questionnaires were incomplete. Only 21% (n = 444) of the questionnaires were deemed suitable for analysis. The findings highlight a range of inconsistencies within and across nursing practice domains. Nurses generally do not use a tool to assess pressure ulcer risk potential, but rely on a range of practice procedures and risk indicators to determine risk potential of developing pressure ulcers. Repositioning patients is the most common approach used in an attempt to prevent the development of pressure ulcers, but additional measures are diverse. Most nurses seem to be familiar with modern wound dressings such as hydrocolloids, foams and alginates in the treatment of second and third stage ulceration. However, the care provided by some nurses reflects an adherence to outdated practices, including the use of water filled gloves, povidone iodine and gauze packing.

  1. FERPA Training Practices: Results of the AACRAO January 2016 60 Second Survey

    ERIC Educational Resources Information Center

    American Association of Collegiate Registrars and Admissions Officers (AACRAO), 2016

    2016-01-01

    The January 2016 American Association of Collegiate Registrars and Admissions Officers (AACRAO) "60 Second Survey" focused on institutional Family Educational Rights and Privacy Act (FERPA) training practices and measuring the level of interest in an AACRAO-developed online FERPA training module. The survey received 878 usable responses.…

  2. A National Survey of Bibliotherapy Preparation and Practices of Professional Counselors

    ERIC Educational Resources Information Center

    Pehrsson, Dale-Elizabeth; McMillen, Paula S.

    2010-01-01

    A national survey of "Bibliotherapy Practices in Counseling" was conducted in 2008. This project was partially supported by an Association of Creativity in Counseling Research Award. Little research exists regarding preparation of professional counselors and their specific use of bibliotherapy interventions. Invitations and survey requests were…

  3. Distance Education Practices: Summary Results of the AACRAO February 2015 60 Second Survey

    ERIC Educational Resources Information Center

    American Association of Collegiate Registrars and Admissions Officers (AACRAO), 2015

    2015-01-01

    The February 2015 American Association of Collegiate Registrars and Admissions Officers (AACRAO) "60 Second Survey" asked respondents to identify whether or not their institution offers distance education, and if so, to answer additional questions about distance education course practices. The survey received 838 unique institutional…

  4. A Survey of Functional Behavior Assessment Methods Used by Behavior Analysts in Practice

    ERIC Educational Resources Information Center

    Oliver, Anthony C.; Pratt, Leigh A.; Normand, Matthew P.

    2015-01-01

    To gather information about the functional behavior assessment (FBA) methods behavior analysts use in practice, we sent a web-based survey to 12,431 behavior analysts certified by the Behavior Analyst Certification Board. Ultimately, 724 surveys were returned, with the results suggesting that most respondents regularly use FBA methods, especially…

  5. Teachers in Television and Other Media; A Survey of Policies and Practices.

    ERIC Educational Resources Information Center

    Mikes, Donald F.

    A survey of 156 institutions using television and other educational media was conducted to determine the extent and nature of contracts or specific policies defining the rights and responsibilities of teachers using educational media. The survey aimed at both discovering present trends in policies and practices and forming a compendium of…

  6. Current practices in clinical analytics: a hospital survey report.

    PubMed

    Womack, Dana M; Kennedy, Rosemary; Bria, Bill

    2012-01-01

    Clinical analytics must become a pervasive activity in healthcare settings to achieve the global vision for timely, effective, equitable, and excellent care. Global adoption of the Electronic Health Record (EHR) has increased the volume of data available for performance measurement and healthcare organizational capacity for continuous quality improvement. However, EHR adoption does not automatically result in optimal use of clinical data for performance improvement. In order to understand organizational factors related to use of data for clinical analytics, a survey was conducted of hospitals and hospital-based clinics. The survey revealed sub-optimal use of data captured as a byproduct of care delivery, the need for tools and methodologies to assist with data analytics, and the need for disciplined organizational structure and strategies. Informatics nurse professionals are well-positioned to lead analytical efforts and serve as a catalyst in their facility's transformations into a data-driven organization.

  7. ANPD technology survey: The state of NPD practice.

    PubMed

    Harper, Mary G; Durkin, Gregory; Orthoefer, Donna Kilcoyne; Powers, Rebekah; Tassinari, Rita M

    2014-01-01

    In 2012, the Association for Nursing Professional Development (ANPD) Educational Technologies Committee surveyed ANPD membership to determine technology usage and education-related needs. Results from over 1,300 members indicated that, overall, technology is not used to its full capacity. Nursing professional development specialists are challenged to develop individual competence in educational technologies, whereas organizations are tasked with demonstrating cost-effective, results-oriented education.

  8. The Survey of College Marketing Programs. Volume 1: Management Practices.

    ERIC Educational Resources Information Center

    Primary Research Group, Inc., New York, NY.

    This report presents 228 tables detailing findings concerning management practices of marketing programs at 68 colleges and universities. Highlights of this report include: a mean of 5 employees regularly visit high school guidance counselors; only 5 percent of the colleges sponsor campus visits for select applicants; 24 percent of the colleges…

  9. A Survey of Ethical Decision Making among Practicing School Psychologists.

    ERIC Educational Resources Information Center

    Chevalier, Nancy E.; Lyon, Mark A.

    1993-01-01

    Invesitgated 50 practicing school psychologists' preferred resolutions to ethical dilemmas. Results indicated general lack of consistency in both actions taken to resolve ethical dilemmas and reasons chosen to support such actions, regardless of respondents' sex, years of experience, self-reported hours of ethics training, frequency of…

  10. Practical Child Safety Education in England: A National Survey of the Child Safety Education Coalition

    ERIC Educational Resources Information Center

    Mulvaney, Caroline A.; Watson, Michael C.; Walsh, Patrick

    2013-01-01

    Objective: To examine the provision of practical safety education by Child Safety Education Coalition (CSEC) organizations in England. Design: A postal survey. Setting: Providers of child practical safety education who were also part of CSEC. Methods: In February 2010 all CSEC organizations were sent a self-completion postal questionnaire which…

  11. Student Perceptions of the Use of Inquiry Practices in a Biology Survey Laboratory Course

    ERIC Educational Resources Information Center

    Fayer, Liz; Zalud, Garreth; Baron, Mark; Anderson, Cynthia M.; Duggan, Timothy J.

    2011-01-01

    Extensive research has shown inquiry in science education to be best practice; however, most universities currently do not include inquiry practices in their coursework. The purpose of this study was to determine the level of inquiry that students in a Biology Survey Laboratory course considered to be the most supportive of their learning at a…

  12. A National Survey of School Counselor Supervision Practices: Administrative, Clinical, Peer, and Technology Mediated Supervision

    ERIC Educational Resources Information Center

    Perera-Diltz, Dilani M.; Mason, Kimberly L.

    2012-01-01

    Supervision is vital for personal and professional development of counselors. Practicing school counselors (n = 1557) across the nation were surveyed to explore current supervision practices. Results indicated that 41.1% of school counselors provide supervision. Although 89% receive some type of supervision, only 10.3% of school counselors receive…

  13. Classroom Assessment Practices: A Survey of Botswana Primary and Secondary School Teachers

    ERIC Educational Resources Information Center

    Koloi-Keaikitse, Setlhomo

    2012-01-01

    The Classroom Assessment Practices and Skills (CAPS) questionnaire was administered to a sample of 691 primary and secondary school teachers in Botswana, Southern Africa to survey their thoughts about classroom assessment and identify classroom assessment practices teachers perceive to be skilled and those that they used most. The study examined…

  14. Patient satisfaction surveys as a market research tool for general practices.

    PubMed Central

    Khayat, K; Salter, B

    1994-01-01

    BACKGROUND. Recent policy developments, embracing the notions of consumer choice, quality of care, and increased general practitioner control over practice budgets have resulted in a new competitive environment in primary care. General practitioners must now be more aware of how their patients feel about the services they receive, and patient satisfaction surveys can be an effective tool for general practices. AIM. A survey was undertaken to investigate the use of a patient satisfaction survey and whether aspects of patient satisfaction varied according to sociodemographic characteristics such as age, sex, social class, housing tenure and length of time in education. METHOD. A sample of 2173 adults living in Medway District Health Authority were surveyed by postal questionnaire in September 1991 in order to elicit their views on general practice services. RESULTS. Levels of satisfaction varied with age, with younger people being consistently less satisfied with general practice services than older people. Women, those in social classes 1-3N, home owners and those who left school aged 17 years or older were more critical of primary care services than men, those in social classes 3M-5, tenants and those who left school before the age of 17 years. CONCLUSION. Surveys and analyses of this kind, if conducted for a single practice, can form the basis of a marketing strategy aimed at optimizing list size, list composition, and service quality. Satisfaction surveys can be readily incorporated into medical audit and financial management. PMID:8204335

  15. Losses told from scrubbing nukes: survey details utility accounting practices

    SciTech Connect

    Not Available

    1980-10-01

    Reduced load forecasts and the Three Mile Island accident led to a record number of nuclear power plant cancellations in 1980, according to a survey of reporting and accounting methods of 60 large electric utilities and 25 gas and water companies. The utilities are trying to recover losses through increased rates, but most are employing accounting methods to defer their losses by using the allowance for funds used during construction (AFUDC). The companies report treating the AFUDC funds in different ways, the majority deducting them from income and construction as a noncash item. (DCK)

  16. A Survey of Adverse Drug Reactions in Family Practice

    PubMed Central

    Reynolds, J. L.

    1984-01-01

    In this study, 232 Canadian family physicians recorded suspected adverse drug reactions (SADRs) in their practices for five months. Patients' age and sex, the drug(s) implicated, type of reaction and any disability were recorded on a card and sent to a central coordinating office each week. The number of SADRs in clinical practice seems to be small. An estimated 300,000 patients were involved in the study, and a total of 314 suspected adverse drug reactions in 314 patients were reported. A proposal is made for a surveillance system for new drugs. Family physicians would monitor all patients taking a drug or group of drugs and matched controls. The status of patients and controls would be recorded regularly and any SADRs reported to a central coordinating centre. PMID:21283495

  17. A survey on retention practice among orthodontists in Malaysia

    PubMed Central

    Low, Tze Fui; Idris, Nur Shaheera

    2016-01-01

    Objective The aim of this study was to evaluate retention practices commonly employed by orthodontists. The objectives were to identify the types of retainer frequently used and to investigate the variations in retention practice. Methods A total of 97 orthodontists were randomly selected, and a questionnaire consisting of 25 multiple-choice questions sent to them by mail. Upon receiving of the completed questionnaires, the data were statistically analyzed. Results A total of 32 responses were received; among these, 59.4% of orthodontists' practiced is in a government setting and 40.6% were in private practice. A vacuum-formed retainer was the most commonly used removable retainer for both maxillary (46.9%) and mandibular (46.9%) arches, followed by a Hawley retainer (maxilla, 43.8%; mandible, 37.5%), and a fixed retainer (maxilla, 3.1%; mandible, 9.4%). Of the responding orthodontists, 78.1% prescribed full-time wear (more than 20 h per day) for a duration of 3–9 months for a maxillary arch, compared to 71.9% for the mandibular arch. Only 18.8% of the orthodontists prescribed part-time wear of the retainer for the maxillary arch, compared to 21.9% for the mandibular arch. The majority of orthodontists did not instruct their patients to stop wearing removable retainers (71.9%) or fixed retainers (66.8%) at any specific time and they preferred their patients to continue wearing retainers. Conclusions Vacuum-formed retainers are the most commonly used retainers among orthodontists. The majority of orthodontists prescribed full-time wear for more than 20 h per day with a duration of 3–9 months and preferred indefinite use of the retainer. PMID:26877981

  18. A survey of the practice of regional anaesthesia.

    PubMed Central

    Buist, R J

    1990-01-01

    A questionnaire designed to elucidate the popularity and practice of regional anaesthesia was circulated to all anaesthetists in the South East Thames Region. Two hundred and eleven completed questionnaires were received and subsequently analysed, a response rate of 65%. Regional anaesthesia was employed at least once per week by 83% of respondents usually in combination with general anaesthesia (77% of respondents). The provision of postoperative analgesia was cited as the main advantage by 86% of anaesthetists. PMID:2250269

  19. Patterns of Psychiatric Outpatient Practice in Taiwan: A Nationwide Survey

    PubMed Central

    Dai, Ying-Xiu; Chen, Mu-Hong; Chen, Tzeng-Ji; Lin, Ming-Hwai

    2016-01-01

    (1) Background: Limited studies have utilized nationwide data to assess the patterns of psychiatric practice in other countries. In this study, data from the National Health Insurance Research Database in Taiwan (NHIRD-TW) for 2012 was analyzed to determine the patterns of psychiatric outpatient practice in Taiwan; (2) Methods: To determine the patterns of psychiatric outpatient practice in Taiwan, the data were drawn from the datasets of Taiwan’s National Health Insurance Research Database for 2012, with 619,760 records of outpatient visits representing 1/500 of all the claims in Taiwan for that year. The analysis of psychiatric outpatient visits included patient demographics, diagnoses, and prescribed medications; (3) Results: Neurotic disorders were the most prevalent diagnoses (43.1%, n = 5714). Hypnotics-sedatives and anxiolytics were prescribed in 51.7% (n = 6850) and 39.1% (n = 5181) of psychiatric visits, respectively, with zolpidem being the most commonly prescribed drug (22.6%, n = 2998); and (4) Conclusion: Hypnotics and sedatives were widely prescribed for the outpatient population, and zolpidem had the highest annual prevalence of use. These findings deserve the attention of clinicians and policy makers for monitoring the abuse and dependence of these agents and subsequent adverse events. PMID:27690067

  20. Personalised medicine in Canada: a survey of adoption and practice in oncology, cardiology and family medicine

    PubMed Central

    Bonter, Katherine; Currier, Nathan; Pun, Jason; Ashbury, Fredrick D

    2011-01-01

    Introduction In order to provide baseline data on genetic testing as a key element of personalised medicine (PM), Canadian physicians were surveyed to determine roles, perceptions and experiences in this area. The survey measured attitudes, practice, observed benefits and impacts, and barriers to adoption. Methods A self-administered survey was provided to Canadian oncologists, cardiologists and family physicians and responses were obtained online, by mail or by fax. The survey was designed to be exploratory. Data were compared across specialties and geography. Results The overall response rate was 8.3%. Of the respondents, 43%, 30% and 27% were family physicians, cardiologists and oncologists, respectively. A strong majority of respondents agreed that genetic testing and PM can have a positive impact on their practice; however, only 51% agreed that there is sufficient evidence to order such tests. A low percentage of respondents felt that they were sufficiently informed and confident practicing in this area, although many reported that genetic tests they have ordered have benefited their patients. Half of the respondents agreed that genetic tests that would be useful in their practice are not readily available. A lack of practice guidelines, limited provider knowledge and lack of evidence-based clinical information were cited as the main barriers to practice. Differences across provinces were observed for measures relating to access to testing and the state of practice. Differences across specialties were observed for the state of practice, reported benefits and access to testing. Conclusions Canadian physicians recognise the benefits of genetic testing and PM; however, they lack the education, information and support needed to practice effectively in this area. Variability in practice and access to testing across specialties and across Canada was observed. These results support a need for national strategies and resources to facilitate physician knowledge

  1. Impact of sepsis on CD4 T cell immunity

    PubMed Central

    Cabrera-Perez, Javier; Condotta, Stephanie A.; Badovinac, Vladimir P.; Griffith, Thomas S.

    2014-01-01

    Sepsis remains the primary cause of death from infection in hospital patients, despite improvements in antibiotics and intensive-care practices. Patients who survive severe sepsis can display suppressed immune function, often manifested as an increased susceptibility to (and mortality from) nosocomial infections. Not only is there a significant reduction in the number of various immune cell populations during sepsis, but there is also decreased function in the remaining lymphocytes. Within the immune system, CD4 T cells are important players in the proper development of numerous cellular and humoral immune responses. Despite sufficient clinical evidence of CD4 T cell loss in septic patients of all ages, the impact of sepsis on CD4 T cell responses is not well understood. Recent findings suggest that CD4 T cell impairment is a multipronged problem that results from initial sepsis-induced cell loss. However, the subsequent lymphopenia-induced numerical recovery of the CD4 T cell compartment leads to intrinsic alterations in phenotype and effector function, reduced repertoire diversity, changes in the composition of naive antigen-specific CD4 T cell pools, and changes in the representation of different CD4 T cell subpopulations (e.g., increases in Treg frequency). This review focuses on sepsis-induced alterations within the CD4 T cell compartment that influence the ability of the immune system to control secondary heterologous infections. The understanding of how sepsis affects CD4 T cells through their numerical loss and recovery, as well as function, is important in the development of future treatments designed to restore CD4 T cells to their presepsis state. PMID:24791959

  2. Diagnostic and prognostic biomarkers of sepsis in critical care.

    PubMed

    Kibe, Savitri; Adams, Kate; Barlow, Gavin

    2011-04-01

    Sepsis is a leading cause of mortality in critically ill patients. Delay in diagnosis and initiation of antibiotics have been shown to increase mortality in this cohort. However, differentiating sepsis from non-infectious triggers of the systemic inflammatory response syndrome (SIRS) is difficult, especially in critically ill patients who may have SIRS for other reasons. It is this conundrum that predominantly drives broad-spectrum antimicrobial use and the associated evolution of antibiotic resistance in critical care environments. It is perhaps unsurprising, therefore, that the search for a highly accurate biomarker of sepsis has become one of the holy grails of medicine. Procalcitonin (PCT) has emerged as the most studied and promising sepsis biomarker. For diagnostic and prognostic purposes in critical care, PCT is an advance on C-reactive protein and other traditional markers of sepsis, but is not accurate enough for clinicians to dispense with clinical judgement. There is stronger evidence, however, that measurement of PCT has a role in reducing the antibiotic exposure of critical care patients. For units intending to incorporate PCT assays into routine clinical practice, the cost-effectiveness of this is likely to depend on the pre-implementation length of an average antibiotic course and the subsequent impact of implementation on emerging antibiotic resistance. In most of the trials to date, the average baseline duration of the antibiotic course was longer than is currently standard practice in many UK critical care units. Many other biomarkers are currently being investigated. To be highly useful in clinical practice, it may be necessary to combine these with other novel biomarkers and/or traditional markers of sepsis.

  3. Measuring Science Instructional Practice: A Survey Tool for the Age of NGSS

    NASA Astrophysics Data System (ADS)

    Hayes, Kathryn N.; Lee, Christine S.; DiStefano, Rachelle; O'Connor, Dawn; Seitz, Jeffery C.

    2016-03-01

    Ambitious efforts are taking place to implement a new vision for science education in the United States, in both Next Generation Science Standards (NGSS)-adopted states and those states creating their own, often related, standards. In-service and pre-service teacher educators are involved in supporting teacher shifts in practice toward the new standards. With these efforts, it will be important to document shifts in science instruction toward the goals of NGSS and broader science education reform. Survey instruments are often used to capture instructional practices; however, existing surveys primarily measure inquiry based on previous definitions and standards and with a few exceptions, disregard key instructional practices considered outside the scope of inquiry. A comprehensive survey and a clearly defined set of items do not exist. Moreover, items specific to the NGSS Science and Engineering practices have not yet been tested. To address this need, we developed and validated a Science Instructional Practices survey instrument that is appropriate for NGSS and other related science standards. Survey construction was based on a literature review establishing key areas of science instruction, followed by a systematic process for identifying and creating items. Instrument validity and reliability were then tested through a procedure that included cognitive interviews, expert review, exploratory and confirmatory factor analysis (using independent samples), and analysis of criterion validity. Based on these analyses, final subscales include: Instigating an Investigation, Data Collection and Analysis, Critique, Explanation and Argumentation, Modeling, Traditional Instruction, Prior Knowledge, Science Communication, and Discourse.

  4. Understanding brain dysfunction in sepsis

    PubMed Central

    2013-01-01

    Sepsis often is characterized by an acute brain dysfunction, which is associated with increased morbidity and mortality. Its pathophysiology is highly complex, resulting from both inflammatory and noninflammatory processes, which may induce significant alterations in vulnerable areas of the brain. Important mechanisms include excessive microglial activation, impaired cerebral perfusion, blood–brain-barrier dysfunction, and altered neurotransmission. Systemic insults, such as prolonged inflammation, severe hypoxemia, and persistent hyperglycemia also may contribute to aggravate sepsis-induced brain dysfunction or injury. The diagnosis of brain dysfunction in sepsis relies essentially on neurological examination and neurological tests, such as EEG and neuroimaging. A brain MRI should be considered in case of persistent brain dysfunction after control of sepsis and exclusion of major confounding factors. Recent MRI studies suggest that septic shock can be associated with acute cerebrovascular lesions and white matter abnormalities. Currently, the management of brain dysfunction mainly consists of control of sepsis and prevention of all aggravating factors, including metabolic disturbances, drug overdoses, anticholinergic medications, withdrawal syndromes, and Wernicke’s encephalopathy. Modulation of microglial activation, prevention of blood–brain-barrier alterations, and use of antioxidants represent relevant therapeutic targets that may impact significantly on neurologic outcomes. In the future, investigations in patients with sepsis should be undertaken to reduce the duration of brain dysfunction and to study the impact of this reduction on important health outcomes, including functional and cognitive status in survivors. PMID:23718252

  5. NPACE nurse practitioner practice characteristics, salary, and benefits survey: 1999. Nurse Practitioner Associates for Continuing Education.

    PubMed

    Pulcini, J; Vampola, D

    2000-11-01

    The purpose of this article is to present the results of a practice characteristics, salary, and benefits survey of 1,557 nurse practitioners from the United States who attended national nurse practitioner conferences in Las Vegas, Nevada, Orlando, Florida, Chicago, Illinois, and Boston, Massachusetts, in 1999. Specific data are presented on the demographics of the population, practice characteristics and responsibilities, benefits for full- and part-time employees, and salary by region, years of practice, type of certification, and location of the practice. The salary data were compared with the 1995-1996 and 1996-1997 NPACE practice characteristics, salary, and benefits surveys (Pulcini & Fitzgerald, 1997; Pulcini, Vampola, & Fitzgerald, 1998). PMID:11858321

  6. Bias in patient assessments of general practice: general practice assessment survey scores in surgery and postal responders.

    PubMed Central

    Bower, Peter; Roland, Martin O

    2003-01-01

    Patient-based measures of the quality of primary care are increasingly important. However, their effective use requires bias to be minimised. Scores on the General Practice Assessment Survey (GPAS) differ according to whether patients are surveyed in the surgery or by post. It is not clear whether these differences relate to the mode of administration or to the types of patients who complete the scale in postal and surgery samples. Regression indicates that the bias reflects both effects and should be considered when GPAS scores are being interpreted. PMID:12817358

  7. Astrometric exoplanet surveys in practice: challenges, opportunities, and results

    NASA Astrophysics Data System (ADS)

    Sahlmann, Johannes

    2015-08-01

    Conversely to the transit photometry and radial velocity methods, the astrometric discovery of exoplanets is still limited by the sensitivity of available instruments. Furthermore, the signature of a planet (described by 7 free parameters) is orders of magnitude smaller than the standard motion of a star (5 free parameters), which has to be solved for first. This has important implications in the design and implementation of astrometric planet search surveys and the large parameter space to be explored calls for efficient fitting algorithms. I will present results of the so-far most precise astrometric planet search from the ground, targeting 20 very low-mass stars and brown dwarfs with an accuracy of 100 micro-arcseconds, which include the discovery of binaries with components in the planetary mass regime and several planet candidates with Neptune-to-Jupiter masses. The employed genetic and MCMC algorithms were shown to be efficient in constraining all astrometric parameters, which makes them important tools for the exploitation of the data currently collected by the Gaia satellite. Gaia is expected to astrometrically discover thousands of giant exoplanets and I will report on several ongoing projects in preparation of this unique harvest, including the expected yield of circumbinary planets.

  8. Open access endoscopy--a nationwide survey of current practice.

    PubMed

    Bramble, M G

    1992-02-01

    In a postal survey of 450 members of the Endoscopy Section of the British Society of Gastroenterology carried out during 1990, 47% of respondants stated that they were offering some form of open access endoscopy. Virtually all of these were offering open access gastroscopy, but one in three were also performing open access flexible sigmoidoscopy. Those units that offered open access endoscopy had significantly more endoscopists sharing the workload, including a greater number of clinical assistants. Only 10% of those who replied, however, were offering 'true' open access endoscopy, the remainder used some form of 'censoring'. There were also important differences in consultants' attitudes to the investigation and management of patients referred with dyspepsia, which may account for the patchy availability of the service. Some 71% of those who did not offer open access endoscopy cited an inability to cope with numbers as their main reason for not doing so. Support for these concerns is gained from the finding that 52% of those that offered the service have had a waiting list exceeding six weeks at some time. Nevertheless, open access endoscopy is becoming more widely available with a large increase in participating units during the past 12 months.

  9. Improving the management of sepsis in a district general hospital by implementing the ‘Sepsis Six’ recommendations

    PubMed Central

    Kumar, Prashant; Jordan, Mark; Caesar, Jenny; Miller, Sarah

    2015-01-01

    Sepsis is a common condition with a major global impact on healthcare resources and expenditure. The Surviving Sepsis Campaign has been vigorous in promoting internationally recognised pathways to improve the management of septic patients and decrease mortality. However, translating recommendations into practice is a challenging and complex task that requires a multi-faceted approach with sustained engagement from local stakeholders. Whilst working at a district general hospital in New Zealand, we were concerned by the seemingly inconsistent management of septic patients, often leading to long delays in the initiation of life-saving measures such as antibiotic, fluid, and oxygen administration. In our hospital there were no clear systems, protocols or guidelines in place for identifying and managing septic patients. We therefore launched the Sepsis Six resuscitation bundle of care in our hospital in an attempt to raise awareness amongst staff and improve the management of septic patients. We introduced a number of simple low-cost interventions that included educational sessions for junior doctors and nursing staff, as well as posters and modifications to phlebotomy trolleys that acted as visual reminders to implement the Sepsis Six bundle. Overall, we found there to a be a steady improvement in the delivery of the Sepsis Six bundle in septic patients with 63% of patients receiving appropriate care within one hour, compared to 29% prior to our interventions. However this did not translate to an improvement in patient mortality. This project forms part of an on going process to instigate a fundamental culture change among local healthcare professionals regarding the management of sepsis. Whilst we have demonstrated improved implementation of the Sepsis Six bundle, the key challenge remains to ensure that momentum of this project continues and forms a platform for sustainable clinical improvement in the long term. PMID:26734403

  10. Analgesia following thoracotomy: a survey of Australian practice.

    PubMed

    Cook, T M; Riley, R H

    1997-10-01

    This survey examines pain management after thoracotomy in Australian hospitals. Questionnaires were sent to senior thoracic anaesthetists at 27 hospitals (16 public and 11 private) with thoracic surgical units. Twenty-six anaesthetists replied and 24 responses were included in the analyses. Seventy-two percent of respondents were from hospitals with acute pain services (APS), and in 94% of these hospitals patients are reportedly visited by the APS. The most frequently used analgesic modalities are epidural analgesia, intravenous patient-controlled analgesia (IVPCA), and nurse-controlled intravenous opioid infusions. Over half of the anaesthetists reported using local anaesthetic intercostal nerve block, non-steroidal anti-inflammatory drugs (NSAIDs), or paracetamol. Combinations of analgesic techniques were cited frequently. Respondents reported that cryoanalgesia, interpleural blockade, paravertebral blockade, subarachnoid infusions, ketamine, and transcutaneous electrical nerve stimulation are used infrequently. Anaesthetists from public hospitals reported using epidural analgesia, IVPCA and NSAIDs more frequently than those from private hospitals. When epidural analgesia is used, most respondents place the catheter in the mid-thoracic region (91%), use a regimen of opioids plus local anaesthetic (96%), use a constant infusion technique (100%), and continue analgesia for up to three days (83%). Over half of the respondents reported that post-thoracotomy patients are nursed in a high-dependency area. Seventy-nine percent of respondents selected epidural analgesia as the best available analgesia technique, whereas 21% consider IVPCA to be the best. Only 75% of respondents reported that the type of analgesia they consider best is also the type which they use most frequently. PMID:9352765

  11. Naked into the World: IT Teaching Experiences on a Final Primary School Teaching Practice--A Second Survey.

    ERIC Educational Resources Information Center

    Dunn, S.; Ridgway, J.

    1991-01-01

    Describes results of a survey of student teachers in the United Kingdom who described their experiences with information technology (IT) during their final primary teaching practice. Data are related to an earlier survey of the same students during their first teaching practice to explore changes in their practices and beliefs about IT. (14…

  12. Health practice correlates in three adult age groups: results from two community surveys.

    PubMed

    Rakowski, W; Lefebvre, R C; Assaf, A R; Lasater, T M; Carleton, R A

    1990-01-01

    Independently done surveys of a target population can make an important contribution to knowledge about the determinants of personal health behavior by highlighting variables that consistently emerge as significant predictors. This investigation examined the correlates of four health practice and knowledge indices related to cardiovascular disease (CVD) in two baseline community surveys of the Pawtucket Heart Health Program (N = 2,413; N = 2,808). An additional dimension was the use of three adult age groups (18-29, 30-49, 50-64) in conducting the analyses. Results of both surveys showed that sex was the strongest correlate of the four indices--knowledge of CVD, encouraging health practice changes in others, dietary intake, and exercise. The four indices related to CVD were also associated with years of education, primary language, and whether or not a recent cholesterol measurement had been obtained, although these relationships were not as consistent as the results for sex. Overall, about half of each survey's significant associations were also found in the other survey (survey 1, 30 of 62; survey 2, 30 of 56). Consistency of significant results between surveys was best for the group ages 30-49. In either survey, it was rare for an association between a predictor and behavioral index to appear in each of the three age groups. This study supports the importance of the subjects' sex in research on personal health practices, suggests the potential for independence even among health-related indices pertinent to a single type of illness, and emphasizes the usefulness of utilizing independent samples to identify important correlates of health behavior. PMID:2120725

  13. Sepsis-associated encephalopathy.

    PubMed

    Gofton, Teneille E; Young, G Bryan

    2012-10-01

    Sepsis-associated encephalopathy (SAE) is a diffuse brain dysfunction that occurs secondary to infection in the body without overt CNS infection. SAE is frequently encountered in critically ill patients in intensive care units, and in up to 70% of patients with severe systemic infection. The severity of SAE can range from mild delirium to deep coma. Seizures and myoclonus are infrequent and cranial nerves are almost always spared, but most severe cases have an associated critical illness neuromyopathy. Development of SAE probably involves a number of mechanisms that are not mutually exclusive and vary from patient to patient. Substantial neurological and psychological morbidities often occur in survivors. Mortality is almost always due to multiorgan failure rather than neurological complications, and is almost 70% in patients with severe SAE. Further research into the pathophysiology, management and prevention of SAE is needed. This Review discusses the epidemiology and clinical presentation of SAE. Recent evidence for SAE pathophysiology is outlined and a diagnostic approach to patients with this syndrome is presented. Lastly, prognosis and management of SAE is discussed.

  14. Antimicrobial Peptides in Human Sepsis

    PubMed Central

    Martin, Lukas; van Meegern, Anne; Doemming, Sabine; Schuerholz, Tobias

    2015-01-01

    Nearly 100 years ago, antimicrobial peptides (AMPs) were identified as an important part of innate immunity. They exist in species from bacteria to mammals and can be isolated in body fluids and on surfaces constitutively or induced by inflammation. Defensins have anti-bacterial effects against Gram-positive and Gram-negative bacteria as well as anti-viral and anti-yeast effects. Human neutrophil peptides (HNP) 1–3 and human beta-defensins (HBDs) 1–3 are some of the most important defensins in humans. Recent studies have demonstrated higher levels of HNP 1–3 and HBD-2 in sepsis. The bactericidal/permeability-increasing protein (BPI) attenuates local inflammatory response and decreases systemic toxicity of endotoxins. Moreover, BPI might reflect the severity of organ dysfunction in sepsis. Elevated plasma lactoferrin is detected in patients with organ failure. HNP 1–3, lactoferrin, BPI, and heparin-binding protein are increased in sepsis. Human lactoferrin peptide 1–11 (hLF 1–11) possesses antimicrobial activity and modulates inflammation. The recombinant form of lactoferrin [talactoferrin alpha (TLF)] has been shown to decrease mortality in critically ill patients. A phase II/III study with TLF in sepsis did not confirm this result. The growing number of multiresistant bacteria is an ongoing problem in sepsis therapy. Furthermore, antibiotics are known to promote the liberation of pro-inflammatory cell components and thus augment the severity of sepsis. Compared to antibiotics, AMPs kill bacteria but also neutralize pathogenic factors such as lipopolysaccharide. The obstacle to applying naturally occurring AMPs is their high nephro- and neurotoxicity. Therefore, the challenge is to develop peptides to treat septic patients effectively without causing harm. This overview focuses on natural and synthetic AMPs in human and experimental sepsis and their potential to provide significant improvements in the treatment of critically ill with severe infections

  15. A Survey of Optometry Graduates to Determine Practice Patterns: Part II: Licensure and Practice Establishment Experiences.

    ERIC Educational Resources Information Center

    Bleimann, Robert L.; Smith, Lee W.

    1985-01-01

    A summary of Part II of a two-volume study of optometry graduates conducted by the Association of Schools and Colleges of Optometry is presented. Part II includes the analysis of the graduates' licensure and practice establishment experiences. (MLW)

  16. Online Learning Policy and Practice Survey: A Survey of the States

    ERIC Educational Resources Information Center

    Center for Digital Education, 2008

    2008-01-01

    In 2008, the Center for Digital Education (CDE) conducted a review of state policy and programs to determine the status of online learning policy and practice across the United States. CDE interviewed state education officials across the nation to evaluate the overall landscape of online learning. The rankings reflect the vision, policies,…

  17. Billing and coding knowledge: a comparative survey of professional coders, practicing orthopedic surgeons, and orthopedic residents.

    PubMed

    Wiley, Kevin F; Yousuf, Tariq; Pasque, Charles B; Yousuf, Khalid

    2014-06-01

    Medical knowledge and surgical skills are necessary to become an effective orthopedic surgeon. To run an efficient practice, the surgeon must also possess a basic understanding of medical business practices, including billing and coding. In this study, we surveyed and compared the level of billing and coding knowledge among current orthopedic residents PGY3 and higher, academic and private practice attending orthopedic surgeons, and orthopedic coding professionals. According to the survey results, residents and fellows have a similar knowledge of coding and billing, regardless of their level of training or type of business education received in residency. Most residents would like formal training in coding, billing, and practice management didactics; this is consistent with data from previous studies. PMID:24945481

  18. A survey of the value of routine intimate examination and related practices in subfertile couples.

    PubMed

    Desai, A K; Jaiyesimi, R A K

    2007-11-01

    The practice of undertaking routine intimate examinations in the management of subfertile couples varies among clinicians. An anonymous self-administered mailed questionnaire survey was carried out to determine the current practices followed by clinicians and the rationale supporting their practice. In the absence of large comparative studies, this survey provides expert opinion regarding this practice. The questionnaire was mailed to the Fellows and members of the Royal College of Obstetricians and Gynaecologists in the Northern, Yorkshire, West Midlands and Wales regions in the UK. A total of 802 questionnaires were posted, of which 516 were returned, giving an overall response rate of 64%. The responses and comments varied. Some 62% of respondents would routinely perform a pelvic examination on all women presenting with subfertility; 23% would do so only in selected cases and 63% of the clinicians would perform a routine transvaginal ultrasound. The male partners are examined by only 19% of the clinicians. A total of 83% of the respondents were of the opinion that the survey made them think about the role and justification of intimate examinations in greater detail. The practice of intimate examination of subfertile couples varies among clinicians in the survey group. There is a need for large prospective comparative studies to study the value of this examination and related practices in the management of subfertile couples. In the absence of comparative trials, this survey provides expert opinion. It may be suggested that an intimate examination should not be carried out routinely in all subfertile couples. It could be done when it has potential to add value to the management of the patient. A pragmatic approach should be adopted in every clinical situation.

  19. Oropharyngeal dysphagia: surveying practice patterns of the speech-language pathologist.

    PubMed

    Martino, Rosemary; Pron, Gaylene; Diamant, Nicholas E

    2004-01-01

    The present study was designed to obtain a comprehensive view of the dysphagia assessment practice patterns of speech-language pathologists and their opinion on the importance of these practices using survey methods and taking into consideration clinician, patient, and practice-setting variables. A self-administered mail questionnaire was developed following established methodology to maximize response rates. Eight dysphagia experts independently rated the new survey for content validity. Test-retest reliability was assessed with a random sample of 23 participants. The survey was sent to 50 speech-language pathologists randomly selected from the Canadian professional association database of members who practice in dysphagia. Surveys were mailed according to the Dillman Total Design Method and included an incentive offer. High survey (64%) and item response (95%) rates were achieved and clinicians were reliable reporters of their practice behaviors (ICC>0.60). Of all the clinical assessment items, 36% were reported with high (>80%) utilization and 24% with low (<20%) utilization, the former pertaining to tongue motion and vocal quality after food/fluid intake and the latter to testing of oral sensation without food. One-third (33%) of instrumental assessment items were highly utilized and included assessment of bolus movement and laryngeal response to bolus misdirection. Overall, clinician experience and teaching institutions influenced greater utilization. Opinions of importance were similar to utilization behaviors (r = 0.947, p = 0.01). Of all patients referred for dysphagia assessment, full clinical assessments were administered to 71% of patients but instrumental assessments to only 36%. A hierarchical model of practice behavior is proposed to explain this pattern of progressively decreasing item utilization.

  20. Current epidemiology of sepsis in mainland China

    PubMed Central

    Liao, Xuelian; Du, Bin; Lu, Meizhu; Wu, Minming

    2016-01-01

    The disease burden of sepsis is a global issue. Most of the large-scale epidemiological investigations on sepsis have been carried out in developed countries. The population of 1.3 billion in mainland China accounts for approximately 1/5th of the whole world population. Thus, the knowledge of the incidence and mortality of sepsis in mainland China is vital before employing measures for its improvement. However, most of the epidemiological data of sepsis in mainland China was obtained from ICU settings, and thus lacks the population-based incidence and mortality of sepsis. In the present review, we summarized the limited literature encompassing the incidence, mortality, long-term outcome, and pathogens of sepsis in mainland China. Therefore, it might provide some valuable information regarding the sepsis disease burden and current issues in the management of sepsis in mainland China. PMID:27713882

  1. Fast Action Can Prevent Sepsis Death: CDC

    MedlinePlus

    ... fullstory_160574.html Fast Action Can Prevent Sepsis Death: CDC Know the signs of extreme response to ... treated long before it causes severe illness or death, U.S. health officials report. Sepsis, or septicemia, occurs ...

  2. Precautionary practices for administering anesthetic gases: A survey of physician anesthesiologists, nurse anesthetists and anesthesiologist assistants.

    PubMed

    Boiano, James M; Steege, Andrea L

    2016-10-01

    Scavenging systems and administrative and work practice controls for minimizing occupational exposure to waste anesthetic gases have been recommended for many years. Anesthetic gases and vapors that are released or leak out during medical procedures are considered waste anesthetic gases. To better understand the extent recommended practices are used, the NIOSH Health and Safety Practices Survey of Healthcare Workers was conducted in 2011 among members of professional practice organizations representing anesthesia care providers including physician anesthesiologists, nurse anesthetists, and anesthesiologist assistants. This national survey is the first to examine self-reported use of controls to minimize exposure to waste anesthetic gases among anesthesia care providers. The survey was completed by 1,783 nurse anesthetists, 1,104 physician anesthesiologists, and 100 anesthesiologist assistants who administered inhaled anesthetics in the seven days prior to the survey. Working in hospitals and outpatient surgical centers, respondents most often administered sevoflurane and, to a lesser extent desflurane and isoflurane, in combination with nitrous oxide. Use of scavenging systems was nearly universal, reported by 97% of respondents. However, adherence to other recommended practices was lacking to varying degrees and differed among those administering anesthetics to pediatric (P) or adult (A) patients. Examples of practices which increase exposure risk, expressed as percent of respondents, included: using high (fresh gas) flow anesthesia only (17% P, 6% A), starting anesthetic gas flow before delivery mask or airway mask was applied to patient (35% P; 14% A); not routinely checking anesthesia equipment for leaks (4% P, 5% A), and using a funnel-fill system to fill vaporizers (16%). Respondents also reported that facilities lacked safe handling procedures (19%) and hazard awareness training (18%). Adherence to precautionary work practices was generally highest among

  3. Severe sepsis management are we doing enough?

    PubMed

    Ahrens, Tom; Vollman, Kathleen

    2003-10-01

    For the first time in medical history, a drug has been shown to reduce the mortality associated with sepsis, the leading cause of death in many ICUs. Optimal use by appropriate selection of patients and early recognition of sepsis could save thousands of lives. Nurses play a major role in recognizing severe sepsis. By using the concepts introduced here, nurses can play a direct role in saving the lives of patients with sepsis.

  4. Dissemination of Evidence-Based Practices for Anxiety Disorders in Wyoming: A Survey of Practicing Psychotherapists

    ERIC Educational Resources Information Center

    Hipol, Leilani J.; Deacon, Brett J.

    2013-01-01

    Despite the well-established effectiveness of exposure-based cognitive-behavioral therapy (CBT) in the treatment of anxiety disorders, therapists have been slow to adopt CBT into their clinical practice. The present study was conducted to examine the utilization of psychotherapy techniques for anxiety disorders among community practitioners in a…

  5. Literacy for the Twenty-First Century: Research, Policy, Practices, and the National Adult Literacy Survey.

    ERIC Educational Resources Information Center

    Smith, M. Cecil, Ed.

    This book focuses on results from secondary analyses of the National Adult Literacy Survey (NALS) and implications of these analyses for policy, practice, and further research on adult literacy. Part I contains an introduction and three additional chapters that provide a substantive summary of the NALS and its purposes: "Introduction: Adult…

  6. Social Workers' Orientation toward the Evidence-Based Practice Process: A Dutch Survey

    ERIC Educational Resources Information Center

    van der Zwet, Renske J. M.; Kolmer, Deirdre M. Beneken genaamd; Schalk, René

    2016-01-01

    Objectives: This study assesses social workers' orientation toward the evidence-based practice (EBP) process and explores which specific variables (e.g. age) are associated. Methods: Data were collected from 341 Dutch social workers through an online survey which included a Dutch translation of the EBP Process Assessment Scale (EBPPAS), along with…

  7. Complete denture impression techniques practiced by private dental practitioners: a survey.

    PubMed

    Kakatkar, Vinay R

    2013-09-01

    Impression making is an important step in fabricating complete dentures. A survey to know the materials used and techniques practiced while recording complete denture impressions was conducted. It is disheartening to know that 33 % practitioners still use base plate custom trays to record final impressions. 8 % still use alginate for making final impressions. An acceptable technique for recording CD impressions is suggested.

  8. Policies, Practices, and Procedures in Graduate Student Aid: A Report on the 1998 NASFAA SOGAPPP Survey.

    ERIC Educational Resources Information Center

    Redd, Kenneth E.

    2000-01-01

    Reports on the 1998 Survey of Graduate Aid Policies, Practices, and Procedures (SOGAPPP) of the National Association of Student Financial Aid Administrators (NASFAA). Finds that professional programs at private institutions have highest tuitions; most students in professional programs receive financial aid; loans are the overwhelming type of aid…

  9. Emergent Literacy Practices and Support for Children with Disabilities: A National Survey

    ERIC Educational Resources Information Center

    McDonnell, Andrea P.; Hawken, Leanne S.; Johnston, Susan S.; Kidder, Jaimee E.; Lynes, Marjorie J.; McDonnell, John J.

    2014-01-01

    A national mail survey of Head Start preschool teachers (N = 500) was conducted to assess their practices, the availability of specialist support, and their views related to emergent literacy instruction for Head Start children who have a disability or developmental delay. The responding teachers (n = 254) reported that (a) nearly one quarter of…

  10. 76 FR 39260 - Direct Investment Surveys: Alignment of Regulations With Current Practices

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-06

    ... Bureau of Economic Analysis 15 CFR Part 806 RIN 0691-AA78 Direct Investment Surveys: Alignment of Regulations With Current Practices AGENCY: Bureau of Economic Analysis, Commerce. ACTION: Final rule. SUMMARY: This final rule amends regulations of the Bureau of Economic Analysis (BEA) related to...

  11. 76 FR 19282 - Direct Investment Surveys: Alignment of Regulations With Current Practices

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-07

    ... Bureau of Economic Analysis 15 CFR Part 806 [Docket No. 110321207-1206-01 0691-AA78 Direct Investment Surveys: Alignment of Regulations With Current Practices AGENCY: Bureau of Economic Analysis, Commerce. ACTION: Notice of proposed rulemaking. SUMMARY: The Bureau of Economic Analysis (BEA) proposes to...

  12. Group Therapy for School-Aged Children Who Stutter: A Survey of Current Practices

    ERIC Educational Resources Information Center

    Liddle, Hilary; James, Sarah; Hardman, Margaret

    2011-01-01

    Although group therapy is recommended for school-aged children who stutter (CWS), it is not widely researched. This study aimed to explore this provision, using a postal survey which investigated the current practices of Speech & Language Therapists (SLTs) in the UK. Seventy percent of SLT services provided some group therapy, but the level of…

  13. A National Survey of Procedural Skill Requirements in Family Practice Residency Programs.

    ERIC Educational Resources Information Center

    Tenore, Josie L.; Sharp, Lisa K.; Lipsky, Martin S.

    2001-01-01

    Surveyed the use and composition of required procedure lists in U.S. family practice residency programs. Although a majority of respondents reported use of a required procedure list, programs differed greatly in terms of required procedures, and few defined how to evaluate the technical competency of their residents. (EV)

  14. Third and Fourth Grade Teacher's Classroom Practices in Writing: A National Survey

    ERIC Educational Resources Information Center

    Brindle, Mary; Graham, Steve; Harris, Karen R.; Hebert, Michael

    2016-01-01

    A random sample of teachers in grades 3 and 4 (N = 157) from across the United States were surveyed about their use of evidence-based writing practices, preparation to teach writing, and beliefs about writing. Teachers' beliefs included their efficacy to teach writing, their orientations to teach writing, their attitude about teaching writing, and…

  15. The Clinical Treatment of School Refusal Behavior: A Survey of Referral and Practice Characteristics.

    ERIC Educational Resources Information Center

    Kearney, Christopher A.; Beasley, Julie F.

    1994-01-01

    Surveyed 63 professional psychologists specializing in youth and family practice about recently referred and treated cases of school refusal behavior. Obtained data on clinical prevalence; demographic characteristics; length of absenteeism; severity; etiology; and length, type, and success of treatments used. Results revealed that children…

  16. Consumer Direction in Managed Long-Term Care: An Exploratory Survey of Practices and Perceptions

    ERIC Educational Resources Information Center

    Meiners, Mark R.; Mahoney, Kevin J.; Shoop, Dawn M.; Squillace, Marie R.

    2002-01-01

    Purpose: This article presents results of a survey of the attitudes and practices of managed care organizations (MCOs) concerning consumer direction. The study focused on understanding several alternative measures of consumer direction and the factors that are associated with the MCOs concerning those measures. Design and Methods: The MCOs that…

  17. Colorado Hospital Survey Covering Salaries, Wages, and Selected Personnel Policies and Practices.

    ERIC Educational Resources Information Center

    Colorado Hospital Association, Denver.

    The data presented in this survey were gathered by mailed questionnaires and cover salary data on 28 "key benchmark" job classifications considered to be most representative in Colorado hospitals regardless of size, location, or type. There are tables of selected benefits, personnel policies, and practices together with actual pay rates and rate…

  18. A Survey of the Practices, Procedures, and Techniques in Undergraduate Organic Chemistry Teaching Laboratories

    ERIC Educational Resources Information Center

    Martin, Christopher B.; Schmidt, Monica; Soniat, Michael

    2011-01-01

    A survey was conducted of four-year institutions that teach undergraduate organic chemistry laboratories in the United States. The data include results from over 130 schools, describes the current practices at these institutions, and discusses the statistical results such as the scale of the laboratories performed, the chemical techniques applied,…

  19. Contemporary Practices in School Psychology: A National Survey of Roles and Referral Problems.

    ERIC Educational Resources Information Center

    Bramlett, Ronald K.; Murphy, John J.; Johnson, Jenna; Wallingsford, Leah; Hall, John D.

    2002-01-01

    School psychologists (N=370) from a national organization were surveyed about their roles, types of referrals, consultation practices, and crisis team involvement. Assessment was the most common role. Most referrals were for academic problems. Behavioral consultation was the most common model. The majority of respondents had some involvement in…

  20. Utilizing a Substance Use Attitudes, Practices and Knowledge Survey for Multidisciplinary Curriculum Development

    ERIC Educational Resources Information Center

    Alexander, Dale; Waters, Vicki; McQueen, Katie; Basinger, Scott

    2006-01-01

    The authors describe the development and administration of a substance use attitudes questionnaire to social work students and clinicians, physician assistant students and practitioners, and medical interns. The general purpose for the Attitudes Survey was to collect baseline data regarding past training, current attitudes, beliefs, practices, and…

  1. A Survey of Ethical Decision-Making among Practicing School Psychologists.

    ERIC Educational Resources Information Center

    Chevalier, Nancy E.; Lyon, Mark A.

    Empirical studies on the ethical decision-making practices of school psychologists are lacking. The purpose of this study was to investigate school psychologists' preferred resolutions to a number of ethical problems and their reasons for acting in a chosen manner. Members (N=76) of the National Association of School Psychologists were surveyed. A…

  2. Does Psychiatry Residency Training Reflect the "Real World" of Psychiatry Practice? A Survey of Residency Graduates

    ERIC Educational Resources Information Center

    Petersen, Timothy; Fava, Maurizio; Alpert, Jonathan E.; Vorono, Sienna; Sanders, Kathy M.; Mischoulon, David

    2007-01-01

    Objective: The authors determine whether Massachusetts General Hospital's residency graduates believed their training reflected their current practice activities. Method: The authors surveyed 134 graduates from MGH and MGH-McLean residency classes from 1983 to 2003. Subjects ranked their satisfaction with different components of training on a…

  3. Assessing Violence Risk and Psychopathy in Juvenile and Adult Offenders: A Survey of Clinical Practices

    ERIC Educational Resources Information Center

    Viljoen, Jodi L.; McLachlan, Kaitlyn; Vincent, Gina M.

    2010-01-01

    This study surveyed 199 forensic clinicians about the practices that they use in assessing violence risk in juvenile and adult offenders. Results indicated that the use of risk assessment and psychopathy tools was common. Although clinicians reported more routine use of psychopathy measures in adult risk assessments compared with juvenile risks…

  4. Video Use in Teacher Education: A Survey of Teacher-Educators' Practices across Disciplines

    ERIC Educational Resources Information Center

    Arya, Poonam; Christ, Tanya; Chiu, Ming Ming

    2016-01-01

    Video methods utilize tenets of high quality teacher education and support education students' learning and application of learning to teaching practices. However, how frequently video is used in teacher education, and in what ways is unknown. Therefore, this study used survey data to identify the extent to which 94 teacher-educators used video in…

  5. A National Survey on the Current Status of Family Practice Residency Education in Geriatric Medicine.

    ERIC Educational Resources Information Center

    Li, Ina; Arenson, Christine; Warshaw, Gregg; Bragg, Elizabeth; Shaull, Ruth; Counsell, Steven R.

    2003-01-01

    A survey of family practice residency directors found that 92 percent have a required geriatrics curriculum; nursing homes, assisted living facilities, and home care are the predominant training sites; the mean number of geriatrics faculty is 2.6 per program; and conflicting time demands with other curricula was ranked as the most significant…

  6. Rainwater harvesting in the United States: a survey of common system practices

    EPA Science Inventory

    Rainwater harvesting (RWH) systems in the United States vary in terms of design and operation. To better understand common practices in the RWH community and motivation for collecting harvested rainwater, an electronic survey was used to poll members of the American Rainwater Cat...

  7. Managing Electronic Resources: A Survey of Current Practices in Academic Libraries.

    ERIC Educational Resources Information Center

    Shaw, Beth Hansen

    This document reports results of an online survey that examined practices and procedures in the management of electronic resources in 65 academic library reference departments. Responses are related to: (1) student population; (2) library use by community people; (3) number of public access workstations, workstations with World Wide Web access,…

  8. Evidence-Based Speech-Language Pathology Practices in Schools: Findings from a National Survey

    ERIC Educational Resources Information Center

    Hoffman, LaVae M.; Ireland, Marie; Hall-Mills, Shannon; Flynn, Perry

    2013-01-01

    Purpose: This study documented evidence-based practice (EBP) patterns as reported by speech-language pathologists (SLPs) employed in public schools during 2010-2011. Method: Using an online survey, practioners reported their EBP training experiences, resources available in their workplaces, and the frequency with which they engage in specific EBP…

  9. Anglo-Nigerian Pidgin in Nigerian Education: A Survey of Policy, Practices and Attitudes.

    ERIC Educational Resources Information Center

    Mann, Charles C.

    Language policy and language usage trends in Nigerian education are examined, particularly as they concern the role of Anglo-Nigerian Pidgin (ANP), an inter-ethnic lingua franca. Language policy and practice for official and native languages both before and since Nigerian independence are chronicled. Results of a survey of 240 individuals in six…

  10. A National Survey of Guided Reading Practices: What We Can Learn from Primary Teachers

    ERIC Educational Resources Information Center

    Ford, Michael P.; Opitz, Michael F.

    2008-01-01

    This study presents the results of a national survey of 1500 K-2 teachers describing understandings and practices related to guided reading. Results focused on five questions: What is the purpose of guided reading groups? What grouping techniques should be used? What texts should be used? How is instruction planned with and away from the teacher?…

  11. Sepsis caused by Flavimonas oryzihabitans.

    PubMed

    Lucas, K G; Kiehn, T E; Sobeck, K A; Armstrong, D; Brown, A E

    1994-07-01

    Previous reports of F. oryzihabitans sepsis involving central venous access devices reveal a relatively high rate of complications, including device removal, despite a course of broad-spectrum anti-microbials with compatible in vitro susceptibility results. In the present report of 22 cases of F. oryzihabitans sepsis treated at Memorial Sloan-Kettering Cancer Center from February 1986 through September 1993, the majority of CVAD-related infections with F. oryzihabitans were successfully treated with a 14-day course of antimicrobials with antipseudomonal activity, and removal of the device was usually not required. Factors that may complicate successful treatment of CVAD-related sepsis caused by F. oryzihabitans include polymicrobial infections and premature discontinuation of antibiotic therapy.

  12. Sepsis caused by Flavimonas oryzihabitans.

    PubMed

    Lucas, K G; Kiehn, T E; Sobeck, K A; Armstrong, D; Brown, A E

    1994-07-01

    Previous reports of F. oryzihabitans sepsis involving central venous access devices reveal a relatively high rate of complications, including device removal, despite a course of broad-spectrum anti-microbials with compatible in vitro susceptibility results. In the present report of 22 cases of F. oryzihabitans sepsis treated at Memorial Sloan-Kettering Cancer Center from February 1986 through September 1993, the majority of CVAD-related infections with F. oryzihabitans were successfully treated with a 14-day course of antimicrobials with antipseudomonal activity, and removal of the device was usually not required. Factors that may complicate successful treatment of CVAD-related sepsis caused by F. oryzihabitans include polymicrobial infections and premature discontinuation of antibiotic therapy. PMID:8041243

  13. Transfusion-associated bacterial sepsis.

    PubMed Central

    Wagner, S J; Friedman, L I; Dodd, R Y

    1994-01-01

    The incidence of sepsis caused by transfusion of bacterially contaminated blood components is similar to or less than that of transfusion-transmitted hepatitis C virus infection, yet significantly exceeds those currently estimated for transfusion-associated human immunodeficiency and hepatitis B viruses. Outcomes are serious and may be fatal. In addition, transfusion of sterile allogenic blood can have generalized immunosuppressive effects on recipients, resulting in increased susceptibility to postoperative infection. This review examines the frequency of occurrence of transfusion-associated sepsis, the organisms implicated, and potential sources of bacteria. Approaches to minimize the frequency of sepsis are discussed, including the benefits and disadvantages of altering the storage conditions for blood. In addition, the impact of high levels of bacteria on the gross characteristics of erythrocyte and platelet concentrates is described. The potentials and limitations of current tests for detecting bacteria in blood are also discussed. PMID:7923050

  14. Epidemiologic trends of sepsis in western countries

    PubMed Central

    Suarez De La Rica, Alejandro; Gilsanz, Fernando

    2016-01-01

    Since the American College of Chest Physicians (ACCP) and the Society of Critical care Medicine (SCCM) published the first consensus definition of syndromes related to sepsis in 1992, the knowledge of epidemiology of sepsis has clearly improved, although no prospective studies have been performed to analyse the incidence of sepsis in general population. There are differences in epidemiologic trends in sepsis between western countries and low-income and middle-income countries. In the United States (US), most of epidemiologic studies have been based on large, administrative databases, reporting an increase in the incidence of severe sepsis over years. In general, studies describing epidemiology of sepsis outside the US use clinical definitions and intensive care unit (ICU) observational cohort designs instead of administrative databases and definitions. Incidence of sepsis has increased over years, probably due to progressive aging of population, the existence of more comorbidities and maybe the liberal use of sepsis codification, by including patients with less severity. Notwithstanding, mortality due to sepsis is clearly decreasing over years, probably to improvement in ICU care, although absolute mortality is growing on account of the raise in incidence. Risk factors for sepsis are the two ends of life, male sex, US black race, presence of comorbidities and certain genetic variants. Respiratory tract infections are the most common source of sepsis, and, nowadays, Gram-positive infections are more frequent that Gram-negative sepsis in most prospective studies. PMID:27713883

  15. Relationships between the Survey of Organizational Research Climate (SORC) and self-reported research practices.

    PubMed

    Crain, A Lauren; Martinson, Brian C; Thrush, Carol R

    2013-09-01

    The Survey of Organizational Research Climate (SORC) is a validated tool to facilitate promotion of research integrity and research best practices. This work uses the SORC to assess shared and individual perceptions of the research climate in universities and academic departments and relate these perceptions to desirable and undesirable research practices. An anonymous web- and mail-based survey was administered to randomly selected biomedical and social science faculty and postdoctoral fellows in the United States. Respondents reported their perceptions of the research climates at their universities and primary departments, and the frequency with which they engaged in desirable and undesirable research practices. More positive individual perceptions of the research climate in one's university or department were associated with higher likelihoods of desirable, and lower likelihoods of undesirable, research practices. Shared perceptions of the research climate tended to be similarly predictive of both desirable and undesirable research practices as individuals' deviations from these shared perceptions. Study results supported the central prediction that more positive SORC-measured perceptions of the research climate were associated with more positive reports of research practices. There were differences with respect to whether shared or individual climate perceptions were related to desirable or undesirable practices but the general pattern of results provide empirical evidence that the SORC is predictive of self-reported research behavior.

  16. ESGE Survey: worldwide practice patterns amongst gastroenterologists regarding the endoscopic management of Barrett’s esophagus

    PubMed Central

    Dunn, Simon J.; Neilson, Laura J.; Hassan, Cesare; Sharma, Prateek; Guy, Claire; Rees, Colin J.

    2016-01-01

    Background and study aims: Barrett’s esophagus is a common condition that is widely encountered in clinical practice. This European Society of Gastrointestinal Endoscopy (ESGE) survey aimed to determine practice patterns amongst European clinicians with regard to the diagnosis and management of Barrett’s esophagus. Methods: Clinicians attending the ESGE learning area at the United European Gastroenterology Week in 2014 were invited to complete a 10-question survey. This survey was programed on to two Apple iPads. Information was gathered with regard to demographics, practice settings, and diagnosis and management strategies for Barrett’s esophagus. Results: In total, 163 responses were obtained. Over half of respondents (61 %) were based in university hospitals, the majority (78 %) were aged 30 – 50 and half had more than 10 years’ experience; 66 % had attended courses on Barrett’s esophagus and more than half (60 %) used the Prague C & M classification. Advanced imaging was used by 73 % of clinicians and 72 % of respondents stated that their group practiced ablation therapy. Most (76 %) practiced surveillance for non-dysplastic Barrett’s, 6 % offered ablation therapy in some situations, and 18 % offered no intervention. For low grade dysplasia, 56 % practiced surveillance, 19 % ablated some cases and 15 % ablated all cases. In total, 32 % of clinicians referred high grade dysplasia to expert centers, with 20 % referring directly for surgery and 46 % using ablation therapy in certain cases. Endoscopic mucosal resection was the most commonly used ablation technique (44 %). Conclusions: There has been reasonable uptake of the Prague C & M classification for describing Barrett’s esophagus, and ablation is widely practiced. However, practice patterns for Barrett’s esophagus vary widely between clinicians with clear guidance and quality standards required. PMID:26793783

  17. Socioeconomic determinants of rates of consultation in general practice based on fourth national morbidity survey of general practices.

    PubMed Central

    Carr-Hill, R. A.; Rice, N.; Roland, M.

    1996-01-01

    OBJECTIVE--To identify the socioeconomic determinants of consultation rates in general practice. DESIGN--Analysis of data from the fourth national morbidity survey of general practices (MSGP4) including sociodemographic details of individual patients and small area statistics from the 1991 census. Multilevel modelling techniques were used to take account of both individual patient data and small area statistics to relate socioeconomic and health status factors directly to a measure of general practitioner workload. RESULTS--Higher rates of consultations were found in patients who were classified as permanently sick, unemployed (especially those who became unemployed during the study year), living in rented accommodation, from the Indian subcontinent, living with a spouse or partner (women only), children living with two parents (girls only), and living in urban areas, especially those living relatively near the practice. When characteristics of individual patients are known and controlled for the role of "indices of deprivation" is considerably reduced. The effect of individual sociodemographic characteristics were shown to vary between different areas. CONCLUSIONS--Demographic and socioeconomic factors can act as powerful predictors of consultation patterns. Though it will always be necessary to retain some local planning discretion, the sets of coefficients estimated for individual level factors, area level characteristics, and for practice groupings may be sufficient to provide an indicative level of demand for general medical services. Although the problems in using socioeconomic data from individual patients would be substantial, these results are relevant to the development of a resource allocation formula for general practice. PMID:8616346

  18. Prevalence and incidence of severe sepsis in Dutch intensive care units

    PubMed Central

    van Gestel, Aukje; Bakker, Jan; Veraart, Christiaan PWM; van Hout, Ben A

    2004-01-01

    Introduction Severe sepsis is a dreaded consequence of infection and necessitates intensive care treatment. Severe sepsis has a profound impact on mortality and on hospital costs, but recent incidence data from The Netherlands are not available. The purpose of the present study was to determine the prevalence and incidence of severe sepsis occurring during the first 24 hours of admission in Dutch intensive care units (ICUs). Methods Forty-seven ICUs in The Netherlands participated in a point prevalence survey and included patients with infection at the time of ICU admission. Clinical symptoms of severe sepsis during the first 24 hours of each patient's ICU stay were recorded and the prevalence of severe sepsis was calculated. Then, the annual incidence of severe sepsis in The Netherlands was estimated, based on the prevalence, the estimated length of stay, and the capacity of the participating ICUs relative to the national intensive care capacity. Results The participating ICUs had 442 beds available for admissions, which was estimated to be 42% of the national ICU capacity. At the time of the survey, 455 patients were currently admitted and 151 were included in the analysis; 134 (29.5%) patients met criteria for severe sepsis. The most common failing organ system was the respiratory system (90%), and most patients were admitted following surgery (37%) and were admitted because of acute infection (62%). The most prevalent source of infection was the lung (47%). The estimated duration of ICU stay for severe sepsis patients was 13.3 ± 1.1 days. Conclusion The annual number of admissions for severe sepsis in Dutch ICUs was calculated at 8643 ± 929 cases/year, which is 0.054% of the population, 0.61% of hospital admissions and 11% of ICU admissions. PMID:15312213

  19. Feasibility of Modified Surviving Sepsis Campaign Guidelines in a Resource-Restricted Setting Based on a Cohort Study of Severe S. Aureus Sepsis

    PubMed Central

    Srisomang, Pramot; Teparrukkul, Prapit; Lorvinitnun, Pichet; Wongyingsinn, Mingkwan; Chierakul, Wirongrong; Hongsuwan, Maliwan; West, T. Eoin; Day, Nicholas P.; Limmathurotsakul, Direk; Peacock, Sharon J.

    2012-01-01

    Background The Surviving Sepsis Campaign (SSC) guidelines describe best practice for the management of severe sepsis and septic shock in developed countries, but most deaths from sepsis occur where healthcare is not sufficiently resourced to implement them. Our objective was to define the feasibility and basis for modified guidelines in a resource-restricted setting. Methods and Findings We undertook a detailed assessment of sepsis management in a prospective cohort of patients with severe sepsis caused by a single pathogen in a 1,100-bed hospital in lower-middle income Thailand. We compared their management with the SSC guidelines to identify care bundles based on existing capabilities or additional activities that could be undertaken at zero or low cost. We identified 72 patients with severe sepsis or septic shock associated with S. aureus bacteraemia, 38 (53%) of who died within 28 days. One third of patients were treated in intensive care units (ICUs). Numerous interventions described by the SSC guidelines fell within existing capabilities, but their implementation was highly variable. Care available to patients on general wards covered the fundamental principles of sepsis management, including non-invasive patient monitoring, antimicrobial administration and intravenous fluid resuscitation. We described two additive care bundles, one for general wards and the second for ICUs, that if consistently performed would be predicted to improve outcome from severe sepsis. Conclusion It is feasible to implement modified sepsis guidelines that are scaled to resource availability, and that could save lives prior to the publication of international guidelines for developing countries. PMID:22363410

  20. Practice patterns of doctors of chiropractic with a pediatric diplomate: a cross-sectional survey

    PubMed Central

    2010-01-01

    Background Complementary and alternative medicine (CAM) is growing in popularity, especially within the pediatric population. Research on CAM practitioners and their specialties, such as pediatrics, is lacking. Within the chiropractic profession, pediatrics is one of the most recently established post-graduate specialty programs. This paper describes the demographic and practice characteristics of doctors of chiropractic with a pediatric diplomate. Methods 218 chiropractors with a pediatric diplomate were invited to complete our survey using either web-based or mailed paper survey methods. Practitioner demographics, practice characteristics, treatment procedures, referral patterns, and patient characteristics were queried with a survey created with the online survey tool, SurveyMonkey©®. Results A total of 135 chiropractors responded (62.2% response rate); they were predominantly female (74%) and white (93%). Techniques most commonly used were Diversified, Activator ®, and Thompson with the addition of cranial and extremity manipulation to their chiropractic treatments. Adjunctive therapies commonly provided to patients included recommendations for activities of daily living, corrective or therapeutic exercise, ice pack\\cryotherapy, and nutritional counseling. Thirty eight percent of respondents' patients were private pay and 23% had private insurance that was not managed care. Pediatrics represented 31% of the survey respondents' patients. Chiropractors also reported 63% of their work time devoted to direct patient care. Health conditions reportedly treated within the pediatric population included back or neck pain, asthma, birth trauma, colic, constipation, ear infection, head or chest cold, and upper respiratory infections. Referrals made to or from these chiropractors were uncommon. Conclusions This mixed mode survey identified similarities and differences between doctors of chiropractic with a pediatric diplomate to other surveys of doctors of chiropractic

  1. A survey of breast feeding practices in infants seen in general practice.

    PubMed

    Chia, S F

    1992-06-01

    This is a study of infant feeding practices of 126 mothers. Seventy-seven mothers or 61.1% practised breast feeding. The typical breast feeding mother was more likely to be a Malay, with lower family income and residing in the rural area. The educational status of the mother was not an important factor in influencing her to breast feed. Health education on breast feeding should be intensified in schools to reinforce the implementation of the Malaysian Code of Ethics for Infant Formula Products. PMID:1494334

  2. A survey of breast feeding practices in infants seen in general practice.

    PubMed

    Chia, S F

    1992-06-01

    This is a study of infant feeding practices of 126 mothers. Seventy-seven mothers or 61.1% practised breast feeding. The typical breast feeding mother was more likely to be a Malay, with lower family income and residing in the rural area. The educational status of the mother was not an important factor in influencing her to breast feed. Health education on breast feeding should be intensified in schools to reinforce the implementation of the Malaysian Code of Ethics for Infant Formula Products.

  3. The research-practice relationship in ergonomics and human factors--surveying and bridging the gap.

    PubMed

    Chung, Amy Z Q; Shorrock, Steven T

    2011-05-01

    Significant discord has been aired regarding the widening research-practice gap in several disciplines (e.g. psychology, healthcare), especially with reference to research published in academic journals. The research-practice gap has profound and wide-ranging implications for the adequacy of ergonomics and human factors (E/HF) research and the implementation of research findings into practice. However, no substantive research on this issue has been identified in E/HF. Using an online questionnaire, practitioners were asked about their application of scientific research findings published in peer-reviewed journals and to suggest ways to improve research application in practice. A total of 587 usable responses were collected, spanning 46 countries. This article describes some of the key differences and correlations concerning reading, usefulness and barriers to application among respondents, who varied in terms of organisational type, percentage of work time devoted to application vs. research, society membership and experience. Various solutions proposed by the survey respondents on ways to bridge the research-practice gap are discussed. STATEMENT OF RELEVANCE: The relationship between research and practice in E/HF has long been a subject of discussion, with commentators pointing to tension and possible implications for the adequacy of the discipline. Findings from a cross-sectional survey provide ergonomics practitioners' views on research, leading to discussion of strategies for achieving better integration.

  4. Frequency of yoga practice predicts health: results of a national survey of yoga practitioners.

    PubMed

    Ross, Alyson; Friedmann, Erika; Bevans, Margaret; Thomas, Sue

    2012-01-01

    Background. Yoga shows promise as a therapeutic intervention, but relationships between yoga practice and health are underexplored. Purpose. To examine the relationship between yoga practice and health (subjective well-being, diet, BMI, smoking, alcohol/caffeine consumption, sleep, fatigue, social support, mindfulness, and physical activity). Methods. Cross-sectional, anonymous internet surveys distributed to 4307 randomly selected from 18,160 individuals at 15 US Iyengar yoga studios; 1045 (24.3%) surveys completed. Results. Mean age 51.7 (± 11.7) years; 84.2% female. Frequency of home practice favorably predicted (P < .001): mindfulness, subjective well-being, BMI, fruit and vegetable consumption, vegetarian status, sleep, and fatigue. Each component of yoga practice (different categories of physical poses, breath work, meditation, philosophy study) predicted at least 1 health outcome (P < .05). Conclusions. Home practice of yoga predicted health better than years of practice or class frequency. Different physical poses and yoga techniques may have unique health benefits. PMID:22927885

  5. Mass Casualty Decontamination in the United States: An Online Survey of Current Practice.

    PubMed

    Power, Sarah; Symons, Charles; Carter, Holly; Jones, Emma; Amlôt, Richard; Larner, Joanne; Matar, Hazem; Chilcott, Robert P

    2016-01-01

    Mass casualty decontamination is a public health intervention that would be employed by emergency responders following a chemical, biological, or radiological incident. The decontamination of large numbers of casualties is currently most often performed with water to remove contaminants from the skin surface. An online survey was conducted to explore US fire departments' decontamination practices and their preparedness for responding to incidents involving mass casualty decontamination. Survey respondents were asked to provide details of various aspects of their decontamination procedures, including expected response times to reach casualties, disrobing procedures, approaches to decontamination, characteristics of the decontamination showering process, provision for special populations, and any actions taken following decontamination. The aim of the survey was to identify any differences in the way in which decontamination guidance is implemented across US states. Results revealed that, in line with current guidance, many US fire departments routinely use the "ladder-pipe system" for conducting rapid, gross decontamination of casualties. The survey revealed significant variability in ladder-pipe construction, such as the position and number of fire hoses used. There was also variability in decontamination characteristics, such as water temperature and water pressure, detergent use, and shower duration. The results presented here provide important insights into the ways in which implementation of decontamination guidance can vary between US states. These inconsistencies are thought to reflect established perceived best practices and local adaptation of response plans to address practical and logistical constraints. These outcomes highlight the need for evidence-based national guidelines for conducting mass casualty decontamination. PMID:27442794

  6. Mass Casualty Decontamination in the United States: An Online Survey of Current Practice.

    PubMed

    Power, Sarah; Symons, Charles; Carter, Holly; Jones, Emma; Amlôt, Richard; Larner, Joanne; Matar, Hazem; Chilcott, Robert P

    2016-01-01

    Mass casualty decontamination is a public health intervention that would be employed by emergency responders following a chemical, biological, or radiological incident. The decontamination of large numbers of casualties is currently most often performed with water to remove contaminants from the skin surface. An online survey was conducted to explore US fire departments' decontamination practices and their preparedness for responding to incidents involving mass casualty decontamination. Survey respondents were asked to provide details of various aspects of their decontamination procedures, including expected response times to reach casualties, disrobing procedures, approaches to decontamination, characteristics of the decontamination showering process, provision for special populations, and any actions taken following decontamination. The aim of the survey was to identify any differences in the way in which decontamination guidance is implemented across US states. Results revealed that, in line with current guidance, many US fire departments routinely use the "ladder-pipe system" for conducting rapid, gross decontamination of casualties. The survey revealed significant variability in ladder-pipe construction, such as the position and number of fire hoses used. There was also variability in decontamination characteristics, such as water temperature and water pressure, detergent use, and shower duration. The results presented here provide important insights into the ways in which implementation of decontamination guidance can vary between US states. These inconsistencies are thought to reflect established perceived best practices and local adaptation of response plans to address practical and logistical constraints. These outcomes highlight the need for evidence-based national guidelines for conducting mass casualty decontamination.

  7. Reirradiation After Radical Radiation Therapy: A Survey of Patterns of Practice Among Canadian Radiation Oncologists

    SciTech Connect

    Joseph, Kurian Jones Al-Mandhari, Zahid; Pervez, Nadeem; Parliament, Matthew; Wu, Jackson; Ghosh, Sunita; Tai, Patricia; Lian Jidong; Levin, Wilfred

    2008-12-01

    Purpose: The objective of this study was to survey the use of reirradiation (Re-RT) for in-field failures after previous radical radiation treatment (RT) among Canadian radiation oncologists (ROs). Methods and Materials: An electronic survey was sent to 271 ROs in Canada. The completed surveys were received electronically via e-mail and the data were analyzed using SAS 9.1.3 software. Results: A total of 183 ROs (67.5%) completed and returned the survey. The majority of the respondents were involved in the practice of either breast (48%) or genitourinary (43%) tumor sites. A total of 49% of the participants were interested in using Re-RT for the management of in-field recurrences. The goals of the therapy would be improvement of quality of life (99%), locoregional control (80%), or cure (32%). Most of the physicians believed that patients should have a minimum Karnofsky performance status of 50 or Eastern Cooperative Oncology Group performance status of 3, a minimum life expectancy of 3 months, and a minimum interval from initial treatment of 3 months if Re-RT were to be given with curative intent. Conclusions: This survey showed that a wide variation existed among ROs in their approach to Re-RT. Newer technologies in RT planning and delivery would be employed to facilitate normal tissue avoidance. The results of this study suggested that a consensus meeting was needed to establish guidelines for the practice and prospective evaluation of Re-RT.

  8. Predictors of health practices within age-sex groups: National Survey of Personal Health Practices and Consequences, 1979.

    PubMed Central

    Rakowski, W

    1988-01-01

    Health promotion-disease prevention programs share with health behavior research the common objective of identifying population subgroups toward whom services can be targeted. For this report, six age-sex groups were examined to determine similarities and differences in the predictors of eight health practice indices. Data were from the 1979 National Survey of Personal Health Practices and Consequences. Results showed very little similarity of predictors across the three age cohorts (20-34, 35-49, 50-64), between men and women, and among the six age-sex groups. No predictor achieved significance consistently for several health practices in any of the six groups, although years of education made the best showing. The lack of overlap among predictors helps to explain why health promotion messages and recruitment strategies may not appeal to as diverse an audience as initially intended. Possible explanations for the absence of similar predictors include differences in the nature of the various practices themselves, absence of data on intentions behind a person's behavior, and the "over-determined" character of an individual person's behavior. PMID:3136496

  9. Change in Pathogens Causing Late-onset Sepsis in Neonatal Intensive Care Unit in Izmir, Turkey

    PubMed Central

    Yilmaz, Nisel Ozkalay; Agus, Neval; Helvaci, Mehmet; Kose, Sukran; Ozer, Esra; Sahbudak, Zumrut

    2010-01-01

    Objective Neonatal sepsis is a common cause of morbidity and mortality among newborns in the developing world. We have investigated the causative agents and their antimicrobial susceptibility of late-onset sepsis (>72 h post-delivery), and determined the possible association between various risk factors and the mortality due to neonatal sepsis in 2008. To view the changes in years, we compared them with the data which we gained in 2004. Methods Medical records of all neonates with late-onset sepsis were reviewed for demographic characteristics (birth weight, gestational age, gender, type of delivery, and mortality rate), positive cultures and risk factors of mortality. Findings One hundred and forty-seven and 227 neonates had been diagnosed as late-onset sepsis in 2004 and 2008, respectively. Coagulase-negative staphylococcus was the most frequent microorganisms. Gram-negative bacilli, particularly Pseudomonas aeruginosa showed a significant increase in years. The mortality rate was 11.5% and 19% in 2004 and 2008, respectively. Birth weight, gestational age, and infection with Klebsiella spp. isolates were found to have significant association with sepsis mortality in our neonatal intensive care unit (NICU). Conclusion The present study emphasizes the importance of periodic surveys of sepsis encountered in particular neonatal setting to recognize the trend. Increased Gram-negative bacilli rate was possibly related to the widespread use of antibiotics in our NICU. PMID:23056745

  10. Supervision in neuropsychological assessment: a survey of training, practices, and perspectives of supervisors.

    PubMed

    Shultz, Laura A Schwent; Pedersen, Heather A; Roper, Brad L; Rey-Casserly, Celiane

    2014-01-01

    Within the psychology supervision literature, most theoretical models and practices pertain to general clinical or counseling psychology. Supervision specific to clinical neuropsychology has garnered little attention. This survey study explores supervision training, practices, and perspectives of neuropsychology supervisors. Practicing neuropsychologists were invited to participate in an online survey via listservs and email lists. Of 451 respondents, 382 provided supervision to students, interns, and/or fellows in settings such as VA medical centers (37%), university medical centers (35%), and private practice (15%). Most supervisors (84%) reported supervision was discussed in graduate school "minimally" or "not at all." Although 67% completed informal didactics or received continuing education in supervision, only 27% reported receiving training specific to neuropsychology supervision. Notably, only 39% were satisfied with their training in providing supervision and 77% indicated they would likely participate in training in providing supervision, if available at professional conferences. Results indicate that clinical neuropsychology as a specialty has paid scant attention to developing supervision models and explicit training in supervision skills. We recommend that the specialty develop models of supervision for neuropsychological practice, supervision standards and competencies, training methods in provision of supervision, and benchmark measures for supervision competencies.

  11. Supervision in neuropsychological assessment: a survey of training, practices, and perspectives of supervisors.

    PubMed

    Shultz, Laura A Schwent; Pedersen, Heather A; Roper, Brad L; Rey-Casserly, Celiane

    2014-01-01

    Within the psychology supervision literature, most theoretical models and practices pertain to general clinical or counseling psychology. Supervision specific to clinical neuropsychology has garnered little attention. This survey study explores supervision training, practices, and perspectives of neuropsychology supervisors. Practicing neuropsychologists were invited to participate in an online survey via listservs and email lists. Of 451 respondents, 382 provided supervision to students, interns, and/or fellows in settings such as VA medical centers (37%), university medical centers (35%), and private practice (15%). Most supervisors (84%) reported supervision was discussed in graduate school "minimally" or "not at all." Although 67% completed informal didactics or received continuing education in supervision, only 27% reported receiving training specific to neuropsychology supervision. Notably, only 39% were satisfied with their training in providing supervision and 77% indicated they would likely participate in training in providing supervision, if available at professional conferences. Results indicate that clinical neuropsychology as a specialty has paid scant attention to developing supervision models and explicit training in supervision skills. We recommend that the specialty develop models of supervision for neuropsychological practice, supervision standards and competencies, training methods in provision of supervision, and benchmark measures for supervision competencies. PMID:25116655

  12. The workload of neurosurgeons: implications of the 1987 practice survey in the USA.

    PubMed Central

    Menken, M

    1991-01-01

    The number of neurosurgeons per million population is much lower in Europe than in the USA, where the point prevalence of neurosurgeons doubled between 1963-87. Results of a 1987 survey of USA neurosurgical practice show that surgery filled 25% of total time in professional activity. Of all cases treated, 64% were spinal disorders and 24% were intracranial disorders. Use of a relative value scale for neurosurgical procedures makes possible a rough and ready estimate of a neurosurgeon's weekly aggregate workload. However, the concept of a mean surgical workload must be examined within the context of the known variation of case mix and volume of surgical services in different practices. PMID:1744648

  13. Prescribing opioid analgesics for chronic non-malignant pain in general practice – a survey of attitudes and practice

    PubMed Central

    Blake, Holly; Leighton, Paul; van der Walt, Gerrie; Ravenscroft, Andrew

    2015-01-01

    Background: This study replicates a previous postal survey of general practitioners (GPs) to explore whether attitudes to opioid prescribing have changed at a time when the number of opioid prescriptions issued in primary care has increased. Methods: With permission, a 57-item survey instrument previously utilised with GPs in the South-west of England was circulated to 214 GPs in city-centre practices in the East Midlands. The survey instrument included items relating to practice context, prescribing patterns and attitudes about analgesic medication, perceived prescribing frequency and reluctance to prescribe. Results: Responses were received from 94 GPs (45%). Almost three-quarters (72.7%) of GPs reported that they sometimes or frequently prescribed strong opioids for chronic non-cancer pain. Over two-thirds (67.8%) reported that they were sometimes or frequently reluctant to prescribe strong opioids for chronic non-cancer pain. No significant relationships were observed between perceived frequency of prescribing and a range of demographic factors; however, concerns about ‘physical dependence’, ‘long-term commitment to prescribing’ and ‘media reports’ were associated with less frequent reported prescribing of, and greater reluctance to prescribe, strong opioids. Discussion: Given the national trend for increased opioid prescriptions, it is unsurprising that more frequent self-reported prescribing is reported here; however, increased frequency does not translate into less reluctance about prescribing. The effectiveness of strong opioids for chronic pain is recognised, but concerns about addiction, dependence and misuse inform a reluctance to use strong opioids. These juxtapositions highlight a continued need for clearer understanding of GPs’ perceptions of strong opioids and point to the potential benefit of dedicated guidelines or specialist education and training to address their uncertainties. PMID:26526705

  14. Older Driver Safety: A Survey of Psychologists' Attitudes, Knowledge, and Practices.

    PubMed

    Love, Janet; Tuokko, Holly

    2016-09-01

    Using an online survey, we examined the knowledge, attitudes, and practices with respect to older driver safety concerns of clinical psychologists from across Canada who self-identified as working with at least some drivers over 60 years of age. Eighty-four psychologists completed the survey, and many were aware of the issues relevant to older driver safety, although only about half reported that assessing fitness to drive was an important issue in their practice. The majority (75%) reported that they would benefit from education concerning evaluation of fitness to drive. The primary recommendation emerging from this investigation is to increase efforts to inform and educate psychologists about driving-related assessment and regulatory issues in general, and specifically with respect to older adults. As the population ages, it is of growing importance for all health care providers to understand the influence of mental health conditions-including cognitive impairment and dementia-on driving skills. PMID:27476964

  15. Clinical evaluation and grading practices in schools of nursing: national survey findings part II.

    PubMed

    Oermann, Marilyn H; Yarbrough, Suzanne S; Saewert, Karen J; Ard, Nell; Charasika, Margie E

    2009-01-01

    To better understand how nurse educators evaluate and grade students' clinical practice, the Evaluation of Learning Advisory Council of the National League for Nursing conducted a survey of faculty (N = 1,573) in all types of prelicensure RN programs. This article describes the findings of that survey in relation to clinical evaluation and grading clinical practice. Nearly all faculty used a clinical evaluation tool to rate students' performance in the clinical setting (n = 1,534, 98 percent); most programs had the same basic tool in all courses, but modified to reflect the unique aspects of each course (n = 1,095, 70 percent). Faculty (n = 1,116, 83 percent) reported using pass/fail for grading in clinical courses rather than a letter or numerical grade.

  16. Variations of transesophageal echocardiography practices in India: A survey by Indian College of Cardiac Anaesthesia

    PubMed Central

    Borde, Deepak Prakash; George, Antony; Joshi, Shreedhar; Nair, Suresh; Koshy, Thomas; Gandhe, Uday; Chakravarthy, Murali

    2016-01-01

    Context: Use of perioperative transesophageal echocardiography (TEE) has expanded in India. Despite attempts to standardize the practice of TEE in cardiac surgical procedures, variation in practice and application exists. This is the first online survey by Indian College of Cardiac Anaesthesia, research and academic wing of the Indian Association of Cardiovascular Thoracic Anaesthesiologists (IACTA). Aims: We hypothesized that variations in practice of intraoperative TEE exist among centers and this survey aimed at analyzing them. Settings and Design: This is an online survey conducted among members of the IACTA. Subjects and Methods: All members of IACTA were contacted using online questionnaire fielded using SurveyMonkey™ software. There were 21 questions over four pages evaluating infrastructure, documentation of TEE, experience and accreditation of anesthesiologist performing TEE, and finally impact of TEE on clinical practice. Questions were also asked about national TEE workshop conducted by the IACTA, and suggestions were invited by members on overseas training. Results: Response rate was 29.7% (382/1222). 53.9% were from high-volume centers (>500 cases annually). TEE machine/probe was available to 75.9% of the respondents and those in high-volume centers had easier (86.9%) access. There was poor documentation of preoperative consent (23.3%) as well as TEE findings (66%). Only 18.2% of responders were board qualified. Almost 90% of the responders felt surgeons respected their TEE diagnosis. Around half of the responders felt that new intraoperative findings by TEE were considered in decision-making in most of the cases and 70% of the responders reported that surgical plan was altered based on TEE finding more than 10 times in the last year. Despite this, only 5% of the responders in this survey were monetarily awarded for performing impactful skill of TEE. Majority (57%) felt that there is no need for overseas training for Indian cardiac anesthesiologists

  17. Digital chromoendoscopy utilization in clinical practice: A survey of gastroenterologists in Connecticut

    PubMed Central

    Langberg, Karl M; Parikh, Neil D; Deng, Yanhong; Ciarlegio, Maria; Laine, Loren; Aslanian, Harry R

    2016-01-01

    AIM: To use a survey to characterize and identify potential barriers to the use of digital chromoendoscopy (DC) by practicing gastroenterologists. METHODS: An anonymous, internet-based survey was sent to gastroenterologists in Connecticut who were members of one of three national gastrointestinal organizations. The survey collected demographic information, frequency of DC use, types of procedures that the respondent performs, setting of practice (academic vs community), years out of training, amount of training in DC, desire to have DC training and perceived barriers to DC use. Responses were collected anonymously. The primary endpoint was the proportion of endoscopists utilizing DC. Associations between the various data collected were analyzed using χ2 test. RESULTS: One hundred and twenty-four gastroenterologists (48%) of 261 who received the online survey responded. Seventy-eight percent of surveyed gastroenterologists have used DC during the performance of upper endoscopy and 81% with lower endoscopy. DC was used in more than half of procedures by only 14% of gastroenterologists during upper endoscopy and 12% during lower endoscopy. Twenty-three percent (upper) and 21% (lower) used DC more than one quarter of the time. DC was used for 10% or less of endoscopies by 60% (upper) and 53% (lower) of respondents. Endoscopists reported lack of training as the leading deterrent to DC use with 36% reporting it as their primary deterrent. Eighty-nine percent of endoscopists never received formal training in DC. Lack of time (30% of respondents), lack of evidence (24%) and lack of reimbursement (10%) were additional deterrents. There were no differences in DC use relative to academic vs community practice setting or years out of training. CONCLUSION: DC is used infrequently by most endoscopists, primarily due to a lack of training. Training opportunities should be expanded to meet the interest expressed by the majority of endoscopists. PMID:27158543

  18. Provision of care to general practice patients with disabling long-term mental illness: a survey in 16 practices.

    PubMed Central

    Kendrick, T; Burns, T; Freeling, P; Sibbald, B

    1994-01-01

    BACKGROUND. Increasing numbers of long-term mentally ill people now live in the community, many of whom lose contact with psychiatric services and come to depend on general practitioners for medical care. However, it has been suggested that general practitioners may be unaware of some of these patients and their needs. AIM. This study set out to investigate the care received by this group of patients. METHOD. Case registers of adults disabled by long-term mental illness were set up in 16 of 110 group general practices asked to participate. A search of each practice's record systems was combined with a survey of local psychiatric and social service teams, to seek practice patients who might not be identified from the general practice data. RESULTS. Of the 440 patients found, 90% were identified from information within the practices, mainly computerized repeat prescription and diagnostic data. The other 10% were identified only by psychiatric services. Over one third of the patients had no current contact with psychiatric services. Patients in contact with psychiatric services had been ill for a shorter time than those not in contact. More patients suffering from psychotic illnesses were in current contact than those with non-psychotic diagnoses. Over 90% of the patients had been seen by their general practitioners within 12 months, on average eight times. Most consultations were for minor physical disorders, repeat prescriptions and sickness certificates. Elements of the formal mental state examination were recorded in one third of cases and adjustments of psychotropic medication in one fifth. CONCLUSION. These findings suggest that patients in long-term contact with specialist services cannot be taken as representative of the whole population with long-term mental illness. General practitioners could use their frequent contacts with long-term mentally ill people to play a greater role in monitoring the mental state and drug treatment of this group. PMID:8068376

  19. Test–Retest Reliability of the Genetics and Genomics in Nursing Practice Survey Instrument

    PubMed Central

    Calzone, Kathleen A.; Culp, Stacey; Jenkins, Jean; Caskey, Sarah; Edwards, Pamela B.; Fuchs, Mary Ann; Reints, Amber; Stange, Brita; Questad, Janice; Badzek, Laurie

    2016-01-01

    Background and Purpose Assessment of nursing genomic competency is critical given increasing genomic applications to health care. The study aims were to determine the test–retest reliability of the Genetics and Genomics in Nursing Practice Survey (GGNPS), which measures this competency, and to revise the survey accordingly. Methods Registered nurses (n = 232) working at 2 Magnet-designated hospitals participating in a multiinstitutional genomic competency study completed the GGNPS. Cohen’s kappa and weighted kappa were used to measure the agreement of item responses between Time 1 and Time 2. Survey items were revised based on the results. Results Mean agreement for the instrument was 0.407 (range = 0.150–1.000). Moderate agreement or higher was achieved in 39% of the items. Conclusions GGNPS test–retest reliability was not optimal, and the instrument was refined based on the study findings. Further testing of the revised instrument is planned to assess the instrument performance. PMID:27103245

  20. The effect of question wording in questionnaire surveys on placebo use in clinical practice.

    PubMed

    Babel, Przemyslaw

    2012-12-01

    To identify factors that contribute to the high variability of the rates of use of placebo interventions reported in questionnaire surveys, the author investigated the effect of the explicit use of the word "placebo" in questionnaire surveys on placebo use in clinical practice on the results obtained. 190 primary care physicians in Poland were divided randomly into two groups. The groups received a questionnaire in which either the word placebo or the term "nonspecific methods of treatment" was used. The respondents who were asked explicitly about the use of placebo interventions declared that they never used placebo interventions significantly more often than participants asked about the use of nonspecific treatment methods. Moreover, the former reported significantly rarer use of placebo interventions than the latter. The study demonstrates that differences in the wording of questions in questionnaire surveys on placebo use can create statistically significant differences in results.

  1. Multidisciplinary Views on Applying Explicit and Implicit Motor Learning in Practice: An International Survey

    PubMed Central

    Kleynen, Melanie; Braun, Susy M.; Rasquin, Sascha M. C.; Bleijlevens, Michel H. C.; Lexis, Monique A. S.; Halfens, Jos; Wilson, Mark R.; Masters, Rich S. W.; Beurskens, Anna J.

    2015-01-01

    Background A variety of options and techniques for causing implicit and explicit motor learning have been described in the literature. The aim of the current paper was to provide clearer guidance for practitioners on how to apply motor learning in practice by exploring experts’ opinions and experiences, using the distinction between implicit and explicit motor learning as a conceptual departure point. Methods A survey was designed to collect and aggregate informed opinions and experiences from 40 international respondents who had demonstrable expertise related to motor learning in practice and/or research. The survey was administered through an online survey tool and addressed potential options and learning strategies for applying implicit and explicit motor learning. Responses were analysed in terms of consensus (≥ 70%) and trends (≥ 50%). A summary figure was developed to illustrate a taxonomy of the different learning strategies and options indicated by the experts in the survey. Results Answers of experts were widely distributed. No consensus was found regarding the application of implicit and explicit motor learning. Some trends were identified: Explicit motor learning can be promoted by using instructions and various types of feedback, but when promoting implicit motor learning, instructions and feedback should be restricted. Further, for implicit motor learning, an external focus of attention should be considered, as well as practicing the entire skill. Experts agreed on three factors that influence motor learning choices: the learner’s abilities, the type of task, and the stage of motor learning (94.5%; n = 34/36). Most experts agreed with the summary figure (64.7%; n = 22/34). Conclusion The results provide an overview of possible ways to cause implicit or explicit motor learning, signposting examples from practice and factors that influence day-to-day motor learning decisions. PMID:26296203

  2. Healthcare-associated pathogens and nursing home policies and practices: results from a national survey.

    PubMed

    Ye, Zhiqiu; Mukamel, Dana B; Huang, Susan S; Li, Yue; Temkin-Greener, Helena

    2015-07-01

    OBJECTIVE To examine the prevalence of healthcare-associated pathogens and the infection control policies and practices in a national sample of nursing homes (NHs). METHODS In 2012, we conducted a national survey about the extent to which NHs follow suggested infection control practices with regard to 3 common healthcare-associated pathogens: methicillin-resistant Staphylococcus aureus, Clostridium difficile, and extended-spectrum β-lactamase producers, and their prevalence in NHs. We adapted a previously used and validated NH infection control survey, including questions on prevalence, admission and screening policies, contact precautions, decolonization, and cleaning practices. RESULTS A total of 1,002 surveys were returned. Of the responding NHs, 14.2% were less likely to accept residents with methicillin-resistant Staphylococcus aureus, with the principal reason being lack of single or cohort rooms. NHs do not routinely perform admission screening (96.4%) because it is not required by regulation (56.2%) and would not change care provision (30.7%). Isolation strategies vary substantially, with gloves being most commonly used. Most NHs (75.1%) do not decolonize carriers of methicillin-resistant Staphylococcus aureus, but some (10.6%) decolonize more than 90% of residents. Despite no guidance on how resident rooms on contact precautions should be cleaned, 59.3% of NHs report enhanced cleaning for such rooms. CONCLUSION Overall, NHs tend to follow voluntary infection control guidelines only if doing so does not require substantial financial investment in new or dedicated staff or infrastructure. PMID:25797334

  3. Healthcare-Associated Pathogens and Nursing Home Policies and Practices: Results from a National Survey

    PubMed Central

    Ye, Zhiqiu; Mukamel, Dana B.; Huang, Susan S.; Li, Yue

    2015-01-01

    Objectives State and federal recommendations for infection control/prevention (IC) in nursing homes (NHs) have become more frequent, but little is known about actual NH policies/practices. Design and setting In 2012, we conducted a national survey about the extent to which NHs follow suggested IC practices with regard to three common healthcare-associated pathogens: methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile (C.diff), and extended-spectrum β-lactamase (ESBL) producers, and their prevalence in NHs. We adapted a previously used and validated NH infection control survey, including questions on prevalence, admission and screening policies, contact precaution, decolonization, and cleaning practices. Results 1,002 surveys were returned. 14.2% of NHs are less likely to accept residents with MRSA, with principal reason being lack of single/cohort rooms. NHs do not routinely perform admission screening (96.4%) because it is not required by regulation (56.2%) and would not change care provision (30.7%). Isolation strategies vary substantially, with gloves being most commonly used. Most NHs (75.1%) do not decolonize MRSA carriers, but some (10.6%) decolonize over 90% of residents. Despite no guidance on how resident rooms on contact precautions should be cleaned, 59.3% of NHs report enhanced cleaning for such rooms. Conclusions Overall, NHs tend to follow voluntary infection control guidelines only if doing so does not require substantial financial investment in new/dedicated staff or infrastructure. PMID:25797334

  4. A Survey of Rounding Practices in Canadian Adult Intensive Care Units

    PubMed Central

    Holodinsky, Jessalyn K.; Hebert, Marilynne A.; Zygun, David A.; Rigal, Romain; Berthelot, Simon; Cook, Deborah J.; Stelfox, Henry T.

    2015-01-01

    Objective To describe rounding practices in Canadian adult Intensive Care Units (ICU) and identify opportunities for improvement. Design Mixed methods design. Cross sectional survey of Canadian Adult ICUs (n = 180) with purposefully sampled follow-up interviews (n = 7). Measurements and Main Results Medical directors representing 111 ICUs (62%) participated in the survey. Rounding practices varied across ICUs with the majority reporting the use of interprofessional rounds (81%) that employed an open (94%) and collaborative (86%) approach, occurred at the patient’s bedside (82%), and started at a standard time (79%) and standard location (56%). Most participants reported that patients (83%) and family members (67%) were welcome to attend rounds. Approximately half of ICUs (48%) used tools to facilitate rounds. Interruptions during rounds were reported to be common (i.e., ≥1 interruption for ≥50% of patients) in 46% of ICUs. Four themes were identified from qualitative analysis of participant responses to open-ended survey questions and interviews: multidisciplinarity, patient and family involvement, factors influencing productivity, and teaching and learning. Conclusions There is considerable variation in current rounding practices in Canadian medical/surgical ICUs. Opportunities exist to improve ICU rounds including ensuring the engagement of essential participants, clearly defining participant roles, establishing a standardized approach to the rounding process, minimizing interruptions, modifying the role of teaching, utilizing a structured rounding tool, and developing a metric for measuring rounding quality. PMID:26700860

  5. Healthcare-associated pathogens and nursing home policies and practices: results from a national survey.

    PubMed

    Ye, Zhiqiu; Mukamel, Dana B; Huang, Susan S; Li, Yue; Temkin-Greener, Helena

    2015-07-01

    OBJECTIVE To examine the prevalence of healthcare-associated pathogens and the infection control policies and practices in a national sample of nursing homes (NHs). METHODS In 2012, we conducted a national survey about the extent to which NHs follow suggested infection control practices with regard to 3 common healthcare-associated pathogens: methicillin-resistant Staphylococcus aureus, Clostridium difficile, and extended-spectrum β-lactamase producers, and their prevalence in NHs. We adapted a previously used and validated NH infection control survey, including questions on prevalence, admission and screening policies, contact precautions, decolonization, and cleaning practices. RESULTS A total of 1,002 surveys were returned. Of the responding NHs, 14.2% were less likely to accept residents with methicillin-resistant Staphylococcus aureus, with the principal reason being lack of single or cohort rooms. NHs do not routinely perform admission screening (96.4%) because it is not required by regulation (56.2%) and would not change care provision (30.7%). Isolation strategies vary substantially, with gloves being most commonly used. Most NHs (75.1%) do not decolonize carriers of methicillin-resistant Staphylococcus aureus, but some (10.6%) decolonize more than 90% of residents. Despite no guidance on how resident rooms on contact precautions should be cleaned, 59.3% of NHs report enhanced cleaning for such rooms. CONCLUSION Overall, NHs tend to follow voluntary infection control guidelines only if doing so does not require substantial financial investment in new or dedicated staff or infrastructure.

  6. Morbidity registration and the fourth general practice morbidity survey in England and Wales.

    PubMed

    Fleming, D M

    1993-01-01

    The fourth morbidity survey in England and Wales is based on a population of 473,000 persons registered in 60 practices and cared for by 241 general practitioners. This presentation traces the evolution of morbidity surveys in England and Wales. That evolution has taken place against a background of advancing computer technology and the drift towards a paperless record. It is motivated by an increasing recognition of the need for data from primary health care an a realisation that a structured record is capable of servicing information needs without intermediary data sheets and coding procedures. The primary objectives of the study include assessment of disease prevalence by region, age-sex and social group; and to study trends over time. Morbidity and social data are collected in the practices and all relevant information stored on practice computers. At the end of the recording year, the computerised record for each patient is copied on to disks in an anonymized but uniquely identified form and transferred to the national Office of Population Censuses & Surveys for analysis. During the year, weekly extracts are taken of new episodes of illness in age and sex groupings which provide the basis of the Weekly Returns Service of the Royal College of General Practitioners.

  7. Epidemiology of Sepsis and Its Recognition by Emergency Medical Services Personnel in the Netherlands.

    PubMed

    van der Wekken, Lena C W; Alam, Nadia; Holleman, Frits; van Exter, Pieternel; Kramer, Mark H H; Nanayakkara, Prabath W B

    2016-01-01

    Little is known about the epidemiology of sepsis in the Netherlands. In addition, information regarding the ability of emergency medical services (EMS) personnel to recognize sepsis is lacking. The aim of this study is to determine epidemiological characteristics of sepsis and the recognition of sepsis by EMS personnel in an urban area in the Netherlands. We conducted a retrospective cohort study using transport information from EMS Amsterdam and admission diagnoses at the emergency department gathered through discharge data from two academic hospitals in Amsterdam for the year 2012. A total of 253 patients with sepsis were evaluated, of which 131 were transported by ambulance. The in-hospital mortality rate of the total population was 21% and a mean length of hospital stay was of 13.5 days. Sixty-seven patients (26.5%) were admitted to the intensive care unit. Almost half of the patients were assigned to the internal medicine ward (117; 46.2%). The most common site of infection was the urinary tract (30%). E. coli was the most frequent cause of infections. EMS staff recognized 18/131 (13.7%) transported patients with (severe) sepsis or septic shock. In 52 cases (39.7%) sepsis went unrecognized, probably due to an incomplete primary survey. In 60 cases (45.8%) sepsis went unrecognized, although enough systemic inflammatory response syndrome criteria were present at initial presentation. Recognition of sepsis by EMS staff in the Netherlands is low, probably due to a lack of awareness of the syndrome and infrequent measurement of temperature and respiratory rate. As early initiation of treatment is crucial, the EMS staff, general practitioners, and other specialties could benefit from more education on this critical illness.

  8. Sepsis, parenteral vaccination and skin disinfection

    PubMed Central

    Cook, Ian F.

    2016-01-01

    ASBSTRACT Disinfection should be required for all skin penetrative procedures including parenteral administration of vaccines. This review analyses medically attended infectious events following parenteral vaccination in terms of their microbiological aetiology and pathogenesis. Like ‘clean’ surgical site infections, the major pathogens responsible for these events were Staphylococcal species, implicating endogenous con-tamination as a significant source of infection. As 70% isopropyl alcohol swabbing has been shown to effectively disinfect the skin, it would be medico-legally difficult to defend a case of sepsis with the omission of skin disinfection unless the very low risk of this event was adequately explained to the patient and documented prior to vaccination. There was a significant cost-benefit for skin disinfection and cellulitis. Skin disinfection in the context of parenteral vaccination represents a new paradigm of medical practice; the use of a low cost intervention to prevent an event of very low prevalence but of significant cost. PMID:27295449

  9. Diagnosing sepsis - The role of laboratory medicine.

    PubMed

    Fan, Shu-Ling; Miller, Nancy S; Lee, John; Remick, Daniel G

    2016-09-01

    Sepsis is the host response to microbial pathogens resulting in significant morbidity and mortality. An accurate and timely diagnosis of sepsis allows prompt and appropriate treatment. This review discusses laboratory testing for sepsis because differentiating systemic inflammation from infection is challenging. Procalcitonin (PCT) is currently an FDA approved test to aid in the diagnosis of sepsis but with questionable efficacy. However, studies support the use of PCT for antibiotic de-escalation. Serial lactate measurements have been recommended for monitoring treatment efficacy as part of sepsis bundles. The 2016 sepsis consensus definitions include lactate concentrations >2mmol/L (>18mg/dL) as part of the definition of septic shock. Also included in the 2016 definitions are measuring bilirubin and creatinine to determine progression of organ failure indicating worse prognosis. Hematologic parameters, including a simple white blood cell count and differential, are frequently part of the initial sepsis diagnostic protocols. Several new biomarkers have been proposed to diagnose sepsis or to predict mortality, but they currently lack sufficient sensitivity and specificity to be considered as stand-alone testing. If sepsis is suspected, new technologies and microbiologic assays allow rapid and specific identification of pathogens. In 2016 there is no single laboratory test that accurately diagnoses sepsis. PMID:27387712

  10. Thromboprophylaxis following cast immobilisation for lower limb injuries--survey of current practice in United Kingdom.

    PubMed

    Batra, Sameer; Kurup, Harish; Gul, Arif; Andrew, J G

    2006-09-01

    The risk of deep vein thrombosis (DVT) and pulmonary embolism (PE) is well documented in patients following cast immobilisation for injuries of lower extremities. There are no generally accepted approaches to preventing this complication and hence there remains substantial practice variation amongst surgeons regarding the use of anticoagulation measures. The present survey was conducted to investigate the current chemothromboprophylaxis practice among UK orthopaedic departments for patients immobilised with plasters for lower extremity injuries and establish any variations in practice. A telephone questionnaire survey was conducted on junior doctors (Senior House Officers and Registrars) in orthopaedic departments of 70 randomly selected hospitals in United Kingdom. This survey assessed the thromboprophylaxis practice for lower limb injuries in plaster casts. Our results show substantial variation amongst British orthopaedic surgeons in the use of chemothromboprophylaxis measures. Sixty-two percent of the departments do not use any DVT prophylaxis in this group of trauma. Furthermore, only 11.4% of the departments performed risk stratification on their patients. Ninety-nine percent of the respondents were unaware of any existing guidelines in this regard. Although the incidence of DVT in patients in plaster for lower extremity injuries is low compared to the Hip/Knee arthroplasty group, this is not insignificant. Both over and under treatment with thromboprophylaxis can have implications in terms of side effects and costs. One possible solution is to use risk stratification to identify individuals who are likely to benefit from prophylaxis. There is a substantial variation and inconsistency in practice among orthopaedic departments in United Kingdom due to a lack of clinical guidelines in this group of trauma and it remains underused even in high-risk group.

  11. The practice patterns of second trimester fetal ultrasonography: A questionnaire survey and an analysis of checklists

    PubMed Central

    Park, Hyun Soo; Hong, Joon Seok; Seol, Hyun-Joo; Hwang, Han Sung; Kim, Kunwoo; Ko, Hyun Sun; Kwak, Dong-Wook; Oh, Soo-young; Kim, Moon Young; Kim, Sa Jin

    2015-01-01

    Objective To analyze practice patterns and checklists of second trimester ultrasonography, and to investigate management plans when soft markers are detected among Korean Society of Ultrasound in Obstetrics and Gynecology (KSUOG) members. Methods An internet-based self-administered questionnaire survey was designed. KSUOG members were invited to the survey. Checklists of the second trimester ultrasonography were also requested. In the questionnaire survey, general practice patterns of the second trimester ultrasonography and management schemes of soft markers were asked. In the checklists analysis, the number of items were counted and also compared with those recommended by other medical societies. Results A total of 101 members responded. Eighty-seven percent routinely recommended second trimester fetal anatomic surveillance. Most (91.1%) performed it between 20+0 and 23+6 weeks of gestation. Written informed consents were given by 15.8% of respondents. Nearly 60% recommended genetic counseling when multiple soft markers and/or advanced maternal age were found. Similar tendencies were found in the managements of individual soft markers. However, practice patterns were very diverse and sometimes conflicting. Forty-eight checklists were analyzed in context with the number and content of the items. The median item number was 46.5 (range, 17 to 109). Of 49 items of checklists recommended by International Society of Ultrasound in Obstetrics and Gynecology and/or American Congress of Obstetricians and Gynecologists, 14 items (28.6%) were found in less than 50% of the checklists analyzed in this study. Conclusion Although general practice patterns were similar among KSUOG members, some of which were conflicting, and there is a need for standardization of the practice patterns and checklists of second trimester ultrasonography, which also have very wide range of spectrum. PMID:26623407

  12. Survey of current practice in clinical transvaginal ultrasound scanning in the UK.

    PubMed

    Martin, Eleanor; Shaw, Adam; Lees, Christoph

    2015-08-01

    During transvaginal ultrasound scanning, the fetus and other sensitive tissues are placed close to the transducer. Heating of these tissues occurs by direct conduction from the transducer and by absorption of ultrasound in the tissue. The extent of any heating will depend on the equipment and settings used, the duration of the scan, imaging modes and other aspects of scanning practice. To ensure that scans are performed with minimum risk, staff should have an appropriate knowledge of safety and follow guidelines issued by professional bodies. An online survey aiming to document current practice in transvaginal ultrasound in the UK was created and distributed to individuals performing this type of scanning. The survey posed questions about the respondents, the departments where scans were performed, the equipment used, knowledge of ultrasound safety, scanning practice and the frequency, duration and mode of transvaginal ultrasound scans for gynaecology, obstetrics and fertility applications. In all, 294 responses were obtained, mostly from sonographers (94%). From the analysis of the responses, it was clear that there was a good understanding of the general meaning of thermal and mechanical index and high awareness of guidelines issued by professional bodies. However, 40% of respondents stated that they rarely or never monitor Thermal or Mechanical indices during scanning. Scanning practice was consistent in terms of the duration of scans, scan protocols followed and use of imaging modes. The results highlight the importance of continued ultrasound safety training and promotion of safety guidelines to users.

  13. Knowledge, Attitude and Practice toward Infant Oral Healthcare among the Pediatricians of Mysore: A Questionnaire Survey

    PubMed Central

    Indira, MD; Nandlal, B

    2015-01-01

    ABSTRACT Background: The aim of this study was to study the knowledge, attitude and practice of the pediatricians toward infant oral healthcare and the objective was to determine what can improve the knowledge, attitude and practice toward infant oral healthcare. Materials and methods: A systematic random survey of pediatricians in Mysore received a questionnaire pertaining to individual details, knowledge level and approach toward infant oral healthcare. Results: Most of pediatricians acknowledged the importance of pediatric dentistry. Pediatricians agree that it is important to do dental examination before 1 year. The importance of initiating oral hygiene practice before the eruption of first tooth was not seen to be prevalent among the pediatricians. Most of them were less aware of the first dental visit including early childhood caries (ECC). All pediatricians agree that both medical and dental professionals together are responsible for infant oral healthcare. They should work together to appropriately educate and train themselves to be able to provide risk assessment and to provide preventive oral health services. How to cite this article: Indira MD, Dhull KS, Nandlal B. Knowledge, Attitude and Practice toward Infant Oral Healthcare among the Pediatricians of Mysore: A Questionnaire Survey. Int J Clin Pediatr Dent 2015;8(3):211-214. PMID:26604540

  14. What clinicians want: findings from a psychotherapy practice research network survey.

    PubMed

    Tasca, Giorgio A; Sylvestre, John; Balfour, Louise; Chyurlia, Livia; Evans, Jane; Fortin-Langelier, Benjamin; Francis, Kylie; Gandhi, Jasmine; Huehn, Linda; Hunsley, John; Joyce, Anthony S; Kinley, Jackie; Koszycki, Diana; Leszcz, Molyn; Lybanon-Daigle, Vanessa; Mercer, Deanna; Ogrodniczuk, John S; Presniak, Michelle; Ravitz, Paula; Ritchie, Kerri; Talbot, Jeanne; Wilson, Brian

    2015-03-01

    Practice research networks may be one way of advancing knowledge translation and exchange (KTE) in psychotherapy. In this study, we document this process by first asking clinicians what they want from psychotherapy research. Eighty-two psychotherapists in 10 focus groups identified and discussed psychotherapy research topics relevant to their practices. An analysis of these discussions led to the development of 41 survey items. In an online survey, 1,019 participants, mostly practicing clinicians, rated the importance to their clinical work of these 41 psychotherapy research topics. Ratings were reduced using a principal components analysis in which 9 psychotherapy research themes emerged, accounting for 60.66% of the variance. Two postsurvey focus groups of clinicians (N = 22) aided in interpreting the findings. The ranking of research themes from most to least important were-Therapeutic Relationship/Mechanisms of Change, Therapist Factors, Training and Professional Development, Client Factors, Barriers and Stigma, Technology and Adjunctive Interventions, Progress Monitoring, Matching Clients to Therapist or Therapy, and Treatment Manuals. Few differences were noted in rankings based on participant age or primary therapeutic orientation. Postsurvey focus group participants were not surprised by the top-rated items, as they were considered most proximal and relevant to therapists and their work with clients during therapy sessions. Lower ranked items may be perceived as externally imposed agendas on the therapist and therapy. We discuss practice research networks as a means of creating new collaborations consistent with KTE goals. Findings of this study can help to direct practitioner-researcher collaborations.

  15. Songs composed for use in music therapy: a survey of original songwriting practices of music therapists.

    PubMed

    Jones, Jennifer D

    2006-01-01

    While researchers have documented the efficacy of clinical songwriting in music therapy, limited research has been conducted on songs composed by music therapists that address clinical goals. The purpose of this research was to examine the original songwriting practices of music therapists. Professional music therapists (N = 1,364) received a 14-question survey via email asking each to identify client populations and clinical goals addressed by original songs, their length of time in clinical practice, and specifics about their acquisition of songwriting skills. The data collected from 302 completed surveys revealed that respondents who used original songs were most likely to work with children and adolescents in schools or the developmental disability field and wrote songs in order to individualize treatment. Music therapists working with persons over 65 years of age in long term care or assisted living programs were the least likely to use original songs in clinical practice, opting for interventions utilizing the client's familiar music. Most music therapists found songwriting generally easy, but only 37% indicated that they acquired this skill during their undergraduate degree. Additional research on the clinical efficacy of original songs and therapist's compositional processes is needed to identify best practices models for strategic songwriting.

  16. Disseminated intravascular coagulation in sepsis.

    PubMed

    Zeerleder, Sacha; Hack, C Erik; Wuillemin, Walter A

    2005-10-01

    Disseminated intravascular coagulation is a frequent complication of sepsis. Coagulation activation, inhibition of fibrinolysis, and consumption of coagulation inhibitors lead to a procoagulant state resulting in inadequate fibrin removal and fibrin deposition in the microvasculature. As a consequence, microvascular thrombosis contributes to promotion of organ dysfunction. Recently, three randomized, double-blind, placebo-controlled trials investigated the efficacy of antithrombin, activated protein C (APC), and tissue factor pathway inhibitor, respectively, in sepsis patients. A significant reduction in mortality was demonstrated in the APC trial. In this article, we first discuss the physiology of coagulation and fibrinolysis activation. Then, the pathophysiology of coagulation activation, consumption of coagulation inhibitors, and the inhibition of fibrinolysis leading to a procoagulant state are described in more detail. Moreover, therapeutic concepts as well as the three randomized, double-blind, placebo-controlled studies are discussed.

  17. Survey of management practices related to bovine respiratory disease in preweaned calves on California dairies.

    PubMed

    Love, W J; Lehenbauer, T W; Karle, B M; Hulbert, Lindsey E; Anderson, Randall J; Van Eenennaam, A L; Farver, T B; Aly, S S

    2016-02-01

    In the spring of 2013, a survey of California (CA) dairies was performed to characterize management practices related to bovine respiratory disease in preweaned calves, compare these practices across geographic regions of the state, and determine the principal components that explain the variability in management between herds. The questionnaire consisted of 53 questions divided into 6 sections to assess management practices affecting dairy calves from precalving to weaning. The questionnaire was mailed to 1,523 grade A licensed dairies in CA and 224 responses (14.7%) were collected. Survey response rates were similar over the 3 defined regions of CA: northern CA, northern San Joaquin Valley, and the greater southern CA region. The mean size of respondent herds was 1,423 milking cows. Most dairies reported raising preweaned calves on-site (59.7%). In 93.3% of dairies, preweaned calves were raised in some form of individual housing. Nonsaleable milk was the most frequent liquid diet fed to preweaned heifers (75.2%). Several important differences were identified between calf-raising practices in CA and practices reported in recent nationwide studies, including herd sizes, housing practices, and sources of milk fed to heifers. The differences between the CA and nationwide studies may be explained by differences in herd size. Regional differences within CA were also identified. Compared with the 2 other regions, northern CA dairies were found to have smaller herds, less Holstein cattle, calves remained with dams for longer periods of time after calving, were more likely to be certified organic dairies, and raised their own calves more often. Principal component analysis was performed and identified 11 components composed of 28 variables (questions) that explained 66.5% of the variability in the data. The identified components and questions will contribute to developing a risk assessment tool for bovine respiratory disease in preweaned dairy calves.

  18. Survey of management practices related to bovine respiratory disease in preweaned calves on California dairies.

    PubMed

    Love, W J; Lehenbauer, T W; Karle, B M; Hulbert, Lindsey E; Anderson, Randall J; Van Eenennaam, A L; Farver, T B; Aly, S S

    2016-02-01

    In the spring of 2013, a survey of California (CA) dairies was performed to characterize management practices related to bovine respiratory disease in preweaned calves, compare these practices across geographic regions of the state, and determine the principal components that explain the variability in management between herds. The questionnaire consisted of 53 questions divided into 6 sections to assess management practices affecting dairy calves from precalving to weaning. The questionnaire was mailed to 1,523 grade A licensed dairies in CA and 224 responses (14.7%) were collected. Survey response rates were similar over the 3 defined regions of CA: northern CA, northern San Joaquin Valley, and the greater southern CA region. The mean size of respondent herds was 1,423 milking cows. Most dairies reported raising preweaned calves on-site (59.7%). In 93.3% of dairies, preweaned calves were raised in some form of individual housing. Nonsaleable milk was the most frequent liquid diet fed to preweaned heifers (75.2%). Several important differences were identified between calf-raising practices in CA and practices reported in recent nationwide studies, including herd sizes, housing practices, and sources of milk fed to heifers. The differences between the CA and nationwide studies may be explained by differences in herd size. Regional differences within CA were also identified. Compared with the 2 other regions, northern CA dairies were found to have smaller herds, less Holstein cattle, calves remained with dams for longer periods of time after calving, were more likely to be certified organic dairies, and raised their own calves more often. Principal component analysis was performed and identified 11 components composed of 28 variables (questions) that explained 66.5% of the variability in the data. The identified components and questions will contribute to developing a risk assessment tool for bovine respiratory disease in preweaned dairy calves. PMID:26709177

  19. Making the journey safe: recognising and responding to severe sepsis in accident and emergency

    PubMed Central

    Pinnington, Sarah; Atterton, Brigid; Ingleby, Sarah

    2016-01-01

    Severe sepsis is a clinical emergency. Despite the nationwide recognition of the sepsis six treatment bundle as the first line emergency treatment for this presentation, compliance in sepsis six provision remains inadequately low. The project goals were to improve compliance with the implementation of the Sepsis Six in patients with severe sepsis and/or septic shock. In improving timely care delivery it was anticipated improvements would be made in relation to patient safety and experience, and reductions in length of stay (LoS) and mortality. The project intended to make the pathway for those presenting with sepsis safe and consistent, where sepsis is recognised and treated in a timely manner according to best practice. The aim of the project was to understand the what the barriers where to providing safe effective care for the patient presenting with severe sepsis in A&E. Using the Safer Clinical Systems (SCS) tools developed byte Health Foundation and Warwick University, the project team identified the hazards and associated risks in the septic patient pathway. The level of analysis employed enabled the project team to identify the major risks, themes, and factors of influence within this pathway. The analysis identified twenty nine possible interventions, of which six were chosen following option appraisal. Further interventions were recommended to the accident and emergency as part of a business case and further changes in process. Audits identified all severely septic patients presenting to A&E in October 2014 (n=67) and post intervention in September 2015 (n=93). Compared analysis demonstrated an increase in compliance with the implementation of the sepsis six care bundle from 7% to 41%, a reduction in LoS by 1.9 days and a decrease in 30 day mortality by 50%. Additional audit reviewed the management of 10 septic patients per week for the duration of the project to assess the real time impact of the selected interventions. PMID:27752314

  20. Sepsis: Medical errors in Poland.

    PubMed

    Rorat, Marta; Jurek, Tomasz

    2016-01-01

    Health, safety and medical errors are currently the subject of worldwide discussion. The authors analysed medico-legal opinions trying to determine types of medical errors and their impact on the course of sepsis. The authors carried out a retrospective analysis of 66 medico-legal opinions issued by the Wroclaw Department of Forensic Medicine between 2004 and 2013 (at the request of the prosecutor or court) in cases examined for medical errors. Medical errors were confirmed in 55 of the 66 medico-legal opinions. The age of victims varied from 2 weeks to 68 years; 49 patients died. The analysis revealed medical errors committed by 113 health-care workers: 98 physicians, 8 nurses and 8 emergency medical dispatchers. In 33 cases, an error was made before hospitalisation. Hospital errors occurred in 35 victims. Diagnostic errors were discovered in 50 patients, including 46 cases of sepsis being incorrectly recognised and insufficient diagnoses in 37 cases. Therapeutic errors occurred in 37 victims, organisational errors in 9 and technical errors in 2. In addition to sepsis, 8 patients also had a severe concomitant disease and 8 had a chronic disease. In 45 cases, the authors observed glaring errors, which could incur criminal liability. There is an urgent need to introduce a system for reporting and analysing medical errors in Poland. The development and popularisation of standards for identifying and treating sepsis across basic medical professions is essential to improve patient safety and survival rates. Procedures should be introduced to prevent health-care workers from administering incorrect treatment in cases.

  1. Anesthetic practices for patients with preeclampsia or HELLP syndrome: A survey

    PubMed Central

    Başaran, Betül; Çelebioğlu, Bilge; Başaran, Ahmet; Altınel, Seher; Kutlucan, Leyla; Martin, James N.

    2016-01-01

    Objective Substantial controversy exists regarding anesthetic management for patients with preeclampsia or hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome. Experts, researchers, clinicians, and residents in Turkey were surveyed about their practices. Material and Methods Questionnaires were distributed to attendees at a national conference, and they were filled out immediately. Anonymous 10-item paper surveys were administered to both residents and non-residents. Descriptive statistics were used in the analysis. Agreement among ≥75% of the respondents was considered a majority opinion. Surveys with missing responses were used to analyze the non-response bias. The Chi-square test was used for comparisons. A historical cohort of obstetricians–gynecologists was used for comparison with anesthesiologists. Results Of 339 surveys distributed, 288 were returned (84.9% response rate). Among the returned surveys, the completion rate was 96.1%. The job experience in years among clinicians and residents was 9±5 and 3±1, respectively. General anesthesia was still significantly preferred by 36.1% among patients with preeclampsia with platelet counts of ≥100,000/μL. Compared to obstetricians–gynecologists, anesthesiologists more often preferred general anesthesia. With platelet counts of <50,000/μL or eclampsia, most respondents preferred general anesthesia 94.4% for very low platelets and 89.5% for eclampsia. Conclusion A preferential trend toward general anesthesia for patients with preeclampsia or HELLP syndrome exists among anesthesiologists in Turkey, particularly for patients with severe thrombocytopenia and/or eclampsia. There exists a need for well-designed and well-executed prospective clinical trials to provide evidence for the best consensus practice.

  2. Trisomy 18: A survey of opinions, attitudes, and practices of neonatologists.

    PubMed

    Jacobs, Adam P; Subramaniam, Akila; Tang, Ying; Philips, Joseph B; Biggio, Joseph R; Edwards, Rodney K; Robin, Nathaniel H

    2016-10-01

    We conducted a survey-based study of the opinions, attitudes, and management practices of neonatologists across the United States regarding prenatally diagnosed Trisomy 18. The survey was designed based on previously validated surveys of severe fetal anomalies and collected demographic information on participants, as well as their attitudes, and management choices given a series of vignettes beginning in the prenatal period. The survey was sent to 3,143 American Academy of Pediatrics Section on Neonatal-Perinatal Medicine members of which 409 (13%) completed the survey. While the response rate was rather low, our respondent pool was representative of the national neonatologist population. Respondents were predominately white (81%), married (88%), Christian (54%), had children (86%), and were pro-choice in terms of abortion (68%). Eighty-three percent (83%) of respondents thought that trisomy 18 is a lethal condition and 60% thought that treatment is futile. Seventy-five percent (75%) expected that the best neurodevelopmental outcome in the case of infant survival would be profound intellectual disability. Regarding neonatal care, 95% stated that they would recommend palliative care only. Ninety-five percent (95%) would never recommend or recommend only if asked full code resuscitation for a neonate with full trisomy 18, yet, 44% would comply partially or in full with a full code request for resuscitation measures. The demographic features that correlated most significantly with these responses were clinician race and years in practice. The attitudes toward and management of infants affected with trisomy 18 seem to be largely driven by parental attitudes and wishes. © 2016 Wiley Periodicals, Inc.

  3. Anesthetic practices for patients with preeclampsia or HELLP syndrome: A survey

    PubMed Central

    Başaran, Betül; Çelebioğlu, Bilge; Başaran, Ahmet; Altınel, Seher; Kutlucan, Leyla; Martin, James N.

    2016-01-01

    Objective Substantial controversy exists regarding anesthetic management for patients with preeclampsia or hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome. Experts, researchers, clinicians, and residents in Turkey were surveyed about their practices. Material and Methods Questionnaires were distributed to attendees at a national conference, and they were filled out immediately. Anonymous 10-item paper surveys were administered to both residents and non-residents. Descriptive statistics were used in the analysis. Agreement among ≥75% of the respondents was considered a majority opinion. Surveys with missing responses were used to analyze the non-response bias. The Chi-square test was used for comparisons. A historical cohort of obstetricians–gynecologists was used for comparison with anesthesiologists. Results Of 339 surveys distributed, 288 were returned (84.9% response rate). Among the returned surveys, the completion rate was 96.1%. The job experience in years among clinicians and residents was 9±5 and 3±1, respectively. General anesthesia was still significantly preferred by 36.1% among patients with preeclampsia with platelet counts of ≥100,000/μL. Compared to obstetricians–gynecologists, anesthesiologists more often preferred general anesthesia. With platelet counts of <50,000/μL or eclampsia, most respondents preferred general anesthesia 94.4% for very low platelets and 89.5% for eclampsia. Conclusion A preferential trend toward general anesthesia for patients with preeclampsia or HELLP syndrome exists among anesthesiologists in Turkey, particularly for patients with severe thrombocytopenia and/or eclampsia. There exists a need for well-designed and well-executed prospective clinical trials to provide evidence for the best consensus practice. PMID:27651719

  4. Trisomy 18: A survey of opinions, attitudes, and practices of neonatologists.

    PubMed

    Jacobs, Adam P; Subramaniam, Akila; Tang, Ying; Philips, Joseph B; Biggio, Joseph R; Edwards, Rodney K; Robin, Nathaniel H

    2016-10-01

    We conducted a survey-based study of the opinions, attitudes, and management practices of neonatologists across the United States regarding prenatally diagnosed Trisomy 18. The survey was designed based on previously validated surveys of severe fetal anomalies and collected demographic information on participants, as well as their attitudes, and management choices given a series of vignettes beginning in the prenatal period. The survey was sent to 3,143 American Academy of Pediatrics Section on Neonatal-Perinatal Medicine members of which 409 (13%) completed the survey. While the response rate was rather low, our respondent pool was representative of the national neonatologist population. Respondents were predominately white (81%), married (88%), Christian (54%), had children (86%), and were pro-choice in terms of abortion (68%). Eighty-three percent (83%) of respondents thought that trisomy 18 is a lethal condition and 60% thought that treatment is futile. Seventy-five percent (75%) expected that the best neurodevelopmental outcome in the case of infant survival would be profound intellectual disability. Regarding neonatal care, 95% stated that they would recommend palliative care only. Ninety-five percent (95%) would never recommend or recommend only if asked full code resuscitation for a neonate with full trisomy 18, yet, 44% would comply partially or in full with a full code request for resuscitation measures. The demographic features that correlated most significantly with these responses were clinician race and years in practice. The attitudes toward and management of infants affected with trisomy 18 seem to be largely driven by parental attitudes and wishes. © 2016 Wiley Periodicals, Inc. PMID:27312333

  5. Early-Onset Neonatal Sepsis

    PubMed Central

    Simonsen, Kari A.; Anderson-Berry, Ann L.; Delair, Shirley F.

    2014-01-01

    SUMMARY Early-onset sepsis remains a common and serious problem for neonates, especially preterm infants. Group B streptococcus (GBS) is the most common etiologic agent, while Escherichia coli is the most common cause of mortality. Current efforts toward maternal intrapartum antimicrobial prophylaxis have significantly reduced the rates of GBS disease but have been associated with increased rates of Gram-negative infections, especially among very-low-birth-weight infants. The diagnosis of neonatal sepsis is based on a combination of clinical presentation; the use of nonspecific markers, including C-reactive protein and procalcitonin (where available); blood cultures; and the use of molecular methods, including PCR. Cytokines, including interleukin 6 (IL-6), interleukin 8 (IL-8), gamma interferon (IFN-γ), and tumor necrosis factor alpha (TNF-α), and cell surface antigens, including soluble intercellular adhesion molecule (sICAM) and CD64, are also being increasingly examined for use as nonspecific screening measures for neonatal sepsis. Viruses, in particular enteroviruses, parechoviruses, and herpes simplex virus (HSV), should be considered in the differential diagnosis. Empirical treatment should be based on local patterns of antimicrobial resistance but typically consists of the use of ampicillin and gentamicin, or ampicillin and cefotaxime if meningitis is suspected, until the etiologic agent has been identified. Current research is focused primarily on development of vaccines against GBS. PMID:24396135

  6. Biosensor of endotoxin and sepsis

    NASA Astrophysics Data System (ADS)

    Shao, Yang; Wang, Xiang; Wu, Xi; Gao, Wei; He, Qing-hua; Cai, Shaoxi

    2001-09-01

    To investigate the relation between biosensor of endotoxin and endotoxin of plasma in sepsis. Method: biosensor of endotoxin was designed with technology of quartz crystal microbalance bioaffinity sensor ligand of endotoxin were immobilized by protein A conjugate. When a sample soliton of plasma containing endotoxin 0.01, 0.03, 0.06, 0.1, 0.5, 1.0Eu, treated with perchloric acid and injected into slot of quartz crystal surface respectively, the ligand was released from the surface of quartz crystal to form a more stable complex with endotoxin in solution. The endotoxin concentration corresponded to the weight change on the crystal surface, and caused change of frequency that occurred when desorbed. The result was biosensor of endotoxin might detect endotoxin of plasma in sepsis, measurements range between 0.05Eu and 0.5Eu in the stop flow mode, measurement range between 0.1Eu and 1Eu in the flow mode. The sensor of endotoxin could detect the endotoxin of plasm rapidly, and use for detection sepsis in clinically.

  7. Early-onset neonatal sepsis.

    PubMed

    Simonsen, Kari A; Anderson-Berry, Ann L; Delair, Shirley F; Davies, H Dele

    2014-01-01

    Early-onset sepsis remains a common and serious problem for neonates, especially preterm infants. Group B streptococcus (GBS) is the most common etiologic agent, while Escherichia coli is the most common cause of mortality. Current efforts toward maternal intrapartum antimicrobial prophylaxis have significantly reduced the rates of GBS disease but have been associated with increased rates of Gram-negative infections, especially among very-low-birth-weight infants. The diagnosis of neonatal sepsis is based on a combination of clinical presentation; the use of nonspecific markers, including C-reactive protein and procalcitonin (where available); blood cultures; and the use of molecular methods, including PCR. Cytokines, including interleukin 6 (IL-6), interleukin 8 (IL-8), gamma interferon (IFN-γ), and tumor necrosis factor alpha (TNF-α), and cell surface antigens, including soluble intercellular adhesion molecule (sICAM) and CD64, are also being increasingly examined for use as nonspecific screening measures for neonatal sepsis. Viruses, in particular enteroviruses, parechoviruses, and herpes simplex virus (HSV), should be considered in the differential diagnosis. Empirical treatment should be based on local patterns of antimicrobial resistance but typically consists of the use of ampicillin and gentamicin, or ampicillin and cefotaxime if meningitis is suspected, until the etiologic agent has been identified. Current research is focused primarily on development of vaccines against GBS.

  8. Sepsis: From Bench to Bedside

    PubMed Central

    Silva, Eliézer; Passos, Rogério Da Hora; Ferri, Maurício Beller; de Figueiredo, Luiz Francisco Poli

    2008-01-01

    Sepsis is a syndrome related to severe infections. It is defined as the systemic host response to microorganisms in previously sterile tissues and is characterized by end-organ dysfunction away from the primary site of infection. The normal host response to infection is complex and aims to identify and control pathogen invasion, as well as to start immediate tissue repair. Both the cellular and humoral immune systems are activated, giving rise to both anti-inflammatory and proinflammatory responses. The chain of events that leads to sepsis is derived from the exacerbation of these mechanisms, promoting massive liberation of mediators and the progression of multiple organ dysfunction. Despite increasing knowledge about the pathophysiological pathways and processes involved in sepsis, morbidity and mortality remain unacceptably high. A large number of immunomodulatory agents have been studied in experimental and clinical settings in an attempt to find an efficacious anti-inflammatory drug that reduces mortality. Even though preclinical results had been promising, the vast majority of these trials actually showed little success in reducing the overwhelmingly high mortality rate of septic shock patients as compared with that of other critically ill intensive care unit patients. Clinical management usually begins with prompt recognition, determination of the probable infection site, early administration of antibiotics, and resuscitation protocols based on “early-goal” directed therapy. In this review, we address the research efforts that have been targeting risk factor identification, including genetics, pathophysiological mechanisms and strategies to recognize and treat these patients as early as possible. PMID:18297215

  9. [Wisconsin Administrative Practice Scale: Special Education. A Survey of Selected Administrative Practices Used in the Coordination of Diagnostic Units for Handicapped Children. Test and Manual.].

    ERIC Educational Resources Information Center

    Lietz, Jeremy Jon

    The Wisconsin Administrative Practice Scale: Special Education (WAPS) is a self-administering survey instrument designed to measure implementation of 162 selected administrative practices and policies used to coordinate diagnostic units for handicapped children. One hundred thirty-five items are grouped into seven subscales each consisting of…

  10. Rational development of guidelines for management of neonatal sepsis in developing countries

    PubMed Central

    Seale, Anna C; Obiero, Christina W; Berkley, James A

    2015-01-01

    Purpose of review This review discusses the rational development of guidelines for the management of neonatal sepsis in developing countries. Recent findings Diagnosis of neonatal sepsis with high specificity remains challenging in developing countries. Aetiology data, particularly from rural, community based studies are very limited, but molecular tests to improve diagnostics are being tested in a community-based study in South Asia. Antibiotic susceptibility data are limited, but suggest reducing susceptibility to first and second line antibiotics in both hospital and community acquired neonatal sepsis. Results of clinical trials in South Asia and sub-Saharan Africa assessing feasibility of simplified antibiotic regimens are awaited. Summary Effective management of neonatal sepsis in developing countries is essential to reduce neonatal mortality and morbidity. Simplified antibiotic regimens are currently being examined in clinical trials, but reduced antimicrobial susceptibility threatens current empiric treatment strategies. Improved clinical and microbiological surveillance is essential, to inform current practice, treatment guidelines, and monitor implementation of policy changes. PMID:25887615

  11. Autoregressive hidden Markov models for the early detection of neonatal sepsis.

    PubMed

    Stanculescu, Ioan; Williams, Christopher K I; Freer, Yvonne

    2014-09-01

    Late onset neonatal sepsis is one of the major clinical concerns when premature babies receive intensive care. Current practice relies on slow laboratory testing of blood cultures for diagnosis. A valuable research question is whether sepsis can be reliably detected before the blood sample is taken. This paper investigates the extent to which physiological events observed in the patient's monitoring traces could be used for the early detection of neonatal sepsis. We model the distribution of these events with an autoregressive hidden Markov model (AR-HMM). Both learning and inference carefully use domain knowledge to extract the baby's true physiology from the monitoring data. Our model can produce real-time predictions about the onset of the infection and also handles missing data. We evaluate the effectiveness of the AR-HMM for sepsis detection on a dataset collected from the Neonatal Intensive Care Unit at the Royal Infirmary of Edinburgh.

  12. Inquiry-based instruction in secondary science classrooms: A survey of teacher practice

    NASA Astrophysics Data System (ADS)

    Gejda, Linda Muggeo

    The purpose of this quantitative investigation was to describe the extent to which secondary science teachers, who were certified through Connecticut's BEST portfolio assessment process between 1997 and 2004 and had taught secondary science during the past academic year, reported practicing the indicators of inquiry-based instruction in the classroom and the factors that they perceived facilitated, obstructed, or informed that practice. Indicators of inquiry-based instruction were derived from the Biological Sciences Curriculum Study (BSCS) 5E model (Bybee, 1997). The method for data collection was a researcher-developed, self-report, questionnaire entitled "Inquiry-based Instruction in Secondary Science Classrooms: A Survey", which was developed and disseminated using a slightly modified Dillman (2000) approach. Almost all of the study participants reported practicing the 5Es (engage, explore, explain, elaborate, and evaluate) of inquiry-based instruction in their secondary science classrooms. Time, resources, the need to cover material for mandatory assessments, the science topics or concepts being taught, and professional development on inquiry-based instruction were reported to be important considerations in participants' decisions to practice inquiry-based instruction in their science classrooms. A majority of the secondary science teachers participating in this study indicated they had the time, access to resources and the professional development opportunities they needed to practice inquiry-based instruction in their secondary classrooms. Study participants ranked having the time to teach in an inquiry-based fashion and the need to cover material for mandated testing as the biggest obstacles to their practice of inquiry-based instruction in the secondary classroom. Classroom experience and collegial exchange informed the inquiry-based instruction practice of the secondary science teachers who participated in this study. Recommendations for further research

  13. International survey for good practices in forecasting uncertainty assessment and communication

    NASA Astrophysics Data System (ADS)

    Berthet, Lionel; Piotte, Olivier

    2014-05-01

    Achieving technically sound flood forecasts is a crucial objective for forecasters but remains of poor use if the users do not understand properly their significance and do not use it properly in decision making. One usual way to precise the forecasts limitations is to communicate some information about their uncertainty. Uncertainty assessment and communication to stakeholders are thus important issues for operational flood forecasting services (FFS) but remain open fields for research. French FFS wants to publish graphical streamflow and level forecasts along with uncertainty assessment in near future on its website (available to the greater public). In order to choose the technical options best adapted to its operational context, it carried out a survey among more than 15 fellow institutions. Most of these are providing forecasts and warnings to civil protection officers while some were mostly working for hydroelectricity suppliers. A questionnaire has been prepared in order to standardize the analysis of the practices of the surveyed institutions. The survey was conducted by gathering information from technical reports or from the scientific literature, as well as 'interviews' driven by phone, email discussions or meetings. The questionnaire helped in the exploration of practices in uncertainty assessment, evaluation and communication. Attention was paid to the particular context within which every insitution works, in the analysis drawn from raw results. Results show that most services interviewed assess their forecasts uncertainty. However, practices can differ significantly from a country to another. Popular techniques are ensemble approaches. They allow to take into account several uncertainty sources. Statistical past forecasts analysis (such as the quantile regressions) are also commonly used. Contrary to what was expected, only few services emphasize the role of the forecaster (subjective assessment). Similar contrasts can be observed in uncertainty

  14. Sport Concussion Knowledge and Clinical Practices: A Survey of Doctors of Chiropractic With Sports Certification

    PubMed Central

    Moreau, William J.; Nabhan, Dustin C.; Walden, Taylor

    2015-01-01

    Objective The purpose of this study is to describe the knowledge base and clinical practices regarding concussion by sports-certified doctors of chiropractic. Methods A 21-item survey was distributed to the 312 attendees of the 2014 American Chiropractic Board of Sports Physicians Sports Sciences Symposium. Results were measured by frequency analysis and descriptive statistics for all surveys completed by sports-certified chiropractors. Results Seventy-six surveys were returned by sports-certified doctors of chiropractic. All (N = 76) 100% of respondents believe that the evaluation of concussion should be performed by a health care provider with training in concussion. The respondents actively assess and manage concussion in adults (96%), adolescents (95%), and children (75%). A majority (79%) of respondents believe that the Sideline Concussion Assessment Tool–3 represents a current standard of care for the sideline evaluation of the athlete who possibly has sustained a sport concussion. Most respondents agreed or strongly agreed that manual therapies may be appropriate in certain circumstances in adults (80%) and minors (80%). Conclusion This cross section of certified sports chiropractors strongly believes that the evaluation of concussion should be performed by a health care provider with specific training in concussion. A high percentage of the sports-certified chiropractors who responded assess and manage sport concussion in their practice, and many of them endorse the use of the Sideline Concussion Assessment Tool–3 as a sideline assessment tool. PMID:26778930

  15. A survey of educator needs to support the implementation of the intrinsic ANZCA Roles in Practice.

    PubMed

    Bunbury, K M; Castanelli, D J

    2015-11-01

    The 'Roles in Practice' framework was introduced into the revised ANZCA curriculum in 2013. We conducted an online survey of Supervisors of Training in Australia and New Zealand to assess understanding of this framework, and teaching and perceived value of the non-scholar intrinsic roles within the framework. One hundred and forty-three survey responses were received (response rate 60.8%). The majority of respondents (52.1%) reported only a fair understanding of the framework. Formal teaching of all the roles was consistently reported as infrequent, with most teaching occurring through the informal curriculum. The Communicator, Collaborator and Professional Roles were rated as better taught and more important to teach than the roles of Health Advocate and Manager. The Communicator Role was perceived as being the role for which the development of resources would be most valuable. Respondents overwhelmingly nominated small group teaching as the preferred medium for resource development of all intrinsic roles. Our survey indicates that there is a need to increase both the understanding of the Roles in Practice framework and the teaching resources available in the ANZCA Supervisor of Training community. PMID:26603803

  16. Prevention of neonatal group B streptococcal sepsis: is routine antenatal screening appropriate.

    PubMed

    Gilbert, G L; Isaacs, D; Burgess, M A; Garland, S M; Grimwood, K; Hogg, G G; McIntyre, P

    1995-05-01

    Four strategies for prevention of early onset neonatal group B streptococcal (GBS) sepsis were considered: A: routine antenatal screening for GBS vaginal carriage at 26-28 weeks' gestation and intrapartum antibiotic prophylaxis for all carriers; B: screening as above and prophylaxis only for carriers with risk factors for sepsis; C: prophylaxis for all women with risk factors; D: as for C plus screening at 37 weeks' gestation and prophylaxis for carriers. The outcomes considered for each option were: the proportion of women given prophylaxis; the risk of anaphylaxis; cases of neonatal GBS sepsis and deaths prevented; costs of screening, prophylaxis and of acute care of remaining cases. Published local and overseas studies of neonatal GBS sepsis, effectiveness of antenatal screening and prophylaxis and estimated costs were evaluated. Any of the proposed strategies can prevent a significant proportion of cases of neonatal GBS sepsis and a strategy for prevention of neonatal group B streptococcal sepsis should be part of routine obstetric practice. Strategy C is simple, effective, inexpensive and avoids unnecessary antibiotic use; it is recommended particularly when antenatal care is provided mainly in community or private practice. Strategy A (using vaginal and rectal swabs for screening) could prevent more cases, but at greater cost which could be justified only if protocols can be properly implemented and monitored.

  17. Sepsis management in the deployed field hospital.

    PubMed

    Johnston, Andrew McD; Easby, D; Ewington, I

    2013-09-01

    Sepsis, a syndrome caused by severe infection, affects a small proportion of military casualties but has a significant effect in increasing morbidity and mortality, including causing some preventable deaths. Casualties with abdominal trauma and those with significant tissue loss appear to be at a greater risk of sepsis. In this article, the diagnosis and management of sepsis in military casualties with reference to the Surviving Sepsis Campaign guidelines are examined. We discuss the management considerations specific to military casualties in the deployed setting and also discuss factors affecting evacuation by the UK Royal Air Force Critical Care Air Support Team. PMID:24109139

  18. Autophagy in sepsis: Degradation into exhaustion?

    PubMed

    Ho, Jeffery; Yu, Jun; Wong, Sunny H; Zhang, Lin; Liu, Xiaodong; Wong, Wai T; Leung, Czarina C H; Choi, Gordon; Wang, Maggie H T; Gin, Tony; Chan, Matthew T V; Wu, William K K

    2016-07-01

    Autophagy is one of the innate immune defense mechanisms against microbial challenges. Previous in vitro and in vivo models of sepsis demonstrated that autophagy was activated initially in sepsis, followed by a subsequent phase of impairment. Autophagy modulation appears to be protective against multiple organ injuries in these murine sepsis models. This is achieved in part by preventing apoptosis, maintaining a balance between the productions of pro- and anti-inflammatory cytokines, and preserving mitochondrial functions. This article aims to discuss the role of autophagy in sepsis and the therapeutic potential of autophagy enhancers.

  19. Sepsis management in the deployed field hospital.

    PubMed

    Johnston, Andrew McD; Easby, D; Ewington, I

    2013-09-01

    Sepsis, a syndrome caused by severe infection, affects a small proportion of military casualties but has a significant effect in increasing morbidity and mortality, including causing some preventable deaths. Casualties with abdominal trauma and those with significant tissue loss appear to be at a greater risk of sepsis. In this article, the diagnosis and management of sepsis in military casualties with reference to the Surviving Sepsis Campaign guidelines are examined. We discuss the management considerations specific to military casualties in the deployed setting and also discuss factors affecting evacuation by the UK Royal Air Force Critical Care Air Support Team.

  20. Assessing the National School Social Work Practice Model: Findings from the Second National School Social Work Survey.

    PubMed

    Kelly, Michael S; Frey, Andy; Thompson, Aaron; Klemp, Heather; Alvarez, Michelle; Berzin, Stephanie Cosner

    2016-01-01

    The Second National School Social Work Survey in 2014 aimed to update knowledge of school social work practice by examining how practitioner characteristics, practice context, and practice choices have evolved since the last national survey in 2008. This second survey was also developed to assess how the new national school social work practice model created by the School Social Work Association of America aligns with early 21st century school social work practice realities. The second survey was conducted from February through April 2014 (3,769 total responses were collected) and represents the largest sample of American school social workers surveyed in two decades. Data from the Second National School Social Work Survey showed a field that still has not fully responded to calls to implement evidence-informed and data-driven practices. This article notes the need to better integrate pre- and postservice training in data-driven practices and provides recommendations for ways to overcome barriers that school social workers report facing.

  1. MO-G-BRE-02: A Survey of IMRT QA Practices for More Than 800 Institutions

    SciTech Connect

    Pulliam, K; Kerns, J; Howell, R; Followill, D; Kry, S; O'Daniel, J

    2014-06-15

    Purpose: A wide range of techniques and measurement devices are employed for IMRT QA, causing a large variation of accepted action limits and potential follow up for failing plans. Such procedures are not well established or accepted in the medical physics community. To achieve the goal of proving insight into current IMRT QA practices, we created an electronic IMRT QA survey. The survey was open to a variety of the most common QA devices and assessed the type of comparison to measurement, action limits, delivery methods, and clinical action for failing QA plans. Methods: We conducted an online survey through the Radiological Physics Center's (RPC) annual survey with the goal of ascertaining elements of routine patient-specific IMRT QA. A total of 874 institutions responded to the survey. The questions ranged from asking for action limits, dosimeter type(s) used, delivery techniques, and actions taken when a plan fails IMRT QA. Results: The most common (52%) planar gamma criteria was 3%/3 mm with a 95% of pixels passing criteria. The most common QA device were diode arrays (48%). The most common first response to a plan failing QA was to re-measure at the same point the point dose (89%), second was to re-measure at a new point (13%), and third was to analyze the plan in relative instead of absolute mode (10%) (Does not add to 100% as not all institutions placed a response for each QA follow-up option). Some institutions, however, claimed that they had never observed a plan failure. Conclusion: The survey provided insights into the way the community currently performs IMRT QA. This information will help in the push to standardize action limits among dosimeters.

  2. A national survey to define a new core curriculum to prepare physicians for managed care practice.

    PubMed

    Meyer, G S; Potter, A; Gary, N

    1997-08-01

    All levels of medical education will require modification to address the challenges in health care practice brought about by managed care. Because preparation for practice in a managed care environment has received insufficient attention, and because the need for change is so great, in 1995 the authors sought information from a variety of sources to serve as a basis for identifying the core curricular components and the staging of these components in the medical education process. This research effort consisted of a survey of 125 U.S. medical school curriculum deans (or equivalent school representatives); four focus groups of managed care practitioners, administrators, educators, and residents; and a survey of a national sample of physicians and medical directors. Findings indicate that almost all the 91 responding school representatives recognized the importance of revising their curricula to meet the managed care challenge and that the majority either had or were developing programs to train students for practice in managed care environments. The focus groups identified a core set of competencies for managed care practice, although numbers differed on whether the classroom or a managed care setting was the best place to teach the components of a new curriculum. Although medical directors and staff physicians differed with respect to the relative levels of importance of these competencies, the findings suggest that before medical school, training should focus on communication and interpersonal skills, information systems, and customer relations; during medical school, on clinical epidemiology, quality assurance, risk management, and decision analysis; during residency, on utilization management, managed care essentials, and multidisciplinary team building; and after residency, on a review of customer relations, communication skills, and utilization management. The authors conclude that a core curriculum and its sequencing can be identified, that the majority of

  3. International survey on variations in practice of the management of the third stage of labour.

    PubMed Central

    Festin, Mario R.; Lumbiganon, Pisake; Tolosa, Jorge E.; Finney, Kathryn A.; Ba-Thike, Katherine; Chipato, Tsungai; Gaitán, Hernando; Xu, Liangzhi; Limpongsanurak, Sompop; Mittal, Suneeta; Peedicayil, Abraham; Pramono, Noor; Purwar, Manorama; Shenoy, Sheela; Daly, Sean

    2003-01-01

    OBJECTIVE: To determine the use of the active management of the third stage of labour in 15 university-based obstetric centres in ten developing and developed countries and to determine whether evidence-based practices were being used. METHODS: From March 1999 to December 1999, the Global Network for Perinatal and Reproductive Health (GNPRH) conducted an observational, cross-sectional survey to assess the use of the practice and its components. Prospective data on patient characteristics and the interventions used in the management of the third stage of labour were collected using standardized methods. Data on approximately 30 consecutive vaginal deliveries in each centre (452 in total) were included. FINDINGS: Significant intracountry and intercountry variation in the practice of the active management of the third stage of labour was found (111/452 deliveries used active management), which confirmed the existence of a large gap between knowledge and practice. CONCLUSION: Areas identified for improvement are the urgent implementation of the evidence-based clinical management practice defined as the active management of the third stage of labour; increased accessibility to systematic reviews in developing countries; and the conduction of clinical trials that assess the impact of this intervention in other settings. PMID:12764495

  4. Daylighting practices of the architectural industry (baseline results of a national survey)

    SciTech Connect

    Hattrup, M.P.

    1990-05-01

    A national survey of over 300 commercial design architects was conducted to develop baseline information on their knowledge, perceptions, and use of daylighting in commercial building designs. Pacific Northwest Laboratory conducted the survey for the US Department of Energy's (DOE) Office of Building and Community Systems (BCS). In the survey daylighting was defined as the intentional use of natural light as a partial substitute for artificially generated light. The results suggested that architects need to be educated about the true benefits of daylighting and the impacts it can have on a building's energy performance. Educational programs that will increase the architects' understanding and awareness of modern daylighting technologies and practices should be developed by utilities, stage agencies, and the federal government. If more architects can be made aware of the true effectiveness and positive attributes of daylighting systems and technologies, daylighting may be used in more commercial buildings. The results of the survey show that the more familiar architects feel they are with daylighting, the more they use daylighting. 3 refs., 19 tabs.

  5. A nation-wide malaria knowledge, attitudes and practices survey in Malawi: objectives and methodology.

    PubMed

    Schultz, L J; Ettling, M; Chitsulo, L; Steketee, R W; Nyasulu, Y; Macheso, A; Nwanyanwu, O C

    1994-03-01

    A malaria knowledge, attitudes and practices survey was conducted in Malawi during April and May, 1992, to provide policy makers and program managers with information needed to design or improve malaria control programs, to establish epidemiologic and behavioral baselines, and to identify indicators for monitoring program effectiveness. Using cluster-sample survey methodology, 1531 households, in 30 clusters of 51-52 households each, were identified and members interviewed. Interviews were conducted by trained survey teams composed of young Malawian women with secondary level education. Heads of households were asked about malaria prevention methods used and about household economics; caretakers of children were asked about treatment and health seeking behavior in a recent malaria episode in a child; and women who had been pregnant in the past 5 years were asked about their antenatal clinic utilization and malaria during pregnancy. Survey results will be used to make programmatic decisions, including developing health education messages and establishing monitoring and evaluation of malaria control activities and outcomes in Malawi.

  6. Practice patterns in the perioperative treatment of patients undergoing septorhinoplasty: a survey of facial plastic surgeons.

    PubMed

    Shadfar, Scott; Deal, Allison M; Jarchow, Andrea M; Yang, Hojin; Shockley, William W

    2014-01-01

    IMPORTANCE The common practices used in the perioperative care of patients undergoing septorhinoplasty are diverse and controversial. A consensus statement on the preferred clinical pathway in the perioperative treatment of patients undergoing septorhinoplasty has yet to be approached formally. OBJECTIVES To investigate the perioperative treatment of patients undergoing septorhinoplasty and to identify common practice patterns based on the preferences of leading facial plastic surgeons. DESIGN, SETTING, AND PARTICIPANTS We distributed an online survey to members of the American Academy of Facial Plastic and Reconstructive Surgery. Specifically, fellowship directors and academic contact members were anonymously polled and stratified by the number of septorhinoplasties performed annually. MAIN OUTCOME AND MEASURE A cohesive clinical guide to perioperative treatment after rhinoplasty. RESULTS Of the 92 members surveyed, 67 (73%) successfully completed the survey. The distribution of respondents included 43 academicians (64%) and 24 physicians in private practice (36%). Twenty-eight surgeons (42%) performed fewer than 50 rhinoplasties a year and 39 (58%), more than 50, representing 3510 to 4549 septorhinoplasties in total among respondents. Forty-four surgeons (66%) refrained from using any packing, and 41 (61%) used intranasal splints, with polymeric silicone splints the most popular of these (n = 24 [59%]). Sixty-six surgeons (99%) used external nasal splints, including 49 (74%) who used a thermoplastic splint and 49 (74%) who left the external nasal splint in place for 7 days or longer. The most common postoperative interventions to reduce edema and ecchymosis were elevation of the head of bed by 62 (93%), ice packs by 50 (75%), and Arnica montana by 33 (49%). Only 12 surgeons (18%) used postoperative corticosteroids to reduce edema. Fifty-six respondents (84%) prohibited participation in contact sports until at least 6 weeks after surgery. CONCLUSIONS AND

  7. Therapists' Use of the Graded Repetitive Arm Supplementary Program (GRASP) Intervention: A Practice Implementation Survey Study

    PubMed Central

    McMahon, Naoimh E.; Watkins, Caroline L.; Eng, Janice J.

    2014-01-01

    Background Only a small percentage of research is ever successfully translated into practice. The Graded Repetitive Arm Supplementary Program (GRASP) is a stroke rehabilitation intervention that anecdotally has had rapid translation from research to clinical practice. This study was conducted to explore the characteristics of this practice implementation. Objectives The aims of this study were: (1) to explore the extent of practice implementation of GRASP in the United Kingdom; (2) using an implementation framework, to explore UK therapists' opinions of implementing GRASP; and (3) if GRASP is found to be used in the United Kingdom, to investigate differences in opinions between therapists who are using GRASP in practice and those who are not. Design A cross-sectional study design was used. Methods Data were collected via an online questionnaire. Participants in this study were members of the College of Occupational Therapy Specialist Section Neurological Practice and the Association of Chartered Physiotherapists Interested in Neurology. Results Of the 274 therapists who responded to the survey, 61 (22.3%) had experience of using GRASP, 114 (41.6%) knew of GRASP but had never used it, and 99 (36.1%) had never heard of GRASP. Therapists displayed positive opinions toward the implementation of a manual with graded progressions of structured upper limb exercises for people after stroke. Opinions were different between therapists who had used GRASP and those who had not. Limitations The findings of this study may be limited by response bias. Conclusions GRASP is a relatively new stroke rehabilitation intervention that has made impressive translation into the knowledge and practice of UK therapists. Therapists' opinions would suggest that GRASP is both an acceptable and feasible intervention and has the potential to be implemented by a greater number of therapists in a range of settings. PMID:24505098

  8. Survey of partner notification practices for sexually transmissible infections in the United States

    PubMed Central

    Desir, Fidel A.; Ladd, Jessica H.; Gaydos, Charlotte A.

    2016-01-01

    Background Partner notification (PN) for sexually transmissible infections (STIs) is a vital STI control method. The most recent evaluation of PN practices in the United States, conducted in 1999, indicated that few STI patients were offered PN services. The objectives of this study were to obtain a preliminary understanding of the current provision of PN services in HIV/STI testing sites throughout the US and to determine the types of PN services available. Methods A convenience sample of 300 randomly selected testing sites was contacted to administer a phone survey about PN practices. These sites were from a large database maintained by the Centers for Disease Control and Prevention. Sites were eligible to participate if they provided testing services for chlamydia, gonorrhoea, HIV or syphilis and were not hospitals or Planned Parenthood locations. Results Of the 300 eligible sites called, 79 sites were successfully reached, of which 74 agreed to participate, yielding a response rate of 24.7% and a cooperation rate of 93.7%. Most surveyed testing sites provided some form of PN service (anonymous or non-anonymous) on site or through an affiliate for chlamydia (100%), gonorrhoea (97%), HIV (91%) and syphilis (96%) infection. Anonymous PN services were available at 67–69% of sites. Only 6–9% of sites offered Internet-based PN services. Conclusions Most surveyed testing sites currently offer some type of PN service for chlamydia, gonorrhoea, HIV or syphilis infection. However, approximately one-third of surveyed sites do not offer anonymous services. Novel, Internet-based methods may be warranted to increase the availability of anonymous services. PMID:26841251

  9. Survey of practices and perceptions regarding feline onychectomy among private practitioners.

    PubMed

    Ruch-Gallie, Rebecca; Hellyer, Peter W; Schoenfeld-Tacher, Regina; Kogan, Lori R

    2016-08-01

    OBJECTIVE To estimate the proportion of veterinarians working with feline patients in private practices who do or do not perform onychectomy and assess attitudes regarding and practices related to onychectomy in a large population of veterinary practitioners. DESIGN Anonymous online survey. SAMPLE 3,441 veterinarians. PROCEDURES An online survey was provided to members of the Veterinary Information Network from June 18, 2014, through July 9, 2014. Descriptive statistics and frequency distributions for applicable response types were calculated, and Mann-Whitney U tests were conducted to compare responses to onychectomy-related opinion questions between respondents who indicated they did or did not perform the procedure. Not all respondents answered every question. RESULTS 2,503 of 3,441 (72.7%) survey respondents reported performing onychectomy, and 827 (24.0%) indicated they did not; 1,534 of 2,498 (61.4%) performing the procedure reported a frequency of < 1 onychectomy/month. Most (2,256/3,023 [74.6%]) respondents who performed onychectomy indicated that they recommended nonsurgical alternatives. Surgical techniques and approaches to analgesia varied, with use of a scalpel only (1,046/1,722 [60.7%]) and perioperative administration of injectable opioids (1,933/2,482 [77.9%]) most commonly reported. Responses to opinion questions in regard to the degree of pain associated with onychectomy and recovery; whether declawing is a form of mutilation, is necessary in some cats for behavioral reasons, or is a necessary alternative to euthanasia in some cats; and whether state organizations should support a legislative ban on onychectomy differed significantly between respondents who did and did not perform the procedure. CONCLUSIONS AND CLINICAL RELEVANCE Onychectomy is a controversial topic, and this was reflected in survey results. In this sample, most veterinarians performing the procedure reported that they did so infrequently, and most offered nonsurgical alternatives

  10. A survey of resilience, burnout, and tolerance of uncertainty in Australian general practice registrars

    PubMed Central

    2013-01-01

    Background Burnout and intolerance of uncertainty have been linked to low job satisfaction and lower quality patient care. While resilience is related to these concepts, no study has examined these three concepts in a cohort of doctors. The objective of this study was to measure resilience, burnout, compassion satisfaction, personal meaning in patient care and intolerance of uncertainty in Australian general practice (GP) registrars. Methods We conducted a paper-based cross-sectional survey of GP registrars in Australia from June to July 2010, recruited from a newsletter item or registrar education events. Survey measures included the Resilience Scale-14, a single-item scale for burnout, Professional Quality of Life (ProQOL) scale, Personal Meaning in Patient Care scale, Intolerance of Uncertainty-12 scale, and Physician Response to Uncertainty scale. Results 128 GP registrars responded (response rate 90%). Fourteen percent of registrars were found to be at risk of burnout using the single-item scale for burnout, but none met the criteria for burnout using the ProQOL scale. Secondary traumatic stress, general intolerance of uncertainty, anxiety due to clinical uncertainty and reluctance to disclose uncertainty to patients were associated with being at higher risk of burnout, but sex, age, practice location, training duration, years since graduation, and reluctance to disclose uncertainty to physicians were not. Only ten percent of registrars had high resilience scores. Resilience was positively associated with compassion satisfaction and personal meaning in patient care. Resilience was negatively associated with burnout, secondary traumatic stress, inhibitory anxiety, general intolerance to uncertainty, concern about bad outcomes and reluctance to disclose uncertainty to patients. Conclusions GP registrars in this survey showed a lower level of burnout than in other recent surveys of the broader junior doctor population in both Australia and overseas. Resilience

  11. A survey of current practices and preferences for internal fixation of displaced olecranon fractures

    PubMed Central

    Wood, Thomas; Thomas, Katie; Farrokhyar, Forough; Ristevski, Bill; Bhandari, Mohit; Petrisor, Bradley

    2015-01-01

    Background Olecranon fractures represent 10% of upper extremity fractures. There is a growing body of literature to support the use of plate fixation for displaced olecranon fractures. The purpose of this survey was to gauge Canadian surgeons’ practices and preferences for internal fixation methods for displaced olecranon fractures. Methods Using an online survey tool, we administered a cross-sectional survey to examine current practice for fixation of displaced olecranon fractures. Results We received 256 completed surveys for a response rate of 31% (95% confidence interval [CI] 30.5–37.5%). The preferred treatment was tension band wiring (78.5%, 95% CI 73–83%) for simple displaced olecranon fractures (Mayo IIA) and plating (81%, 95% CI 75.5–85%) for displaced comminuted olecranon fractures (Mayo IIB). Fracture morphology with a mean impact of 3.31 (95% CI 3.17–3.45) and comminution with a mean impact of 3.34 (95% CI 3.21–3.46) were the 2 factors influencing surgeons’ choice of fixation method the most. The major deterrent to using tension band wiring for displaced comminuted fractures (Mayo IIB) was increased stability obtained with other methods described by 75% (95% CI 69–80%) of respondents. The major deterrent for using plating constructs for simple displaced fractures (Mayo IIA) was better outcomes with other methods. Hardware prominence was the most commonly perceived complication using either method of fixation: 77% (95% CI 71.4–81.7%) and 76.2% (95% CI 70.6–81.0%) for tension band wiring and plating, respectively. Conclusion Divergence exists with current literature and surgeon preference for fixation of displaced olecranon fractures. PMID:26204363

  12. Survey of self-assessed preparedness for clinical practice in one Croatian medical school

    PubMed Central

    Bojanić, Katarina; Schears, Gregory J; Schroeder, Darrell R; Jenkins, Sarah M; Warner, David O; Sprung, Juraj

    2009-01-01

    Background The Croatian higher education system is in the process of reforming its medical curricula to comply with European Union standards. We conducted a survey of students enrolled at the University of Zagreb (Croatia) asking them to rate their perception of preparedness for clinical practice prior to initiation of the reform process. The purpose of the survey was to identify self-perceived deficiencies in education and to establish a reference point for the later assessment of ongoing educational reform. Findings One-hundred and forty seven (N = 147) graduates reported the levels of perceived preparedness on 30 items grouped into 8 educational domains. Main domains were: understanding science, practical skills/patient management, holistic care, prevention, interpersonal skills, confidence/coping skills, collaboration, and self-directed learning. For each item, graduates self assessed their preparedness on a scale ranging from 1 to 4, with 1 = "Very inadequate", 2 = "Somewhat inadequate", 3 = "Somewhat adequate", and 4 = "Very adequate". In 7 out of 8 domains the achieved median score was ≥ 3. Students expressed low confidence (defined when ≥ 25% of respondents supplied a rating for the survey question as: "very inadequate" or "somewhat inadequate") with interpersonal skills (discussing terminal disease, counseling distraught patients, balancing professional and personal life), and in performing certain basic semi-invasive or invasive procedures. Conclusion Zagreb medical graduates identified several deficiencies within educational domains required for standard clinical practice. Ongoing educational efforts need to be directed towards the correction of these deficiencies in order to achieve standards required by the European Union. PMID:19635136

  13. Detection and location of leaks in district heating steam systems: Survey and review of current technology and practices

    SciTech Connect

    Kupperman, D.S.; Raptis, A.C.; Lanham, R.N.

    1992-03-01

    This report presents the results of a survey undertaken to identify and characterize current practices for detecting and locating leaks in district heating systems, particular steam systems. Currently used technology and practices are reviewed. In addition, the survey was used to gather information that may be important for the application of acoustic leak detection. A few examples of attempts to locate leaks in steam and hot water pipes by correlation of acoustic signals generated by the leaks are also discussed.

  14. Teaching Intercultural Communication in a Basic Technical Writing Course: A Survey of Our Current Practices and Methods

    ERIC Educational Resources Information Center

    Matveeva, Natalia

    2008-01-01

    This research article reports the results of an online survey distributed among technical writing instructors in 2006. The survey aimed to examine how we teach intercultural communication in basic technical writing courses: our current practices and methods. The article discusses three major challenges that instructors may face when teaching about…

  15. Casino gambling in private school and adjudicated youngsters: A survey of practices and related variables.

    PubMed

    Kearney, C A; Roblek, T; Thurman, J; Turnbough, P D

    1996-09-01

    This study provides additional information about casino gambling practices in two adolescent samples. Specifically, 109 adolescents from a religious high school and 84 adolescents from a juvenile detention facility in Las Vegas, Nevada were surveyed. Of these, 71 (36.8%) were found to gamble regularly (58 males, 13 females, mean age 15.9 years). Results indicated many similarities among the two groups. The overall sample appeared to have a strong affinity for casino gambling, were diverse in their practices and reasons for gambling, reported a variety of emotional and physiological behaviors when gambling, occasionally experienced problems from casino gambling, and had parents who generally approved and were aware of their children's gambling behavior. The accessibility and family-oriented nature of many new casinos may be responsible for these effects.

  16. What clinicians want: findings from a psychotherapy practice research network survey.

    PubMed

    Tasca, Giorgio A; Sylvestre, John; Balfour, Louise; Chyurlia, Livia; Evans, Jane; Fortin-Langelier, Benjamin; Francis, Kylie; Gandhi, Jasmine; Huehn, Linda; Hunsley, John; Joyce, Anthony S; Kinley, Jackie; Koszycki, Diana; Leszcz, Molyn; Lybanon-Daigle, Vanessa; Mercer, Deanna; Ogrodniczuk, John S; Presniak, Michelle; Ravitz, Paula; Ritchie, Kerri; Talbot, Jeanne; Wilson, Brian

    2015-03-01

    Practice research networks may be one way of advancing knowledge translation and exchange (KTE) in psychotherapy. In this study, we document this process by first asking clinicians what they want from psychotherapy research. Eighty-two psychotherapists in 10 focus groups identified and discussed psychotherapy research topics relevant to their practices. An analysis of these discussions led to the development of 41 survey items. In an online survey, 1,019 participants, mostly practicing clinicians, rated the importance to their clinical work of these 41 psychotherapy research topics. Ratings were reduced using a principal components analysis in which 9 psychotherapy research themes emerged, accounting for 60.66% of the variance. Two postsurvey focus groups of clinicians (N = 22) aided in interpreting the findings. The ranking of research themes from most to least important were-Therapeutic Relationship/Mechanisms of Change, Therapist Factors, Training and Professional Development, Client Factors, Barriers and Stigma, Technology and Adjunctive Interventions, Progress Monitoring, Matching Clients to Therapist or Therapy, and Treatment Manuals. Few differences were noted in rankings based on participant age or primary therapeutic orientation. Postsurvey focus group participants were not surprised by the top-rated items, as they were considered most proximal and relevant to therapists and their work with clients during therapy sessions. Lower ranked items may be perceived as externally imposed agendas on the therapist and therapy. We discuss practice research networks as a means of creating new collaborations consistent with KTE goals. Findings of this study can help to direct practitioner-researcher collaborations. PMID:25528356

  17. Interest and satisfaction of dentists in practicing periodontics: A survey based on treatment of gingival recession

    PubMed Central

    Grover, Vishakha; Kapoor, Anoop; Malhotra, Ranjan; Sachdeva, Sonia

    2012-01-01

    Background: Gingival recession is a common occurrence and patients often report to dental clinic with associated problems such as root surface hypersensitivity, esthetic concerns, cervical root abrasions, and root caries that make it a concern for patients. Based upon the fact that gingival recession is an enigma for clinicians because of multitude of etiological factors and plethora of treatment modalities present for its treatment, a survey was conducted to assess knowledge as well as opinion about most common etiology, classification, and preferred treatment of gingival recession and to evaluate the interest and satisfaction of dentists in practicing periodontics. Materials and Methods: Study design consisted of a cross-sectional online survey, conducted among dentists practicing in state of Punjab, India, in the month of April 2011. A structured online questionnaire consisting of 17 questions evaluating the interest of dentists in periodontics based on knowledge about gingival recession (most of them giving the possibility of multiple choices of answers) was sent to about 300 dentists. Pearson Chi-Square and Mann-Whitney U tests were used for statistical analysis of data collected. P ≤ 0.05 was considered as statistically significant and P ≤ 0.01 considered as highly significant. Results: A greater proportion of periodontists had better knowledge about etiology (P = 0.07), classification (P = 0.000), and treatment of gingival recession (P = 0.000). A greater number of periodontists opted for the surgical modalities to correct the defects produced by gingival recession as compared to non-periodontists and had better interest (P = 0.000) and satisfaction (P = 0.000) in practicing periodontics. Conclusion: The results elucidated that periodontists had better interest and satisfaction in practicing periodontics, and were more inclined towards surgical correction of gingival recession as compared to non-periodontists. PMID:23162580

  18. Survey of food safety practices on small to medium-sized farms and in farmers markets.

    PubMed

    Harrison, Judy A; Gaskin, Julia W; Harrison, Mark A; Cannon, Jennifer L; Boyer, Renee R; Zehnder, Geoffrey W

    2013-11-01

    As produce consumption has increased, so have foodborne disease outbreaks associated with fresh produce. Little research has addressed food safety practices used on small to medium-sized farms selling locally or in farmers markets. This study evaluated current food safety practices used by farmers on small to medium-sized farms and managers of farmers markets in Georgia, Virginia, and South Carolina based on responses to surveys. Surveys were developed, pretested, and revised before implementation with target audiences and were implemented via mail and the Web to maximize participation, with reminders sent to nonrespondents. Data were collected from 226 farmers and 45 market managers. Frequencies and percentages were calculated for all response variables. Responses from farmers indicated that more than 56% of them use manures. Of those who use manures, 34% use raw or mixtures of raw and composted manure, and over 26% wait fewer than 90 days between application of raw manure and harvest. Over 27% use water sources that have not been tested for safety for irrigation, and 16% use such water sources for washing produce. Over 43% do not sanitize surfaces that touch produce at the farm. Only 33% of farmers always clean transport containers between uses. Responses from market managers indicated that over 42% have no food safety standards in place for the market. Only 2 to 11% ask farmers specific questions about conditions on the farm that could affect product safety. Less than 25% of managers sanitize market surfaces. Only 11% always clean market containers between uses. Over 75% of markets offer no sanitation training to workers or vendors. While farmers and market managers are using many good practices, the results indicate that some practices being used may put consumers at risk of foodborne illness. Consequently, there is a need for training for both farmers and market managers.

  19. A Survey to Assess Family Physicians’ Motivation to Teach Undergraduates in Their Practices

    PubMed Central

    May, Marcus; Mand, Peter; Biertz, Frank; Hummers-Pradier, Eva; Kruschinski, Carsten

    2012-01-01

    Background In Germany, family physicians (FPs) are increasingly needed to participate in undergraduate medical education. Knowledge of FPs’ motivation to teach medical students in their practices is lacking. Purpose To describe a novel questionnaire that assesses the motivation of FPs to teach undergraduates in their practices and to show the results of a subsequent survey using this instrument. Methods The questionnaire was developed based on a review of the literature. Previously used empirical instruments assessing occupational values and motivation were included. A preliminary version was pretested in a pilot study. The resulting 68-item questionnaire was sent to 691 FPs involved in undergraduate medical education. Reliability was assessed and subgroups were analyzed with regard to differences in motivation. Results A total of 523 physicians in n = 458 teaching practices participated (response rate 75.7%). ‘Helping others’ and ‘interest’ were revealed as the predominant motives. Responses showed a predominantly intrinsic motivation of the participating FPs. Their main incentives were an ambition to work as a medical preceptor, to generally improve undergraduate education and to share knowledge. Material compensation was of minor importance. Time restraints were indicated as a barrier by some FPs, but were not a general concern. Conclusion German FPs involved in medical education have altruistic attitudes towards teaching medical students in their practices. Motivational features give an important insight for the recruitment of FP preceptors as well as for their training in instructional methods. PMID:23029272

  20. Reasons why doctors choose or reject careers in general practice: national surveys

    PubMed Central

    Lambert, Trevor; Goldacre, Raph; Smith, Fay; Goldacre, Michael J

    2012-01-01

    Background Less than one-third of newly qualified doctors in the UK want a career in general practice. The English Department of Health expects that half of all newly qualified doctors will become GPs. Aim To report on the reasons why doctors choose or reject careers in general practice, comparing intending GPs with doctors who chose hospital careers. Design and setting Questionnaire surveys in all UK medical graduates in selected qualification years. Method Questions about specialty career intentions and motivations, put to the qualifiers of 1993, 1996, 1999, 2000, 2002, 2005, 2008, and 2009, 1 year after qualification, and at longer time intervals thereafter. Results ‘Enthusiasm for and commitment to the specialty’ was a very important determinant of choice for intending doctors, regardless of chosen specialty. ‘Hours and working conditions’ were a strong influence for intending GPs (cited as having had ‘a great deal’ of influence by 75% of intending GPs in the first year after qualification), much more so than for doctors who wanted a hospital career (cited by 30%). Relatively few doctors had actually considered general practice seriously but then rejected it; 78% of the doctors who rejected general practice gave ‘job content’ as their reason, compared with 32% of doctors who rejected other specialties. Conclusion The shortfall of doctors wanting a career in general practice is not accounted for by doctors considering and rejecting it. Many do not consider it at all. There are very distinctive factors that influence choice for, and rejection of, general practice. PMID:23211266

  1. Improving the Odds of Surviving Sepsis

    MedlinePlus

    ... Improving the Odds of Surviving Sepsis Inside Life Science View All Articles | Inside Life Science Home Page Improving the Odds of Surviving Sepsis ... Threatening Bacterial Infection Remains Mysterious This Inside Life Science article also appears on LiveScience . Learn about related ...

  2. Estrogen sulfotransferase ablation sensitizes mice to sepsis

    PubMed Central

    Chai, Xiaojuan; Guo, Yan; Jiang, Mengxi; Hu, Bingfang; Li, Zhigang; Fan, Jie; Deng, Meihong; Billiar, Timothy R.; Kucera, Heidi; Gaikwad, Nilesh W.; Xu, Meishu; Lu, Peipei; Yan, Jiong; Fu, Haiyan; Liu, Youhua; Yu, Lushan; Huang, Min; Zeng, Su; Xie, Wen

    2015-01-01

    Sepsis is the host's deleterious systemic inflammatory response to microbial infections. Here we report an essential role for the estrogen sulfotransferase (EST or SULT1E1), a conjugating enzyme that sulfonates and deactivates estrogens, in sepsis response. Both the cecal ligation and puncture (CLP) and lipopolysacharide (LPS) models of sepsis induce the expression of EST and compromise the activity of estrogen, an anti-inflammatory hormone. Surprisingly, EST ablation sensitizes mice to sepsis-induced death. Mechanistically, EST ablation attenuates sepsis-induced inflammatory responses due to compromised estrogen deactivation, leading to increased sepsis lethality. In contrast, transgenic overexpression of EST promotes estrogen deactivation and sensitizes mice to CLP-induced inflammatory response. The induction of EST by sepsis is NF-κB dependent and EST is a NF-κB target gene. The reciprocal regulation of inflammation and EST may represent a yet to be explored mechanism of endocrine regulation of inflammation, which has an impact on the clinical outcome of sepsis. PMID:26259151

  3. Pseudomonas sepsis with Noma: an association?

    PubMed

    Vaidyanathan, S; Tullu, M S; Lahiri, K R; Deshmukh, C T

    2005-08-01

    We report here a 2.5-year-old male child with community-acquired Pseudomonal sepsis showing the characteristic lesions of ecthyma gangrenosum. The child had development of gangrenous changes of the nose and face - the 'cancrum oris' or 'Noma'. We highlight the possible association of Pseudomonas sepsis and Noma, with malnutrition playing a central role in causing both the diseases.

  4. Test result communication in primary care: a survey of current practice

    PubMed Central

    Litchfield, Ian; Bentham, Louise; Lilford, Richard; McManus, Richard J; Hill, Ann; Greenfield, Sheila

    2015-01-01

    Background The number of blood tests ordered in primary care continues to increase and the timely and appropriate communication of results remains essential. However, the testing and result communication process includes a number of participants in a variety of settings and is both complicated to manage and vulnerable to human error. In the UK, guidelines for the process are absent and research in this area is surprisingly scarce; so before we can begin to address potential areas of weakness there is a need to more precisely understand the strengths and weaknesses of current systems used by general practices and testing facilities. Methods We conducted a telephone survey of practices across England to determine the methods of managing the testing and result communication process. In order to gain insight into the perspectives from staff at a large hospital laboratory we conducted paired interviews with senior managers, which we used to inform a service blueprint demonstrating the interaction between practices and laboratories and identifying potential sources of delay and failure. Results Staff at 80% of practices reported that the default method for communicating normal results required patients to telephone the practice and 40% of practices required that patients also call for abnormal results. Over 80% had no fail-safe system for ensuring that results had been returned to the practice from laboratories; practices would otherwise only be aware that results were missing or delayed when patients requested results. Persistent sources of missing results were identified by laboratory staff and included sample handling, misidentification of samples and the inefficient system for collating and resending misdirected results. Conclusions The success of the current system relies on patients both to retrieve results and in so doing alert staff to missing and delayed results. Practices appear slow to adopt available technological solutions despite their potential for

  5. Pelvic sepsis after stapled hemorrhoidopexy

    PubMed Central

    van Wensen, Remco JA; van Leuken, Maarten H; Bosscha, Koop

    2008-01-01

    Stapled hemorrhoidopexy is a surgical procedure used worldwide for the treatment of grade III and IV hemorrhoids in all age groups. However, life-threatening complications occur occasionally. The following case report describes the development of pelvic sepsis after stapled hemorrhoidopexy. A literature review of techniques used to manage major septic complications after stapled hemorrhoidopexy was performed. There is no standardized treatment currently available. Stapled hemorrhoidopexy is a safe, effective and time-efficient procedure in the hands of experienced colorectal surgeons. PMID:18855996

  6. Awareness and knowledge of sepsis in the general Korean population: comparison with the awareness and knowledge of acute myocardial infarction and stroke

    PubMed Central

    Park, Minji; Kim, Kyuseok; Lee, Jae Hyuk; Kang, Changwoo; Jo, You Hwan; Kim, Dong Hoon; Kang, Kyeong Won; Lee, Soo Hoon; Park, Chanjong; Kim, Joonghee; Chung, Heajin; Park, Hyunmi; Jang, Sujin

    2014-01-01

    Objective Patients with severe sepsis or septic shock require timely, aggressive management to improve their outcomes, and early presentation of patients to the hospital may also be important. Thus, public awareness about sepsis may be important for improved outcomes. However, there are no studies regarding the public awareness of sepsis in the general Korean population. Therefore, the objective of this survey was to gain insight into the public awareness of sepsis. Methods Prospective paper-based and web-based surveys were issued between May and June 2013 to adults aged ≥18 years. Results A total of 1,081 participants responded to the survey (394 paper-based and 687 web-based). Mean age was 38.7±11.4 years, and 541 participants (50%) were men. Of the 1,081 participants, 831 (76.9%) had heard of the term “sepsis.” Of these participants, only 295 (35%) responded correctly regarding the definition of sepsis. However, 1,019 participants (94.3%) had heard of acute myocardial infarction, and 817 of these (80%) correctly defined acute myocardial infarction. Regarding stroke, 1,047 (96.9%) had heard of stroke, and 975 of these responded (93.1%) correctly to the definition of stroke. Conclusion There is poor public awareness about sepsis compared with that of acute myocardial infarction and stroke. This may limit the timely management of severe sepsis and septic shock. PMID:27752551

  7. A survey of helminth control practices on sheep farms in Great Britain and Ireland.

    PubMed

    Morgan, E R; Hosking, B C; Burston, S; Carder, K M; Hyslop, A C; Pritchard, L J; Whitmarsh, A K; Coles, G C

    2012-06-01

    A telephone survey of 600 farmers throughout Great Britain and Ireland was conducted in order to characterise helminth control practices, and identify factors correlated with perceived anthelmintic failure. Overall, 93% of surveyed farmers routinely treated their sheep against nematodes, 67% against liver fluke and 58% against tapeworms. Anthelmintic resistance in nematodes was perceived by farmers to be present on 10% of farms. Farmers who dosed ewes at mating were more likely to have observed anthelmintic failure, than those who were aware of national guidelines on parasite control. However, objective assessment of anthelmintic efficacy had only been undertaken on 19% of farms. Ewes were treated at mating and lambing on 63% and 62% of farms, respectively. On average, lambs were treated 3.6 times annually, depending on geographical region and on dates of lambing and finishing. Although 'quarantine' treatments were widely administered to bought-in stock, these were appropriately applied in only 3% of cases. This study provides baseline data against which the impact of future anthelmintic information campaigns can be assessed; it will facilitate the development of rational, farm-level mathematical models in support of sustainable parasite control, and will aid in the design of farm management practices that prolong the effective lifespan of novel classes of anthelmintic. PMID:21908211

  8. Informed consent for epidural analgesia in labour: a survey of Irish practice.

    PubMed

    Hegarty, A; Omer, W; Harmon, D

    2014-06-01

    Currently, we do not have a national standard regarding epidural consent in Ireland. The aim of this survey was to assess practice in obstetric units in Ireland with regard to obtaining informed consent prior to epidural insertion, and whether the risks discussed with women are being documented. A postal survey of anaesthetists in Irish obstetric units was performed in January 2012 to assess practice regarding obtaining informed consent prior to epidural insertion, and documentation of the risks discussed. The response rate was 16/18 (88%). There was major variation both in which risks are discussed with women in labour and what risks are quoted. The most frequently quoted risks were headache--15/16 (93.8% of the respondents), partially/not working epidural--15/16 (93.8%), drop in blood pressure--14/16 (87.5%) and temporary backache/local tenderness--12/16 (75%). The more serious risks were not discussed as frequently: permanent nerve damage--8/16 (50%), paralysis--8/16 (50%), epidural abscess/haematoma--6/16 (37.5%), meningitis--3/16 (18.7%). The vast majority of respondents supported introduction of a national standardised information leaflet, detailing all the benefits and risks of epidural analgesia, to be shown to all women before consenting to epidural insertion.

  9. A survey of helminth control practices on sheep farms in Great Britain and Ireland.

    PubMed

    Morgan, E R; Hosking, B C; Burston, S; Carder, K M; Hyslop, A C; Pritchard, L J; Whitmarsh, A K; Coles, G C

    2012-06-01

    A telephone survey of 600 farmers throughout Great Britain and Ireland was conducted in order to characterise helminth control practices, and identify factors correlated with perceived anthelmintic failure. Overall, 93% of surveyed farmers routinely treated their sheep against nematodes, 67% against liver fluke and 58% against tapeworms. Anthelmintic resistance in nematodes was perceived by farmers to be present on 10% of farms. Farmers who dosed ewes at mating were more likely to have observed anthelmintic failure, than those who were aware of national guidelines on parasite control. However, objective assessment of anthelmintic efficacy had only been undertaken on 19% of farms. Ewes were treated at mating and lambing on 63% and 62% of farms, respectively. On average, lambs were treated 3.6 times annually, depending on geographical region and on dates of lambing and finishing. Although 'quarantine' treatments were widely administered to bought-in stock, these were appropriately applied in only 3% of cases. This study provides baseline data against which the impact of future anthelmintic information campaigns can be assessed; it will facilitate the development of rational, farm-level mathematical models in support of sustainable parasite control, and will aid in the design of farm management practices that prolong the effective lifespan of novel classes of anthelmintic.

  10. Diagnostic virology practices for respiratory syncytial virus and influenza virus among children in the hospital setting: a national survey.

    PubMed

    Jafri, Hasan S; Ramilo, Octavio; Makari, Doris; Charsha-May, Deborah; Romero, José R

    2007-10-01

    A survey was sent to the emergency room and laboratory directors of 400 randomly selected US hospitals to assess the diagnostic testing practices for respiratory syncytial virus and influenza virus in children. The results demonstrate that the majority of hospitals routinely perform viral testing for both viruses and use virology testing practices appropriate for the reasons reported for testing.

  11. Sepsis-induced acute kidney injury.

    PubMed

    Majumdar, Arghya

    2010-01-01

    Acute kidney injury (AKI) is a common sequel of sepsis in the intensive care unit. It is being suggested that sepsis-induced AKI may have a distinct pathophysiology and identity. Availability of biomarkers now enable us to detect AKI as early as four hours after it's inception and may even help us to delineate sepsis-induced AKI. Protective strategies such as preferential use of vasopressin or prevention of intra-abdominal hypertension may help, in addition to the other global management strategies of sepsis. Pharmacologic interventions have had limited success, may be due to their delayed usage. Newer developments in extracorporeal blood purification techniques may proffer effects beyond simple replacement of renal function, such as metabolic functions of the kidney or modulation of the sepsis cascade.

  12. Sepsis-associated encephalopathy: not just delirium

    PubMed Central

    Zampieri, Fernando Godinho; Park, Marcelo; Machado, Fabio Santana; Azevedo, Luciano Cesar Pontes

    2011-01-01

    Sepsis is a major cause of mortality and morbidity in intensive care units. Organ dysfunction is triggered by inflammatory insults and tissue hypoperfusion. The brain plays a pivotal role in sepsis, acting as both a mediator of the immune response and a target for the pathologic process. The measurement of brain dysfunction is difficult because there are no specific biomarkers of neuronal injury, and bedside evaluation of cognitive performance is difficult in an intensive care unit. Although sepsis-associated encephalopathy was described decades ago, it has only recently been subjected to scientific scrutiny and is not yet completely understood. The pathophysiology of sepsis-associated encephalopathy involves direct cellular damage to the brain, mitochondrial and endothelial dysfunction and disturbances in neurotransmission. This review describes the most recent findings in the pathophysiology, diagnosis, and management of sepsis-associated encephalopathy and focuses on its many presentations. PMID:22012058

  13. Sepsis Induced by Cecal Ligation and Puncture

    PubMed Central

    Wen, Haitao

    2014-01-01

    Summary Despite advances in intensive care unit interventions, including the use of specific antibiotics and anti-inflammation treatment, sepsis with concomitant multiple organ failure is the most common cause of death in many acute care units. In order to understand the mechanisms of clinical sepsis and develop effective therapeutic modalities, there is a need to use effective experimental models that faithfully replicate what occurs in patients with sepsis. Several models are commonly used to study sepsis, including intravenous endotoxin challenge, injection of live organisms into the peritoneal cavity, establishing abscesses in the extremities, and the induction of polymicrobial peritonitis via cecal ligation and puncture (CLP). Here, we describe the surgery procedure of CLP in mice, which has been proposed to closely replicate the nature and course of clinical sepsis in humans. PMID:23824895

  14. Hemostasis and endothelial damage during sepsis.

    PubMed

    Johansen, Maria Egede

    2015-08-01

    The sepsis syndrome represents a disease continuum, including severe sepsis and septic shock associated with high mortality. One of the main problems in severe sepsis and septic shock, resulting in organ failure and death, are disturbances in the hemostasis due to sepsis-related coagulopathy. Sepsis-related coagulopathy affects not only traditional coagulation factors, but also the platelets and endothelium. Functional testing of the hemostatic system has found application in critical illness. Thrombelastography (TEG) provides an overview of the hemostatic system allowing for an evaluation of interactions between coagulation factors and platelets. Additionally, the role of the endothelium during sepsis can be explored through testing of biomarkers of endothelial damage. The three studies comprising this PhD thesis all investigate important aspects of the disturbed hemostasis during sepsis, including endothelial damage. Together, the specific findings from the three studies improve the existing understanding of sepsis-related coagulopathy, and the possible influences of some of the treatments offered these patients. The first study investigates the occurrence of antimicrobial-induced thrombocytopenia among critically ill patients. In sepsis, thrombocytopenia is a predictor of poor outcome, and reports, of mainly casuistic nature, have previously hypothesized that specific antimicrobial agents could induce in sepsis-related thrombocytopenia. This hypothesis was tested using a randomized designed set-up, encompassing 1147 critically ill patients, and no significant difference in risk of thrombocytopenia was observed among patients receiving large amounts of antimicrobials vs. patients receiving standard-of-care. As a consequence, the risk of antimicrobial-induced thrombocytopenia in the general population of critically ill patients seemingly does not represent a substantial problem and thrombocytopenia during critical illness is most likely due to other factors such

  15. Collection development and outsourcing in academic health sciences libraries: a survey of current practices.

    PubMed

    Blecic, D D; Hollander, S; Lanier, D

    1999-04-01

    Academic health sciences libraries in the United States and Canada were surveyed regarding collection development trends, including their effect on approval plan and blanket order use, and use of outsourcing over the past four years. Results of the survey indicate that serials market forces, budgetary constraints, and growth in electronic resources purchasing have resulted in a decline in the acquisition of print items. As a result, approval plan use is being curtailed in many academic health sciences libraries. Although use of blanket orders is more stable, fewer than one-third of academic health sciences libraries report using them currently. The decline of print collections suggests that libraries should explore cooperative collection development of print materials to ensure access and preservation. The decline of approval plan use and the need for cooperative collection development may require additional effort for sound collection development. Libraries were also surveyed about their use of outsourcing. Some libraries reported outsourcing cataloging and shelf preparation of books, but none reported using outsourcing for resource selection. The reason given most often for outsourcing was that it resulted in cost savings. As expected, economic factors are driving both collection development and outsourcing practices. PMID:10219477

  16. Exome Sequencing Reveals Primary Immunodeficiencies in Children with Community-Acquired Pseudomonas aeruginosa Sepsis

    PubMed Central

    Asgari, Samira; McLaren, Paul J.; Peake, Jane; Wong, Melanie; Wong, Richard; Bartha, Istvan; Francis, Joshua R.; Abarca, Katia; Gelderman, Kyra A.; Agyeman, Philipp; Aebi, Christoph; Berger, Christoph; Fellay, Jacques; Schlapbach, Luregn J.; Posfay-Barbe, Klara

    2016-01-01

    One out of three pediatric sepsis deaths in high income countries occur in previously healthy children. Primary immunodeficiencies (PIDs) have been postulated to underlie fulminant sepsis, but this concept remains to be confirmed in clinical practice. Pseudomonas aeruginosa (P. aeruginosa) is a common bacterium mostly associated with health care-related infections in immunocompromised individuals. However, in rare cases, it can cause sepsis in previously healthy children. We used exome sequencing and bioinformatic analysis to systematically search for genetic factors underpinning severe P. aeruginosa infection in the pediatric population. We collected blood samples from 11 previously healthy children, with no family history of immunodeficiency, who presented with severe sepsis due to community-acquired P. aeruginosa bacteremia. Genomic DNA was extracted from blood or tissue samples obtained intravitam or postmortem. We obtained high-coverage exome sequencing data and searched for rare loss-of-function variants. After rigorous filtrations, 12 potentially causal variants were identified. Two out of eight (25%) fatal cases were found to carry novel pathogenic variants in PID genes, including BTK and DNMT3B. This study demonstrates that exome sequencing allows to identify rare, deleterious human genetic variants responsible for fulminant sepsis in apparently healthy children. Diagnosing PIDs in such patients is of high relevance to survivors and affected families. We propose that unusually severe and fatal sepsis cases in previously healthy children should be considered for exome/genome sequencing to search for underlying PIDs. PMID:27703454

  17. Exploring knowledge, attitudes, and practices related to alcohol in Mongolia: a national population-based survey

    PubMed Central

    2013-01-01

    Background The leading cause of mortality in Mongolia is Non-Communicable Disease. Alcohol is recognised by the World Health Organization as one of the four major disease drivers and so, in order to better understand and triangulate recent national burden-of-disease surveys and to inform policy responses to alcohol consumption in Mongolia, a national Knowledge, Attitudes and Practices survey was conducted. Focusing on Non-Communicable Diseases and their risk factors, this publication explores the alcohol-related findings of this national survey. Methods A door-to-door, household-based questionnaire was conducted on 3450 people from across Mongolia. Participants were recruited using a multi-stage random cluster sampling technique, and eligibility was granted to permanent residents of households who were aged between 15 and 64 years. A nationally representative sample size was calculated, based on methodologies aligned with the WHO STEPwise approach to Surveillance. Results Approximately 50% of males and 30% of females were found to be current drinkers of alcohol. Moreover, nine in ten respondents agreed that heavy episodic drinking of alcohol is common among Mongolians, and the harms of daily alcohol consumption were generally perceived to be high. Indeed, 90% of respondents regarded daily alcohol consumption as either ‘harmful’ or ‘very harmful’. Interestingly, morning drinking, suggestive of problematic drinking, was highest in rural men and was associated with lower-levels of education and unemployment. Conclusion This research suggests that Mongolia faces an epidemiological challenge in addressing the burden of alcohol use and related problems. Males, rural populations and those aged 25-34 years exhibited the highest levels of risky drinking practices, while urban populations exhibit higher levels of general alcohol consumption. These findings suggest a focus and context for public health measures addressing alcohol-related harm in Mongolia. PMID

  18. Identification of Best Practices for Resident Aesthetic Clinics in Plastic Surgery Training: The ACAPS National Survey

    PubMed Central

    Wu, Cindy; Bentz, Michael L.; Redett, Richard J.; Shack, R. Bruce; David, Lisa R.; Taub, Peter J.; Janis, Jeffrey E.

    2015-01-01

    Introduction: Resident aesthetic clinics (RACs) have demonstrated good outcomes and acceptable patient satisfaction, but few studies have evaluated their educational, financial, or medicolegal components. We sought to determine RAC best practices. Methods: We surveyed American Council of Academic Plastic Surgeon members (n = 399), focusing on operational details, resident supervision, patient safety, medicolegal history, financial viability, and research opportunities. Of the 96 respondents, 63 reported having a RAC, and 56% of plastic surgery residency program directors responded. Results: RACs averaged 243 patient encounters and 53.9 procedures annually, having been in existence for 19.6 years (mean). Full-time faculty (73%) supervised chief residents (84%) in all aspects of care (65%). Of the 63 RACs, 45 were accredited, 40 had licensed procedural suites, 28 had inclusion/exclusion criteria, and 31 used anesthesiologists. Seventeen had overnight capability, and 17 had a Life Safety Plan. No cases of malignant hyperthermia occurred, but 1 facility death was reported. Sixteen RACs had been involved in a lawsuit, and 33 respondents reported financial viability of the RACs. Net revenue was transferred to both the residents’ educational fund (41%) and divisional/departmental overhead (37%). Quality measures included case logs (78%), morbidity/mortality conference (62%), resident surveys (52%), and patient satisfaction scores (46%). Of 63 respondents, 14 have presented or published RAC-specific research; 80 of 96 of those who were surveyed believed RACs enhanced education. Conclusions: RACs are an important component of plastic surgery education. Most clinics are financially viable but carry high malpractice risk and consume significant resources. Best practices, to maximize patient safety and optimize resident education, include use of accredited procedural rooms and direct faculty supervision of all components of care. PMID:26146599

  19. Perceived future career prospects in general practice: quantitative results from questionnaire surveys of UK doctors

    PubMed Central

    Lambert, Trevor W; Smith, Fay; Goldacre, Michael J

    2016-01-01

    Background There are more studies of current job satisfaction among GPs than of their views about their future career prospects, although both are relevant to commitment to careers in general practice. Aim To report on the views of GPs compared with clinicians in other specialties about their future career prospects. Design and setting Questionnaire surveys were sent to UK medical doctors who graduated in selected years between 1974 and 2008. Method Questionnaires were sent to the doctors at different times after graduation, ranging from 3 to 24 years. Results Based on the latest survey of each graduation year of the 20 940 responders, 66.2% of GPs and 74.2% of hospital doctors were positive about their prospects and 9.7% and 8.3%, respectively, were negative. However, with increasing time since graduation and increasing levels of seniority, GPs became less positive about their prospects; by contrast, over time, surgeons became more positive. Three to 5 years after graduation, 86.3% of those training in general practice were positive about their prospects compared with 52.9% of surgical trainees: in surveys conducted 12–24 years after graduation, 60.2% of GPs and 76.6% of surgeons were positive about their prospects. Conclusion GPs held broadly positive views of their career prospects, as did other doctors. However, there was an increase in negativity with increasing time since graduation that was not seen in hospital doctors. Research into the causes of this negativity and policy measures to ameliorate it would contribute to the continued commitment of GPs and may help to reduce attrition. PMID:27578813

  20. Early PREdiction of Severe Sepsis (ExPRES-Sepsis) study: protocol for an observational derivation study to discover potential leucocyte cell surface biomarkers

    PubMed Central

    Antonelli, Jean; Warner, Noel; Brown, Kenneth Alun; Wright, John; Simpson, A John; Rennie, Jillian; Hulme, Gillian; Lewis, Sion Marc; Mare, Tracey Anne; Cookson, Sharon; Weir, Christopher John; Dimmick, Ian; Keenan, Jim; Rossi, Adriano Giorgio; Shankar-Hari, Manu; Walsh, Timothy S

    2016-01-01

    Introduction Sepsis is an acute illness resulting from infection and the host immune response. Early identification of individuals at risk of developing life-threatening severe sepsis could enable early triage and treatment, and improve outcomes. Currently available biomarkers have poor predictive value for predicting subsequent clinical course in patients with suspected infection. Circulating leucocytes provide readily accessible tissues that reflect many aspects of the complex immune responses described in sepsis. We hypothesise that measuring cellular markers of immune responses by flow cytometry will enable early identification of infected patients at risk of adverse outcomes. We aim to characterise leucocyte surface markers (biomarkers) and their abnormalities in a population of patients presenting to the hospital emergency department with suspected sepsis, and explore their ability to predict subsequent clinical course. Methods and analysis We will conduct a prospective, multicentre, clinical, exploratory, cohort observational study. To answer our study question, 3 patient populations will be studied. First, patients with suspected sepsis from the emergency department (n=300). To assess performance characteristics of potential tests, critically ill patients with established sepsis, and age and gender matched patients without suspicion of infection requiring hospital admission (both n=100) will be recruited as comparator populations. In all 3 groups, we plan to assess circulating biomarker profiles using flow cytometry. We will select candidate biomarkers by cross-cohort comparison, and then explore their predictive value for clinical outcomes within the cohort with suspected sepsis. Ethics and dissemination The study will be carried out based on the principles in the Declaration of Helsinki and the International Conference on Harmonisation Good Clinical Practice. Ethics approval has been granted from the Scotland A Research Ethics Committee (REC) and Oxford C

  1. Factors Affecting Dengue Prevention Practices: Nationwide Survey of the Malaysian Public

    PubMed Central

    Wong, Li Ping; Shakir, Sharina Mahavera Mohamad; Atefi, Narges; AbuBakar, Sazaly

    2015-01-01

    Background Efforts to stamp dengue in many dengue endemic countries has met little success. There is a need to re-examine and understand how the public at large view the dengue prevention efforts. This study aimed to examine the demographic factors, theoretical constructs of the Health Belief Model and knowledge about dengue and how these influence the practice of dengue prevention. Methods A national telephone survey was carried out with 2,512 individuals of the Malaysian public aged 18–60 years. Results The majority (73%) of the Malaysian public had a total dengue prevention score of 51–100 (of a possible score of 1–100). Multivariate analysis suggests significant correlates of higher dengue prevention practices with demographic background, perception of susceptibility to dengue, perceived density of mosquitoes in the neighbourhood and knowledge about dengue. Households of lower income of which the majority (40.7%) were from the rural areas, were associated with the highest odds [OR = 1.33; 95%CI = 1.09–1.67; p = 0.004] of dengue prevention. Dengue prevention practices were also less likely to be undertaken in neighbourhoods where the responders perceived there is no and/or low density of mosquitoes. Dengue prevention practices are also less likely to be practiced by skilled workers [OR = 0.78; 95%CI = 0.63–0.95; p = 0.029] compared to those unemployed. Higher perceived susceptibility to dengue was associated with higher dengue prevention practices and participants with higher dengue knowledge were found to have a higher level of involvement in dengue prevention practices. Conclusion Results from the study suggest that in formulating approaches to contain dengue, strategies should be developed to cultivate dengue prevention practices among urban population and target areas with low density of mosquitoes where public perceived a less likely chance of getting dengue. Dengue prevention campaigns should focus on messages highlighting the risk of contracting

  2. Integration of Complementary and Alternative Medicine into Family Practices in Germany: Results of a National Survey

    PubMed Central

    Joos, Stefanie; Musselmann, Berthold; Szecsenyi, Joachim

    2011-01-01

    More than two-thirds of patients in Germany use complementary and alternative medicine (CAM) provided either by physicians or non-medical practitioners (“Heilpraktiker”). There is little information about the number of family physicians (FPs) providing CAM. Given the widespread public interest in the use of CAM, this study aimed to ascertain the use of and attitude toward CAM among FPs in Germany. A postal questionnaire developed based on qualitatively derived data was sent to 3000 randomly selected FPs in Germany. A reminder letter including a postcard (containing a single question about CAM use in practice and reasons for non-particpation in the survey) was sent to all FPs who had not returned the questionnaire. Of the 3000 FPs, 1027 (34%) returned the questionnaire and 444 (15%) returned the postcard. Altogether, 886 of the 1471 responding FPs (60%) reported using CAM in their practice. A positive attitude toward CAM was indicated by 503 FPs (55%), a rather negative attitude by 127 FPs (14%). Chirotherapy, relaxation and neural therapy were rated as most beneficial CAM therapies by FPs, whereas neural therapy, phytotherapy and acupuncture were the most commonly used therapies in German family practices. This survey clearly demonstrates that CAM is highly valued by many FPs and is already making a substantial contribution to first-contact primary care in Germany. Therefore, education and research about CAM should be increased. Furthermore, with the provision of CAM by FPs, the role of non-medical CAM practitioners within the German healthcare system is to be questioned. PMID:19293252

  3. Consumer Shell Egg Consumption and Handling Practices: Results from a National Survey.

    PubMed

    Kosa, Katherine M; Cates, Sheryl C; Bradley, Samantha; Godwin, Sandria; Chambers, Delores

    2015-07-01

    Numerous cases and outbreaks of Salmonella infection are attributable to shell eggs each year in the United States. Safe handling and consumption of shell eggs at home can help reduce foodborne illness attributable to shell eggs. A nationally representative Web survey of 1,504 U.S. adult grocery shoppers was conducted to describe consumer handling practices and consumption of shell eggs at home. Based on self-reported survey data, most respondents purchase shell eggs from a grocery store (89.5%), and these eggs were kept refrigerated (not at room temperature; 98.5%). As recommended, most consumers stored shell eggs in the refrigerator (99%) for no more than 3 to 5 weeks (97.6%). After cracking eggs, 48.1% of respondents washed their hands with soap and water. More than half of respondents who fry and/or poach eggs cooked them so that the whites and/or the yolks were still soft or runny, a potentially unsafe practice. Among respondents who owned a food thermometer (62.0%), only 5.2% used it to check the doneness of baked egg dishes when they prepared such a dish. Consumers generally followed two of the four core "Safe Food Families" food safety messages ("separate" and "chill") when handling shell eggs at home. To prevent Salmonella infection associated with shell eggs, consumers should improve their practices related to the messages "clean" (i.e., wash hands after cracking eggs) and "cook" (i.e., cook until yolks and whites are firm and use a food thermometer to check doneness of baked egg dishes) when preparing shell eggs at home. These findings will be used to inform the development of science-based consumer education materials that can help reduce foodborne illness from Salmonella infection.

  4. Manipulative practice in the cervical spine: a survey of IFOMPT member countries

    PubMed Central

    Carlesso, Lisa; Rivett, Darren

    2011-01-01

    The International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) aims to achieve worldwide promotion of excellence and unity in clinical and academic standards for manual and musculoskeletal physical therapists. To this end, IFOMPT has sponsored several conference panel sessions and a survey of Member Organizations (MOs) and Registered Interest Groups (RIGs) regarding current cervical spine manipulation and pre-manipulative screening practice in each country. The purpose of this study was to determine common elements of cervical spine manipulative practice and pre-manipulative screening between countries. In late 2007, a questionnaire investigating recommended pre-manipulative screening protocol/guideline use, informed consent regarding risks, screening procedures, and treatment/manipulation technique was sent to all twenty MOs and five RIGs. The response rate was 88%. The main findings of the survey included: 77% of respondent organizations use pre-manipulative guidelines, with Australian guidelines the most frequently adopted internationally (36%); recommendations concerning the provision of information about the possibility of serious adverse events is not standard practice in all countries (50%); positional tests for vertebrobasilar insufficiency are used by all respondent organizations; craniovertebral ligament testing is sometimes taught as a pre-manipulative screening tool (36%); the use of upper cervical spine manipulation has declined in some countries (41%); and of the respondent organizations that continue to teach upper cervical manipulation, most (70%) minimize the rotation component. The findings of this research will inform an IFOMPT international standard for screening the cervical region prior to orthopaedic manual therapy intervention. The development of an IFOMPT endorsed document will be of assistance to manual therapy clinicians worldwide in safely managing disorders of the cervical spine. PMID:22547915

  5. Consumer Shell Egg Consumption and Handling Practices: Results from a National Survey.

    PubMed

    Kosa, Katherine M; Cates, Sheryl C; Bradley, Samantha; Godwin, Sandria; Chambers, Delores

    2015-07-01

    Numerous cases and outbreaks of Salmonella infection are attributable to shell eggs each year in the United States. Safe handling and consumption of shell eggs at home can help reduce foodborne illness attributable to shell eggs. A nationally representative Web survey of 1,504 U.S. adult grocery shoppers was conducted to describe consumer handling practices and consumption of shell eggs at home. Based on self-reported survey data, most respondents purchase shell eggs from a grocery store (89.5%), and these eggs were kept refrigerated (not at room temperature; 98.5%). As recommended, most consumers stored shell eggs in the refrigerator (99%) for no more than 3 to 5 weeks (97.6%). After cracking eggs, 48.1% of respondents washed their hands with soap and water. More than half of respondents who fry and/or poach eggs cooked them so that the whites and/or the yolks were still soft or runny, a potentially unsafe practice. Among respondents who owned a food thermometer (62.0%), only 5.2% used it to check the doneness of baked egg dishes when they prepared such a dish. Consumers generally followed two of the four core "Safe Food Families" food safety messages ("separate" and "chill") when handling shell eggs at home. To prevent Salmonella infection associated with shell eggs, consumers should improve their practices related to the messages "clean" (i.e., wash hands after cracking eggs) and "cook" (i.e., cook until yolks and whites are firm and use a food thermometer to check doneness of baked egg dishes) when preparing shell eggs at home. These findings will be used to inform the development of science-based consumer education materials that can help reduce foodborne illness from Salmonella infection. PMID:26197282

  6. United States Guild Certified Feldenkrais Teachers®: a survey of characteristics and practice patterns

    PubMed Central

    2014-01-01

    Background Feldenkrais Method® teachers help students improve function and quality of life through verbally and manually guided lessons. The reasons people seek Feldenkrais® lessons are poorly understood. Similarly, little is known about practice characteristics and patterns. To address these knowledge gaps, we conducted an extensive survey of United States Guild Certified Feldenkrais Teachers®. Methods We invited all Feldenkrais Teachers to participate in this survey delivered in web-based or print formats. We obtained overall and question-specific response rates, descriptive statistics, chi-square tests of response bias, and performed qualitative thematic review of comments. Results Overall response rate was 30.5% (392/1287). Ninety percent of responders had college degrees in diverse fields; 12.5% had credentials outside health care, 36.9% held conventional health care licenses, and 23.1% had complementary and alternative medicine credentials. Mean age was 55.7 years; most teachers were women (83%). California (n = 100) and New York (n = 34) had the most teachers. Forty-five percent of teachers earned ≤ 20% of their gross income from their practices, while 26% earned > 80%. Most saw < 10 students/week for individual lessons and < 10 students/week for group lessons. Students were mostly women (71.1%) and 45–64 years old. The primary reason students sought Feldenkrais lessons was pain. A quarter of students self-referred, a fifth were referred by conventional health care providers, and two-thirds paid for services directly. Themes from comments included: beliefs that Feldenkrais training had important personal and professional benefits for teachers; recognition of the challenges of operating small businesses and succinctly describing the Feldenkrais Method; the variety of practice approaches; and a deep commitment to the Feldenkrais Method. Conclusions Most Feldenkrais Teachers were well educated, often held additional credentials

  7. Infection control implementations at forensic medicine practice: a national survey in Turkey.

    PubMed

    Aydin, Berna; Tanyel, Esra; Colak, Basar; Fisgin, Nuriye; Tulek, Necla

    2009-06-01

    Because forensic medicine workers have a greater occupational risk for infectious diseases, strict rules and measures against infections must be implemented at every stage of forensic medicine practices. In this study, we aim to evaluate the infection control implementations in forensic medicine practices in Turkey.A questionnaire survey was mailed to forensic medicine specialists and residents between April and June 2005. The questionnaire consisted of 36 questions whose designed was based on standard precautions and protective barriers against infectious risks.In all, 111 doctors from 27 different cities responded to the questionnaire. Of those doctors who responded, 43.2% reported performing external examination anywhere. The percentage of doctors performing external examinations who regularly wore gloves, masks, and gowns, and washed hands with a disinfectant were 81.5%, 24.7%, 30.9%, and 81.5%, respectively. The percentage of doctors performing autopsies who regularly wore masks, protective eye-wear, gloves, special gloves, and special boots were 59.6%, 10.6%, 98.9%, 71.3%, and 36.2%, respectively. Only 2 negative pressure rooms were reported.According to these results, precautionary measures against infectious risks in forensic medicine practice in our country are insufficient. Conditions to facilitate and to improve the compliance with infection control procedures must be prepared.

  8. A survey of frameworks for best practices in weight-of-evidence analyses.

    PubMed

    Rhomberg, Lorenz R; Goodman, Julie E; Bailey, Lisa A; Prueitt, Robyn L; Beck, Nancy B; Bevan, Christopher; Honeycutt, Michael; Kaminski, Norbert E; Paoli, Greg; Pottenger, Lynn H; Scherer, Roberta W; Wise, Kimberly C; Becker, Richard A

    2013-10-01

    The National Academy of Sciences (NAS) Review of the Environmental Protection Agency's Draft IRIS Assessment of Formaldehyde proposed a "roadmap" for reform and improvement of the Agency's risk assessment process. Specifically, it called for development of a transparent and defensible methodology for weight-of-evidence (WoE) assessments. To facilitate development of an improved process, we developed a white paper that reviewed approximately 50 existing WoE frameworks, seeking insights from their variations and nominating best practices for WoE analyses of causation of chemical risks. Four phases of WoE analysis were identified and evaluated in each framework: (1) defining the causal question and developing criteria for study selection, (2) developing and applying criteria for review of individual studies, (3) evaluating and integrating evidence and (4) drawing conclusions based on inferences. We circulated the draft white paper to stakeholders and then held a facilitated, multi-disciplinary invited stakeholder workshop to broaden and deepen the discussion on methods, rationales, utility and limitations among the surveyed WoE frameworks. The workshop developed recommendations for improving the conduct of WoE evaluations. Based on the analysis of the 50 frameworks and discussions at the workshop, best practices in conducting WoE analyses were identified for each of the four phases. Many of these best practices noted from the analysis and workshop could be implemented immediately, while others may require additional refinement as part of the ongoing discussions for improving the scientific basis of chemical risk assessments.

  9. Five additions to the list of Sepsidae Diptera for Vietnam: Perochaeta cuirassa sp. n., Perochaeta lobo sp. n., Sepsis spura sp. n., Sepsis sepsi Ozerov, 2003 and Sepsis monostigma Thompson, 1869

    PubMed Central

    Ang, Yuchen; Meier, Rudolf

    2010-01-01

    Abstract A recent collecting trip to Vietnam yielded three new species and two new records of Sepsidae (Diptera) for the country. Here we describe two new species in the species-poor genus Perochaeta (Perochaeta cuirassa sp. n. andPerochaeta lobo sp. n.) and one to the largest sepsid genus Sepsis (Sepsis spura sp. n.) which is also found in Sumatra and Sulawesi. Two additional Sepsis species are new records for Vietnam (Sepsis sepsi Ozerov, 2003; Sepsis monostigma Thompson, 1869). We conclude with a discussion of the distribution of Perochaeta and the three Sepsis species. PMID:21594042

  10. The Surviving Sepsis Campaign: past, present and future.

    PubMed

    Schorr, Christa A; Dellinger, R Phillip

    2014-04-01

    The Surviving Sepsis Campaign (SSC) was created in 2002 and consists of severe sepsis management guidelines and a sepsis performance improvement program. The second revision of the guidelines, published in 2013, are sponsored by 30 international scientific organizations and contain changes in recommendations for fluids and vasopressor administration. The new 3- and 6-hour sepsis 'bundles' (sets of care elements) include a software program that can be downloaded free from the Surviving Sepsis Campaign website (www.survivingsepsis.org). The traditional intensive care unit and emergency department champion-driven sepsis performance improvement program continues internationally with the kick off of a new grant-funded hospital floor sepsis performance improvement initiative.

  11. The role of platelets in sepsis.

    PubMed

    de Stoppelaar, Sacha F; van 't Veer, Cornelis; van der Poll, Tom

    2014-10-01

    Platelets are small circulating anucleate cells that are of crucial importance in haemostasis. Over the last decade, it has become increasingly clear that platelets play an important role in inflammation and can influence both innate and adaptive immunity. Sepsis is a potentially lethal condition caused by detrimental host response to an invading pathogen. Dysbalanced immune response and activation of the coagulation system during sepsis are fundamental events leading to sepsis complications and organ failure. Platelets, being major effector cells in both haemostasis and inflammation, are involved in sepsis pathogenesis and contribute to sepsis complications. Platelets catalyse the development of hyperinflammation, disseminated intravascular coagulation and microthrombosis, and subsequently contribute to multiple organ failure. Inappropriate accumulation and activity of platelets are key events in the development of sepsis-related complications such as acute lung injury and acute kidney injury. Platelet activation readouts could serve as biomarkers for early sepsis recognition; inhibition of platelets in septic patients seems like an important target for immune-modulating therapy and appears promising based on animal models and retrospective human studies. PMID:24966015

  12. The role of platelets in sepsis.

    PubMed

    de Stoppelaar, Sacha F; van 't Veer, Cornelis; van der Poll, Tom

    2014-10-01

    Platelets are small circulating anucleate cells that are of crucial importance in haemostasis. Over the last decade, it has become increasingly clear that platelets play an important role in inflammation and can influence both innate and adaptive immunity. Sepsis is a potentially lethal condition caused by detrimental host response to an invading pathogen. Dysbalanced immune response and activation of the coagulation system during sepsis are fundamental events leading to sepsis complications and organ failure. Platelets, being major effector cells in both haemostasis and inflammation, are involved in sepsis pathogenesis and contribute to sepsis complications. Platelets catalyse the development of hyperinflammation, disseminated intravascular coagulation and microthrombosis, and subsequently contribute to multiple organ failure. Inappropriate accumulation and activity of platelets are key events in the development of sepsis-related complications such as acute lung injury and acute kidney injury. Platelet activation readouts could serve as biomarkers for early sepsis recognition; inhibition of platelets in septic patients seems like an important target for immune-modulating therapy and appears promising based on animal models and retrospective human studies.

  13. Update in sepsis and acute kidney injury 2014.

    PubMed

    Schortgen, Frédérique; Asfar, Pierre

    2015-06-01

    Sepsis and acute kidney injury (AKI) represent an important burden in intensive care unit clinical practices. The Journal published important contributions in sepsis for novel therapeutic approaches suggesting that combined molecular targets (e.g., dual inhibition of IL-1β and IL-18, and coadministration of endothelial progenitor cells and stromal cell-derived factor-1α analog) could perform better. The clinical effectiveness of 1,25-dihydroxyvitamin D was reported in a double-blind, randomized, placebo-controlled trial. Although its experimental properties appeared favorable in the pro- and antiinflammatory cytokine balance, 1,25-dihydroxyvitamin D failed to improve survival. Strategies for decreasing antimicrobial resistances are of particular importance. Effective (aerosolized antibiotics for ventilator-associated pneumonia) and ineffective (procalcitonin algorithm for antibiotic deescalation) approaches were published. In 2014, several publications raised an important point shared by survivors from sepsis and/or AKI. The increased number of survivors over time brought out long-term sequelae, leading to a poor outcome after hospital discharge. Among them, cardiovascular events and chronic kidney disease may explain the significant increase in the risk of death, which can persist up to 10 years and significantly increases the use of health care. Postdischarge survival represents a new target for future research in sepsis and AKI to find how we can prevent and manage long-term sequelae. A milestone of the year was the Ebola outbreak. The Journal contributed to our better understanding of Ebola virus disease with a paper underlying the crucial role of a large implementation of pragmatic supportive care, including fluid infusion and correction of metabolic abnormalities, to save more lives. PMID:26029837

  14. Marked variation in newborn resuscitation practice: A national survey in the UK☆

    PubMed Central

    Mann, Chantelle; Ward, Carole; Grubb, Mark; Hayes-Gill, Barrie; Crowe, John; Marlow, Neil; Sharkey, Don

    2012-01-01

    Background Although international newborn resuscitation guidance has been in force for some time, there are no UK data on current newborn resuscitation practices. Objective Establish delivery room (DR) resuscitation practices in the UK, and identify any differences between neonatal intensive care units (NICU), and other local neonatal services. Methods We conducted a structured two-stage survey of DR management, among UK neonatal units during 2009–2010 (n = 192). Differences between NICU services (tertiary level) and other local neonatal services (non-tertiary) were analysed using Fisher's exact and Student's t-tests. Results There was an 89% response rate (n = 171). More tertiary NICUs institute DR CPAP than non-tertiary units (43% vs. 16%, P = 0.0001) though there was no significant difference in frequency of elective intubation and surfactant administration for preterm babies. More tertiary units commence DR resuscitation in air (62% vs. 29%, P < 0.0001) and fewer in 100% oxygen (11% vs. 41%, P < 0.0001). Resuscitation of preterm babies in particular, commences with air in 56% of tertiary units. Significantly more tertiary units use DR pulse oximeters (58% vs. 29%, P < 0.01) and titrate oxygen based on saturations. Almost all services use occlusive wrapping to maintain temperature for preterm infants. Conclusions In the UK, there are many areas of good evidence based DR practice. However, there is marked variation in management, including between units of different designation, suggesting a need to review practice to fulfil new resuscitation guidance, which will have training and resource implications. PMID:22245743

  15. Hepatocellular Carcinoma Screening Practices in the Department of Veterans Affairs: Findings from a National Facility Survey

    PubMed Central

    Alsarraj, Abeer; Richardson, Peter; Davila, Jessica A.; Kramer, Jennifer R.; Durfee, Janet; Kanwal, Fasiha

    2013-01-01

    Background Previous studies suggest low rates of hepatocellular carcinoma (HCC) screening in clinical practice. There is little information on the provider- and healthcare-facility-related factors that explain the use of HCC screening. Aims We used data from the 2007 Survey to Assess Hepatitis C Care in Veterans Health Administration that collected information regarding the care of patients with hepatitis C virus (HCV) from 138 of 140 Veterans Administration healthcare facilities nationwide. Methods All providers caring for veterans with HCV were invited to respond. In addition, each facility was asked to identify a lead HCV clinician to respond to facility-specific questions. Our outcome was a response concordant with HCC screening guidelines [HCC screening in patients with cirrhosis or in patients with chronic hepatitis B virus (HBV), and screening every 6 or 12 months]. Results A total of 268 providers responded (98 % facility participation rate). Of these, 190 respondents (70.9 %) reported recommending HCC screening with guideline-concordant risk groups and frequency. Providers reporting guideline-concordant HCC screening practices were significantly more likely to have expertise in liver disease (MD, gastroenterologists or hepatologists), routinely screen for varices, prescribe HCV treatment, and refer or manage patients with liver transplant. The availability of HCC-specific treatments on site was the main facility factor associated with guideline-concordant HCC screening. Conclusions Self-reported rates of guideline-concordant HCC screening are considerably higher than those seen in routine VA practice. Provider expertise in liver disease and the perceived availability of HCC treatment including transplantation in the local facility are important factors driving self-reported HCC screening practices. PMID:23868438

  16. Sepsis

    MedlinePlus

    ... fluids are given through a vein. Other medical treatments include: Medicines that increase blood pressure Dialysis if there is kidney failure A breathing machine ( mechanical ventilation ) if there is lung failure

  17. Sepsis

    MedlinePlus

    ... 100.4°F [38°C] and above rectal temperature) in newborns and young infants labored or unusual breathing change in skin color (paler than usual or mildly bluish) or a rash listlessness or lethargy change in the sound of the baby's cry or excessive crying change ...

  18. Diagnostic Value of Presepsin for Sepsis

    PubMed Central

    Zhang, Jing; Hu, Zhi-De; Song, Jia; Shao, Jiang

    2015-01-01

    Abstract Several individual studies have reported the diagnostic accuracy of presepsin (sCD14-ST) for sepsis, but the results are inconsistent. The present systematic review and meta-analysis pooled data to better ascertain the value of circulatory presepsin as a biomarker for sepsis. Studies published in English before November 7, 2014 and assessing the diagnostic accuracy of presepsin for sepsis were retrieved from medical databases. The quality of eligible studies was assessed using a revised Quality Assessment for Studies of Diagnostic Accuracy (QUADAS-2). The overall diagnostic accuracy of presepsin for sepsis was pooled according to a bivariate model. Publication bias was assessed using Deek funnel plot asymmetry test. Eleven studies satisfied the inclusion criteria. The overall diagnostic sensitivity of presepsin for sepsis was 0.83 (95% CI: 0.77–0.88), and specificity was 0.78 (95% CI: 0.72–0.83). The area under the summary receiver operating characteristic curve was 0.88 (95% CI: 0.84–0.90). The pretest probability of sepsis was 0.56 among all subjects. When presepsin was introduced as the diagnostic test for sepsis, the posttest probabilities were 0.81 for a positive result and 0.19 for a negative. The major design deficits of the included studies were lack of prespecified thresholds and patient selection bias. The publication bias was negative. Presepsin is an effective adjunct biomarker for the diagnosis of sepsis, but is insufficient to detect or rule out sepsis when used alone. PMID:26632748

  19. Ethical and practical challenges raised by an adult day program's caregiver satisfaction survey.

    PubMed

    Madeo, Anica; Feld, Sheila; Spencer, Beth

    2008-01-01

    A consumer satisfaction survey was completed by 21 caregivers to persons with dementia, who participated in Silver Club, a person-centered Adult Day Service program. Two themes emerged: caregivers expressed high program satisfaction based on joint benefits to members and caregivers, and they desired more information about the nature of the members' daily participation. These findings raised two important issues for program staff. First, Adult Day Service programs are often referred to and marketed as providing caregiver respite. This approach does not acknowledge caregivers' interest in programs that meet the needs of their loved ones, and may lead to reluctance to use programs that only stress the value of respite. Second, caregivers' desires for detailed feedback about members' program participation raise ethical and practical challenges within person-centered models of care. Collecting feedback from both participants and their caregivers can help monitor and improve services provided by person-centered Adult Day Service programs.

  20. End‐of‐life decisions in medical practice: a survey of doctors in Victoria (Australia)

    PubMed Central

    Neil, D A; Coady, C A J; Thompson, J; Kuhse, H

    2007-01-01

    Objectives To discover the current state of opinion and practice among doctors in Victoria, Australia, regarding end‐of‐life decisions and the legalisation of voluntary euthanasia. Longitudinal comparison with similar 1987 and 1993 studies. Design and participants Cross‐sectional postal survey of doctors in Victoria. Results 53% of doctors in Victoria support the legalisation of voluntary euthanasia. Of doctors who have experienced requests from patients to hasten death, 35% have administered drugs with the intention of hastening death. There is substantial disagreement among doctors concerning the definition of euthanasia. Conclusions Disagreement among doctors concerning the meaning of the term euthanasia may contribute to misunderstanding in the debate over voluntary euthanasia. Among doctors in Victoria, support for the legalisation of voluntary euthanasia appears to have weakened slightly over the past 17 years. Opinion on this issue is sharply polarised. PMID:18055904

  1. Informed consent for epidural analgesia in labour: a survey of UK practice.

    PubMed

    Middle, J V; Wee, M Y K

    2009-02-01

    Anaesthetists are legally obliged to obtain informed consent before performing regional analgesia in labour. A postal survey of consultant-led UK anaesthetic units was performed in September 2007 to assess practice regarding obtaining informed consent before inserting an epidural, and documentation of the risks discussed. The response rate was 72% (161/223). There was great variation between units regarding which risks women were informed about and the likely incidence of that risk. One hundred and twenty-three respondents out of 157 providing an epidural service (78%) supported a national standardised information card endorsed by the Obstetric Anaesthetists' Association, with all the benefits and risks stated, to be shown to all women before consenting to an epidural in labour.

  2. A telephone survey of internal parasite control practices on sheep farms in Spain.

    PubMed

    Rojo-Vázquez, Francisco A; Hosking, Barry C

    2013-02-18

    A telephone survey of farmers was conducted to determine current internal parasite control practices on sheep farms in Spain; the farmers were interviewed by their veterinarians. Anthelmintic choice was largely on veterinary advice and dominated by benzimidazoles and macrocyclic lactones. Anthelmintic rotation was separated into: no rotation (42% of farms); annual rotation (36%); rotate within year (20%); and rotate every second year (2%). The mean annual number of treatments varied subtly by region; ewes and rams 1.6-2.1, replacement lambs 1.7-2.1. Anthelmintics are administered primarily during spring and early summer (47% of treatments), and autumn (41%). Thirty-two percent of farmers introduced sheep to their properties and more than half did not quarantine drench the arrivals.

  3. Reinforcing staff performance in residential facilities: a survey of common managerial practices.

    PubMed

    Green, C W; Reid, D H

    1991-08-01

    A national survey was conducted to investigate how managers in public residential facilities for persons with mental retardation attempt to reinforce work performance of direct-care staff. The reinforcement procedure reported most frequently by 460 managers was performance feedback (as opposed to monetary increments and time off). Essentially all managers reported using feedback, and virtually all of them reported that feedback was effective to varying degrees as a means of reinforcing staff performance. In response to an open-ended question regarding other procedures for reinforcing staff performance, they most frequently reported increasing staff involvement in management decision-making. Results were discussed in light of future research needs for improving staff work performance and incorporating results of management research into routine management practices.

  4. Disease Risk Perception and Safety Practices: A Survey of Australian Flying Fox Rehabilitators

    PubMed Central

    Sánchez, Cecilia A.; Baker, Michelle L.

    2016-01-01

    Interactions with flying foxes pose disease transmission risks to volunteer rehabilitators (carers) who treat injured, ill, and orphaned bats. In particular, Australian bat lyssavirus (ABLV) can be transmitted directly from flying foxes to humans in Australia. Personal protective equipment (PPE) and rabies vaccination can be used to protect against lyssavirus infection. During May and June 2014, active Australian flying fox carers participated in an online survey (SOAR: Survey Of Australian flying fox Rehabilitators) designed to gather demographic data, assess perceptions of disease risk, and explore safety practices. Responses to open-ended questions were analysed thematically. A logistic regression was performed to assess whether rehabilitators’ gender, use of PPE, threat perception, and years of experience predicted variation in their odds of being bitten or scratched. Eligible responses were received from 122 rehabilitators located predominantly on the eastern coast of Australia. Eighty-four percent of respondents were female. Years of experience ranged from <1 to 30 years (median 5 years). Respondents were highly educated. All rehabilitators were vaccinated against rabies and 94% received a rabies titre check at least every two years. Sixty-three percent of carers did not perceive viruses in flying foxes as a potential threat to their health, yet 74% of carers reported using PPE when handling flying foxes. Eighty-three percent of rehabilitators had received a flying fox bite or scratch at some point during their career. Carers provide an important community service by rescuing and rehabilitating flying foxes. While rehabilitators in this study have many excellent safety practices, including a 100% vaccination rate against rabies, there is room for improvement in PPE use. We recommend 1) the establishment of an Australia-wide set of guidelines for safety when caring for bats and 2) that the responsible government agencies in Australia support carers who

  5. Large-scale survey to describe acne management in Brazilian clinical practice

    PubMed Central

    Seité, Sophie; Caixeta, Clarice; Towersey, Loan

    2015-01-01

    Background Acne is a chronic disease of the pilosebaceous unit that mainly affects adolescents. It is the most common dermatological problem, affecting approximately 80% of teenagers between 12 and 18 years of age. Diagnosis is clinical and is based on the patient’s age at the time the lesions first appear, and on its polymorphism, type of lesions, and their anatomical location. The right treatment for the right patient is key to treating acne safely. The aim of this investigational survey was to evaluate how Brazilian dermatologists in private practice currently manage acne. Materials and methods Dermatologists practicing in 12 states of Brazil were asked how they manage patients with grades I, II, III, and IV acne. Each dermatologist completed a written questionnaire about patient characteristics, acne severity, and the therapy they usually prescribe for each situation. Results In total, 596 dermatologists were interviewed. Adolescents presented as the most common acneic population received by dermatologists, and the most common acne grade was grade II. The doctors could choose more than one type of treatment for each patient, and treatment choices varied according to acne severity. A great majority of dermatologists considered treatment with drugs as the first alternative for all acne grades, choosing either topical or oral presentation depending on the pathology severity. Dermocosmetics were chosen mostly as adjunctive therapy, and their inclusion in the treatment regimen decreased as acne grades increased. Conclusion This survey illustrates that Brazilian dermatologists employ complex treatment regimens to manage acne, choosing systemic drugs, particularly isotretinoin, even in some cases of grade I acne, and heavily prescribe antibiotics. Because complex regimens are harder for patients to comply with, this result notably raises the question of adherence, which is a key factor in successful treatment. PMID:26609243

  6. Disease Risk Perception and Safety Practices: A Survey of Australian Flying Fox Rehabilitators.

    PubMed

    Sánchez, Cecilia A; Baker, Michelle L

    2016-02-01

    Interactions with flying foxes pose disease transmission risks to volunteer rehabilitators (carers) who treat injured, ill, and orphaned bats. In particular, Australian bat lyssavirus (ABLV) can be transmitted directly from flying foxes to humans in Australia. Personal protective equipment (PPE) and rabies vaccination can be used to protect against lyssavirus infection. During May and June 2014, active Australian flying fox carers participated in an online survey (SOAR: Survey Of Australian flying fox Rehabilitators) designed to gather demographic data, assess perceptions of disease risk, and explore safety practices. Responses to open-ended questions were analysed thematically. A logistic regression was performed to assess whether rehabilitators' gender, use of PPE, threat perception, and years of experience predicted variation in their odds of being bitten or scratched. Eligible responses were received from 122 rehabilitators located predominantly on the eastern coast of Australia. Eighty-four percent of respondents were female. Years of experience ranged from <1 to 30 years (median 5 years). Respondents were highly educated. All rehabilitators were vaccinated against rabies and 94% received a rabies titre check at least every two years. Sixty-three percent of carers did not perceive viruses in flying foxes as a potential threat to their health, yet 74% of carers reported using PPE when handling flying foxes. Eighty-three percent of rehabilitators had received a flying fox bite or scratch at some point during their career. Carers provide an important community service by rescuing and rehabilitating flying foxes. While rehabilitators in this study have many excellent safety practices, including a 100% vaccination rate against rabies, there is room for improvement in PPE use. We recommend 1) the establishment of an Australia-wide set of guidelines for safety when caring for bats and 2) that the responsible government agencies in Australia support carers who rescue

  7. A survey of French general practitioners on the epidemiology of wounds in family practice

    PubMed Central

    Sarazin, Marianne; Roberton, Florence; Charles, Rodolphe; Falchi, Alessandra; Chiappe, Solange Gonzales; Blanchon, Thierry; Lucht, Frédéric; Hanslik, Thomas

    2015-01-01

    Background To measure the frequency and nature of wounds in patients treated in general practice and to describe the patients’ tetanus vaccination status and the sources providing information about this status. Methods A descriptive, prospective, week-long, national electronic survey was conducted among general practitioners within the Sentinelles network. Results The participation rate was 12.6% (95% confidence interval [CI], 10.6%–14.6%; 130 general practitioners): 197 patients with wounds were reported, and 175 of them were described. Wound frequency was 1.4 (95% CI, 1.2–1.6) per 100 consultations. These wounds had an acute character in 76 (95% CI, 69.7–82.3) of cases, were mostly of traumatic origin (54.8% of cases; 95% CI, 47.5%–62.1%), were more than 24 hours old (67.1%; 95% CI, 59.1%–75.1%), and were clean, without bone and/or muscle decay (94%; 95% CI, 90.5%–97.5%). Vaccination status was known for 71 (95% CI, 64–78) patients. According to the 2013 immunization schedule, 21% (95% CI, 13.9%–28.1%) of the patients had not updated their vaccinations, mostly among the patients older than 75 years. Conclusion This survey describes in detail the wounds treated in general practice in France and the associated patients’ immunization status. It also shows how difficult it is for general practitioners to assess the risk of contracting tetanus and the disease’s development. It highlights as well the fact that the ideal solution to assess tetanus risk is an up-to-date immunization schedule. PMID:26124675

  8. A survey of offloading practices for diabetes-related plantar neuropathic foot ulcers

    PubMed Central

    2014-01-01

    Background Offloading is key to preventing or healing plantar neuropathic foot ulcers in diabetes. Total contact casts or walkers rendered irremovable are recommended in guidelines as first-line options for offloading, however the use of such devices has been found to be low. This study aimed to investigate offloading practices for diabetes-related plantar neuropathic ulcers. Methods An online survey of closed and open-ended questions was administered via SurveyMonkey®. Forty-one podiatrists experienced in high-risk foot practice, from 21 high-risk foot services around Australia, were approached to participate. Results The response rate was 88%. Participants reported using 21 modalities or combinations of modalities, for offloading this ulcer type. The most frequently used modalities under the forefoot and hallux were felt padding, followed by removable casts or walkers, then non-removable casts or walkers. Participants indicated that many factors were considered when selecting offloading modality, including: compliance, risk of adverse effects, psycho-social factors, restrictions on activities of daily living, work needs and features of the wound. The majority of participants (83%) considered non-removable casts or walkers to be the gold-standard for offloading this ulcer type, however they reported numerous, particularly patient-related, barriers to their use. Conclusions Selecting offloading for the management of foot ulceration is complex. Felt padding, not the gold-standard non-removable cast or walker, was reported as the most commonly selected modality for offloading plantar neuropathic ulceration. However, further evaluation of felt padding in high quality clinical trials is required to ascertain its effectiveness for ulcer healing. PMID:25694793

  9. Dysglycemia and Glucose Control During Sepsis.

    PubMed

    Plummer, Mark P; Deane, Adam M

    2016-06-01

    Sepsis predisposes to disordered metabolism and dysglycemia; the latter is a broad term that includes hyperglycemia, hypoglycemia, and glycemic variability. Dysglycemia is a marker of illness severity. Large randomized controlled trials have provided considerable insight into the optimal blood glucose targets for critically ill patients with sepsis. However, it may be that the pathophysiologic consequences of dysglycemia are dynamic throughout the course of a septic insult and also altered by premorbid glycemia. This review highlights the relevance of hyperglycemia, hypoglycemia, and glycemic variability in patients with sepsis with an emphasis on a rational approach to management. PMID:27229647

  10. Management of neonatal sepsis in term newborns

    PubMed Central

    Du Pont-Thibodeau, Geneviève; Joyal, Jean-Sébastien

    2014-01-01

    Neonatal sepsis is a common and deadly disease. It is broadly defined as a systemic inflammatory response, occurring in the first four weeks of life, as a result of a suspected or proven infection. Yet, more reliable and consistently applied diagnostic criteria would help improve our knowledge of the disease epidemiology. Several therapeutic attempts to control systemic inflammation in sepsis were unsuccessful. Immediate empirical administration of broad-spectrum anti-microbials, aggressive fluid resuscitation, and vaso-active or inotropic support (or both) are the mainstays of the therapeutic management of neonatal sepsis. PMID:25165566

  11. Morganella morganii sepsis with massive hemolysis.

    PubMed

    Kim, Jong Hoon; Cho, Chong Rae; Um, Tae Hyun; Rhu, Ji Yoon; Kim, Eu Suk; Jeong, Jae Won; Lee, Hye Ran

    2007-12-01

    Morganella morganii is a facultative gram-negative and anaerobic rod. It may be a cause of devastating infections in neonates and immunocompromised hosts. Some bacterial infections such as Clostridium and Vibrio are associated with hemolysis. However, massive hemolysis caused by M. morganii sepsis has not yet been reported. We observed a 59-yr-old man who had chemotherapy-induced neutropenia and was found to have massive hemolysis and metabolic acidosis due to sepsis. He died 6 hr after admission in spite of aggressive treatment. Two sets of blood cultures revealed the growth of M. morganii. We report here that M. morganii sepsis can cause fatal massive hemolysis leading to death.

  12. Sepsis Resuscitation: Fluid Choice and Dose.

    PubMed

    Semler, Matthew W; Rice, Todd W

    2016-06-01

    Sepsis is a common and life-threatening inflammatory response to severe infection treated with antibiotics and fluid resuscitation. Despite the central role of intravenous fluid in sepsis management, fundamental questions regarding which fluid and in what amount remain unanswered. Recent advances in understanding the physiologic response to fluid administration, and large clinical studies examining resuscitation strategies, fluid balance after resuscitation, colloid versus crystalloid solutions, and high- versus low-chloride crystalloids, inform the current approach to sepsis fluid management and suggest areas for future research.

  13. Evidence-Based Practice Knowledge, Use, and Factors that Influence Decisions: Results from an Evidence-Based Practice Survey of Providers in American Indian/Alaska Native Communities

    ERIC Educational Resources Information Center

    Sheehan, Angela; Walrath-Greene, Christine; Fisher, Sylvia; Crossbear, Shannon; Walker, Joseph

    2007-01-01

    Data from the Evidence-based Treatment Survey were used to compare providers serving families in American Indian and Alaska Native communities to their counterparts in non-American Indian/Alaska Native communities on provider characteristics and factors that influence their decision to use evidence-based practices (N = 467). The findings suggest…

  14. Rorschach scores in applied clinical practice: a survey of perceived validity by experienced clinicians.

    PubMed

    Meyer, Gregory J; Hsiao, Wei-Cheng; Viglione, Donald J; Mihura, Joni L; Abraham, Leah M

    2013-01-01

    We surveyed practicing clinicians who regularly used the Rorschach about the perceived clinical validity of specific Rorschach scores from many coding systems. The survey included quantitative feedback on the validity of specific variables as well as qualitative input in several areas, including the validity of specific variables, the potentially unique information that can be obtained from them, coding challenges associated with Comprehensive System (CS) codes, and recommendations for CS developments. Participants were recruited by applying a snowball sampling strategy. Based on responses from 246 experienced clinicians from 26 countries, composite judgments on rated variables were quite reliable (e.g., M α = .95 across 88 CS variables), despite limited agreement among any 2 judges. The aggregated judgments clearly differentiated among scores that were considered more and less clinically valid and the overall results aligned with recently obtained meta-analytic conclusions from the traditional validity literature (Mihura, Meyer, Dumitrascu, & Bombel, 2012). The judges also provided guidance concerning revisions and enhancements that would facilitate Rorschach-based assessment in the future. We discuss the implication of the quantitative and qualitative findings and provide suggestions for future directions based on the results. PMID:23452352

  15. A Survey on Transport Management Practices Associated with Injuries and Health Problems in Horses.

    PubMed

    Padalino, Barbara; Raidal, Sharanne L; Hall, Evelyn; Knight, Peter; Celi, Pietro; Jeffcott, Leo; Muscatello, Gary

    2016-01-01

    An online survey was conducted to determine associations between transport management and transport-related injuries and diseases in horses in Australia. The survey was composed of three sections: respondents' demographic information, transport management strategies or procedures (before, during and after transportation) and transport diseases experienced in the previous two year period. Univariate and multivariate modelling was performed exploring associations between variables (respondents' details and transport management strategies) and the following transport-related diseases as outcomes: traumatic injuries, diarrhoea, heat stroke, muscular problems, laminitis, transport pneumonia and colic. The survey generated 797 responses. Traumatic injuries were the most common transport-related problem, with a reported incidence of 45.0%. Younger respondents (<40 years old) caring for large numbers of horses (>30 in a week) were more likely to report transport-related injuries. Injury risk was also linked to the use of protections and tranquilizers prior to transport, and checking horses after the journey. Diarrhoea (20.0%) and heat stroke (10.5%) were reported more by amateur than professional horse carers. Increased risk of heat stroke was linked to the restriction of hay and water prior to transportation. Muscular problems (13.0%) appeared to be exacerbated when horse health was not assessed before journey; whilst the risk of laminitis (2.9%) was around three fold greater when post transport recovery strategies were not applied. Associations were made between transport pneumonia (9.2%) and duration of journey, and with activity (horses involved in racing at greater risk). No associations were seen between the incidence of colic (10.3%) and the variables examined. Study findings should be interpreted with caution as they represent participant perceptions and recall. Nevertheless, results support many current recommendations for safe transportation of horses. They also

  16. Tyrosine monitoring in children with early and continuously treated phenylketonuria: results of an international practice survey.

    PubMed

    Sharman, Rachael; Sullivan, Karen A; Young, Ross McD; McGill, James J

    2010-12-01

    Investigations into the biochemical markers associated with executive function (EF) impairment in children with early and continuously treated phenylketonuria (ECT-PKU) remain largely phenylalanine-only focused, despite experimental data showing that a high phenylalanine:tyrosine (phe:tyr) ratio is more strongly associated with EF deficit than phe alone. A high phe:tyr ratio is hypothesized to lead to a reduction in dopamine synthesis within the brain, which in turn results in the development of EF impairment. This paper provides a snapshot of current practice in the monitoring and/or treatment of tyrosine levels in children with PKU, across 12 countries from Australasia, North America and Europe. Tyrosine monitoring in this population has increased over the last 5 years, with over 80% of clinics surveyed reporting routine monitoring of tyrosine levels in infancy alongside phe levels. Twenty-five percent of clinics surveyed reported actively treating/managing tyrosine levels (with supplemental tyrosine above that contained in PKU formulas) to ensure tyrosine levels remain within normal ranges. Anecdotally, supplemental tyrosine has been reported to ameliorate symptoms of both attention deficit hyperactivity disorder and depression in this population. EF assessment of children with ECT-PKU was likewise highly variable, with 50% of clinics surveyed reporting routine assessments of intellectual function. However when function was assessed, test instruments chosen tended towards global measures of IQ prior to school entry, rather than specific assessment of EF development. Further investigation of the role of tyrosine and its relationship with phe and EF development is needed to establish whether routine tyrosine monitoring and increased supplementation is recommended. PMID:20882350

  17. A Survey on Transport Management Practices Associated with Injuries and Health Problems in Horses

    PubMed Central

    Padalino, Barbara; Raidal, Sharanne L.; Hall, Evelyn; Knight, Peter; Celi, Pietro; Jeffcott, Leo; Muscatello, Gary

    2016-01-01

    An online survey was conducted to determine associations between transport management and transport-related injuries and diseases in horses in Australia. The survey was composed of three sections: respondents’ demographic information, transport management strategies or procedures (before, during and after transportation) and transport diseases experienced in the previous two year period. Univariate and multivariate modelling was performed exploring associations between variables (respondents’ details and transport management strategies) and the following transport-related diseases as outcomes: traumatic injuries, diarrhoea, heat stroke, muscular problems, laminitis, transport pneumonia and colic. The survey generated 797 responses. Traumatic injuries were the most common transport-related problem, with a reported incidence of 45.0%. Younger respondents (<40 years old) caring for large numbers of horses (>30 in a week) were more likely to report transport-related injuries. Injury risk was also linked to the use of protections and tranquilizers prior to transport, and checking horses after the journey. Diarrhoea (20.0%) and heat stroke (10.5%) were reported more by amateur than professional horse carers. Increased risk of heat stroke was linked to the restriction of hay and water prior to transportation. Muscular problems (13.0%) appeared to be exacerbated when horse health was not assessed before journey; whilst the risk of laminitis (2.9%) was around three fold greater when post transport recovery strategies were not applied. Associations were made between transport pneumonia (9.2%) and duration of journey, and with activity (horses involved in racing at greater risk). No associations were seen between the incidence of colic (10.3%) and the variables examined. Study findings should be interpreted with caution as they represent participant perceptions and recall. Nevertheless, results support many current recommendations for safe transportation of horses. They

  18. Sepsis, venous return, and teleology.

    PubMed

    McNeilly, R G

    2014-11-01

    An understanding of heart-circulation interaction is crucial to our ability to guide our patients through an episode of septic shock. Our knowledge has advanced greatly in the last one hundred years. There are, however, certain empirical phenomena that may lead us to question the wisdom of our prevailing treatment algorithm. Three extreme but iatrogenically possible haemodynamic states exist. Firstly, inappropriately low venous return; secondly, overzealous arteriolar constriction; and finally, misguided inotropy and chronotropy. Following an unsuccessful fluid challenge, it would be logical to first set the venous tone, then set the cardiac rate and contractility, and finally set the peripheral vascular resistance. It is hypothesized that a combination of dihydroergotamine, milrinone and esmolol should be superior to a combination of noradrenaline and dobutamine for surviving sepsis. PMID:25245463

  19. A prospective treatment for sepsis.

    PubMed

    Shahidi Bonjar, Mohammad Rashid; Shahidi Bonjar, Leyla

    2015-01-01

    The present paper proposes a prospective auxiliary treatment for sepsis. There exists no record in the published media on the subject. As an auxiliary therapy, efficacious extracorporeal removal of sepsis-causing bacterial antigens and their toxins (BATs) from the blood of septic patients is discussed. The principal component to this approach is a bacterial polyvalent antibody-column (BPVAC), which selectively traps wide spectrum of BATs from blood in an extracorporeal circuit, and detoxified blood returns back to the patient's body. BPVAC treatment would be a device of targeted medicine. Detoxification is performed under supervision of trained personnel using simple blood-circulating machines in which blood circulates from the patient to BPVAC and back to the patient aseptically. BPVACs' reactive sites consist of carbon nanotubes on which a vast spectra of polyvalent BATs-antibodies are bond to. The devise acts as a biological filter that selectively immobilizes harmful BATs from intoxicated blood; however, no dialysis is involved. For effective neutralization, BPVAC provides large contact surface area with blood. BPVAC approach would have advantages of: 1) urgent neutralization of notorious BATs from blood of septic patients; 2) applicability in parallel with conventional treatments; 3) potential to minimize side effects of the malady; 4) applicability for a vast range of BATs; 5) potential to eliminate contact of BATs with internal tissues and organs; 6) tolerability by patients sensitive to antiserum injections; 7) capability for universal application; 8) affectivity when antibiotic-resistant bacteria are involved and the physician has no or limited access to appropriate antibiotics; and 10) being a single-use, disposable, and stand-alone device. Before using it for clinical trials in human beings, it should pass animal evaluations accurately; however, research works should optimize its implementation in human beings. For optimization, it needs appropriate

  20. A prospective treatment for sepsis

    PubMed Central

    Shahidi Bonjar, Mohammad Rashid; Shahidi Bonjar, Leyla

    2015-01-01

    The present paper proposes a prospective auxiliary treatment for sepsis. There exists no record in the published media on the subject. As an auxiliary therapy, efficacious extracorporeal removal of sepsis-causing bacterial antigens and their toxins (BATs) from the blood of septic patients is discussed. The principal component to this approach is a bacterial polyvalent antibody-column (BPVAC), which selectively traps wide spectrum of BATs from blood in an extracorporeal circuit, and detoxified blood returns back to the patient’s body. BPVAC treatment would be a device of targeted medicine. Detoxification is performed under supervision of trained personnel using simple blood-circulating machines in which blood circulates from the patient to BPVAC and back to the patient aseptically. BPVACs’ reactive sites consist of carbon nanotubes on which a vast spectra of polyvalent BATs-antibodies are bond to. The devise acts as a biological filter that selectively immobilizes harmful BATs from intoxicated blood; however, no dialysis is involved. For effective neutralization, BPVAC provides large contact surface area with blood. BPVAC approach would have advantages of: 1) urgent neutralization of notorious BATs from blood of septic patients; 2) applicability in parallel with conventional treatments; 3) potential to minimize side effects of the malady; 4) applicability for a vast range of BATs; 5) potential to eliminate contact of BATs with internal tissues and organs; 6) tolerability by patients sensitive to antiserum injections; 7) capability for universal application; 8) affectivity when antibiotic-resistant bacteria are involved and the physician has no or limited access to appropriate antibiotics; and 10) being a single-use, disposable, and stand-alone device. Before using it for clinical trials in human beings, it should pass animal evaluations accurately; however, research works should optimize its implementation in human beings. For optimization, it needs appropriate

  1. Seeking Sepsis in the Emergency Department- Identifying Barriers to Delivery of the Sepsis 6.

    PubMed

    Bentley, James; Henderson, Susan; Thakore, Shobhan; Donald, Michael; Wang, Weijie

    2016-01-01

    The Sepsis 6 is an internationally accepted management bundle that, when initiated within one hour of identifying sepsis, can reduce morbidity and mortality. This management bundle was advocated by the Scottish Patient Safety Programme as part of its Acute Adult campaign launched in 2008 and adopted by NHS Tayside in 2012. Despite this, the Emergency Department (ED) of Ninewells Hospital, a tertiary referral centre and major teaching hospital in Scotland, was displaying poor success in the Sepsis 6. We therefore set out to improve compliance by evaluating the application of all aspects of the NHS Tayside Sepsis 6 bundle within one hour of ED triage time, to identify what human factors may influence achieving the one hour The Sepsis 6 bundle. This allowed us to tailor a number of specific interventions including educational sessions, regular audit and personal feedback and check list Sepsis 6 sticker. These interventions promoted a steady increase in compliance from an initial rate of 51.0% to 74.3%. The project highlighted that undifferentiated patients create a challenge in initiating the Sepsis 6. Pyrexia is a key human factor-trigger for recognising sepsis with initial nursing assessment being vital in recognition and identifying the best area (resus) of the department to manage severely septic patients. EDs need to recognise these challenges and develop educational and feedback plans for staff and utilise available resources to maximise the Sepsis 6 compliance. PMID:27239303

  2. Seeking Sepsis in the Emergency Department- Identifying Barriers to Delivery of the Sepsis 6

    PubMed Central

    Bentley, James; Henderson, Susan; Thakore, Shobhan; Donald, Michael; Wang, Weijie

    2016-01-01

    The Sepsis 6 is an internationally accepted management bundle that, when initiated within one hour of identifying sepsis, can reduce morbidity and mortality. This management bundle was advocated by the Scottish Patient Safety Programme as part of its Acute Adult campaign launched in 2008 and adopted by NHS Tayside in 2012. Despite this, the Emergency Department (ED) of Ninewells Hospital, a tertiary referral centre and major teaching hospital in Scotland, was displaying poor success in the Sepsis 6. We therefore set out to improve compliance by evaluating the application of all aspects of the NHS Tayside Sepsis 6 bundle within one hour of ED triage time, to identify what human factors may influence achieving the one hour The Sepsis 6 bundle. This allowed us to tailor a number of specific interventions including educational sessions, regular audit and personal feedback and check list Sepsis 6 sticker. These interventions promoted a steady increase in compliance from an initial rate of 51.0% to 74.3%. The project highlighted that undifferentiated patients create a challenge in initiating the Sepsis 6. Pyrexia is a key human factor-trigger for recognising sepsis with initial nursing assessment being vital in recognition and identifying the best area (resus) of the department to manage severely septic patients. EDs need to recognise these challenges and develop educational and feedback plans for staff and utilise available resources to maximise the Sepsis 6 compliance. PMID:27239303

  3. Anesthesia Practice and Clinical Trends in Interventional Radiology: A European Survey

    SciTech Connect

    Haslam, Philip J.; Yap, Bernard; Mueller, Peter R.; Lee, Michael J.

    2000-07-15

    Purpose: To determine current European practice in interventional radiology regarding nursing care, anesthesia, and clinical care trends.Methods: A survey was sent to 977 European interventional radiologists to assess the use of sedoanalgesia, nursing care, monitoring equipment, pre- and postprocedural care, and clinical trends in interventional radiology. Patterns of sedoanalgesia were recorded for both vascular and visceral interventional procedures. Responders rated their preferred level of sedoanalgesia for each procedure as follows: (a) awake/alert, (b) drowsy/arousable, (c) asleep/arousable, (d) deep sedation, and (e) general anesthesia. Sedoanalgesic drugs and patient care trends were also recorded. A comparison was performed with data derived from a similar survey of interventional practice in the United States.Results: Two hundred and forty-three of 977 radiologists responded (25%). The total number of procedures analyzed was 210,194. The majority (56%) of diagnostic and therapeutic vascular procedures were performed at the awake/alert level of sedation, 32% were performed at the drowsy/arousable level, and 12% at deeper levels of sedation. The majority of visceral interventional procedures were performed at the drowsy/arousable level of sedation (41%), 29% were performed at deeper levels of sedation, and 30% at the awake/alert level. In general, more sedoanalgesia is used in the United States. Eighty-three percent of respondents reported the use of a full-time radiology nurse, 67% used routine blood pressure/pulse oximetry monitoring, and 46% reported the presence of a dedicated recovery area. Forty-nine percent reported daily patient rounds, 30% had inpatient hospital beds, and 51% had day case beds.Conclusion: This survey shows clear differences in the use of sedation for vascular and visceral interventional procedures. Many, often complex, procedures are performed at the awake/alert level of sedation in Europe, whereas deeper levels of sedation are

  4. Survey of utilization of medetomidine and atipamezole in private veterinary practice in Quebec in 2002.

    PubMed

    Kaartinen, M Johanna; Cuvelliez, Sophie; Brouillard, Line; Rondenay, Yves; Kona-Boun, Jean Jacques; Troncy, Eric

    2007-07-01

    This survey evaluates early perceptions about the use of medetomidine and atipamezole among veterinary practitioners in Quebec in 2002. Response rate was 23.5%; 71.1% of the practitioners did not use these products because of lack of information (69.3%), unavailability of the drugs in the practice (23.3%), or other reasons (7.3%), including concerns about the safety of alpha-2 agonists. Most veterinarians who used these products (70.4%) used them only rarely. Sedation by medetomidine was qualified as good (44.2%) or excellent (36%), and analgesia as good (46.5%) or average (32.7%). Waking up after atipamezole was qualified as good (47.5%) or excellent (40.9%). These perceptions indicate an opportunity for wider use of the products in veterinary practice. With more education and experience, practitioners could find medetomidine hydrochloride alone or in combination with an opioid useful for sedation, analgesia, and premedication for healthy animals. Reversal with atipamezole hydrochloride is considered effective, when residual sedation is undesirable. PMID:17824157

  5. Electronic submission of academic works: a survey of current editorial practices of radiologic journals.

    PubMed

    Jackson, G W; Davidson, H C; Wiggins, R H; Harnsberger, H R

    2001-06-01

    Computers are nearly ubiquitous in academic medicine, and authors create and compile much of their work in the electronic environment, yet the process of manuscript submission often fails to utilize the advantages of electronic communication. The purpose of this report is to review the submission policies of major academic journals in the field of radiology and assess current editorial practices relating to electronic submission of academic works. The authors surveyed 16 radiologic journals that are indexed in the Index Medicus and available in our medical center library. They compared the manuscript submission policies of these journals as outlined in recent issues of the journals and the corresponding worldwide web sites. The authors compared the journals on the following criteria: web site access to instructions; electronic submission of text, both with regard to initial submission and final submission of the approved document; text hardcopy requirements; word processing software restrictions; electronic submission of figures, figure hardcopy requirements; figure file format restrictions; and electronic submission media. Although the trend seems to be toward electronic submission, there currently is no clear-cut standard of practice. Because all of the journals that accept electronic documents also require a hardcopy, many of the advantages gained through electronic submission are nullified. In addition, many publishers only utilize electronic documents after a manuscript has been accepted, thus utilizing the benefits of digital information in the printing process but not in the actual submission and peer-review process.

  6. Rehabilitation following rotator cuff repair: a survey of current UK practice

    PubMed Central

    Bateman, Marcus

    2015-01-01

    Background Rotator cuff disorders, including rotator cuff tears, are common and can be treated conservatively or surgically. Data suggest that the incidence of surgery to repair the rotator cuff is rising. Despite this rise, the most effective approach to postoperative rehabilitation, a critical component of the recovery process, is not well developed. The present study aimed to describe current practice in the UK in relation to rehabilitation following rotator cuff repair. Methods An electronic survey was developed and disseminated to UK based physiotherapists and surgeons involved with rotator cuff repair. Results One hundred valid responses were received. Although there is a degree of variation, current practice for the majority of respondents consists of sling immobilization for 4 weeks to 6 weeks. During this time, passive movement would be commenced before active movement is introduced towards the end of this phase. Resisted exercise begins 7 weeks to 12 weeks postoperatively, alongside return to light work. A progressive resumption of function, including manual work and sport, is advised from approximately 13 weeks. Conclusions In the context of the current literature, it might be suggested that the current approach to rehabilitation following rotator cuff repair for the majority of respondents is somewhat cautious and has not progressed for over a decade. PMID:27582979

  7. Brazilian obstetrician-gynecologists and abortion: a survey of knowledge, opinions and practices

    PubMed Central

    Goldman, Lisa A; García, Sandra G; Díaz, Juan; Yam, Eileen A

    2005-01-01

    Background Abortion laws are extremely restrictive in Brazil. The knowledge, opinions of abortion laws, and abortion practices of obstetrician-gynecologists can have a significant impact on women's access to safe abortion. Methods We conducted a mail-in survey with a 10% random sample of obstetrician-gynecologists affiliated with the Brazilian Federation of Obstetricians and Gynecologists. We documented participants' experiences performing abortion under a range of legal and illegal circumstances, and asked about which abortion techniques they had experience with. We used chi-square tests and crude logistic regression models to determine which sociodemographic, knowledge-related, or practice-related variables were associated with physician opinion. Results Of the 1,500 questionnaires that we mailed out, we received responses from 572 (38%). Less than half (48%) of the respondents reported accurate knowledge about abortion law and 77% thought that the law should be more liberal. One-third of respondents reported having previous experience performing an abortion, and very few of these physicians reported having experience with manual vacuum aspiration (MVA) or with misoprostol with either mifepristone or methotrexate. Physicians that favored liberalization of the law were more likely to have correct knowledge about abortion law, and to be in favor of public funding for abortion services. Conclusion Brazilian obstetrician-gynecologists need more information on abortion laws and on safe, effective abortion procedures. PMID:16288647

  8. Asthma prescribing practices of government and private doctors in Malaysia--a nationwide questionnaire survey.

    PubMed

    Loh, Li-Cher; Wong, Pel-Se

    2005-03-01

    A self-answered, anonymously completed questionnaire survey was performed between June 2002 and May 2003 where doctors from government and private sectors in Malaysia were invited to participate by post or during medical meetings. One hundred and sixteen government doctors and 110 private doctors provided satisfactorily completed questionnaires (effective respondent rate: 30.1%). The most preferred medications for 'first-line', 'second-line' and 'third-line' treatment were for government doctors: inhaled short-acting beta2-agonist (SABA) (98%), inhaled corticosteroids (CS) (75%), and leukotriene antagonist (52%); and for private doctors: oral SABA (81%), inhaled CS (68%), and oral CS (58%). The first choice inhaler device for most government and private doctors were metered dose inhalers, with cost and personal preferences (for private doctors), and technical ability (for government doctors) as the key considerations when deciding on the choice of device. This benchmark data on the asthma prescribing practices of a healthcare delivery system fully dichotomized into government and private sector, provides evidence for practice differences affected by the nature of the healthcare system, and might have implications on healthcare systems of other countries that share similarities with that of Malaysia.

  9. A survey of husbandry practices for lorisid primates in North American zoos and related facilities.

    PubMed

    Fuller, Grace; Kuhar, Christopher W; Dennis, Patricia M; Lukas, Kristen E

    2013-01-01

    Zoos and related facilities in North America currently manage five species in the primate family Lorisidae: the greater (Nycticebus coucang), Bengal (N. bengalensis) and pygmy (N. pygmaeus) slow lorises, red slender loris (Loris tardigradus), and potto (Perodicticus potto). We used an online survey to describe institutional housing and husbandry practices for these species and assess the extent to which practices are consistent with established guidelines. Our results show that most captive lorisids are housed solitarily or in pairs. Most individuals occupy a single exhibit space in a building dedicated to nocturnal animals. Facilities are commonly meeting recommendations for abiotic exhibit design and are providing animals with an enriched environment. However, pottos and slender lorises currently occupy exhibit spaces smaller than the recommended minimum, and the impact of cleaning protocols on olfactory communication should be critically evaluated. Few facilities are taking advantage of the benefits of positive reinforcement training for promoting animal welfare. Research is greatly needed on the effects of exhibit lighting on behavior, health, and reproduction; and to determine how best to manage the social needs of lorisids with naturally dispersed social structures. Although captive populations of slender lorises, pottos, and slow lorises are declining, we suggest that improved husbandry knowledge has the potential to positively influence population sustainability and to enhance future efforts to manage the growing pygmy loris population.

  10. Educational improvement in Medical English Practice: Questionnaire survey to sophomore medical students of Hokkaido University.

    PubMed

    Murakami, Manabu; Olga, Amengual; Iguchi, Kaori; Otaki, Junji

    2015-11-01

    In the past, we made several efforts making curriculum changes to Medical English Practice, however, these changes did not improve motivation effectively. We have completely modified the curriculum in 2012, and performed a questionnaire survey to 112 sophomore medical students. In the final exam, students answered a questionnaire assessing all classes of the course by scoring 3 points (no change required), 2 points (minor change required), and 1 point (major change required or discontinue). In addition, students could write free comments about potential contents they would like to add to the curriculum. Each class was assessed as more than or equal to 2.5 points on average (range: 2.50-2.96). Potential contents students want to add are: 1. Speaking (45 students [55%]), 2. Listening (30 students [37%]), 3. Reading (6 students [7%]), 4. Writing (1 student [1%]). The most frequent suggestion was to include group discussions in speaking (27 students [33%]), followed by listening on topics of healthcare systems (11 students [13%]). Many students suggested to include conversation classes in small groups, or classes in which international students introduce the structure of healthcare systems of their home countries to the curriculum. Increasing the participation of international faculty, staff and students in the Medical English Practice might contribute to the improvement of medical students' motivation.

  11. Practice patterns of physiotherapists in neonatal intensive care units: A national survey

    PubMed Central

    Chokshi, Tejas; Alaparthi, Gopala Krishna; Krishnan, Shyam; Vaishali, K.; Zulfeequer, C.P.

    2013-01-01

    Objective: To determine practice pattern of physiotherapists in the neonatal intensive care units (ICUs) in India with regards to cardiopulmonary and neuromuscular physiotherapy. Materials and Methods: A cross-sectional survey was conducted across India, in which 285 questionnaires were sent via e-mail to physiotherapists working in neonatal intensive care units. Results: A total of 139 completed questionnaires were returned with a response rate of 48.7%, with a majority of responses from Karnataka, Maharashtra and Gujarat. More than 90% of physiotherapists performed chest physiotherapy in neonatal ICUs. Chest physiotherapy assessment predominantly focused on vital parameter assessment (86%) and in treatment predominantly focused on percussion (74.1%), vibration (75.5%), chest manipulation (73.3%), postural drainage (67.6%) and suction (65.4%). In neuromuscular physiotherapy more than 60% of physiotherapists used positioning, and parent education, whereas more than 45% focused on passive range of motion exercise and therapeutic handling. Conclusion: The practice pattern of physiotherapists for neonates in neonatal intensive care units involves both chest physiotherapy as well neuromuscular physiotherapy. Chest physiotherapy assessment focused mainly on vital parameter assessment (heart rate, respiratory rate and partial pressure of oxygen saturation SpO2). Treatment focused on airway clearance techniques including percussion, vibration, postural drainage and airway suction. In neuromuscular physiotherapy most physiotherapists focused on parent education and passive range of motion exercise, therapeutic handling, as well as positioning. PMID:24501488

  12. New choices for continuing education: a statewide survey of the practices and preferences of nurse practitioners.

    PubMed

    Charles, Patricia A; Mamary, Edward M

    2002-01-01

    Technological innovations in the past decade have made possible several promising new modes for delivering continuing education (CE). Offering a wide variety of educational approaches is necessary to satisfy the different learning needs and preferences of program participants. Continuing education planners need to assess the preferences and practices of Advanced Practitioners of Nursing (APNs) when choosing the modes they will offer for delivering CE programs. A survey was conducted with the entire population of licensed APNs in Nevada to assess practices, preferences, and barriers to use of various CE delivery modes. In-person conferences and live satellite conferences were the most frequently used methods. The top three preferences, in rank order, were in-person conference, print-based self-study, and interactive video conference. Live satellite conference was the least preferred method of earning CE credits. Computer-based modes of CE delivery, which include the Internet and CD-ROM, were among the least used. Findings from this study provide useful information for planners of CE programs for APNs. Data acquired in this study also address the dearth of information related to computer use by APNs for obtaining CE.

  13. Survey of the use of whole blood in current blood transfusion practice.

    PubMed

    MacLennan, S; Murphy, M F

    2001-12-01

    Limited use of whole blood has continued despite a general move to blood component therapy in recent years. This paper describes the results of a questionnaire survey which was distributed to haematologists in charge of blood banks in England and North Wales to ascertain how much and for which indications whole blood was being requested. There was a 58% response rate. More than 90% of hospitals that responded had not requested whole blood during the last 12 months. Indications for the use of whole blood were primarily in paediatric practice, mostly for neonatal exchange transfusion or paediatric surgery (cardiac or craniofacial). Infrequent use in adult practice was for "major bleeding" when whole blood was available, and in cardiac surgery, when post-operative bleeding was unresponsive to standard replacement therapy. The evidence for the use of whole blood in preference to component therapy in the massive transfusion setting was reviewed, and no compelling evidence was found for its routine use for this indication. It is worth noting that, as currently supplied in the UK, "whole blood" is not strictly "whole" as the leucocyte-depletion process removes platelets. PMID:11843887

  14. Antibiotic prescription behaviours in Lao People's Democratic Republic: a knowledge, attitude and practice survey

    PubMed Central

    Quet, Fabrice; Leyer, Caroline; Buisson, Yves; Newton, Paul N; Naphayvong, Philaysak; Keoluangkhot, Valy; Chomarat, Monique; Longuet, Christophe; Steenkeste, Nicolas; Jacobs, Jan

    2015-01-01

    Abstract Objective To assess the antibiotic prescribing practices of doctors working in the Lao People's Democratic Republic and their knowledge of local antibiotic resistance patterns. Methods Doctors attending morning meetings in 25 public hospitals in four provinces were asked to complete a knowledge, attitude and practice survey. The questionnaire contained 43 multiple choice questions that the doctor answered at the time of the meeting. Findings The response rate was 83.4% (386/463). Two hundred and seventy doctors (59.8%) declared that they had insufficient information about antibiotics. Only 14.0% (54/386) recognized the possibility of cephalosporin cross-resistance in methicillin-resistant Staphylococcus aureus. Most participants had no information about local antibiotic resistance for Salmonella Typhi (211/385, 54.8%) and hospital-acquired pneumonia (253/384, 65.9%). Unnecessary antibiotic prescriptions were considered as harmless by 115 participants and 148 considered locally-available generic antibiotics to be of poor quality. Nearly three-quarters (280/386) of participants agreed that it was difficult to select the correct antibiotics. Most participants (373/386) welcomed educational programmes on antibiotic prescribing and 65.0% (249/383) preferred local over international antibiotic guidelines. Conclusion Doctors in the Lao People's Democratic Republic seem to favour antibiotic prescribing interventions. Health authorities should consider a capacity building programme that incorporates antibiotic prescribing and hospital infection control. PMID:26229186

  15. New choices for continuing education: a statewide survey of the practices and preferences of nurse practitioners.

    PubMed

    Charles, Patricia A; Mamary, Edward M

    2002-01-01

    Technological innovations in the past decade have made possible several promising new modes for delivering continuing education (CE). Offering a wide variety of educational approaches is necessary to satisfy the different learning needs and preferences of program participants. Continuing education planners need to assess the preferences and practices of Advanced Practitioners of Nursing (APNs) when choosing the modes they will offer for delivering CE programs. A survey was conducted with the entire population of licensed APNs in Nevada to assess practices, preferences, and barriers to use of various CE delivery modes. In-person conferences and live satellite conferences were the most frequently used methods. The top three preferences, in rank order, were in-person conference, print-based self-study, and interactive video conference. Live satellite conference was the least preferred method of earning CE credits. Computer-based modes of CE delivery, which include the Internet and CD-ROM, were among the least used. Findings from this study provide useful information for planners of CE programs for APNs. Data acquired in this study also address the dearth of information related to computer use by APNs for obtaining CE. PMID:11916344

  16. Neonatal survival interventions in humanitarian emergencies: a survey of current practices and programs

    PubMed Central

    2012-01-01

    Background Neonatal deaths account for over 40% of all deaths in children younger than five years of age and neonatal mortality rates are highest in areas affected by humanitarian emergencies. Of the ten countries with the highest neonatal mortality rates globally, six are currently or recently affected by a humanitarian emergency. Yet, little is known about newborn care in crisis settings. Understanding current policies and practices for the care of newborns used by humanitarian aid organizations will inform efforts to improve care in these challenging settings. Methods Between August 18 and September 25, 2009, 56 respondents that work in humanitarian emergencies completed a web-based survey either in English or French. A snow ball sampling technique was used to identify organizations that provide health services during humanitarian emergencies to gather information on current practices for maternal and newborn care in these settings. Information was collected about continuum-of-care services for maternal, newborn and child health, referral services, training and capacity development, health information systems, policies and guidelines, and organizational priorities. Data were entered into MS Excel and frequencies and percentages were calculated. Results The majority of responding organizations reported implementing components of neonatal and maternal health interventions. However, multiple barriers exist in providing comprehensive care, including: funding shortages (63.3%), gaps in training (51.0%) and staff shortages and turnover (44.9%). Conclusions Neonatal care is provided by most of the responding humanitarian organizations; however, the quality, breadth and consistency of this care are limited. PMID:22824461

  17. The 2015 NASN School Nurse Survey: Developing and Providing Leadership to Advance School Nursing Practice.

    PubMed

    Mangena, Anantha Sameera; Maughan, Erin

    2015-11-01

    This article summarizes the results of the 2015 NASN School Nurse Survey, identifies similarities and differences between this survey and the 2013 NASN School Nurse Survey, and evaluates the possible impacts of this data on the organization. PMID:26515570

  18. Survey of electronic veterinary medical record adoption and use by independent small animal veterinary medical practices in Massachusetts

    PubMed Central

    Krone, Lauren M.; Brown, Catherine M.; Lindenmayer, Joann M.

    2016-01-01

    Objective To estimate the proportion of independent small animal veterinary medical practices in Massachusetts that use electronic veterinary medical records (EVMRs), determine the purposes for which EVMRs are used, and identify perceived barriers to their use. Design Survey. Sample 100 veterinarians. Procedures 213 of 517 independent small animal veterinary practices operating in Massachusetts were randomly chosen for study recruitment. One veterinarian at each practice was invited by telephone to answer a hardcopy survey regarding practice demographics, medical records type (electronic, paper, or both), purposes of EVMR use, and perceived barriers to adoption. Surveys were mailed to the first 100 veterinarians who agreed to participate. Practices were categorized by record type and size (large [≥ 5 veterinarians], medium [3 to 4 veterinarians], or small [1 to 2 veterinarians]). Results 84 surveys were returned; overall response was 84 of 213 (39.4%). The EVMRs were used alone or together with paper records in 66 of 82 (80.5%) practices. Large and medium-sized practices were significantly more likely to use EVMRs combined with paper records than were small practices. The EVMRs were most commonly used for ensuring billing, automating reminders, providing cost estimates, scheduling, recording medical and surgical information, and tracking patient health. Least common uses were identifying emerging infectious diseases, research, and insurance. Eleven veterinarians in paper record–only practices indicated reluctance to change, anticipated technological problems, time constraints, and cost were barriers to EVMR use. Conclusions and Clinical Relevance Results indicated EVMRs were underutilized as a tool for tracking and improving population health and identifying emerging infectious diseases. Efforts to facilitate adoption of EVMRs for these purposes should be strengthened by the veterinary medical, human health, and public health professions. PMID:25029312

  19. A Survey of American Chiropractic Association Members’ Experiences, Attitudes, and Perceptions of Practice in Integrated Health Care Settings

    PubMed Central

    Bronston, Leo J.; Austin-McClellan, Lauren E.; Lisi, Anthony J.; Donovan, Kevin C.; Engle, Walter W.

    2015-01-01

    Objective The purpose of this study is to examine the self-report of experiences, attitudes, and perceived educational needs of American Chiropractic Association members regarding practice in integrated health care settings. Methods This was a descriptive observational study of the American Chiropractic Association members. Participants completed an electronic survey reporting their current participation and interest in chiropractic integrated practice. Results The survey was completed in 2011 by 1142 respondents, for a response rate of 11.8%. The majority of respondents (82.9%) did not currently practice in an integrated setting, whereas 17.1% did. Those practicing in various integrated medical settings reported delivering a range of diagnostic, therapeutic, and case management services. Participation in administrative and scholarly activities was less common. Respondents not practicing in integrated settings reported being interested in delivering a very similar array of clinical services. Doctors of chiropractic practicing in hospital or outpatient medical facilities reported frequent engagement in interprofessional collaboration. Both nonintegrated and integrated respondents reported very similar educational interests on a range of clinical topics. Conclusion The findings of this survey provide insight into the experiences, participation, and interests in integrated clinical practice for members of the American Chiropractic Association. PMID:26793034

  20. Inequalities in family practitioner use by sexual orientation: evidence from the English General Practice Patient Survey

    PubMed Central

    Urwin, Sean; Whittaker, William

    2016-01-01

    Objective To test for differences in primary care family practitioner usage by sexual orientation. Design Multivariate logistic analysis of pooled cross-sectional postal questionnaire responses to family practitioner usage. Setting Patient-reported use and experience of primary care in England, UK. Data from several waves of a postal questionnaire (General Practice Patient Survey) 2012–2014. Population 2 807 320 survey responses of adults aged 18 years and over, registered with a family practitioner. Main outcome measures Probability of a visit to a family practitioner within the past 3 months. Results Lesbian women were 0.803 times (95% CI 0.755 to 0.854) less likely to have seen a family practitioner in the past 3 months relative to heterosexual women (bisexual women OR=0.887, 95% CI 0.817 to 0.963). Gay men were 1.218 times (95% CI 1.163 to 1.276) more likely to have seen a family practitioner relative to heterosexual men (bisexual men OR=1.084, 95% CI 0.989 to 1.188). Our results are robust to the timing of the family practitioner visit (0–3, 0–6, 0–12 months). Gay men were more likely to have seen a family practitioner than heterosexual men where the proportion of women practitioners in the practice was higher (OR=1.238, 95% CI 1.041 to 1.472). Conclusions Inequalities in the use of primary care across sexual orientation in England exist having conditioned on several measures of health status, demographic and family practitioner characteristics. The findings suggest these differences may be reduced by policies targeting a reduction of differences in patient acceptability of primary care. In particular, further research is needed to understand whether lower use among heterosexual men represents unmet need or overutilisation among gay men, and the barriers to practitioner use seemingly occurring due to the gender distribution of practices. PMID:27173816

  1. Sepsis in Pregnancy: Identification and Management.

    PubMed

    Albright, Catherine M; Mehta, Niharika D; Rouse, Dwight J; Hughes, Brenna L

    2016-01-01

    Sepsis accounts for up to 28% of all maternal deaths. Prompt, appropriate treatment improves maternal and fetal morbidity and mortality. To date, there are no validated tools for identification of sepsis in pregnant women, and tools used in the general population tend to overestimate mortality. Once identified, management of pregnancy-associated sepsis is goal-directed, but because of the lack of studies of sepsis management in pregnancy, it must be assumed that modifications need to be made on the basis of the physiologic changes of pregnancy. Key to management is early fluid resuscitation and early initiation of appropriate antimicrobial therapy directed toward the likely source of infection or, if the source is unknown, empiric broad-spectrum therapy. Efforts directed at identifying the source of infection and appropriate source control measures are critical. Development of an illness severity scoring system and treatment algorithms validated in pregnant women needs to be a research priority.

  2. Neonatal infectious diseases: evaluation of neonatal sepsis.

    PubMed

    Camacho-Gonzalez, Andres; Spearman, Paul W; Stoll, Barbara J

    2013-04-01

    Neonatal sepsis remains a feared cause of morbidity and mortality in the neonatal period. Maternal, neonatal, and environmental factors are associated with risk of infection, and a combination of prevention strategies, judicious neonatal evaluation, and early initiation of therapy are required to prevent adverse outcomes. This article reviews recent trends in epidemiology and provides an update on risk factors, diagnostic methods, and management of neonatal sepsis.

  3. Sepsis: From Pathophysiology to Individualized Patient Care

    PubMed Central

    László, Ildikó; Trásy, Domonkos; Molnár, Zsolt; Fazakas, János

    2015-01-01

    Sepsis has become a major health economic issue, with more patients dying in hospitals due to sepsis related complications compared to breast and colorectal cancer together. Despite extensive research in order to improve outcome in sepsis over the last few decades, results of large multicenter studies were by-and-large very disappointing. This fiasco can be explained by several factors, but one of the most important reasons is the uncertain definition of sepsis resulting in very heterogeneous patient populations, and the lack of understanding of pathophysiology, which is mainly based on the imbalance in the host-immune response. However, this heroic research work has not been in vain. Putting the results of positive and negative studies into context, we can now approach sepsis in a different concept, which may lead us to new perspectives in diagnostics and treatment. While decision making based on conventional sepsis definitions can inevitably lead to false judgment due to the heterogeneity of patients, new concepts based on currently gained knowledge in immunology may help to tailor assessment and treatment of these patients to their actual needs. Summarizing where we stand at present and what the future may hold are the purpose of this review. PMID:26258150

  4. Raftlin: a new biomarker in human sepsis.

    PubMed

    Lee, Wonhwa; Yoo, Hayoung; Ku, Sae-Kwang; Kim, Shin-Woo; Bae, Jong-Sup

    2014-06-01

    Raftlin is a major protein in lipid raft. The aim of this study was to evaluate blood levels of raftlin in septic patients. A prospective study of 82 patients with sepsis was conducted. Human umbilical vein endothelial cells (HUVECs) or mice were exposed to lipopolysaccharide (LPS, 100 ng/ml to HUVECs or 10 mg/kg to mice) or subjected to cecal ligation and puncture (CLP) surgery. Data showed that LPS induced upregulation of the synthesis and secretion of raftlin in LPS-treated HUVECs, and LPS-injected and CLP-mice. In patients admitted to the intensive care unit with sepsis, circulating levels of raftlin were significantly elevated, compared with control donors. Raftlin levels were higher in patients with septic shock, 891.6 (789.7-1,087.8, n = 30) than in patients with severe sepsis, 681.6 (480.1-819.6, n = 22) or sepsis, 496.1 (418.1-738.9, n = 30), compared with healthy volunteers 364.9 (312.1-392.4, n = 21). These results suggest that in septic patients, raftlin blood level is related to the severity of sepsis and the outcome of the patient and may represent a novel marker of endothelial cell dysfunction, and that raftlin can be used as a biomarker for determining the severity of sepsis.

  5. [Are statins a therapeutic alternative in sepsis?].

    PubMed

    Carrillo-Esper, Raúl; Rivera-Buendía, Santos; Carrillo-Córdova, Jorge Raúl; Carrillo-Córdova, Luis Daniel

    2007-01-01

    Sepsis continues to be a major cause of morbidity and mortality. Evidence is emerging from observational studies and basic science research that statins might be associated with reduced mortality in sepsis. Statins have diverse immunomodulatory and antiinflammatory properties independent of their lipid-lowering ability. The protective association between statins and sepsis persisted in high-risk subgroups including patients with diabetes mellitus, those with malignancy, and those receiving steroids. This review discusses the basis of these observations and the current place of statin therapy in patients with sepsis. This is a rapidly growing field of fascinating experimental biology. It suggests an urgent need to investigate the pharmacology of these drugs and reappraise their therapeutic indications in critically ill patients. If this finding is supported by prospective controlled trials, statins may play an important role in sepsis related mortality. By the other hand statins are significantly cheaper than other therapies that have been shown to improve outcome in sepsis, and the demonstration of mortality benefit would have enormous cost-benefit implication.

  6. Practice and research in Australian massage therapy: a national workforce survey

    PubMed Central

    Wardle, Jonathan L.; Barnett, Rebecca; Adams, Jon

    2015-01-01

    Background Massage is the largest complementary medicine profession in Australia, in terms of public utilisation, practitioner distribution, and number of practitioners, and is being increasingly integrated into the Australian health care system. However, despite the increasing importance of massage therapists in Australian health care delivery, or the increased practice and education obligations this may entail, there has been little exploration of practice, research, and education characteristics of the Australian massage therapist workforce. Purpose To identify practice, research, and education characteristics among the Australian massage therapist workforce. Settings The Australian massage therapy profession. Participants 301 randomly selected members of the Association of Massage Therapists (Australia). Research Design A 15-item, cross-sectional telephone survey. Main Outcomes Measures Massage therapists’ demographic information, practice characteristics, and education and research characteristics. Results Most respondents (73.8%) worked 20 hours per week or less practising massage, nearly half of all respondents (46.8%) treated fewer than 10 massage clients per week, and over three-quarters (81.7%) of respondents were self-employed. Massage therapy was the sole source of income for just over half (55.0%) of the study respondents. Only 5.7% of respondents earned over the average wage ($50,000) through their massage activities. Nearly half of all respondents (43.3%) reported regularly exceeding their continuing professional education (CPE) quota mandated by their professional association. However, 21.1% reported struggling to achieve their CPE quota each year. Over one-third of respondents (35.6%) were not interested in acquiring further CPE points beyond minimum requirements. Respondents were significantly more likely to have an active approach to research if they had higher income (p = .015). Multivariate analysis showed factors associated with access to

  7. A survey of biosecurity-related practices, opinions and communications across dairy farm veterinarians and advisors.

    PubMed

    Sayers, R G; Good, M; Sayers, G P

    2014-05-01

    Biosecurity at farm-level can often be poorly implemented, and lack of information has been cited by many studies as a potential explanation. Veterinary practitioners (VPs) and dairy advisors (DAs) play a central role in the provision of animal health and management services to dairy farmers. The objective of this study was to document and compare biosecurity-related practices and opinions across VPs and DAs in Ireland. A selection of veterinary experts (VEs) from outside of Ireland was also surveyed. Questionnaires were completed and response rates of 47% (VPs), 97% (DAs), and 65% (VEs) were achieved. Significant differences were identified in the promotion and implementation of biosecurity between VPs and DAs, with a higher proportion of VPs regularly receiving requests from (P = 0.004), and dispensing advice to (P < 0.0001), their farm clients. Communication between DAs and VPs was sub-optimal with over 60% of each group not in regular communication with each other. With regard to the main farmer motivation for biosecurity implementation, the majority of VPs (62%) prioritised external factors such as 'economic benefit' and 'mandatory obligation', while the majority of DAs prioritised health/animal-related factors (69%), which were similar to those of farmers (83.1%), although they remained significantly less likely (OR = 1.8) than farmers to choose such motivators (P = 0.005). Inconsistencies in the implementation of, and in opinions relating to, farm biosecurity were highlighted across all the groups surveyed emphasising the need for standardised information and improved communication.

  8. Resident Physicians and Cancer Health Disparities: a Survey of Attitudes, Knowledge, and Practice.

    PubMed

    Mejia de Grubb, Maria C; Kilbourne, Barbara; Zoorob, Roger; Gonzalez, Sandra; Mkanta, William; Levine, Robert

    2016-09-01

    Workforce development initiatives designed to mitigate cancer health disparities focus primarily on oncologists rather than on primary care providers (PCPs) who could be better positioned to address the issue at the preventive and community levels. The purpose of this project was to assess primary care resident physicians' self-perceived attitudes and comfort level in addressing cancer health disparities. Resident physicians in their first- through third-year of training in family, internal, preventive/occupational medicine, and obstetrics and gynecology (OB/GYN) at three academic centers responded to a 13-question survey in the spring of 2013. Descriptive and chi-square statistics were performed to analyze responses to (1) attitudes about cross-cultural communication and understanding, (2) knowledge about sources of cancer health disparities, (3) self-reported preparedness to provide cross-cultural cancer care and skills to manage specific situations, and (4) relevance of cancer-disparity education to clinical practice. A total of 78 (70.9 %) residents responded to the survey. Twenty three (29.5 %) of the respondents felt they did not understand the socio-demographic characteristics of their patients' communities, and 20 (25.6 %) did not feel capable of discussing current cancer-related care guidelines when the patients' personal beliefs conflict with their own. Few of the relationships between residency program and location with outcome measures met the criteria for statistical significance. Family medicine residents were the most likely to report in that it was hard to interact with persons from other cultures. As PCPs will play a key role in addressing cancer health disparities, effective educational opportunities in cancer care by primary care residents are warranted. PMID:25943900

  9. Exercise training characteristics in cardiac rehabilitation programmes: a cross-sectional survey of Australian practice

    PubMed Central

    Abell, Bridget; Glasziou, Paul; Briffa, Tom; Hoffmann, Tammy

    2016-01-01

    Introduction Exercise training is a core component of cardiac rehabilitation (CR), however, little information exists regarding the specific exercise interventions currently provided for coronary heart disease in Australian practice. We aimed to analyse the current status of exercise-based CR services across Australia. Design Cross-sectional survey. Methods Australian sites offering exercise-based CR were identified from publically available directories. All sites were invited by email to participate in an online Survey Monkey questionnaire between October 2014 and March 2015, with reminders via email and phone follow-up. Questions investigated the demographics and format of individual programmes, as well as specific exercise training characteristics. Results 297 eligible programmes were identified, with an 82% response rate. Most sites (82%) were based at hospital or outpatient centres, with home (15%), community (18%) or gym-based options (5%) less common. While CR was most often offered in a comprehensive format (72% of sites), the level of exercise intervention varied greatly among programmes. Most frequently, exercise was prescribed 1–2 times per week for 60 min over 7 weeks. Almost one-quarter (24%) had a sole practitioner supervising exercise, although the majority used a nurse/physiotherapist combination. Low to moderate exercise intensities were used in 60% of programmes, however, higher intensity prescriptions were not uncommon. Few sites (<6%) made use of technology, such as mobile phones or the internet, to deliver or support exercise training. Conclusions While advances have been made towards providing flexible and accessible exercise-based CR, much of Australia's service remains within traditional models of care. A continuing focus on service improvement and evidence-based care should, therefore, be considered a core aim of those providing exercise for CR in order to improve health service delivery and optimise outcomes for patients. PMID

  10. Design and Practice on Metadata Service System of Surveying and Mapping Results Based on Geonetwork

    NASA Astrophysics Data System (ADS)

    Zha, Z.; Zhou, X.

    2011-08-01

    Based on the analysis and research on the current geographic information sharing and metadata service,we design, develop and deploy a distributed metadata service system based on GeoNetwork covering more than 30 nodes in provincial units of China.. By identifying the advantages of GeoNetwork, we design a distributed metadata service system of national surveying and mapping results. It consists of 31 network nodes, a central node and a portal. Network nodes are the direct system metadata source, and are distributed arround the country. Each network node maintains a metadata service system, responsible for metadata uploading and management. The central node harvests metadata from network nodes using OGC CSW 2.0.2 standard interface. The portal shows all metadata in the central node, provides users with a variety of methods and interface for metadata search or querying. It also provides management capabilities on connecting the central node and the network nodes together. There are defects with GeoNetwork too. Accordingly, we made improvement and optimization on big-amount metadata uploading, synchronization and concurrent access. For metadata uploading and synchronization, by carefully analysis the database and index operation logs, we successfully avoid the performance bottlenecks. And with a batch operation and dynamic memory management solution, data throughput and system performance are significantly improved; For concurrent access, , through a request coding and results cache solution, query performance is greatly improved. To smoothly respond to huge concurrent requests, a web cluster solution is deployed. This paper also gives an experiment analysis and compares the system performance before and after improvement and optimization. Design and practical results have been applied in national metadata service system of surveying and mapping results. It proved that the improved GeoNetwork service architecture can effectively adaptive for distributed deployment

  11. Upper gastro-intestinal disease in Scotland: a survey of practice amongst Scottish gastroenterologists.

    PubMed

    Kubba, A K; Whyman, M R

    1996-10-01

    Given the range of causes of upper gastrointestinal disease (UGD), the evolving role of Helicobacter pylori in its pathogenesis and the variety of treatments available, one might expect complex management strategies in the management of these diseases. The aim of this study was to determine the current management strategies used in peptic ulcer disease and gastritis in Scotland and to identify areas where large and clinically important variations in practice exist between gastro-intestinal specialists. Between June and September 1994, 130 gastro-intestinal physicians and surgeons were sent a postal questionnaire based on their response to four hypothetical clinical scenarios. Eighty-one (63%) correspondents returned completed questionnaires. The case histories related to: bleeding duodenal ulcer; peptic ulceration whilst taking non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids; management of dyspepsia in the young; and management of gastritis. Thirty-eight per cent of clinicians surveyed advocated the use of intravenous acid reducing agents in peptic ulcer bleeding. A total of 88% advocated endoscopic therapy in the presence of stigmata of recent haemorrhage and 5% suggested a follow up of endoscopy to confirm healing after ulcer bleeding. In treating the patient with ulcer while on NSAIDs, 45% of clinicians would use H2 receptor antagonists, 37% would use omeprazole, 14% misoprostol and 4% helicobacter eradication. Of the clinicians surveyed, 63% said they would investigate a 25-year-old patient with dyspepsia by endoscopy and 84% of these will biopsy for H. pylori. Empirical treatment was favoured by 37% and 4% considered a barium meal. There was no consensus in the treatment of gastritis. There exists considerable divergence of opinion between clinicians in investigation and treatment of upper gastrointestinal disease. The role of endoscopy, the type and duration of medical treatment of bleeding and non bleeding ulcer and gastritis require

  12. International Brachytherapy Practice Patterns: A Survey of the Gynecologic Cancer Intergroup (GCIG)

    SciTech Connect

    Viswanathan, Akila N.; Creutzberg, Carien L.; Craighead, Peter; McCormack, Mary; Toita, Takafumi; Narayan, Kailash; Reed, Nicholas; Long, Harry; Kim, Hak-Jae; Marth, Christian; Lindegaard, Jacob C.; Cerrotta, Annmarie; Small, William; Trimble, Edward

    2012-01-01

    Purpose: To determine current practice patterns with regard to gynecologic high-dose-rate (HDR) brachytherapy among international members of the Gynecologic Cancer Intergroup (GCIG) in Japan/Korea (Asia), Australia/New Zealand (ANZ), Europe (E), and North America (NAm). Methods and Materials: A 32-item survey was developed requesting information on brachytherapy practice patterns and standard management for Stage IB-IVA cervical cancer. The chair of each GCIG member cooperative group selected radiation oncology members to receive the survey. Results: A total of 72 responses were analyzed; 61 respondents (85%) used HDR. The three most common HDR brachytherapy fractionation regimens for Stage IB-IIA patients were 6 Gy for five fractions (18%), 6 Gy for four fractions (15%), and 7 Gy for three fractions (11%); for Stage IIB-IVA patients they were 6 Gy for five fractions (19%), 7 Gy for four fractions (8%), and 7 Gy for three fractions (8%). Overall, the mean combined external-beam and brachytherapy equivalent dose (EQD2) was 81.1 (standard deviation [SD] 10.16). The mean EQD2 recommended for Stage IB-IIA patients was 78.9 Gy (SD 10.7) and for Stage IIB-IVA was 83.3 Gy (SD 11.2) (p = 0.02). By region, the mean combined EQD2 was as follows: Asia, 71.2 Gy (SD 12.65); ANZ, 81.18 (SD 4.96); E, 83.24 (SD 10.75); and NAm, 81.66 (SD, 6.05; p = 0.02 for Asia vs. other regions).The ratio of brachytherapy to total prescribed dose was significantly higher for Japan (p = 0.0002). Conclusion: Although fractionation patterns may vary, the overall mean doses administered for cervical cancer are similar in Australia/New Zealand, Europe, and North America, with practitioners in Japan administering a significantly lower external-beam dose but higher brachytherapy dose to the cervix. Given common goals, standardization should be possible in future clinical trials.

  13. The updating of clinical practice guidelines: insights from an international survey

    PubMed Central

    2011-01-01

    Background Clinical practice guidelines (CPGs) have become increasingly popular, and the methodology to develop guidelines has evolved enormously. However, little attention has been given to the updating process, in contrast to the appraisal of the available literature. We conducted an international survey to identify current practices in CPG updating and explored the need to standardize and improve the methods. Methods We developed a questionnaire (28 items) based on a review of the existing literature about guideline updating and expert comments. We carried out the survey between March and July 2009, and it was sent by email to 106 institutions: 69 members of the Guidelines International Network who declared that they developed CPGs; 30 institutions included in the U.S. National Guideline Clearinghouse database that published more than 20 CPGs; and 7 institutions selected by an expert committee. Results Forty-four institutions answered the questionnaire (42% response rate). In the final analysis, 39 completed questionnaires were included. Thirty-six institutions (92%) reported that they update their guidelines. Thirty-one institutions (86%) have a formal procedure for updating their guidelines, and 19 (53%) have a formal procedure for deciding when a guideline becomes out of date. Institutions describe the process as moderately rigorous (36%) or acknowledge that it could certainly be more rigorous (36%). Twenty-two institutions (61%) alert guideline users on their website when a guideline is older than three to five years or when there is a risk of being outdated. Twenty-five institutions (64%) support the concept of "living guidelines," which are continuously monitored and updated. Eighteen institutions (46%) have plans to design a protocol to improve their guideline-updating process, and 21 (54%) are willing to share resources with other organizations. Conclusions Our study is the first to describe the process of updating CPGs among prominent guideline

  14. [An opinion survey among French physicians in independent practice (Winter 2007-Spring 2008)].

    PubMed

    Doan, Bui Dang Ha; Lévy, Danièle; Teitelbaum, Juan; Allemand, Hélène

    2009-01-01

    In the French health care system, most of the ambulatory health services are provided by independent practitioners, GP's and specialists, paid on a fee-for-service basis. Nearly all French residents are enrolled in a public sickness insurance fund. The fund pays directly to the doctor (or reimburse to the patient) on the basis of a honorarium-scale, negotiated by the fund and the medical associations. The specialists working in a private hospital (called "clinique") are considered physicians in independent practice and paid on a fee-for-service basis, whereas the specialists working in public (or para-public) hospitals are salaried. In early 2008, approximately 60 percent of all the medical profession were in independent practice. Out of 100 independent practitioners, 52 declared that their workload was "normal" and 44 that their own was "too heavy". Only 2 percent declared that their workload was "insufficient". The survey showed no correlation between the number of independent physicians working in an area and the average workload of each of them. The competition among medical offices was rather low. At the time of the survey, the French health system was dominated by a wide feeling of medical workforce shortage. However, only one quarter of the independent physicians were convinced that shortage existed in their own area. Difficulties and problems arisen from the relationship with partners were mentioned by a great number of independent practitioners: exaggerate requests from the patients (mentioned by 62%), bureaucratic approaches from the sickness insurance fund (32%), working ties with the public or para-public hospitals (23%)...During the period 2005-2008, the proportion of practitioners having difficulties in their professional relations has increased, in particular among specialists. However, during the same period, there was a change in the mood of the medical profession. The proportion of independent physicians who estimated that their standards of

  15. Instructional Practices in Introductory Geoscience Courses: Results of a National Faculty Survey

    NASA Astrophysics Data System (ADS)

    MacDonald, R.; Manduca, C. A.; Mogk, D. W.; Tewksbury, B. J.

    2004-12-01

    The NAGT professional development program "On the Cutting Edge" recently surveyed 7000 geoscience faculty in the United States to develop a snapshot of current instructional practices in undergraduate geoscience courses, faculty strategies for learning new content and new teaching approaches, and faculty involvement in the geoscience education community. Over 2200 faculty responded to the survey which was conducted by the American Institute of Physics. Results for introductory courses (814 responses) indicate that lecture is the most common teaching strategy used in courses of all sizes. Many faculty incorporate some interactive activities in their courses. Most commonly, they use questioning, demonstrations, discussions, and in-class exercises. Less common, but not rare, are small group discussion or think-pair-share and classroom debates or role-playing. Activities involving problem solving, using quantitative skills, working with data and primarily literature, and structured collaboration are incorporated by many faculty in introductory courses, suggesting efforts to teach the process of science. Activities in which students address a problem of national or local interest, analyze their own data, or address problems of their own design are less common but not rare. Field experiences are common but not ubiquitous for students in introductory courses. A wide variety of assessment strategies are used in introductory courses of all sizes, including exams, quizzes, problem sets, papers, oral presentations, and portfolios. While papers are used for assessment more extensively in small classes, a significant number of faculty use papers in large classes (greater than 81 students). A majority of faculty use rubrics in grading. Faculty report that in the past two years, approximately one-third have made changes in the content of their introductory courses while just under half have changed the teaching methods they use. While faculty learn about both new content and

  16. Implant removal of osteosynthesis: the Dutch practice. Results of a survey

    PubMed Central

    2012-01-01

    Background The aim of this survey study was to evaluate the current opinion and practice of trauma and orthopaedic surgeons in the Netherlands in the removal of implants after fracture healing. Methods A web-based questionnaire consisting of 44 items was sent to all active members of the Dutch Trauma Society and Dutch Orthopaedic Trauma Society to determine their habits and opinions about implant removal. Results Though implant removal is not routinely done in the Netherlands, 89% of the Dutch surgeons agreed that implant removal is a good option in case of pain or functional deficits. Also infection of the implant or bone is one of the main reasons for removing the implant (> 90%), while making money was a motivation for only 1% of the respondents. In case of younger patients (< 40 years of age) only 34% of the surgeons agreed that metal implants should always be removed in this category. Orthopaedic surgeons are more conservative and differ in their opinion about this subject compared to general trauma surgeons (p = 0.002). Though the far majority removes elastic nails in children (95%). Most of the participants (56%) did not agree that leaving implants in is associated with an increased risk of fractures, infections, allergy or malignancy. Yet in case of the risk of fractures, residents all agreed to this statement (100%) whereas staff specialists disagreed for 71% (p < 0.001). According to 62% of the surgeons titanium plates are more difficult to remove than stainless steel, but 47% did not consider them safer to leave in situ compared to stainless steel. The most mentioned postoperative complications were wound infection (37%), unpleasant scarring (24%) and postoperative hemorraghe (19%). Conclusion This survey indicates that there is no general opinion about implant removal after fracture healing with a lack of policy guidelines in the Netherlands. In case of symptomatic patients a majority of the surgeons removes the implant, but this is not

  17. Antiepileptic drug treatment of rolandic epilepsy and Panayiotopoulos syndrome: clinical practice survey and clinical trial feasibility

    PubMed Central

    Mellish, Louise C; Dunkley, Colin; Ferrie, Colin D; Pal, Deb K

    2015-01-01

    Background The evidence base for management of childhood epilepsy is poor, especially for the most common specific syndromes such as rolandic epilepsy (RE) and Panayiotopoulos syndrome (PS). Considerable international variation in management and controversy about non-treatment indicate the need for high quality randomised controlled trials (RCT). The aim of this study is, therefore, to describe current UK practice and explore the feasibility of different RCT designs for RE and PS. Methods We conducted an online survey of 590 UK paediatricians who treat epilepsy. Thirty-two questions covered annual caseload, investigation and management practice, factors influencing treatment, antiepileptic drug preferences and hypothetical trial design preferences. Results 132 responded (22%): 81% were paediatricians and 95% at consultant seniority. We estimated, annually, 751 new RE cases and 233 PS cases. Electroencephalography (EEG) is requested at least half the time in approximately 70% of cases; MRI brain at least half the time in 40%–65% cases and neuropsychological evaluation in 7%–8%. Clinicians reported non-treatment in 40%: main reasons were low frequency of seizures and parent/child preferences. Carbamazepine is the preferred older, and levetiracetam the preferred newer, RCT arm. Approximately one-half considered active and placebo designs acceptable, choosing seizures as primary and cognitive/behavioural measures as secondary outcomes. Conclusions Management among respondents is broadly in line with national guidance, although with possible overuse of brain imaging and underuse of EEG and neuropsychological assessments. A large proportion of patients in the UK remains untreated, and clinicians seem amenable to a range of RCT designs, with carbamazepine and levetiracetam the preferred active drugs. PMID:25202134

  18. A survey of clinical practice patterns in diagnosis and management of Cushing's disease in Iran

    PubMed Central

    Malek, Mojtaba; Esfehanian, Fatemeh; Amouzegar, Atieh; Sarvghadi, Farzaneh; Moossavi, Zohreh; Mohajeri-Tehrani, Mohammad R.; Khamseh, Mohammad E.; Amirbaigloo, Alireza; Ebrahim Valojerdi, Ameneh

    2016-01-01

    Background: Cushing's disease is the most prevalent cause of endogenous adrenocorticotrophic hormone hypersecretion. The aim of this study was to document the current clinical practice pattern in the management of Cushing's disease by Iranian Endocrinologists to determine their opinions and compare them with the current clinical practice guidelines. Methods: An eight-item questionnaire dealing with diagnosis, treatment and follow up of patients with Cushing's disease was developed, piloted, and sent to the members of Iranian Endocrinology Society. Results: Among 90 endocrinologists invited to participate in the survey, 76 replied. Most respondents selected overnight dexamethasone suppression test (ONDST) and assessment of 24-hour urinary free cortisol (UFC) as the best screening tests followed by midnight serum cortisol and midnight salivary cortisol. Classic high dose dexamethasone suppression test and measurement of serum ACTH were selected for localization of the primary lesion by 64.5%. The primary choice of treatment was trans-sphenoidal pituitary surgery (86.8%). For the recurrence of Cushing's disease, the preferred treatment modality was medical therapy followed by bilateral adrenalectomy, and pituitary re-surgery. In case of treatment failure after the first pituitary surgery and ketoconazole treatment, 51% chose bilateral adrenalectomy, while36.8% selected pasireotide only. Conclusion: ONDST and UFC are two most common tests used to screen an index case with signs and symptoms of hypercortisolism. The primary choice of treatment in Cushing's disease is pituitary surgery. However, medical treatment by ketokonazol is preferred for the recurrences. Pasireotide is the second alternative after bilateral adrenalectomy in case of treatment failure after pituitary surgery and ketoconazole. PMID:27390704

  19. Survey of Endodontic Practice amongst Iranian Dentists Participating Restorative Dentistry Congress in Shiraz, November 2007

    PubMed Central

    Ravanshad, Shohreh; Sahraei, Saied; Khayat, Akbar

    2008-01-01

    INTRODUCTION: General dental practitioners provide the majority of treatment in Iran. The aim of this study was to gather information on the methods, materials and attitudes employed in root canal treatment by dentists participated in 7th Congress of Iranian Academy of Restorative Dentistry in Shiraz /2007 in order to evaluate the quality of current practice. MATERIALS AND METHODS: A questionnaire for this cross-sectional study was designed with the purpose of evaluating the routine endodontic treatment performed by Iranian dentists. The questionnaire made up of 24 questions with multiple-choice answers. Covering subjects are demographic and professional activity, root-canal preparation and instrumentation, choice of irrigants and disinfectants, and choice of obturation techniques. RESULTS: A total of 247 questionnaires (49.4%) were returned. Ninety-one percent of the respondents were general dental practitioners. The results indicate that there are discrepancies between daily practice and academic teaching, especially regarding the use of rubber dam (only 0.9 % report using it as a standard procedure). Most of practitioners used manual instruments manipulated with a filing technique and few used rotary for canal preparation. The majority of the respondents prepared root canals 0.5-1 mm short of the radiographic apex. The first-choice root-canal irrigant was normal saline (55%), followed by sodium hypochlorite. Approximately, 68% used intracanal medications. The most popular obturation technique was cold lateral condensation (90%) with zinc-oxide eugenol as sealer. Most practitioners performed treatment in two visits for teeth with two or more canals. Eighty-four percent of the dentists used radiograph for determining the working length, and only 2.7% used Apex-locator. CONCLUSION: The survey mentions the importance of continuing dental education for practitioners to update their knowledge. PMID:24265636

  20. A profile of osteopathic practice in Australia 2010–2011: a cross sectional survey

    PubMed Central

    2013-01-01

    Background There is limited evidence available to describe a profile of osteopathic practice in Australia. The purpose of this study was to describe the current activities of Australian osteopaths, using an internationally-developed standardised data collection tool. Methods A voluntary national paper-based survey using a modified UK-developed standardised data collection tool was distributed to and completed by osteopaths across Australia between June 2010 and June 2011. Results Fifty four osteopaths participated in this study and returned a total of 799 patient records. Two thirds of patients were female, with a median age of 39 years and age range of 7 days - 89 years. Almost three quarters of people seeking osteopathic care were employed and the largest source of referral was by word-of-mouth. The majority of presenting complaints were acute musculoskeletal in nature. Approximately 38% of patients presented with a coexisting condition; the highest incidences were found in the cardiovascular and respiratory systems, along with mental health disorders. Main treatment approaches were soft tissue (22.3%), muscle energy technique (14.6%), articulation techniques (14.3%) and education/advice (11.9%). Improvement or resolution of the complaint was experienced by 96.2% of patients within a small number of treatments. Complications of treatment were minor and of low frequency. Conclusions In this study, Australian osteopaths mainly see patients with acute or sub-acute musculoskeletal problems which are predominantly spinal conditions. A significant proportion of these patients have one or more co-existing condition, largely of the cardiovascular and respiratory systems, along with mental health disorders. The majority of patients have a significant improvement within few treatments, with infrequent and minor adverse events reported. These findings should be tested through multi-centred pragmatic trials of osteopathic practice. PMID:23915239

  1. A survey of knowledge, attitudes, and practices towards skin and soft tissue infections in rural Alaska

    PubMed Central

    Gaines, Joanna; Bulkow, Lisa R.; Kinzer, Michael H.; Hennessy, Thomas W.; Klejka, Joseph A.; Bruce, Michael G.

    2016-01-01

    Background Community-acquired methicillin-resistant Staphylococcus aureus and methicillin-sensitive S. aureus infections are common to south-western Alaska and have been associated with traditional steambaths. More than a decade ago, recommendations were made to affected communities that included preventive skin care, cleaning methods for steambath surfaces, and the use of protective barriers while in steambaths to reduce the risk of S. aureus infection. Objective A review of community medical data suggested that the number of skin infection clinical encounters has increased steadily over the last 3 years and we designed a public health investigation to seek root causes. Study design Using a mixed methods approach with in-person surveys, a convenience sample (n=492) from 3 rural communities assessed the range of knowledge, attitudes and practices concerning skin infections, skin infection education messaging, prevention activities and home self-care of skin infections. Results We described barriers to implementing previous recommendations and evaluated the acceptability of potential interventions. Prior public health messages appear to have been effective in reaching community members and appear to have been understood and accepted. We found no major misconceptions regarding what a boil was or how someone got one. Overall, respondents seemed concerned about boils as a health problem and reported that they were motivated to prevent boils. We identified current practices used to avoid skin infections, such as the disinfection of steambaths. We also identified barriers to engaging in protective behaviours, such as lack of access to laundry facilities. Conclusions These findings can be used to help guide public health strategic planning and identify appropriate evidence-based interventions tailored to the specific needs of the region. PMID:26928370

  2. Mapping international practice patterns in EUS-guided tissue sampling: outcome of a global survey

    PubMed Central

    van Riet, Priscilla A.; Cahen, Djuna L.; Poley, Jan-Werner; Bruno, Marco J.

    2016-01-01

    Background and study aims: Although Endoscopic Ultrasound (EUS)-guided tissue sampling is widely used, the optimal sampling strategy remains subject of debate. We evaluated practice patterns within the international endosonographic community. Patients and methods: An online questionnaire was sent to 400 endosonographers from the United States, Europe, and Asia. Results: A total of 186 (47 %) endosonographers participated: United States 54 (29 %), Europe 85 (46 %), and Asia 47 (25 %). European (75 %) and Asian (84 %) respondents routinely check coagulation status, whereas US respondents only check on indication (64 %, P = 0.007). While propofol sedation is standard in the United States (83 %), conscious sedation is still widely used in Europe (52 %) and Asia (84 %, P < 0.001). Overall, the 22-gauge needle is most commonly used (52 %). For fine-needle aspiration (FNA) of solid pancreatic lesions, 22-gauge (45 %) and 25-gauge (49 %) needles are used equally. For fine-needle biopsy (FNB) of solid masses, the 25-gauge device is less favored than the 22-gauge FNA device (49 % versus 21 %). The 19-gauge needle is generally used for FNB of submucosal masses (62 %). Rapid on-site pathological evaluation (ROSE) is utilized more often by US (98 %) than by European and Asian respondents (51 %, P < 0.001). Cytolyt (52 %), formalin (15 %) and alcohol (15 %) are used for FNA specimen preservation in the United States and Europe, while saline (27 %) and alcohol (38 %) are widely used in Asia (P < 0.001). Conclusions: EUS-guided tissue sampling practices vary substantially within the international endosonographic community and differ considerably from recommendations expressed in guidelines. Because the clinical relevance of these variations is largely unknown, the outcome of this survey suggests a need for further studies. PMID:27227103

  3. Surrogate consent for research involving adults with impaired decision making: Survey of Institutional Review Board practices

    PubMed Central

    Gong, Michelle Ng; Winkel, Gary; Rhodes, Rosamond; Richardson, Lynne D.; Silverstein, Jeffrey H.

    2013-01-01

    Objectives Most critically ill adults have impaired decision-making capacity and are unable to consent to research. Yet, little is known about how Institutional Review Boards interpret the Common Rule’s call for safeguards in research involving incapacitated adults. We aimed to examine Institutional Review Board practices on surrogate consent and other safeguards to protect incapacitated adults in research. Design, Settings, and Participants A cross-sectional survey of 104 Institutional Review Boards from a random sample of U.S. institutions engaged in adult human subject research (response rate, 68%) in 2007 and 2008. Interventions None. Measurements Institutional Review Board acceptance of surrogate consent, research risks, and other safeguards in research involving incapacitated adults. Main Results Institutional Review Boards reported that, in the previous year, they sometimes (49%), frequently (33%), or very frequently (2%) reviewed studies involving patients in the intensive care unit. Six Institutional Review Boards (6%) do not accept surrogate consent for research from any persons, and 22% of Institutional Review Boards accept only an authorized proxy, spouse, or parent as surrogates, excluding adult children and other family. Institutional Review Boards vary in their limits on research risks in studies involving incapacitated adults: 15% disallow any research regardless of risk in studies without direct benefit, whereas 39% allow only minimal risks. When there was potential benefit, fewer Institutional Review Boards limit the risk at minimal (11%; p < .001). Even in populations at high risk for impaired decision making, many Institutional Review Boards rarely or never required procedures to determine capacity (13%–21%). Institutional Review Boards also varied in their use of independent monitors, research proxies, and advanced research directives. Conclusions Much variability exists in Institutional Review Board surrogate consent practices and limits

  4. Accountability Practice in Adult Education. A Survey Among Its Membership Sponsored by the Northwest Adult Education Association.

    ERIC Educational Resources Information Center

    Pierson, William W.; Scheel, Jean W.

    In 1973, the Northwest Adult Education Association distributed a questionnaire to the membership requesting information about accountability practices in the institutions represented. The survey format was open-ended, which facilitated diversity in the responses. Returns were categorized by types of institutions: Adult Education Training Centers,…

  5. Views of Evidence-Based Practice among Faculty in Master of Social Work Programs: A National Survey

    ERIC Educational Resources Information Center

    Rubin, Allen; Parrish, Danielle

    2007-01-01

    Objective: A national online survey assessed the views of 973 faculty members in master of social work programs regarding their receptivity toward, definition of, and views of disparate sources of evidence pertinent to evidence-based practice (EBP) and the teaching of EBP. Method: Due to Internet-related technical difficulties, the response rate…

  6. Comparison of Evidence-Based Practice between Physicians and Nurses: A National Survey of Regional Hospitals in Taiwan

    ERIC Educational Resources Information Center

    Chiu, Ya-Wen; Weng, Yi-Hao; Lo, Heng-Lien; Hsu, Chih-Cheng; Shih, Ya-Hui; Kuo, Ken N.

    2010-01-01

    Introduction: Although evidence-based practice (EBP) has been widely investigated, few studies compare physicians and nurses on performance. Methods: A structured questionnaire survey was used to investigate EBP among physicians and nurses in 61 regional hospitals of Taiwan. Valid postal questionnaires were collected from 605 physicians and 551…

  7. Survey of Knowledge, Attitudes and Practices of Fifth and Eighth Grade Students Regarding Alcoholic Beverages in Urban Parochial Schools.

    ERIC Educational Resources Information Center

    Lee, Essie E.

    1983-01-01

    Examined the knowledge, attitudes, and practices of fifth- and eighth-grade urban parochial school students (N=3,785) regarding alcoholic beverages. Survey results showed a religiously oriented school environment had little influence on drinking behavior. Family, friends, and cultural norms were strong influences. Sixth and seventh grades appear…

  8. Relationships between Electronic Information Media and Records Management Practices: Results of a Survey of United Nations Organizations. A Rand Note.

    ERIC Educational Resources Information Center

    Bikson, T. K.; Schieber, L.

    A Technical Panel on Electronic Records Management (TP/REM), which was established by the Advisory Committee for the Co-ordination of Information Systems (ACCIS), conducted a survey of existing electronic records management practices and standards related to new information and communication technologies and their interrelationships within the…

  9. Relations between Characteristics of Workplace Practices and Types of Informal Work-Related Learning: A Survey Study among Dutch Police

    ERIC Educational Resources Information Center

    Doornbos, Anja J.; Simons, Robert-Jan; Denessen, Eddie

    2008-01-01

    Some organizations seek to promote informal work-related learning to stimulate organizational performance. This study focuses on six types of work-related learning in relation to personal, relational, and work characteristics of the workplace practice. A survey was conducted to identify types and levels of work-related learning for executive Dutch…

  10. Child Injury Prevention in the Home: A National Survey of Safety Practices and Use of Safety Equipment in Deprived Families

    ERIC Educational Resources Information Center

    Mulvaney, C. A.; Watson, M. C.; Smith, S.; Coupland, C.; Kendrick, D.

    2014-01-01

    Objective: To determine the prevalence of home safety practices and use of safety equipment by disadvantaged families participating in a national home safety equipment scheme in England. Design: Cross-sectional postal survey sent to a random sample of 1,000 families. Setting: England, United Kingdom. Results: Half the families (51%) returned a…

  11. A State Survey of Child Advocacy Center Therapists' Attitudes toward Treatment Manuals and Evidence-Based Practice

    ERIC Educational Resources Information Center

    Staudt, Marlys; Williams-Hayes, Mona

    2011-01-01

    The objective of this descriptive study was to examine Child Advocacy Center therapists' attitudes toward treatment manuals and evidence-based practices and to gather information about the treatments they use most frequently. An online survey was sent to 30 therapists employed by 15 Child Advocacy Centers in a southeastern state. The response rate…

  12. What Teachers Want: A Statewide Survey of Reading and English Language Arts Teachers' Instructional Materials, Preferences, and Practices

    ERIC Educational Resources Information Center

    Lenski, Susan; Larson, Mindy; McElhone, Dot; Davis, Dennis S.; Lauritzen, Carol; Villagómez, Amanda; Yeigh, Maika; Landon-Hays, Melanie; LeJeune, Marie; Scales, W. David

    2016-01-01

    This study reports the results of a survey of a representative sample of 1,206 elementary reading and English Language Arts teachers in Oregon to learn (1) what materials are currently being used, (2) what materials teachers would prefer, and (3) what instructional practices teachers use. Qualitative data included 365 comments and 34 interviews…

  13. A Survey of the Practice of Patient Education with Spinal Cord Injured Patients in Rehabilitation Centers in the United States.

    ERIC Educational Resources Information Center

    Mullins, June B.; Bendel, Judith G.

    Practices in patient education for spinal cord injured persons in 10 hospital rehabilitation centers were examined. Surveys revealed that a majority of the centers conducted patient education (designed to provide facts about the injury as well as psychological support). Findings revealed a large number of staff involved, but a wide difference in…

  14. Heterosexual practices of women and men living with HIV attending hospital outpatient services (ANRS-VESPA2 survey): a French comparative study with the general population (CSF survey).

    PubMed

    Boyer, V; Vilotitch, A; Panjo, H; Sagaon-Teyssier, L; Marcellin, F; Dray-Spira, R; Spire, B; Bajos, N

    2016-11-01

    HAART has improved the well-being of many people living with HIV (PLWH). This study aimed at (i) comparing heterosexual practices between PLWH and the general population by gender, and (ii) identifying factors associated with sexual practices and at-risk behaviors in the two populations. Self-reported data were collected among PLWH attending hospitals (VESPA2 survey; n = 3022) and the general population (CSF survey; n = 10,280). Significant differences between the two samples were corrected for by implementing propensity score matching on both socio-demographic characteristics and sexual behavior in terms of number of partners. Men not reporting heterosexual intercourse were excluded. After matching, 61% of women (out of 707) and 68% of men (out of 709) were sexually active in both populations. PLWH practiced oral sex less than the general population and used condoms more consistently over the previous 12-month period, irrespective of having multiple sexual partners or not. For women living with HIV: those with several sexual partners and those consuming drugs over the previous 12 months were more likely to practice oral sex; those living in a couple for at least 6 years and migrants were less likely to practice anal intercourse. For men living with HIV: those reporting bisexual relationships and those with multiple sexual partners over the previous 12 months were more likely to practice anal heterosexual intercourse; migrants reported less oral sex, irrespective of HIV status. Error term correlations showed that anal intercourse was not linked to condom use for women or men from either population. Our results show that PLWH had a lower rate of heterosexual practices compared with the general population, and used condoms more often, irrespective of the number of sexual partners and strong cultural background (e.g., for Sub-Saharan African women). Further preventive information needs to be disseminated on the risk of infection transmission through

  15. Heterosexual practices of women and men living with HIV attending hospital outpatient services (ANRS-VESPA2 survey): a French comparative study with the general population (CSF survey).

    PubMed

    Boyer, V; Vilotitch, A; Panjo, H; Sagaon-Teyssier, L; Marcellin, F; Dray-Spira, R; Spire, B; Bajos, N

    2016-11-01

    HAART has improved the well-being of many people living with HIV (PLWH). This study aimed at (i) comparing heterosexual practices between PLWH and the general population by gender, and (ii) identifying factors associated with sexual practices and at-risk behaviors in the two populations. Self-reported data were collected among PLWH attending hospitals (VESPA2 survey; n = 3022) and the general population (CSF survey; n = 10,280). Significant differences between the two samples were corrected for by implementing propensity score matching on both socio-demographic characteristics and sexual behavior in terms of number of partners. Men not reporting heterosexual intercourse were excluded. After matching, 61% of women (out of 707) and 68% of men (out of 709) were sexually active in both populations. PLWH practiced oral sex less than the general population and used condoms more consistently over the previous 12-month period, irrespective of having multiple sexual partners or not. For women living with HIV: those with several sexual partners and those consuming drugs over the previous 12 months were more likely to practice oral sex; those living in a couple for at least 6 years and migrants were less likely to practice anal intercourse. For men living with HIV: those reporting bisexual relationships and those with multiple sexual partners over the previous 12 months were more likely to practice anal heterosexual intercourse; migrants reported less oral sex, irrespective of HIV status. Error term correlations showed that anal intercourse was not linked to condom use for women or men from either population. Our results show that PLWH had a lower rate of heterosexual practices compared with the general population, and used condoms more often, irrespective of the number of sexual partners and strong cultural background (e.g., for Sub-Saharan African women). Further preventive information needs to be disseminated on the risk of infection transmission through

  16. Barriers to suicide risk management in clinical practice: a national survey of oncology nurses.

    PubMed

    Valente, Sharon; Saunders, Judith M

    2004-09-01

    Standards of practice identify the nurse's pivotal role in risk detection, assessment, intervention, and management of suicidal patients, but scant research explores the barriers that hinder this role. This study describes the analysis of barriers to suicide risk management from a survey of a random sample of members of a national organization, the Oncology Nursing Society (n = 1200), who participated in a descriptive study exploring nurses' knowledge and attitudes about suicide. The 454 (37%) respondents included respondents from the United States, Canada, and Puerto Rico. Instruments included a demographic inventory, the Suicide Opinion Questionnaire (SOQ), a suicide attitude measure (SUIATT), and a vignette of a suicidal patient. Nurses knew an average of 4.8 out of 9 suicide risk factors and 49.4% miscalculated the risk of suicide. In contrast with their moderate to high ratings of suicide risk, they indicated minimal interventions. Barriers to management of suicidal patients included deficits in skill, knowledge, referrals, patient teaching, advocacy, or consultation as well as participants' and religious/other values, uncomfortable feelings, personal experiences, and the weight of professional responsibility. Strategies for intervention include: suicide prevention education, consultation, values clarification, ethical analysis, and conflict resolution and psychosocial support to reduce barriers. Nurses are not alone in their request for more education about suicide prevention; this study confirms earlier research of psychologists and psychiatrists who report they need more education in suicide risk management. PMID:15371147

  17. Domiciliary Non-invasive Ventilation in COPD: An International Survey of Indications and Practices.

    PubMed

    Crimi, Claudia; Noto, Alberto; Princi, Pietro; Cuvelier, Antoine; Masa, Juan F; Simonds, Anita; Elliott, Mark W; Wijkstra, Peter; Windisch, Wolfram; Nava, Stefano

    2016-08-01

    Despite the fact that metanalyses and clinical guidelines do not recommend the routine use of domiciliary non-invasive ventilation (NIV) for patients diagnosed with severe stable Chronic Obstructive Pulmonary Disease (COPD) and with chronic respiratory failure, it is common practice in some countries. We conducted an international web-survey of physicians involved in provision of long-term NIV to examine patterns of domiciliary NIV use in patients diagnosed with COPD. The response rate was 41.6%. A reduction of hospital admissions, improvements in quality of life and dyspnea relief were considered as the main expected benefits for patients. Nocturnal oxygen saturation assessment was the principal procedure performed before NIV prescription. Recurrent exacerbations (>3) requiring NIV and failed weaning from in hospital NIV were the most important reasons for starting domiciliary NIV. Pressure support ventilation (PSV) was the most common mode, with "low" intensity settings (PSV-low) the most popular (44.4 ± 30.1%) compared with "high" intensity (PSV-high) strategies (26.9 ± 25.9%), with different geographical preferences. COPD is confirmed to be a common indication for domiciliary NIV. Recurrent exacerbations and failed weaning from in-hospital NIV were the main reasons for its prescription. PMID:26744042

  18. Imaging and image management: A survey on current outlook and awareness in pathology practice

    PubMed Central

    Indu, M; Sunil, S; Rathy, R; Binu, MP

    2015-01-01

    Background: Flexibility of digital photography enables it to be an integral part of pathology practice. An assessment of guidelines of imaging is essential for proper usage of photographs. Objectives: The purpose of the study was to assess awareness of oral pathologists about various aspects of medical photography. Methods: Questionnaire based on the availability of facilities, usage, technical details and ethical issues of medical photography was sent to postgraduate students and teaching faculties of Oral Pathology in various localities in India. Results: Photographs were taken mostly for the purposes of publication, medical documentation and education. Significant number of postgraduate students and faculties of Oral Pathology didn’t receive any training or hadn’t gone through any publications/books (P = 0.000) about medical photography. Consent for patient photography was taken by significant number of respondents (P = 0.000) but in a verbal form. Majority of people used image editing software, but 19.0% of faculties and 21.1% of postgraduate students were unaware of deleterious effect of image editing. Firm and sensible instructions concerning image storage, sharing and accessibility were not yet created. Conclusion: This survey drew attention towards lack of proper understanding about the technical details, medical protocols and ethical issues related to medical photography. These findings recommend implementation of basic training for medical photography and policy for image management for students and faculties in every health care institution. PMID:26604489

  19. A survey of program evaluation practices in family-centered pediatric rehabilitation settings.

    PubMed

    Moreau, Katherine A; Cousins, J Bradley

    2014-04-01

    Program evaluation is becoming increasingly important in pediatric rehabilitation settings that adhere to the family-centered service (FCS) philosophy. However, researchers know little about the specific evaluation activities occurring in these settings or the extent to which evaluators/service providers uphold FCS in their program evaluation activities. Through a questionnaire survey, this study aimed to document evaluators/service providers' perceptions of the level of program evaluation occurring in their Canadian pediatric rehabilitation centers. It also investigated the extent to which evaluators/service providers perceive program evaluation practices at their centers to be consistent with the FCS context of Canadian pediatric rehabilitation settings. The findings suggested that the amount of evaluation activities occurring within the respondents' centers is variable; that the majority of individuals working in program evaluation do not have formal training in it; and that the respondents' centers have limited resources for evaluation. The study also showed that staff members believe their centers' evaluation activities are somewhat consistent with FCS philosophy, but that improvements are needed.

  20. Survey of Intraocular Antibiotics Prophylaxis Practice after Open Globe Injury in China

    PubMed Central

    Tan, Junlian; Yang, Yao; Yuan, Zhaohui; Lin, Xiaofeng

    2016-01-01

    Purpose To elucidate the Chinese practice of intraocular antibiotics administration for prophylaxis after open globe injury. Methods A cross-sectional questionnaire survey was performed online by scanning a Quickmark (QR) code with smartphones at the 20th Chinese National Conference of Ocular Trauma in November 2014. Results A total of 153 (30.6%) of all participators at the conference responded. Of the respondents, 20.9% were routinely administered with prophylactic intraocular injection of antibiotics at the conclusion of the primary eye repair, and 56.9% were used only in cases with high risk of endophthalmitis development. The intraocular route of delivery was mainly included with intracameral injection (47.9%) and intravitreal injection (42.0%). Cephalosporins (53.8%) and vancomycin (42.0%) were the main choices of antibiotic agents, followed by fluoroquinolones (24.3%), and aminoglycosides (13.4%). Only 21.9% preferred a combination of two or more two drugs routinely. In addition, significantly more respondents from the referral eye hospital (92.7%) replied using intraocular antibiotics injection for prophylaxis compared to those respondents from the primary hospital (69.4%) (p = 0.001, Fisher’s exact test). Conclusions Intraocular antibiotics injection for post-traumatic endophthalmitis prophylaxis is widely used in China. However, the choice of antibiotic agents and the intraocular route of delivery vary. A well-designed clinical trial is needed to establish a standardized protocol of intraocular antibiotics administration for post-traumatic endophthalmitis prophylaxis. PMID:27275777

  1. A Survey of Quality Assurance Practices in Biomedical Open Source Software Projects

    PubMed Central

    Koru, Günes; Neisa, Angelica; Umarji, Medha

    2007-01-01

    Background Open source (OS) software is continuously gaining recognition and use in the biomedical domain, for example, in health informatics and bioinformatics. Objectives Given the mission critical nature of applications in this domain and their potential impact on patient safety, it is important to understand to what degree and how effectively biomedical OS developers perform standard quality assurance (QA) activities such as peer reviews and testing. This would allow the users of biomedical OS software to better understand the quality risks, if any, and the developers to identify process improvement opportunities to produce higher quality software. Methods A survey of developers working on biomedical OS projects was conducted to examine the QA activities that are performed. We took a descriptive approach to summarize the implementation of QA activities and then examined some of the factors that may be related to the implementation of such practices. Results Our descriptive results show that 63% (95% CI, 54-72) of projects did not include peer reviews in their development process, while 82% (95% CI, 75-89) did include testing. Approximately 74% (95% CI, 67-81) of developers did not have a background in computing, 80% (95% CI, 74-87) were paid for their contributions to the project, and 52% (95% CI, 43-60) had PhDs. A multivariate logistic regression model to predict the implementation of peer reviews was not significant (likelihood ratio test = 16.86, 9 df, P = .051) and neither was a model to predict the implementation of testing (likelihood ratio test = 3.34, 9 df, P = .95). Conclusions Less attention is paid to peer review than testing. However, the former is a complementary, and necessary, QA practice rather than an alternative. Therefore, one can argue that there are quality risks, at least at this point in time, in transitioning biomedical OS software into any critical settings that may have operational, financial, or safety implications. Developers of

  2. Attitudes and beliefs toward the use of a dental diagnostic terminology A survey of dental providers in a dental practice

    PubMed Central

    Ramoni, Rachel B.; Walji, Muhammad F.; Kim, Soyun; Tokede, Oluwabunmi; McClellan, Lyle; Simmons, Kristen; Skourtes, Eugene; Yansane, Alfa; White, Joel M.; Kalenderian, Elsbeth

    2015-01-01

    Background Attitudes and views are critical to the adoption of innovation. While there have been broadening calls for a standardized dental diagnostic terminology, little is known about the views of private practice dental team members towards the adoption of such a terminology. Methods A survey was developed using validated questions identified through literature review. Domain experts’ input allowed for further modifications. The final survey was administered electronically to 814 team members at a multi-office practice based in the Pacific Northwest. Results Response proportion was 92%. The survey had excellent reliability (Cronbach alpha coefficient = 0.87). Results suggested that participants showed, in general, positive attitudes and beliefs towards using a standardized diagnostic terminology in their practices. Additional written comments by participants highlighted the potential for improved communication with use of the terminology. Conclusions Dental providers and staff in one multi-office practice showed positive attitudes towards the use of a diagnostic terminology, specifically they believed it would improve communication between the dentist and patient as well as among providers, while expressing some concerns if using standardized dental diagnostic terms helps clinicians to deliver better dental care. Practical Implications As the dental profession is advancing towards the use of standardized diagnostic terminologies, successful implementation will require that dental team leaders prepare their dental teams by gauging their attitude toward the use of such a terminology. PMID:26025826

  3. National Kidney Foundation Council on Renal Nutrition survey: past-present clinical practices and future strategic planning.

    PubMed

    Moore, Harold; Reams, Susan M; Wiesen, Karen; Nolph, Karl D; Khanna, Ramesh; Laothong, Chonwit

    2003-07-01

    Early nutritional intervention is thought to play a major role in the preservation of renal function and the overall wellbeing in the renal patient. In preparation for renal replacement therapy (RRT), a consultation with the renal nutritionist to establish a diet consistent with the existing diagnosis may increase the likelihood of reducing cardiovascular risk factors, preventing malnutrition and anemia, and slowing the progression of renal disease, all of which can contribute to positive patient outcomes. In a 1999 United States Renal Data System survey of 3,468 new dialysis patients, 46% indicated that they had not consulted with a dietitian before the initiation of dialysis. To help with establishing education programs, determine staffing guidelines, and planning future endeavors, the National Kidney Foundation Council on Renal Nutrition conducted a survey of their 1,748 members. The survey was designed to assess the current demographic profile and clinical practice elements of practicing renal dietitians. Surveys were distributed as a section of the 1999-2000 winter issue of the CRN Quarterly Newsletter, with 353 of the members responding. Information collected pertained to patient care settings, number of facilities covered, patient age, patient treatment modalities, dietitian contact hours required to effectively educate pre-end-stage renal disease patients on a low-protein diet and to ensure optimal nutrition status for the chronic kidney disease patients. The dietitians of this cohort had practiced dietetics for 14.5 +/- 8.6 years and renal nutrition for 9.15 +/- 6.9 years. The survey data showed a discrepancy between what the clinical practices were in 1999 and what the current recommendations are, based on the Kidney Disease Outcomes Quality Initiatives (K/DOQI) Clinical Practice Guidelines. PMID:12874750

  4. Sepsis biomarkers in unselected patients on admission to intensive or high-dependency care

    PubMed Central

    2013-01-01

    Introduction Although many sepsis biomarkers have shown promise in selected patient groups, only C-reactive protein and procalcitonin (PCT) have entered clinical practice. The aim of this study was to evaluate three promising novel sepsis biomarkers in unselected patients at admission to intensive care. We assessed the performance of pancreatic stone protein (PSP), soluble CD25 (sCD25) and heparin binding protein (HBP) in distinguishing patients with sepsis from those with a non-infective systemic inflammatory response and the ability of these markers to indicate severity of illness. Methods Plasma levels of the biomarkers, PCT and selected inflammatory cytokines were measured in samples taken from 219 patients during the first six hours of admission to intensive or high dependency care. Patients with a systemic inflammatory response were categorized as having sepsis or a non-infective aetiology, with or without markers of severity, using standard diagnostic criteria. Results Both PSP and sCD25 performed well as biomarkers of sepsis irrespective of severity of illness. For both markers the area under the receiver operating curve (AUC) was greater than 0.9; PSP 0.927 (0.887 to 0.968) and sCD25 0.902 (0.854 to 0.949). Procalcitonin and IL6 also performed well as markers of sepsis whilst in this intensive care unit (ICU) population, HBP did not: PCT 0.840 (0.778 to 0.901), IL6 0.805 (0.739 to 0.870) and HBP 0.607 (0.519 to 0.694). Levels of both PSP and PCT reflected severity of illness and both markers performed well in differentiating patients with severe sepsis from severely ill patients with a non-infective systemic inflammatory response: AUCs 0.955 (0.909 to 1) and 0.837 (0.732 to 0.941) respectively. Although levels of sCD25 did not correlate with severity, the addition of sCD25 to either PCT or PSP in a multivariate model improved the diagnostic accuracy of either marker alone. Conclusions PSP and sCD25 perform well as sepsis biomarkers in patients with

  5. Mechanisms of Intestinal Barrier Dysfunction in Sepsis.

    PubMed

    Yoseph, Benyam P; Klingensmith, Nathan J; Liang, Zhe; Breed, Elise R; Burd, Eileen M; Mittal, Rohit; Dominguez, Jessica A; Petrie, Benjamin; Ford, Mandy L; Coopersmith, Craig M

    2016-07-01

    Intestinal barrier dysfunction is thought to contribute to the development of multiple organ dysfunction syndrome in sepsis. Although there are similarities in clinical course following sepsis, there are significant differences in the host response depending on the initiating organism and time course of the disease, and pathways of gut injury vary widely in different preclinical models of sepsis. The purpose of this study was to determine whether the timecourse and mechanisms of intestinal barrier dysfunction are similar in disparate mouse models of sepsis with similar mortalities. FVB/N mice were randomized to receive cecal ligation and puncture (CLP) or sham laparotomy, and permeability was measured to fluoresceinisothiocyanate conjugated-dextran (FD-4) six to 48 h later. Intestinal permeability was elevated following CLP at all timepoints measured, peaking at 6 to 12 h. Tight junction proteins claudin 1, 2, 3, 4, 5, 7, 8, 13, and 15, Junctional Adhesion Molecule-A (JAM-A), occludin, and ZO-1 were than assayed by Western blot, real-time polymerase chain reaction, and immunohistochemistry 12 h after CLP to determine potential mechanisms underlying increases in intestinal permeability. Claudin 2 and JAM-A were increased by sepsis, whereas claudin-5 and occludin were decreased by sepsis. All other tight junction proteins were unchanged. A further timecourse experiment demonstrated that alterations in claudin-2 and occludin were detectable as early as 1 h after the onset of sepsis. Similar experiments were then performed in a different group of mice subjected to Pseudomonas aeruginosa pneumonia. Mice with pneumonia had an increase in intestinal permeability similar in timecourse and magnitude to that seen in CLP. Similar changes in tight junction proteins were seen in both models of sepsis although mice subjected to pneumonia also had a marked decrease in ZO-1 not seen in CLP. These results indicate that two disparate, clinically relevant models of sepsis

  6. Fitting a square peg into a round hole: are the current Surviving Sepsis Campaign guidelines feasible for Africa?

    PubMed

    Jacob, Shevin T; West, T Eoin; Banura, Patrick

    2011-01-01

    In their article, Baelani and colleagues surveyed anesthesia providers from African low- and middle-income countries (LMICs) to evaluate whether or not the current Surviving Sepsis Campaign (SSC) guidelines are feasible in such resource-constrained settings. The authors report that an alarmingly low percentage of hospitals have the capacity to implement the SSC guidelines in their entirety but a higher percentage are able to implement the majority of SSC guidelines and grade 1 recommendations. In reality, the probability of adherence to SSC guidelines for septic management is even lower than reported, given that the majority of sepsis management in African LMICs is likely performed by non-intensivists outside of intensive care units. Efforts to address the challenges of managing severely ill patients in LMICs have recently been taken on by the World Health Organization. After reviewing available evidence for sepsis management predominantly from high-income countries, a panel of experts developed a consensus-based strategy tailored for resource-limited settings. However, more research that can evaluate the challenges specific to sepsis management in LMICs and not currently addressed by the SSC guidelines is needed. Comprehensive, evidence-based guidelines combined with innovative approaches to sepsis management in LMICs are required to make a meaningful impact on worldwide sepsis survival.

  7. Neonatal sepsis in Dubai, United Arab Emirates.

    PubMed

    Koutouby, A; Habibullah, J

    1995-06-01

    The case records of all neonates admitted to the neonatal unit of Al Wasl Hospital (Dubai) in a period of 60 months (May 1987-April 1992) were analysed. One-hundred-and-six neonates had confirmed sepsis. The most common causative organisms were Group B Streptococci (23 per cent), E. coli (17 per cent), Staph. epidermidis (17 per cent), and Klebsiella pneumoniae (16 per cent). Group B Streptococcus presented as the most common organism in very early (< or = 24 hours) and early onset (2-6 days) of sepsis (34 per cent, 21/61), Klebsiella pneumoniae (24 per cent), Staphylococcal epidermidis (18 per cent) and Candida (13 per cent) were most common organisms causing late onset of sepsis (7-30 days). Pseudomonas aeruginosa and Klebsiella pneumoniae had highest mortality (71 per cent, 5/7; and 59 per cent, 10/17, respectively). Lowest mortality (4 per cent, 1/25) was observed in Group B Streptococcus sepsis. Prematurity, low birth weight, and nosocomial sepsis were high risk factors associated with fatal outcome.

  8. Neuromuscular Dysfunction in Experimental Sepsis and Glutamine

    PubMed Central

    Çankayalı, İlkin; Boyacılar, Özden; Demirağ, Kubilay; Uyar, Mehmet; Moral, Ali Reşat

    2016-01-01

    Background: Electrophysiological studies show that critical illness polyneuromyopathy appears in the early stage of sepsis before the manifestation of clinical findings. The metabolic response observed during sepsis causes glutamine to become a relative essential amino acid. Aims: We aimed to assess the changes in neuromuscular transmission in the early stage of sepsis after glutamine supplementation. Study Design: Animal experimentation. Methods: Twenty male Sprague-Dawley rats were randomized into two groups. Rats in both groups were given normal feeding for one week. In the study group, 1 g/kg/day glutamine was added to normal feeding by feeding tube for one week. Cecal ligation and perforation (CLP) surgery was performed at the end of one week. Before and 24 hours after CLP, compound muscle action potentials were recorded from the gastrocnemius muscle. Results: Latency measurements before and 24 hours after CLP were 0.68±0.05 ms and 0.80±0.09 ms in the control group and 0.69±0.07 ms and 0.73±0.07 ms in the study group (p<0.05). Conclusion: Since enteral glutamine prevented compound muscle action potentials (CMAP) latency prolongation in the early phase of sepsis, it was concluded that enteral glutamine replacement might be promising in the prevention of neuromuscular dysfunction in sepsis; however, further studies are required. PMID:27308070

  9. Year in review 2008: Critical Care - sepsis

    PubMed Central

    2009-01-01

    The present report highlights the most important papers appearing in Critical Care and other major journals about severe sepsis, the systemic inflammatory response and multiorgan dysfunction over the past year. A number of these clinical and laboratory studies will have a considerable impact on the sepsis research agenda for years to come. The steroid controversy, the debate over tight glycemic control, the colloid versus crystalloid issue, the value of selective decontamination of the digestive tract, the enlarging role of biomarkers, the value of genomics and rapid diagnostic techniques have all been prominently featured in recent publications. Basic research into novel predictive assays, genetic polymorphisms, and new molecular methods to risk-stratify and to determine treatment options for sepsis have occupied much of the Critical Care publications relating to sepsis pathophysiology in 2008. We will attempt to briefly summarize what we consider to be the most significant contributions to the sepsis literature over the last year, and their likely ramifications in the future, for critical care clinicians, clinical investigators and basic researchers alike. PMID:19886974

  10. Parasite control practices and public perception of parasitic diseases: A survey of dog and cat owners.

    PubMed

    Matos, Mariana; Alho, Ana Margarida; Owen, Sinclair Patrick; Nunes, Telmo; Madeira de Carvalho, Luís

    2015-11-01

    Drugs used in the control of internal and external parasites in companion animals play a crucial role in Animal and Public Health. To ensure continuing protection, these drugs should be administered regularly and in intervals, as suggested by the manufacturers. To assess parasite control practices and other related factors, including the degree of public awareness on the topic, 312 dog and cat owners were surveyed while attending the Small Animal Hospital, Faculty of Veterinary Medicine, Lisbon University. Results showed that 89.7% of the dogs were currently being treated with endoparasitic drugs. Of these, 74.3% were dewormed every four months or longer and merely 11.8% with the recommended treatment regimen (minimum quarterly). In cats, 63.6% were being treated with endoparasitic drugs and 85.7% of these were irregularly dewormed every four months or longer and merely 5.5% with the recommended treatment regimen (minimum quarterly). Combinations of praziquantel, pyrantel embonate and febantel were the most commonly used drugs in dogs, whereas macrocyclic lactones were more frequently used in cats. Regarding external parasitic control, 92.2% of the dogs were being treated, 50.5% of these at monthly intervals (all-year round or seasonally). The most common ectoparasitic drug formulation used on dogs was the spot-on imidacloprid+permethrin (89%). Only 28.4% of the dogs were uninterruptedly protected throughout the year from the main canine vector borne diseases transmitted by fleas, ticks, sandflies and mosquitoes. Merely 63.6% of the cats were being controlled with ectoparasitic drugs, most at infrequent drug intervals and imidacloprid was the most frequently used drug on cats (44.4%). Additionally, 85% of the respondents had never heard of the word "zoonosis" and 37% of them did not collect their dog's faeces in all public places. Scabies, toxoplasmosis and leishmaniasis were the most frequent parasitic diseases identified by the public in this survey. Although the

  11. Parasite control practices and public perception of parasitic diseases: A survey of dog and cat owners.

    PubMed

    Matos, Mariana; Alho, Ana Margarida; Owen, Sinclair Patrick; Nunes, Telmo; Madeira de Carvalho, Luís

    2015-11-01

    Drugs used in the control of internal and external parasites in companion animals play a crucial role in Animal and Public Health. To ensure continuing protection, these drugs should be administered regularly and in intervals, as suggested by the manufacturers. To assess parasite control practices and other related factors, including the degree of public awareness on the topic, 312 dog and cat owners were surveyed while attending the Small Animal Hospital, Faculty of Veterinary Medicine, Lisbon University. Results showed that 89.7% of the dogs were currently being treated with endoparasitic drugs. Of these, 74.3% were dewormed every four months or longer and merely 11.8% with the recommended treatment regimen (minimum quarterly). In cats, 63.6% were being treated with endoparasitic drugs and 85.7% of these were irregularly dewormed every four months or longer and merely 5.5% with the recommended treatment regimen (minimum quarterly). Combinations of praziquantel, pyrantel embonate and febantel were the most commonly used drugs in dogs, whereas macrocyclic lactones were more frequently used in cats. Regarding external parasitic control, 92.2% of the dogs were being treated, 50.5% of these at monthly intervals (all-year round or seasonally). The most common ectoparasitic drug formulation used on dogs was the spot-on imidacloprid+permethrin (89%). Only 28.4% of the dogs were uninterruptedly protected throughout the year from the main canine vector borne diseases transmitted by fleas, ticks, sandflies and mosquitoes. Merely 63.6% of the cats were being controlled with ectoparasitic drugs, most at infrequent drug intervals and imidacloprid was the most frequently used drug on cats (44.4%). Additionally, 85% of the respondents had never heard of the word "zoonosis" and 37% of them did not collect their dog's faeces in all public places. Scabies, toxoplasmosis and leishmaniasis were the most frequent parasitic diseases identified by the public in this survey. Although the

  12. Awareness of dengue and practice of dengue control among the semi-urban community: a cross sectional survey.

    PubMed

    Naing, Cho; Ren, Wong Yih; Man, Chan Yuk; Fern, Koh Pei; Qiqi, Chua; Ning, Choo Ning; Ee, Clarice Wong Syun

    2011-12-01

    Primary prevention is the most effective measure in dengue prevention and control. The objectives were (i) to determine the level of knowledge and practice of dengue control amongst the study community, and (ii) to explore the factors affecting practice of dengue control in the study area. A cross-sectional study was conducted in a semi-urban Town of Malaysia, using a structured questionnaire covering sociodemography, knowledge related to dengue, knowledge related to Aedes mosquito and preventive measures against the disease. For comparison of survey responses, chi-square test was applied for categorical data. To explore the factors affecting the practice of dengue control, a linear regression model was introduced. Almost all of the respondents (95%) had heard about dengue. Overall, misconceptions of dengue transmission were identified and the practice of dengue control in the study population was insufficient. About half (50.5%) had misconceptions that Aedes can breed in dirty water and the preferred biting time is dusk or sunset (45.6%). Only 44.5% of the households surveyed had covered their water containers properly. Significant associations were found between knowledge scores of dengue and age (P = 0.001), education level (P = 0.001), marital status (P = 0.012), and occupation (P = 0.007). In regression analysis, only the knowledge of dengue was significantly and positively associated with practice on dengue control. A future study with larger samples and more variables to assess the knowledge, attitudes and practices of dengue control is recommended.

  13. Chinese Urologists' Views of Practice Patterns in the Diagnosis and Treatment of Benign Prostatic Hyperplasia: A Nationwide Survey

    PubMed Central

    Sun, Jian; Yu, Pulin; Sun, Zhenqiu

    2012-01-01

    Purpose To assess the compliance of Chinese urologists with China's benign prostatic hyperplasia (BPH) clinical practice guideline and to explore the diagnosis and therapy modalities for geriatric patients with BPH. Methods A cross-sectional survey study was carried out in 33 medical centers in 11 different cities in China. A total of 190 urologists participated in a survey to record their preferences for diagnostic tests and treatment options for BPH outpatients. Diagnostic test results as well as health care demands were collected by surveying 2,027 outpatients aged 60 years and older. Results The survey response rate was 97.4%. The respondents generally used the diagnostic tests recommended in China's BPH clinical practice guideline at varying rates. The used rates for medical history, ultrasonography, and urinalysis were above 90.0%; that for uroflowmetry was 31.2%. In addition, the rate of use of recommended tests was higher among doctors in the north than among those in the south. Combination therapy with α-adrenoceptor antagonists and 5α-reductase inhibitors was the preferred treatment option for BPH, and was increasingly used with worsening lower urinary tract symptoms. Finasteride was the most prescribed medication (48.0%), followed by tamsulosin (22.7%). Conclusions This study assessed the preferences of urologists in the diagnosis and treatment of BPH, which will serve as an important reference for updating and improving China's current BPH clinical practice guideline. PMID:23346486

  14. Endotoxins and other sepsis triggers.

    PubMed

    Opal, Steven M

    2010-01-01

    Endotoxin, or more accurately termed bacterial lipopolysaccharide (LPS), is recognized as the most potent microbial mediator implicated in the pathogenesis of sepsis and septic shock. Yet despite its discovery well over a century ago, the fundamental role of circulating endotoxin in the blood of most patients with septic shock remains enigmatic and a subject of considerable controversy. LPS is the most prominent 'alarm molecule' sensed by the host's early warning system of innate immunity presaging the threat of invasion of the internal milieu by Gram-negative bacterial pathogens. In small doses within a localized tissue space, LPS signaling is advantageous to the host in orchestrating an appropriate antimicrobial defense and bacterial clearance mechanisms. Conversely, the sudden release of large quantities of LPS into the bloodstream is clearly deleterious to the host, initiating the release of a dysregulated and potentially lethal array of inflammatory mediators and procoagulant factors in the systemic circulation. The massive host response to this single bacterial pattern recognition molecule is sufficient to generate diffuse endothelial injury, tissue hypoperfusion, disseminated intravascular coagulation and refractory shock. Numerous attempts to block endotoxin activity in clinical trials with septic patients have met with inconsistent and largely negative results. Yet the groundbreaking discoveries within the past decade into the precise molecular basis for LPS-mediated cellular activation and tissue injury has rekindled optimism that a new generation of therapies that specifically disrupt LPS signaling might succeed. Other microbial mediators found in Gram-positive bacterial and viral and fungal pathogens are now appreciated to activate many of the same host defense networks induced by LPS. This information is providing novel interventions in the continuing effots to improve the care of septic patients.

  15. Alcohol Consumption Practices among Married Women of Reproductive Age in Nepal: A Population Based Household Survey

    PubMed Central

    Thapa, Narbada; Aryal, Krishna Kumar; Puri, Rupendra; Shrestha, Saraswoti; Shrestha, Sheela; Thapa, Pukar; Mehata, Suresh; Thapa, Pushpa; Banjara, Megha Raj; Stray-Pedersen, Babill

    2016-01-01

    Background Alcohol chemically known as ethanol, causes several health, economic and social consequences across the world. Literatures suggest potential harm of alcohol drinking by pregnant women especially to the fetus and the mother. Despite anumber of significant public health problems related to alcohol consumption, this area has been ignored in Nepal and information at the national level is limited. Thus this study aimed at finding the prevalence of alcohol consumption among married women of reproductive age. Methods A nationally representative household survey was carried out from April to August 2013 by taking 16 districts across all 15 eco administrative regions. From the selected districts, 86 village development committees and 14 municipalities were selected as primary sampling units using probability proportionate to size, followed by random selection of 3 wards from each primary sampling unit. Finally, 30 households within each ward were selected using systematic random sampling, and one married women of reproductive age from each household. A total of 9000 married women of reproductive age were interviewed using a semi-structured questionnaire, on alcohol consumption practices including environmental factors and socio demographic characteristics and were included in the analysis. Results National prevalence of alcohol consumption ever among married women of reproductive age was 24.7% (95% CI:21.7–28.0), last 12 months 17.9% (95% CI:15.3–20.7) and last 30 days (current drinking) 11.8% (95% CI:9.8–14.1). There was substantial variation among the districts ranging from 2% to 60%. Multivariable analysis suggests women with no education or within formal education, dalit and janajatis ethnicity, whose husbands drink alcohol, who brew alcohol at home and women from mountains were significantly at higher risk of consuming alcohol. Among the women who drank alcohol in last 12 months, a substantial proportion of them drank home brewed alcoholic beverages

  16. Pain management policies and practices in pediatric emergency care: a nationwide survey of Italian hospitals

    PubMed Central

    2013-01-01

    Background Pain experienced by children in emergency departments (EDs) is often poorly assessed and treated. Although local protocols and strategies are important to ensure appropriate staff behaviours, few studies have focussed on pain management policies at hospital or department level. This study aimed at describing the policies and reported practices of pain assessment and treatment in a national sample of Italian pediatric EDs, and identifying the assocoated structural and organisational factors. Methods A structured questionnaire was mailed to all the 14 Italian pediatric and maternal and child hospitals and to 5 general hospitals with separate pediatric emergency room. There were no refusals. Information collected included the frequency and mode of pain assessment, presence of written pain management protocols, use of local anaesthetic (EMLA cream) before venipuncture, and role of parents. General data on the hospital and ED were also recorded. Multiple Correspondence Analysis was used to explore the multivariable associations between the characteristics of hospitals and EDs and their pain management policies and practices. Results Routine pain assessment both at triage and in the emergency room was carried out only by 26% of surveyed EDs. About one third did not use algometric scales, and almost half (47.4%) did not have local protocols for pain treatment. Only 3 routinely reassessed pain after treatment, and only 2 used EMLA. All EDs allowed parents’ presence and most (17, 89.9%) allowed them to stay when painful procedures were carried out. Eleven hospitals (57.9%) allowed parents to hold their child during blood sampling. Pediatric and maternal and child hospitals, those located in the North of Italy, equipped with medico-surgical-traumatological ED and short stay observation, and providing full assessment triage over 24 hours were more likely to report appropriate policies for pain management both at triage and in ER. A nurses to admissions ratio

  17. Survey of dairy management practices on one hundred thirteen north central and northeastern United States dairies.

    PubMed

    Fulwider, W K; Grandin, T; Rollin, B E; Engle, T E; Dalsted, N L; Lamm, W D

    2008-04-01

    The objective was to conduct a broad survey of dairy management practices that have an effect on animal well-being. Dairies were visited during the fall and winter of 2005 and 2006 in Wisconsin, Minnesota, Indiana, Iowa, and New York. Data were collected on 113 dairies on colostrum feeding, dehorning, tail-docking, euthanasia methods, producer statements about welfare, use of specialized calf-raising farms (custom), level of satisfaction with calf-raising by producers, and cow behavior. Calves were raised by the owner on 50.4% of dairies; 30.1% were raised on custom farms during the milk-feeding period, 18.6% were custom raised after weaning, and 1% sold calves with the option to buy them back as first-lactation heifers. A total of 51.8% of producers were very satisfied with their current calf-raising methods. Three feedings of colostrum were fed to the calves on 23.9% of dairies, 2 feedings on 39.8% of farms, 1 feeding on 31.0% of farms, and colostrum replacement products were fed on 5.3% of farms. Many farms (61.9%) provided 3.8 L at first feeding. Calves were dehorned at different ages by various methods. By 8 wk, 34.5% of calves were dehorned. By 12 wk, 78.8% of calves were dehorned. The majority of calves were dehorned by hot iron (67.3%). The remainder were dehorned by gouging (8.8%), paste (9.7%), saw (3.5%), or unknown by calf owner (10.6%). Anesthetic use was reported by 12.4% of dairy owners and analgesia use by 1.8%. Tail-docking was observed on 82.3% of dairies. The most common reported docking time was pre- or postcalving (35.2%). The second most commonly reported time was d 1 (15.4%). Rubber band was the most common method (92.5%), followed by amputation (7.5%). Three dairies amputated precalving, 1 at 2 mo and 3 at d 1 or 2. Cow hygiene was the most common reason given to dock (73.5%), followed by parlor worker comfort (17.4%) and udder health (1.0%). Producers reported 2.0% of cows obviously lame. Gun was the preferred euthanasia method (85

  18. Neonatal sepsis caused by Shewanella algae: A case report.

    PubMed

    Charles, Marie Victor Pravin; Srirangaraj, Sreenivasan; Kali, Arunava

    2015-01-01

    Sepsis remains a leading cause of mortality among neonates, especially in developing countries. Most cases of neonatal sepsis are attributed to Escherichia coli and other members of the Enterobacteriaceae family. Shewanella algae (S. algae) is a gram-negative saprophytic bacillus, commonly associated with the marine environment, which has been isolated from humans. Early onset neonatal sepsis caused by S. algae is uncommon. We report a case of S. algae blood stream infection in a newborn with early onset neonatal sepsis.

  19. Chronic hepatitis C in Western Canada: A survey of practice patterns among gastroenterologists in Alberta and British Columbia

    PubMed Central

    Pai, Rohit; Ramji, Alnoor; Lee, Samuel S; Wong, Winnie W; Yoshida, Eric M

    2014-01-01

    OBJECTIVE: To survey gastroenterologists in British Columbia and Alberta with regard to awareness of chronic hepatitis C virus (HCV) management and practice patterns among physicians who treat and do not treat HCV-infected patients. METHODS: An anonymous two-page mail survey was distributed to actively practicing adult gastroenterologists in British Columbia and Alberta. Among physicians who treated HCV patients, respondents answered assessment of fibrosis pretreatment, measurement of rapid virological response, prescription of protease inhibitors (PIs), barriers to using these agents and referral patterns. For those who did not treat HCV, referral of patients for treatment and to whom was assessed. RESULTS: Seventy-seven of 166 individuals completed the survey (46% response rate). Most (49%) practiced in academic or large community (42%) settings. Chronic liver disease comprised <25% of individual practice in 71%. Forty-eight (62%) treated HCV and two-thirds prescribed a PI. Barriers to prescription included unfamiliarity (six of 16), lack of allied health (five of 16) and few suitable patients (seven of 16). Pretreatment liver biopsy was performed by 33% (16 of 48) and 69% (33 of 48) used noninvasive measures. Rapid virological response was measured in 83% (40 of 48). Referral patterns changed in 46% (22 of 48) of physicians who treated HCV. All respondents who did not treat HCV referred patients for consideration, with 90% (26 of 29) made to hepatologists. CONCLUSIONS: Chronic liver disease comprised <25% of practice in the majority of surveyed respondents. Among those who treated HCV, one-third have not prescribed a PI. Barriers to prescription and referral pattern changes are noted by those currently treating patients with HCV infection. PMID:24212914

  20. Patterns of Practice in Palliative Radiotherapy for Painful Bone Metastases: A Survey in Japan

    SciTech Connect

    Nakamura, Naoki; Shikama, Naoto; Wada, Hitoshi; Harada, Hideyuki; Nozaki, Miwako; Nagakura, Hisayasu; Tago, Masao; Oguchi, Masahiko; Uchida, Nobue

    2012-05-01

    Purpose: To determine the current patterns of practice in Japan and to investigate factors that may make clinicians reluctant to use single-fraction radiotherapy (SF-RT). Methods and Materials: Members of the Japanese Radiation Oncology Study Group (JROSG) completed an Internet-based survey and described the radiotherapy dose fractionation they would recommend for four hypothetical cases describing patients with painful bone metastasis (BM). Case 1 described a patient with an uncomplicated painful BM in a non-weight-bearing site from non-small-cell lung cancer. Case 2 investigated whether management for a case of uncomplicated spinal BM would be different from that in Case 1. Case 3 was identical with Case 2 except for the presence of neuropathic pain. Case 4 investigated the prescription for an uncomplicated painful BM secondary to oligometastatic breast cancer. Radiation oncologists who recommended multifraction radiotherapy (MF-RT) for Case 2 were asked to explain why they considered MF-RT superior to SF-RT. Results: A total of 52 radiation oncologists from 50 institutions (36% of JROSG institutions) responded. In all four cases, the most commonly prescribed regimen was 30 Gy in 10 fractions. SF-RT was recommended by 13% of respondents for Case 1, 6% for Case 2, 0% for Case 3, and 2% for Case 4. For Case 4, 29% of respondents prescribed a high-dose MF-RT regimen (e.g., 50 Gy in 25 fractions). The following factors were most often cited as reasons for preferring MF-RT: 'time until first increase in pain' (85%), 'incidence of spinal cord compression' (50%), and 'incidence of pathologic fractures' (29%). Conclusions: Japanese radiation oncologists prefer a schedule of 30 Gy in 10 fractions and are less likely to recommend SF-RT. Most Japanese radiation oncologists regard MF-RT as superior to SF-RT, based primarily on the time until first increase in pain.

  1. A nation-wide malaria knowledge, attitudes and practices survey in Malawi: introduction.

    PubMed

    Wirima, J J

    1994-03-01

    In Malawi malaria is the most frequent cause of morbidity and mortality in children and pertinent hospitalizations have been increasing annually since 1982. In 1990, malaria and malaria-associated anemia constituted the leading cause of outpatient visits for all age groups and the leading cause of pediatric hospitalizations, and pediatric inpatient deaths. The Ministry of Health in Malawi has had a National Malaria Control Plan since 1985. This plan calls for improvement in: 1) awareness of malaria in the population; 2) accurate diagnosis; (3) effective and affordable treatment nationwide; 4) effective prevention for high risk groups; 5) clarification of feasibility of alternative methods of vector control; 6) improved training in diagnosis and management; 7) accurate reporting; 8) effective management at national, regional, and district levels; 9) improved ability to monitor and evaluate progress; and 10) increased government and donor investment in malaria control. The Ministry of Health undertook a national baseline survey to explore deficiencies in current malaria control practices, and also included a cost assessment of household expenditure on malaria. A number of articles document the results of this effort highlighting characteristics of malaria in Malawi and current control methods by the population. These aspects include: 1) malaria is perceived as a very important health problem: 2) prompt treatment with a full dosage of the recommended antimalarials occurs in less than 10% of febrile children; 3) a malaria prevention program based in antenatal clinics could provide affordable malaria prevention for most pregnant women; 4) few households use measures to prevent malaria which is largely associated with poverty: and 5) a high proportion of available household income is spent on malaria treatment or is lost to malaria illness. The Malawian situation is similar to that of neighboring nations, and it is hoped that they also embark on malaria control in their

  2. Quality assurance practices in Europe: a survey of molecular genetic testing laboratories

    PubMed Central

    Berwouts, Sarah; Fanning, Katrina; Morris, Michael A; Barton, David E; Dequeker, Elisabeth

    2012-01-01

    In the 2000s, a number of initiatives were taken internationally to improve quality in genetic testing services. To contribute to and update the limited literature available related to this topic, we surveyed 910 human molecular genetic testing laboratories, of which 291 (32%) from 29 European countries responded. The majority of laboratories were in the public sector (81%), affiliated with a university hospital (60%). Only a minority of laboratories was accredited (23%), and 26% was certified. A total of 22% of laboratories did not participate in external quality assessment (EQA) and 28% did not use reference materials (RMs). The main motivations given for accreditation were to improve laboratory profile (85%) and national recognition (84%). Nearly all respondents (95%) would prefer working in an accredited laboratory. In accredited laboratories, participation in EQA (P<0.0001), use of RMs (P=0.0014) and availability of continuous education (CE) on medical/scientific subjects (P=0.023), specific tasks (P=0.0018), and quality assurance (P<0.0001) were significantly higher than in non-accredited laboratories. Non-accredited laboratories expect higher restriction of development of new techniques (P=0.023) and improvement of work satisfaction (P=0.0002) than accredited laboratories. By using a quality implementation score (QIS), we showed that accredited laboratories (average score 92) comply better than certified laboratories (average score 69, P<0.001), and certified laboratories better than other laboratories (average score 44, P<0.001), with regard to the implementation of quality indicators. We conclude that quality practices vary widely in European genetic testing laboratories. This leads to a potentially dangerous situation in which the quality of genetic testing is not consistently assured. PMID:22739339

  3. Mitochondrial dysfunction and resuscitation in sepsis.

    PubMed

    Ruggieri, Albert J; Levy, Richard J; Deutschman, Clifford S

    2010-07-01

    Sepsis is among the most common causes of death in patients in intensive care units in North America and Europe. In the United States, it accounts for upwards of 250,000 deaths each year. Investigations into the pathobiology of sepsis have most recently focused on common cellular and subcellular processes. One possibility would be a defect in the production of energy, which translates to an abnormality in the production of adenosine triphosphate and therefore in the function of mitochondria. This article presents a clear role for mitochondrial dysfunction in the pathogenesis and pathophysiology of sepsis. What is less clear is the teleology underlying this response. Prolonged mitochondrial dysfunction and impaired biogenesis clearly are detrimental. However, early inhibition of mitochondrial function may be adaptive. PMID:20643307

  4. Host innate immune responses to sepsis

    PubMed Central

    Wiersinga, Willem Joost; Leopold, Stije J; Cranendonk, Duncan R; van der Poll, Tom

    2014-01-01

    The immune response to sepsis can be seen as a pattern recognition receptor-mediated dysregulation of the immune system following pathogen invasion in which a careful balance between inflammatory and anti-inflammatory responses is vital. Invasive infection triggers both pro-inflammatory and anti-inflammatory host responses, the magnitude of which depends on multiple factors, including pathogen virulence, site of infection, host genetics, and comorbidities. Toll-like receptors, the inflammasomes, and other pattern recognition receptors initiate the immune response after recognition of danger signals derived from microorganisms, so-called pathogen-associated molecular patterns or derived from the host, so-called danger-associated molecular patterns. Further dissection of the role of host–pathogen interactions, the cytokine response, the coagulation cascade, and their multidirectional interactions in sepsis should lead toward the development of new therapeutic strategies in sepsis. PMID:23774844

  5. Anticoagulant modulation of inflammation in severe sepsis.

    PubMed

    Allen, Karen S; Sawheny, Eva; Kinasewitz, Gary T

    2015-05-01

    Inflammation and coagulation are so tightly linked that the cytokine storm which accompanies the development of sepsis initiates thrombin activation and the development of an intravascular coagulopathy. This review examines the interaction between the inflammatory and coagulation cascades, as well as the role of endogenous anticoagulants in regulating this interaction and dampening the activity of both pathways. Clinical trials attempting to improve outcomes in patients with severe sepsis by inhibiting thrombin generation with heparin and or endogenous anticoagulants are reviewed. In general, these trials have failed to demonstrate that anticoagulant therapy is associated with improvement in mortality or morbidity. While it is possible that selective patients who are severely ill with a high expected mortality may be shown to benefit from such therapy, at the present time none of these anticoagulants are neither approved nor can they be recommended for the treatment of sepsis. PMID:25938026

  6. Disseminated intravascular coagulation in meningococcal sepsis. Case 7.

    PubMed

    Zeerleder, S; Zürcher Zenklusen, R; Hack, C E; Wuillemin, W A

    2003-08-01

    We report on a man (age: 49 years), who died from severe meningococcal sepsis with disseminated intravascular coagulation (DIC), multiple organ dysfunction syndrome and extended skin necrosis. We discuss in detail the pathophysiology of the activation of coagulation and fibrinolysis during sepsis. The article discusses new therapeutic concepts in the treatment of disseminated intravascular coagulation in meningococcal sepsis, too.

  7. An Evidence Based Approach to Sepsis: Educational Program

    ERIC Educational Resources Information Center

    Perez, Dolores

    2015-01-01

    Evidence-based guidelines for recognizing and treating sepsis have been available for decades, yet healthcare providers do not adhere to the recommendations. Sepsis can progress rapidly if not recognized early. Literature reports reveal that sepsis is the leading cause of death in non-cardiac intensive care units (ICUs), and it is one of the most…

  8. Ghrelin inhibits sympathetic nervous activity in sepsis.

    PubMed

    Wu, Rongqian; Zhou, Mian; Das, Padmalaya; Dong, Weifeng; Ji, Youxin; Yang, Derek; Miksa, Michael; Zhang, Fangming; Ravikumar, Thanjavur S; Wang, Ping

    2007-12-01

    Our previous studies have shown that norepinephrine (NE) upregulates proinflammatory cytokines by activating alpha(2)-adrenoceptor. Therefore, modulation of the sympathetic nervous system represents a novel treatment for sepsis. We have also shown that a novel stomach-derived peptide, ghrelin, is downregulated in sepsis and that its intravenous administration decreases proinflammatory cytokines and mitigates organ injury. However, it remains unknown whether ghrelin inhibits sympathetic activity through central ghrelin receptors [i.e., growth hormone secretagogue receptor 1a (GHSR-la)] in sepsis. To study this, sepsis was induced in male rats by cecal ligation and puncture (CLP). Ghrelin was administered through intravenous or intracerebroventricular injection 30 min before CLP. Our results showed that intravenous administration of ghrelin significantly reduced the elevated NE and TNF-alpha levels at 2 h after CLP. NE administration partially blocked the inhibitory effect of ghrelin on TNF-alpha in sepsis. GHSR-la inhibition by the administration of a GHSR-la antagonist, [d-Arg(1),d-Phe(5), d-Trp(7,9),Leu(11)]substance P, significantly increased both NE and TNF-alpha levels even in normal animals. Markedly elevated circulating levels of NE 2 h after CLP were also significantly decreased by intracerebroventricular administration of ghrelin. Ghrelin's inhibitory effect on NE release was completely blocked by intracerebroventricular injection of the GHSR-1a antagonist or a neuropeptide Y (NPY)/Y(1) receptor antagonist. However, ghrelin's downregulatory effect on TNF-alpha release was only partially diminished by these agents. Thus ghrelin has sympathoinhibitory properties that are mediated by central ghrelin receptors involving a NPY/Y1 receptor-dependent pathway. Ghrelin's inhibitory effect on TNF-alpha production in sepsis is partially because of its modulation of the overstimulated sympathetic nerve activation.

  9. A web-based survey of the relationship between buddhist religious practices, health, and psychological characteristics: research methods and preliminary results.

    PubMed

    Wiist, W H; Sullivan, B M; Wayment, H A; Warren, M

    2010-03-01

    A Web-based survey was conducted to study the religious and health practices, medical history and psychological characteristics among Buddhist practitioners. This report describes the development, advertisement, administration and preliminary results of the survey. Over 1200 Buddhist practitioners responded. Electronic advertisements were the most effective means of recruiting participants. Survey participants were mostly well educated with high incomes and white. Participants engaged in Buddhist practices such as meditation, attending meetings and obtaining instruction from a monk or nun, and practiced healthful behaviors such as regular physical activity and not smoking. Buddhist meditative practice was related to psychological mindfulness and general health.

  10. Developing and Validating Technological Pedagogical Content Knowledge-Practical (TPACK-Practical) through the Delphi Survey Technique

    ERIC Educational Resources Information Center

    Yeh, Yi-Fen; Hsu, Ying-Shao; Wu, Hsin-Kai; Hwang, Fu-Kwun; Lin, Tzu-Chiang

    2014-01-01

    Technological pedagogical content knowledge TPACK refers to the knowledge set that teachers currently use to further improve the quality of their teaching and assist their students in learning. Several TPACK models have been proposed, either for discussing TPACK's possible composition or its practical applications. Considering that…

  11. Urinary Intestinal Fatty Acid-Binding Protein Can Distinguish Necrotizing Enterocolitis from Sepsis in Early Stage of the Disease

    PubMed Central

    Snajdauf, Jiri; Rygl, Michal

    2016-01-01

    Necrotizing enterocolitis (NEC) is severe disease of gastrointestinal tract, yet its early symptoms are nonspecific, easily interchangeable with sepsis. Therefore, reliable biomarkers for early diagnostics are needed in clinical practice. Here, we analyzed if markers of gut mucosa damage, caspase cleaved cytokeratin 18 (ccCK18) and intestinal fatty acid-binding protein (I-FABP), could be used for differential diagnostics of NEC at early stage of disease. We collected paired serum (at enrollment and week later) and urine (collected for two days in 6 h intervals) samples from 42 patients with suspected NEC. These patients were later divided into NEC (n = 24), including 13 after gastrointestinal surgery, and sepsis (n = 18) groups using standard criteria. Healthy infants (n = 12), without any previous gut surgery, served as controls. Both biomarkers were measured by a commercial ELISA assay. There were no statistically significant differences in serum ccCK18 between NEC and sepsis but NEC patients had significantly higher levels of serum and urinary I-FABP than either sepsis patients or healthy infants. Urinary I-FABP has high sensitivity (81%) and specificity (100%) and can even distinguish NEC from sepsis in patients after surgery. Urinary I-FABP can be used to distinguish NEC from neonatal sepsis, including postoperative one, better than abdominal X-ray. PMID:27110575

  12. Urinary Intestinal Fatty Acid-Binding Protein Can Distinguish Necrotizing Enterocolitis from Sepsis in Early Stage of the Disease.

    PubMed

    Coufal, Stepan; Kokesova, Alena; Tlaskalova-Hogenova, Helena; Snajdauf, Jiri; Rygl, Michal; Kverka, Miloslav

    2016-01-01

    Necrotizing enterocolitis (NEC) is severe disease of gastrointestinal tract, yet its early symptoms are nonspecific, easily interchangeable with sepsis. Therefore, reliable biomarkers for early diagnostics are needed in clinical practice. Here, we analyzed if markers of gut mucosa damage, caspase cleaved cytokeratin 18 (ccCK18) and intestinal fatty acid-binding protein (I-FABP), could be used for differential diagnostics of NEC at early stage of disease. We collected paired serum (at enrollment and week later) and urine (collected for two days in 6 h intervals) samples from 42 patients with suspected NEC. These patients were later divided into NEC (n = 24), including 13 after gastrointestinal surgery, and sepsis (n = 18) groups using standard criteria. Healthy infants (n = 12), without any previous gut surgery, served as controls. Both biomarkers were measured by a commercial ELISA assay. There were no statistically significant differences in serum ccCK18 between NEC and sepsis but NEC patients had significantly higher levels of serum and urinary I-FABP than either sepsis patients or healthy infants. Urinary I-FABP has high sensitivity (81%) and specificity (100%) and can even distinguish NEC from sepsis in patients after surgery. Urinary I-FABP can be used to distinguish NEC from neonatal sepsis, including postoperative one, better than abdominal X-ray. PMID:27110575

  13. Pediatric sepsis: challenges and adjunctive therapies

    PubMed Central

    Hanna, William; Wong, Hector R.

    2012-01-01

    SYNOPSIS Sepsis remains an important challenge in pediatric critical care medicine. The current review intends to provide an appraisal of adjunctive therapies for sepsis and to highlight opportunities for meeting selected challenges in the field. Future clinical studies should address long-term and functional outcomes, as well as acute outcomes. Potential adjunctive therapies such as corticosteroids, hemofiltration, hemoadsorption, and plasmapheresis may have important roles, but still require formal and more rigorous testing by way of clinical trials. Finally, the design of future clinical trials should consider novel approaches for stratifying outcome risks as a means of improving the risk to benefit ratio of experimental therapies. PMID:23537672

  14. The Use of Fluids in Sepsis.

    PubMed

    Avila, Audrey A; Kinberg, Eliezer C; Sherwin, Nomi K; Taylor, Robinson D

    2016-03-10

    Sepsis is a systemic inflammatory response to severe infection causing significant morbidity and mortality that costs the health care system $20.3 billion annually within the United States. It is well established that fluid resuscitation is a central component of sepsis management; however, to date there is no consensus as to the ideal composition of fluid used for resuscitation. In this review, we discuss the progression of clinical research comparing various fluids, as well as the historical background behind fluid selection for volume resuscitation. We conclude that the use of balanced fluids, such as Ringer's Lactate, seems very promising but further research is needed to confirm their role.

  15. Sepsis and septic shock: a review.

    PubMed

    Chong, Josebelo; Dumont, Tiffany; Francis-Frank, Lyndave; Balaan, Marvin

    2015-01-01

    Sepsis and septic shock are a continuum of disease resulting from a complex host response to infection. They are major health issues in the United States, causing significant financial burden to the health care system in addition to multisystem morbidity and high rates of mortality. In recent decades, landmark trials in sepsis management have demonstrated improved mortality. Although the value of protocol-driven care is currently under question, it is clear that early recognition, prompt resuscitation, and timely use of antibiotics are of utmost importance.

  16. The Use of Fluids in Sepsis

    PubMed Central

    Avila, Audrey A; Sherwin, Nomi K; Taylor, Robinson D

    2016-01-01

    Sepsis is a systemic inflammatory response to severe infection causing significant morbidity and mortality that costs the health care system $20.3 billion annually within the United States. It is well established that fluid resuscitation is a central component of sepsis management; however, to date there is no consensus as to the ideal composition of fluid used for resuscitation. In this review, we discuss the progression of clinical research comparing various fluids, as well as the historical background behind fluid selection for volume resuscitation. We conclude that the use of balanced fluids, such as Ringer’s Lactate, seems very promising but further research is needed to confirm their role. PMID:27081589

  17. Incidence and mortality of sepsis, severe sepsis, and septic shock in intensive care unit patients with candidemia.

    PubMed

    Ng, Kevin; Schorr, Christa; Reboli, Annette C; Zanotti, Sergio; Tsigrelis, Constantine

    2015-08-01

    In this incidence study, of 16 074 patients admitted to the intensive care unit (ICU) from 1/1/2003 to 7/31/2011, 161 cases of candidemia were identified. The incidence of sepsis (27%), severe sepsis (31%), and septic shock (40%) was remarkably high in these cases of candidemia, as was the all-cause in-hospital mortality for sepsis (30%), severe sepsis (44%), and septic shock (65%).

  18. Use of Thickened Liquids to Manage Feeding Difficulties in Infants: A Pilot Survey of Practice Patterns in Canadian Pediatric Centers.

    PubMed

    Dion, Stephanie; Duivestein, Janice A; St Pierre, Astrid; Harris, Susan R

    2015-08-01

    Improved survival rates of sick or preterm infants have resulted in an increase of observed feeding difficulties. One common method for managing feeding difficulties in infants is to manipulate liquid viscosity by adding thickening agents to formula or expressed breast milk. Concerns regarding the lack of clinical practice guidelines for the use of this strategy have been raised in the literature and in clinical settings for several years. This study aimed to survey feeding clinicians working in major Canadian pediatric centers to identify current practice patterns for use of thickened liquids in managing feeding difficulties of infants and to justify the need for standardization of this practice. A web-based pilot survey was developed using Fluidsurveys software. The questionnaire contained 37 questions targeting the process of prescribing thickeners, choice of thickener, awareness of issues, and inconsistencies raised in the literature about thickener use and how to address them. A total of 69 questionnaire responses were analyzed using descriptive statistics and inductive thematic analysis methods. Our study results indicate that thickened liquids continue to be broadly used to manage feeding difficulties in Canadian infants, despite numerous areas of concern related to their use raised by our respondents. While clear practice patterns for assessment and management were observed among the respondents, some areas of practice did not reflect recent published research or experts' opinion. Further research to develop a systematic approach for assessment, intervention, and follow-up is warranted to guide clinicians in this complex decision-making process. PMID:26025758

  19. Changes in Optimal Childcare Practices in Kenya: Insights from the 2003, 2008-9 and 2014 Demographic and Health Surveys

    PubMed Central

    Matanda, Dennis Juma; Urke, Helga Bjørnøy; Mittelmark, Maurice B.

    2016-01-01

    Objective(s) Using nationally representative surveys conducted in Kenya, this study examined optimal health promoting childcare practices in 2003, 2008–9 and 2014. This was undertaken in the context of continuous child health promotion activities conducted by government and non-government organizations throughout Kenya. It was the aim of such activities to increase the prevalence of health promoting childcare practices; to what extent have there been changes in optimal childcare practices in Kenya during the 11-year period under study? Methods Cross-sectional data were obtained from the Kenya Demographic and Health Surveys conducted in 2003, 2008–9 and 2014. Women 15–49 years old with children 0–59 months were interviewed about a range of childcare practices. Logistic regression analysis was used to examine changes in, and correlates of, optimal childcare practices using the 2003, 2008–9 and 2014 data. Samples of 5949, 6079 and 20964 women interviewed in 2003, 2008–9 and 2014 respectively were used in the analysis. Results Between 2003 and 2014, there were increases in all health facility-based childcare practices with major increases observed in seeking medical treatment for diarrhoea and complete child vaccination. Mixed results were observed in home-based care where increases were noted in the use of insecticide treated bed nets, sanitary stool disposal and use of oral rehydration solutions, while decreases were observed in the prevalence of urging more fluid/food during diarrhoea and consumption of a minimum acceptable diet. Logit models showed that area of residence (region), household wealth, maternal education, parity, mother's age, child’s age and pregnancy history were significant determinants of optimal childcare practices across the three surveys. Conclusions The study observed variation in the uptake of the recommended optimal childcare practices in Kenya. National, regional and local child health promotion activities, coupled with changes

  20. What Is Your KVO? Historical Perspectives, Review of Evidence, and a Survey About an Often Overlooked Nursing Practice.

    PubMed

    Paquet, France; Marchionni, Caroline

    2016-01-01

    Like many nursing "sacred cows," the practice of keeping a vein open with a small infusion of intravenous solution does not have clear origins or robust evidence. A survey of Canadian nurses was conducted to determine current practices. More than 50% of respondents reported regularly using a keep-vein-open (KVO) rate between doses of intermittent medication. Frequently, the rate was not specified by the prescriber; in this case, nurses preferred 21 to 30 mL/h. Given the absence of evidence and the frequent use, it is important to ensure that KVO is used properly in the context of a medical prescription or an organizational protocol.

  1. What Is Your KVO? Historical Perspectives, Review of Evidence, and a Survey About an Often Overlooked Nursing Practice.

    PubMed

    Paquet, France; Marchionni, Caroline

    2016-01-01

    Like many nursing "sacred cows," the practice of keeping a vein open with a small infusion of intravenous solution does not have clear origins or robust evidence. A survey of Canadian nurses was conducted to determine current practices. More than 50% of respondents reported regularly using a keep-vein-open (KVO) rate between doses of intermittent medication. Frequently, the rate was not specified by the prescriber; in this case, nurses preferred 21 to 30 mL/h. Given the absence of evidence and the frequent use, it is important to ensure that KVO is used properly in the context of a medical prescription or an organizational protocol. PMID:26714117

  2. The Working Practices and Clinical Experiences of Paediatric Speech and Language Therapists: A National UK Survey

    ERIC Educational Resources Information Center

    Pring, Tim; Flood, Emma; Dodd, Barbara; Joffe, Victoria

    2012-01-01

    Background: The majority of speech and language therapists (SLTs) work with children who have speech, language and communication needs. There is limited information about their working practices and clinical experience and their views of how changes to healthcare may impact upon their practice. Aims: To investigate the working practices and…

  3. Collecting Survey Data for Assessment: A Practice Brief Based on BEAMS Project Outcomes

    ERIC Educational Resources Information Center

    Kinzie, Jullian

    2008-01-01

    This practice brief is one of a series highlighting key practices undertaken by some of the many successful Building Engagement and Attainment for Minority Students (BEAMS) schools during the project's five years of data collection and action plan implementation. These practice briefs accompany a monograph that details the process BEAMS…

  4. Survey of Practices in Health Promotion and Education Supervision of Theses and Dissertations

    ERIC Educational Resources Information Center

    Murnan, Judy; Cottrell, Randall; Rojas-Guyler, Liliana

    2009-01-01

    There have been no published studies documenting current practices regarding graduate student research supervision by faculty in health education programs. Documenting current standards for such supervision may help programs gauge their practices against a national sample. This study assessed practices utilized by U.S. universities and colleges…

  5. Patient Engagement Practices in Clinical Research among Patient Groups, Industry, and Academia in the United States: A Survey

    PubMed Central

    Smith, Sophia K.; Selig, Wendy; Harker, Matthew; Roberts, Jamie N.; Hesterlee, Sharon; Leventhal, David; Klein, Richard; Patrick-Lake, Bray; Abernethy, Amy P.

    2015-01-01

    Objective Patient-centered clinical trial design and execution is becoming increasingly important. No best practice guidelines exist despite a key stakeholder declaration to create more effective engagement models. This study aims to gain a better understanding of attitudes and practices for engaging patient groups so that actionable recommendations may be developed. Methods Individuals from industry, academic institutions, and patient groups were identified through Clinical Trials Transformation Initiative and Drug Information Association rosters and mailing lists. Objectives, practices, and perceived barriers related to engaging patient groups in the planning, conduct, and interpretation of clinical trials were reported in an online survey. Descriptive and inferential statistical analysis of survey data followed a literature review to inform survey questions. Results Survey respondents (n = 179) valued the importance of involving patient groups in research; however, patient group respondents valued their contributions to research protocol development, funding acquisition, and interpretation of study results more highly than those contributions were valued by industry and academic respondents (all p < .001). Patient group respondents placed higher value in open communications, clear expectations, and detailed contract execution than did non–patient group respondents (all p < .05). Industry and academic respondents more often cited internal bureaucratic processes and reluctance to share information as engagement barriers than did patient group respondents (all p < .01). Patient groups reported that a lack of transparency and understanding of the benefits of collaboration on the part of industry and academia were greater barriers than did non–patient group respondents (all p< .01). Conclusions Despite reported similarities among approaches to engagement by the three stakeholder groups, key differences exist in perceived barriers and benefits to partnering with

  6. A Nationwide Survey of Nonspeech Oral Motor Exercise Use: Implications for Evidence-Based Practice

    ERIC Educational Resources Information Center

    Lof, Gregory L.; Watson, Maggie M.

    2008-01-01

    Purpose: A nationwide survey was conducted to determine if speech-language pathologists (SLPs) use nonspeech oral motor exercises (NSOMEs) to address children's speech sound problems. For those SLPs who used NSOMEs, the survey also identified (a) the types of NSOMEs used by the SLPs, (b) the SLPs' underlying beliefs about why they use NSOMEs, (c)…

  7. Mitigating Errors of Representation: A Practical Case Study of the University Experience Survey

    ERIC Educational Resources Information Center

    Whiteley, Sonia

    2014-01-01

    The Total Survey Error (TSE) paradigm provides a framework that supports the effective planning of research, guides decision making about data collection and contextualises the interpretation and dissemination of findings. TSE also allows researchers to systematically evaluate and improve the design and execution of ongoing survey programs and…

  8. Diagnosis, Management and Assessment of Adults with Joint Hypermobility Syndrome: A UK-Wide Survey of Physiotherapy Practice.

    PubMed

    Palmer, Shea; Cramp, Fiona; Lewis, Rachel; Muhammad, Shahid; Clark, Emma

    2015-06-01

    Joint hypermobility syndrome (JHS) is a heritable disorder associated with excessive joint range of motion and pain in the absence of inflammatory joint disease. It is a relatively common cause of musculoskeletal pain but is generally understood to be under-recognized and poorly managed in clinical practice. The present study therefore aimed to identify how JHS is diagnosed, managed and assessed in routine physiotherapy practice. A survey tool was developed from similar physiotherapy surveys of musculoskeletal practice, a review of the literature, and consultation with researchers and clinicians. Paper copies of the final survey were sent to 201 randomly selected secondary care organizations across the UK and an electronic version was advertised through physiotherapy professional networks. A total of 66 responses (80% women) were received from physiotherapists, with a wide range of clinical experience. Only 32% of respondents reported that they had received formal training in JHS management. The Brighton diagnostic criteria for JHS were not often used (only 31% of respondents). The stated aims of physiotherapy and the specific interventions employed seem well matched, with a focus on advice, education, exercise and self-management. Although pain relief was not reported as a high priority in terms of treatment aims, pain was most often assessed as an outcome, suggesting a mismatch between what clinicians aim to achieve and what they measure. The results suggest that reported management strategies are broadly appropriate to long-term musculoskeletal conditions but additional training specific to JHS may be required, particularly in diagnosis and assessment.

  9. [International guidelines of the Surviving Sepsis Campaign : update 2012].

    PubMed

    Briegel, J; Möhnle, P

    2013-04-01

    An update of the international guidelines for therapy of sepsis was published in February 2012 by the Surviving Sepsis Campaign (SSC). The update includes a further development of the guidelines from 2004 and 2008. The guidelines are divided into three sections, sepsis-specific therapeutic measures, recommendations on general intensive care measures for sepsis and finally special features of sepsis in pediatric intensive care medicine are presented in detail. This article discusses the most important amendments in the first two sections and delving deeper into the guidelines.

  10. Therapeutic Targets in Sepsis: Past, Present, and Future.

    PubMed

    Seeley, Eric J; Bernard, Gordon R

    2016-06-01

    Antibiotics and fluids have been standard treatment for sepsis since World War II. Many molecular mediators of septic shock have since been identified. In models of sepsis, blocking these mediators improved organ injury and decreased mortality. Clinical trials, however, have failed. The absence of new therapies has been vexing to clinicians, clinical researchers, basic scientists, and the pharmaceutical industry. This article examines the evolution of sepsis therapy and theorizes about why so many well-reasoned therapies have not worked in human trials. We review new molecular targets for sepsis and examine trial designs that might lead to successful treatments for sepsis. PMID:27229636

  11. Elucidating the role of genomics in neonatal sepsis.

    PubMed

    Srinivasan, Lakshmi; Kirpalani, Haresh; Cotten, Charles Michael

    2015-12-01

    Sepsis is a major cause of neonatal morbidity and mortality, especially in vulnerable preterm populations. Immature immune defenses, and environmental and maternal factors contribute to this risk, with as many as a third of very preterm infants experiencing sepsis during their stay in the neonatal intensive care unit (NICU). Epidemiologic and twin studies have suggested that there is a genetic contribution to sepsis predilection. Several investigators have conducted candidate gene association studies on variants of specific interest and potential functional significance in neonatal sepsis. In this review, we describe details of studies that have evaluated genetic susceptibility in neonatal sepsis, and summarize findings from a review of candidate gene association studies.

  12. A Nordic survey of management practices and owners' attitudes towards keeping horses in groups.

    PubMed

    Hartmann, E; Bøe, K E; Christensen, J W; Hyyppä, S; Jansson, H; Jørgensen, G H M; Ladewig, J; Mejdell, C M; Norling, Y; Rundgren, M; Särkijärvi, S; Søndergaard, E; Keeling, L J

    2015-09-01

    Keeping horses in groups is widely recommended but limited information is available about how this is implemented in practice. The aim of this survey was to describe how horses are kept in the Nordic countries in relation to sex, age, breed, and equestrian discipline and to assess owners' attitudes toward keeping horses in groups. Horse owners in Denmark, Finland, Norway, and Sweden were approached using a web-based questionnaire, which was translated into 4 languages and distributed online via equestrian forums, organizations, and social media. The number of respondents was 3,229, taking care of 17,248 horses. Only 8% of horses were never kept in groups, 47% were permanently grouped for 24 h/d, and 45% were stabled singly but grouped during turnout. Yearlings were most often permanently kept in groups (75%), mares and geldings more commonly during parts of the day (50 and 51%, respectively), and stallions were often kept alone (38%). Icelandic horses were more likely to be permanently kept in groups (36%) than warmbloods (16%) and ponies (15%). Twice as many competition horses (51%) were never grouped compared with horses used for breeding (20%) or leisure purposes (15%). The majority of respondents (86%) strongly agreed that group housing benefits horse welfare and that it is important for horses to have the company of conspecifics (92%). Nevertheless, not all horses were kept in groups, showing that attitudes toward group housing may not necessarily reflect current management. The risk of injury was a concern of many respondents (45%), as was introducing unfamiliar horses into already established groups (40%) and challenges in relation to feeding in groups (44%). Safety of people (23%) and difficulties handling group-kept horses (19%) were regarded as less problematic. Results suggest that the majority of horses have the possibility to freely interact with other horses, either as fulltime members of a group during 24 h/d or during turnout. Future research should

  13. A survey of digital radiography practice in four South African teaching hospitals: an illuminative study

    PubMed Central

    Nyathi, T; Chirwa, TF; van der Merwe, DG

    2010-01-01

    Purpose: The purpose of this study was to assess radiographer familiarity and preferences with digital radiography in four teaching hospitals and thereafter make recommendations in line with the migration from screen film to digital radiography. Materials and methods: A questionnaire was designed to collect data from either qualified or student radiographers from four teaching hospitals. From the four teaching hospitals, there were a total of 205 potential respondents. Among other things, responses regarding experiences and preferences with digital radiography, quality control procedures, patient dose, advantages and disadvantages of digital radiography were sought. The information collected was based on self-reporting by the participants. The study is exploratory in nature and descriptive statistics were generated from the collected data using Microsoft Excel 2007 and StatsDirect software. Results: Sixty-three out of 205 (31%) radiographers from all the four radiology centers responded to the circulated questionnaire. Only 15% (8) of the qualified radiographers had 4 or more years of experience with digital radiography compared to 68% (36) for the same amount of experience with screen-film radiography. Sixty-one percent (38) of the participants had been exposed to digital radiography during their lectures while at university. A small proportion, 16% (10) of the respondents underwent formal training in quality control procedures on the digital X-ray units they were using. Slightly more than half (55%) of the participants felt it was easier for them to retake an image in digital radiography than in screen film radiography. Conclusion: The results of this survey showed that the participants are familiar with digital radiography and have embraced this relatively new technology as shown by the fact that they can identify both its advantages and disadvantages as applied to clinical practice. However, there are minimal quality control procedures specific to digital

  14. A Nordic survey of management practices and owners' attitudes towards keeping horses in groups.

    PubMed

    Hartmann, E; Bøe, K E; Christensen, J W; Hyyppä, S; Jansson, H; Jørgensen, G H M; Ladewig, J; Mejdell, C M; Norling, Y; Rundgren, M; Särkijärvi, S; Søndergaard, E; Keeling, L J

    2015-09-01

    Keeping horses in groups is widely recommended but limited information is available about how this is implemented in practice. The aim of this survey was to describe how horses are kept in the Nordic countries in relation to sex, age, breed, and equestrian discipline and to assess owners' attitudes toward keeping horses in groups. Horse owners in Denmark, Finland, Norway, and Sweden were approached using a web-based questionnaire, which was translated into 4 languages and distributed online via equestrian forums, organizations, and social media. The number of respondents was 3,229, taking care of 17,248 horses. Only 8% of horses were never kept in groups, 47% were permanently grouped for 24 h/d, and 45% were stabled singly but grouped during turnout. Yearlings were most often permanently kept in groups (75%), mares and geldings more commonly during parts of the day (50 and 51%, respectively), and stallions were often kept alone (38%). Icelandic horses were more likely to be permanently kept in groups (36%) than warmbloods (16%) and ponies (15%). Twice as many competition horses (51%) were never grouped compared with horses used for breeding (20%) or leisure purposes (15%). The majority of respondents (86%) strongly agreed that group housing benefits horse welfare and that it is important for horses to have the company of conspecifics (92%). Nevertheless, not all horses were kept in groups, showing that attitudes toward group housing may not necessarily reflect current management. The risk of injury was a concern of many respondents (45%), as was introducing unfamiliar horses into already established groups (40%) and challenges in relation to feeding in groups (44%). Safety of people (23%) and difficulties handling group-kept horses (19%) were regarded as less problematic. Results suggest that the majority of horses have the possibility to freely interact with other horses, either as fulltime members of a group during 24 h/d or during turnout. Future research should

  15. Perceptions and practices of pharmaceutical wholesalers surrounding counterfeit medicines in a developing country: a baseline survey

    PubMed Central

    2011-01-01

    Background Recent investigations by the Ministry of Health of Cambodia suggest that counterfeit medicines have been introduced into the pharmaceutical market in tampered packaging. To further explore this possibility, an interview survey was conducted at the wholesaler level to investigate the medicinal supply chain in Cambodia. Methods Managing executives of 62 (83.8%) registered wholesalers of modern medicines in Cambodia were interviewed in 2009 on their knowledge of, perception on, and practices related to counterfeiting issues through a semi-structured questionnaire. Results According to our findings, 12.9% of the wholesalers had encountered counterfeit medicine. However, they demonstrated a variety of perceptions regarding this issue. A majority (59.7%) defined counterfeit medicines as medicines without registration, while other definitions included medicines that were fraudulently manufactured, medicines without a batch/lot number, those containing harmful ingredients or a reduced amount of active ingredients, and expired medicines. Additionally, 8.1% responded that they did not know what counterfeit medicines were. During procurement, 66.1% of the wholesalers consider whether the product is registered in Cambodia, while 64.5% consider the credibility and quality of the products and 61.3% consider the reputation of the manufacturers. When receiving a consignment, 80.6% of wholesalers check the intactness of medicines, 72.6% check the specification and amount of medicines, 71% check Cambodian registration, 56.5% check that the packaging is intact, 54.8% check batch and lot numbers, 48.4% check the dates of manufacture and expiration, and 9.7% check analytical certificates. Out of 62 wholesalers, 14.5% had received medicines that arrived without packages or were separated from their packaging and had to be repacked before distribution. Significant statistical association was found between wholesalers who received medicines separately from their packs

  16. Vascular access and infection prevention and control: a national survey of routine practices in Irish haemodialysis units

    PubMed Central

    McCann, Margaret; Clarke, Michael; Mellotte, George; Plant, Liam; Fitzpatrick, Fidelma

    2013-01-01

    Background National and international guidelines recommend the use of effective vascular access (VA) and infection prevention and control practices within the haemodialysis environment. Establishing an arterio-venous fistula (AVF) and preventing central venous catheter (CVC)-related infections are ongoing challenges for all dialysis settings. We surveyed VA and routine infection prevention and control practices in dialysis units, to provide national data on these practices in Ireland. Methods A descriptive survey was emailed to nurse managers at all adult (n = 19) and children (n = 1) outpatient haemodialysis units in the Republic of Ireland. Data collected included AVF formation, CVC insertion and maintenance practices, VA use and surveillance of infection and screening protocols. Nineteen of the 20 units responded to the survey. Results The AVF prevalence was 49% for 1370 patients in 17 units who provided these data [mean prevalence per unit: 45.7% (SD 16.2)]; the CVC mean prevalence per unit was 52.5% (SD 16.0). Fourteen dialysis units experienced inadequate access to vascular surgical procedures either due to a lack of dedicated theatre time or hospital beds. Six units administered intravenous prophylactic antimicrobials prior to CVC insertion with only two units using a CVC insertion checklist at the time of catheter insertion. Conclusion In general, dialysis units in Ireland show a strong adherence to national guidelines. Compared with the 12 countries participating in the Dialysis Outcomes Practice Patterns Study (DOPPS 4), in 2010, AVF prevalence in Irish dialysis units is the second lowest. Recommendations include establishing an AVF national prevalence target rate, discontinuing the administration of intravenous prophylactic antimicrobials prior to CVC insertion and promoting the use of CVC insertion checklists. PMID:26019846

  17. Global Epidemiology of Pediatric Severe Sepsis: The Sepsis Prevalence, Outcomes, and Therapies Study

    PubMed Central

    Weiss, Scott L.; Pappachan, John; Wheeler, Derek; Jaramillo-Bustamante, Juan C.; Salloo, Asma; Singhi, Sunit C.; Erickson, Simon; Roy, Jason A.; Bush, Jenny L.; Nadkarni, Vinay M.; Thomas, Neal J.

    2015-01-01

    Rationale: Limited data exist about the international burden of severe sepsis in critically ill children. Objectives: To characterize the global prevalence, therapies, and outcomes of severe sepsis in pediatric intensive care units to better inform interventional trials. Methods: A point prevalence study was conducted on 5 days throughout 2013–2014 at 128 sites in 26 countries. Patients younger than 18 years of age with severe sepsis as defined by consensus criteria were included. Outcomes were severe sepsis point prevalence, therapies used, new or progressive multiorgan dysfunction, ventilator- and vasoactive-free days at Day 28, functional status, and mortality. Measurements and Main Results: Of 6,925 patients screened, 569 had severe sepsis (prevalence, 8.2%; 95% confidence interval, 7.6–8.9%). The patients’ median age was 3.0 (interquartile range [IQR], 0.7–11.0) years. The most frequent sites of infection were respiratory (40%) and bloodstream (19%). Common therapies included mechanical ventilation (74% of patients), vasoactive infusions (55%), and corticosteroids (45%). Hospital mortality was 25% and did not differ by age or between developed and resource-limited countries. Median ventilator-free days were 16 (IQR, 0–25), and vasoactive-free days were 23 (IQR, 12–28). Sixty-seven percent of patients had multiorgan dysfunction at sepsis recognition, with 30% subsequently developing new or progressive multiorgan dysfunction. Among survivors, 17% developed at least moderate disability. Sample sizes needed to detect a 5–10% absolute risk reduction in outcomes within interventional trials are estimated between 165 and 1,437 patients per group. Conclusions: Pediatric severe sepsis remains a burdensome public health problem, with prevalence, morbidity, and mortality rates similar to those reported in critically ill adult populations. International clinical trials targeting children with severe sepsis are warranted. PMID:25734408

  18. Pathogenesis of Multiple Organ Failure in Sepsis.

    PubMed

    Rossaint, Jan; Zarbock, Alexander

    2015-01-01

    Sepsis is a severe critical illness syndrome that arises from infectious insults. While the host immune system is generally beneficial, an overshooting and unregulated immune response can cause serious organ tissue injury. During sepsis, systemic hypotension, disturbed perfusion of the microcirculation, and direct tissue-toxicity caused by inflammatory immune reaction can occur and contribute to organ failure. The failure of two or more vital organ systems is termed multi-organ dysfunction syndrome (MODS) and resembles a very critical condition associated with high morbidity and mortality. Importantly, no specific treatment strategy exists to efficiently prevent the development of MODS during sepsis. In this review, we aim to identify the relevant molecular immunological pathways involved in the pathogenesis of MODS during sepsis. We believe that a detailed understanding of this mechanism is necessary for the development of new treatment approaches for septic patients. In particular, knowledge of the endogenous regulators keeping the balance between necessary immune system activation to combat infections and prevention of host tissue damage would greatly improve the chances for the development of effective interventions.

  19. Immunomodulation during sepsis in organ transplanted children.

    PubMed

    Angele, M K; Loehe, F; Faist, E

    2005-10-01

    Newer immunosuppressive agents have dramatically reduced the rates of acute graft rejection over the last decade but may have exacerbated the problem of post-transplant infections. Causes of early mortality include graft dysfunction and sepsis. Late mortality occurs mainly due to sepsis. An excessive inflammatory response followed with a dramatic paralysis of cell-mediated immunity has been documented in septic patients. In transplanted individuals the pathophysiological changes of the immune response are further complicated by immunosuppressive agents. This article will focus on the effect of immunosuppressive agents and sepsis on cell-mediated immune responses. Moreover, potentially promising immunomodulatory approaches, i.e. human activated protein C, immunomodulatory diets containing L-arginine and fish oil, selective cytokine blockade, platelet-activating factor receptor antagonist, LPS receptor CD14 blockade and G-CSF, for the treatment of immunodysfunction in septic patients will be outlined in this review article. Most of them, however, have not been tested in the clinical arena in transplanted patients. Thus, the main part of the article, immunomodulation during sepsis in organ transplanted children is quite speculative and based on immunomodulatory strategies in other non-transplanted septic patients.

  20. Current treatment of sepsis and endotoxaemia.

    PubMed

    Periti, P

    2000-09-01

    This article reviews the new criteria for selecting the proper antimicrobial agent and dosage regimen for standard treatment of severe sepsis, with the intention of preventing septic shock. After introducing new concepts on the pathogenesis of sepsis and septic shock, the authors analyse the parameters of beta-lactam antibacterial activity, the antibiotic-induced release of bacterial endotoxin and the interrelationships between pharmacokinetics and pharmacodynamics of antibiotics in the search for an optimum dosage regimen of antimicrobial mono- or polytherapy for severely ill septic patients admitted to the intensive care unit. The mortality rate resulting from severe bacterial sepsis, particularly that associated with shock, still approaches 50% in spite of appropriate antimicrobial therapy and optimum supportive care. Bacterial endotoxins that are part of the cell wall are one of the cofactors in the pathogenesis of sepsis and septic shock and are often induced by antimicrobial chemotherapy, even if administered rationally. Not all antimicrobial agents are equally capable of inducing septic shock; this is dependent on their mechanism of action rather than on the causative pathogen species. The quantity of endotoxin released depends on the drug dose and whether filaments or spheroplast formation predominate. Some antibiotics, such as carbapenems, ceftriaxone, cefepime, glycopeptides, aminoglycosides and quinolones, do not have the propensity to provoke septic shock because their rapid bacterial activity induces mainly spheroplast or fragile spheroplast-like bacterial forms.

  1. [Pharmaconutrition with parenteral selenium in sepsis].

    PubMed

    Langlois, P L; de Oliveira Figliolino, L F; Hardy, G; Manzanares, W

    2014-04-01

    Critical illness is characterized by oxidative stress which leads to multiple organ failure, and sepsis-related organ dysfunction remains the most common cause of death in the intensive care unit. Over the last 2 decades, different antioxidant therapies have been developed to improve outcomes in septic patients. According to recent evidence, selenium therapy should be considered the cornerstone of the antioxidant strategies. Selenium given as selenious acid or sodium selenite should be considered as a drug or pharmaconutrient with prooxidant and cytotoxic effects when a loading dose in intravenous bolus form is administered, particularly in the early stage of severe sepsis/septic shock. To date, several phase ii trials have demonstrated that selenium therapy may be able to decrease mortality, improve organ dysfunction and reduce infections in critically ill septic patients. The effect of selenium therapy in sepsis syndrome must be confirmed by large, well designed phase iii clinical trials. The purpose of this review is to discuss current evidence on selenium pharmaconutrition in sepsis syndrome.

  2. [Pharmaconutrition with parenteral selenium in sepsis].

    PubMed

    Langlois, P L; de Oliveira Figliolino, L F; Hardy, G; Manzanares, W

    2014-04-01

    Critical illness is characterized by oxidative stress which leads to multiple organ failure, and sepsis-related organ dysfunction remains the most common cause of death in the intensive care unit. Over the last 2 decades, different antioxidant therapies have been developed to improve outcomes in septic patients. According to recent evidence, selenium therapy should be considered the cornerstone of the antioxidant strategies. Selenium given as selenious acid or sodium selenite should be considered as a drug or pharmaconutrient with prooxidant and cytotoxic effects when a loading dose in intravenous bolus form is administered, particularly in the early stage of severe sepsis/septic shock. To date, several phase ii trials have demonstrated that selenium therapy may be able to decrease mortality, improve organ dysfunction and reduce infections in critically ill septic patients. The effect of selenium therapy in sepsis syndrome must be confirmed by large, well designed phase iii clinical trials. The purpose of this review is to discuss current evidence on selenium pharmaconutrition in sepsis syndrome. PMID:24021703

  3. Clinical analysis of cases of neonatal Streptococcus agalactiae sepsis.

    PubMed

    Zeng, S J; Tang, X S; Zhao, W L; Qiu, H X; Wang, H; Feng, Z C

    2016-01-01

    With the advent of antibiotic resistance, pathogenic bacteria have become a major threat in cases of neonatal sepsis; however, guidelines for treatment have not yet been standardized. In this study, 15 cases of neonatal Streptococcus agalactiae sepsis from our hospital were retrospectively analyzed. Of these, nine cases showed early-onset and six cases showed late-onset sepsis. Pathogens were characterized by genotyping and antibiotic sensitivity tests on blood cultures. Results demonstrated that in cases with early-onset sepsis, clinical manifestations affected mainly the respiratory tract, while late-onset sepsis was accompanied by intracranial infection. Therefore, we suggest including a cerebrospinal fluid examination when diagnosing neonatal sepsis. Bacterial genotyping indicated the bacteria were mainly type Ib, Ia, and III S. agalactiae. We recommend treatment with penicillin or ampicillin, since bacteria were resistant to clindamycin and tetracycline. In conclusion, our results provide valuable information for the clinical treatment of S. agalactiae sepsis in neonatal infants.

  4. Complementary feeding practices in South Asia: analyses of recent national survey data by the South Asia Infant Feeding Research Network.

    PubMed

    Senarath, Upul; Dibley, Michael J

    2012-01-01

    South Asian region has the highest global burden of child undernutrition, with almost 41% of children stunted, 16% wasted and 33% underweight. Improved feeding of children less than 2 years of age is particularly important because they experience rapid growth and development, and are vulnerable to illnesses such as acute respiratory infections and diarrhoeal diseases. The present supplement aimed to describe complementary feeding practices in five South Asian countries - Bangladesh, India, Nepal, Pakistan and Sri Lanka - using the new and updated global complementary feeding indicators and to identify determinants of inappropriate complementary feeding practices. The South Asia Infant Feeding Research Network held a series of workshops to study and discuss the operational guidelines for the new complementary feeding indicators in consultation with regional and international experts. The latest Demographic and Health Surveys for Bangladesh, Nepal, Pakistan and Sri Lanka, and the National Family Health Survey of India were used as data sources. Four key indicators were calculated: introduction of solid, semisolid or soft foods in 6-8 months aged, minimum dietary diversity, minimum meal frequency and minimum acceptable diet in 6-23-month-aged children. Univariate and multivariate logistic regression analyses were performed to identify determinants of poor complementary feeding practices. The papers in this supplement present results of these analyses for each individual country and a comparison between countries. The results have important implications for policies, programmes and research on infant and young child feeding in the region, especially for targeting groups at high risk for suboptimal practices.

  5. A survey of environmental and occupational work practices in the automotive refinishing industry of a developing country: Sonora, Mexico.

    PubMed

    Velázquez, Luis; Bello, Dhimiter; Munguia, Nora; Zavala, Andrea; Marin, Amina; Moure-Eraso, Rafael

    2008-01-01

    The automotive repair and refinishing industry has been studied intensively in industrialized countries, in part due to use of hazardous chemicals such as isocyanates and solvents, but little is known about industry practices in the developing world. The main objective of this paper was to investigate environmental and occupational work practices of this industry in a developing region, Sonora, Mexico. An integrated survey approach maximizes the opportunity for identifying risks as well as reducing risks. This investigation included detailed workplace visits to 41 body shops and 6 paint suppliers, as well as a survey of shop owners and 24 workers. Information was collected on work practices, level of technology in the shops, use of personal protective equipment, consumption and handling of hazardous chemicals and waste, hazard communication, and environmental consciousness. Most shops had little capital, outdated technology for exposure control, poor working conditions, high potential for exposure to hazardous chemicals, and little awareness of environmental and occupational health and safety. We concluded that work practices in the Sonoran auto refinishing industry are unsustainable and may pose a health risk to workers and the environment.

  6. Diversity of endoscopy center operations and practice variation across California’s safety-net hospital system: a statewide survey

    PubMed Central

    2013-01-01

    Background Little is known about endoscopic services provided or operational practice variation within California public hospital endoscopy centers. Methods A survey was distributed to all 18 California public hospitals with endoscopy centers to assess operational practices. Results Eight of 18 hospitals responded to the survey. Six of the eight responding hospitals used a closed access system for patient referrals. Mean wait time for an endoscopic procedure was 42.4 ± 37.7 days (N = 8) with a mean procedure no-show/cancellation rate of 14.5 ± 8.0% (N = 7). All responding public hospitals performed colonoscopy, esophagogastroduodenoscopy, PEG tube placement, and endoscopic retrograde cholangiopancreatography (ERCP) with two hospitals performing endoscopic ultrasound. There was significant practice variation in the documentation of endoscopic quality and performance measurements among the responding hospitals. Multiple methods were used to communicate pathology results to patients: GI clinic visit (6/8), primary physician (4/8), telephone (2/8) or letter (1/8). Conclusion Our study highlights the diversity and practice variations of endoscopy center operations at California public hospitals and serves as a catalyst for future collaborations among safety-net hospitals. PMID:23767938

  7. Translational research and biomarkers in neonatal sepsis.

    PubMed

    Delanghe, Joris R; Speeckaert, Marijn M

    2015-12-01

    As neonatal sepsis is a severe condition, there is a call for reliable biomarkers to differentiate between infected and noninfected newborns. Although blood culture has been considered as the gold standard, this analysis is still too slow and limited by false negative results. Use of CRP is hampered by a physiological 3-day increase, resulting in a low sensitivity to detect sepsis at an early stage. A moderate diagnostic accuracy of other acute phase proteins has been demonstrated (serum amyloid A, procalcitonin, lipopolysaccharide binding protein, mannose binding lectin and hepcidin). In neonatal sepsis, changed chemokine/cytokine levels are observed before those of acute phase reactants. High IL-6, IL-8, IL-10 and TNF-α concentrations are detected in infected infants. Soluble interleukin-2 receptor has been used to identify bacteremia, whereas low plasma RANTES concentrations are characteristic for septicemia. Several cell adhesion molecules contribute to the pathogenesis of sepsis. As an upregulated CD64 expression on granulocytes is found within 1-6h after bacterial invasion, serial CD64 measurements could guide antibiotic therapy. An increased CD11b/CD18 density can improve the diagnosis, and a positive correlation between CD11b and the severity of systemic inflammation has been reported. An early increase in sCD14-ST presepsin is also observed during sepsis, whereas high sTREM-1 values in early-onset neonatal sepsis (EOS) have been associated with mortality. Biomarkers resulting from proteomics are also promising. A 4-biomarker 'mass restricted' score has been validated as diagnostic for intra-amniotic infection and/or inflammation. S100A8 in amniotic fluid is a strong predictor of an increased incidence of EOS. Proteomic analysis of cord blood has revealed altered protein expression patterns. The ApoSAA score is useful for identifying sepsis and could guide prescription of antibiotics. (1)H-NMR and GC-MS metabolomics allow to diagnose septic shock, which is

  8. The chlamydia knowledge, awareness and testing practices of Australian general practitioners and practice nurses: survey findings from the Australian Chlamydia Control Effectiveness Pilot (ACCEPt)

    PubMed Central

    2013-01-01

    Background ACCEPt, a large cluster randomized control trial, aims to determine if annual testing for 16 to 29 year olds in general practice can reduce chlamydia prevalence. ACCEPt is the first trial investigating the potential role of practice nurses (PN) in chlamydia testing. To inform the design of the ACCEPt intervention, we aimed to determine the chlamydia knowledge, attitudes, and testing practices of participating general practitioners (GPs) and PNs. Methods GPs and PNs from 143 clinics recruited from 52 areas in 4 Australian states were asked to complete a survey at time of recruitment. Responses of PNs and GPs were compared using conditional logistic regression to account for possible intra cluster correlation within clinics. Results Of the PNs and GPs enrolled in ACCEPt, 81% and 72% completed the questionnaire respectively. Less than a third of PNs (23%) and GPs (32%) correctly identified the two age groups with highest infection rates in women and only 16% vs 17% the correct age groups in men. More PNs than GPs would offer testing opportunistically to asymptomatic patients aged ≤25 years; women having a pap smear (84% vs 55%, P<0.01); antenatal checkup (83% vs 44%, P<0.01) and Aboriginal men with a sore throat (79% vs 33%, P<0.01), but also to patients outside of the guideline age group at the time of the survey; 26 year old males presenting for a medical check (78% vs 30%, P = <0.01) and 33 year old females presenting for a pill prescription (83% vs 55%, P<0.01). More PNs than GPs knew that retesting was recommended after chlamydia treatment (93% vs 87%, P=0.027); and the recommended timeframe was 3 months (66% vs 26%, P<0.01). A high proportion of PNs (90%) agreed that they could conduct chlamydia testing in general practice, with 79% wanting greater involvement and 89% further training. Conclusions Our survey reveals gaps in chlamydia knowledge and management among GPs and PNs that may be contributing to low testing rates in general practice. The

  9. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)

    PubMed Central

    Singer, Mervyn; Deutschman, Clifford S.; Seymour, Christopher Warren; Shankar-Hari, Manu; Annane, Djillali; Bauer, Michael; Bellomo, Rinaldo; Bernard, Gordon R.; Chiche, Jean-Daniel; Coopersmith, Craig M.; Hotchkiss, Richard S.; Levy, Mitchell M.; Marshall, John C.; Martin, Greg S.; Opal, Steven M.; Rubenfeld, Gordon D.; van der Poll, Tom; Vincent, Jean-Louis; Angus, Derek C.

    2016-01-01

    IMPORTANCE Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination. OBJECTIVE To evaluate and, as needed, update definitions for sepsis and septic shock. PROCESS A task force (n = 19) with expertise in sepsis pathobiology, clinical trials, and epidemiology was convened by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. Definitions and clinical criteria were generated through meetings, Delphi processes, analysis of electronic health record databases, and voting, followed by circulation to international professional societies, requesting peer review and endorsement (by 31 societies listed in the Acknowledgment). KEY FINDINGS FROMEVIDENCE SYNTHESIS Limitations of previous definitions included an excessive focus on inflammation, the misleading model that sepsis follows a continuum through severe sepsis to shock, and inadequate specificity and sensitivity of the systemic inflammatory response syndrome (SIRS) criteria. Multiple definitions and terminologies are currently in use for sepsis, septic shock, and organ dysfunction, leading to discrepancies in reported incidence and observed mortality. The task force concluded the term severe sepsis was redundant. RECOMMENDATIONS Sepsis should be defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. For clinical operationalization, organ dysfunction can be represented by an increase in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score of 2 points or more, which is associated with an in-hospital mortality greater than 10%. Septic shock should be defined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a

  10. Surveying the Knowledge and Practices of Health Professionals in China, India, Iran, and Mexico on Treating Tuberculosis

    PubMed Central

    Hoffman, Steven J.; Guindon, G. Emmanuel; Lavis, John N.; Randhawa, Harkanwal; Becerra-Posada, Francisco; Dejman, Masoumeh; Falahat, Katayoun; Malek-Afzali, Hossein; Ramachandran, Parasurama; Shi, Guang; Yesudian, C. A. K.

    2016-01-01

    Research evidence continues to reveal findings important for health professionals' clinical practices, yet it is not consistently disseminated to those who can use it. The resulting deficits in knowledge and service provision may be especially pronounced in low- and middle-income countries that have greater resource constraints. Tuberculosis treatment is an important area for assessing professionals' knowledge and practices because of the effectiveness of existing treatments and recognized gaps in professionals' knowledge about treatment. This study surveyed 384 health professionals in China, India, Iran, and Mexico on their knowledge and practices related to tuberculosis treatment. Few respondents correctly answered all five knowledge questions (12%) or self-reported performing all five recommended clinical practices “often or very often” (3%). Factors associated with higher knowledge scores included clinical specialization and working with researchers. Factors associated with better practices included training in the care of tuberculosis patients, being based in a hospital, trusting systematic reviews of randomized controlled double-blind trials, and reading summaries of articles, reports, and reviews. This study highlights several strategies that may prove effective in improving health professionals' knowledge and practices related to tuberculosis treatment. Facilitating interactions with researchers and training in acquiring systematic reviews may be especially helpful. PMID:26903613

  11. Potentially Inadvertent Immunomodulation: Norepinephrine Use in Sepsis.

    PubMed

    Stolk, Roeland F; van der Poll, Tom; Angus, Derek C; van der Hoeven, Johannes G; Pickkers, Peter; Kox, Matthijs

    2016-09-01

    Septic shock is a major cause of death worldwide and a considerable healthcare burden in the twenty-first century. Attention has shifted from damaging effects of the proinflammatory response to the detrimental role of antiinflammation, a phenomenon known as sepsis-induced immunoparalysis. Sepsis-induced immunoparalysis may render patients vulnerable to secondary infections and is associated with impaired outcome. The immunoparalysis hypothesis compels us to reevaluate the current management of septic shock and to assess whether we are inadvertently compromising or altering the host immune response. In this perspective, we discuss the potential detrimental role of norepinephrine, the cornerstone treatment for septic shock, in sepsis-induced immunoparalysis. We provide a short overview of the current understanding of the immunologic pathophysiology of sepsis, followed by a detailed description of the immunomodulatory effects of norepinephrine and alternative vasopressors. We conclude that although the development of novel therapies aimed at reversing immunoparalysis is underway, the use of norepinephrine may aggravate the development, extent, and duration of sepsis-induced immunoparalysis. Current in vitro and animal data indicate that norepinephrine treatment exerts immunosuppressive and bacterial growth-promoting effects and may increase susceptibility toward infections. However, evidence in humans is circumstantial, as immunologic effects of norepinephrine have not been investigated properly in experimental or clinical studies. Alternatives such as vasopressin/selepressin, angiotensin II, and phenylephrine could have a fundamental advantage over norepinephrine with respect to their immunologic properties. However, also for these agents, in vivo immunologic data in humans are largely lacking. As such, human studies on the immunomodulatory properties of norepinephrine and viable alternatives are highly warranted. PMID:27398737

  12. Hospitalization Type and Subsequent Severe Sepsis

    PubMed Central

    Dickson, Robert P.; Rogers, Mary A. M.; Langa, Kenneth M.; Iwashyna, Theodore J.

    2015-01-01

    Rationale: Hospitalization is associated with microbiome perturbation (dysbiosis), and this perturbation is more severe in patients treated with antimicrobials. Objectives: To evaluate whether hospitalizations known to be associated with periods of microbiome perturbation are associated with increased risk of severe sepsis after hospital discharge. Methods: We studied participants in the U.S. Health and Retirement Study with linked Medicare claims (1998–2010). We measured whether three hospitalization types associated with increasing severity of probable dysbiosis (non–infection-related hospitalization, infection-related hospitalization, and hospitalization with Clostridium difficile infection [CDI]) were associated with increasing risk for severe sepsis in the 90 days after hospital discharge. We used two study designs: the first was a longitudinal design with between-person comparisons and the second was a self-controlled case series design using within-person comparison. Measurements and Main Results: We identified 43,095 hospitalizations among 10,996 Health and Retirement Study–Medicare participants. In the 90 days following non–infection-related hospitalization, infection-related hospitalization, and hospitalization with CDI, adjusted probabilities of subsequent admission for severe sepsis were 4.1% (95% confidence interval [CI], 3.8–4.4%), 7.1% (95% CI, 6.6–7.6%), and 10.7% (95% CI, 7.7–13.8%), respectively. The incidence rate ratio (IRR) of severe sepsis was 3.3-fold greater during the 90 days after hospitalizations than during other observation periods. The IRR was 30% greater after an infection-related hospitalization versus a non–infection-related hospitalization. The IRR was 70% greater after a hospitalization with CDI than an infection-related hospitalization without CDI. Conclusions: There is a strong dose–response relationship between events known to result in dysbiosis and subsequent severe sepsis hospitalization that is not present

  13. Plasma soluble Tim-3 emerges as an inhibitor in sepsis: sepsis contrary to membrane Tim-3 on monocytes.

    PubMed

    Ren, F; Li, J; Jiang, X; Xiao, K; Zhang, D; Zhao, Z; Ai, J; Hou, C; Jia, Y; Han, G; Xie, L

    2015-11-01

    Immune dysfunction is the main characteristic of sepsis. T cell Ig and mucin domain protein 3 (Tim-3) on the monocytes has been reported to promote immune homeostasis during sepsis, but the influences of plasm soluble Tim-3 (sTim-3) on the immune system during sepsis remain unknown. Here, 100 patients with different severities of sepsis (40 sepsis, 42 severe sepsis, and 18 septic shock) were enrolled in this study. The Tim-3 and human leukocyte antigen-DR (HLA-DR) on the circulating monocytes were detected using flow cytometry. Plasma sTim-3 was detected by enzyme-linked immunosorbent assay. Inflammatory factors and two kinds of A disintegrin and metalloprotease (ADAM) - ADAM10 and ADAM17 were assessed. The Tim-3 and HLA-DR on the monocytes decreased with increasing sepsis severity. The sTim-3 was reduced in the sepsis and severe sepsis patients but was elevated in the septic shock patients who exhibited significant immunosuppression as predicted by HLA-DR. sTim-3 levels were negatively correlated with IL-12 and TNF-α. ADAM10 and ADAM17, sheddases of Tim-3, exhibited trends toward elevations in the septic shock group. In conclusion, sTim-3 was involved in the development of sepsis. The homeostasis-promoting role of the Tim-3 on the monocytes was disrupted, while the inhibitory role of sTim-3 emerged during sepsis-induced immunosuppression.

  14. Assessment of the Farm Management of Culling Cattle: A Survey of Existing Practices and Suggestions for Drafting of Best Practices

    PubMed Central

    Frattasi, Alessandro Russo; Cesano, Lorenzo; Botta, Michelangelo

    2014-01-01

    The aim of this study is to evaluate different aspects regarding culled cattle and to suggest operating procedures for their correct management. Information collected in Piedmont region allowed for an assessment of the number of cattle put down on the farm, a quantification of slaughters performed in urgency and emergency (SUS/SES) and a headcount of those which died during farming. The survey highlighted the limited use of euthanasia or putting down compared to the number of cases of SUS/SES which were approximately ten times higher. If cattle displays severe health problems, such as a multifactorial disease like downer cow, the farmer has to decide rapidly the treatment to avoid cattle distress. A checklist has been developed and a flow chart has been revised to assist farmers and vets to quicken the decision-taking process and to manage the cattle in a more efficient manner. During this study a number of different problems have been stressed out. Particularly, the shortcomings in the training of operators commissioned to manage the animals, the inadequacy of structures used for the sheltering and slaughter of bovines on the farm, and differences in the operating procedures for culled cattle across the territory. From the obtained results, we can conclude that it is necessary to adopt a transversal approach, so that the information regarding these animals (welfare, health status, drug treatments and destination) will be uniform and adequate during all the steps of production, to ensure animal welfare and food safety. PMID:27800327

  15. Profile of tobacco users identified in primary care practice and predictors of readiness to quit: a cross-sectional survey

    PubMed Central

    Papadakis, Sophia; Tulloch, Heather E.; Gharib, Marie; Pipe, Andrew L.

    2016-01-01

    Background: The aim of this study was to document the prevalence of tobacco use and describe the characteristics of tobacco users identified in primary care practices. Methods: We conducted a cross-sectional survey in 49 primary care practices in the province of Ontario. Consecutive patients were screened for smoking status at the time of their clinic appointment. Patients reporting current tobacco use completed a survey, which documented sociodemographic and smoking-related characteristics. Multilevel modelling was used to examine predictors of readiness to quit smoking and the presence of anxiety and/or depression. Results: A total of 56 592 patients were screened, and 5245 tobacco users participated in the survey. Prevalence of tobacco use was 18.2% and varied significantly across practices (range 12.4%-36.1%). Of the respondents, 46.3% reported current anxiety and/or depression, and 61.3% reported smoking within the first 30 minutes of waking. A total of 41.1% of respondents reported they were ready to quit smoking in the next 6 months, and 30.1% reported readiness to quit in the next 30 days. Readiness to quit was positively associated with higher self-efficacy, male sex, presence of chronic obstructive pulmonary disease and more years of tobacco use. The presence of anxiety and/or depression was associated with lower cessation self-efficacy and time to first cigarette within 30 minutes of waking, but did not predict readiness to quit. Interpretation: Tobacco users identified in primary care practices reported high rates of nicotine dependence and anxiety and/or depression, but also high rates of readiness to quit. Study findings support the need to tailor interventions to address the needs of tobacco users identified in primary care settings. PMID:27280113

  16. Assessment and Intervention Practices for Attention Deficit Hyperactivity Disorder (ADHD): A National Survey of School Psychologists

    ERIC Educational Resources Information Center

    Borick, Timothy J.

    2011-01-01

    This study examined school psychologists' assessment and intervention practices regarding ADHD. Five hundred school psychologists who practiced in a school setting and were regular members of the National Association of School Psychologists were randomly selected to complete and return a questionnaire titled Assessment and Intervention Practices…

  17. Symptomatic Management of Fever in Children: A National Survey of Healthcare Professionals’ Practices in France

    PubMed Central

    Bertille, Nathalie; Pons, Gerard; Khoshnood, Babak; Fournier-Charrière, Elisabeth; Chalumeau, Martin

    2015-01-01

    Despite the production and dissemination of recommendations related to managing fever in children, this symptom saturates the practices of primary healthcare professionals (HPs). Data on parent practices related to fever are available, but data on HPs’ practices are limited. We studied HPs’ practices, determinants of practices and concordance with recommendations in France. We conducted a national cross-sectional observational study between 2007 and 2008 among French general practitioners, primary care pediatricians and pharmacists. HPs were asked to include 5 consecutive patients aged 1 month to 12 years with acute fever. HPs completed a questionnaire about their practices for the current fever episode. We used a multilevel logistic regression model to assess the joint effects of patient- and HP-level variables associated with this behavior. In all, 1,534 HPs (participation rate 13%) included 6,596 children (mean age 3.7 ± 2.7 years). Physicians measured the temperature of 40% of children. Primary HPs recommended drug treatment for 84% of children (including monotherapy for 92%) and physical treatment for 62% (including all recommended physical treatments for 7%). HPs gave written advice or a pamphlet for 13% of children. Significant practice variations were associated with characteristics of the child (age, fever level and diagnosis) and HP (profession and experience). In France, despite the production and dissemination of national recommendations for managing fever in children, primary HPs’ observed practices differed greatly from current recommendations, which suggests potential targets for continuing medical education. PMID:26599740

  18. Symptomatic Management of Fever in Children: A National Survey of Healthcare Professionals' Practices in France.

    PubMed

    Bertille, Nathalie; Pons, Gerard; Khoshnood, Babak; Fournier-Charrière, Elisabeth; Chalumeau, Martin

    2015-01-01

    Despite the production and dissemination of recommendations related to managing fever in children, this symptom saturates the practices of primary healthcare professionals (HPs). Data on parent practices related to fever are available, but data on HPs' practices are limited. We studied HPs' practices, determinants of practices and concordance with recommendations in France. We conducted a national cross-sectional observational study between 2007 and 2008 among French general practitioners, primary care pediatricians and pharmacists. HPs were asked to include 5 consecutive patients aged 1 month to 12 years with acute fever. HPs completed a questionnaire about their practices for the current fever episode. We used a multilevel logistic regression model to assess the joint effects of patient- and HP-level variables associated with this behavior. In all, 1,534 HPs (participation rate 13%) included 6,596 children (mean age 3.7 ± 2.7 years). Physicians measured the temperature of 40% of children. Primary HPs recommended drug treatment for 84% of children (including monotherapy for 92%) and physical treatment for 62% (including all recommended physical treatments for 7%). HPs gave written advice or a pamphlet for 13% of children. Significant practice variations were associated with characteristics of the child (age, fever level and diagnosis) and HP (profession and experience). In France, despite the production and dissemination of national recommendations for managing fever in children, primary HPs' observed practices differed greatly from current recommendations, which suggests potential targets for continuing medical education. PMID:26599740

  19. Symptomatic Management of Fever in Children: A National Survey of Healthcare Professionals' Practices in France.

    PubMed

    Bertille, Nathalie; Pons, Gerard; Khoshnood, Babak; Fournier-Charrière, Elisabeth; Chalumeau, Martin

    2015-01-01

    Despite the production and dissemination of recommendations related to managing fever in children, this symptom saturates the practices of primary healthcare professionals (HPs). Data on parent practices related to fever are available, but data on HPs' practices are limited. We studied HPs' practices, determinants of practices and concordance with recommendations in France. We conducted a national cross-sectional observational study between 2007 and 2008 among French general practitioners, primary care pediatricians and pharmacists. HPs were asked to include 5 consecutive patients aged 1 month to 12 years with acute fever. HPs completed a questionnaire about their practices for the current fever episode. We used a multilevel logistic regression model to assess the joint effects of patient- and HP-level variables associated with this behavior. In all, 1,534 HPs (participation rate 13%) included 6,596 children (mean age 3.7 ± 2.7 years). Physicians measured the temperature of 40% of children. Primary HPs recommended drug treatment for 84% of children (including monotherapy for 92%) and physical treatment for 62% (including all recommended physical treatments for 7%). HPs gave written advice or a pamphlet for 13% of children. Significant practice variations were associated with characteristics of the child (age, fever level and diagnosis) and HP (profession and experience). In France, despite the production and dissemination of national recommendations for managing fever in children, primary HPs' observed practices differed greatly from current recommendations, which suggests potential targets for continuing medical education.

  20. Core Practices for Teaching History: The Results of a Delphi Panel Survey

    ERIC Educational Resources Information Center

    Fogo, Bradley

    2014-01-01

    Recent education literature and research has focused on identifying effective core teaching practices to inform and help shape teacher education and professional development. Although a rich literature on the teaching and learning of history has continued to develop over the past decade, core practice research has largely overlooked…

  1. Survey of UK Speech and Language Therapists' Assessment and Treatment Practices for People with Progressive Dysarthria

    ERIC Educational Resources Information Center

    Collis, Jessica; Bloch, Steven

    2012-01-01

    Background: Dysarthria knowledge is predominantly impairment-based. As a result, speech and language therapists (SLTs) have traditionally adopted impairment-focused management practices. However, guidance for best practice suggests that SLTs should consider the client holistically, including the impact of dysarthria beyond the impairment. Aims: To…

  2. Benchmarking Work Practices and Outcomes in Australian Universities Using an Employee Survey

    ERIC Educational Resources Information Center

    Langford, Peter H.

    2010-01-01

    The purpose of the current study was to benchmark a broad range of work practices and outcomes in Australian universities against other industries. Past research suggests occupational stress experienced by academic staff is worse than experienced by employees in other industries. However, no other practices or outcomes can be compared confidently.…

  3. The role of immune and metabolic biomarkers for improved management of sepsis patients.

    PubMed

    Schuetz, Philipp; Mueller, Beat

    2014-09-01

    Sepsis, the body`s overwhelming response to systemic infections, is responsible for significant morbidity, mortality, and financial burden. Pathogens and their antigens stimulate pro- and anti-inflammatory mediators and immune markers which characterize the host defense and orchestrate leukocyte recruitment to the acute site of infection. Different immune and metabolic biomarkers have been studied in relation to sepsis for their diagnostic and/or prognostic aid. Recent studies have provided abundant evidence that specific immune and metabolic biomarkers improve a physician`s ability to guide early sepsis recognition, severity assessment and therapeutic decisions in individual patients. This may allow for a transition from bundled sepsis care (protocols combining several medical practices) to more individualized management. First, lactate has now been widely used for risk stratification and guidance of fluid resuscitation. Second, procalcitonin correlates with risks of bacterial infections and helps guide therapeutic decisions about initiation and withdrawal of anti-microbial therapy. Third, prognostic markers such as pro-adrenomedullin improve early mortality prediction and thereby site-of-care decisions in respiratory infections. For these markers interventional trials have documented their value when integrated in clinical protocols.

  4. Eating practices and habitus in mothers. A Brazilian population-based survey.

    PubMed

    de Morais Sato, Priscila; da Rocha Pereira, Patrícia; de Carvalho Stelmo, Isis; Unsain, Ramiro Fernandez; Ulian, Mariana Dimitrov; Sabatini, Fernanda; Martins, Paula Andrea; Scagliusi, Fernanda Baeza

    2014-11-01

    A population-based cross-sectional study was conducted with mothers living in the city of Santos, Brazil, in order to investigate their eating practices, and the interface between those practices and the concept of habitus. From a cluster analysis of the scores for dietary pattern and for food preparation and consumption, the mothers were categorised into five clusters of eating practices: practical mothers (19.8%), symbiotic mothers (3.2%), health-conscious hedonists (17.3%), traditionalists (34.6%), and family cooks (25.1%). To access the habitus of the eating-practice clusters, the following variables were compared: location of residence, profession, socioeconomic status, weight-loss practices, risk behaviours for eating disorders, disordered eating attitudes, body dissatisfaction, and cultural and technological consumption. For all the groups, the observed eating practices were permeated by responsibility for the family's diet, but with different manifestations. For symbiotic mothers, practical mothers, and family cooks, the primary function of their relation with food was to nourish their families, with little expression of their own tastes and preferences. The traditionalists and the health-conscious hedonists, on the other hand, manifested their role as mothers by providing food considered 'nutritionally proper' to their family members. Furthermore, aspects of contemporary lifestyles, such as little time for food, individualisation of meals, and consumption of processed foods, were found to coexist with the valorisation and maintenance of the traditional meals within some groups. The variety of eating practices could not be understood as a linear association between economic and cultural capitals; however, eating practices seemed to interact with those capitals, composing a habitus.

  5. Eating practices and habitus in mothers. A Brazilian population-based survey.

    PubMed

    de Morais Sato, Priscila; da Rocha Pereira, Patrícia; de Carvalho Stelmo, Isis; Unsain, Ramiro Fernandez; Ulian, Mariana Dimitrov; Sabatini, Fernanda; Martins, Paula Andrea; Scagliusi, Fernanda Baeza

    2014-11-01

    A population-based cross-sectional study was conducted with mothers living in the city of Santos, Brazil, in order to investigate their eating practices, and the interface between those practices and the concept of habitus. From a cluster analysis of the scores for dietary pattern and for food preparation and consumption, the mothers were categorised into five clusters of eating practices: practical mothers (19.8%), symbiotic mothers (3.2%), health-conscious hedonists (17.3%), traditionalists (34.6%), and family cooks (25.1%). To access the habitus of the eating-practice clusters, the following variables were compared: location of residence, profession, socioeconomic status, weight-loss practices, risk behaviours for eating disorders, disordered eating attitudes, body dissatisfaction, and cultural and technological consumption. For all the groups, the observed eating practices were permeated by responsibility for the family's diet, but with different manifestations. For symbiotic mothers, practical mothers, and family cooks, the primary function of their relation with food was to nourish their families, with little expression of their own tastes and preferences. The traditionalists and the health-conscious hedonists, on the other hand, manifested their role as mothers by providing food considered 'nutritionally proper' to their family members. Furthermore, aspects of contemporary lifestyles, such as little time for food, individualisation of meals, and consumption of processed foods, were found to coexist with the valorisation and maintenance of the traditional meals within some groups. The variety of eating practices could not be understood as a linear association between economic and cultural capitals; however, eating practices seemed to interact with those capitals, composing a habitus. PMID:25014744

  6. Access to complementary medicine in general practice: survey in one UK health authority.

    PubMed

    Wearn, A M; Greenfield, S M

    1998-09-01

    Complementary therapy (CT) has become increasingly popular with the general public and interest from the health professions has been rising. There has been no study focusing on the pattern of availability of CT within urban and inner-city general practice. We aimed to describe the prevalence and pattern of access to complementary therapy in this setting, identifying the characteristics of practices offering CT and the perceived barriers to service provision. We sent a postal questionnaire to all 254 general practices on the Birmingham Family Health Services Authority list. Practices were asked whether they offered any access to CTs, how services were organized and which therapies were available and to identify any barriers to provision. 175 practices (68.9%) responded. Half of the practices offered access to CT. Of these, half offered an in-house service, usually provided by the doctor (81.8%). Of GPs practising therapies themselves, 58% began in or after 1990. Seventeen separate therapies were offered, most commonly acupuncture, osteopathy, chiropractic, hypnotherapy and homoeopathy. Practices significantly more likely to offer access to CT were of larger list size and training or teaching practices. They were equally likely to be fundholders or non-fundholders. Practices offering an in-house service tended to be fundholding, training and of larger list size. Finance was perceived as the major barrier. In the area studied, many patients now have some access to CT within primary care, often within their own practice. In the main, therapies offered are the 'medically acceptable face' of complementary medicine.

  7. Recruitment using mobile telephones in an Irish general population sexual health survey: challenges and practical solutions

    PubMed Central

    2012-01-01

    Background Non-coverage of households without a landline telephone is a major concern of telephone survey researchers. Sampling mobile telephone users in national surveys is vital in order to gain access to the growing proportion of households that use mobile telephones extensively or exclusively. The complex logistics of conducting surveys with mobile telephones have been discussed in the literature. This paper outlines the actual challenges encountered during a recent national sexual health survey in Ireland, which utilized a mobile telephone sampling frame to recruit approximately half of the sample. Method The 2010 Irish Contraception and Crisis Pregnancy Survey (ICCP-2010) is a nationally representative sample of adults aged 18-45 years living in Ireland (n = 3002; 1416 recruited by landline telephone and 1586 recruited by mobile telephone). The overall response rate for the survey was 69% (79% for the landline telephone strand; 61% for the mobile telephone strand). All interviews were conducted using computer-assisting telephone interviewing. Results During the 18-week fieldwork period, five main challenges relating to the use of mobile telephones were encountered: (1) explaining to respondents how random digit dialling works in relation to mobile telephones; (2) establishing the respondent's eligibility; (3) calling the respondent with the Caller ID blocked or withheld; (4) calling the respondent when they are in any number of locations or situations; and (5) explaining to respondents the importance of refusal conversion calls for the response rate calculation. Details of how the survey protocols and procedures were monitored and adapted throughout the study to ensure a high response rate are outlined. Conclusion It is undeniably more challenging to recruit respondents using mobile telephones as opposed to landline telephones. Respondents are generally not familiar with being contacted on their personal mobile telephone for the purposes of being recruited

  8. Assessment and management of the communication difficulties of children with cerebral palsy: a UK survey of SLT practice

    PubMed Central

    Mary Watson, Rose; Pennington, Lindsay

    2015-01-01

    Background Communication difficulties are common in cerebral palsy (CP) and are frequently associated with motor, intellectual and sensory impairments. Speech and language therapy research comprises single-case experimental design and small group studies, limiting evidence-based intervention and possibly exacerbating variation in practice. Aims To describe the assessment and intervention practices of speech–language therapist (SLTs) in the UK in their management of communication difficulties associated with CP in childhood. Methods & Procedures An online survey of the assessments and interventions employed by UK SLTs working with children and young people with CP was conducted. The survey was publicized via NHS trusts, the Royal College of Speech and Language Therapists (RCSLT) and private practice associations using a variety of social media. The survey was open from 5 December 2011 to 30 January 2012. Outcomes & Results Two hundred and sixty-five UK SLTs who worked with children and young people with CP in England (n = 199), Wales (n = 13), Scotland (n = 36) and Northern Ireland (n = 17) completed the survey. SLTs reported using a wide variety of published, standardized tests, but most commonly reported assessing oromotor function, speech, receptive and expressive language, and communication skills by observation or using assessment schedules they had developed themselves. The most highly prioritized areas for intervention were: dysphagia, alternative and augmentative (AAC)/interaction and receptive language. SLTs reported using a wide variety of techniques to address difficulties in speech, language and communication. Some interventions used have no supporting evidence. Many SLTs felt unable to estimate the hours of therapy per year children and young people with CP and communication disorders received from their service. Conclusions & Implications The assessment and management of communication difficulties associated with CP in childhood varies widely in the

  9. Developing a household survey tool for health equity: A practical guide in Islamic Republic of Iran

    PubMed Central

    Beheshtian, Maryam; Khosravi, Ardeshir; Olyaeemanesh, Alireza; Malekafzali, Hossein; Bonakdar Esfahani, Shirin; Hosseiny Ghavamabad, Leila; Aghamohammadi, Saeideh; Nouri, Mahnaz; Kazemi, Elaheh; Zakeri, Mohammadreza; Sagha, Fatemeh

    2015-01-01

    Background: An obvious gradient in health outcomes has been implicated in many evidences relating to social and economic factors. Proper data are requested to convince policy-makers calling for intersectoral action for health. Recently, I.R. of Iran has come up with 52 health equity indicators to monitor health equity through the country. Conducting regular surveys on 14 out of 52 national health equity indicators is needed to provide a basis for the health inequality analysis through the country. We aimed to introduce a survey tool and its related protocols on health equity indicators. Methods: This study was conducted through addressing the literature and expertise of health and demographic surveys at the national and international levels. Also, we conducted technical and consultative committee meetings, a final consensus workshop and a pilot study to finalize the survey tool. Results: We defined the study design, sampling method, reliable questionnaires and instructions, data collection and supervision procedure. We also defined the data analysis protocol on health equity indicators, generated from non-routine data. Conclusion: A valid and reliable tool, which could be employed at the national and sub-national levels, was designed to measure health equity in Iran. Policy-makers can use this survey tool to generate useful information and evidence to design appropriate required intervention and reduce health inequality across the country. PMID:26913268

  10. Adult Dental Health Survey 2009: implications of findings for clinical practice and oral health policy.

    PubMed

    Watt, R G; Steele, J G; Treasure, E T; White, D A; Pitts, N B; Murray, J J

    2013-01-01

    This is the final paper in a series reporting on the results of the 2009 Adult Dental Health Survey. Since 1968 national adult surveys have been repeated every decade with broadly similar methods providing a unique overview of trends in oral health over a 40-year period. This paper aims to explore the implications for dentists and oral health policy of the key results from the Adult Dental Health Survey 2009. Although repeat, cross-sectional, epidemiological surveys provide very valuable data on trends in disease patterns, they do not provide answers to test causal relationships and therefore cannot identify the causes for the significant improvements in oral health over the last 40 years. Evidence would indicate, however, that broad societal shifts in population norms and behaviours, combined with changes in clinical diagnostic criteria, treatment planning and clinical procedures are the main reasons for the changes that have taken place. Key implications of the survey results include the need to monitor, support and maintain the good state of oral health of the increasing proportion of younger adults with relatively simple treatment needs. A smaller number of young and middle aged adults but a significant proportion of older adults will have far more complex treatment needs requiring advanced restorative and periodontal care. Future oral health policy will need to address oral health inequalities, encourage skill mix and promote and facilitate the dental profession to deliver appropriate and high quality care relevant to the needs of their local population.

  11. Sirtuin-2 Regulates Sepsis Inflammation in ob/ob Mice

    PubMed Central

    Wang, Xianfeng; Buechler, Nancy L.; Martin, Ayana; Wells, Jonathan; Yoza, Barbara; McCall, Charles E.; Vachharajani, Vidula

    2016-01-01

    Objective Obesity increases morbidity and resource utilization in sepsis patients. Sepsis transitions from early/hyper-inflammatory to late/hypo-inflammatory phase. Majority of sepsis-mortality occurs during the late sepsis; no therapies exist to treat late sepsis. In lean mice, we have shown that sirtuins (SIRTs) modulate this transition. Here, we investigated the role of sirtuins, especially the adipose-tissue abundant SIRT-2 on transition from early to late sepsis in obese with sepsis. Methods Sepsis was induced using cecal ligation and puncture (CLP) in ob/ob mice. We measured microvascular inflammation in response to lipopolysaccharide/normal saline re-stimulation as a “second-hit” (marker of immune function) at different time points to track phases of sepsis in ob/ob mice. We determined SIRT-2 expression during different phases of sepsis. We studied the effect of SIRT-2 inhibition during the hypo-inflammatory phase on immune function and 7-day survival. We used a RAW264.7 (RAW) cell model of sepsis for mechanistic studies. We confirmed key findings in diet induced obese (DIO) mice with sepsis. Results We observed that the ob/ob-septic mice showed an enhanced early inflammation and a persistent and prolonged hypo-inflammatory phase when compared to WT mice. Unlike WT mice that showed increased SIRT1 expression, we found that SIRT2 levels were increased in ob/ob mice during hypo-inflammation. SIRT-2 inhibition in ob/ob mice during the hypo-inflammatory phase of sepsis reversed the repressed microvascular inflammation in vivo via activation of endothelial cells and circulating leukocytes and significantly improved survival. We confirmed the key finding of the role of SIRT2 during hypo-inflammatory phase of sepsis in this project in DIO-sepsis mice. Mechanistically, in the sepsis cell model, SIRT-2 expression modulated inflammatory response by deacetylation of NFκBp65. Conclusion SIRT-2 regulates microvascular inflammation in obese mice with sepsis and may

  12. Post–Acute Care Use and Hospital Readmission after Sepsis

    PubMed Central

    Jones, Tiffanie K.; Fuchs, Barry D.; Small, Dylan S.; Halpern, Scott D.; Hanish, Asaf; Umscheid, Craig A.; Baillie, Charles A.; Kerlin, Meeta Prasad; Gaieski, David F.

    2015-01-01

    Rationale: The epidemiology of post–acute care use and hospital readmission after sepsis remains largely unknown. Objectives: To examine the rate of post–acute care use and hospital readmission after sepsis and to examine risk factors and outcomes for hospital readmissions after sepsis. Methods: In an observational cohort study conducted in an academic health care system (2010–2012), we compared post–acute care use at discharge and hospital readmission after 3,620 sepsis hospitalizations with 108,958 nonsepsis hospitalizations. We used three validated, claims-based approaches to identify sepsis and severe sepsis. Measurements and Main Results: Post–acute care use at discharge was more likely after sepsis, driven by skilled care facility placement (35.4% after sepsis vs. 15.8%; P < 0.001), with the highest rate observed after severe sepsis. Readmission rates at 7, 30, and 90 days were higher postsepsis (P < 0.001). Compared with nonsepsis hospitalizations (15.6% readmitted within 30 d), the increased readmission risk was present regardless of sepsis severity (27.3% after sepsis and 26.0–26.2% after severe sepsis). After controlling for presepsis characteristics, the readmission risk was found to be 1.51 times greater (95% CI, 1.38–1.66) than nonsepsis hospitalizations. Readmissions after sepsis were more likely to result in death or transition to hospice care (6.1% vs. 13.3% after sepsis; P < 0.001). Independent risk factors associated with 30-day readmissions after sepsis hospitalizations included age, malignancy diagnosis, hospitalizations in the year prior to the index hospitalization, nonelective index admission type, one or more procedures during the index hospitalization, and low hemoglobin and high red cell distribution width at discharge. Conclusions: Post–acute care use and hospital readmissions were common after sepsis. The increased readmission risk after sepsis was observed regardless of sepsis severity and was associated with

  13. Self-reported attitudes, skills and use of evidence-based practice among Canadian doctors of chiropractic: a national survey

    PubMed Central

    Bussières, André E.; Terhorst, Lauren; Leach, Matthew; Stuber, Kent; Evans, Roni; Schneider, Michael J.

    2015-01-01

    Objectives: To identify Canadian chiropractors’ attitudes, skills and use of evidence based practice (EBP), as well as their level of awareness of previously published chiropractic clinical practice guidelines (CPGs). Methods: 7,200 members of the Canadian Chiropractic Association were invited by e-mail to complete an online version of the Evidence Based practice Attitude & utilisation SurvEy (EBASE); a valid and reliable measure of participant attitudes, skills and use of EBP. Results: Questionnaires were completed by 554 respondents. Most respondents (>75%) held positive attitudes toward EBP. Over half indicated a high level of self-reported skills in EBP, and over 90% expressed an interest in improving these skills. A majority of respondents (65%) reported over half of their practice was based on evidence from clinical research, and only half (52%) agreed that chiropractic CPGs significantly impacted on their practice. Conclusions: While most Canadian chiropractors held positive attitudes towards EBP, believed EBP was useful, and were interested in improving their skills in EBP, many did not use research evidence or CPGs to guide clinical decision making. Our findings should be interpreted cautiously due to the low response rate. PMID:26816412

  14. Stroke unit Nurse Managers' views of individual and organizational factors liable to influence evidence-based practice: A survey.

    PubMed

    Drury, Peta; McInnes, Elizabeth; Hardy, Jennifer; Dale, Simeon; Middleton, Sandy

    2016-04-01

    The uptake of evidence into practice may be impeded or facilitated by individual and organizational factors within the local context. This study investigated Nurse Managers of New South Wales, Australia, stroke units (n = 19) in their views on: leadership ability (measured by the Leadership Practices Inventory), organizational learning (measured by the Organizational Learning Survey), attitudes and beliefs towards evidence-based practice (EBP) and readiness for change. Overall Nurse Managers reported high-level leadership skills and a culture of learning. Nurse Managers' attitude towards EBP was positive, although nursing colleague's attitudes were perceived as less positive. Nurse Managers agreed that implementing evidence in practice places additional demands on staff; and almost half (n = 9, 47%) reported that resources were not available for evidence implementation. The findings indicate that key persons responsible for evidence implementation are not allocated sufficient time to coordinate and implement guidelines into practice. The findings suggest that barriers to evidence uptake, including insufficient resources and time constraints, identified by Nurse Managers in this study are not likely to be unique to stroke units. Furthermore, Nurse Managers may be unable to address these organizational barriers (i.e. lack of resources) and thus provide all the components necessary to implement EBP. PMID:25943688

  15. Knowledge, Practices, and Perceived Barriers Regarding Cancer Pain Management Among Physicians and Nurses In Korea: A Nationwide Multicenter Survey

    PubMed Central

    Jho, Hyun Jung; Kim, Yeol; Kong, Kyung Ae; Kim, Dae Hyun; Choi, Jin Young; Nam, Eun Jeong; Choi, Jin Young; Koh, Sujin; Hwang, Kwan Ok; Baek, Sun Kyung; Park, Eun Jung

    2014-01-01

    Purpose Medical professionals’ practices and knowledge regarding cancer pain management have often been cited as inadequate. This study aimed to evaluate knowledge, practices and perceived barriers regarding cancer pain management among physicians and nurses in Korea. Methods A nationwide questionnaire survey was administered to physicians and nurses involved in the care of cancer patients. Questionnaire items covered pain assessment and documentation practices, knowledge regarding cancer pain management, the perceived barriers to cancer pain control, and processes perceived as the major causes of delay in opioid administration. Results A total of 333 questionnaires (149 physicians and 284 nurses) were analyzed. Nurses performed pain assessment and documentation more regularly than physicians did. Although physicians had better knowledge of pain management than did nurses, both groups lacked knowledge regarding the side effects and pharmacology of opioids. Physicians working in the palliative care ward and nurses who had received pain management education obtained higher scores on knowledge. Physicians perceived patients’ reluctance to take opioids as a barrier to pain control, more so than did nurses, while nurses perceived patients’ tendency to under-report of pain as a barrier, more so than did physicians. Physicians and nurses held different perceptions regarding major cause of delay during opioid administration. Conclusions There were differences between physicians and nurses in knowledge and practices for cancer pain management. An effective educational strategy for cancer pain management is needed in order to improve medical professionals’ knowledge and clinical practices. PMID:25144641

  16. Survey of biosecurity protocols and practices adopted by growers on commercial poultry farms in Georgia, U. S. A.

    PubMed

    Dorea, F C; Berghaus, R; Hofacre, C; Cole, D J

    2010-09-01

    The integrated commercial poultry system is a highly connected network in which routine activities keep farms within a geographic area in constant contact. Consequently, biosecurity practices designed to minimize the transmission of infectious diseases between and within farms are an important component of modern flock health programs. A survey of Georgia poultry growers was conducted in order to assess the level of adoption of standard biosecurity measures by farm personnel and visitors. The results showed that compliance with recommended biosecurity practices did not significantly vary by company, farm size, or number of farms owned by the same grower. However, biosecurity was higher in the northern part of the state, where the density of farms is higher, and where there was an ongoing outbreak of infectious laryngotracheitis at the time of the study. The survey found that growers place more emphasis on biosecurity measures targeting farm visitors than those targeting farm personnel. Most growers reported that all visitors to the farm were required to wear shoe covers, although visitors were not typically required to park outside the farm entrance or to wash tires on their vehicles. No visitor type was reportedly excluded from poultry houses during grow out on all farms. The results highlight the need to evaluate the comparative efficacy of specific biosecurity measures in order to set priorities and attain feasible rates of implementation of targeted biosecurity practices.

  17. Severe sepsis and septic shock: defining the clinical problem.

    PubMed

    Opal, Steven M

    2003-01-01

    It is generally acknowledged that severe sepsis/septic shock is a major problem in clinical medicine, yet the extent of the problem and its basic immunology remain poorly defined. The generation of accurate statistics about sepsis is confounded by the imprecise and highly variable terminology used to describe sepsis by clinicians around the world. The problem of sepsis is further complicated by the remarkably diverse spectrum of illness encompassed under the term 'sepsis'. Sepsis may range in severity from mild systemic inflammation without significant clinical consequences to multisystem failure in septic shock with an exceedingly high mortality rate. Sepsis connotes a clinical syndrome that may occur in any age group, in markedly different patient populations, and in response to a multitude of microbial pathogens from multiple different anatomical sites within the human body. A concerted effort has been made to standardize definitions of sepsis by the use of international committees and consensus opinions from panels of experts in sepsis research. While consensus definitions of sepsis have proven to be of value, the lack of uniformity in interpretation of these definitions continues to be problematic by clinicians and basic researchers alike. Recently, a new conceptual framework for understanding sepsis has been developed, called the PIRO concept (predisposition, infection, response and organ dysfunction). This has been conceptually modeled from the TNM classification (tumor size, nodal spread, metastases) which has been successfully used in defining treatment and prognostic indicators in clinical oncology. Further refinements in the definitions and predisposing factors of severe sepsis should improve the understanding and management of severe sepsis and septic shock in the near future.

  18. Evidence of dose saving in routine CT practice using iterative reconstruction derived from a national diagnostic reference level survey

    PubMed Central

    Hayton, A; Beveridge, T; Marks, P; Wallace, A

    2015-01-01

    Objective: To assess the influence and significance of the use of iterative reconstruction (IR) algorithms on patient dose in CT in Australia. Methods: We examined survey data submitted to the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) National Diagnostic Reference Level Service (NDRLS) during 2013 and 2014. We compared median survey dose metrics with categorization by scan region and use of IR. Results: The use of IR results in a reduction in volume CT dose index of between 17% and 44% and a reduction in dose–length product of between 14% and 34% depending on the specific scan region. The reduction was highly significant (p < 0.001, Wilcoxon rank-sum test) for all six scan regions included in the NDRLS. Overall, 69% (806/1167) of surveys included in the analysis used IR. Conclusion: The use of IR in CT is achieving dose savings of 20–30% in routine practice in Australia. IR appears to be widely used by participants in the ARPANSA NDRLS with approximately 70% of surveys submitted employing this technique. Advances in knowledge: This study examines the impact of the use of IR on patient dose in CT on a national scale. PMID:26133224

  19. Insect repellent plants traditional usage practices in the Ethiopian malaria epidemic-prone setting: an ethnobotanical survey

    PubMed Central

    2014-01-01

    Background The usage of insect repellent plants (IRPs) is one of the centuries-old practices in Africa. In Ethiopia, malaria remains a leading cause of morbidity and mortality, subsequently the majority of people have a tendency to apply various plants as repellents to reduce or interrupt the biting activity of insects. Accordingly, this survey was undertaken to document and evaluate knowledge and usage practices of the local inhabitants on IRPs in the malaria epidemic-prone setting of Ethiopia. Methods Ethnobotanical survey was conducted between January and May 2013. Selected 309 household members were interviewed by administering pre-tested questionnaire on knowledge and usage practices of repellent plants, in Bechobore Kebele, Jimma Zone, Ethiopia. Results Overall, 70.2% (217/309) and 91.8% (199/217) of the respondents have had ample awareness and usage practices of repellent plants, respectively. Informants cited about twenty-two plant species as repellents and also indicated that these plants are useful(85.5%), accessible(86.8%), and affordable(83.9%) too. Residents mainly applying dried leaves [93.9% (187/199)] by means of burning/smouldering [98.9% (197/199)] with the traditional charcoal stove to repel insects, primarily mosquitoes. About 52.8% (105/199) of the informants using aproximately15g of dried plant-materials every day. A Chi-square analysis shows statistically a significant link between the knowledge on repellent plants and gender as well as average monthly income although not with the age of the respondents. Nevertheless, the repellent plant usage custom was not significantly associated with gender, monthly income, and age of the informants. Conclusion Though most of the people have had an adequate awareness still a sizable faction of society suffers with deprivation of IRPs knowledge and usage practices. Therefore, this study calls for more surveys to conserve the existing indigenous knowledge and cultural practices. It could lay the first stone

  20. The Integration of Clients' Religion and Spirituality in Social Work Practice: A National Survey.

    PubMed

    Oxhandler, Holly K; Parrish, Danielle E; Torres, Luis R; Achenbaum, W Andrew

    2015-07-01

    This article describes the results of a cross-sectional study of licensed clinical social workers' (LCSWs') views and behaviors related to integrating clients' religion and spirituality in clinical practice. A total of 442 LCSWs from across the United States who advertised their services on the Internet provided anonymous responses to an online administration of the Religious/Spiritually Integrated Practice Assessment Scale. The results indicate that LCSWs have positive attitudes, high levels of self-efficacy, and perceive such integration as feasible, but report low levels of engagement in integrating clients' religious and spiritual beliefs into practice. Moreover, two variables emerged as significant predictors for LCSWs' overall orientation toward integrating clients' religion and spirituality in practice: practitioners' intrinsic religiosity and prior training (prior course work or continuing education). Implications and next steps for social work education and continuing training efforts are discussed.