Sample records for takes great care

  1. Taking Care of Your Diabetes Means Taking Care of Your Heart (Tip Sheet)

    MedlinePlus

    ... Diabetes Means Taking Care of Your Heart Taking Care of Your Diabetes Means Taking Care of Your Heart Diabetes and Heart Disease For ... What you can do now Ask your health care team these questions: What can I do to ...

  2. Taking Care of Your Hair

    MedlinePlus

    ... Educators Search English Español Taking Care of Your Hair KidsHealth / For Teens / Taking Care of Your Hair ... role in how healthy it looks. Caring for Hair How you take care of your hair depends ...

  3. Taking Care of Your Teeth

    MedlinePlus

    ... Educators Search English Español Taking Care of Your Teeth KidsHealth / For Kids / Taking Care of Your Teeth ... they help you look your best. Why Healthy Teeth Are Important How does taking care of your ...

  4. Taking Care of Your Teeth

    MedlinePlus

    ... Educators Search English Español Taking Care of Your Teeth KidsHealth / For Teens / Taking Care of Your Teeth ... may need braces or have other issues. More Dental Problems Dental caries (tooth decay) can attack the ...

  5. Take Care of Your Child's Teeth

    MedlinePlus

    ... Topic En español Take Care of Your Child’s Teeth Browse Sections The Basics Overview Tooth Decay Take ... the toothpaste instead of swallowing it Make brushing teeth fun. Getting kids to brush their teeth can ...

  6. Take Care of Your Teeth and Gums

    MedlinePlus

    ... This Topic En español Take Care of Your Teeth and Gums Browse Sections The Basics Overview Take ... Brushing Tips 3 of 5 sections Take Action: Dental Checkups Get regular checkups at the dentist. Visit ...

  7. Nurses speak out for home care: winning the last great civil rights battle.

    PubMed

    Halamandaris, Val J

    2009-06-01

    In closing, it is clear that home care nurses are a very special breed. They are missionaries, committed to the goal of helping vulnerable Americans manage their health care needs and to preserving the freedoms and the independence that everyone cherishes. As is clear from the vignettes above, their first and last thoughts each day are for the well-being of their patients. They are so busy providing sophisticated care for a raft of complex medical problems common to their patients and filling out Medicare forms that they sometimes forget to take care of themselves. There is no doubt that they make a difference in the lives of patients and their families. Historically, nurses have been reluctant to take time away from caring for patients to take part in politics. As is evident from the summaries above and the stories of nurses from all 50 states that follow, nurses have had a change of heart. They have reached the conclusion that they must advocate for the aged, infirm, disabled and dying patients because patients cannot speak out for themselves. More and more nurses are becoming involved. One out of every 44 voters today is a nurse. Nurses show up at the polls; home care nurses have made it their responsibility to help make sure that homebound person vote by absentee ballot. They are also committed to march, to speak out for home care and hospice in what more and more are coming to call The Last Great Civil Rights Battle. They are also pushing for the inclusion of home and community based long-term care as part of national health care reform. They believe that home care is the answer to keeping the 12 percent of Americans who suffer from multiple chronic diseases and generate 75 percent of U.S. health care costs out of the hospital. The historian Arnold Toynbee put all these issues in perspective when he wrote that it is possible to measure the longevity and the accomplishment of any society by a common yardstick. I heard President John F. Kennedy quote Toynbee in

  8. Taking Care of Yourself - Advanced Cancer and Caregivers

    Cancer.gov

    Caring for someone with advanced cancer brings new challenges and concerns. It's important to take care of yourself and reach out for help. Find tips specific to caregivers of patients with advanced cancer.

  9. Taking Care of Type 2 Diabetes

    MedlinePlus

    ... needed. • Take care of your diabetes ABCs: A: A1C (average blood glucose) B: blood pressure C: cholesterol • ... below 180 mg/dL below ______ below ______ Have an A1C test at least twice a year. It tells ...

  10. It Doesn't Take a Rocket Scientist: Great Amateurs of Science

    NASA Astrophysics Data System (ADS)

    Malone, John

    2002-10-01

    Did you know. . . . . . that the woman who discovered the largest and most complete T. rex fossil on record was a high-school dropout who became one of the world's greatest fossil hunters? . . . that the great British scientist Michael Faraday was the son of a blacksmith and had very little formal education? . . . that Gregor Mendel had time to study inherited traits in garden peas because he failed the test to qualify as a high school science teacher? This is just a small sampling of the many surprises you'll find in this enlightening survey of the mavericks, misfits, and unschooled investigators who have been responsible for some of the greatest scientific discoveries in history. It Doesn't Take a Rocket Scientist explains the achievements of each of these accomplished amateurs, describes how they approached their investigations, and discusses the impact of their discoveries. In these amazing and inspiring stories, you'll learn about: Grote Reber and the birth of radio astronomy Arthur C. Clarke's vision of communication satellites Joseph Priestley and the discovery of oxygen Felix d'Herelle's pinpointing of bacteriophages, killers of bacteria Thomas Jefferson and the science of archaeology You'll also discover which fields of science still offer great opportunities for modern amateurs eager to make a name for themselves. After all, it doesn't take a rocket scientist!

  11. TakeCARE, a Video to Promote Bystander Behavior on College Campuses: Replication and Extension.

    PubMed

    Jouriles, Ernest N; Sargent, Kelli S; Salis, Katie Lee; Caiozzo, Christina; Rosenfield, David; Cascardi, Michele; Grych, John H; O'Leary, K Daniel; McDonald, Renee

    2017-08-01

    Previous research has demonstrated that college students who view TakeCARE, a video bystander program designed to encourage students to take action to prevent sexual and relationship violence (i.e., bystander behavior), display more bystander behavior relative to students who view a control video. The current study aimed to replicate and extend these findings by testing two different methods of administering TakeCARE and examining moderators of TakeCARE's effects on bystander behavior. Students at four universities ( n = 557) were randomly assigned to one of three conditions: (a) view TakeCARE in a monitored computer lab, (b) view TakeCARE at their own convenience after receiving an email link to the video, or (c) view a video about study skills (control group). Participants completed measures of bystander behavior at baseline and at a 1-month follow-up. Participants in both TakeCARE conditions reported more bystander behavior at follow-up assessments, compared with participants in the control condition. The beneficial effect of TakeCARE did not differ significantly across administration methods. However, the effects of TakeCARE on bystander behavior were moderated by students' perceptions of campus responsiveness to sexual violence, with more potent effects when students perceived their institution as responsive to reports of sexual violence.

  12. Using quantile regression to examine health care expenditures during the Great Recession.

    PubMed

    Chen, Jie; Vargas-Bustamante, Arturo; Mortensen, Karoline; Thomas, Stephen B

    2014-04-01

    To examine the association between the Great Recession of 2007-2009 and health care expenditures along the health care spending distribution, with a focus on racial/ethnic disparities. Secondary data analyses of the Medical Expenditure Panel Survey (2005-2006 and 2008-2009). Quantile multivariate regressions are employed to measure the different associations between the economic recession of 2007-2009 and health care spending. Race/ethnicity and interaction terms between race/ethnicity and a recession indicator are controlled to examine whether minorities encountered disproportionately lower health spending during the economic recession. The Great Recession was significantly associated with reductions in health care expenditures at the 10th-50th percentiles of the distribution, but not at the 75th-90th percentiles. Racial and ethnic disparities were more substantial at the lower end of the health expenditure distribution; however, on average the reduction in expenditures was similar for all race/ethnic groups. The Great Recession was also positively associated with spending on emergency department visits. This study shows that the relationship between the Great Recession and health care spending varied along the health expenditure distribution. More variability was observed in the lower end of the health spending distribution compared to the higher end. © Health Research and Educational Trust.

  13. Using Quantile Regression to Examine Health Care Expenditures during the Great Recession

    PubMed Central

    Chen, Jie; Vargas-Bustamante, Arturo; Mortensen, Karoline; Thomas, Stephen B

    2014-01-01

    Objective To examine the association between the Great Recession of 2007–2009 and health care expenditures along the health care spending distribution, with a focus on racial/ethnic disparities. Data Sources/Study Setting Secondary data analyses of the Medical Expenditure Panel Survey (2005–2006 and 2008–2009). Study Design Quantile multivariate regressions are employed to measure the different associations between the economic recession of 2007–2009 and health care spending. Race/ethnicity and interaction terms between race/ethnicity and a recession indicator are controlled to examine whether minorities encountered disproportionately lower health spending during the economic recession. Principal Findings The Great Recession was significantly associated with reductions in health care expenditures at the 10th–50th percentiles of the distribution, but not at the 75th–90th percentiles. Racial and ethnic disparities were more substantial at the lower end of the health expenditure distribution; however, on average the reduction in expenditures was similar for all race/ethnic groups. The Great Recession was also positively associated with spending on emergency department visits. Conclusion This study shows that the relationship between the Great Recession and health care spending varied along the health expenditure distribution. More variability was observed in the lower end of the health spending distribution compared to the higher end. PMID:24134797

  14. Taking good care of myself: a qualitative study on self-care behavior among Chinese persons with a permanent colostomy.

    PubMed

    Tao, Hui; Songwathana, Praneed; Isaramalai, Sang-arun; Wang, Qingxi

    2014-12-01

    In Chinese culture, as a possible consequence of Confucianism, caring for the sick is considered a moral obligation of family members, while self-care is only the basis of fulfilling filial piety. This qualitative study aims to explore the self-care behavior among persons with a permanent colostomy in a Chinese cultural context of emphasizing the role of family caregiving. Data from in-depth interviews with seven Chinese adults at a university hospital in southwest China were analyzed using content analysis. Informants' self-care behavior was characterized by "taking good care of myself," which underlined individuals' efforts to manage colostomy-related impacts involving: (i) taking care of my colostomy with a proper degree of independence; (ii) taking care of my life by dealing with limitations; (iii) taking care of my mood in a positive way. Findings revealed that informants' self-care behavior was linked to their Confucian beliefs in family obligations, and also influenced by a happy-go-lucky outlook of life, a likely product of Taoism. The information is useful for nurses to design a culturally appropriate care plan to improve self-care behavior and proper family caregiving. © 2014 Wiley Publishing Asia Pty Ltd.

  15. 36 CFR 1254.36 - What care must I take when handling documents?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false What care must I take when... Room Rules Rules Relating to Using Original Documents § 1254.36 What care must I take when handling... must not use paper clips, rubber bands, self-stick notes or similar devices to identify documents. (e...

  16. Taking care of my baby: mexican-american mothers in the neonatal intensive care unit.

    PubMed

    Cleveland, Lisa M; Horner, Sharon D

    2012-01-01

    The admission of an infant to the neonatal intensive care unit (NICU) can produce significant stress for mothers and may contribute to a difficult transition following discharge. Past research has primarily focused on Caucasian women. Mexican-Americans are the fastest growing ethnic population in the U.S. with the highest fertility rate; therefore, the purpose of this grounded theory study was to gain a better understanding of the NICU experience for Mexican-American mothers. Fifteen women were recruited and data were collected through semi-structured interviews. A theoretical model, taking care of my baby, was developed. The mothers' experiences began with the unexpected event of having an infant admitted to the NICU and played out in a context that fluctuated between being supportive (making meaningful connections) or inhibitive (struggling to mother). The women developed strategies to help them take care of their babies during the NICU stay: balancing responsibilities, leaving part of me with my baby, and watching over. The process concluded in one of two ways: bringing my baby home or losing my baby. These findings offer insight for neonatal nurses who provide care for Mexican-American NICU mothers and may help inform their practice. Further research is needed with this growing population to ensure supportive nursing care and influence positive outcomes.

  17. My Daddy Takes Care of Me! Fathers as Care Providers. Current Population Reports. Household Economic Studies.

    ERIC Educational Resources Information Center

    Casper, Lynne M.

    1997-01-01

    This report examines statistical data on fathers caring for their children during mothers' working hours and which types of fathers are the most likely to take care of their children. Data are taken from the Survey of Income and Program Participation, a longitudinal survey conducted at four-month intervals by the Census Bureau. Care by fathers is…

  18. [Physicians' perception on taking care of Jehovah's witnesses].

    PubMed

    Gouezec, H; Lerenard, I; Jan, S; Bajeux, E; Renaudier, P; Mertes, P M

    2016-11-01

    The goal of this study is to assess the physician's management of patients who refuse blood transfusion. A questionnaire to assess the experience, the acceptance or refusal and the operating methods in case of vital risk has been realized and circulated at a national scale. A total of 793 questionnaires were sent back and analysed according to 3 different categories: anesthesiologists, physicians and surgeons. Seventy-nine percent of total respondents and 90% of anesthesiologists had had to take care of a Jehovah's Witness. In 51% of all cases, it appears to be associated with mainly relational problems with the patient or his family. Nevertheless, 83% accept to take care a Jehovah witness, the most reluctant of them being anesthesiologists. A written confirmation of blood transfusion refusal even at vital risk and a piece of written evidence of belonging to Jehovah's Witnesses are not systematically required. For them, the impossibility to foresee with certainty the need for blood transfusion represents the main barrier to the medical care of a Jehovah's Witness. In case of imminent vital risk and if there are no available alternative procedures, 67% of respondents administer blood products (89% if the patient is unconscious). This situation has nothing exceptional but the medical community does not seem to know all the regulatory requirements. Generally speaking, they do not oppose the medical care of a Jehovah's Witness, but remain committed to their primary focus: to save the patient, as long as it is not an end-of-life situation. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  19. Take Care of Your Teeth | NIH MedlinePlus the Magazine

    MedlinePlus

    ... Feature: Fighting Gum Disease Take Care of Your Teeth Past Issues / Fall 2010 Table of Contents Ever ... never show him smiling? He suffered from poor dental health, lost his teeth at an early age, ...

  20. Taking on Turnover: An Action Guide for Child Care Center Teachers and Directors.

    ERIC Educational Resources Information Center

    Whitebook, Marcy; Bellm, Dan

    Based on the "Taking On Turnover" training series conducted by the Center for the Child Care Workforce, this action guide for center-based child care teachers and directors is designed to assist in managing and reducing the increasingly serious problem of job turnover in the child care profession. Following several introductory sections,…

  1. Does early care affect joint attention in great apes (Pan troglodytes, Pan paniscus, Pongo abelii, Pongo pygmaeus, Gorilla gorilla)?

    PubMed

    Pitman, Caisie A; Shumaker, Robert W

    2009-08-01

    The ability to share attention with another is the foundation on which other theory of mind skills are formed. The quality of care received during infancy has been correlated with increased joint attention in humans. The purpose of this study was to assess the effects of care style (responsive or basic) and caregiver type (ape or human) during the first 6 months on joint attention in 4 great ape species (Pan troglodytes, Gorilla gorilla, Pongo spp., and Pan pansicus). Great apes engaged in joint attention with conspecifics and humans regardless of the style of early care they experienced from either a great ape mother or human caregiver. This finding suggests that joint attention is a robust ability in great apes that is resilient against at least some differences in early care. Future studies using additional measures of early care quality are recommended. Copyright 2009 APA, all rights reserved.

  2. "Fathers and Sons" in Xenophon's Teaching of the Man Taking Care of Himself

    ERIC Educational Resources Information Center

    Pichugina, Victoria; Bezrogov, Vitaly

    2017-01-01

    This article considers the oeuvre of Xenophon (c.430-354 bc) as providing an insight into the concept of "care of the self" in Greek education. In many of his works the leading characters are men who take care of themselves through education. Addressing the theme of "fathers and sons," Xenophon aimed to show that "care of…

  3. A High School-Based Evaluation of TakeCARE, a Video Bystander Program to Prevent Adolescent Relationship Violence.

    PubMed

    Sargent, Kelli S; Jouriles, Ernest N; Rosenfield, David; McDonald, Renee

    2017-03-01

    Although bystander programs to prevent relationship and sexual violence have been evaluated with college students, few evaluations have been conducted with high school students. This study evaluated the effectiveness of TakeCARE, a brief video bystander program designed to promote helpful bystander behavior in situations involving relationship violence among high school students. Students (N = 1295; 52.5% female; 72.3% Hispanic) reported their bystander behavior at a baseline assessment. Classrooms (N = 66) were randomized to view TakeCARE or to a control condition, and high school counselors administered the video in the classrooms assigned to view TakeCARE. Students again reported their bystander behavior at a follow-up assessment approximately 3 months afterward. Results indicate that students who viewed TakeCARE reported more helpful bystander behavior at the follow-up assessment than students in the control condition. Results of exploratory analyses of the likelihood of encountering and intervening upon specific situations calling for bystander behavior are also reported. TakeCARE is efficacious when implemented in an urban high school by high school counselors.

  4. Street Smarts: Activities That Help Teenagers Take Care of Themselves.

    ERIC Educational Resources Information Center

    Kirby, Michael

    Because growing up has become the art of survival for many young people, a professionally conducted course in street smarts can help them identify problems, understand consequences, and make good decisions. The information and activities contained in this text can teach students how to take care of themselves when confronted with challenges. It…

  5. [Taking Care of Asylum Seekers: Occupational Health Aspects with a Special Focus on Vaccination].

    PubMed

    Kolb, S; Hörmansdorfer, S; Ackermann, N; Höller, C; Brenner, B; Herr, C

    2016-04-01

    Employees and volunteers often feel insecure about the potential transmission of infectious diseases when taking care of asylum seekers. It could be shown that overall only a minor risk of infection emanates from asylum seekers. However, aspects of occupational health and vaccination should be kept in mind.Besides the standard vaccination the Standing Committee on Vaccination (STIKO) recommends for occupational indication, which is given for employees and volunteers in asylum facilities, vaccination against hepatitis A, hepatitis B, polio (if the last vaccination was more than 10 years before) as well as influenza (seasonal).According to the German Occupational Safety and Health Act taking care of the employer has to determine which exposures might occur at the workplace (risk assessment) and define necessary protection measures. Depending on task and exposure when taking care of asylum seekers different acts (e. g. biological agents regulation) and technical guidelines for the handling biological agents (e. g. TRBA 250 or TRBA 500) have to be applied.The Bavarian Health and Food Safety Authority (LGL) has published several information sheets regarding "asylum seekers and health management" for employees and volunteers from the non-medical as well as the medical area (www.lgl.bayern.de search term "Asylbewerber"). With theses publications insecurities in taking care of asylum seekers should be prevented. Furthermore the employer gets support in the implementation of legal obligations to ensure occupational safety for the employees. © Georg Thieme Verlag KG Stuttgart · New York.

  6. Turn-taking in cooperative offspring care: by-product of individual provisioning behavior or active response rule?

    PubMed

    Savage, James L; Browning, Lucy E; Manica, Andrea; Russell, Andrew F; Johnstone, Rufus A

    2017-01-01

    For individuals collaborating to rear offspring, effective organization of resource delivery is difficult because each carer benefits when the others provide a greater share of the total investment required. When investment is provided in discrete events, one possible solution is to adopt a turn-taking strategy whereby each individual reduces its contribution rate after investing, only increasing its rate again once another carer contributes. To test whether turn-taking occurs in a natural cooperative care system, here we use a continuous time Markov model to deduce the provisioning behavior of the chestnut-crowned babbler ( Pomatostomus ruficeps ), a cooperatively breeding Australian bird with variable number of carers. Our analysis suggests that turn-taking occurs across a range of group sizes (2-6), with individual birds being more likely to visit following other individuals than to make repeat visits. We show using a randomization test that some of this apparent turn-taking arises as a by-product of the distribution of individual inter-visit intervals ("passive" turn-taking) but that individuals also respond actively to the investment of others over and above this effect ("active" turn-taking). We conclude that turn-taking in babblers is a consequence of both their individual provisioning behavior and deliberate response rules, with the former effect arising through a minimum interval required to forage and travel to and from the nest. Our results reinforce the importance of considering fine-scale investment dynamics when studying parental care and suggest that behavioral rules such as turn-taking may be more common than previously thought. Caring for offspring is a crucial stage in the life histories of many animals and often involves conflict as each carer typically benefits when others contribute a greater share of the work required. One way to resolve this conflict is to monitor when other carers contribute and adopt a simple "turn-taking" rule to ensure

  7. Ruth's resolve: what Jesus' great-grandmother may teach about bioethics and care.

    PubMed

    Hall, Amy Laura

    2005-04-01

    When thinking about the intersection of care and Christian bioethics, it is helpful to follow closely the account of Ruth, who turned away from security and walked alongside her grieving mother-in-law to Bethlehem. Remembering Ruth may help one to heed Professor Kaveny's summoning of Christians to remember "the Order of Widows" and the church's historic calling to bring "the almanah into its center rather than pushing her to its margins." Disabled, elderly and terminally ill people often seem, at least implicitly, expendable. By hearing the scriptural account of Jesus' steadfast great-grandmother, readers may recall another way. One may read Ruth's care for Naomi as a performative, prophetic act of faith. Ruth's faithful resolve, when set next to Orpah's prudent way, challenges the notion that a bioethic of care is innately feminine, and may further call women and men corporately to participate in a kind of care that is strenuous work.

  8. Complementarity of no-take marine reserves and individual transferable catch quotas for managing the line fishery of the great barrier reef.

    PubMed

    Little, L R; Grafton, R Q; Kompas, T; Smith, A D M; Punt, A E; Mapstone, B D

    2011-04-01

    Changes in the management of the fin fish fishery of the Great Barrier Reef motivated us to investigate the combined effects on economic returns and fish biomass of no-take areas and regulated total allowable catch allocated in the form of individual transferable quotas (such quotas apportion the total allowable catch as fishing rights and permits the buying and selling of these rights among fishers). We built a spatially explicit biological and economic model of the fishery to analyze the trade-offs between maintaining given levels of fish biomass and the net financial returns from fishing under different management regimes. Results of the scenarios we modeled suggested that a decrease in total allowable catch at high levels of harvest either increased net returns or lowered them only slightly, but increased biomass by up to 10% for a wide range of reserve sizes and an increase in the reserve area from none to 16% did not greatly change net returns at any catch level. Thus, catch shares and no-take reserves can be complementary and when these methods are used jointly they promote lower total allowable catches when harvest is relatively high and encourage larger no-take areas when they are small. ©2010 Society for Conservation Biology.

  9. Taking health care back: the physician's role in quality improvement.

    PubMed

    Becher, Elise C; Chassin, Mark R

    2002-10-01

    Physicians now enjoy a moment of tactical advantage in the evolution of the struggle for control over health care in the United States. The most effective way to capitalize on this-perhaps fleeting-position and to more permanently alter the balance of power in their favor is for physicians to establish strong and visionary leadership in health care quality improvement. Such an undertaking, if successful, could place the very essence of health care-defining, measuring, and improving its quality-in the hands of physicians. To succeed requires understanding the relationships between the different kinds of quality problems that plague our health care system, the various kinds of errors that lead to them, and how amenable these different kinds of errors may be to different interventions. The authors delineate a conceptual framework that describes these relationships, as well as their implications for conducting effective and durable quality improvement. The authors then illustrate how physicians could engage in this activity in three different settings: a four-or-five-physician primary care practice, a 50-physician multispecialty group, and a 450-bed community hospital. Finally, the authors submit that now is an opportune time for physicians and the organizations they direct or guide to take the leadership role in conducting health care quality improvement. Realizing the opportunity will require dedicating significant resources and changing traditional approaches to quality, but in so doing, physicians can regain much of the autonomy over the practice of medicine previously lost to government and managed care.

  10. Comparison of foot pain and foot care among rheumatoid arthritis patients taking and not taking anti-TNFα therapy: an epidemiological study.

    PubMed

    Otter, S J; Lucas, K; Springett, K; Moore, A; Davies, K; Young, A; Walker-Bone, K

    2011-11-01

    Epidemiological studies report foot pain affects more than 90% of people with rheumatoid arthritis (RA). Most data about foot involvement in RA were collected prior to the availability of novel treatments such as biologics. The objective of this study is to compare the prevalence of foot symptoms, frequency of foot examination, and access to foot care services among RA patients currently treated with anti-TNFα to those not receiving biologics. This study is a cross-sectional epidemiological study: a 28-item self-administered questionnaire was posted to 1,040 people with RA throughout the UK. Overall, 585 (55%) useable replies were received, and 120 (20.5%) respondents were currently taking anti-TNFα medication. Prevalence of current foot pain was 99% among the biologics group compared with 76% not treated with biologics. Stiffness, swelling, and numbness in the feet were all significantly more common in the anti-TNFα group (P < 0.05). Most respondents (90%) taking biologics discussed their foot pain with their rheumatologist, but only 70% were receiving podiatry (compared to 78% not taking anti-TNFα). Subjects reported that their feet were examined significantly less frequently (P < 0.001) than their hands. Foot complaints are common in this group, and allied health professions could enhance rheumatological care by undertaking foot assessment.

  11. [The health care system requires individuals to take more personal responsibility].

    PubMed

    Schaefer, Corinna; Weißbach, Lothar

    2012-01-01

    In the health care context, the phrase "personal responsibility" is frequently used as a euphemism for restricting publicly funded health care services. The concept of responsibility, however, primarily comprises the individual's own autonomous choices in consideration of their possible implications. In order to be able to act responsibly in respect to health care issues, the individual must rely on objective information about the possible consequences of his or her decision. The current profit-oriented competitive medical care environment prevents the distribution of objective information. A mutually supportive community benefits from its members acting responsibly, since citizens are capable of supporting themselves before they avail themselves of community support. This requires the State to respect the individual and his or her autonomous decision-making. If the community established rules as to what is considered a healthy lifestyle or even required people to adopt one, it would, to a large part, take away the citizens' autonomy and thus prevent them to assume responsibility. Copyright © 2012. Published by Elsevier GmbH.

  12. TakeCARE, a Video Bystander Program to Help Prevent Sexual Violence on College Campuses: Results of Two Randomized, Controlled Trials

    PubMed Central

    Jouriles, Ernest N.; McDonald, Renee; Rosenfield, David; Levy, Nicole; Sargent, Kelli; Caiozzo, Christina; Grych, John H.

    2015-01-01

    Objective The present research reports on two randomized controlled trials evaluating TakeCARE, a video bystander program designed to help prevent sexual violence on college campuses. Method In Study 1, students were recruited from psychology courses at two universities. In Study 2, first-year students were recruited from a required course at one university. In both studies, students were randomly assigned to view one of two videos: TakeCARE or a control video on study skills. Just before viewing the videos, students completed measures of bystander behavior toward friends and ratings of self-efficacy for performing such behaviors. The efficacy measure was administered again after the video, and both the bystander behavior measure and the efficacy measure were administered at either one (Study 1) or two (Study 2) months later. Results In both studies, students who viewed TakeCARE, compared to students who viewed the control video, reported engaging in more bystander behavior toward friends and greater feelings of efficacy for performing such behavior. In Study 1, feelings of efficacy mediated effects of TakeCARE on bystander behavior; this result did not emerge in Study 2. Conclusions This research demonstrates that TakeCARE, a video bystander program, can positively influence bystander behavior toward friends. Given its potential to be easily distributed to an entire campus community, TakeCARE might be an effective addition to campus efforts to prevent sexual violence. PMID:27867694

  13. [The health care of children in Leningrad during the Great Patriotic War].

    PubMed

    2011-01-01

    The article deals with the task solutions on life and health preservation of children during the Great patriotic war and Leningrad blockade. The examples are presented illustrating the measures undertaken by the state and public health service concerning the evacuation, nutrition of children in conditions of strict deficiency of all food products, organization of medical care (including the development and implementation of new system of polyclinic care), the activities on health improvement of children, etc. The long-term qualitative and quantitative starvation of children adversely impacted the physical development, contributed to increased morbidity and mortality. The characteristic of children morbidity is given? Infectious morbidity included. The role of researchers from Leningrad pediatric medical institute in preservation of children's life is demonstrated.

  14. "Take the Volume Pledge" may result in disparity in access to care.

    PubMed

    Blanco, Barbara A; Kothari, Anai N; Blackwell, Robert H; Brownlee, Sarah A; Yau, Ryan M; Attisha, John P; Ezure, Yoshiki; Pappas, Sam; Kuo, Paul C; Abood, Gerard J

    2017-03-01

    "Take the Volume Pledge" proposes restricting pancreatectomies to hospitals that perform ≥20 per year. Our purpose was to identify those factors that characterize patients at risk for loss of access to pancreatic cancer care with enforcement of volume standards. Using the Healthcare Cost and Utilization Project State Inpatient Database from Florida, we identified patients who underwent pancreatectomy for pancreatic malignancy from 2007-2011. American Hospital Association and United States Census Bureau data were linked to patient-level data. High-volume hospitals were defined as performing ≥20 pancreatic resections per year. Univariable and multivariable statistics compared patient characteristics and utilization of high-volume hospitals. Classification and Regression Tree modeling was used to predict patients at risk for losing access to care. Our study included 1,663 patients. Five high-volume hospitals were identified, and they treated 1,056 (63.5%) patients. Patients residing far from high-volume hospitals, in areas with the highest population density, non-Caucasian ethnicity, and greater income had decreased odds of obtaining care at high-volume hospitals. Using these factors, we developed a Classification and Regression Tree-based predictive tool to identify these patients. Implementation of "Take the Volume Pledge" is an important step toward improving pancreatectomy outcomes; however, policymakers must consider the potential impact on limiting access and possible health disparities that may arise. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. "Doing the heavy lifting: health care workers take back their backs".

    PubMed

    Morse, Tim; Fekieta, Renee; Rubenstein, Harriet; Warren, Nick; Alexander, Darryl; Wawzyniecki, Patricia

    2008-01-01

    Health care workers have the highest musculoskeletal disorder prevalence and incidence of any occupational/industry group, and patient handling tasks are so biomechanically demanding that they cannot be made safe through the commonly used, technique-oriented methods such as "back school" training programs. Although there is standard-setting activity for "no-lift" programs in some states, there is still no federal standard. Health care worker unions and nurses' associations have begun to take action through training members in equipment need, use, and acceptance in programs to encourage adoption of no-lifting programs. Acceptance of lifting equipment is increasing due to recognition of the high human and economic costs of MSD, consistent documentation of cost savings from no-lift programs, major improvements in lifting equipment, and shortages of health care staff. An action-oriented training program for health care workers is described that provides knowledge about the 1) Scope of the current problem of back injuries in health care, 2) Costs of injuries, both to workers and to the hospital, 3) Elements of a safe patient-handling program, and 4) Success stories. The program also builds skills through: 1) Hands-on experience with safe lifting equipment, and 2) Assessing organizational and union readiness and planning for action at the workplace.

  16. Diabetes - taking care of your feet

    MedlinePlus

    Diabetes - foot care - self-care; Diabetic foot ulcer - foot care; Diabetic neuropathy - foot care ... else to check your feet. Call your health care provider right way about any foot problems you ...

  17. Maternal note-taking and infant care: a pilot randomised controlled trial.

    PubMed

    Kistin, Caroline J; Barrero-Castillero, Alejandra; Lewis, Sheilajane; Hoch, Rachel; Philipp, Barbara L; Bauchner, Howard; Wang, C Jason

    2012-10-01

    A pilot randomised controlled trial was conducted with postpartum mothers to assess the feasibility and impact of note-taking during newborn teaching. Controls received standard teaching; the intervention group received pen and paper to take notes. Subjects were called 2 days post-discharge to assess infant sleep position, breastfeeding, car seat use, satisfaction and information recall. 126 mothers were randomised. There was a consistent trend that intervention subjects were more likely to report infant supine sleep position (88% vs 78%, relative risks (RR) 1.13; 95% CI 0.95 to 1.34), breastfeeding (96% vs 86%, RR 1.11; 95% CI 0.99 to 1.25) and correct car seat use (98% vs 87%, RR 1.12; 95% CI 1.00 to 1.25). Satisfaction and information recall did not differ. Among first-time mothers, intervention subjects were significantly more likely to report infant supine sleep position (95% vs 65%, RR 1.46; 95% CI 1.06 to 2.00). Maternal note-taking is feasible and potentially efficacious in promoting desirable infant care.

  18. Taking personal responsibility: Nurses' and assistant nurses' experiences of good nursing practice in psychiatric inpatient care.

    PubMed

    Gabrielsson, Sebastian; Sävenstedt, Stefan; Olsson, Malin

    2016-10-01

    Therapeutic nurse-patient relationships are considered essential for good nursing practice in psychiatric inpatient care. Previous research suggests that inpatient care fails to fulfil patients' expectations in this regard, and that nurses might experience the reality of inpatient care as an obstruction. The aim of the present study was to explore nurses' and assistant nurses' experiences of good nursing practice in the specific context of psychiatric inpatient care. Qualitative interviews were conducted with 12 skilled, relationship-oriented nurses and assistant nurses in order to explore their experiences with nursing practice related to psychiatric inpatient care. Interviews were transcribed and analysed using an interpretive descriptive approach. Findings describe good nursing practice as a matter of nurses and assistant nurses taking personal responsibility for their actions and for the individual patient as a person. Difficulties in providing dignified nursing care and taking personal responsibility cause them to experience feelings of distress and frustration. Shared values and nursing leadership supports being moral and treating patients with respect, having enough time supports being present and connecting with patients, and working as a part of a competent team with critical daily discussions and diversity supports being confident and building trust. The findings suggest that taking personal responsibility is integral to good nursing practice. If unable to improve poor circumstances, nurses might be forced to promote their own survival by refuting or redefining their responsibility. Nurses need to prioritize being with patients and gain support in shaping their own nursing practice. Nursing leadership should provide moral direction and defend humanistic values. © 2016 Australian College of Mental Health Nurses Inc.

  19. 5 CFR 792.207 - When does the child care subsidy program law become effective and how may agencies take advantage...

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false When does the child care subsidy program law become effective and how may agencies take advantage of this law? 792.207 Section 792.207... When does the child care subsidy program law become effective and how may agencies take advantage of...

  20. Great Lakes Shipping. Earth Systems - Education Activities for Great Lakes Schools (ES-EAGLS).

    ERIC Educational Resources Information Center

    Fortner, Rosanne W., Ed.

    This activity book is part of a series designed to take a concept or idea from the existing school curriculum and develop it in the context of the Great Lakes using teaching approaches and materials appropriate for students in middle and high school. The theme of this book is Great Lakes shipping. Students learn about the connections between the…

  1. Opening Our Doors: Taking Public Library Service to Preschool and Day-Care Facilities.

    ERIC Educational Resources Information Center

    Harris, Sally

    The Opening Our Doors Project of the Pioneer Library System of Norman, Oklahoma takes public library service to preschool and day care facilities by means of learning kits housed in tote bags. The sturdy, zippered tote bags are full of books, games, toys, learning folders, and so forth. There is a tote bag for each of 75 different topics. Topics…

  2. Humour in health‐care interactions: a risk worth taking

    PubMed Central

    McCreaddie, May; Payne, Sheila

    2012-01-01

    Abstract Background  Humour is a complex, dynamic phenomenon that mainly occurs in social situations between two or more people. Most humour research reviews rehearsed as opposed to spontaneous humour and rarely review the patients’ perspective. Aim  We explore patients’ perspectives on the use of humour in health care. We discuss the asymmetrical and divergent humour use between patients and clinical nurse specialists and posit nurses’ approaches to risk as a contributing factor. Design  A constructivist grounded theory collated researcher‐provoked (interviews, observation, field notes, pre‐and post‐interaction audio diaries) and non‐researcher‐provoked data (naturally occurring interactions) over 18 months. This paper is based upon four patient focus groups. A constant comparison approach to data collection and analyses was applied using interpretative and illustrative frameworks that balanced what was ‘known’ and ‘unknown’ about humour. Setting and participants  Patients were recruited from four patient–peer groups. Three audio‐taped (n = 20) and one observed focus group interactions (n = 12) were undertaken at the groups’ regular meeting places. Results  Patients hold a broad appreciation of humour and recognize it as being evident in subtle and nuanced forms. Patients wish health‐care staff to initiate and reciprocate humour. Conclusion  A chasm exists between what patients apparently want with regard to humour use in health‐care interactions and what actually transpires. Initiating humour involves risk, and risk‐taking requires a degree of self‐esteem and confidence. Nurses are, arguably, risk‐averse and have low self‐esteem. Future research could review confidence and self‐esteem markers with observed humour use in nurses and their interactions across a range of specialities. PMID:22212380

  3. What great managers do.

    PubMed

    Buckingham, Marcus

    2005-03-01

    Much has been written about the qualities that make a great manager, but most of the literature overlooks a fundamental question: What does a great manager actually do? While there are countless management styles, one thing underpins the behavior of all great managers. Above all, an exceptional manager comes to know and value the particular quirks and abilities of her employees. She figures out how to capitalize on her staffers' strengths and tweaks her environment to meet her larger goals. Such a specialized approach may seem like a lot of work. But in fact, capitalizing on each person's uniqueness can save time. Rather than encourage employees to conform to strict job descriptions that may include tasks they don't enjoy and aren't good at, a manager who develops positions for his staff members based on their unique abilities will be rewarded with behaviors that are far more efficient and effective than they would be otherwise. This focus on individuals also makes employees more accountable. Because staffers are evaluated on their particular strengths and weaknesses, they are challenged to take responsibility for their abilities and to hone them. Capitalizing on a person's uniqueness also builds a stronger sense of team. By taking the time to understand what makes each employee tick, a great manager shows that he sees his people for who they are. This personal investment not only motivates individuals but also galvanizes the entire team. Finally, this approach shakes up existing hierarchies, which leads to more creative thinking. To take great managing from theory to practice, the author says, you must know three things about a person: her strengths, the triggers that activate those strengths, and how she learns. By asking the right questions, squeezing the right triggers, and becoming aware of your employees' learning styles, you will discover what motivates each person to excel.

  4. The parents' ability to take care of their baby as a factor in decisions to withhold or withdraw life-prolonging treatment in two Dutch NICUs.

    PubMed

    Moratti, Sofia

    2010-06-01

    In The Netherlands, it is openly acknowledged that the parents' ability to take care of their child plays a role in the decision-making process over administration of life-prolonging treatment to severely defective newborn babies. Unlike other aspects of such decision-making process up until the present time, the 'ability to take care' has not received specific attention in regulation or in empirical research. The present study is based on interviews with neonatologists in two Dutch NICUs concerning their definition of the ability to take care and its relevance in non-treatment decisions. All of the respondents think that the ability to take care consists of more than one factor. Most doctors mention the parents' emotional state, social network and cognitive abilities. Some doctors mention the presence of psychological conditions in the parents, their financial situation and physical condition. A few refer to the parents' experience and age, their chances to have another baby and their cultural background. Most doctors think the ability to take care has a secondary relevance in the decision-making process, while the primary concern is assessing the condition of the child. A substantial minority thinks the ability to take care does not play any role, while one doctor thinks it is a factor of primary importance. The study constitutes an important stepping-stone for future research in The Netherlands and elsewhere.

  5. Preventive health care and owner-reported disease prevalence of horses and ponies in Great Britain.

    PubMed

    Ireland, J L; Wylie, C E; Collins, S N; Verheyen, K L P; Newton, J R

    2013-10-01

    This study aimed to describe the provision of preventive health care and owner-reported disease prevalence in horses and ponies within Great Britain (GB), and to assess geographical variations in health care provision. A cross-sectional survey was conducted, using a postal questionnaire administered to a random sample of veterinary-registered owners of horses and ponies in GB (n=797). The majority of animals received regular preventive health care: 95.6% had regular hoof care; 71.3% were vaccinated for both influenza and tetanus and median time since last anthelmintic administration was 8.7 weeks. Thirty-one percent of owners indicated their animal was overweight/obese. A new health problem within the previous 7 days was reported for 7.4% of animals, 59.3% of which were veterinary-diagnosed. Thirty-two percent of animals were reported to have a long-term/recurrent condition, of which osteoarthritis (13.9%) was the most prevalent. Obesity, musculoskeletal disorders, and dermatological conditions were the most prevalent conditions affecting veterinary-registered horses/ponies. Copyright © 2013 Elsevier Ltd. All rights reserved.

  6. The dentist's care-taking perspective of dental fear patients - a continuous and changing challenge.

    PubMed

    Gyllensvärd, K; Qvarnström, M; Wolf, E

    2016-08-01

    The aim was to analyse the care taking of dental fear patients from the perspective of the dentist, using a qualitative methodology. In total, 11 dentists from both the private and public dental service were selected through a purposive sampling according to their experience of treating dental fear patients, their gender, age, service affiliation and location of undergraduate education. Data were obtained using one semi-structured interview with each informant. The interviews were taped and verbatim transcribed. The text was analysed using qualitative content analysis. The theme, 'The transforming autodidactic process of care taking', covering the interpretative level of data content was identified. The first main category covering the descriptive level of data was 'The continuous and changing challenge', with the subcategories 'The emotional demand' and 'The financial stress'. The second main category identified was 'The repeated collection of experience', with the subcategories 'The development of resources' and 'The emotional change'. The dentists' experience of treating dental fear patients was considered a challenging self-taught process under continuous transformation. The competence and routine platform expanded over time, parallel to a change of connected emotions from frustration towards safety, although challenges remained. © 2016 John Wiley & Sons Ltd.

  7. Life in the Great Lakes. Earth Systems - Education Activities for Great Lakes Schools (ES-EAGLS).

    ERIC Educational Resources Information Center

    Sheaffer, Amy L., Ed.

    This activity book is part of a series designed to take a concept or idea from the existing school curriculum and develop it in the context of the Great Lakes using teaching approaches and materials appropriate for students in middle and high school. The theme of this book is life in the Great Lakes. Students learn about shorebird adaptations,…

  8. Risk-Taking Attitudes of Patients who Seek Health Care: An Exploratory Approach through Lottery Games.

    PubMed

    Martín-Fernández, Jesús; Ariza-Cardiel, Gloria; Polentinos-Castro, Elena; Gil-Lacruz, Ana Isabel; Gómez-Gascón, Tomás; Domínguez-Bidagor, Julia; Del-Cura-González, Isabel

    2016-03-23

    The characterization of the risk-taking attitude of individuals may be useful for planning health care interventions. It has been attempted to study expressions of risk-taking attitude and evaluate characteristics of a standard lottery game in a population that seeks health care to elicit these attitudes. Multicentric cross-sectional study. Demographic and socioeconomic characteristics, quality of life (EuroQol-5D), and health risk behaviors were collected from 662 users of 23 health centers selected by random sampling. Risk-taking attitude was evaluated by means of a self-evaluation scale and two lottery games, (L1 and L2; L2 included the possibility of economic losses). Generalized estimating equations (GEE) explicative models were used to evaluate the variability of risk-taking attitude. Nineteen percent out of interviewed people (CI95%: 15.6-22.6%) expressed a high risk appetite, but only 10.0% (CI95% 7.0 to 13.0) were classified as risk-seeking by L2. It was found association between increased risk appetite and having a better perception of health status (0.110, CI95%: 0,007-0,212) or a higher income (0.010, CI95%: 0.017- 0.123) or smoking status (0.059, CI95%: 0.004- 0.114). Being Spanish was associated with lower risk appetite (-0.105, CI95%: -0.005 --0.205), as being over 65 (-0.031, CI95%:- 0.061- -0.001) or a woman (-0.038, CI95%:-0.064- -0.012). The intraclass correlation coefficient for self-evaluation scale was 0.511 (95% CI: 0.372 to 0.629), 0.571 (95% CI: 0.441 to 0.678) for L1 and 0.349 (95% CI: 0.186-0.493) to L2. People who seek health care express certain inclination to risk, but this feature is attenuated when methodologies involving losses are used. Risk appetite seems greater in young people, males, people with better health, or more income, and in immigrants. Lottery games such as the proposed ones are a simple and useful tool to estimate individuals' inclination to risk.

  9. The Great Debate: Should All 8th Graders Take Algebra?

    ERIC Educational Resources Information Center

    McKibben, Sarah

    2009-01-01

    While 8th grade algebra was once reserved as a course for the gifted, today, more U.S. 8th graders take algebra than any other math course. This article discusses a report from the Brookings Institution which chronicles the history of the 8th-grade algebra surge and its impact on today's low-performing students. The report indicates that many of…

  10. The Take-Up of Employer-Sponsored Insurance Among Americans with Mental Disorders: Implications for Health Care Reform.

    PubMed

    Zuvekas, Samuel H

    2015-07-01

    Little is known about how take-up of private health insurance coverage differs between those with and without mental disorders. This study seeks to fill this gap by using data from the 2004-2008 Medical Expenditure Panel Survey to examine differences in offers and take-up of employer-sponsored insurance (ESI) among adults aged 27-54. Little evidence that mental disorders are associated with take-up of offers of ESI coverage was found. This suggests that take-up rates in the Affordable Care Act (ACA) marketplaces by those with and without mental disorders may be similar. The ACA is especially important to Americans with mental disorders, many of whom lack access to ESI coverage to pay for mental health treatment either through their own job or through a spouse's job.

  11. Emergency care provision at the 2009 Special Olympics Great Britain.

    PubMed

    Williamson, Timothy; Wheeler, Patrick; Stephens, Catherine; Ferguson, Mike

    2013-05-01

    The Special Olympics Great Britain (SOLGB) summer games 2009 were held in Leicester between 25 and 31 July. They involved 2413 athletes that were engaged in 21 different sports across 19 different locations. The onsite healthcare was provided by a specialist medical team. The hospital services available were at the local emergency department (ED) and the co-located urgent care centre (UCC). To assess the on-site provision required to support a large multisport event for people with learning disabilities and to ascertain the impact on the local hospital services. On-site consultations were documented on SOLGB medical record forms. Referrals to the local ED and UCC were identified from the SOLGB medical notes or from the ED/UCC attendance codes, as a specific code was applied to all patients related to the games. 581 on-site consultations were documented at SOLGB 2009, of which 95% of these were for athletes. 477 treatments were completed in total, of which 444 were undertaken on-site (93%). 20 people attended the ED; there were no documented attendances at the UCC. 17 of the 20 attendances at the ED were athletes competing. Allocation of the healthcare team was appropriate, with the exception of one sport, where a doctor was moved from a nearby event to consult on 13 occasions. Attendances to the local ED and UCC were minimal. Therefore, the model of on-site medical care that was used, which led to minimal impact on NHS resources, will support the arrangements of medical requirements at future SOLGB games.

  12. Health care in Brazil.

    PubMed Central

    Haines, A

    1993-01-01

    Brazil has great geopolitical importance because of its size, environmental resources, and potential economic power. The organisation of its health care system reflects the schisms within Brazilian society. High technology private care is available to the rich and inadequate public care to the poor. Limited financial resources have been overconcentrated on health care in the hospital sector and health professionals are generally inappropriately trained to meet the needs of the community. However, recent changes in the organisation of health care are taking power away from federal government to state and local authorities. This should help the process of reform, but many vested interests remain to be overcome. A link programme between Britain and Brazil focusing on primary care has resulted in exchange of ideas and staff between the two countries. If primary care in Brazil can be improved it could help to narrow the health divide between rich and poor. Images p503-a p504-a p505-a PMID:8448465

  13. Great Lakes Climate and Water Movement. Earth Systems - Education Activities for Great Lakes Schools (ES-EAGLS).

    ERIC Educational Resources Information Center

    Miller, Heidi, Ed.; Sheaffer, Amy L., Ed.

    This activity book is part of a series designed to take a concept or idea from the existing school curriculum and develop it in the context of the Great Lakes using teaching approaches and materials appropriate for students in middle and high school. The theme of this book is Great Lakes climate and water movement. Students learn about land-sea…

  14. Health care consumerism movement takes a step forward.

    PubMed

    Thompson, Michael; Cutler, Charles M

    2010-01-01

    One of the contributing factors to both the increase in health care costs and the backlash to managed care was the lack of consumer awareness of the cost of health care service, the effect of health care costs on profits and wages, and the need to engage consumers more actively as consumers in health care decisions. This article reviews the birth of the health care consumerism movement and identifies gaps in health care consumerism today. The authors reveal some of the keys to building a sustainable health care consumerism framework, which involves enlisting consumers as well as other stakeholders.

  15. Taking Care of Your Skin

    MedlinePlus

    ... care you need. Solving Skin Problems Bug bites , bee stings, and poison ivy are all common skin ... Notice of Nondiscrimination Visit the Nemours Web site. Note: All information on KidsHealth® is for educational purposes ...

  16. Income inequality and foregone medical care in Europe during The Great Recession: multilevel analyses of EU-SILC surveys 2008-2013.

    PubMed

    Elstad, Jon Ivar

    2016-07-07

    The association between income inequality and societal performance has been intensely debated in recent decades. This paper reports how unmet need for medical care has changed in Europe during The Great Recession, and investigates whether countries with smaller income differences have been more successful than inegalitarian countries in protecting access to medical care during an economic crisis. Six waves of EU-SILC surveys (2008-2013) from 30 European countries were analyzed. Foregone medical care, defined as self-reported unmet need for medical care due to costs, waiting lists, or travel difficulties, was examined among respondents aged 30-59 years (N = 1.24 million). Countries' macro-economic situation was measured by Real Gross Domestic Product (GDP) per capita. The S80/S20 ratio indicated the country's level of income inequality. Equity issues were highlighted by separate analyses of disadvantaged respondents with limited economic resources and relatively poor health. Cross-tabulations and multilevel linear probability regression models were utilized. Foregone medical care increased 2008-2013 in the majority of the 30 countries, especially among the disadvantaged parts of the population. For the disadvantaged, unmet need for medical care tended to be higher in countries with larger income inequalities, regardless of the average economic standard in terms of GDP per capita. Both for disadvantaged and for other parts of the samples, a decline in GDP had more severe effects on access in inegalitarian countries than in countries with less income inequality. During The Great Recession, unmet need for medical care increased in Europe, and social inequalities in foregone medical care widened. Overall, countries with a more egalitarian income distribution have been more able to protect their populations, and especially disadvantaged groups, against deteriorated access to medical care when the country is confronted with an economic crisis.

  17. Taking Care of You: Body, Mind, Spirit--A Unique Stress Management Program That Improves Lifestyle Behaviors

    ERIC Educational Resources Information Center

    Vetter-Smith, Molly; Massey, Vera; Rellergert, Linda; Wissmann, Mary

    2014-01-01

    Taking Care of You: Body, Mind, Spirit is a multi-session group program developed by University of Missouri Extension that provides a unique and practical approach to helping adults better managing their stress and bounce back from life's challenges while improving lifestyle behaviors. The program combines mindfulness and a variety of other…

  18. Expert Discussion on Taking a Spiritual History.

    PubMed

    Paal, Piret; Frick, Eckhard; Roser, Traugott; Jobin, Guy

    2017-01-01

    This article elaborates on the hazards of spiritual history taking. It provides expert insights to consider before entering the field. In summer 2012, a group of spiritual care experts were invited to discuss the complexity of taking spiritual histories in a manner of hermeneutic circle. Thematic analysis was applied to define the emerging themes. The results demonstrate that taking a spiritual history is a complex and challenging task, requiring a number of personal qualities of the interviewer, such as 'being present', 'not only hearing, but listening', 'understanding the message beyond the words uttered', and 'picking up the words to respond'. To 'establish a link of sharing', the interviewer is expected 'to go beyond the ethical stance of neutrality'. The latter may cause several dilemmas, such as 'fear of causing more problems', 'not daring to take it further', and above all, 'being ambivalent about one's role'. Interviewer has to be careful in terms of the 'patient's vulnerability'. To avoid causing harm, it is essential to propose 'a follow-up contract' that allows responding to 'patient's yearning for genuine care'. These findings combined with available literature suggest that the quality of spiritual history taking will remain poor unless the health-care professionals revise the meaning of spirituality and the art of caring on individual level.

  19. Land & Water Interactions in the Great Lakes. Earth Systems - Education Activities for Great Lakes Schools (ES-EAGLS).

    ERIC Educational Resources Information Center

    Sheaffer, Amy L., Ed.

    This activity book is part of a series designed to take a concept or idea from the existing school curriculum and develop it in the context of the Great Lakes using teaching approaches and materials appropriate for students in middle and high school. The subject of this book is land and water interactions. Students examine how the Great Lakes were…

  20. 'Taking care' in the age of AIDS: older rural South Africans' strategies for surviving the HIV epidemic.

    PubMed

    Angotti, Nicole; Mojola, Sanyu A; Schatz, Enid; Williams, Jill R; Gómez-Olivé, F Xavier

    2018-03-01

    Older adults have been largely overlooked in community studies of HIV in highly endemic African countries. In our rural study site in Mpumalanga Province, South Africa, HIV prevalence among those aged 50 and older is 16.5%, suggesting that older adults are at risk of both acquiring and transmitting HIV. This paper utilises community-based focus-group interviews with older rural South African men and women to better understand the normative environment in which they come to understand and make decisions about their health as they age in an HIV endemic setting. We analyse the dimensions of an inductively emerging theme: ku ti hlayisa (to take care of yourself). For older adults, 'taking care' in an age of AIDS represented: (1) an individualised pathway to achieving old-age respectability through the taking up of responsibilities and behaviours that characterise being an older person, (2) a set of gendered norms and strategies for reducing one's HIV risk, and (3) a shared responsibility for attenuating the impact of the HIV epidemic in the local community. Findings reflect the individual, interdependent and communal ways in which older rural South Africans understand HIV risk and prevention, ways that also map onto current epidemiological thinking for improving HIV-related outcomes in high-prevalence settings.

  1. Relationship between after-school care of adolescents and substance use, risk taking, depressed mood, and academic achievement.

    PubMed

    Richardson, J L; Radziszewska, B; Dent, C W; Flay, B R

    1993-07-01

    To examine the relationship between parental monitoring and six negative behaviors: cigarette, alcohol, and marijuana use; depressed mood; risk taking; and lower academic grades. Survey of 3993 ninth-grade students in six school districts in southern California. The sample consisted of 1930 boys and 2063 girls, self-classified as non-Hispanic white (32%), African-American (13%), Hispanic (46%), or Asian (9%). A relationship was found between unsupervised care after school and susceptibility to cigarette, alcohol, and marijuana use; depressed mood; risk taking; and lower academic grades. Adolescents who were unsupervised at home were slightly more likely to engage in problem behavior than those who were supervised at home. Adolescents at a neighbor's house, at school, or at a job and especially those who "hang out" were most likely to engage in problem behavior. Risk was higher if the parent had an unengaged parenting style. Although girls were less likely than boys to engage in problem behavior when supervised, as supervision decreased they were significantly more likely to have each of these problems. Family structure had little impact on risk. Self-care, especially when it occurs outside of the home, is associated with substance use, risk taking, depressed mood, and lower academic grades.

  2. Hiring: take your time but not too much

    NASA Astrophysics Data System (ADS)

    Usher, Linda

    2010-08-01

    People are any company's greatest asset. Without a great team no company would be able to conceive of a product or service. It would not be able to design or develop a product or service. It could not possibly market or sell that product or service. How a company goes about hiring its talent is one of the most critical components to developing a great team, to having low attrition, and to having a high level of employee faith in management. Far too often I have seen companies when tasked with filling requisitions not take the time to consider, or layout and execute their priorities in hiring. It's a pretty safe assumption that if one doesn't feel they have enough time to be careful and thorough in their hiring approach in order to get the right person the first time - they probably won't have enough time to replace someone they would not have hired had they done it right in the first place! The flip side of this is the problem of letting too much time pass in the process and therefore losing opportunities to hire great people. This paper will point out many mistakes I have seen made in hiring approaches so that hopefully, different strategies can be adopted to avoid those mistakes in the future.

  3. Enhancing Student Empathetic Engagement, History-Taking, and Communication Skills During Electronic Medical Record Use in Patient Care.

    PubMed

    LoSasso, Alisa Alfonsi; Lamberton, Courtney E; Sammon, Mary; Berg, Katherine T; Caruso, John W; Cass, Jonathan; Hojat, Mohammadreza

    2017-07-01

    To examine whether an intervention on proper use of electronic medical records (EMRs) in patient care could help improve medical students' empathic engagement, and to test the hypothesis that the training would reduce communication hurdles in clinical encounters. Seventy third-year medical students from the Sidney Kimmel Medical College at Thomas Jefferson University were randomly divided into intervention and control groups during their six-week pediatric clerkship in 2012-2013. The intervention group received a one-hour training session on EMR-specific communication skills, including discussion of EMR use, the SALTED mnemonic and technique (Set-up, Ask, Listen, Type, Exceptions, Documentation), and role-plays. Both groups completed the Jefferson Scale of Empathy (JSE) at the clerkship's start and end. At clerkship's end, faculty and standardized patients (SPs) rated students' empathic engagement in SP encounters, using the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE), and their history-taking and communication skills. Faculty mean ratings on the JSPPPE, history-taking skills, and communication skills were significantly higher for the intervention group than the control group. SP mean ratings on history-taking skills were significantly higher for the intervention group than the control group. Both groups' JSE mean scores increased pretest to posttest, but the changes were not significant. The intervention group's posttest JSE mean score was higher than the control group's, but the difference was not significant. The findings suggest that a simple intervention providing specialized training in EMR-specific communication can improve medical students' empathic engagement in patient care, history-taking skills, and communication skills.

  4. Toward the adoption of complexity science in health care: implications for risk-taking and decision-making activities.

    PubMed

    Perez, Bianca; Liberman, Aaron

    2011-01-01

    This article explores the issues of risk taking and decision making in health care. An analysis of various sociocultural and psychological influences is provided for understanding of the dominant mind set in this industry. In tandem with this analysis, the evolution of system theories is described so as to promote understanding of the relative merits of the mechanistic and complexity philosophies. These philosophies are at odds with each other, conceptually and practically speaking; however, it seems that the complexity approach offers more promising strategies for the growth and development of health care. Recommendations for improving employee competencies and the organizational structure and culture in health care are offered in light of this analysis. These recommendations are relevant to activities that are clinical and administrative in nature.

  5. Family Day Care Services: Our Great-Grandmothers' Quilt

    ERIC Educational Resources Information Center

    Arruda, Joan

    2009-01-01

    This article features Family Day Care Services, one of the largest nonprofit providers of licensed home and centre-based child care programs in the Greater Toronto Area with 400 staff serving more than 4,000 children and their families. Family Day Care Services is also the lead agency for five Ontario Early Years Centres which are family…

  6. Improve medical malpractice law by letting health care insurers take charge.

    PubMed

    Reinker, Kenneth S; Rosenberg, David

    2011-01-01

    This essay discusses unlimited insurance subrogation (UIS) as a means of improving the deterrence and compensation results of medical malpractice law. Under UIS, health care insureds could assign their entire potential medical malpractice claims to their first-party commercial and government insurers. UIS should improve deterrence by establishing first-party insurers as plaintiffs to confront liability insurers on the defense side, leading to more effective prosecution of meritorious claims and reducing meritless and unnecessary litigation. UIS should improve compensation outcomes by converting litigation cost- and risk- laden "tort insurance" into cheaper and enhanced first-party insurance. UIS also promises dynamic benefits through further reforms by contract between the first-party and liability insurers that would take charge of system. No UIS-related costs are apparent that would outweigh these benefits. © 2011 American Society of Law, Medicine & Ethics, Inc.

  7. Taking to bed. Rapid functional decline in an independently mobile older population living in an intermediate-care facility.

    PubMed

    Clark, L P; Dion, D M; Barker, W H

    1990-09-01

    The objective of this study was to determine the incidence and selected clinical outcomes of taking to bed among a population of independently ambulating older individuals. It was designed as a retrospective case series and was conducted in the intermediate-care facility of a not-for-profit, teaching nursing home. Our study group was composed of individuals over 65 years of age who became bed bound. Thirty-six taking-to-bed episodes occurred in 36 individuals during one calendar year, giving an incidence of 13 per 1,000 resident-months (95% CI, 4 to 23 per 1,000). Twelve of the 36 died within 3 months, and 17 within 6 months, but almost all who survived regained ambulation. Survival was significantly shorter for the five without localizing symptoms (P less than .05). Orthopedic, neurologic, psychiatric, and iatrogenic conditions were most commonly identified as concurrent medical events. Almost half who took to bed had multiple concurrent medical events, and these residents were more likely to present without localizing symptoms (P less than .05). Twenty-one (58%) of the episodes occurred after a fall. The incidence of taking to bed in this population indicates that clinicians caring for older persons should be alert to its occurrence. The dramatic decline in mobility deserves careful assessment because it initiated a period of relatively rapid change in the health careers of the individuals we studied: almost half died within 6 months, but nearly all who survived regained ambulation. Those without localizing symptoms may have more complex interacting medical problems and a worse prognosis.

  8. Health-care reform's great expectations and physician reality.

    PubMed

    Van Mol, Andre

    2010-09-01

    The Patient Protection and Affordable Care Act will not prove to be the reform for which physicians were long hoping. Private insurance rates will climb sharply, forcing people onto government programs; physician reimbursement will plummet; the physician shortage will worsen; rationing in the form of waiting lists is certain; health care as a whole will worsen; and once fully engaged, nationalization of health care will be irreversible.

  9. Difficulties in taking care of business: women addicts as mothers.

    PubMed

    Rosenbaum, M

    1979-01-01

    This paper is devoted to a discussion of women addicts as mothers. Women who are addicted while pregnant begin their careers as mothers with extreme guilt and a sense of initial failure. Heroin becomes a mechanism for coping with the routine difficulties of childraising. Children can also act as a controlling force on their mother's addiction if she has the option to perform her mothering duties in an otherwise "normal" fashion. If the woman is being supported adequately and can be available for her children, it is possible to combine addiction and mothering. Often, however, the woman has to work outside the home (usually in criminal pursuits) and the general chaos of her life greatly impinges on her ability to fulfill her mothering duties. Children are occasionally mistreated, sometimes neglected physically, and often neglected psychologically by a mother who is frequently absent. Addicted mothers feel extreme guilt and remorse over this neglect, and often take stock of their situation when their roles as a mother is threatened; the children are being taken away physically or growing up and she is losing them to time. The woman addict most often wants "out" of the heroin life when her children and her role as mother--her last remaining option--are in jeopardy.

  10. Taking Care of the Kids: The Corporate Role in Providing Child Care.

    ERIC Educational Resources Information Center

    Friedman, Dana E.

    1985-01-01

    More and more people are beginning to look to their employers for a solution to the child care dilemma. Various types of employer supported child care are described, including day care centers, after school programs, summer day camps, financial assistance, flexible benefit plans, and information and referral services. (CB)

  11. Taking Care of Yourself: Stress and the Librarian

    ERIC Educational Resources Information Center

    Spencer, Roxanne Myers

    2013-01-01

    Stress is a part of our working lives and is not likely to decrease in tomorrow's workplace. A difficult economy, downsizing, taking on additional responsibilities without assistance or additional pay--all are taking their toll on our physical, mental, and emotional well-being. Community college librarians can often feel isolated as the only…

  12. NICA: Natural Interaction with a Caring Agent

    NASA Astrophysics Data System (ADS)

    de Carolis, Berardina; Mazzotta, Irene; Novielli, Nicole

    Ambient Intelligence solutions may provide a great opportunity for elderly people to live longer at home. Assistance and care are delegated to the intelligence embedded in the environment. However, besides considering service-oriented response to the user needs, the assistance has to take into account the establishment of social relations. We propose the use of a robot NICA (as the name of the project Natural Interaction with a Caring Agent) acting as a caring assistant that provides a social interface with the smart home services. In this paper, we introduce the general architecture of the robot's "mind" and then we focus on the need to properly react to affective and socially oriented situations.

  13. Taking Assent to New Heights: A Case Report on Do-Not-Resuscitate Status in Pediatric Palliative Care Procedures.

    PubMed

    Ballard, Heather A; Suresh, Santhanam

    2018-03-01

    Dying adolescents presenting for palliative procedures have complicated developmental and ethical issues, especially when reconsidering do-not-resuscitate orders. Though the American Academy of Pediatrics has guidelines, there is limited information in the literature on how to take care of these patients. We describe the case of a 14-year-old patient presenting to the interventional radiology suite for management of superior vena cava syndrome. The patient's goals of treatment were elucidated through a comprehensive care team consisting of the procedural and oncology teams. Effective communication with the patient and family was paramount for success.

  14. Nurses take center stage in private duty home care.

    PubMed

    Brackett, Nicole

    2013-06-01

    The Affordable Care Act gives America's largest group of health care providers--nurses--a unique chance to lead in improving outcomes, increasing patient satisfaction, and lowering costs. Nurses' roles continue to grow in settings from hospitals and long-term care facilities to home health and hospice agencies. Nurses are also key players in private duty home care, where they serve as care coordinators for clients. Working directly with doctors, therapists, in-home caregivers, and families, nurses are critical in delivering quality, seamless in-home care.

  15. A fundamental conflict of care: Nurses' accounts of balancing patients' sleep with taking vital sign observations at night.

    PubMed

    Hope, Joanna; Recio-Saucedo, Alejandra; Fogg, Carole; Griffiths, Peter; Smith, Gary B; Westwood, Greta; Schmidt, Paul E

    2017-12-21

    To explore why adherence to vital sign observations scheduled by an early warning score protocol reduces at night. Regular vital sign observations can reduce avoidable deterioration in hospital. early warning score protocols set the frequency of these observations by the severity of a patient's condition. Vital sign observations are taken less frequently at night, even with an early warning score in place, but no literature has explored why. A qualitative interpretative design informed this study. Seventeen semi-structured interviews with nursing staff working on wards with varying levels of adherence to scheduled vital sign observations. A thematic analysis approach was used. At night, nursing teams found it difficult to balance the competing care goals of supporting sleep with taking vital sign observations. The night-time frequency of these observations was determined by clinical judgement, ward-level expectations of observation timing and the risk of disturbing other patients. Patients with COPD or dementia could be under-monitored, while patients nearing the end of life could be over-monitored. In this study, we found an early warning score algorithm focused on deterioration prevention did not account for long-term management or palliative care trajectories. Nurses were therefore less inclined to wake such patients to take vital sign observations at night. However, the perception of widespread exceptions and lack of evidence regarding optimum frequency risks delegitimising the early warning score approach. This may pose a risk to patient safety, particularly patients with dementia or chronic conditions. Nurses should document exceptions and discuss these with the wider team. Hospitals should monitor why vital sign observations are missed at night, identify which groups are under-monitored and provide guidance on prioritising competing expectations. early warning score protocols should take account of different care trajectories. © 2017 The Authors. Journal of

  16. Community Vital Signs: Taking the Pulse of the Community While Caring for Patients.

    PubMed

    Hughes, Lauren S; Phillips, Robert L; DeVoe, Jennifer E; Bazemore, Andrew W

    2016-01-01

    In 2014 both the Institute of Medicine and the National Quality Forum recommended the inclusion of social determinants of health data in electronic health records (EHRs). Both entities primarily focus on collecting socioeconomic and health behavior data directly from individual patients. The burden of reliably, accurately, and consistently collecting such information is substantial, and it may take several years before a primary care team has actionable data available in its EHR. A more reliable and less burdensome approach to integrating clinical and social determinant data exists and is technologically feasible now. Community vital signs-aggregated community-level information about the neighborhoods in which our patients live, learn, work, and play-convey contextual social deprivation and associated chronic disease risks based on where patients live. Given widespread access to "big data" and geospatial technologies, community vital signs can be created by linking aggregated population health data with patient addresses in EHRs. These linked data, once imported into EHRs, are a readily available resource to help primary care practices understand the context in which their patients reside and achieve important health goals at the patient, population, and policy levels. © Copyright 2016 by the American Board of Family Medicine.

  17. Patients' perspectives on taking warfarin: qualitative study in family practice

    PubMed Central

    Dantas, Guilherme Coelho; Thompson, Barbara V; Manson, Judith A; Tracy, C Shawn; Upshur, Ross EG

    2004-01-01

    Background Despite the well-documented benefits of using warfarin to prevent stroke, physicians remain reluctant to initiate therapy, and especially so with the elderly owing to the higher risk of hemorrhage. Prior research suggests that patients are more accepting of the risk of bleeding than are physicians, although there have been few qualitative studies. The aim of this study was to employ qualitative methods to investigate the experience and perspective of individuals taking warfarin. Methods We conducted face-to-face interviews with 21 older patients (12 male, 9 female) who had been taking warfarin for a minimum of six months. Participants were patients at a family practice clinic situated in a large, tertiary care teaching hospital. We used a semistructured interview guide with four main thematic areas: decision-making, knowledge/education, impact, and satisfaction. Data were analysed according to the principles of content analysis. Results and Discussion Participants tended to have minimal input into the decision to initiate warfarin therapy, instead relying in great part on physicians' expertise. There appeared to be low retention of information received regarding the therapy; half the patients in our sample possessed only a superficial level of understanding of the risks and benefits. This notwithstanding, participants reported a high level of satisfaction with the care provided and a low level of impact on their day-to-day lives. Conclusions Minimal patient involvement in the initial decision and modest knowledge did not appear to diminish satisfaction with warfarin management. At the same time, care providers exert a tremendous influence on the initiation of warfarin therapy and should strive to incorporate patient preferences and expectations into the decision-making process. PMID:15268764

  18. What does it take to set goals for self-management in primary care? A qualitative study.

    PubMed

    Lenzen, Stephanie Anna; van Dongen, Jerôme Jean Jacques; Daniëls, Ramon; van Bokhoven, Marloes Amantia; van der Weijden, Trudy; Beurskens, Anna

    2016-12-01

    There is an increasing number of patients with a chronic illness demanding primary care services. This demands for effective self-management support, including collaborative goal setting. Despite the fact that primary care professionals seem to have difficulties implementing goal setting, little information is available about the factors influencing the complexity of this process in primary care. The aim of this study was to contribute to an understanding of the complexity of self-management goal setting in primary care by exploring experts' and primary care professionals' experiences with self-management goal setting and viewpoints regarding influencing factors. A descriptive qualitative research methodology was adopted. Two focus groups and three individual interviews were conducted (total participants n = 17). Thematic content analysis was used to analyse the data. The findings were categorized into four main themes with subordinated subthemes. The themes focus around the complexity of setting non-medical goals and around professionals' skills and attitudes to negotiate and decide about goals with patients. Furthermore, patients' skills and attitudes for goal setting and the integration of goal setting in the time available were formulated as themes. Setting self-management goals in primary care, especially in family medicine, might require a shift from a medical perspective to a biopsychosocial perspective, with an increasing role set aside for the professional to coach the patient in expressing his self-management goals and to take responsibility for these goals. © The Author 2016. Published by Oxford University Press.

  19. The importance of ground water in the Great Lakes Region

    USGS Publications Warehouse

    Grannemann, N.G.; Hunt, R.J.; Nicholas, J.R.; Reilly, T.E.; Winter, T.C.

    2000-01-01

    Ground water is a major natural resource in the Great Lakes Region that helps link the Great Lakes and their watershed. This linkage needs to be more fully understood and quantified before society can address some of the important water-resources issues in the Great Lakes. The Great Lakes constitute the largest concentration of unfrozen fresh surface water in the western hemisphere—about 5,440 mi3. Because the quantity of water in the lakes is so large, ground water in the Great Lakes Basin is often overlooked when evaluating the hydrology of the region. Ground water, however, is more important to the hydrology of the Great Lakes and to the health of ecosystems in the watershed than is generally recognized.Although more than 1,000 mi3 of ground water are stored in the basin—a volume of water that is approximately equal to that of Lake Michigan—development of the groundwater resource must be carefully planned. Development of the ground-water resource removes water from storage and alters the paths of ground-water flow. Ground water that normally discharges to streams, lakes, and wetlands can be captured by pumping (the most common form of development), which may deplete or reduce inflows to the Great Lakes.Ground water is important to ecosystems in the Great Lakes Region because it is, in effect, a large, subsurface reservoir from which water is released slowly to provide a reliable minimum level of water flow to streams, lakes, and wetlands. Ground-water discharge to streams generally provides good quality water that, in turn, promotes habitat for aquatic animals and sustains aquatic plants during periods of low precipitation. Because of the slow movement of ground water, the effects of surface activities on ground-water flow and quality can take years to manifest themselves. As a result, issues relative to ground water are often seemingly less dire than issues related to surface water alone.Ground water is a major natural resource in the Great Lakes Region

  20. Taking care of your vascular access for hemodialysis

    MedlinePlus

    ... blood through the access. This is called stenosis. Day-to-day Care of Your Vascular Access Following these guidelines ... pulse (also called thrill) in your access every day. Your health care provider will show you how. ...

  1. Nontraditional or noncentralized models of diabetes care: models in which other HCPs take on a leading role in managing patients' diabetes.

    PubMed

    Arnold, K C

    2011-11-01

    Nurse practitioners (NPs) are advanced practice nurses who have increased responsibility,such as prescribing authority. In the NP-led model, the NP is the primary care provider for clinic patients and takes on an autonomous role in patient management. In some states, NP-led clinics are required to have a supervising or collaborating physician. There is evidence that NP-led and physician-led primary care is comparable for multiple health outcomes. The NP-led model emphasizes the strong interaction between health care provider and patient. Challenges of NP-led care include physician resistance, legal restrictions, inaccessibility and cost of malpractice insurance, and limited payouts from insurance companies

  2. Taking Innovation To Scale In Primary Care Practices: The Functions Of Health Care Extension.

    PubMed

    Ono, Sarah S; Crabtree, Benjamin F; Hemler, Jennifer R; Balasubramanian, Bijal A; Edwards, Samuel T; Green, Larry A; Kaufman, Arthur; Solberg, Leif I; Miller, William L; Woodson, Tanisha Tate; Sweeney, Shannon M; Cohen, Deborah J

    2018-02-01

    Health care extension is an approach to providing external support to primary care practices with the aim of diffusing innovation. EvidenceNOW was launched to rapidly disseminate and implement evidence-based guidelines for cardiovascular preventive care in the primary care setting. Seven regional grantee cooperatives provided the foundational elements of health care extension-technological and quality improvement support, practice capacity building, and linking with community resources-to more than two hundred primary care practices in each region. This article describes how the cooperatives varied in their approaches to extension and provides early empirical evidence that health care extension is a feasible and potentially useful approach for providing quality improvement support to primary care practices. With investment, health care extension may be an effective platform for federal and state quality improvement efforts to create economies of scale and provide practices with more robust and coordinated support services.

  3. Taking Innovation To Scale In Primary Care Practices: The Functions Of Health Care Extension

    PubMed Central

    Ono, Sarah S.; Crabtree, Benjamin F.; Hemler, Jennifer R.; Balasubramanian, Bijal A.; Edwards, Samuel T.; Green, Larry A.; Kaufman, Arthur; Solberg, Leif I.; Miller, William L.; Woodson, Tanisha Tate; Sweeney, Shannon M.; Cohen, Deborah J.

    2018-01-01

    Health care extension is an approach to providing external support to primary care practices with the aim of diffusing innovation. EvidenceNOW was launched to rapidly disseminate and implement evidence-based guidelines for cardiovascular preventive care in the primary care setting. Seven regional grantee cooperatives provided the foundational elements of health care extension—technological and quality improvement support, practice capacity building, and linking with community resources—to more than two hundred primary care practices in each region. This article describes how the cooperatives varied in their approaches to extension and provides early empirical evidence that health care extension is a feasible and potentially useful approach for providing quality improvement support to primary care practices. With investment, health care extension may be an effective platform for federal and state quality improvement efforts to create economies of scale and provide practices with more robust and coordinated support services. PMID:29401016

  4. Take the IBS Test

    MedlinePlus

    ... Committed to Quality in Patient Care TAKE THE IBS TEST Do you have recurrent abdominal pain or ... have a real and treatable medical condition called irritable bowel syndrome (IBS). Your doctor now has new information and ...

  5. Diabetes Care in India.

    PubMed

    Joshi, Shashank R

    2015-01-01

    Diabetes has become a major health care problem in India with an estimated 66.8 million people suffering from the condition, representing the largest number of any country in the world. The rising burden of diabetes has greatly affected the health care sector and economy in India. The goal of health care experts in India is to transform India into a diabetes care capital in the world. An expert detailed review of the medical literature with an Asian Indian context was performed. Recent epidemiologic studies from India point to a great burden from diabetes. Diabetes control in India is far from ideal with a mean hemoglobin A1c of 9.0%-at least 2.0% higher than suggested by international bodies. Nearly half of people with diabetes remain undetected, accounting for complications at the time of diagnosis. Screening can differentiate an asymptomatic individual at high risk from one at low risk for diabetes. Despite the large number of people with diabetes in India, awareness is low and needs to be addressed. Other challenges include balancing the need for glycemic control with risk reduction due to overly tight control, especially in high-risk groups and taking into account health care professional expertise, attitudes, and perceptions. Pharmacologic care should be individualized with early consideration of combination therapy. Regular exercise, yoga, mindful eating, and stress management form a cornerstone in the management of diabetes. Considering the high cost incurred at various steps of screening, diagnosis, monitoring, and management, it is important to realize the cost-effective measures of diabetes care that are necessary to implement. Result-oriented organized programs involving patient education, as well as updating the medical fraternity on various developments in the management of diabetes, are required to combat the current diabetes epidemic in India. Copyright © 2015. Published by Elsevier Inc.

  6. Do school-based health centers improve adolescents' access to health care, health status, and risk-taking behavior?

    PubMed

    Kisker, E E; Brown, R S

    1996-05-01

    The purpose of this investigation was to assess the School-Based Adolescent Health Care Program, which provided comprehensive health-related services in 24 school-based health centers. The outcomes evaluation compared a cohort of students attending 19 participating schools and a national sample of urban youths, using logit models to control for observed differences between the two groups of youths. Outcome measures included self-reports concerning health center utilization, use of other health care providers, knowledge of key health facts, substance use, sexual activity, contraceptive use, pregnancies and births, and health status. The health centers increased students' access to health care and improved their health knowledge. However, the estimated impacts on health status and risky behaviors were inconsistent, and most were small and not statistically significant. School-based health centers can increase students' health knowledge and access to health-related services, but more intensive or different services are needed if they are to significantly reduce risk-taking behaviors.

  7. Self-Management: Taking Charge of Your Health

    MedlinePlus

    ... Childbirth Women Men Seniors Your Health Resources Healthcare Management End-of-Life Issues Insurance & Bills Self Care ... You NeedFood Poisoning Home Your Health Resources Healthcare Management Self-care Self-management: Taking Charge of Your ...

  8. "Our own limited role in policing those boundaries": taking small steps on health care.

    PubMed

    Whittington, Keith E

    2013-04-01

    The Patient Protection and Affordable Care Act ignited a political firestorm and raised intriguing new questions of constitutional law. Cutting a path between the liberals and conservatives on the US Supreme Court, Chief Justice John Roberts made small adjustments in established constitutional law to uphold key features of the act. In doing so, he not only upheld the statute but also left the landscape of constitutional law much as he had found it. He did, however, suggest that the federal courts should take a more active role in monitoring how Congress uses its constitutional powers and should not shy away from making specific determinations of whether Congress had abused its power in particular cases.

  9. Nurses' reasoning process during care planning taking pressure ulcer prevention as an example. A think-aloud study.

    PubMed

    Funkesson, Kajsa Helena; Anbäcken, Els-Marie; Ek, Anna-Christina

    2007-09-01

    Nurses' clinical reasoning is of great importance for the delivery of safe and efficient care. Pressure ulcer prevention allows a variety of aspects within nursing to be viewed. The aim of this study was to describe both the process and the content of nurses' reasoning during care planning at different nursing homes, using pressure ulcer prevention as an example. A qualitative research design was chosen. Seven different nursing homes within one community were included. Eleven registered nurses were interviewed. The methods used were think-aloud technique, protocol analysis and qualitative content analysis. Client simulation illustrating transition was used. The case used for care planning was in three parts covering the transition from hospital until 3 weeks in the nursing home. Most nurses in this study conducted direct and indirect reasoning in a wide range of areas in connection with pressure ulcer prevention. The reasoning focused different parts of the nursing process depending on part of the case. Complex assertations as well as strategies aiming to reduce cognitive strain were rare. Nurses involved in direct nursing care held a broader reasoning than consultant nurses. Both explanations and actions based on older ideas and traditions occurred. Reasoning concerning pressure ulcer prevention while care planning was dominated by routine thinking. Knowing the person over a period of time made a more complex reasoning possible. The nurses' experience, knowledge together with how close to the elderly the nurses work seem to be important factors that affect the content of reasoning.

  10. Political devolution and the health services in Great Britain.

    PubMed

    Woods, Kevin J

    2004-01-01

    This article reviews the effects of political devolution on health care in the countries of Great Britain at the end of the first term of the new political institutions created in 1999. In the light of the powers transferred, an assessment is made of the nature and extent of policy autonomy exercised by the devolved administrations. The author considers the question of whether political devolution is leading to local variations in health care provision that threaten established concepts of equity in a U.K. National Health Service. Policy areas discussed include the personal care of older people, mental health, governance, competition, the role of the private sector, and the health care workforce. Also discussed are the dynamics of intergovernmental relations in the longer term, including the effects of the developing European Union. The article concludes by assessing the extent to which the individual countries within Great Britain are likely to develop health care systems with distinctive identities.

  11. Bridging existing governance gaps: five evidence-based actions that boards can take to pursue high quality care.

    PubMed

    Leggat, Sandra G; Balding, Cathy

    2017-11-13

    Objective To explore the impact of the organisational quality systems on quality of care in Victorian health services. Methods During 2015 a total of 55 focus groups were conducted with more than 350 managers, clinical staff and board members in eight Victorian health services to explore the effectiveness of health service quality systems. A review of the quality and safety goals and strategies outlined in the strategic and operating plans of the participating health services was also undertaken. Results This paper focuses on the data related to the leadership role of health service boards in ensuring safe, high-quality care. The findings suggest that health service boards are not fully meeting their governance accountability to ensure consistently high-quality care. The data uncovered major clinical governance gaps between stated board and executive aspirations for quality and safety and the implementation of these expectations at point of care. These gaps were further compounded by quality system confusion, over-reliance on compliance, and inadequate staff engagement. Conclusion Based on the existing evidence we propose five specific actions boards can take to close the gaps, thereby supporting improved care for all consumers. What is known about this topic? Effective governance is essential for high-quality healthcare delivery. Boards are required to play an active role in their organisation's pursuit of high quality care. What does this paper add? Recent government reports suggest that Australian health service boards are not fully meeting their governance requirements for high quality, safe care delivery, and our research pinpoints key governance gaps. What are the implications for practitioners? Based on our research findings we outline five evidence-based actions for boards to improve their governance of quality care delivery. These actions focus on an organisational strategy for high-quality care, with the chief executive officer held accountable for

  12. Taking care of your new knee joint

    MedlinePlus

    Knee arthroplasty - precautions; Knee replacement - precautions ... After you have knee replacement surgery , you will need to be careful about how you move your knee, especially for the first few ...

  13. Taking care of your feet.

    PubMed

    Sabine, P M

    1999-10-01

    For anyone who finds walking and standing painful, the working day can seem interminable and miserable. This is compounded for nurses who lead busy, active lives, and foot problems can become a major barrier to an effective working day. Chronic foot problems have led nurses to seek alternative employment, often outside the profession, thus leaving health services even less well staffed with experienced personnel. Foot health, then, plays an important role in maintaining the mobility of nurses and foot care is vital for continued comfort during gait. It is equally important to understand which foot problems may be safely dealth with by the sufferer and to identify those that require specialist help and advice from a State Registered Chiropodist/Podiatrist.

  14. Family Practitioners' Advice about Taking Time Off Work for Lower Respiratory Tract Infections: A Prospective Study in Twelve European Primary Care Networks.

    PubMed

    Godycki-Cwirko, Maciek; Nocun, Marek; Butler, Christopher C; Little, Paul; Verheij, Theo; Hood, Kerenza; Fleten, Nils; Kowalczyk, Anna; Melbye, Hasse

    2016-01-01

    Acute cough and lower respiratory tract infections (LRTIs) are one of the most important causes of lost working hours. to explore variation and predictors in family practitioners (FPs) advice to patients with LRTIs about taking time off work in different European countries. Prospective observational study in primary care networks in 12 countries, with multilevel mixed-effects binomial logistic regression. 324 FPs recruited 1616 employed adults who presented to primary care with LRTIs. The proportion of patients advised to take time off work varied from 7.6% in the Netherlands to 89.2% in Slovakia, and of these, 88.2% overall were advised to stay off work for seven days or less. None of Finnish or Dutch patients were advised to take more than 7 days off, in contrast to 35.5% of Polish and 27.0% of Slovak patients. The strongest predictors of FPs' advice about time off work were: patient symptoms interfering with normal activities (OR 4.43; P<0.001), fever (2.49; P<0.001), patients feeling generally unwell (2.21; P<0.001), antibiotic prescribing (1.51; P = 0.025) and auscultation abnormality (1.50; P = 0.029). Advice to take time off was not associated with patient reported recovery. There is large variation in FPs' advice given to patients with LRTIs in Europe about taking time off work, which is not explained by differences in patients' reported illness duration, but might be explained by differences in regulations around certification and sick pay. Evidence based guidance for advising patients about taking time off work for this common condition is needed.

  15. Taking Teachers from the River to the Coast: a COSEE Great Lakes and Lake Superior NERR Collaboration

    EPA Science Inventory

    The Center for Ocean Sciences Education Excellence (COSEE) Great Lakes Shipboard and Shoreline Science Workshop provides 15 formal and informal educators of G5-10 an opportunity to spend a week aboard the US EPA’s 180’ R/V Lake Guardian working side-by-side with Great Lakes scien...

  16. Taking Care of Your Bowels--The Basics

    MedlinePlus

    Home » Information & Education » Pamphlets About Us Patient Care Resources Information & Education SCI Empowerment Project Projects & Research FAQ © 2018 University of Washington SCI Pamphlets: Staying Healthy after a Spinal Cord Injury The pamphlet ...

  17. Who Cares for Those Who Take Care? Risks and Resources of Work in Care Homes

    PubMed Central

    Gozzoli, Caterina; Gazzaroli, Diletta; D’Angelo, Chiara

    2018-01-01

    Over the years – due to the aging population, the process of corporatisation and a demand for a higher quality of services – professionals who work in Care Homes have been exposed to an increasing risk of physical and emotional malaise because of the number of challenges they’ve been asked to manage. Given these factors, there is a growing interest in the study and understanding of professions in geriatric care settings. In the literature there is a prevalence of quantitative studies offering an overview in terms of indicators – at the individual or group or organizational level – concerning the potential development of situations of professional malaise. Conversely, there is a lack of qualitative studies exploring the risk and protection factors. For this reason, in this study we decided to use a qualitative approach to explore “more up close” this kind of organizational context and to keep together the different levels in systemic terms in order to identify – according to professionals’ perceptions – resource factors (in order to leverage these aspects) and fatigue factors (to identify them and treat them). Three Italian Care Homes were involved and the interview’s sample was composed of 45 professionals – 15 nurses, 30 total Patient Care Assistants (PCAs) and Auxiliary Care Assistants (ACAs), of these, 17 males and 28 females, with an average age of 43 years (SD = 0.78) – selected using a sampling of maximum variability. From the analysis of the materials there seem to be four profiles of the professionals involved. Implications to ensure a functional human resource management are discussed for the purpose of promote the well-being of the various professionals, and, as a result, an increasing quality of service. PMID:29593615

  18. ["Great jobs"-also in psychiatry?].

    PubMed

    Spiessl, H; Hübner-Liebermann, B

    2003-09-01

    Against the background of a beginning shortage of psychiatrists, results from interviews with 112 employees of an automotive company with the topic "Great Job" are presented to discuss their relevance to psychiatry. The interviews were analysed by means of a qualitative content analysis. Most employees assigned importance to great pay, constructive collaboration with colleagues, and work appealing to personal interests. Further statements particularly relevant to psychiatry were: successful career, flexible working hours, manageable job, work-life balance, well-founded training, no bureaucracy within the company, and personal status in society. The well-known economic restrictions in health care and the still negative attitude towards psychiatry currently reduce the attraction of psychiatry as a profession. From the viewpoint of personnel management, the attractors of a great job revealed in this study are proposed as important clues for the recruitment of medical students for psychiatry and the development of psychiatric staff.

  19. Impact of the Great East Japan Earthquake on Regional Obstetrical Care in Miyagi Prefecture.

    PubMed

    Sugawara, Junichi; Hoshiai, Tetsuro; Sato, Kazuyo; Tokunaga, Hideki; Nishigori, Hidekazu; Arai, Takanari; Okamura, Kunihiro; Yaegashi, Nobuo

    2016-06-01

    The authors report the results of surveys on the emergency transport or evacuation status of obstetric patients conducted in Miyagi prefecture, one of the major disaster areas of the Great East Japan Earthquake and tsunami. The surveys examined the damages to maternity institutions, evacuation status and transport of pregnant women, and prehospital childbirths and were conducted in 50 maternity institutions and 12 fire departments in Miyagi. Two coastal institutions were destroyed completely, and four institutions were destroyed partially by the tsunami, forcing them to stop medical services. In the two-month period after the disaster, 217 pregnant women received hospital transport or gave birth after evacuation. Satisfactory perinatal outcomes were maintained. Emergency obstetric transport increased to approximately 1.4 fold the number before the disaster. Twenty-three women had prehospital childbirths, indicating a marked increase to approximately three times the number of the previous year. In the acute phase of the tsunami disaster, maternity institutions were damaged severely and perinatal transport was not possible; as a result, pregnant women inevitably gave birth in unplanned institutions, and the number of prehospital births was increased extremely. To obtain satisfactory obstetric outcomes, it is necessary to construct a future disaster management system and to re-recognize pregnant women as people with special needs in disaster situations. Sugawara J , Hoshiai T , Sato K , Tokunaga H , Nishigori H , Arai T , Okamura K , Yaegashi N . Impact of the Great East Japan Earthquake on regional obstetrical care in Miyagi Prefecture. Prehosp Disaster Med. 2016;31(3):255- 258.

  20. Partnering with parents in a pediatric ambulatory care setting: a new model.

    PubMed

    Tourigny, Jocelyne; Chartrand, Julie

    2015-06-01

    Pediatric care has greatly evolved during the past 30 years, moving from a traditional, medically oriented approach to a more consultative, interactive model. In the literature, the concept of partnership has been explored and presented in various terms, including presence, collaboration, involvement, and participation. The models of partnership that have been proposed have rarely been evaluated, and do not take the unique environment of ambulatory care into account. Based on a literature review, strong clinical experience with families, and previous research with parents and health professionals, both the conceptual and empirical phases of a new model are described. This model can be adapted to other pediatric health care contexts in either primary or tertiary care and should be evaluated in terms of efficacy and usefulness.

  1. KENNEDY SPACE CENTER, FLA. - A Great Blue Heron takes flight from waters on KSC. It is one of 310 species of birds that inhabit the National Merritt Island Wildlife Refuge, which shares a boundary with KSC. The marshes and open water of the refuge also provide wintering areas for 23 species of migratory waterfowl, as well as a year-round home for great blue herons, great egrets, wood storks, cormorants, brown pelicans and other species of marsh and shore birds.

    NASA Image and Video Library

    2003-07-29

    KENNEDY SPACE CENTER, FLA. - A Great Blue Heron takes flight from waters on KSC. It is one of 310 species of birds that inhabit the National Merritt Island Wildlife Refuge, which shares a boundary with KSC. The marshes and open water of the refuge also provide wintering areas for 23 species of migratory waterfowl, as well as a year-round home for great blue herons, great egrets, wood storks, cormorants, brown pelicans and other species of marsh and shore birds.

  2. Patients' experiences of care and support at home after a family member's participation in an intervention during palliative care.

    PubMed

    Norinder, Maria; Goliath, Ida; Alvariza, Anette

    2017-06-01

    Patients who receive palliative home care are in need of support from family members, who take on great responsibility related to caregiving but who often feel unprepared for this task. Increasing numbers of interventions aimed at supporting family members in palliative care have been described and evaluated. It is not known whether and how these interventions actually affect the care or support provided to a patient, even though it has been suggested that family members would be likely to provide better care and support and thus allow for positive experiences for patients. However, this has not been studied from the perspective of the patients themselves. The objective of our study was to explore patients' experiences of care and support at home after family members' participation in a psychoeducational intervention during palliative care. Our study took a qualitative approach, and interviews were conducted with 11 patients whose family members had participated in a psychoeducational intervention during palliative home care. The interviews were analyzed employing interpretive description. Patients' experiences were represented by three themes: "safe at home," "facilitated and more honest communication," and "feeling like a unit of care." Patients felt that their needs were better met and that family members became more confident at home without risking their own health. Patients felt relieved when family members were given the opportunity to talk and reflect with others and hoped that the intervention would contribute to more honest communications between themselves and their family members. Further, it was of great importance to patients that family members receive attention from and be confirmed and supported by healthcare professionals. Our findings show how an intervention targeted at family members during palliative home care also benefits the patients.

  3. Disability studies and health care curriculum: the great divide.

    PubMed

    Hubbard, Sandra

    2004-01-01

    Models or paradigms of disability are used to guide health care professionals' perceptions so that they can serve people with disabilities, enhance their futures, and facilitate the resources they need. Health care curricula, which in essence train students to make such decisions, are influenced by these models. The medical model, which locates disability within the individual, assumes the individual with a disability is a victim who must be cured or made more normal. The functional-limitation paradigm expands on the medical model, focusing on the interaction of physical or mental limitations with social and environmental factors. The economic model, based on the concept of employability, emphasizes a health-related inability (or limited ability) to work rather than physical functioning of the individual. The sociopolitical model views disability as a policy and civil rights issue. Health care professionals face a dilemma as the disability rights movement demands a shift in social power from the paternalistic view of the medical model to the autonomist view of the sociopolitical model. The question is asked if curricula are preparing our future health care professionals to distinguish how to view each situation and each individual through the lens of the appropriate model.

  4. Impact of the Great East Japan Earthquake and tsunami on health, medical care and public health systems in Iwate Prefecture, Japan, 2011.

    PubMed

    Nohara, Masaru

    2011-10-01

    The Great East Japan Earthquake was one of the largest earthquakes ever recorded in global history. The damage was spread over a wide area, with the worst-hit areas being Iwate, Miyagi and Fukushima prefectures. In this paper we report on the damage and the impact of the damage to describe the health consequences among disaster victims in Iwate Prefecture. In Iwate Prefecture the tsunami claimed 4659 lives, with 1633 people missing. In addition to electricity, water and gas being cut off following the disaster, communication functions were paralysed and there was a lack of gasoline. Medical and public health teams from Iwate Prefecture and around the country, including many different specialists, engaged in a variety of public health activities mainly at evacuation centres, including medical and mental health care and activities to prevent infectious diseases. Given the many fatalities, there were relatively few patients who required medical treatment for major injuries. However, there were significant medical needs in the subacute and chronic phases of care in evacuation centres, with great demand for medical treatment and public health assistance, measures to counteract infection and mental health care. By referring to past experiences of national and international large-scale disasters, it was possible to respond effectively to the health-related challenges. However, there are still challenges concerning how to share information and coordinate overall activities among multiple public health response teams. Further examination will be required to ensure better preparedness in response to future disasters.

  5. Feeding habitat characteristics of the great blue heron and great egret nesting along the Upper Mississippi River, 1995-1998

    USGS Publications Warehouse

    Custer, Christine M.; Suarez, S.A.; Olsen, D.A.

    2004-01-01

    The Great Blue Heron (Ardea herodias) and Great Egret (Ardea alba) nested in eight colonies along the Upper Mississippi River, USA, and individual birds were followed by airplane to feeding sites during the nesting seasons in 1995-1998. Both species used braided channel/backwater habitats for feeding more than expected, based on availability, and open pool and main navigation channel less than expected. Most individuals of both species fed 10 km away. Habitat and distance need to be considered simultaneously when assessing habitat quality for herons and egrets. The Great Blue Heron flew farther to feeding sites during the care-of-young period than during incubation and the Great Egret showed the opposite pattern. The Great Blue Heron tended to feed solitarily; only 10% of the feeding flights ended at a location where another heron was already present. About one-third of Great Egret feeding flights ended at a location with another egret already present. Colony placement on the landscape seemed to be a function of the feeding radius of each colony.

  6. Great Minds? Great Lakes!

    ERIC Educational Resources Information Center

    Environmental Protection Agency, Chicago, IL. Great Lakes National Program Office.

    This book contains lesson plans that provide an integrated approach to incorporating Great Lakes environmental issues into elementary subjects. The book is divided into three subject areas: (1) History, which includes the origins of the Great Lakes, Great Lakes people, and shipwrecks; (2) Social Studies, which covers government, acid rain as a…

  7. "Just take your medicine and everything will be fine": Responsibilisation narratives in accounts of transitioning young people with HIV into adult care services in Australia.

    PubMed

    Newman, Christy E; Persson, Asha; Miller, Angela; Brown, Rebecca J

    2016-01-01

    Young people who have grown up with perinatally acquired HIV in wealthy nations are increasingly transitioning into adult care settings which expect more independence and self-regulation than paediatric care. Drawing on the first qualitative study on growing up with HIV in Australia, this paper examines "responsibilisation" narratives in semi-structured interviews conducted with young people with HIV and their paediatric and adult care providers. Three dominant narratives were identified: responsibilisation as imperative, practice and contest. This suggests that while young people growing up with HIV in an advanced liberal setting such as Australia may value the independence of adult care, and appreciate the need to take responsibility for their health, the practices involved in becoming a responsible health citizen are shaped by individual histories and circumstances, and in some cases, can lead to serious contestation and conflict with care providers. Placing a stronger emphasis on what young people can gain from taking an active role in managing their health may more successfully foster responsibilisation, rather than focusing on what they will lose. Clinicians could benefit from greater support regarding how to engage young people with the elements of responsibilisation likely to resonate more meaningfully at different points in their lives.

  8. Computer-assisted history-taking systems (CAHTS) in health care: benefits, risks and potential for further development.

    PubMed

    Pappas, Yannis; Anandan, Chantelle; Liu, Joseph; Car, Josip; Sheikh, Aziz; Majeed, Azeem

    2011-01-01

    A computer-assisted history-taking system (CAHTS) is a tool that aids clinicians in gathering data from patients to inform a diagnosis or treatment plan. Despite the many possible applications and even though CAHTS have been available for nearly three decades, these remain underused in routine clinical practice. Through an interpretative review of the literature, we provide an overview of the field of CAHTS, which also offers an understanding of the impact of these systems on policy, practice and research. We conducted a search and critique of the literature on CAHTS. Using a comprehensive set of terms, we searched: MEDLINE, EMBASE, The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, The Cochrane Central Register of Controlled Trials, The Cochrane Methodology Register, Health Technology Assessment Database and the NHS Economic Evaluation Database over a ten-year period (January 1997 to May 2007) to identify systematic reviews, technical reports and health technology assessments, and randomised controlled trials. The systematic review of the literature suggests that CAHTS can save professionals' time, improve delivery of care to those with special needs and also facilitate the collection of information, especially potentially sensitive information (e.g. sexual history, alcohol consumption). The use of CAHTS also has disadvantages that impede the process of history taking and may pose risks to patients. CAHTS are inherently limited when detecting non-verbal communication, may pose irrelevant questions and frustrate the users with technical problems. Our review suggests that barriers such as a preference for pen-and-paper methods and concerns about data loss and security still exist and affect the adoption of CAHTS. In terms of policy and practice, CAHTS make input of data from disparate sites possible, which facilitates work from disparate sites and the collection of data for nationwide screening programmes such as the vascular

  9. Dental care coverage and income-related inequalities in foregone dental care in Europe during the great recession.

    PubMed

    Elstad, Jon Ivar

    2017-08-01

    This study examines income inequalities in foregone dental care in 23 European countries during the years with global economic crisis. Associations between dental care coverage from public health budgets or social insurance, and income-related inequalities in perceived access to dental care, are analysed. Survey data 2008-2013 from 23 countries were combined with country data on macro-economic conditions and coverage for dental care. Foregone dental care was defined as self-reported abstentions from needed dental care because of costs or other crisis-related reasons. Age-standardized percentages reporting foregone dental care were estimated for respondents, age 20-74, in the lowest and highest income quartile. Associations between dental care coverage and income inequalities in foregone dental care, adjusted for macro-economic indicators, were examined by country-level regression models. In all 23 countries, respondents in the lowest income quartile reported significantly higher levels of foregone dental care than respondents in the highest quartile. During 2008-2013, income inequalities in foregone dental care widened significantly in 13 of 23 countries, but decreased in only three countries. Adjusted for countries' macro-economic situation and severity of the economic crisis, higher dental care coverage was significantly associated with smaller income inequalities in foregone dental care and less widening of these inequalities. Income-related inequalities in dental care have widened in Europe during the years with global economic crisis. Higher dental care coverage corresponded to less income-related inequalities in foregone dental care and less widening of these inequalities. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. The great intimidators.

    PubMed

    Kramer, Roderick M

    2006-02-01

    After Disney's Michael Eisner, Miramax's Harvey Weinstein, and Hewlett-Packard's Carly Fiorina fell from their heights of power, the business media quickly proclaimed thatthe reign of abrasive, intimidating leaders was over. However, it's premature to proclaim their extinction. Many great intimidators have done fine for a long time and continue to thrive. Their modus operandi runs counter to a lot of preconceptions about what it takes to be a good leader. They're rough, loud, and in your face. Their tactics include invading others' personal space, staging tantrums, keeping people guessing, and possessing an indisputable command of facts. But make no mistake--great intimidators are not your typical bullies. They're driven by vision, not by sheer ego or malice. Beneath their tough exteriors and sharp edges are some genuine, deep insights into human motivation and organizational behavior. Indeed, these leaders possess political intelligence, which can make the difference between paralysis and successful--if sometimes wrenching--organizational change. Like socially intelligent leaders, politically intelligent leaders are adept at sizing up others, but they notice different things. Those with social intelligence assess people's strengths and figure out how to leverage them; those with political intelligence exploit people's weaknesses and insecurities. Despite all the obvious drawbacks of working under them, great intimidators often attract the best and brightest. And their appeal goes beyond their ability to inspire high performance. Many accomplished professionals who gravitate toward these leaders want to cultivate a little "inner intimidator" of their own. In the author's research, quite a few individuals reported having positive relationships with intimidating leaders. In fact, some described these relationships as profoundly educational and even transformational. So before we throw out all the great intimidators, the author argues, we should stop to consider what

  11. Personal care assistants' experiences of caring for people on home mechanical ventilation.

    PubMed

    Israelsson-Skogsberg, Åsa; Lindahl, Berit

    2017-03-01

    The aim of this study was to describe personal care assistants' (PCA) experiences of working with a ventilator-assisted person at home. Data were collected from fifteen audiotaped semistructured interviews with PCAs supporting a child or adult using home mechanical ventilation (HMV). Thirteen women and two men participated; their working experience with HMV users ranged from one to 17 years (median 6 years). Data were subjected to qualitative content analysis in an inductive and interpretive manner. Five categories emerged from the data: Being part of a complex work situation; Taking on a multidimensional responsibility; Caring carried out in someone's home; Creating boundaries in an environment with indistinct limits; and Being close to another's body and soul. The participants felt very close to the person they worked with, both physically and emotionally. They had a great responsibility and therefore a commensurate need for support, guidance and a well-functioning organisation around the HMV user. There is international consensus that advanced home care will continue to expand and personal care assistance is key in this development. We suggest that one way to move forward for PCAs working with HMV users is to create multiprofessional teams led by a key-person who coordinates the individual needs. More research is needed within this area from a broad perspective including the HMV-assisted persons, relatives, personal care assistants and management organisations. © 2016 Nordic College of Caring Science.

  12. The Great Kanto earthquake and F. Scott Fitzgerald

    NASA Astrophysics Data System (ADS)

    Kawakatsu, Hitoshi; Bina, Craig R.

    How many recall the following striking sentence from The Great Gatsby by F. Scott Fitzgerald, which appears on the second page of the novel, where Fitzgerald first introduces Gatsby? “If personality is an unbroken series of successful gestures, then there was something gorgeous about him, some heightened sensitivity to the promises of life, as if he were related to one of those intricate machines that register earthquakes ten thousand miles away.”This line may have failed to focus our attention when we first read the book in our younger days. Now, however, as a Japanese seismologist and an American geophysicist (and student of Japanese culture), we would be greatly remiss for failing to take greater note of this statement. Indeed, as The Great Gatsby was published in 1925, it occurred to us that the earthquake Fitzgerald might have been thinking of was the Great Kanto earthquake, which occurred on September 1, 1923 and devastated the Tokyo metropolitan area.

  13. Vital signs: taking the pulse of your managed care contract performance.

    PubMed

    Waymack, Pamela M; Ward, William J

    2005-07-01

    Three essential baseline measures of managed care performance that should be reported on a regular basis are: Overall profitability of the organization's managed care portfolio. Payer mix and profitability. Performance of major managed care contracts.

  14. Factors influencing nurse and pharmacist willingness to take or not take responsibility for non-medical prescribing.

    PubMed

    Maddox, C; Halsall, D; Hall, J; Tully, M P

    2016-01-01

    In the UK, the majority of non-medical prescribers (NMPs) are nurses or pharmacists working in community or primary care. However, little is known about what influences their decisions to prescribe, unlike with medical prescribing. It is also unclear whether the medical findings can be extrapolated, given their very different prescribing training. To explore the factors influencing whether nurse and pharmacist NMPs in community and primary care settings take responsibility for prescribing. Initially, 20 NMPs (15 nurses and 5 pharmacists) were purposively selected and interviewed using the critical incident technique about situations where they felt it was inappropriate for them to take responsibility for prescribing or where they were uneasy about doing so. In addition, more general factors influencing their decision to take or not take prescribing responsibility were discussed. Subsequently, the themes from the interview analysis were validated in three focus groups with a total of 10 nurse NMPs. All data were analyzed using a constant comparison approach. Fifty-two critical incidents were recorded--12 from pharmacist NMPs and 40 from nurse NMPs. Participants experienced situations where they were reluctant to accept responsibility for prescribing. Perceptions of competency, role and risk influenced their decision to prescribe. Workarounds such as delaying the prescribing decision or refer the patient to a doctor were used. For NMPs to feel more confident about taking responsibility for prescribing, these issues of competency, role and perceived risk need to be addressed. Roles of NMPs must be clear to colleagues, doctors and patients. Training and support must be provided to enable professional development and increasing competence of NMPs. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. The Great Red Spot Plunge (animation)

    NASA Image and Video Library

    2017-12-11

    This frame from an animation takes the viewer on a simulated flight into, and then out of, Jupiter's upper atmosphere at the location of the Great Red Spot. The perspective begins about 2,000 miles (3,000 kilometers) above the cloud tops of the planet's southern hemisphere. The bar at far left indicates altitude during the quick descent; a second gauge next to that depicts the dramatic increase in temperature that occurs as the perspective dives deeper down. The clouds turn crimson as the perspective passes through the Great Red Spot. Finally, the view ascends out of the spot. This video was created by combining an image from the JunoCam imager on NASA's Juno spacecraft with a computer-generated animation. The animation is available at https://photojournal.jpl.nasa.gov/catalog/PIA22176

  16. Standard operating procedures for taking a sexual history.

    PubMed

    Althof, Stanley E; Rosen, Raymond C; Perelman, Michael A; Rubio-Aurioles, Eusebio

    2013-01-01

    While there is evidence of increased professional and public awareness of sexual problems, both male and female sexual dysfunctions remain underdiagnosed and undertreated by health care professionals around the world. Health care professionals (HCPs) are typically reluctant, disinterested, or unskilled in sexual problem management and regrettably are often disinclined to inquire about sexual issues. HCPs in all countries receive variable, nonstandardized, or inadequate training in sexual history taking and its treatment. This article presents a standard operating procedure (SOP) for taking a sexual history from men or women with sexual problems or performance concerns. Review of relevant evidence-based literature identified through a PubMed search, integrated with expert opinion. Guidelines for taking a sexual history are presented along with the relevant domains, opening and follow-up questions. The SOP presented in this article offers HCPs a brief, structured, and uniform method for obtaining a sexual history from men or women seeking health care services. Sexual history taking should be based on three basic principles, which serve as the foundation for managing sexual problems in men and women. These include the following: (i) a patient-centered approach; (ii) evidenced-based diagnostic and treatment recommendations; and (iii) use of a unified management approach for men and women. Sexual history taking should always be conducted in a culturally sensitive manner, taking account of the individual's background and lifestyle, status of the partner relationship, and the clinician's comfort and experience with the topic. Sexual inquiry should be incorporated into all new patient encounters, when possible, if only to ask one or two broad questions such as the following: "Are you sexually active? Do you have any sexual concerns or problems you would like to discuss?" Sexual history taking is a cornerstone of sexual medicine clinical practice. All patients should be

  17. The potential for multi-disciplinary primary health care services to take action on the social determinants of health: actions and constraints

    PubMed Central

    2013-01-01

    Background The Commission on the Social Determinants of Health and the World Health Organization have called for action to address the social determinants of health. This paper considers the extent to which primary health care services in Australia are able to respond to this call. We report on interview data from an empirical study of primary health care centres in Adelaide and Alice Springs, Australia. Methods Sixty-eight interviews were held with staff and managers at six case study primary health care services, regional health executives, and departmental funders to explore how their work responded to the social determinants of health and the dilemmas in doing so. The six case study sites included an Aboriginal Community Controlled Organisation, a sexual health non-government organisation, and four services funded and managed by the South Australian government. Results While respondents varied in the extent to which they exhibited an understanding of social determinants most were reflexive about the constraints on their ability to take action. Services’ responses to social determinants included delivering services in a way that takes account of the limitations individuals face from their life circumstances, and physical spaces in the primary health care services being designed to do more than simply deliver services to individuals. The services also undertake advocacy for policies that create healthier communities but note barriers to them doing this work. Our findings suggest that primary health care workers are required to transverse “dilemmatic space” in their work. Conclusions The absence of systematic supportive policy, frameworks and structure means that it is hard for PHC services to act on the Commission on the Social Determinants of Health’s recommendations. Our study does, however, provide evidence of the potential for PHC services to be more responsive to social determinants given more support and by building alliances with communities and

  18. The potential for multi-disciplinary primary health care services to take action on the social determinants of health: actions and constraints.

    PubMed

    Baum, Frances E; Legge, David G; Freeman, Toby; Lawless, Angela; Labonté, Ronald; Jolley, Gwyneth M

    2013-05-10

    The Commission on the Social Determinants of Health and the World Health Organization have called for action to address the social determinants of health. This paper considers the extent to which primary health care services in Australia are able to respond to this call. We report on interview data from an empirical study of primary health care centres in Adelaide and Alice Springs, Australia. Sixty-eight interviews were held with staff and managers at six case study primary health care services, regional health executives, and departmental funders to explore how their work responded to the social determinants of health and the dilemmas in doing so. The six case study sites included an Aboriginal Community Controlled Organisation, a sexual health non-government organisation, and four services funded and managed by the South Australian government. While respondents varied in the extent to which they exhibited an understanding of social determinants most were reflexive about the constraints on their ability to take action. Services' responses to social determinants included delivering services in a way that takes account of the limitations individuals face from their life circumstances, and physical spaces in the primary health care services being designed to do more than simply deliver services to individuals. The services also undertake advocacy for policies that create healthier communities but note barriers to them doing this work. Our findings suggest that primary health care workers are required to transverse "dilemmatic space" in their work. The absence of systematic supportive policy, frameworks and structure means that it is hard for PHC services to act on the Commission on the Social Determinants of Health's recommendations. Our study does, however, provide evidence of the potential for PHC services to be more responsive to social determinants given more support and by building alliances with communities and social movements. Further research on the value

  19. Case Management Takes Hold in Long-Term Care.

    ERIC Educational Resources Information Center

    Rose, Stephen M.; And Others

    1992-01-01

    Includes "Empowering Case Management Clients" (Rose); "Case Management in Rural Japan" (Maeda, Takahashi); "Coordinated-Care Teams" (Brodsky, Sobol); "Comparing Practice in the United States and the United Kingdom" (Sturges); "Business of Case Management Flourishing in the U.S." (Cress); and…

  20. Developing a Consensus-based Definition of "Kokoro-no Care" or Mental Health Services and Psychosocial Support: Drawing from Experiences of Mental Health Professionals Who Responded to the Great East Japan Earthquake.

    PubMed

    Suzuki, Yuriko; Fukasawa, Maiko; Nakajima, Satomi; Narisawa, Tomomi; Keiko, Asano; Kim, Yoshiharu

    2015-01-29

    In this survey, we aimed to build consensus and gather opinions on 'Kokoro-no care' or mental health services and psychosocial support (MHSPSS) after a disaster, among mental health professionals who engaged in care after the Great East Japan Earthquake. We recruited mental health professionals who engaged in support activities after the Great East Japan Earthquake, which included local health professionals in the affected areas and members of mental health care teams dispatched from outside (n = 131). Adopting the Delphi process, we proposed a definition of 'Kokoro-no care', and asked the participants to rate the appropriateness on a 5-point Likert scale. We also solicited free comments based on the participants' experiences during the disaster. After Round 1, we presented the summary statistics and comments, and asked the participants to re-rate the definition that had been modified based on their comments. This process was repeated twice, until the consensus criterion of ≥ 80% of the participants scoring ≥ 4 on the statement was fulfilled. In Round 1, 68.7% of the respondents rated the proposed definition ≥ 4 for its appropriateness, and 88.4% did so in Round 2. The comments were grouped into categories (and subcategories) based on those related to the definition in general (Appropriate, Continuum of MHSPSS, Cautions in operation, Alternative categorisation of care components, Whether the care component should be categorised according to the professional involved, Ambiguous use of psychology, and Others), to mental health services (Appropriate, More specification within mental health services, More explicit remarks on mental health services, and Others), and to psychosocial support (Whether the care component should be categorised according to the professional involved, Raising concerns about the terms, and Others), and others. We achieved a consensus on the definition of 'Kokoro-no care', and systematically obtained suggestions on the concept, and

  1. Taking Metabolomics to the Field: A Pilot Study in a Great Lakes Area of Concern (AOC)

    EPA Science Inventory

    Measurement of changes in endogenous metabolites via 1H-NMR-based metabolomics has shown great potential for assessing organisms exposed to environmental pollutants, and thus could aid the efforts of risk assessors. However, to date, the application of metabolomics to ecologi...

  2. Care 3 phase 2 report, maintenance manual

    NASA Technical Reports Server (NTRS)

    Bryant, L. A.; Stiffler, J. J.

    1982-01-01

    CARE 3 (Computer-Aided Reliability Estimation, version three) is a computer program designed to help estimate the reliability of complex, redundant systems. Although the program can model a wide variety of redundant structures, it was developed specifically for fault-tolerant avionics systems--systems distinguished by the need for extremely reliable performance since a system failure could well result in the loss of human life. It substantially generalizes the class of redundant configurations that could be accommodated, and includes a coverage model to determine the various coverage probabilities as a function of the applicable fault recovery mechanisms (detection delay, diagnostic scheduling interval, isolation and recovery delay, etc.). CARE 3 further generalizes the class of system structures that can be modeled and greatly expands the coverage model to take into account such effects as intermittent and transient faults, latent faults, error propagation, etc.

  3. Second-Generation Outcomes of the Great Migration.

    PubMed

    Alexander, J Trent; Leibbrand, Christine; Massey, Catherine; Tolnay, Stewart

    2017-12-01

    The mass migration of African Americans out of the South during the first two-thirds of the twentieth century represents one of the most significant internal migration flows in U.S. Those undertaking the Great Migration left the South in search of a better life, and their move transformed the cultural, social, and political dynamics of African American life specifically and U.S. society more generally. Recent research offers conflicting evidence regarding the migrants' success in translating their geographic mobility into economic mobility. Due in part to the lack of a large body of longitudinal data, almost all studies of the Great Migration have focused on the migrants themselves, usually over short periods of their working lives. Using longitudinally linked census data, we take a broader view, investigating the long-term economic and social effects of the Great Migration on the migrants' children. Our results reveal modest but statistically significant advantages in education, income, and poverty status for the African American children of the Great Migration relative to the children of southerners who remained in the South. In contrast, second-generation white migrants experienced few benefits from migrating relative to southern or northern stayers.

  4. Great Lakes: Great Gardening.

    ERIC Educational Resources Information Center

    New York Sea Grant Inst., Albany, NY.

    This folder contains 12 fact sheets designed to improve the quality of gardens near the Great Lakes. The titles are: (1) "Your Garden and the Great Lakes"; (2) "Organic Gardening"; (3) "Fruit and Vegetable Gardening"; (4) "Composting Yard Wastes"; (5) "Herbicides and Water Quality"; (6)…

  5. Taking Care: Understanding the Roles of Caregiver and Being Cared for in a Kindergarten Classroom

    ERIC Educational Resources Information Center

    Quigley, Cassie F.; Hall, Anna H.

    2016-01-01

    Despite concerns about the importance of teachers learning to care for their students, most teacher education programs do not utilize relational pedagogy and place little emphasis on caring. In the current study, the authors used conversational interviews with one kindergarten teacher and photo-elicitation interviews with her 22 kindergarten…

  6. Risk-taking attitudes and their association with process and outcomes of cardiac care: a cohort study

    PubMed Central

    King, Kathryn M; Norris, Colleen M; Knudtson, Merril L; Ghali, William A

    2009-01-01

    Background Prior research reveals that processes and outcomes of cardiac care differ across sociodemographic strata. One potential contributing factor to such differences is the personality traits of individuals within these strata. We examined the association between risk-taking attitudes and cardiac patients' clinical and demographic characteristics, the likelihood of undergoing invasive cardiac procedures and survival. Methods We studied a large inception cohort of patients who underwent cardiac catheterization between July 1998 and December 2001. Detailed clinical and demographic data were collected at time of cardiac catheterization and through a mailed survey one year post-catheterization. The survey included three general risk attitude items from the Jackson Personality Inventory. Patients' (n = 6294) attitudes toward risk were categorized as risk-prone versus non-risk-prone and were assessed for associations with baseline clinical and demographic characteristics, treatment received (i.e., medical therapy, coronary artery bypass graft (CABG) surgery, percutaneous coronary intervention (PCI)), and survival (to December 2005). Results 2827 patients (45%) were categorized as risk-prone. Having risk-prone attitudes was associated with younger age (p < .001), male sex (p < .001), current smoking (p < .001) and higher household income (p < .001). Risk-prone patients were more likely to have CABG surgery in unadjusted (Odds Ratio [OR] = 1.21; 95% CI 1.08–1.36) and adjusted (OR = 1.18; 95% CI 1.02–1.36) models, but were no more likely to have PCI or any revascularization. Having risk-prone attitudes was associated with better survival in an unadjusted survival analysis (Hazard Ratio [HR] = 0.78 (95% CI 0.66–0.93), but not in a risk-adjusted analysis (HR = 0.92, 95% CI 0.77–1.10). Conclusion These exploratory findings suggest that patient attitudes toward risk taking may contribute to some of the documented differences in use of invasive cardiac procedures

  7. Obstacles to the take-up of mental health-care provision by adult males in rural and remote areas of Australia: A systematic review protocol.

    PubMed

    Stroud, Peter; Lockwood, Craig

    The objective is to identify and synthesise the best available evidence on the obstacles to the take-up of health-care provision by adult rural and remote dwelling males in Australia seeking mental health services. Men's health, in general health-care practice, is defined as the global management of mental, emotional, and physical health conditions, and related risk factors, that are specific to men in order to promote and generate optimal health.Research and practice tends to suggest that health-care and mental-health care practitioners seem to be confronted with obstacles such as distance clients need to travel and rurality in delivering care to adult rural males. Possible issues might be whether, or to what extent, care providers are conscious of these obstacles. Another issue might be how care providers work with these obstacles in practice, and whether or not they may, also to some extent, share some of the responsibility for the existence of these obstacles, on their own, or in conjunction with other factors which might be said to exist purely in the rural context. There is also a need to explore the contributions to obstacles from the adult rural male side as well. There may also be factors at work in the particular unique nature of rural and remote health-care and mental-health care as well, which could also be involved in the creation of obstacles.The structure and functioning of rural care available to adult males of all cultural backgrounds and the obstacles to the take-up of that care represents an area which warrants further exploration and understanding. A foundation paper in this field by Karoski suggests that obstacles exist in health-care provision, particularly in the field of mental-health care to adult males. Other research suggests that, while obstacles in service provision are common to all areas, some obstacles are more significant for rural and remote areas.The reasons for framing this review in terms of the adult rural and remote male (ARRM

  8. Nurses' willingness to take care of people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)--does a teaching intervention make a difference?

    PubMed

    Mockiene, Vida; Suominen, Tarja; Välimäki, Maritta; Razbadauskas, Arturas; Caplinskas, Saulius; Martinkenas, Arvydas

    2011-08-01

    The aim of this study is to describe the impact of an education intervention programme on nurses' willingness to care for HIV-positive people in Lithuania. The study utilizes a randomized controlled trial design (RCT). The total sample comprises 185 nurses working in medical, surgical and gynaecological units, and primary health care centres from the same hospital areas in three Lithuanian hospitals. The data were analyzed using SPSS 12.0 and descriptive statistics. Our educational intervention did not have an impact on the nurses' willingness to take care of people living with HIV (PLHIV), as their level of willingness was high already before the education intervention. Further research on this issue is needed to try to understand the forces acting on our nursing staff in order to ensure appropriate care for PLHIV. Copyright © 2010 Elsevier Ltd. All rights reserved.

  9. Emergency thoracotomy. Care of the patient in the OR: a case study.

    PubMed

    Singer, N

    1987-12-01

    As an OR staff nurse at Cook County Hospital, some of my most challenging and rewarding nursing experiences have come from caring for emergency open-chest trauma patients. From the moment we receive a call that an open-chest patient is on the way, everyone assigned is in a high state of tension. Every decision takes on exaggerated importance. The circulating nurse, by virtue of his or her position during an emergency, is the "hub of the wheel" of activity. He or she is privy to all facets of care that are being administered to the patient. The nursing challenge of the emergency open-chest trauma is great, but it is not an impossible task.

  10. Critical Care

    MedlinePlus

    Critical care helps people with life-threatening injuries and illnesses. It might treat problems such as complications from surgery, ... attention by a team of specially-trained health care providers. Critical care usually takes place in an ...

  11. When populism takes over the delivery of health care: Venezuela.

    PubMed

    Daryanani, Sunil

    2017-01-01

    Adequate and modern health care is not available in Venezuela at this moment. A humanitarian crisis of post war dimensions is currently rampant and afflicting all Venezuelans alike. The delivery and availability of cancer care is severely limited and inadequate. No funding is available as populist measures, mismanagement, pillaging, corruption, lack of forethought and expertise have brought the country into severe economic collapse and political turmoil.

  12. When populism takes over the delivery of health care: Venezuela

    PubMed Central

    Daryanani, Sunil

    2017-01-01

    Adequate and modern health care is not available in Venezuela at this moment. A humanitarian crisis of post war dimensions is currently rampant and afflicting all Venezuelans alike. The delivery and availability of cancer care is severely limited and inadequate. No funding is available as populist measures, mismanagement, pillaging, corruption, lack of forethought and expertise have brought the country into severe economic collapse and political turmoil. PMID:29225695

  13. Quantitative interpretation of Great Lakes remote sensing data

    NASA Technical Reports Server (NTRS)

    Shook, D. F.; Salzman, J.; Svehla, R. A.; Gedney, R. T.

    1980-01-01

    The paper discusses the quantitative interpretation of Great Lakes remote sensing water quality data. Remote sensing using color information must take into account (1) the existence of many different organic and inorganic species throughout the Great Lakes, (2) the occurrence of a mixture of species in most locations, and (3) spatial variations in types and concentration of species. The radiative transfer model provides a potential method for an orderly analysis of remote sensing data and a physical basis for developing quantitative algorithms. Predictions and field measurements of volume reflectances are presented which show the advantage of using a radiative transfer model. Spectral absorptance and backscattering coefficients for two inorganic sediments are reported.

  14. Taking Legal Histories in Psychiatric Assessments.

    PubMed

    Morris, Nathaniel P

    2018-05-25

    People with mental illness are often disproportionately affected by the U.S. justice system, yet psychiatrists and other mental health professionals may avoid or feel uncomfortable talking with patients about legal history. This column examines why legal history is relevant to psychiatric assessments and provides guidance for talking with patients about these issues. Key aspects of taking a legal history are reviewed, including suggested questions, the role of collateral information, and considerations for medicolegal documentation. Developing skills in taking patients' legal histories may equip clinicians to better understand their patients' stories and to provide more effective psychiatric care.

  15. Introduction to Integrative Medicine in the Primary Care Setting.

    PubMed

    Ring, Melinda; Mahadevan, Rupa

    2017-06-01

    Integrative Medicine has been described as "healing oriented medicine that takes account of the whole person (body, mind, and spirit) including all aspects of lifestyle. It emphasizes therapeutic relationships and makes use of all appropriate therapies, both conventional and alternative." National surveys consistently report that approximately one-third of adults and 12% of children use complementary and integrative medicine approaches. Although there are barriers to primary care professionals engaging in discussions about lifestyle change and complementary and integrative medicine options, there is also great potential to impact patient well-being. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. The Role of Care Coordinator for Children with Complex Care Needs: A Systematic Review

    PubMed Central

    Hillis, Rowan; Larkin, Philip J; Cawley, Des; Connolly, Michael

    2016-01-01

    Introduction: This systematic review seeks to identify the intended components of the role of care coordinator for children with complex care needs and the factors that determine its composition in practice. Theory and methods: The initial search identified 1,157 articles, of which 37 met the inclusion criteria. They were quality assessed using the SIGN hierarchy of evidence structure. Results: Core components of the role include: coordination of care needs, planning and assessment, specialist support, emotional support, administration and logistics and continuing professional development. Influencing factors on the role include the external environment (political and socio-economic), the internal environment (organisational structure and funding protocols), the skills, qualifications and experience of the coordinator, the family circumstances and the nature of the interaction between the care coordinator and the family. Discussion: The lack of consistent terminology creates challenges and there is a need for greater consensus on this issue. Organisations and healthcare professionals need to recognise the extent to which contextual factors influence the role of a care coordinator in practice and plan accordingly. Despite evidence that suggests that the role is pivotal in ensuring that care needs are sustained, there remains great variability in the understanding of the role of a care coordinator for this population. Conclusions: As the provision of care increasingly moves closer to home there is a need for greater understanding of the nature and composition of the interaction between care coordinators and families to determine the extent to which appropriate services are being provided. Further work in this area should take into consideration any potential variance in service provision, for example any potential inequity arising due to geographic location. It is also imperative, where appropriate, to seek the views of children with complex care needs and their

  17. The Great Recession and Health Spending among Uninsured U.S. Immigrants: Implications for the Affordable Care Act Implementation

    PubMed Central

    Bustamante, Arturo Vargas; Chen, Jie

    2014-01-01

    Objective We study the association between the timing of the Great Recession (GR) and health spending among uninsured adults distinguishing by citizenship/nativity status and time of U.S. residence. Data Source Uninsured U.S. citizens and noncitizens from the 2005–2006 and 2008–2009 Medical Expenditure Panel Survey. Study Design The probability of reporting any health spending and the natural logarithm of health spending are our main dependent variables. We compare health spending across population categories before/during the GR. Subsequently, we implement two-part regression analyses of total and specific health-spending measures. We predict average health spending before/during the GR with a smearing estimation. Principal Findings The probability of reporting any spending diminished for recent immigrants compared to citizens during the GR. For those with any spending, recent immigrants reported higher spending during the GR (27 percent). Average reductions in total spending were driven by the decline in the share of the population reporting any spending among citizens and noncitizens. Conclusions Our study findings suggest that recent immigrants could be forgoing essential care, which later translates into higher spending. It portrays the vulnerability of a population that would remain exposed to income shocks, even after the Affordable Care Act (ACA) implementation. PMID:24962550

  18. 20 CFR 10.505 - What actions must the employer take?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... AMENDED Continuing Benefits Return to Work-Employer's Responsibilities § 10.505 What actions must the employer take? Upon authorizing medical care, the employer should advise the employee in writing as soon as... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false What actions must the employer take? 10.505...

  19. The Great American Recession and forgone healthcare: Do widened disparities between African-Americans and Whites remain?

    PubMed

    Travers, Jasmine L; Cohen, Catherine C; Dick, Andrew W; Stone, Patricia W

    2017-01-01

    During the Great Recession in America, African-Americans opted to forgo healthcare more than other racial/ethnic groups. It is not understood whether disparities in forgone care returned to pre-recession levels. Understanding healthcare utilization patterns is important for informing subsequent efforts to decrease healthcare disparities. Therefore, we examined changes in racial disparities in forgone care before, during, and after the Great Recession. Data were pooled from the 2006-2013 National Health Interview Survey. Forgone medical, mental, and prescription care due to affordability were assessed among African-Americans and Whites. Time periods were classified as: pre-recession (May 2006-November 2007), early recession (December 2007-November 2008), late recession (December 2008-May 2010) and post-recession (June 2010-December 2013). Multivariable logistic regressions of race, interacted with time periods, were used to identify disparities in forgone care controlling for other demographics, health insurance coverage, and having a usual place for medical care across time periods. Adjusted Wald tests were performed to identify significant changes in disparities across time periods. The sample consisted of 110,746 adults. African-Americans were more likely to forgo medical care during the post- recession compared to Whites (OR = 1.16, CI = 1.06, 1.26); changes in foregone medical care disparities were significant in that they increased in the post-recession period compared to the pre-recession (OR = 1.17, CI = 1.08, 1.28 and OR = 0.89, CI = 0.77, 1.04, respectively, adjusted Wald Test p-value < 0.01). No changes in disparities were seen in prescription and mental forgone care. A persistent increase in forgone medical care disparities existed among African-Americans compared to Whites post-Great Recession and may be a result of outstanding issues related to healthcare access, cost, and quality. While health insurance is an important component of access to care, it

  20. Compiling, costing and funding complex packages of home-based health care.

    PubMed

    Noyes, Jane; Lewis, Mary

    2007-06-01

    Nurses play a central role in putting together complex packages of care to support children with complex healthcare needs and their families in the community. However, there is little evidence or guidance to support this area of practice. At present, the process of compiling a care package and obtaining funding takes too long, causing significant delays in discharge and great frustration for parents, children and professionals. This article presents a combination of best practice guidance and, where possible, evidence-based principles that can be adapted and applied to an individual case irrespective of the child's diagnosis. The aim is to assist nurses and other healthcare professionals in organising funding for packages of care, bringing about the desired outcomes of successful discharge and appropriate community support. To work effectively as keyworkers for these children and families nurses need knowledge and skills in relation to: multidisciplinary assessment frameworks and processes, identifying appropriate models of service provision, costing care packages and approaches to obtaining funding. A further article next month will address risk management and clinical governance issues in delivering complex home-based care.

  1. Medicaid: taking stock.

    PubMed

    Davidson, S M

    1993-01-01

    In the last few years, Medicaid has attracted more than casual attention, one reflection of which is the fact that JHPPL has published five papers on the program in its last few issues. This paper, a sixth, takes a broader view of the program than is typically the case. After a critique of the five recent articles, I discuss several questions raised by them and reach the following conclusions: First, the states do not invest enough in producing program data suitable for policy analysis and research. One lesson: Better data and analysis can help the states to avoid expensive mistakes. Second, those policy analyses that have been offered fail to give sufficient attention to the political dimension of policy. That is one reason why policy choices produce unexpected effects. Third, since Medicaid is a relatively small player in the vast medical care market, incentives adopted by Medicaid officials throughout the country rarely have the desired effects. Finally, as long as Medicaid remains the principal mechanism to provide access to health care for the poor, it must be made as efficient and effective as possible. Yet, for both political and economic reasons, Medicaid can never be what its original planners had hoped, the vehicle for providing the poor with reliable access to mainstream medical care.

  2. Lost in the Great Divide: Motivation in Religious Studies Classrooms

    ERIC Educational Resources Information Center

    Gravett, Emily O.

    2018-01-01

    One of the most illuminating finds in Barbara E. Walvoord's "Teaching and Learning in College Introductory Religion Courses" (2008) is what she calls "the great divide," a mismatch between instructors' goals for their courses, which are academic, and the students' reasons for taking them, which relate to their personal…

  3. [Primary care in Belgium].

    PubMed

    Sánchez-Sagrado, T

    2017-09-01

    Belgium is an attractive country to work in, not just for doctors but for all Spanish workers, due to it having the headquarters of European Union. The health job allure is double; on the one hand, the opportunity to find a decent job, and on the other, because it is possible to develop their professional abilities with patients of the same nationality in a health system with a different way of working. The Belgium health care system is based on security social models. Health care is financed by the government, social security contributions, and voluntary private health insurance. Primary care in Belgium is very different to that in Spain. Citizens may freely choose their doctor (general practitioner or specialist) increasing the lack of coordination between primary and specialized care. This leads to serious patient safety problems and loss of efficiency within the system. Belgium is a European country with room to improve preventive coverage. General practitioners are self-employed professionals with free choice of setting, and their salary is linked to their professional activity. Ambulatory care is subjected to co-payment, and this fact leads to great inequities on access to care. The statistics say that there is universal coverage but, in 2010, 14% of the population did not seek medical contact due to economic problems. It takes 3 years to become a General Practitioner and continuing medical education is compulsory to be revalidated. In general, Belgian and Spaniards living and working in Belgium are happy with the functioning of the health care system. However, as doctors, we should be aware that it is a health care system in which access is constrained for some people, and preventive coverage could be improved. Copyright © 2016 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Caregiver Leave-Taking in Spain: Rate, Motivations, and Barriers.

    PubMed

    Rogero-García, Jesús; García-Sainz, Cristina

    2016-01-01

    This paper aims to (1) determine the rate of (full- and part-time) caregiver leave-taking in Spain, (2) identify the reasons conducive to a more intense use of this resource, and (3) ascertain the main obstacles to its use, as perceived by caregivers. All 896 people covered by the sample were engaging in paid work and had cared for dependent adults in the last 12 years. This resource, in particular the full-time alternative, was found to be a minority option. The data showed that legal, work-related, and family and gender norm issues are the four types of factors that determine the decision to take such leaves. The most significant obstacles to their use are the forfeiture of income and the risk of losing one's job. Our results suggest that income replacement during a leave would increase the take-up of these resources. Moreover, enlargement of public care services would promote the use of leave as a free choice of caregivers.

  5. Kidney stones - self-care

    MedlinePlus

    ... self-care; Nephrolithiasis and self-care; Stones and kidney - self-care; Calcium stones and self-care; Oxalate ... provider or the hospital because you have a kidney stone. You will need to take self-care ...

  6. Great horned owls are released at CCAFS

    NASA Technical Reports Server (NTRS)

    2000-01-01

    A great horned owl flies to freedom after its release at Cape Canaveral Air Force Station, Complex 25/29. The owl is one of two found in June on the floor of CCAFS Hangar G, where their nest was located. They were treated at a local veterinary hospital and then taken to the Florida Wildlife Hospital in Melbourne for care and rehabilitation before release.

  7. "Nailing" the management of the ingrown great toenail.

    PubMed

    Block, Stan L

    2014-11-01

    "Nailing" the management of the severely ingrown great toenail, commonly encountered in the adolescent population, is an important tool in the pediatrician's armamentarium. I have found great toenail removal to be worthwhile, with straightforward indications; and quite rewarding for my patients in terms of time, convenience, and costs. The key to the procedure is to keep it simple. Four basic vital steps are involved: (1) operative permit and explanation; (2) performing a careful complete digital nerve block; (3) removing the entire toenail; and, importantly, (4) performing a partial chemical matricectomy--with readily available silver nitrate sticks--to prevent frequent recurrences. Copyright 2014, SLACK Incorporated.

  8. Top 10 Tips for Taking an Elderly Parent to the Emergency Department

    MedlinePlus

    ... Department Top 10 Tips for Taking an Elderly Parent to the Emergency Department With America's rapidly growing ... to seek emergency care. Caring for an elderly parent is one of the most important things an ...

  9. Caring Science and the Development of Forensic Psychiatric Caring.

    PubMed

    Hörberg, Ulrica

    2015-10-01

    This study aimed to discuss how caring science can contribute and provide a theoretical foundation for the development of caring within forensic psychiatric care. It is not only a challenge but also a great opportunity to use caring science theory within forensic psychiatric care when caring for the patients and supporting their health processes. There is a need for more knowledge about, understanding of, and willingness to care for patients within forensic psychiatric settings in a "true caring" way. In order to achieve this, a caring culture is required, one that supports carers and provides them with opportunities to further develop a caring attitude. © 2014 Wiley Periodicals, Inc.

  10. Campus Daddies: Unwed Fathers Take on Responsibilities of Babies and Books.

    ERIC Educational Resources Information Center

    Taylor, Ronald A.

    1995-01-01

    Increasingly, unwed black fathers are taking responsibility for their children's care while fulfilling their roles as college students. Localities and institutions are offering more programs of day care and referral to school and social services to provide support to these fathers. (MSE)

  11. Is there a need for health care rationing?

    NASA Astrophysics Data System (ADS)

    Baily, Mary Ann

    1995-10-01

    Rising expenditures on health care have become a major cause for public concern. Attention focuses on the level of expenditures and the increasing share they take of GNP, but for most Americans, the real issue is not how much society spends, but what it gets for the money. There are several ways in which it could be said that the United States fails to get full value for the dollars spent on health care. Some care does not benefit, or even harms, those who receive it. Some care is beneficial but could be produced with fewer resources. Some care is efficiently produced and yields benefits, but the benefits are not worth their cost. And finally, despite the system's cost, many people are excluded from it and thus fail to receive care of great benefit. The need to address the problem of wasteful care is relatively uncontroversial. Everyone agrees that it would be desirable to eliminate care of no benefit and to produce beneficial care as efficiently as possible. There is also a growing consensus that steps must be taken soon to improve access. There is far less agreement on what, if anything, needs to be done about care whose benefits are not worth their cost. The public's limited understanding of this issue is an obstacle to good health policy. Meaningful debate about health care reform must include open and informed discussion of the extent to which different reform proposals will restrict beneficial care, how they will do it, and how well the results will reflect the preferences and values of the

  12. [The organization of maternity and child care in the Buryat-Mongolskaya ASSR during the Great Patriotic War].

    PubMed

    Batoev, S D

    2010-01-01

    In Ulan-Ude, in 1942, the mortality of children at the age from 0 to 15 years consisted 64% of total numbers of died persons. The main causes of children mortality during all the war were tuberculosis, pneumonia, toxic dyspepsia and diarrhea. In October 1942, the government adopted a special decree obligated Narcomzdrav of the USSR to re-establish the system of maternity and child care existed before the war. The focus was made on the district principle of functioning of women and children consultations and polyclinics and to take measures to enhance the children diet and food vitaminization. In Buryat-Mongolskaya ASSR, during the war period, no epidemics of infectious diseases were allowed. In this difficult period of life the first multifield children hospital and municipal infection hospital with children beds were established and functioned with success.

  13. Taking Pressure off Families: Child-Care Subsidies Lessen Mothers' Work-Hour Problems

    ERIC Educational Resources Information Center

    Press, Julie E.; Fagan, Jay; Laughlin, Lynda

    2006-01-01

    We use the Philadelphia Survey of Child Care and Work to model the effect of child-care subsidies and other ecological demands and resources on the work hour, shift, and overtime problems of 191 low-income urban mothers. Comparing subsidy applicants who do and do not receive cash payments for child care, we find that mothers who receive subsidies…

  14. Education in Great Britain and Ireland. Bulletin, 1919, No. 9

    ERIC Educational Resources Information Center

    Kandel, I. L.

    1919-01-01

    The educational movements that have been taking place in Great Britain during the past two or three years have aroused widespread interest among teachers and publicists in this country. This report is an attempt to analyze these movements and to indicate their significance in the broader movement for reconstruction. The educational reforms that…

  15. A Pilot Study of a Creative Bonding Intervention to Promote Nursing Students' Attitudes towards Taking Care of Older People

    PubMed Central

    Lamet, Ann R.; Sonshine, Rosanne; Walsh, Sandra M.; Molnar, David; Rafalko, Sharon

    2011-01-01

    Although numbers of older people are increasing, nursing students have negative attitudes towards older people and do not plan to care for them following graduation. Multiple strategies have been implemented to reverse students' attitudes with mixed results. The purpose of this pilot quasi-experimental study was to test a Creative-Bonding Intervention (CBI) with students implementing art activities with older people to promote students' willingness to take care of them. Using a self-transcendence conceptual framework, control (n = 56) and experimental (n = 14) student groups were pre- and post-tested on attitudes toward older people, self-transcendence, and willingness to serve. The CBI improved attitudes towards older people with negative attitudes significantly changed (P = .008) but with no significant differences on self-transcendence and willingness to serve. However, willingness to serve results approached significance (P = .08). The willingness measure (one question) should be expanded. Curricula changes that incorporate creative activities such as the CBI with larger and equal numbers in student groups and longitudinal follow up to determine long-term results after graduation are suggested. PMID:21994833

  16. Great horned owls are released at CCAFS

    NASA Technical Reports Server (NTRS)

    2000-01-01

    Eileen Olejarski (left), manager of Florida Wildlife Hospital, holds a great horned owl before releasing it at Cape Canaveral Air Force Station, Complex 25/29. The owl is one of two found in June on the floor of CCAFS Hangar G, where their nest was located. They were treated at a local veterinary hospital and then taken to the Florida Wildlife Hospital in Melbourne for care and rehabilitation before release.

  17. Great horned owls are released at CCAFS

    NASA Technical Reports Server (NTRS)

    2000-01-01

    Susan Small, director of the Florida Wildlife Hospital, holds a great horned owl before releasing it at Cape Canaveral Air Force Station, Complex 25/29. The owl is one of two found in June on the floor of CCAFS Hangar G, where their nest was located. They were treated at a local veterinary hospital and then taken to the Florida Wildlife Hospital in Melbourne for care and rehabilitation before release.

  18. Taking Responsibility for Your Own Learning: Maximizing Training Opportunities

    ERIC Educational Resources Information Center

    Rivers, Carmen

    2011-01-01

    Teaching young children takes a great deal of dedication and commitment. One spends every day helping young children to grow and change. It's important to be as committed to one's own growth as one is to the children's. By setting goals related to one's own personal growth, being an active participant in learning events, and creating an action…

  19. Enlarged prostate - after care

    MedlinePlus

    BPH - self-care; Benign prostatic hypertrophy - self-care; Benign prostatic hyperplasia - self-care ... Your health care provider may have you take a medicine called alpha-1- blocker. Most people find that these drugs help ...

  20. Taking patient and public involvement online: qualitative evaluation of an online forum for palliative care and rehabilitation research.

    PubMed

    Brighton, Lisa Jane; Pask, Sophie; Benalia, Hamid; Bailey, Sylvia; Sumerfield, Marion; Witt, Jana; de Wolf-Linder, Susanne; Etkind, Simon Noah; Murtagh, Fliss E M; Koffman, Jonathan; Evans, Catherine J

    2018-01-01

    Patient and public involvement (PPI) is increasingly recognised as important in research. Most PPI takes place face-to-face, but this can be difficult for people who are unwell or have caring responsibilities. As these challenges are particularly common in palliative care and rehabilitation research, we developed an online forum for PPI: www.csipublicinvolvement.co.uk. In this study, we explored how well the online forum worked, if it is a suitable method for PPI, and how PPI members and researchers reacted to using it. We used an existing theory about online interventions to help choose the 'right' questions to ask participants. We invited PPI members and researchers who had used the online forum to participate in focus groups, and identified the most important themes discussed. Within this study, PPI members have helped with the interview questions, analysis, and write up. Overall, four PPI members and five researchers participated in the focus groups. Participants felt the online forum worked well and had multiple benefits. From the discussions, we identified four key questions to consider when developing online methods for PPI: how does the forum work, how does it engage people, how does it empower people, and what is the impact? Participants suggested the forum could be improved by being more PPI and less researcher focused. We conclude that when developing online methods of PPI, a functioning forum is not enough: it also needs to be engaging and empowering to have an impact. Future work can use these four domains when developing their own online PPI methods. Patient and public involvement (PPI) in research is increasingly recognised as important. Most PPI activities take place face-to-face, yet this can be difficult for people with ill health or caring responsibilities, and may exclude people from hard-to-reach populations (e.g. living in vulnerable social circumstances and/or remote geographical locations). These challenges are particularly pertinent in

  1. Firing back: how great leaders rebound after career disasters.

    PubMed

    Sonnenfeld, Jeffrey A; Ward, Andrew J

    2007-01-01

    Among the tests of a leader, few are more challenging-and more painful-than recovering from a career catastrophe. Most fallen leaders, in fact, don't recover. Still, two decades of consulting experience, scholarly research, and their own personal experiences have convinced the authors that leaders can triumph over tragedy--if they do so deliberately. Great business leaders have much in common with the great heroes of universal myth, and they can learn to overcome profound setbacks by thinking in heroic terms. First, they must decide whether or not to fight back. Either way, they must recruit others into their battle. They must then take steps to recover their heroic status, in the process proving, both to others and to themselves, that they have the mettle necessary to recover their heroic mission. Bernie Marcus exemplifies this process. Devastated after Sandy Sigoloff ired him from Handy Dan, Marcus decided to forgo the distraction of litigation and instead make the marketplace his batttleground. Drawing from his network of carefully nurtured relationships with both close and more distant acquaintances, Marcus was able to get funding for a new venture. He proved that he had the mettle, and recovered his heroic status, by building Home Depot, whose entrepreneurial spirit embodied his heroic mission. As Bank One's Jamie Dimon, J.Crew's Mickey Drexler, and even Jimmy Carter, Martha Stewart, and Michael Milken have shown, stunning comebacks are possible in all industries and walks of life. Whatever the cause of your predicament, it makes sense to get your story out. The alternative is likely to be long-lasting unemployment. If the facts of your dismissal cannot be made public because they are damning, then show authentic remorse. The public is often enormously forgiving when it sees genuine contrition and atonement.

  2. The burden and quality of life of caregivers of sickle cell anemia patients taking hydroxyurea versus those not taking hydroxyurea

    PubMed Central

    da Silva, Luiz Bernardino Lima; Ivo, Maria Lúcia; de Souza, Albert Schiaveto; Pontes, Elenir Rose Jardim Cury; Pinto, Alexandra Maria Almeida Carvalho; de Araujo, Olinda Maria Rodrigues

    2012-01-01

    Objective To assess the burden and quality of life of caregivers of patients with sickle cell anemia taking hydroxyurea versus those of patients not taking hydroxyurea. Methods A cross-sectional study was performed of caregivers of outpatients with sickle cell anemia in two public hospitals in Campo Grande, MS, from January through June 2010. The World Health Organization Quality of Life-BREF Scale and the Caregiver Burden Scale were used. Results Of the 37 caregivers in this study, 81.1% were women, 73.0% were mothers, 59.5% were married, 54.1%were mulattos, 48.6% were housewives, 54.1% had family incomes of up to one minimum wage and 75.7% had onlycompleted elementary education. The mean duration of care provided (time after diagnosis) was 16.08 ± 9.88 yearsand 89.2% reported that they provided 24-hour care. Regarding health, 27.0% of study participants reported having physical and 13.5% emotional problems. There were no significant relationships between these variables either with the different domains or the total score of the WHOQOL-BREF comparing caregivers of patients taking hydroxyurea versusthose of patients not taking hydroxyurea. There was a moderate negative linear correlation between the WHOQOL-BREF and the Caregiver Burden Scale scores (linear correlation test of Pearson: p-value = 0.003, r = -0.477). The burden of caregivers of patients who did not take hydroxyurea was significantly higher than those of patients who took the medication in terms of general tension, disappointment, environment and total score (student t-test: p-value < 0.05). Conclusion In the perception of the caregiver, looking after sickle cell anemia patients represents a moderate negative burden. PMID:23049439

  3. Dental Care Every Day: A Caregiver's Guide. Practical Oral Care for People with Developmental Disabilities

    ERIC Educational Resources Information Center

    National Institute of Dental and Craniofacial Research (NIDCR), 2009

    2009-01-01

    Taking care of someone with a developmental disability requires patience and skill. As a caregiver, you know this as well as anyone does. You also know how challenging it is to help that person with dental care. It takes planning, time, and the ability to manage physical, mental, and behavioral problems. Dental care isn't always easy, but you can…

  4. Taking Steps: Matching Child Care Options with Corporate Needs.

    ERIC Educational Resources Information Center

    Massachusetts Bay Community Coll., Watertown.

    The conference at which these two papers were presented was sponsored by the Employer Supported Child Care Network, the Executive Office of Economic Affairs, and the Massachusetts Bay Community College. Opening remarks were provided by President Roger Van Winkle of Massachusetts Bay Community College and Evelyn Murphy, Secretary of Economic…

  5. Ambulatory care pavilion takes its place out front by solving multiple needs.

    PubMed

    Saukaitis, C A

    1994-09-01

    In sum, this structure exemplifies the fact that high-tech tertiary care medical centers can be user-friendly to the ambulatory health care consumer by serving their routine needs conveniently and efficiently. Says Gerald Miller, president of Crozer-Chester: "The ambulatory care pavilion has enabled Crozer to successfully and efficiently merge physicians' offices with institutional-based services and inpatient services. We are pleased with how the pavilion positions our medical center for the next century.

  6. 77 FR 73646 - Essar Steel Minnesota, LLC v. Great Lakes Gas Transmission Limited Partnership; Notice of Complaint

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-11

    ... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. RP13-313-000] Essar Steel Minnesota, LLC v. Great Lakes Gas Transmission Limited Partnership; Notice of Complaint Take notice that on.... 717(a), Essar Steel Minnesota, LLC (Complainant) filed a formal complaint against Great Lakes Gas...

  7. "SHOUT" to improve the quality of care delivered to patients with acute kidney injury at Great Western Hospital.

    PubMed

    Brady, Paul; Gorham, James; Kosti, Angeliki; Seligman, William; Courtney, Alona; Mazan, Karolina; Paterson, Stuart; Ramcharitar, Steve; Chandrasekaran, Badri; Juniper, Mark; Greamspet, Mala; Daniel, Jessica; Chalstrey, Sue; Ahmed, Ijaz; Dasgupta, Tanaji

    2015-01-01

    Acute kidney injury (AKI) affects up to 20% of all patients admitted to hospital, and is associated with a higher risk of adverse clinical outcomes, increased healthcare costs, as well as long term risks of chronic kidney disease and end stage renal failure. The aim of this project was to improve the quality of care for patients with AKI admitted to the acute medical unit (AMU) at the Great Western Hospital (GWH). We assessed awareness and self reported confidence among physicians in our Trust, in addition to basic aspects of care relevant to AKI on our AMU. A multifaceted quality improvement strategy was developed, which included measures to improve awareness such as a Trust wide AKI awareness day, and reconfiguring the admission proforma on our AMU in order to enhance risk assessment, staging, and early response to AKI. Ancillary measures such as the dissemination of flashcards for lanyards containing core information were also used. Follow up assessments showed that foundation year one (FY1) doctors' self reported confidence in managing AKI increased from 2.8 to 4.2, as measured on a five point Likert scale (P=0.0003). AKI risk assessment increased from 13% to 57% (P=0.07) following a change in the admission proforma. Documentation of the diagnosis of AKI increased from 66% to 95% (P=0.038) among flagged patients. Documentation of urine dip results increased from 33% to 73% (P=0.01), in addition to a rise in appropriate referral for specialist input, although this was not statistically significant. Our results suggest that using the twin approaches of improving awareness, and small changes to systemic factors such as modification of the admission proforma, can lead to significant enhancements in the quality of care of patients with AKI.

  8. Great horned owls are released at CCAFS

    NASA Technical Reports Server (NTRS)

    2000-01-01

    Eileen Olejarski (left), manager of Florida Wildlife Hospital, and Susan Small, director of the hospital, get ready to release two great horned owls at Cape Canaveral Air Force Station, Complex 25/29. The owls were found in June on the floor of CCAFS Hangar G, where their nest was located. They were treated at a local veterinary hospital and then taken to the Florida Wildlife Hospital in Melbourne for care and rehabilitation before release.

  9. Premenstrual syndrome - self-care

    MedlinePlus

    PMS - self-care; Premenstrual dysphoric disorder - self-care ... Your health care provider may recommend that you take vitamins or supplements. Vitamin B6, calcium, and magnesium may be recommended. Tryptophan ...

  10. [The health care structure law as a political public health reform in ambulatory and day surgery].

    PubMed

    Sorgatz, H

    1994-01-01

    The statutory opening of hospitals for ambulatory surgery can't without more ado be derived from the health-care reform which came into force on the 1st of January 1993. From the genesis of this reform it can be understood that the field of ambulatory surgery has been integrated just shortly before its legislation into the outlines of the health-care reform. As a consequence the hospitals are obliged to follow the principle "ambulatory before stationary" even in the stationary field. In this way the strict separation between the two fields (ambulatory and stationary) will be overcome to a great extent. Taking into consideration the further changes brought by the health-care reform in the stationary field new ranges of action for hospitals, with their chances but also their risks, have to be expected.

  11. Patient, Treatment, and Health Care Utilization Variables Associated with Adherence to Metabolic Monitoring Practices in Children and Adolescents Taking Second-Generation Antipsychotics.

    PubMed

    Coughlin, Mary; Goldie, Catherine Lindsay; Tranmer, Joan; Khalid-Khan, Sarosh; Tregunno, Deborah

    2018-04-01

    Children and adolescents with a range of psychiatric disorders are increasingly being prescribed atypical or second-generation antipsychotics (SGAs). While SGAs are effective at treating conduct and behavioural symptoms, they infer significant cardiometabolic risk. This study aims to explore what patient, treatment, and health care utilization variables are associated with adherence to Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in Children (CAMESA) metabolic monitoring guidelines. A retrospective chart review of 294 children and adolescents accessing a large outpatient psychiatry setting within a 2-year study period (2014-2016) was conducted. Baseline and follow-up metabolic monitoring, demographic, treatment, and health care utilization variables were then assessed over a 1-year period of interest. Metabolic monitoring practices did not adhere to CAMESA guidelines and were very poor over the 1-year observation period. There were significant differences between children (ages 4-12 years, n = 99) and adolescents (ages 13-18 years, n = 195). In adolescents, factors associated with any baseline metabolic monitoring were a higher number of psychiatry visits (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.10 to 1.41), longer duration of contact (OR, 14; 95% CI, 2.31 to 82.4), and use of other non-SGA medications (OR, 3.2; 95% CI, 1.17 to 8.94). Among children, having an emergency room visit (OR, 3.4; 95% CI, 1.01 to 11.71) and taking aripiprazole (OR, 7.4; 95% CI, 2.02 to 27.45) increased the odds of receiving baseline metabolic monitoring. Findings from this study highlight the need for better metabolic monitoring for children and adolescents taking SGAs. Enhanced focus on opportunities for multidisciplinary collaboration is needed to improve the quality of care offered to this population.

  12. Medicine on Mars: Remote medical care and the space exploration initiative

    NASA Technical Reports Server (NTRS)

    Simmons, S. C.; Billica, R. D.

    1992-01-01

    Mars exploration missions as described in the Synthesis Group report will involve extended exposures of crew members to remote, hazardous environments for up to 100 days. Maintenance of crew health and performance will be critical to ensure mission success. Because of the great distances between the Earth and Mars, round trip telecommunication will take from seven to forty minutes and immediate return to Earth will not be feasible: an autonomous medical care system that integrates preventive, occupational, and environmental aspects of health care and provides diagnostic and treatment capabilities will be necessary. Providing medical care for Mars explorers will pose some unique technical and engineering challenges. Medical care equipment will need to be designed to be modular and portable to ensure that it is interchangeable between vehicle and planetary surface elements. Miniaturization will be necessary to reduce mass and volume. Computerized systems that automatically acquire and manage medical information and provide medical references (literature), decision support, and automated medical record keeping will be a crucial part of a Martian medical care system. Medical care will also rely on remote consultation with Earth-based specialists. This presentation will provide an overview of the health and medical concerns associated with Mars exploration missions and will describe some specific concepts for Mars medical care systems.

  13. On the precipice of great things: the current state of UK nurse education.

    PubMed

    Taylor, Julie; Irvine, Fiona; Bradbury-Jones, Caroline; McKenna, Hugh

    2010-04-01

    The significant policy changes in UK health care over the past decade have led to a consequent shift in the delivery of nurse education to ensure the development and sustainability of a knowledgeable nursing workforce. One of the most recent, radical and important initiatives is Modernising Nursing Careers, which outlined four key priority areas for nursing, all of which have implications for nurse education. In light of this initiative, we explore the extent to which the modernisation of nursing careers is rhetoric or reality for UK nurse education - we are on the precipice of great change. To facilitate this, we move chronologically through the issues of recruitment and access; pre-registration preparation; and post-qualification education and careers. In discussing these issues, we demonstrate that more changes are needed to produce nurses who are flexible, visionary and prepared to take risks. We suggest that vision, leadership and strong realignment with health priorities are needed to bring nurse education to a point where nurses are truly prepared for the demands of a 21st century health service.

  14. Great horned owls are released at CCAFS

    NASA Technical Reports Server (NTRS)

    2000-01-01

    Eileen Olejarski (left), manager of Florida Wildlife Hospital, and Susan Small, director of the hospital, remove two great horned owls from the vehicle before releasing them at Cape Canaveral Air Force Station, Complex 25/29. The owls were found in June on the floor of CCAFS Hangar G, where their nest was located. They were treated at a local veterinary hospital and then taken to the Florida Wildlife Hospital in Melbourne for care and rehabilitation before release..

  15. 2017 Federal Green Challenge Award Winners in the Great Lakes Region

    EPA Pesticide Factsheets

    2017 FGC award winners in the Great Lakes region:the VA Minneapolis Health Care System, the EPA National Vehicle and Fuel Emissions Laboratory, the DOE Argonne National Lab, and the DHS U.S. Customs and Border Protection Detroit Field Office.

  16. Risk-Taking, Safety and Older People. Selected Bibliographies on Ageing 3.

    ERIC Educational Resources Information Center

    Jackson, Wendy, Comp.

    This annotated bibliography, which was developed as part of a series of selected bibliographies on aging for Great Britain's Centre for Policy on Ageing, contains a total of 368 entries organized under the following subject headings: risk (identification, nature, responsibilities, risk taking, security); environmental safety (hazards, design,…

  17. Health care 2020: reengineering health care delivery to combat chronic disease.

    PubMed

    Milani, Richard V; Lavie, Carl J

    2015-04-01

    Chronic disease has become the great epidemic of our times, responsible for 75% of total health care costs and the majority of deaths in the US. Our current delivery model is poorly constructed to manage chronic disease, as evidenced by low adherence to quality indicators and poor control of treatable conditions. New technologies have emerged that can engage patients and offer additional modalities in the treatment of chronic disease. Modifying our delivery model to include team-based care in concert with patient-centered technologies offers great promise in managing the chronic disease epidemic. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Physicians, the Affordable Care Act, and primary care: disruptive change or business as usual?

    PubMed

    Jacobson, Peter D; Jazowski, Shelley A

    2011-08-01

    The Patient Protection and Affordable Care Act 1 (ACA) presages disruptive change in primary care delivery. With expanded access to primary care for millions of new patients, physicians and policymakers face increased pressure to solve the perennial shortage of primary care practitioners. Despite the controversy surrounding its enactment, the ACA should motivate organized medicine to take the lead in shaping new strategies for meeting the nation's primary care needs. In this commentary, we argue that physicians should take the lead in developing policies to address the primary care shortage. First, physicians and medical professional organizations should abandon their long-standing opposition to non-physician practitioners (NPPs) as primary care providers. Second, physicians should re-imagine how primary care is delivered, including shifting routine care to NPPs while retaining responsibility for complex patients and oversight of the new primary care arrangements. Third, the ACA's focus on wellness and prevention creates opportunities for physicians to integrate population health into primary care practice.

  19. Perceived benefits and proposed solutions for teen pregnancy: qualitative interviews with youth care workers.

    PubMed

    Boustani, Maya Mroué; Frazier, Stacy L; Hartley, Chelsey; Meinzer, Michael; Hedemann, Erin

    2015-01-01

    The purpose of this article is to examine youth care workers' perceptions of the specific and unique sexual health needs of youth at risk for foster care. Semistructured interviews were conducted with youth care workers (N = 10) at a shelter for youth in or at risk for foster care. Youth care workers perceive that youth have unique experiences and needs related to sexual health programming and pregnancy prevention. Reflecting a great deal of family dysfunction, 3 themes emerged that revealed perceived benefits of teen pregnancy: youths' effort to prove themselves as adults, opportunity to secure their relationship with a partner, and desire to create an emotional connection with a baby. Lack of knowledge and accumulation of risk factors were viewed as most problematic. Current pregnancy prevention programs assume teen pregnancies are unwanted and emphasize the costs of sexual risk taking. Current findings suggest that sexual health programming for youth in or at risk for foster care should account for 3 perceived benefits of teen pregnancy. New opportunities for improving the reach and effectiveness of intervention for youth in or at risk for foster care are discussed.

  20. It takes a whole nation ... to create a health care system.

    PubMed

    Curtin, Leah

    2003-01-01

    The biggest failure we face today is that we argue about the effects of poverty and the benefits of welfare rather than about how to sustain a reasonably cohesive and integrated community that optimizes human development for everybody. Yet that is exactly what must happen if we are to integrate our recreational, educational, health care, and health promotion systems and employment policies to create a healthier population. Care of the sick and the elderly is not a primary wealth- (or health-) producing social function; it is a derivative activity. If a society overinvests in it, it may underinvest in the real economy ... which then will not create the jobs, stability, and wealth that support the health of the population. This is not the kind of problem that the health care system alone, or any one sector of society, can actually tackle on its own. The challenge is to create real partnerships with all sectors: employers, labor leaders, educators, police, and governmental groups.

  1. Reducing gravity takes the bounce out of running.

    PubMed

    Polet, Delyle T; Schroeder, Ryan T; Bertram, John E A

    2018-02-13

    In gravity below Earth-normal, a person should be able to take higher leaps in running. We asked 10 subjects to run on a treadmill in five levels of simulated reduced gravity and optically tracked centre-of-mass kinematics. Subjects consistently reduced ballistic height compared with running in normal gravity. We explain this trend by considering the vertical take-off velocity (defined as maximum vertical velocity). Energetically optimal gaits should balance the energetic costs of ground-contact collisions (favouring lower take-off velocity), and step frequency penalties such as leg swing work (favouring higher take-off velocity, but less so in reduced gravity). Measured vertical take-off velocity scaled with the square root of gravitational acceleration, following energetic optimality predictions and explaining why ballistic height decreases in lower gravity. The success of work-based costs in predicting this behaviour challenges the notion that gait adaptation in reduced gravity results from an unloading of the stance phase. Only the relationship between take-off velocity and swing cost changes in reduced gravity; the energetic cost of the down-to-up transition for a given vertical take-off velocity does not change with gravity. Because lower gravity allows an elongated swing phase for a given take-off velocity, the motor control system can relax the vertical momentum change in the stance phase, thus reducing ballistic height, without great energetic penalty to leg swing work. Although it may seem counterintuitive, using less 'bouncy' gaits in reduced gravity is a strategy to reduce energetic costs, to which humans seem extremely sensitive. © 2018. Published by The Company of Biologists Ltd.

  2. Taking 'women's work' 'like a man': husbands' experiences of care work.

    PubMed

    Calasanti, Toni; King, Neal

    2007-08-01

    We adopted a feminist, structural approach to husbands' experiences of caring for wives with Alzheimer's disease. This framework posited that men and women draw upon gender repertoires-situational ideals of behavior based upon their respective structural locations-that create gendered experiences of stress and coping strategies. We used a qualitative, constructivist approach to analyze in-depth interviews with 22 spousal caregivers and observations within support groups. Our analysis focused on the nine husbands, the strategies these men reported using to deal with problems that arose in their care work, and the extent to which these are congruent with the masculinities of White men in the United States. We found that these husbands' approaches to caregiving and their strategies for dealing with the work and feelings involved were rooted in their sense of selves as men. We outline their overall approaches to caregiving, identify six strategies husbands used to deal with problems stemming from care work-exerting force, focusing on tasks, blocking emotions, minimizing disruption, distracting attention, and self-medicating-and tie these to their structural positions as working-, middle-, and professional-class men. Theories of gender differences in the performance or quality of care work should tie these to structural arrangements. Unless the gendered bases upon which different styles or experiences are removed (i.e., structural inequality), designers of interventions cannot and should not expect to use the experience of one group to inform appropriate strategies for the other.

  3. 'Aid-in-dying' and the taking of human life.

    PubMed Central

    Campbell, C S

    1992-01-01

    In several US states, the legalisation of euthanasia has become a question for voters to decide in public referenda. This democratic approach in politics is consistent with notions of personal autonomy in medicine, but the right of choice does not mean all choices are morally equal. A presumption against the taking of human life is embedded in the formative moral traditions of society; human life does not have absolute value, but we do and should impose a strict burden of justification for exceptions to the presumption, as exemplified by the moral criteria invoked to justify self-defence, capital punishment, or just war. These criteria can illuminate whether another exception should be carved out for doctor-assisted suicide or active euthanasia. It does not seem, in the United States at any rate, that all possible alternatives to affirm the control and dignity of the dying patient and to relieve pain and suffering, short of taking life, have been exhausted. Moreover, the procedural safeguards built into many proposals for legalised euthanasia would likely be undone by the sorry state of the US health care system, with its lack of universal access to care, chronic cost-containment ills, a litigious climate, and socioeconomic barriers to care. There remains, however, common ground in the quest for humane care of the dying. PMID:1404279

  4. Improving Health Care Management in Primary Care for Homeless People: A Literature Review.

    PubMed

    Jego, Maeva; Abcaya, Julien; Ștefan, Diana-Elena; Calvet-Montredon, Céline; Gentile, Stéphanie

    2018-02-10

    Homeless people have poorer health status than the general population. They need complex care management, because of associated medical troubles (somatic and psychiatric) and social difficulties. We aimed to describe the main characteristics of the primary care programs that take care of homeless people, and to identify which could be most relevant. We performed a literature review that included articles which described and evaluated primary care programs for homeless people. Most of the programs presented a team-based approach, multidisciplinary and/or integrated care. They often proposed co-located services between somatic health services, mental health services and social support services. They also tried to answer to the specific needs of homeless people. Some characteristics of these programs were associated with significant positive outcomes: tailored primary care organizations, clinic orientation, multidisciplinary team-based models which included primary care physicians and clinic nurses, integration of social support, and engagement in the community's health. Primary health care programs that aimed at taking care of the homeless people should emphasize a multidisciplinary approach and should consider an integrated (mental, somatic and social) care model.

  5. “SHOUT” to improve the quality of care delivered to patients with acute kidney injury at Great Western Hospital

    PubMed Central

    Brady, Paul; Gorham, James; Kosti, Angeliki; Seligman, William; Courtney, Alona; Mazan, Karolina; Paterson, Stuart; Ramcharitar, Steve; Chandrasekaran, Badri; Juniper, Mark; Greamspet, Mala; Daniel, Jessica; Chalstrey, Sue; Ahmed, Ijaz; Dasgupta, Tanaji

    2015-01-01

    Acute kidney injury (AKI) affects up to 20% of all patients admitted to hospital, and is associated with a higher risk of adverse clinical outcomes, increased healthcare costs, as well as long term risks of chronic kidney disease and end stage renal failure. The aim of this project was to improve the quality of care for patients with AKI admitted to the acute medical unit (AMU) at the Great Western Hospital (GWH). We assessed awareness and self reported confidence among physicians in our Trust, in addition to basic aspects of care relevant to AKI on our AMU. A multifaceted quality improvement strategy was developed, which included measures to improve awareness such as a Trust wide AKI awareness day, and reconfiguring the admission proforma on our AMU in order to enhance risk assessment, staging, and early response to AKI. Ancillary measures such as the dissemination of flashcards for lanyards containing core information were also used. Follow up assessments showed that foundation year one (FY1) doctors’ self reported confidence in managing AKI increased from 2.8 to 4.2, as measured on a five point Likert scale (P=0.0003). AKI risk assessment increased from 13% to 57% (P=0.07) following a change in the admission proforma. Documentation of the diagnosis of AKI increased from 66% to 95% (P=0.038) among flagged patients. Documentation of urine dip results increased from 33% to 73% (P=0.01), in addition to a rise in appropriate referral for specialist input, although this was not statistically significant. Our results suggest that using the twin approaches of improving awareness, and small changes to systemic factors such as modification of the admission proforma, can lead to significant enhancements in the quality of care of patients with AKI. PMID:26734401

  6. [Intensive and palliative care medicine. From academic distance to caring affection].

    PubMed

    Burchardi, H

    2014-02-01

    Intensive care medicine has made great contributions to the immense success of modern curative medicine. However, emotional care and empathy for the patient and his family seem to be sparse. There is an assumed constraint to objectivity and efficiency, as well as a massive economic pressure which transfers the physician into an agent of the disease instead of a trustee of the ill human being. The physician struggles against the disease and feels the death of his patient as his personal defeat. However, in futile situations the intensivist must learn to let go. He is responsible for futile overtreatment as well as for successful treatment. Today, in futile situations in the intensive care unit (ICU), it is possible to change the goal from curative treatment to palliative care. This is a consequent further development from critical care medicine. In end-of-life situations in the intensive care unit, emotional care and empathy are mandatory using intensive dialogues with the family. Despite great workload stress enough time for such conversation should be taken, because the physician will generously be repaid by the way he sees his medical activity. The maintenance of a culture of empathy within the intensive care team is a major task for the leader. In this manner, the ICU will become and remain a place for living humanity.

  7. Affordable Care Act and Diabetes Mellitus.

    PubMed

    Shi, Qian; Nellans, Frank P; Shi, Lizheng

    2015-12-01

    The Affordable Care Act (ACA) has the potential for great impact on U.S. health care, especially for chronic disease patients requiring long-term care and management. The act was designed to improve insurance coverage, health care access, and quality of care for all Americans, which will assist patients with diabetes mellitus in acquiring routine monitoring and diabetes-related complication screening for better health management and outcomes. There is great potential for patients with diabetes to benefit from the new policy mandating health insurance coverage and plan improvement, Medicaid expansion, minimum coverage guarantees, and free preventative care. However, policy variability among states and ACA implementation present challenges to people with diabetes in understanding and optimizing ACA impact. This paper aims to select the most influential components of the ACA as relates to people with diabetes and discuss how the ACA may improve health care for this vulnerable population.

  8. It takes a village: a community partnership model in caring for the homeless.

    PubMed

    Zazworsky, Donna; Johnson, Nancy

    2014-01-01

    Population health management calls for hospitals and health care entities to better align their strategies in order to deliver quality care more efficiently. Although these efforts tend to be addressed with insured populations, the homeless demand a very intentional focus. The issue of homelessness has adverse effects on the health care system, resulting in the inefficient use of resources. Community-wide efforts must be mobilized to address this inefficiency and need for preventative care and self-management education for this population. Carondelet Health Network, in partnership with El Rio Community Health Center, a federally qualified health center, along with other health care and social service providers, has established the Southern Arizona Health Village for the Homeless, providing a health care delivery system to ensure the best functional and clinical outcomes. This system includes a van (the Van of Hope), licensed as a health center, and staffed with an El Rio Community Health Center nurse practitioner and a medical assistant partnering with a Carondelet Health Network behavioral health specialist and a community outreach worker. Clinical patient information is managed via an electronic health record inclusive of clinical data, number of visits, referrals, self-management education, hospitalizations, and follow-up care. A post-hospital program with shelters and an Emergency Room Navigation Program are additional components of the village that provide a comprehensive pre-acute and post-acute effort to support the homeless. Financial impact is measured by reductions in hospitalizations and average length of stay.

  9. Cost inefficiency under financial strain: a stochastic frontier analysis of hospitals in Washington State through the Great Recession.

    PubMed

    Izón, Germán M; Pardini, Chelsea A

    2017-06-01

    The importance of increasing cost efficiency for community hospitals in the United States has been underscored by the Great Recession and the ever-changing health care reimbursement environment. Previous studies have shown mixed evidence with regards to the relationship between linking hospitals' reimbursement to quality of care and cost efficiency. Moreover, current evidence suggests that not only inherently financially disadvantaged hospitals (e.g., safety-net providers), but also more financially stable providers, experienced declines to their financial viability throughout the recession. However, little is known about how hospital cost efficiency fared throughout the Great Recession. This study contributes to the literature by using stochastic frontier analysis to analyze cost inefficiency of Washington State hospitals between 2005 and 2012, with controls for patient burden of illness, hospital process of care quality, and hospital outcome quality. The quality measures included in this study function as central measures for the determination of recently implemented pay-for-performance programs. The average estimated level of hospital cost inefficiency before the Great Recession (10.4 %) was lower than it was during the Great Recession (13.5 %) and in its aftermath (14.1 %). Further, the estimated coefficients for summary process of care quality indexes for three health conditions (acute myocardial infarction, pneumonia, and heart failure) suggest that higher quality scores are associated with increased cost inefficiency.

  10. Cost-utility of collaborative care for major depressive disorder in primary care in the Netherlands.

    PubMed

    Goorden, Maartje; Huijbregts, Klaas M L; van Marwijk, Harm W J; Beekman, Aartjan T F; van der Feltz-Cornelis, Christina M; Hakkaart-van Roijen, Leona

    2015-10-01

    Major depression is a great burden on society, as it is associated with high disability/costs. The aim of this study was to evaluate the cost-utility of Collaborative Care (CC) for major depressive disorder compared to Care As Usual (CAU) in a primary health care setting from a societal perspective. A cluster randomized controlled trial was conducted, including 93 patients that were identified by screening (45-CC, 48-CAU). Another 57 patients were identified by the GP (56-CC, 1-CAU). The outcome measures were TiC-P, SF-HQL and EQ-5D, respectively measuring health care utilization, production losses and general health related quality of life at baseline three, six, nine and twelve months. A cost-utility analysis was performed for patients included by screening and a sensitivity analysis was done by also including patients identified by the GP. The average annual total costs was €1131 (95% C.I., €-3158 to €750) lower for CC compared to CAU. The average quality of life years (QALYs) gained was 0.02 (95% C.I., -0.004 to 0.04) higher for CC, so CC was dominant from a societal perspective. Taking a health care perspective, CC was less cost-effective due to higher costs, €1173 (95% C.I., €-216 to €2726), of CC compared to CAU which led to an ICER of 53,717 Euro/QALY. The sensitivity analysis showed dominance of CC. The cost-utility analysis from a societal perspective showed that CC was dominant to CAU. CC may be a promising treatment for depression in the primary care setting. Further research should explore the cost-effectiveness of long-term CC. Netherlands Trial Register ISRCTN15266438. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Example of the application of the PERSONA methodology in the definition of needs and requirements for the WeTakeCare system.

    PubMed

    Barbera-Guillem, Ricard; Poveda-Puente, Rakel; Neumann, Silke; Becker, Heidrun; Ramírez, Miguel; Wienholtz, Arno; Schaedler, Inge

    2015-01-01

    In user-centred design and marketing, personas are fictional characters created to represent the different user types that might use a site, brand, or product in a similar way [1]. As in other projects, the main application and use value of the persona approach in WeTakeCare project has been to depict and thus make "vivid" the characters and the milieus created and selected. It has helped to better understand and communicate the differences among the potential users. It has also helped to understand the heterogeneity and diversity of the users' lives and to focus on how to meet their actual needs [2].

  12. Flexible compensation of uniparental care: female poison frogs take over when males disappear.

    PubMed

    Ringler, Eva; Pašukonis, Andrius; Fitch, W Tecumseh; Huber, Ludwig; Hödl, Walter; Ringler, Max

    2015-01-01

    Parental care systems are shaped by costs and benefits to each sex of investing into current versus future progeny. Flexible compensatory parental care is mainly known in biparental species, particularly where parental desertion or reduction of care by 1 parent is common. The other parent can then compensate this loss by either switching parental roles and/or by increasing its own parental effort. In uniparental species, desertion of the caregiver usually leads to total brood loss. In the poison frog, Allobates femoralis , obligatory tadpole transport (TT) is generally performed by males, whereas females abandon their clutches after oviposition. Nevertheless, in a natural population we previously observed 7.8% of TT performed by females, which we could link to the absence of the respective fathers. In the following experiment, under laboratory conditions, all tested A. femoralis females flexibly took over parental duties, but only when their mates were removed. Our findings provide clear evidence for compensatory flexibility in a species with unisexual parental care. Contrary to the view of amphibian parental care as being stereotypical and fixed, these results demonstrate behavioral flexibility as an adaptive response to environmental and social uncertainty. Behavioral flexibility might actually represent a crucial step in the evolutionary transition from uniparental to biparental care in poison frogs. We suspect that across animal species flexible parental roles are much more common than previously thought and suggest the idea of a 3-dimensional continuum regarding flexibility, parental involvement, and timing, when thinking about the evolution of parental care.

  13. Flexible compensation of uniparental care: female poison frogs take over when males disappear

    PubMed Central

    Pašukonis, Andrius; Fitch, W. Tecumseh; Huber, Ludwig; Hödl, Walter; Ringler, Max

    2015-01-01

    Parental care systems are shaped by costs and benefits to each sex of investing into current versus future progeny. Flexible compensatory parental care is mainly known in biparental species, particularly where parental desertion or reduction of care by 1 parent is common. The other parent can then compensate this loss by either switching parental roles and/or by increasing its own parental effort. In uniparental species, desertion of the caregiver usually leads to total brood loss. In the poison frog, Allobates femoralis, obligatory tadpole transport (TT) is generally performed by males, whereas females abandon their clutches after oviposition. Nevertheless, in a natural population we previously observed 7.8% of TT performed by females, which we could link to the absence of the respective fathers. In the following experiment, under laboratory conditions, all tested A. femoralis females flexibly took over parental duties, but only when their mates were removed. Our findings provide clear evidence for compensatory flexibility in a species with unisexual parental care. Contrary to the view of amphibian parental care as being stereotypical and fixed, these results demonstrate behavioral flexibility as an adaptive response to environmental and social uncertainty. Behavioral flexibility might actually represent a crucial step in the evolutionary transition from uniparental to biparental care in poison frogs. We suspect that across animal species flexible parental roles are much more common than previously thought and suggest the idea of a 3-dimensional continuum regarding flexibility, parental involvement, and timing, when thinking about the evolution of parental care. PMID:26167099

  14. Memory boosts turn taking in evolutionary dilemma games.

    PubMed

    Wang, Tao; Chen, Zhigang; Yang, Lei; Zou, You; Luo, Juan

    2015-05-01

    Spontaneous turn taking phenomenon can be observed in many self-organized systems, and the mechanism is unclear. This paper tries to model it by evolutionary dilemma games with memory mechanism. Prisoner's dilemma, Snowdrift (including Leader and Hero) and Stag-hunt games are unified on an extended S-T plane. Agents play game with all the others and make decision by the last game histories. The experiments find that when agents remember last 2-step histories or more, a kind of cooperative turn taking (CAD) bursts at the area of Snowdrift game with restriction of S + T > 2R and S ≠ T, while the consistent strategy (DorC) gathers on the line of S + T > 2R and S = T. We also find that the system's fitness ratio greatly improved with 2-step memory. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  15. Hospital Capital Investment During the Great Recession.

    PubMed

    Choi, Sung

    2017-01-01

    Hospital capital investment is important for acquiring and maintaining technology and equipment needed to provide health care. Reduction in capital investment by a hospital has negative implications for patient outcomes. Most hospitals rely on debt and internal cash flow to fund capital investment. The great recession may have made it difficult for hospitals to borrow, thus reducing their capital investment. I investigated the impact of the great recession on capital investment made by California hospitals. Modeling how hospital capital investment may have been liquidity constrained during the recession is a novel contribution to the literature. I estimated the model with California Office of Statewide Health Planning and Development data and system generalized method of moments. Findings suggest that not-for-profit and public hospitals were liquidity constrained during the recession. Comparing the changes in hospital capital investment between 2006 and 2009 showed that hospitals used cash flow to increase capital investment by $2.45 million, other things equal.

  16. Hospital Capital Investment During the Great Recession

    PubMed Central

    Choi, Sung

    2017-01-01

    Hospital capital investment is important for acquiring and maintaining technology and equipment needed to provide health care. Reduction in capital investment by a hospital has negative implications for patient outcomes. Most hospitals rely on debt and internal cash flow to fund capital investment. The great recession may have made it difficult for hospitals to borrow, thus reducing their capital investment. I investigated the impact of the great recession on capital investment made by California hospitals. Modeling how hospital capital investment may have been liquidity constrained during the recession is a novel contribution to the literature. I estimated the model with California Office of Statewide Health Planning and Development data and system generalized method of moments. Findings suggest that not-for-profit and public hospitals were liquidity constrained during the recession. Comparing the changes in hospital capital investment between 2006 and 2009 showed that hospitals used cash flow to increase capital investment by $2.45 million, other things equal. PMID:28617202

  17. Improving Health Care Management in Primary Care for Homeless People: A Literature Review

    PubMed Central

    Abcaya, Julien; Ștefan, Diana-Elena; Calvet-Montredon, Céline; Gentile, Stéphanie

    2018-01-01

    Background: Homeless people have poorer health status than the general population. They need complex care management, because of associated medical troubles (somatic and psychiatric) and social difficulties. We aimed to describe the main characteristics of the primary care programs that take care of homeless people, and to identify which could be most relevant. Methods: We performed a literature review that included articles which described and evaluated primary care programs for homeless people. Results: Most of the programs presented a team-based approach, multidisciplinary and/or integrated care. They often proposed co-located services between somatic health services, mental health services and social support services. They also tried to answer to the specific needs of homeless people. Some characteristics of these programs were associated with significant positive outcomes: tailored primary care organizations, clinic orientation, multidisciplinary team-based models which included primary care physicians and clinic nurses, integration of social support, and engagement in the community’s health. Conclusions: Primary health care programs that aimed at taking care of the homeless people should emphasize a multidisciplinary approach and should consider an integrated (mental, somatic and social) care model. PMID:29439403

  18. The impact of taking or not taking ARVs on HIV stigma as reported by persons living with HIV infection in five African countries.

    PubMed

    Makoae, Lucy N; Portillo, Carmen J; Uys, Leana R; Dlamini, Priscilla S; Greeff, Minrie; Chirwa, Maureen; Kohi, Thecla W; Naidoo, Joanne; Mullan, Joseph; Wantland, Dean; Durrheim, Kevin; Holzemer, William L

    2009-11-01

    This study examined the impact of taking or not taking antiretroviral (ARV) medications on stigma, as reported by people living with HIV infection in five African countries. A two group (taking or not taking ARVs) by three (time) repeated measures analysis of variance examined change in reported stigma in a cohort sample of 1454 persons living with HIV infection in Lesotho, Malawi, South Africa, Swaziland, and Tanzania. Participants self-reported taking ARV medications and completed a standardized stigma scale validated in the African context. Data were collected at three points in time, from January 2006 to March 2007. Participants taking ARV medications self-reported a mean CD4 count of 273 and those not taking ARVs self-reported a mean CD4 count of 418. Both groups reported significant decreases in total HIV stigma over time; however, people taking ARVs reported significantly higher stigma at Time 3 compared to those not taking ARVs. This study documents that this sample of 1454 HIV infected persons in five countries in Africa reported significantly less HIV stigma over time. In addition, those participants taking ARV medications experienced significantly higher HIV stigma over time compared to those not taking ARVs. This finding contradicts some authors' opinions that when clients enroll in ARV medication treatment it signifies that they are experiencing less stigma. This work provides caution to health care providers to alert clients new to ARV treatment that they may experience more stigma from their families and communities when they learn they are taking ARV medications.

  19. Precipitation Dynamical Downscaling Over the Great Plains

    NASA Astrophysics Data System (ADS)

    Hu, Xiao-Ming; Xue, Ming; McPherson, Renee A.; Martin, Elinor; Rosendahl, Derek H.; Qiao, Lei

    2018-02-01

    Detailed, regional climate projections, particularly for precipitation, are critical for many applications. Accurate precipitation downscaling in the United States Great Plains remains a great challenge for most Regional Climate Models, particularly for warm months. Most previous dynamic downscaling simulations significantly underestimate warm-season precipitation in the region. This study aims to achieve a better precipitation downscaling in the Great Plains with the Weather Research and Forecast (WRF) model. To this end, WRF simulations with different physics schemes and nudging strategies are first conducted for a representative warm season. Results show that different cumulus schemes lead to more pronounced difference in simulated precipitation than other tested physics schemes. Simply choosing different physics schemes is not enough to alleviate the dry bias over the southern Great Plains, which is related to an anticyclonic circulation anomaly over the central and western parts of continental U.S. in the simulations. Spectral nudging emerges as an effective solution for alleviating the precipitation bias. Spectral nudging ensures that large and synoptic-scale circulations are faithfully reproduced while still allowing WRF to develop small-scale dynamics, thus effectively suppressing the large-scale circulation anomaly in the downscaling. As a result, a better precipitation downscaling is achieved. With the carefully validated configurations, WRF downscaling is conducted for 1980-2015. The downscaling captures well the spatial distribution of monthly climatology precipitation and the monthly/yearly variability, showing improvement over at least two previously published precipitation downscaling studies. With the improved precipitation downscaling, a better hydrological simulation over the trans-state Oologah watershed is also achieved.

  20. The Situation-Specific Theory of Heart Failure Self-Care: Revised and Updated.

    PubMed

    Riegel, Barbara; Dickson, Victoria Vaughan; Faulkner, Kenneth M

    2016-01-01

    Since the situation-specific theory of heart failure (HF) self-care was published in 2008, we have learned much about how and why patients with HF take care of themselves. This knowledge was used to revise and update the theory. The purpose of this article was to describe the revised, updated situation-specific theory of HF self-care. Three major revisions were made to the existing theory: (1) a new theoretical concept reflecting the process of symptom perception was added; (2) each self-care process now involves both autonomous and consultative elements; and (3) a closer link between the self-care processes and the naturalistic decision-making process is described. In the revised theory, HF self-care is defined as a naturalistic decision-making process with person, problem, and environmental factors that influence the everyday decisions made by patients and the self-care actions taken. The first self-care process, maintenance, captures those behaviors typically referred to as treatment adherence. The second self-care process, symptom perception, involves body listening, monitoring signs, as well as recognition, interpretation, and labeling of symptoms. The third self-care process, management, is the response to symptoms when they occur. A total of 5 assumptions and 8 testable propositions are specified in this revised theory. Prior research illustrates that all 3 self-care processes (ie, maintenance, symptom perception, and management) are integral to self-care. Further research is greatly needed to identify how best to help patients become experts in HF self-care.

  1. Genomic Sequencing: Assessing The Health Care System, Policy, And Big-Data Implications

    PubMed Central

    Phillips, Kathryn A.; Trosman, Julia; Kelley, Robin K.; Pletcher, Mark J.; Douglas, Michael P.; Weldon, Christine B.

    2014-01-01

    New genomic sequencing technologies enable the high-speed analysis of multiple genes simultaneously, including all of those in a person's genome. Sequencing is a prominent example of a “big data” technology because of the massive amount of information it produces and its complexity, diversity, and timeliness. Our objective in this article is to provide a policy primer on sequencing and illustrate how it can affect health care system and policy issues. Toward this end, we developed an easily applied classification of sequencing based on inputs, methods, and outputs. We used it to examine the implications of sequencing for three health care system and policy issues: making care more patient-centered, developing coverage and reimbursement policies, and assessing economic value. We conclude that sequencing has great promise but that policy challenges include how to optimize patient engagement as well as privacy, develop coverage policies that distinguish research from clinical uses and account for bioinformatics costs, and determine the economic value of sequencing through complex economic models that take into account multiple findings and downstream costs. PMID:25006153

  2. Genomic sequencing: assessing the health care system, policy, and big-data implications.

    PubMed

    Phillips, Kathryn A; Trosman, Julia R; Kelley, Robin K; Pletcher, Mark J; Douglas, Michael P; Weldon, Christine B

    2014-07-01

    New genomic sequencing technologies enable the high-speed analysis of multiple genes simultaneously, including all of those in a person's genome. Sequencing is a prominent example of a "big data" technology because of the massive amount of information it produces and its complexity, diversity, and timeliness. Our objective in this article is to provide a policy primer on sequencing and illustrate how it can affect health care system and policy issues. Toward this end, we developed an easily applied classification of sequencing based on inputs, methods, and outputs. We used it to examine the implications of sequencing for three health care system and policy issues: making care more patient-centered, developing coverage and reimbursement policies, and assessing economic value. We conclude that sequencing has great promise but that policy challenges include how to optimize patient engagement as well as privacy, develop coverage policies that distinguish research from clinical uses and account for bioinformatics costs, and determine the economic value of sequencing through complex economic models that take into account multiple findings and downstream costs. Project HOPE—The People-to-People Health Foundation, Inc.

  3. Leading Good Schools to Greatness: Mastering What Great Principals Do Well

    ERIC Educational Resources Information Center

    Gray, Susan Penny; Streshly, William A.

    2010-01-01

    Great leaders are made, not born. Written by the authors of "From Good Schools to Great Schools," this sequel shows how great school leaders can be developed and how leaders can acquire the powerful personal leadership characteristics that the best administrators use to lead their schools to greatness. Based on sound strategies and the work of Jim…

  4. Negotiating the new health system: purchasing publicly accountable managed care.

    PubMed

    Rosenbaum, S

    1998-04-01

    The transformation to managed care is one of the most important and complex changes ever to take place in the American health system. One key aspect of this transformation is its implications for public health policy and practice. Both public and private buyers purchase managed care; increasingly, public programs that used to act as their own insurers (i.e., Medicare, Medicaid and CHAMPUS) are purchasing large quantities of managed care insurance from private companies. The transformation to managed care is altering the manner in which public health policy makers conceive of and carry out public health activities (particularly activities that involve the provision of personal health services). The degree to which managed care changes public health and in turn is altered by public health will depend in great measure on the extent to which public and private policy makers understand the implications of their choices for various aspects of public health and take steps to address them. Because both publicly and privately managed care arrangements are relatively deregulated, much of the dialogue between public health and managed care purchasers can be expected to take place within the context of the large service agreements that are negotiated between buyers and sellers of managed care products. This is particularly true for Medicaid because of the importance of Medicaid coverage, payment and access policies to public health policy makers, and because of the public nature of the Medicaid contracting process. A nationwide study of Medicaid managed care contracts offers the first detailed analysis of the content and structure of managed care service agreements and the public health issues they raise. Four major findings emerge from a review of the contracts. First, most of the agreements fail to address key issues regarding which Medicaid-covered services and benefits are the contractor's responsibility and which remain the residual responsibility of the state agency

  5. Frequency and nature of potentially harmful preventable problems in primary care from the patient's perspective with clinician review: a population-level survey in Great Britain.

    PubMed

    Stocks, Susan Jill; Donnelly, Ailsa; Esmail, Aneez; Beresford, Joanne; Luty, Sarah; Deacon, Richard; Danczak, Avril; Mann, Nicola; Townsend, David; Ashley, James; Gamble, Carolyn; Bowie, Paul; Campbell, Stephen M

    2018-06-13

    To estimate the frequency of patient-perceived potentially harmful problems occurring in primary care. To describe the type of problem, patient predictors of perceiving a problem, the primary care service involved, how the problem was discussed and patient suggestions as to how the problem might have been prevented. To describe clinician/public opinions regarding the likelihood that the patient-described scenario is potentially harmful. Population-level survey. Great Britain. A nationally representative sample of 3975 members of the public aged ≥15 years interviewed during April 2016. Counts of patient-perceived potentially harmful problems in the last 12 months, descriptions of patient-described scenarios and review by clinicians/members of the public. 3975 of 3996 participants in a nationally representative survey completed the relevant questions (99.5%). 300 (7.6%; 95% CI 6.7% to 8.4%) of respondents reported experiencing a potentially harmful preventable problem in primary care during the past 12 months and 145 (48%) discussed their concerns within primary care. This did not vary with age, gender or type of service used. A substantial minority (30%) of the patient-perceived problems occurred outside general practice, particularly the dental surgery, walk in clinic, out of hours care and pharmacy. Patients perceiving a potentially harmful preventable problem were eight times more likely to have 'no confidence and trust in primary care' compared with 'yes, definitely' (OR 7.9; 95% CI 5.9 to 10.7) but those who discussed their perceived-problem appeared to maintain higher trust and confidence. Generally, clinicians ranked the patient-described scenarios as unlikely to be potentially harmful. This study highlights the importance of actively soliciting patient's views about preventable harm in primary care as patients frequently perceive potentially harmful preventable problems and make useful suggestions for their prevention. Such engagement may also help to

  6. Constructing a Self-Funded Program Takes More than Just Dollars and Cents

    ERIC Educational Resources Information Center

    Burke, Scott

    2012-01-01

    With a little ingenuity and a lot of dedication, the author created a self-funded construction program that is weathering the ups and downs of school funding; it enjoys great support from the community, is accomplishing more with less, and collaborative efforts between teachers are paying off. Creating such a program takes time, vision,…

  7. When Health Systems Are Barriers to Health Care: Challenges Faced by Uninsured Mexican Kidney Patients

    PubMed Central

    Kierans, Ciara; Padilla-Altamira, Cesar; Garcia-Garcia, Guillermo; Ibarra-Hernandez, Margarita; Mercado, Francisco J.

    2013-01-01

    Background Chronic Kidney Disease disproportionately affects the poor in Low and Middle Income Countries (LMICs). Mexico exemplifies the difficulties faced in supporting Renal Replacement Therapy (RRT) and providing equitable patient care, despite recent attempts at health reform. The objective of this study is to document the challenges faced by uninsured, poor Mexican families when attempting to access RRT. Methods The article takes an ethnographic approach, using interviewing and observation to generate detailed accounts of the problems that accompany attempts to secure care. The study, based in the state of Jalisco, comprised interviews with patients, their caregivers, health and social care professionals, among others. Observations were carried out in both clinical and social settings. Results In the absence of organised health information and stable pathways to renal care, patients and their families work extraordinarily hard and at great expense to secure care in a mixed public-private healthcare system. As part of this work, they must navigate challenging health and social care environments, negotiate treatments and costs, resource and finance healthcare and manage a wide range of formal and informal health information. Conclusions Examining commonalities across pathways to adequate healthcare reveals major failings in the Mexican system. These systemic problems serve to reproduce and deepen health inequalities. A system, in which the costs of renal care are disproportionately borne by those who can least afford them, faces major difficulties around the sustainability and resourcing of RRTs. Attempts to increase access to renal therapies, therefore, need to take into account the complex social and economic demands this places on those who need access most. This paper further shows that ethnographic studies of the concrete ways in which healthcare is accessed in practice provide important insights into the plight of CKD patients and so constitute an

  8. When health systems are barriers to health care: challenges faced by uninsured Mexican kidney patients.

    PubMed

    Kierans, Ciara; Padilla-Altamira, Cesar; Garcia-Garcia, Guillermo; Ibarra-Hernandez, Margarita; Mercado, Francisco J

    2013-01-01

    Chronic Kidney Disease disproportionately affects the poor in Low and Middle Income Countries (LMICs). Mexico exemplifies the difficulties faced in supporting Renal Replacement Therapy (RRT) and providing equitable patient care, despite recent attempts at health reform. The objective of this study is to document the challenges faced by uninsured, poor Mexican families when attempting to access RRT. The article takes an ethnographic approach, using interviewing and observation to generate detailed accounts of the problems that accompany attempts to secure care. The study, based in the state of Jalisco, comprised interviews with patients, their caregivers, health and social care professionals, among others. Observations were carried out in both clinical and social settings. In the absence of organised health information and stable pathways to renal care, patients and their families work extraordinarily hard and at great expense to secure care in a mixed public-private healthcare system. As part of this work, they must navigate challenging health and social care environments, negotiate treatments and costs, resource and finance healthcare and manage a wide range of formal and informal health information. Examining commonalities across pathways to adequate healthcare reveals major failings in the Mexican system. These systemic problems serve to reproduce and deepen health inequalities. A system, in which the costs of renal care are disproportionately borne by those who can least afford them, faces major difficulties around the sustainability and resourcing of RRTs. Attempts to increase access to renal therapies, therefore, need to take into account the complex social and economic demands this places on those who need access most. This paper further shows that ethnographic studies of the concrete ways in which healthcare is accessed in practice provide important insights into the plight of CKD patients and so constitute an important source of evidence in that effort.

  9. Resilience, post-traumatic growth, and work engagement among health care professionals after the Great East Japan Earthquake: A 4-year prospective follow-up study.

    PubMed

    Nishi, Daisuke; Kawashima, Yuzuru; Noguchi, Hiroko; Usuki, Masato; Yamashita, Akihiro; Koido, Yuichi; Matsuoka, Yutaka J

    2016-07-22

    Although attention has been paid to post-traumatic stress disorder (PTSD) among health care professionals after disasters, the impact of traumatic events on their work has not been elucidated. The aim of this study was to examine whether disaster-related distress, resilience, and post-traumatic growth (PTG) affect work engagement among health care professionals who had been deployed to the areas affected by the Great East Japan Earthquake that occurred on March 11, 2011. We recruited disaster medical assistance team members who were engaged in rescue activities after the earthquake. The short version of the Resilience Scale (RS-14) and Peritraumatic Distress Inventory (PDI) were administered one month after the earthquake, and the short form of Posttraumatic Growth Inventory (SF-PTGI) and Utrecht Work Engagement Scale (UWES) were administered four years after the earthquake. Work engagement is composed of vigor, dedication, and absorption. Regression analyses were used to examine the relationship of UWES with RS-14, PDI, and SF-PTGI. We obtained baseline data of 254 participants in April 2011, and 191 (75.2%) completed the follow-up assessment between December 2014 and March 2015. The results showed that RS-14 predicted vigor, dedication, and absorption; in addition, SF-PTGI was positively related with these three parameters (p<0.01 for all). Resilience at baseline and PTG after rescue activities may increase work engagement among health care professionals after disasters. These findings could be useful for establishing a support system after rescue activities during a large-scale disaster and for managing work-related stress among health care professionals.

  10. Atlas of Great Comets

    NASA Astrophysics Data System (ADS)

    Stoyan, Ronald; Dunlop, Storm

    2015-01-01

    Foreword; Using this book; Part I. Introduction: Cometary beliefs and fears; Comets in art; Comets in literature and poetry; Comets in science; Cometary science today; Great comets in antiquity; Great comets of the Middle Ages; Part II. The 30 Greatest Comets of Modern Times: The Great Comet of 1471; Comet Halley 1531; The Great Comet of 1556; The Great Comet of 1577; Comet Halley, 1607; The Great Comet of 1618; The Great Comet of 1664; Comet Kirch, 1680; Comet Halley, 1682; The Great Comet of 1744; Comet Halley, 1759; Comet Messier, 1769; Comet Flaugergues, 1811; Comet Halley, 1835; The Great March Comet of 1843; Comet Donati, 1858; Comet Tebbutt, 1861; The Great September Comet of 1882; The Great January Comet of 1910; Comet Halley, 1910; Comet Arend-Roland, 1956; Comet Ikeya-Seki, 1965; Comet Bennett, 1970; Comet Kohoutek, 1973-4; Comet West, 1976; Comet Halley, 1986; Comet Shoemaker-Levy 9, 1994; Comet Hyakutake, 1996; Comet Hale-Bopp, 1997; Comet McNaught, 2007; Part III. Appendices; Table of comet data; Glossary; References; Photo credits; Index.

  11. Great Minds? Great Lakes!

    ERIC Educational Resources Information Center

    Environmental Protection Agency, Chicago, IL. Great Lakes National Program Office.

    This booklet introduces an environmental curriculum for use in a variety of elementary subjects. The lesson plans provide an integrated approach to incorporating Great Lakes environmental issues into the subjects of history, social studies, and environmental sciences. Each of these sections contains background information, discussion points, and a…

  12. Do/Will You Remember? Taking a Child Care Program's Past into the Future.

    ERIC Educational Resources Information Center

    Ranck, Edna Runnels

    1995-01-01

    Gives basic information about establishing an archive in a limited amount of space and accommodating some special materials. Discusses why a day care center or similar facility should bother to keep such records. Outlines start-up and maintenance tasks and includes a useful table of types of archival documents and artifacts in child care centers.…

  13. Great Apes

    USGS Publications Warehouse

    Sleeman, Jonathan M.; Cerveny, Shannon

    2014-01-01

    Anesthesia of great apes is often necessary to conduct diagnostic analysis, provide therapeutics, facilitate surgical procedures, and enable transport and translocation for conservation purposes. Due to the stress of remote delivery injection of anesthetic agents, recent studies have focused on oral delivery and/or transmucosal absorption of preanesthetic and anesthetic agents. Maintenance of the airway and provision of oxygen is an important aspect of anesthesia in great ape species. The provision of analgesia is an important aspect of the anesthesia protocol for any procedure involving painful stimuli. Opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) are often administered alone, or in combination to provide multi-modal analgesia. There is increasing conservation management of in situ great ape populations, which has resulted in the development of field anesthesia techniques for free-living great apes for the purposes of translocation, reintroduction into the wild, and clinical interventions.

  14. Taking Aim at Interdisciplinary Education for Continuous Improvement in Health Care.

    ERIC Educational Resources Information Center

    Bellack, Janis P.; Gerrity, Patricia; Moore, Shirley M.; Novotny, Jeanne; Quinn, Doris; Norman, Linda; Harper, Doreen C.

    1997-01-01

    Local interdisciplinary teams from universities in the District of Columbia, Cleveland, Virginia, Pennsylvania, and South Carolina participated in a national project that involved nursing, medicine, and health administration students in experiential learning and continuous improvement in health care settings. (SK)

  15. So simple, so hard: Taking medication as directed.

    PubMed

    Burkholder, Rebecca; Linn, Elaine

    Millions of Americans either fail to take the full course of prescribed medication or they take it incorrectly. The problem is particularly serious for people with cardiovascular disease, respiratory disease, and diabetes, and for racially and ethnically diverse populations. The (U.S.) National Consumers League through its Script Your Future medication adherence awareness campaign presented the conference "So Simple, So Hard: Taking Medications as Directed", convening health care professionals, community health workers, consumer and patient advocates, researchers, industry representatives, public agencies, and policymakers. This a one-day research symposium aimed to explore challenges and barriers to medication adherence and to highlight tools and strategies to improve adherence and health outcomes, particularly among underserved populations. The conference began with presentations on adherence research and health disparities, and continued with presentations on strategies and tools to improve adherence that could be utilized in health care practices or organizations (including assessing adherence, medication synchronization, and comprehensive medication management). Through group discussions, the conference provided a forum for participants to interact and lay the groundwork to develop partnerships for collaborative initiatives to improve appropriate medication use and adherence. Participants surveyed at the end of the day and 30 days after the conference reported that they found the meeting highly useful (rated 4.6 out of 5), with the vast majority saying they learned about research and tools they can apply in their work and made new connections for potential collaborations. The conference learnings are being shared by participants and disseminated to other interested organizations and individuals. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Taking care of my own blood”: Older women's relationships to their households in rural South Africa1

    PubMed Central

    SCHATZ, ENID J.

    2010-01-01

    Aim: This paper examines financial, emotional, and physical responsibilities elderly women are being asked to take on due to the incapacity of their adult children to care for the next generation; such incapacity is likely to increase as the HIV/AIDS epidemic worsens. Methods: This paper combines quantitative and qualitative data. Census data from the Agincourt health and demographic surveillance system (AHDSS) describe the presence of the elderly (specifically women over the age of 60 and men over the age of 65) in households in the Agincourt study site. Semi-structured interviews with 30 female residents aged 60–75 complement the census data by exploring the roles that older women, in particular, are playing in their households. Results: An elderly man and/or woman lives in 27.6% of households; 86% of elders live with non-elders. Households with a woman over the age of 60 resident (as opposed to those without) are twice as likely to have a fostered child living in the household and three times as likely to have an orphaned child in the household. Elderly women face financial, physical, and emotional burdens related to the morbidity and mortality of their adult children, and to caring for grandchildren left behind due to adult children's mortality, migration, (re)marriage, and unemployment. Conclusions: Older women provide crucial financial, physical, and emotional support for ill adult children and fostered and orphaned grandchildren in their households. As more prime-aged adults suffer from HIV/AIDS-related morbidity and mortality, these obligations are likely to increase. PMID:17676516

  17. Pediatric primary care as a component of systems of care.

    PubMed

    Brown, Jonathan D

    2010-02-01

    Systems of care should be defined in a manner that includes primary care. The current definition of systems of care shares several attributes with the definition of primary care: both are defined as community-based services that are accessible, accountable, comprehensive, coordinated, culturally competent, and family focused. However, systems of care is defined as serving only children and youth with serious emotional disturbance and their families and does not fully embrace the concept of primary prevention. Although similarities in the definitions of primary care and systems of care may provide a theoretical foundation for including primary care within the systems of care framework, a definition of systems of care that incorporates the idea of prevention and takes into account the broad population served in primary care would provide communities with a definition that can be used to further the work of integrating primary care into systems of care.

  18. On Great Teachers

    ERIC Educational Resources Information Center

    Murphy, Tonia Hap

    2015-01-01

    In this article, the author lists key elements of greatness in a professor, and offers comments based on her experiences with great professors she has known. The first virtue mentioned is "he or she leaves students with valuable lessons they will remember throughout their careers." The "great" professor fosters broader lessons…

  19. [Primary care in Ireland].

    PubMed

    Sánchez-Sagrado, T

    Spanish doctors are still leaving the country to look for quality work. Ireland is not a country with many Spanish professionals but it is interesting to know its particular Health care system. Ireland is one of the countries with a national health care system, although it has a mixture of private health care insurance schemes. People have a right to health care if they have been living in Ireland at least for a year. Access to the primary care health system depends on age and income: free of charge for Category 1 and co-payments for the rest. This division generates great inequalities among the population. Primary Care doctors are self-employed, and they work independently. However, since 2001 they have tended to work in multidisciplinary teams in order to strengthen the Primary Care practice. Salary is gained from a combination of public and private incomes which are not differentiated. The role of the General Practitioner consists in the treatment of acute and chronic diseases, minor surgery, child care, etc. There is no coordination between Primary and Secondary care. Access to specialised medicine is regulated by the price of consultation. Primary Care doctors are not gatekeepers. To be able to work here, doctors must have three years of training after medical school. After that, Continuing Medical Education is compulsory, and the college of general practitioners monitors it annually. The Irish health care system does not fit into the European model. Lack of a clear separation between public and private health care generates great inequalities. The non-existence of coordination between primary and specialised care leads to inefficiencies, which Ireland cannot allow itself after a decade of economic crisis. Copyright © 2017 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Microsimulation of private health insurance and medicaid take-up following the U.S. Supreme court decision upholding the Affordable Care Act.

    PubMed

    Parente, Stephen T; Feldman, Roger

    2013-04-01

    To predict take-up of private health insurance and Medicaid following the U.S. Supreme Court decision upholding the Affordable Care Act (ACA). Data came from three large employers and a sampling of premiums from ehealthinsurance.com. We supplemented the employer data with information on state Medicaid eligibility and costs from the Kaiser Family Foundation. National predictions were based on the MEPS Household Component. We estimated a conditional logit model of health plan choice in the large group market. Using the coefficients from the choice model, we predicted take-up in the group and individual health insurance markets. Following ACA implementation, we added choices to the individual market corresponding to plans that will be available in state and federal exchanges. Depending on eligibility for premium subsidies, we reduced the out-of-pocket premiums for those choices. We simulated several possible patterns for states opting out of the Medicaid expansion, as allowed by the Supreme Court. The ACA will increase coverage substantially in the private insurance market and Medicaid. HSAs will remain desirable in both the individual and employer markets. If states opt out of the Medicaid expansion, this could increase the federal cost of health reform, while reducing the number of newly covered lives. © Health Research and Educational Trust.

  1. Microsimulation of Private Health Insurance and Medicaid Take-Up Following the U.S. Supreme Court Decision Upholding the Affordable Care Act

    PubMed Central

    Parente, Stephen T; Feldman, Roger

    2013-01-01

    Objective To predict take-up of private health insurance and Medicaid following the U.S. Supreme Court decision upholding the Affordable Care Act (ACA). Data Sources Data came from three large employers and a sampling of premiums from http://ehealthinsurance.com. We supplemented the employer data with information on state Medicaid eligibility and costs from the Kaiser Family Foundation. National predictions were based on the MEPS Household Component. Study Design We estimated a conditional logit model of health plan choice in the large group market. Using the coefficients from the choice model, we predicted take-up in the group and individual health insurance markets. Following ACA implementation, we added choices to the individual market corresponding to plans that will be available in state and federal exchanges. Depending on eligibility for premium subsidies, we reduced the out-of-pocket premiums for those choices. We simulated several possible patterns for states opting out of the Medicaid expansion, as allowed by the Supreme Court. Principal Findings The ACA will increase coverage substantially in the private insurance market and Medicaid. HSAs will remain desirable in both the individual and employer markets. Conclusions If states opt out of the Medicaid expansion, this could increase the federal cost of health reform, while reducing the number of newly covered lives. PMID:23398372

  2. The changing health care delivery structure: opportunities for nursing practice and administration.

    PubMed

    Barter, M; Graves, J; Phoon, J; Corder, K

    1995-01-01

    The increase in national health care expenditures has placed great stress on the economy and has contributed to a widespread consensus that reform of the health care delivery system is necessary. Three interrelated strategies are frequently used to cope with the turbulent environment in the health care industry today: managed care, hospital merger and acquisition to form integrated health care delivery systems, and redefined roles for nurses and other health care workers. These strategies have profound implications and will offer great opportunities for nursing administrators to foster nursing practice in new and improved systems of care delivery.

  3. The chewing lice (Phthiraptera: Ischnocera, Amblycera) of the great cormorant (Phalacrocorax carbo).

    PubMed

    Leitinger, Jan Phillip; Richter, Stefan

    2018-08-01

    The Great Cormorant is a widespread bird species with almost worldwide distribution. Accordingly, its general biology has been investigated thoroughly. Less well known, however, are the chewing lice that live inside the plumage of this diving bird. We examined the two known species of Great Cormorant chewing lice, Eidmanniella pellucida (Rudow, 1869) (Amblycera: Menoponidae) and Pectinopygus gyricornis (Denny, 1842) (Ischnocera: Philopteridae). Taking advantage of the autofluorescence of the cuticle, confocal laser scanning microscopy (CLSM) was used to explore the external morphology of all developmental stages of P. gyricornis. Morphometric analyses revealed a standard increase in body size from first larval instar to the adult. In addition, all instars exhibited increasing body segment differentiation, especially in the abdomen and the head. A total of 277 individuals of Pectinopygus gyricornis and 2 individuals of Eidmanniella pellucida were collected from eleven Great Cormorants from Mecklenburg-Western Pomerania, Germany, in 2015. Copyright © 2018 Elsevier B.V. All rights reserved.

  4. Evaluating multidisciplinary health care teams: taking the crisis out of CRM.

    PubMed

    Sutton, Gigi

    2009-08-01

    High-reliability organisations are those, such as within the aviation industry, which operate in complex, hazardous environments and yet despite this are able to balance safety and effectiveness. Crew resource management (CRM) training is used to improve the non-technical skills of aviation crews and other high-reliability teams. To date, CRM within the health sector has been restricted to use with "crisis teams" and "crisis events". The purpose of this discussion paper is to examine the application of CRM to acute, ward-based multidisciplinary health care teams and more broadly to argue for the repositioning of health-based CRM to address effective everyday function, of which "crisis events" form just one part. It is argued that CRM methodology could be applied to evaluate ward-based health care teams and design non-technical skills training to increase their efficacy, promote better patient outcomes, and facilitate a range of positive personal and organisational level outcomes.

  5. [Care and Self-Care Among Families with a Person Suffering from Bipolar Disorder and Belonging to the Psychoeducational Group of the Psychiatry Department of the University of Antioquia, Colombia].

    PubMed

    Correa, María Victoria Builes; Hernández, Mauricio Bedoya

    2013-03-01

    To analyze the families from the Psychoeducational Group of the Psychiatry Department of the University of Antioquia that have one member with bipolar disorder (BD) in order to identify their care-related practices. A comprehensive research project using the phenomenological and hermeneutic method. Semi-structured interviews were conducted with twelve families. The data obtained were analyzed using the Atlas ti qualitative software. Two main categories emerged: 1. Care and family life course and 2. Care and self-care in relation to bipolar disorder. The first category manifests itself through practices such as: Taking care of the diseased person by being physically present, providing physical or emotional support, or by transferring care-related actions to other family members. Two main perspectives could be identified in the second category, namely: the caretaker's perspective and that of the person being taken care of. Two tendencies were found regarding the first one: taking care of others brings about transformations in the caretakers and taking care of others is tough. The second perspective has the same number of tendencies: self-care as poetics and taking care of oneself in order to go from the Diving Bell to the Butterfly. Taking care of others is a way of building humanity. Conducting research on care and self-care practices (i.e. the practices of both the caretaker and the person being taken care of) results in a more aesthetic way of providing care and a more aesthetic patient-caretaker dyad. Copyright © 2013 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  6. Is take-over time all that matters? The impact of visual-cognitive load on driver take-over quality after conditionally automated driving.

    PubMed

    Zeeb, Kathrin; Buchner, Axel; Schrauf, Michael

    2016-07-01

    Currently, development of conditionally automated driving systems which control both lateral and longitudinal vehicle guidance is attracting a great deal of attention. The driver no longer needs to constantly monitor the roadway, but must still be able to resume vehicle control if necessary. The relaxed attention requirement might encourage engagement in non-driving related secondary tasks, and the resulting effect on driver take-over is unclear. The aim of this study was to examine how engagement in three different naturalistic secondary tasks (writing an email, reading a news text, watching a video clip) impacted take-over performance. A driving simulator study was conducted and data from a total of 79 participants (mean age 40 years, 35 females) were used to examine response times and take-over quality. Drivers had to resume vehicle control in four different non-critical scenarios while engaging in secondary tasks. A control group did not perform any secondary tasks. There was no influence of the drivers' engagement in secondary tasks on the time required to return their hands to the steering wheel, and there seemed to be only little if any influence on the time the drivers needed to intervene in vehicle control. Take-over quality, however, deteriorated for distracted drivers, with drivers reading a news text and drivers watching a video deviating on average approximately 8-9cm more from the lane center. These findings seem to indicate that establishing motor readiness may be carried out almost reflexively, but cognitive processing of the situation is impaired by driver distraction. This, in turn, appears to determine take-over quality. The present findings emphasize the importance to consider both response times and take-over quality for a comprehensive understanding of factors that influence driver take-over. Furthermore, a training effect in response times was found to be moderated by the drivers' prior experience with driver assistance systems. This shows

  7. Health care employee perceptions of patient-centered care.

    PubMed

    Balbale, Salva Najib; Turcios, Stephanie; LaVela, Sherri L

    2015-03-01

    Given the importance of health care employees in the delivery of patient-centered care, understanding their unique perspectives is essential for quality improvement. The purpose of this study was to use photovoice to evaluate perceptions and experiences around patient-centered care among U.S. Veterans Affairs (VA) health care employees. We asked participants to take photographs of salient features in their environment related to patient-centered care. We used the photographs to facilitate dialogue during follow-up interviews. Twelve VA health care employees across two VA sites participated in the project. Although most participants felt satisfied with their work environment and experiences at the VA, they identified several areas for improvement. These included a need for more employee health and wellness initiatives and a need for enhanced opportunities for training and professional growth. Application of photovoice enabled us to learn about employees' unique perspectives around patient-centered care while engaging them in an evaluation of care delivery. © The Author(s) 2014.

  8. 10th Arnual Great Moonbuggy Race

    NASA Technical Reports Server (NTRS)

    2003-01-01

    Students from across the United States and as far away as Puerto Rico came to Huntsville, Alabama for the 10th annual Great Moonbuggy Race at the U.S. Space Rocket Center. Sixty-eight teams, representing high schools and colleges from all over the United States, and Puerto Rico, raced human powered vehicles over a lunar-like terrain. Vehicles powered by two team members, one male and one female, raced one at a time over a half-mile obstacle course of simulated moonscape terrain. The competition is inspired by development, some 30 years ago, of the Lunar Roving Vehicle (LRV), a program managed by the Marshall Space Flight Center. The LRV team had to design a compact, lightweight, all-terrain vehicle that could be transported to the Moon in the small Apollo spacecraft. The Great Moonbuggy Race challenges students to design and build a human powered vehicle so they will learn how to deal with real-world engineering problems similar to those faced by the actual NASA LRV team. In this photograph, racers from C-1 High School in Lafayette County, Missouri, get ready to tackle the course. The team pedaled its way to victory over 29 other teams to take first place honors. It was the second year in a row a team from the school has placed first in the high school division. (NASA/MSFC)

  9. Resilience, post-traumatic growth, and work engagement among health care professionals after the Great East Japan Earthquake: A 4-year prospective follow-up study

    PubMed Central

    Nishi, Daisuke; Kawashima, Yuzuru; Noguchi, Hiroko; Usuki, Masato; Yamashita, Akihiro; Koido, Yuichi; Matsuoka, Yutaka J

    2016-01-01

    Objectives: Although attention has been paid to post-traumatic stress disorder (PTSD) among health care professionals after disasters, the impact of traumatic events on their work has not been elucidated. The aim of this study was to examine whether disaster-related distress, resilience, and post-traumatic growth (PTG) affect work engagement among health care professionals who had been deployed to the areas affected by the Great East Japan Earthquake that occurred on March 11, 2011. Methods: We recruited disaster medical assistance team members who were engaged in rescue activities after the earthquake. The short version of the Resilience Scale (RS-14) and Peritraumatic Distress Inventory (PDI) were administered one month after the earthquake, and the short form of Posttraumatic Growth Inventory (SF-PTGI) and Utrecht Work Engagement Scale (UWES) were administered four years after the earthquake. Work engagement is composed of vigor, dedication, and absorption. Regression analyses were used to examine the relationship of UWES with RS-14, PDI, and SF-PTGI. Results: We obtained baseline data of 254 participants in April 2011, and 191 (75.2%) completed the follow-up assessment between December 2014 and March 2015. The results showed that RS-14 predicted vigor, dedication, and absorption; in addition, SF-PTGI was positively related with these three parameters (p<0.01 for all). Conclusions: Resilience at baseline and PTG after rescue activities may increase work engagement among health care professionals after disasters. These findings could be useful for establishing a support system after rescue activities during a large-scale disaster and for managing work-related stress among health care professionals. PMID:27265533

  10. Treatment of great auricular neuralgia with real-time ultrasound-guided great auricular nerve block

    PubMed Central

    Jeon, Younghoon; Kim, Saeyoung

    2017-01-01

    Abstract Rationale: The great auricular nerve can be damaged by the neck surgery, tumor, and long-time pressure on the neck. But, great auricular neuralgia is very rare condition. It was managed by several medication and landmark-based great auricular nerve block with poor prognosis. Patient concerns: A 25-year-old man presented with a pain in the left lateral neck and auricle. Diagnosis: He was diagnosed with great auricular neuralgia. Interventions: His pain was not reduced by medication. Therefore, the great auricular nerve block with local anesthetics and steroid was performed under ultrasound guidance. Outcomes: Ultrasound guided great auricular nerve block alleviated great auricular neuralgia. Lessons: This medication-resistant great auricular neuralgia was treated by the ultrasound guided great auricular nerve block with local anesthetic agent and steroid. Therefore, great auricular nerve block can be a good treatment option of medication resistant great auricular neuralgia. PMID:28328811

  11. [Delivery of health care for military veterans abroad. The USA and Great Britain models].

    PubMed

    Bolekhan, V N; Ivanov, V V; Ivchenko, E V; Krassiĭ, A B; Morovikova, T V; Nagibovich, O A; Rezvantsev, M V

    2013-03-01

    The present review is dedicated to organization and management of military veteran's health care system of the US and UK. It is shown that despite the differences in health care systems of both countries their veterans receive the stat-of-the-art medical service which is readily available and financially affordable.

  12. Taking "Women's Work" "Like a Man": Husbands' Experiences of Care Work

    ERIC Educational Resources Information Center

    Calasanti, Toni; King, Neal

    2007-01-01

    Purpose: We adopted a feminist, structural approach to husbands' experiences of caring for wives with Alzheimer's disease. This framework posited that men and women draw upon gender repertoires--situational ideals of behavior based upon their respective structural locations--that create gendered experiences of stress and coping strategies. Design…

  13. [Health promotion in a workplace in The United Kingdom of Great Britain and Northern Ireland by taking into consideration acts prohibited tobacco smoking].

    PubMed

    Kurzepa-Hasan, Edyta; Adamek, Renata; Hasan, Kawa

    2008-01-01

    This study presents health promotion strategies in a workplace in The United Kingdom of Great Britain and Northern Ireland. A workplace is a very important area for health promotion activities because of almost unlimited access to target group--adult group, especially good opportunity to access to men, who rather seldom going to a doctor. In 2004 Committee on Tobacco and Heath (SCOTH) classified environmental tobacco smoking (ETS) for category: "serious hazards for public health" after conducted study of harmful effects of ETS. In 2007 England becomes "free" from ETS, because of acts prohibited tobacco smoking in public places and in workplaces. In 26th of March 2006 Health Act in Scotland and in the second of April 2007 in Wales also prohibited smoking in public places. The aim of a new act was to protect health and prevention illness caused by exposition to ETS. So, there is prohibition for everyone: employees, clients, employers and guests in a whole company, in closed area and fundamental closed areas (according act). The act is also about previous areas intended for tobacco smoking. In 30th of April in 2007 Northern Ireland also prohibited smoking in public places. There are many profits for everyone, for example: protection people's health exposed to ETS, much slower development some serious illness, reduction of medical care cost and improvement of environment for community. If smokers decide to quit smoking or even reduce the number of smoking cigarettes per day, a population would be healthier.

  14. Health care consumerism: engaging the real buyers--employees.

    PubMed

    Terry, Martha

    2005-01-01

    Many employers have begun moving toward health care consumerism strategies designed to encourage employees to take more responsibility for their health care and the cost of that care. Recent surveys suggest ways employers can ensure their consumerism strategies succeed in engaging employees and, ultimately, encourage employees to change their behavior. This article describes what those surveys reveal about employer and employee perspectives on consumerism and suggests steps employers can take to align their interests with those of their employees in order to manage the demand for and use of health care.

  15. Is This Time Different? The Slowdown in Health Care Spending.

    PubMed

    Chandra, Amitabh; Holmes, Jonathan; Skinner, Jonathan

    2013-01-01

    Why have health care costs moderated in the last decade? Some have suggested that the Great Recession alone was the cause, but health expenditure growth in the depths of the recession was nearly identical to growth prior to the recession. Nor can the Affordable Care Act (ACA) take credit, since the slowdown began prior to its implementation. Instead, we identify three primary causes of the slowdown: the rise in high-deductible insurance plans, state-level efforts to control Medicaid costs, and a general slowdown in the diffusion of new technology, particularly for use by the Medicare population. A more difficult question is: Will this slowdown continue? On this question we are pessimistic, and not entirely because a similar (and temporary) slowdown occurred in the early 1990s. The primary determinant of long-term growth is the continued development of expensive technology, and there is little evidence of a permanent slowdown in that pipeline. Proton beam accelerators are on target to double between 2010 and 2014, while the market for heart-assist devices (costing more than $300,000 each) is projected to grow rapidly. Accountable care organizations (ACOs) and emboldened insurance companies may yet stifle health care cost growth, but our best estimate over the next two decades is that health care costs will grow at GDP plus 1.2 percent, a rate lower than previous estimates but still on track to cause serious fiscal pain for taxpayers and workers who bear the costs of higher premiums.

  16. Why does it take two to tango? Lifetime fitness consequences of parental care in a burying beetle

    PubMed Central

    2017-01-01

    In species that require parental care, each parent can either care for their offspring or leave them in the care of the other parent. For each parent this creates three possible parental care strategies: biparental care, uniparental (male or female) care, and uniparental desertion by either the male or female. The burying beetle, Nicrophorus orbicollis, typically exhibits biparental care of offspring, and thus provides a unique system that allows us to compare the fitness benefits of these parental care strategies in an unconfounded way. In this study, we assess the lifetime fitness of biparental care, uniparental care, and uniparental desertion strategies in both male and female N. orbicollis. Specifically, we tested for increased fitness of the biparental care strategy compared to uniparental care strategies. Second, we test for equality of fitness between uniparental care and uniparental desertion strategies. Surprisingly, biparental care yields lower lifetime fitness for both parents compared to the other two strategies. Also, uniparental care and uniparental desertion strategies yielded equal fitness. The evolution of biparental care in this system is not consistent with the expectation of a mutual fitness benefit. We discuss other potential explanations for the evolution of biparental care in this system. PMID:29088220

  17. Why does it take two to tango? Lifetime fitness consequences of parental care in a burying beetle.

    PubMed

    Smith, Ashlee N; Creighton, J Curtis; Belk, Mark C

    2017-01-01

    In species that require parental care, each parent can either care for their offspring or leave them in the care of the other parent. For each parent this creates three possible parental care strategies: biparental care, uniparental (male or female) care, and uniparental desertion by either the male or female. The burying beetle, Nicrophorus orbicollis, typically exhibits biparental care of offspring, and thus provides a unique system that allows us to compare the fitness benefits of these parental care strategies in an unconfounded way. In this study, we assess the lifetime fitness of biparental care, uniparental care, and uniparental desertion strategies in both male and female N. orbicollis. Specifically, we tested for increased fitness of the biparental care strategy compared to uniparental care strategies. Second, we test for equality of fitness between uniparental care and uniparental desertion strategies. Surprisingly, biparental care yields lower lifetime fitness for both parents compared to the other two strategies. Also, uniparental care and uniparental desertion strategies yielded equal fitness. The evolution of biparental care in this system is not consistent with the expectation of a mutual fitness benefit. We discuss other potential explanations for the evolution of biparental care in this system.

  18. Care management role in end-of-life discussions.

    PubMed

    Meyer, Star

    2012-01-01

    How do we prepare our patients for decisions that will need to be made for end-of-life care? End-of-life care discussions should occur early on in the patient's disease process and often requires a great deal of coordination between multiple caregivers. There are also ethical, cultural social and spiritual considerations during this very important time in the disease process. Research suggests that we are not doing an adequate job of addressing end-of-life care with our patients and that a great deal of money and resources are being spent in the last days of life when there may be no clinical indication to do so. Registered nurse case managers have a unique knowledge base to serve in the role of coordinating care and leading the multidisciplinary care team in an effort to use resources responsibly while providing patients and families with options for end-of-life care.

  19. Forty years of the Law 180: the aspirations of a great reform, its successes and continuing need.

    PubMed

    Mezzina, R

    2018-03-06

    Italy pioneered deinstitutionalisation over the past 60 years and enforced a famous mental health (MH) reform law in 1978. Deinstitutionalisation has been completed with the very closure of all psychiatric hospitals over two decades. After 40 years of implementation, this article presents the main achievements and challenges of the Italian MH reform law, including its long-term effect and impact in Italy and abroad. The Legislation of 1978 was based on the discovery of rights as a key tool in mental healthcare. At the climax of crisis of psychiatric hospitals as total institutions in this country, through the new community-based system of care, it has fostered the lowest rate of involuntary care and gave back the full citizenship to people with MH disorders. This act was also part of a social movement for expanding civil and social rights, and a promise of a true paradigm shift not only in psychiatry, but also in the way of providing an adequate welfare community for all citizens. According to the WHO, the Italian city of Trieste, together with its region, is a practical example of how the Italian movement achieved deinstitutionalisation, intended as a complex process resulting in the gradual relocation of the economic and human resources and subsequent creation of 24 h services together with the development of social inclusion programmes. Even if the great principles of the Italian reform law were anticipatory (e.g., the UN Convention on Rights of Persons with Disabilities - CRPD), the law application has been poorly provided with resources and did not follow those avant-garde experiences as models. Limitations are evident today especially at the organisational levels, such as services capable to take up the challenge and transforming the field, left free from the imprint of total institutions. These endemic critical aspects concerning to implementation policies, together with the financial crisis of the Italian healthcare system, must be taken into consideration

  20. Activities Contributing a Great Deal to the Students' Interactive Skills in Foreign Language Classes

    ERIC Educational Resources Information Center

    Asatryan, Susanna

    2016-01-01

    While teaching speaking it is desired to provide a rich environment in class for meaningful communication to take place. With this aim, various speaking activities can contribute a great deal to students in developing their interactive skills necessary for life. These activities make students active in the learning process and at the same time…

  1. Data Collection During the Great American Eclipse

    NASA Astrophysics Data System (ADS)

    Vernier, Dave

    2017-12-01

    I am lucky enough (and old enough) to have seen three total eclipses. About a year ago, I became aware of the total eclipse that was coming to the United States on August 21, 2017. Because I knew how exciting a total eclipse can be, I spent a lot of time encouraging people to travel to the zone of totality if they possibly could. I also encouraged teachers to turn this event into a STEM lesson by taking data. We asked teachers to join us in collecting data during the eclipse and to share it. The people collecting these data were either teachers or former teachers (like me). Many times, the sensors were mounted with duct tape and rubber bands, but we got some great data!

  2. Mental health services in South Africa: taking stock.

    PubMed

    Lund, C; Petersen, I; Kleintjes, S; Bhana, A

    2012-11-01

    There is new policy commitment to mental health in South Africa, demonstrated in the national mental health summit of April 2012. This provides an opportunity to take stock of our mental health services. At primary care level key challenges include- training and supervision of staff in the detection and management of common mental disorders, and the development of community-based psychosocial rehabilitation programmes for people with severe mental illness (in collaboration with existing non-governmental organizations). At secondary level, resources need to be invested in 72-hour observation facilities at designated district and regional hospitals, in keeping with the Mental Health Care Act. At tertiary level, greater continuity of care with primary and secondary levels is required to prevent "revolving door" patterns of care. There are major challenges and also opportunities related to the high level of comorbidity between mental illness and a range of other public health priorities, notably HIV/AIDS, cardiovascular disease and diabetes. The agenda for mental health services research needs to shift to a focus on evaluating interventions. With current policy commitment, the time to act and invest in evidence-based mental health services is now.

  3. Story sharing: restoring the reciprocity of caring in long-term care.

    PubMed

    Heliker, Diane

    2007-07-01

    Residents in long-term care facilities often experience an interruption in the reciprocity of caring, inadvertently cut off when they enter the unfamiliar surroundings of a residential health care system. This transition from the give and take of caring to being completely cared for often leads to a breakdown of meaning, a loss of identity, and loneliness. This article addresses how an intervention called story sharing can restore the reciprocity of caring. Beginning with a review of the significance and functions of storytelling and listening, a specific story sharing intervention-the mutual sharing of everyday experiences among nurse aides and the nursing home residents for whom they care-is described. The theoretical and practice implications of story sharing are discussed.

  4. New Hampshire Nurse Practitioners Take the Lead in Forming an Accountable Care Organization.

    PubMed

    Wright, Wendy L

    In 2012, New Hampshire nurse practitioners (NPs), along with Anthem Blue Cross/Blue Shield, formed the first Patient Centered Shared Savings Program in the nation, composed of patients managed by nurse practitioners employed within NP-owned and operated clinics. In this accountable care organization (ACO), NP-attributed patients were grouped into one risk pool. Data from the ACO and the NP risk pool, now in its third year, have produced compelling statistics. Nurse practitioners participating in this program have met or exceeded the minimum scores for 29 quality metrics along with a demonstrated cost-savings in the first 2 years of the program. Hospitalization rates for NP-managed patients are among the lowest in the state. Cost of care for NP-managed patients is $66.85 less per member per month than the participating physician-managed patients. Data from this ACO provide evidence that NPs provide cost-effective, quality health care and are integral to the formation and sustainability of any ACO.

  5. Urostomy - stoma and skin care

    MedlinePlus

    ... the correct size opening, so urine does not leak Taking good care of the skin around your stoma To care for you skin in this area: Wash your skin with warm water and dry it well before you attach the ...

  6. Pre-hospital care in burn injury

    PubMed Central

    Shrivastava, Prabhat; Goel, Arun

    2010-01-01

    The care provided to the victims of burn injury immediately after sustaining burns can largely affect the extent and depth of the wound. Although standard guidelines have been formulated by various burn associations, they are still not well known to public at large in our country. In burn injuries, most often, the bystanders are the first care providers. The swift implementation of the measures described in this article for first aid in thermal, chemical, electrical and inhalational injuries in the practical setting, within minutes of sustaining the burn, plays a vital role and can effectively reduce the morbidity and mortality to a great extent. In case of burn disasters, triage needs to be carried out promptly as per the defined protocols. Proper communication and transport from the scene of the accident to the primary care centre and onto the burn care facility greatly influences the execution of the management plans PMID:21321651

  7. Hippocrates takes a blow: the Family and Medical Leave Act and health care administration.

    PubMed

    Wyld, D C

    1995-12-01

    This article examines the special legal and administrative issues for health care management that are posed by the recently enacted Family and Medical Leave Act (FMLA). Following a question-and-answer format, the article outlines the basic provisions of the law and answers what will likely be the most commonly faced administrative questions. It will be seen that FMLA issues and administration will be of significant concern to managers at all levels in health care organizations for some time to come. The conclusion of the article outlines a series of administrative steps that health care managers should undertake to proactively administer the federal leave law.

  8. The impact of stroke unit care on outcome in a Scottish stroke population, taking into account case mix and selection bias.

    PubMed

    Turner, Melanie; Barber, Mark; Dodds, Hazel; Dennis, Martin; Langhorne, Peter; Macleod, Mary Joan

    2015-03-01

    Randomised trials indicate that stroke unit care reduces morbidity and mortality after stroke. Similar results have been seen in observational studies but many have not corrected for selection bias or independent predictors of outcome. We evaluated the effect of stroke unit compared with general ward care on outcomes after stroke in Scotland, adjusting for case mix by incorporating the six simple variables (SSV) model, also taking into account selection bias and stroke subtype. We used routine data from National Scottish datasets for acute stroke patients admitted between 2005 and 2011. Patients who died within 3 days of admission were excluded from analysis. The main outcome measures were survival and discharge home. Multivariable logistic regression was used to estimate the OR for survival, and adjustment was made for the effect of the SSV model and for early mortality. Cox proportional hazards model was used to estimate the hazard of death within 365 days. There were 41 692 index stroke events; 79% were admitted to a stroke unit at some point during their hospital stay and 21% were cared for in a general ward. Using the SSV model, we obtained a receiver operated curve of 0.82 (SE 0.002) for mortality at 6 months. The adjusted OR for survival at 7 days was 3.11 (95% CI 2.71 to 3.56) and at 1 year 1.43 (95% CI 1.34 to 1.54) while the adjusted OR for being discharged home was 1.19 (95% CI 1.11 to 1.28) for stroke unit care. In routine practice, stroke unit admission is associated with a greater likelihood of discharge home and with lower mortality up to 1 year, after correcting for known independent predictors of outcome, and excluding early non-modifiable mortality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  9. Taking a Concept to Commercialization: Designing Relevant Tests to Address Safety.

    PubMed

    Ferrara, Lisa A

    2016-04-01

    Taking a product from concept to commercialization requires careful navigation of the regulatory pathway through a series of steps: (A) moving the idea through proof of concept and beyond; (B) evaluating new technologies that may provide added value to the idea; (C) designing appropriate test strategies and protocols; and (D) evaluating and mitigating risks. Moving an idea from the napkin stage of development to the final product requires a team effort. When finished, the product rarely resembles the original design, but careful steps throughout the product life cycle ensure that the product meets the vision.

  10. Rationing critical care medicine: recent studies and current trends.

    PubMed

    Ward, Nicholas S

    2005-12-01

    This paper reviews the literature on the rationing of critical care resources. Although much has been written about the concept of rationing, there have been few scientific studies as to its prevalence. A recent meta-analysis reviewed all previously published studies on rationing access to intensive care units but little is known about practices within the intensive care unit. Much literature in the past few years has focused on the growing use of critical care resources and projections for the future. Several authors suggest there may be a crisis in financial or personnel resources if some rationing does not take place. Other papers have argued that the methods of rationing critical care previously proposed, such as limiting the care of dying patients or using cost-effectiveness analysis to determine care, may not be effective or viewed as ethical by some. Finally, several recent papers review how critical care is practiced and allocated in India and Asian countries that already practice open rationing in their health care systems. There is currently no published evidence that overt rationing is taking place in critical care medicine. There is growing evidence that in the future, the need for critical care may outstrip financial resources unless some form of rationing takes place. It is also clear from the literature that choosing how to ration critical care will be a difficult task.

  11. [Philosophy of care, care and nursing care: a literature review for a research at the intersection of philosophy and care].

    PubMed

    Remy-Largeau, Isabelle

    2011-12-01

    Very recently the concept of care has burst on the French philosophical scene. What are the contours of this developing "philosophy of care"? How does it place itself in relation to what are today called the ethics of care? And how does it take account of nursing care, as a discipline understood in its triple dimension: social, pedagogical and epistemological? The research presented in this paper examines some of the founding texts of this philosophy of care through the prism of these questions. It is the partial presentation of a reflection developed from a literature review that will include two other sections. The second section will focus on studying the way in which the ethics of care allow for nursing care and enter into dialogue with the nascent philosophy of care. The third will focus, conversely, on the way nurses integrate reflections derived from ethics of care and the philosophy of care into the evolution of their own discipline and contribute back to the development of a philosophy of care. These three questions are in turn part of more extensive research carried out in preparation for a philosophy thesis. They are meant as an invitation and a contribution towards what we hope will be a successful encounter between philosophy and nursing care.

  12. What makes British general practitioners take part in a quality improvement scheme?

    PubMed

    Spooner, A; Chapple, A; Roland, M

    2001-07-01

    To understand the reasons for the apparent success of a quality improvement scheme designed to produce widespread changes in chronic disease management in primary care. Purposeful sample of 36 primary care staff, managers and specialists. Qualitative analysis of 27 interviews in East Kent Health Authority area, where, over a three-year period, more than three-quarters of general practitioners (GPs) and enrolled in a quality improvement programme which required them to meet challenging chronic disease management targets (PRImary Care Clinical Effectiveness--PRICCE). Major changes in clinical practice appeared to have taken place as a result of participation in PRICCE. The scheme was significantly dependent on leadership from the health authority and on local professional support. Factors that motivated GPs to take part in the project included: a desire to improve patient care; financial incentives; maintenance of professional autonomy in how to reach the targets; maintenance of professional pride; and peer pressure. Good teamworking was essential to successful completion of the project and often improved as a result of taking part. The scheme included a combination of interventions known to be effective in producing professional behavioural change. When managerial vision is aligned to professional values, and combined with a range of interventions known to influence professional behaviour including financial incentives, substantial changes in clinical practice can result. Lessons are drawn for future quality improvement programmes in the National Health Service.

  13. It takes chutzpah: oncology nurse leaders.

    PubMed

    Green, E

    1999-01-01

    Chutzpah, according to the Oxford Dictionary of Current English (1996) is a slang term from the Yiddish language which means shameless audacity. Chutzpah has been used to identify people with courage who take on situations that others avoid and somehow achieve the impossible. Tim Porter-O'Grady (1997) recently wrote that management is dead, and has been replaced by process leadership. Health care organizations have made shifts from hierarchical structures to process or program models where people have dual/multiple reporting/communication relationship. In this new orientation, management functions of controlling, directing, organizing and disciplining are replaced by process leadership functions of coordinating, facilitating, linking and sustaining (Porter O'Grady, 1997). Herein lies the challenge for oncology nurse leaders: "what lies behind us and what lies before us are tiny matters compared to what lies within us" (Ralph Waldo Emerson). Leadership is not a function of job title. The evidence for this is clear in current practice.... There are no/few positions of nurse leaders. Titles have changed to eliminate the professional discipline, and reflect a non-descript orientation. The new titles are process leaders, program leaders, professional practice leaders. Nurse leaders need new points of reference to take in the challenges of influencing, facilitating and linking. Those points of reference are: principle-centered leadership, integrity and chutzpah. This presentation will focus on examining current thinking, defining key characteristics and attributes, and using scenarios to illustrate the impact of leadership. We, as leaders in oncology nursing, must use chutzpah to make positive change and long-term gains for patient care and the profession of nursing.

  14. Are red-tailed hawks and great horned owls diurnal-nocturnal dietary counterparts?

    USGS Publications Warehouse

    Marti, C.D.; Kochert, Michael N.

    1995-01-01

    Red-tailed Hawks (Buteo jamaicensis) and Great Homed Owls (Bubo virginianus)are common in North America where they occupy a wide range of habitats, often sympatrically. The two species are similar in size and have been portrayed as ecological counterparts, eating the same prey by day and night. We tested the trophic similarity of the two species by comparing published dietary data from across the United States. Both species ate primarily mammals and birds, and mean proportions of those two prey types did not differ significantly between diets of the two raptors. Red-tailed Hawks ate significantly more reptiles, and Great Homed Owls significantly more invertebrates. Dietary diversity was not significantly different at the level of prey taxonomic class, and diet overlap between the two species averaged 91%. At the prey species level, dietary overlap averaged only 50%, and at that level Red-tailed Hawk dietary diversity was significantly greater than that of Great Horned Owls. Mean prey mass of Red-tailed Hawks was significantly greater than that of Great Homed Owls. Populations of the two species in the western United States differed trophically more than did eastern populations. We conclude that, although the two species are generalist predators, they take largely different prey species in the same localities resulting in distinctive trophic characteristics.

  15. Impact of the 2011 Great East Japan Earthquake on community health: ecological time series on transient increase in indirect mortality and recovery of health and long-term-care system.

    PubMed

    Uchimura, Mari; Kizuki, Masashi; Takano, Takehito; Morita, Ayako; Seino, Kaoruko

    2014-09-01

    The objectives were to clarify the trend in the cause-specific mortality rate and changes in health and long-term-care use after the Great East Japan Earthquake in 2011. We obtained the following data from national sources: the number of deaths by cause, age and month; the amount of healthcare insurance expenditures by type of services, age and month; the amount of long-term-care insurance expenditures by type of services, age, care need and month. We estimated increase in standardised mortality rate postearthquake compared with pre-earthquake, and change in the standardised amount of health and long-term-care insurance expenditures post-earthquake compared with pre-earthquake in three severely affected prefectures, Iwate, Miyagi and Fukushima, by the adjustment for trends in the other prefectures. The risk of indirect mortality increased in the month of the earthquake (relative risk (RR) with 95% CI 1.20 (1.13 to 1.28) for those 60-69 years of age, 1.25 (1.17 to 1.32) for 70-79 years, and 1.33 (1.27 to 1.38) for 80 years and older). The amount of health and long-term-care insurance expenditures decreased among elderly persons in the month of the earthquake, and recovered to 95% of usual level within 1-5 months. Among cities and towns hit by tsunami, higher percentage of households flooded was associated with higher risk of indirect mortality (p<0.001), lower expenditures for outpatient medical care (p<0.001), and lower expenditures for home-care services (p<0.001). This study showed transient increase in indirect mortality and recovery of health and long-term-care system after the earthquake. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  16. The Evolution of Military Trauma and Critical Care Medicine: Applications for Civilian Medical Care Systems

    DTIC Science & Technology

    2008-01-01

    evidence - based medicine . Like great leaders in medicine such as Ibn Sina, war and conflict have also been credited with advances in medical and surgical therapy throughout the centuries. Like in previous conflicts, many authors note that innovations in trauma and critical care evolving from the current global war on terrorism may significantly impact civilian trauma care, critical

  17. Great Lakes Literacy Principles

    NASA Astrophysics Data System (ADS)

    Fortner, Rosanne W.; Manzo, Lyndsey

    2011-03-01

    Lakes Superior, Huron, Michigan, Ontario, and Erie together form North America's Great Lakes, a region that contains 20% of the world's fresh surface water and is home to roughly one quarter of the U.S. population (Figure 1). Supporting a $4 billion sport fishing industry, plus $16 billion annually in boating, 1.5 million U.S. jobs, and $62 billion in annual wages directly, the Great Lakes form the backbone of a regional economy that is vital to the United States as a whole (see http://www.miseagrant.umich.edu/downloads/economy/11-708-Great-Lakes-Jobs.pdf). Yet the grandeur and importance of this freshwater resource are little understood, not only by people in the rest of the country but also by many in the region itself. To help address this lack of knowledge, the Centers for Ocean Sciences Education Excellence (COSEE) Great Lakes, supported by the U.S. National Science Foundation and the National Oceanic and Atmospheric Administration, developed literacy principles for the Great Lakes to serve as a guide for education of students and the public. These “Great Lakes Literacy Principles” represent an understanding of the Great Lakes' influences on society and society's influences on the Great Lakes.

  18. Caring for older people in prehospital emergency care: can nurses make a difference?

    PubMed

    Melby, Vidar; Ryan, Assumpta

    2005-10-01

    The aim of this paper is to explore older people's experiences in prehospital emergency care, and identify benefits and difficulties associated with developing a nurse-led ambulance service. Data were collected at sites in Sweden and Norway. Focus group interviews were conducted to enable the collection of data from paramedics, ambulance nurses and nursing students, while individual interviews were utilized to gather data from older people. There is little research on the quality of care older people over 65 years old receive in prehospital emergency care. Older people often present with multiple pathology and diverse needs that nurses are well equipped to deal with, but presently there is no clearly defined role for nurses in prehospital emergency care in the United Kingdom, although other countries such as Sweden and Norway are developing an ambulance nurse role. If the multiple needs of older people were addressed in the prehospital field, a reduction in readmissions and increased functional ability might be achieved. Comprehensive training is required for ambulance staff to enable them to meet such needs. While nurses have a great foundation for this care, additional specialist ambulance training is required alongside a need for education on older people's needs and attitudes to older people. The introduction of ambulance nurses will result in role differentiation between paramedics and ambulance nurses, which has the potential for creating role conflict. To ensure a smooth transition appropriate training and education for nurses and paramedics should be provided. The end result is a potentially greatly enhanced ambulance care provision, enabling high quality care to all patients.

  19. [Influence of inclusive child day-care on nursery school teachers: a questionnaire survey of teachers with experience in inclusive child day-care in K City].

    PubMed

    Kawachi, Shinobu; Fukuzawa, Yukiko; Hamada, Yuuko

    2006-09-01

    The purpose of this survey questionnaire is to investigate the factors influencing how nursery school teachers perceive inclusive child day-care in K City in order to qualify what support we can provide. The questionnaire was sent to nursery school teachers with experience in inclusive child day-care in K City. Three hundred seventeen teachers provided sufficient data for analysis. The results of this survey suggest that teachers perceive inclusive child day-care to lead up to self-development and the pleasure of child-caring. On the other hand, they feel a burden of inclusive child day-care, with teachers in their 40 s feeling a stronger burden than teachers in their 20 s. And teachers with experience in taking care of emotionally disturbed children or teachers with experience in taking care of hearing-impaired children feel a stronger burden than teachers without experience in taking care of them. The results of our survey also suggest that it is necessary for support systems to have special knowledge about disabled children and special ways of caring, and to decrease teachers' burden or dissatisfaction with inclusive child day-care.

  20. The Great Alliance Between Politics and Science

    NASA Astrophysics Data System (ADS)

    Grasso, Pietro

    2014-07-01

    Dear Friends, I accepted the invitation to take part in this important scientific appointment, which has remarkably reached its 46th edition this year, with great pleasure. First of all, I would like to warmly welcome and thank the scientists who have come from all over the world to give their contribution of intelligence and commitment to the future of our planet and of humanity. I would like to thank the World Federation of Scientists, the ICSC World Lab and the Ettore Majorana Foundation for their invitation and hospitality and I would like to express my personal consideration and respect for Professor Antonino Zichichi, for his competent and passionate dedication in keeping the attention of science, public opinion and politics focused on planetary emergencies for decades, combining scientific rigour and popularisation skill...

  1. Women’s Experiences of Abnormal Cervical Cytology: Illness Representations, Care Processes, and Outcomes

    PubMed Central

    Karasz, Alison; McKee, M. Diane; Roybal, Krista

    2003-01-01

    BACKGROUND We wanted to explore the conceptual representations of illness and experiences with care among women who have learned of an abnormal Papanicolaou (Pap) smear result. METHODS The study took place in 2 primary care, family practice clinics serving low-income, multiethnic patients in the Bronx, New York City. We conducted qualitative, semistructured telephone interviews with 17 patients who had recently learned of abnormal findings on a Pap smear. After a preliminary coding phase, the investigators identified 2 important outcomes: distress and dissatisfaction with care, and factors affecting these outcomes. A model was developed on a subset of the data, which was then tested on each transcript with an explicit search for disconfirming cases. A revised coding scheme conforming to the dimensions of the model was used to recode transcripts. RESULTS Women reported complex, syncretic models of illness that included both biomedical and folk elements. Many concerns, especially nonbiomedical concerns, were not addressed in interactions with physicians. An important source of both distress and dissatisfaction with care was the women’s lack of understanding of the inherent ambiguity of Pap smear results. When perceived care needs, which included emotional support as well as information, were not met, distress and dissatisfaction were greatly increased. CONCLUSION In this study, patients’ illness models and expectations of care were not routinely addressed in their conversations with physicians about abnormal Pap smear results. When physicians can take the time to review patients’ illness models carefully, distress and dissatisfaction with care can be reduced considerably. PMID:15055408

  2. Reconsidering inequalities in preventive health care: an application of cultural health capital theory and the life-course perspective to the take-up of mammography screening.

    PubMed

    Missinne, Sarah; Neels, Karel; Bracke, Piet

    2014-11-01

    While there are abundant descriptions of socioeconomic inequalities in preventive health care, knowledge about the true mechanisms is still lacking. Recently, the role of cultural health capital in preventive health-care inequalities has been discussed theoretically. Given substantial analogies, we explore how our understanding of cultural health capital and preventive health-care inequalities can be advanced by applying the theoretical principles and methodology of the life-course perspective. By means of event history analysis and retrospective data from the Survey of Health Ageing and Retirement, we examine the role of cultural capital and cultural health capital during childhood on the timely initiation of mammography screening in Belgium (N = 1348). In line with cumulative disadvantage theory, the results show that childhood cultural conditions are independently associated with mammography screening, even after childhood and adulthood socioeconomic position and health are controlled for. Lingering effects from childhood are suggested by the accumulation of cultural health capital that starts early in life. Inequalities in the take-up of screening are manifested as a lower probability of ever having a mammogram, rather than in the late initiation of screening. © 2014 The Authors. Sociology of Health & Illness © 2014 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

  3. Exemplification of Movement Patterns and Their Influence on Body Posture in Younger School-Age Children on the Basis of an Authorial Program "I Take Care of My Spine".

    PubMed

    Brzek, Anna; Plinta, Ryszard

    2016-03-01

    Exemplification of movement patterns is most noticeable in the youngest pupils group. Generally, children do not know which patterns are correct and which ones are risk factors. After correcting and stabilizing some improper patterns, a child can perform their daily activities without constant cognizance of their appropriateness. The concept of this research is included in a paradigm for the quality research conducted as action-research, which assumed a quality and efficiency improvement of health education in Polish schools.The main aim of this study was to encourage pupils, their parents and teachers to perform pro-health behaviors oriented toward maintaining an appropriate body posture. First, the study aimed to assess the postures of children involved in the authorial program "I take care of my spine" in comparison with a group of children without diagnosed postural defects and not involved in the curriculum.The examinations covered a group of 144 children (group A) ages 7 to 9 years (mean 7.60 ± 0.64 years) with appropriate body postures recognized in the screening test, which was conducted at a school where the curriculum "I take care of my spine" was launched. The control group included 222 healthy children at a similar age who attended schools where the curriculum was not implemented. The examinations were performed 2 times, as follows: the first time occurred before the program "I take care of my spine" was launched (initial examination), and the second time after 9 to 10 months of full participation in the program's activities and after 1 year of observation of children from group B (final examination).A significant improvement of posturometric parameters in the main group and worsening of the parameters in the control group were noted. The results in examined groups of children and diversification of the results were linked to implementing the prevention program in the main group. In the group of children involved in the postural prevention program

  4. Quality care as ethical care: a poststructural analysis of palliative and supportive district nursing care.

    PubMed

    Nagington, Maurice; Walshe, Catherine; Luker, Karen A

    2016-03-01

    Quality of care is a prominent discourse in modern health-care and has previously been conceptualised in terms of ethics. In addition, the role of knowledge has been suggested as being particularly influential with regard to the nurse-patient-carer relationship. However, to date, no analyses have examined how knowledge (as an ethical concept) impinges on quality of care. Qualitative semi-structured interviews were conducted with 26 patients with palliative and supportive care needs receiving district nursing care and thirteen of their lay carers. Poststructural discourse analysis techniques were utilised to take an ethical perspective on the current way in which quality of care is assessed and produced in health-care. It is argued that if quality of care is to be achieved, patients and carers need to be able to redistribute and redevelop the knowledge of their services in a collaborative way that goes beyond the current ways of working. Theoretical works and extant research are then used to produce tentative suggestions about how this may be achieved. © 2015 The Authors Nursing Inquiry Published by John Wiley & Sons Ltd.

  5. The Great Recession and inequalities in access to health care: a study of unemployment and unmet medical need in Europe in the economic crisis.

    PubMed

    Madureira-Lima, Joana; Reeves, Aaron; Clair, Amy; Stuckler, David

    2018-02-01

    Unmet medical need (UMN) had been declining steadily across Europe until the 2008 Recession, a period characterized by rising unemployment. We examined whether becoming unemployed increased the risk of UMN during the Great Recession and whether the extent of out-of-pocket payments (OOP) for health care and income replacement for the unemployed (IRU) moderated this relationship. We used the European Survey on Income and Living Conditions (EU-SILC) to construct a pseudo-panel (n = 135 529) across 25 countries to estimate the relationship between unemployment and UMN. We estimated linear probability models, using a baseline of employed people with no UMN, to test whether this relationship is mediated by financial hardship and moderated by levels of OOP and IRU. Job loss increased the risk of UMN [β = 0.027, 95% confidence interval (CI) 0.022-0.033] and financial hardship exacerbated this effect. Fewer people experiencing job loss lost access to health care in countries where OOPs were low or in countries where IRU is high. The results are robust to different model specifications. Unemployment does not necessarily compromise access to health care. Rather, access is jeopardized by diminishing financial resources that accompany job loss. Lower OOPs or higher IRU protect against loss of access, but they cannot guarantee it. Policy solutions should secure financial protection for the unemployed so that resources do not have to be diverted from health. © The Author 2017. Published by Oxford University Press on behalf of the International Epidemiological Association

  6. The Great Lakes

    EPA Pesticide Factsheets

    The Great Lakes form the largest surface freshwater system on Earth. The U.S. and Canada work together to restore and protect the environment in the Great Lakes Basin. Top issues include contaminated sediments, water quality and invasive species.

  7. Intensive care unit research ethics and trials on unconscious patients.

    PubMed

    Gillett, G R

    2015-05-01

    There are widely acknowledged ethical issues in enrolling unconscious patients in research trials, particularly in intensive care unit (ICU) settings. An analysis of those issues shows that, by and large, patients are better served in units where research is actively taking place for several reasons: i) they do not fall prey to therapeutic prejudices without clear evidential support, ii) they get a chance of accessing new and potentially beneficial treatments, iii) a climate of careful monitoring of patients and their clinical progress is necessary for good clinical research and affects the care of all patients and iv) even those not in the treatment arm of a trial of a new intervention must receive best current standard care (according to international evidence-based treatment guidelines). Given that we have discovered a number of 'best practice' regimens of care that do not optimise outcomes in ICU settings, it is of great benefit to all patients (including those participating in research) that we are constantly updating and evaluating what we do. Therefore, the practice of ICU-based clinical research on patients, many of whom cannot give prospective informed consent, ticks all the ethical boxes and ought to be encouraged in our health system. It is very important that the evaluation of protocols for ICU research should not overlook obvious (albeit probabilistic) benefits to patients and the acceptability of responsible clinicians entering patients into well-designed trials, even though the ICU setting does not and cannot conform to typical informed consent procedures and requirements.

  8. Is This Time Different? The Slowdown in Health Care Spending

    PubMed Central

    Chandra, Amitabh; Holmes, Jonathan; Skinner, Jonathan

    2014-01-01

    Why have health care costs moderated in the last decade? Some have suggested that the Great Recession alone was the cause, but health expenditure growth in the depths of the recession was nearly identical to growth prior to the recession. Nor can the Affordable Care Act (ACA) take credit, since the slowdown began prior to its implementation. Instead, we identify three primary causes of the slowdown: the rise in high-deductible insurance plans, state-level efforts to control Medicaid costs, and a general slowdown in the diffusion of new technology, particularly for use by the Medicare population. A more difficult question is: Will this slowdown continue? On this question we are pessimistic, and not entirely because a similar (and temporary) slowdown occurred in the early 1990s. The primary determinant of long-term growth is the continued development of expensive technology, and there is little evidence of a permanent slowdown in that pipeline. Proton beam accelerators are on target to double between 2010 and 2014, while the market for heart-assist devices (costing more than $300,000 each) is projected to grow rapidly. Accountable care organizations (ACOs) and emboldened insurance companies may yet stifle health care cost growth, but our best estimate over the next two decades is that health care costs will grow at GDP plus 1.2 percent, a rate lower than previous estimates but still on track to cause serious fiscal pain for taxpayers and workers who bear the costs of higher premiums. PMID:25418992

  9. Megamarketing strategies for health care services.

    PubMed

    Mobley, M F; Elkins, R L

    1990-01-01

    Megamarketing, as coined by Kotler (1968), is a strategic way of thinking which takes an enlarged view of the skills and resources needed to enter and operate in obstructed or protected markets. The concept of megamarketing emphasizes the mastering and coordination of economic, psychological, political, and public relation skills and suggest that organizations can take a proactive stance in shaping macroenvironmental conditions. As health care delivery is characterized by a highly regulated environment, this marketing approach has definite applications for the health care marketer.

  10. Great Lakes: Chemical Monitoring

    ERIC Educational Resources Information Center

    Delfino, Joseph J.

    1976-01-01

    The Tenth Great Lakes Regional Meeting of the American Chemical Society met to assess current Chemical Research activity in the Great Lakes Basin, and addressed to the various aspects of the theme, Chemistry of the Great Lakes. Research areas reviewed included watershed studies, atmospheric and aquatic studies, and sediment studies. (BT)

  11. Home health care

    MedlinePlus

    ... Skilled nursing - home health; Skilled nursing - home care; Physical therapy - at home; Occupational therapy - at home; Discharge - ... and any medicines that you may be taking. Physical and occupational therapists can make sure your home ...

  12. Women's and care providers' perspectives of quality prenatal care: a qualitative descriptive study

    PubMed Central

    2012-01-01

    Background Much attention has been given to the adequacy of prenatal care use in promoting healthy outcomes for women and their infants. Adequacy of use takes into account the timing of initiation of prenatal care and the number of visits. However, there is emerging evidence that the quality of prenatal care may be more important than adequacy of use. The purpose of our study was to explore women's and care providers' perspectives of quality prenatal care to inform the development of items for a new instrument, the Quality of Prenatal Care Questionnaire. We report on the derivation of themes resulting from this first step of questionnaire development. Methods A qualitative descriptive approach was used. Semi-structured interviews were conducted with 40 pregnant women and 40 prenatal care providers recruited from five urban centres across Canada. Data were analyzed using inductive open and then pattern coding. The final step of analysis used a deductive approach to assign the emergent themes to broader categories reflective of the study's conceptual framework. Results The three main categories informed by Donabedian's model of quality health care were structure of care, clinical care processes, and interpersonal care processes. Structure of care themes included access, physical setting, and staff and care provider characteristics. Themes under clinical care processes were health promotion and illness prevention, screening and assessment, information sharing, continuity of care, non-medicalization of pregnancy, and women-centredness. Interpersonal care processes themes were respectful attitude, emotional support, approachable interaction style, and taking time. A recurrent theme woven throughout the data reflected the importance of a meaningful relationship between a woman and her prenatal care provider that was characterized by trust. Conclusions While certain aspects of structure of care were identified as being key dimensions of quality prenatal care, clinical and

  13. Perspective-Taking Judgments Among Young Adults, Middle-Aged, and Elderly People

    ERIC Educational Resources Information Center

    Ligneau-Herve, Catherine; Mullet, Etienne

    2005-01-01

    Perspective-taking judgments among young adults, middle-aged, and elderly people were examined. In 1 condition, participants were instructed to judge the likelihood of acceptance of a painkiller as a function of 3 cues: severity of the condition, potential side effects, and level of trust in the health care provider. In the other condition,…

  14. What blocks health visitors from taking on a leadership role?

    PubMed

    Hyett, Erika

    2003-07-01

    Current government documents in the United Kingdom call for all nurses to take on a greater leadership role. This paper critically considers some of the management factors that block one group of specialist nurses (health visitors) from fulfilling their leadership role. Health visitors have a key role to play in meeting the public health targets of local primary care trusts, known as local health improvement plans. But to take on a greater public health role, health visitors need to move away from working independently within separate general practitioner surgeries and to work in teams which share the vision and goals of the primary care trusts. The paper explores different styles of management that promote transformational leadership and relate to practice. It is suggested that use of the Servant-Leader model of management should encourage the empowerment of staff, and through empowerment health visitors should be able to instigate change and become more innovative in their practice. Persistent recruitment and retention problems have resulted in little time being available to focus on the effectiveness of services. The future management of health visitors will be to primarily run the service while supporting staff in accessing and influencing those in power.

  15. Access to Oral Health Care: A National Crisis and Call for Reform.

    PubMed

    Bersell, Catherine H

    2017-02-01

    Purpose: According to the report Healthy People 2020, oral health is integral to overall health and access to dental services is essential to promoting and maintaining good oral health. Yet, those who need dental care the most are often the least likely to receive it. The dental hygiene profession is poised to play a pivotal role in the resolution of oral health disparities. The purpose of this manuscript is to examine the critical issue of access to oral health care in the United States from various perspectives and consider potential implications for dental professionals and the oral health care system. This report focuses on major underserved and vulnerable populations and highlights several barriers that significantly affect the ability to access and navigate the oral health care system. These include low socioeconomic status; the shortage and maldistribution of dentists; a lack of professional training regarding current evidence-based oral health guidelines; deficient continuity of care due to inadequate interdisciplinary collaboration; low oral health literacy; and patient perceptions and misconceptions about preventive dental care. This report also contains an update on provider participation in Medicaid; the state of children's oral health; and emerging workforce models, state initiatives, and legislative reforms. Recommendations increasing access to care require local, state, and federal stakeholders to combine forces that take advantage of the existing dental hygiene workforce, utilize innovative delivery models, improve license reciprocity, reduce prohibitive supervision, and expand the dental hygiene scope of practice. The major focus of future research will be on the implementation of mid-level oral health care providers. Dental hygienists are an integral part of the access to care solution and have a great opportunity to lead the call to action and fulfill the American Dental Hygienists' Association's mandate that oral health care is the right of all

  16. Coast Guard Assists with Mapping of Great Lakes Ice

    NASA Image and Video Library

    1976-11-21

    A group of Coast Guard seamen leave their ship to verify ice formations on the Great Lakes as part of an joint effort with the National Aeronautics and Space Administration (NASA) Lewis Research Center and the National Oceanic and Atmospheric Administration. The regular winter freezing of large portions of the Great Lakes stalled the shipping industry. Lewis began working on two complementary systems to monitor the ice. The Side Looking Airborne Radar (SLAR) system used microwaves to measure the ice distribution and electromagnetic systems used noise modulation to determine the thickness of the ice. The images were then transferred via satellite to the Coast Guard station. The Coast Guard then transmitted the pertinent images by VHF to the ship captains to help them select the best route. The Great Lakes ice mapping devices were first tested on NASA aircraft during the winter of 1972 and 1973. The pulsed radar system was transferred to the Coast Guard’s C-130 aircraft for the 1975 and 1976 winter. The SLAR was installed in the rear cargo door, and the small S-band antenna was mounted to the underside of the aircraft. Coast Guard flights began in January 1975 at an altitude of 11,000 feet. Early in the program, teams of guardsmen and NASA researchers frequently set out in boats to take samples and measurements of the ice in order to verify the radar information.

  17. To provide care and be cared for in a multiple-bed hospital room.

    PubMed

    Persson, Eva; Määttä, Sylvia

    2012-12-01

    To illuminate patients' experiences of being cared for and nurses' experiences of caring for patients in a multiple-bed hospital room. Many patients and healthcare personnel seem to prefer single-bed hospital rooms. However, certain advantages of multiple-bed hospital rooms (MBRs) have also been described. Eight men and eight women being cared for in a multiple-bedroom were interviewed, and two focus-group interviews (FGI) with 12 nurses were performed. A qualitative content analysis was used. One theme--Creating a sphere of privacy--and three categories were identified based on the patient interviews. The categories were: Being considerate, Having company and The patients' area. In the FGI, one theme--Integrating individual care with care for all--and two categories emerged: Experiencing a friendly atmosphere and Providing exigent care. Both patients and nurses described the advantages and disadvantages of multiple-bed rooms. The patient culture of taking care of one another and enjoying the company of room-mates were considered positive and gave a sense of security of both patients and nurses. The advantages were slight and could easily become disadvantages if, for example, room-mates were very ill or confused. The patients tried to maintain their privacy and dignity and claimed that there were small problems with room-mates listening to conversations. In contrast, the nurses stressed patient integrity as a main disadvantage and worked to protect the integrity of individual patients. Providing care for all patients simultaneously had the advantage of saving time. The insights gained in the present study could assist nurses in reducing the disadvantages and taking advantage of the positive elements of providing care in MBRs. Health professionals need to be aware of how attitudes towards male and female patients, respectively, could affect care provision. © 2012 The Authors. Scandinavian Journal of Caring Sciences © 2012 Nordic College of Caring Science.

  18. Survey of the provision of prophylactic dental care for horses in Great Britain and Ireland between 1999 and 2002.

    PubMed

    Dixon, P M; Andrew, R; Brannon, H; Burgess, R; Gibson, A; Little, J C; Orange, B; Ross, L; Rudolph, T; Shaw, D J

    2004-11-27

    A survey of 854 horse owners, trainers and equestrian managers in 10 regions of Great Britain and Ireland showed that 83 per cent provided their horses with routine prophylactic dental care at fixed intervals, including 49 per cent at intervals of 12 months and 30 per cent at intervals of six months; a further 10 per cent provided it only when they felt it was required and 7 per cent did not provide it at all. Overall, 44 per cent of the owners had their horse's wolf teeth (first premolar) extracted routinely; when prophylactic dentistry was provided, it was carried out solely by equine dental technicians (EDTS) for 53 per cent of owners, solely by veterinarians for 35 per cent, by both EDTS or veterinarians for 10 per cent of owners and by other than veterinarians or EDTS for 1 per cent. There was confusion among some horse owners concerning the qualifications of the EDTS, because no recognised British qualification was available until towards the end of this survey in 2001. Several reasons were cited by owners for choosing between veterinarians and EDTS including their perceived qualifications, personal recommendations, costs, the availability of a wide range of dental equipment and sedation, and the time and effort devoted to the procedures.

  19. More action needed: Psychotropic prescribing in Australian residential aged care.

    PubMed

    Westbury, Juanita; Gee, Peter; Ling, Tristan; Kitsos, Alex; Peterson, Gregory

    2018-02-01

    For at least two decades, concerns have been raised about inappropriate psychotropic prescribing in Australian residential aged care facilities, due to their modest therapeutic benefit and increased risk of falls and mortality. To date, the majority of prevalence data has been collected in Sydney exclusively and it is not known if recent initiatives to promote appropriate psychotropic prescribing have impacted utilisation. Thus, we aimed to comprehensively analyse psychotropic use in a large national sample of residential aged care facility residents. A cross-sectional, retrospective cohort study of residents from 150 residential aged care facilities distributed nationally during April 2014-October 2015. Antipsychotic, anxiolytic/hypnotic and antidepressant utilisation was assessed, along with anticonvulsant and anti-dementia drug use. Negative binomial regression analysis was used to examine variation in psychotropic use. Full psychotropic prescribing data was available from 11,368 residents. Nearly two-thirds (61%) were taking psychotropic agents regularly, with over 41% prescribed antidepressants, 22% antipsychotics and 22% of residents taking benzodiazepines. Over 30% and 11% were charted for 'prn' (as required) benzodiazepines and antipsychotics, respectively. More than 16% of the residents were taking sedating antidepressants, predominantly mirtazapine. South Australian residents were more likely to be taking benzodiazepines ( p < 0.05) and residents from New South Wales/Australian Capital Territory less likely to be taking them ( p < 0.01), after adjustment for rurality and size of residential aged care facility. Residents located in New South Wales/Australian Capital Territory were also significantly less likely to take antidepressants ( p < 0.01), as were residents from outer regional residential aged care facilities ( p < 0.01). Antipsychotic use was not associated with State, rurality or residential aged care facility size. Regular

  20. The Great Equalizer: Health Care Access and Infant Mortality in Thailand.

    PubMed

    Gruber, Jonathan; Hendren, Nathaniel; Townsend, Robert M

    2014-01-01

    This paper analyzes Thailand's 2001 healthcare reform, "30 Baht". The program increased funding available to hospitals to care for the poor and reduced copays to 30 Baht (~$0.75). Our estimates suggest the supply-side funding of the program increased healthcare utilization, especially amongst the poor. Moreover, we find significant impacts on infant mortality: prior to 30 Baht poorer provinces had significantly higher infant mortality rates than richer provinces. After 30 Baht this correlation evaporates to zero. The results suggest that increased access to healthcare among the poor can significantly reduce their infant mortality rates.

  1. From managing access to managing care: the impact of primary care on health care delivery organizations.

    PubMed

    Hickey, M E

    1995-10-01

    Professional "revenge of the nerds" is currently taking place, as managed care evolves generalist physicians into new professional prominence. Primary care physicians are finding themselves at the center of health care market reform as health plans, insurers, and other financing organizations turn to them as the key to cost control. In short supply, they are prospering financially from the demand. As the source of patients, they are gaining in prestige from specialists and hospitals who once demeaned them. But these newfound roles are only the initial steps in the transformation of the primary care practitioner. The change that the generalists are experiencing is essentially managing access to care, not truly managing care itself. There are large and crucial differences between managing access to care and actually managing care. These differences are, in many ways, a higher calling for primary care practitioners as they refocus attention on patient outcomes, which will in itself result in a lower resource utilization above and beyond the crude controlling of access. What those differences are, what new roles they require, and what impact they will have on organizations that either house or contract with primary care physicians will be the focus of this article.

  2. Travel characteristics and risk-taking attitudes in youths traveling to nonindustrialized countries.

    PubMed

    Han, Pauline; Balaban, Victor; Marano, Cinzia

    2010-01-01

    International travel to developing countries is increasing with rising levels of disposable income; this trend is seen in both adults and children. Risk-taking attitude is fundamental to research on the prevention of risky health behaviors, which can be an indicator of the likelihood of experiencing illness or injury during travel. The aim of this study is to investigate whether risk-taking attitudes of youths are associated with travel characteristics and likelihood of experiencing illness or injury while traveling to nonindustrialized countries. Data were analyzed from the 2008 YouthStyles survey, an annual mail survey gathering demographics and health knowledge, attitudes, and practices of individuals from 9 through 18 years of age. Travelers were defined as respondents who reported traveling in the last 12 months to a destination other than the United States, Canada, Europe, Japan, Australia, or New Zealand. Risk-taking attitude was measured by using a four-item Brief Sensation-Seeking Scale. All p values ≤ 0.05 were considered significant. Of 1,704 respondents, 131 (7.7%) traveled in the last 12 months. Females and those with higher household income were more likely to travel (odds ratio = 1.6,1.1). Of those who traveled, 16.7% reported seeking pretravel medical care, with most visiting a family doctor for that care (84.0%). However, one-fifth of respondents reported illness and injury during travel; of these, 83.3% traveled with their parents. Males and older youths had higher mean sensation-seeking scores. Further, travelers had a higher mean sensation-seeking score than nontravelers. Those who did not seek pretravel medical care also had higher mean sensation-seeking scores (p = 0.1, not significant). Our results show an association between risk-taking attitudes and youth travel behavior. However, adult supervision during travel and parental directives prior to travel should be taken into consideration. Communication messages should emphasize the

  3. Barriers and facilitators in the provision of post-abortion care at district level in central Uganda – a qualitative study focusing on task sharing between physicians and midwives

    PubMed Central

    2014-01-01

    Background Abortion is restricted in Uganda, and poor access to contraceptive methods result in unwanted pregnancies. This leaves women no other choice than unsafe abortion, thus placing a great burden on the Ugandan health system and making unsafe abortion one of the major contributors to maternal mortality and morbidity in Uganda. The existing sexual and reproductive health policy in Uganda supports the sharing of tasks in post-abortion care. This task sharing is taking place as a pragmatic response to the increased workload. This study aims to explore physicians’ and midwives’ perception of post-abortion care with regard to professional competences, methods, contraceptive counselling and task shifting/sharing in post-abortion care. Methods In-depth interviews (n = 27) with health care providers of post-abortion care were conducted in seven health facilities in the Central Region of Uganda. The data were organized using thematic analysis with an inductive approach. Results Post-abortion care was perceived as necessary, albeit controversial and sometimes difficult to provide. Together with poor conditions post-abortion care provoked frustration especially among midwives. Task sharing was generally taking place and midwives were identified as the main providers, although they would rarely have the proper training in post-abortion care. Additionally, midwives were sometimes forced to provide services outside their defined task area, due to the absence of doctors. Different uterine evacuation skills were recognized although few providers knew of misoprostol as a method for post-abortion care. An overall need for further training in post-abortion care was identified. Conclusions Task sharing is taking place, but providers lack the relevant skills for the provision of quality care. For post-abortion care to improve, task sharing needs to be scaled up and in-service training for both doctors and midwives needs to be provided. Post-abortion care should further be

  4. The Great War as a Crucial Point in the History of Russian Science and Technology.

    PubMed

    Saprykin, Dmitry L

    2016-01-01

    The paper is devoted to one of the most important and, at the same time, relatively unexplored phases in the history of Russian science and technology. The Great War coincided with the beginning of a heyday in science, engineering education, and technology in Russia. It was precisely the time in which Russia's era of "Big Science" was emer- ging. Many Russian and Soviet technical projects and scientific schools were rooted in the time of the Great War. The "engineerization" of science and a "physical-technical" way of thinking had already begun before the war. But it was precisely the war which encouraged a large proportion of the Russian academic community to take part in industrial projects. Academics also played a significant role in developing concepts and implementing strategic plans during the Great War. This article also discusses how the organization of science and the academic community was transformed during, and after, the Great War. And it looks at the impact that war had on Russia's participation in the international scientific community.

  5. Great Lakes in January

    NASA Image and Video Library

    2017-12-08

    This image taken on January 13, 2015 from the Suomi NPP satellite's VIIRS instrument shows the Great Lakes and surrounding areas. The latest Great Lakes Surface Environmental Analysis (GLSEA) from the NOAA Great Lakes Environmental Research Laboratory shows total ice cover of 29.3% as of January 13th. Credit: NOAA/NASA/NPP Via NOAA Environmental Visualization Laboratory

  6. From the North American Great Basin to the planet Mars: Taking Lacustrine Geomorphology into the 21st Century

    NASA Astrophysics Data System (ADS)

    Edgett, Kenneth S.; Parker, Timothy J.

    1997-09-01

    Introduction. The entire planet Mars is presently a desert more arid than any on Earth. The planet appears to have had more water in the past, and some of this water affected the surface geology and geomorphology by carving a variety of channels. Despite the evidence for running water in the martian past, the presence of sanding bodies of water (lakes, oceans) has been a topic of considerable controversy in the past two decades. The issue is still not settled, but evidence has mounted to suggest that lakes and oceans were indeed a major factor in shaping the present geomorphology of the martian surface. Although there remains uncertainty as to whether lakes were present on Mars, major efforts to seek evidence for fossil martian organisms are focused on the search for lake sediments and tufa deposits [1]. In 2001 and 2003, the NASA Mars Surveyor Program will launch mobile rovers designed to explore the surface and collect samples for return to Earth. The first set of samples will reach Earth in 2008. The types of landing sites being considered for the '01 and '03 missions include areas interpreted as ancient lacustrine deposits. Knowledge and experience with the geomorphology of lacustrine features in the North American Great Basin is crucial for identifying lake features on Mars. Martian Lakes and Oceans: Prior to spacecraft exploration of Mars, many early astronomers though that the low-albedo surfaces of Mars could be seas or lakes, others considered these to be vast tracts of vegetation [2]. The low-albedo surfaces are now known to be the result of aeolian action on the distribution of sand and dust. The Mariner 4, 6, and 7 spacecraft in 1965 and 1969 stunned the world by showing a cratered, lunar-like martian surface. In 1972, Mariner 9 showed a more Earth-like surface - indeed, there were numerous channels, some carved by massive floods, others perhaps by fluvial run-off or sapping. The Viking orbiters (1976-1980) provided additional images; these formed the

  7. Exemplification of Movement Patterns and Their Influence on Body Posture in Younger School-Age Children on the Basis of an Authorial Program “I Take Care of My Spine”

    PubMed Central

    Brzek, Anna; Plinta, Ryszard

    2016-01-01

    Abstract Exemplification of movement patterns is most noticeable in the youngest pupils group. Generally, children do not know which patterns are correct and which ones are risk factors. After correcting and stabilizing some improper patterns, a child can perform their daily activities without constant cognizance of their appropriateness. The concept of this research is included in a paradigm for the quality research conducted as action-research, which assumed a quality and efficiency improvement of health education in Polish schools. The main aim of this study was to encourage pupils, their parents and teachers to perform pro-health behaviors oriented toward maintaining an appropriate body posture. First, the study aimed to assess the postures of children involved in the authorial program “I take care of my spine” in comparison with a group of children without diagnosed postural defects and not involved in the curriculum. The examinations covered a group of 144 children (group A) ages 7 to 9 years (mean 7.60 ± 0.64 years) with appropriate body postures recognized in the screening test, which was conducted at a school where the curriculum “I take care of my spine” was launched. The control group included 222 healthy children at a similar age who attended schools where the curriculum was not implemented. The examinations were performed 2 times, as follows: the first time occurred before the program “I take care of my spine” was launched (initial examination), and the second time after 9 to 10 months of full participation in the program's activities and after 1 year of observation of children from group B (final examination). A significant improvement of posturometric parameters in the main group and worsening of the parameters in the control group were noted. The results in examined groups of children and diversification of the results were linked to implementing the prevention program in the main group. In the group of children involved in the

  8. Physician leadership: a health-care system's investment in the future of quality care.

    PubMed

    Orlando, Rocco; Haytaian, Marcia

    2012-08-01

    The current state of health care and its reform will require physician leaders to take on greater management responsibilities, which will require a set of organizational and leadership competencies that traditional medical education does not provide. Physician leaders can form a bridge between the clinical and administrative sides of a health-care organization, serving to further the organization's strategy for growth and success. Recognizing that the health-care industry is rapidly changing and physician leaders will play a key role in that transformation, Hartford HealthCare has established a Physician Leadership Development Institute that provides advanced leadership skills and management education to select physicians practicing within the health-care system.

  9. Regional implementation of a national cancer policy: taking forward multiprofessional, collaborative cancer care.

    PubMed

    Ferguson, A; Makin, W; Walker, B; Dublon, G

    1998-09-01

    The vision of the Calman-Hine paper is of patient-centred care, delivered by co-ordinated services which have genuine partnerships with each other. There is integration of other providers of support, to meet psychological and non-clinical needs. There is access to palliative care when required, from diagnosis onwards, and not just in the terminal stage. Effective communications and networks are the keys to making this vision a reality. Our recommendations are based upon in-depth discussions with purchasers, doctors and nurses, and others involved with cancer services within hospitals or the community across the region. They reflect the priorities placed on the development of good practice. Purchasers and providers should work together to implement these guidelines.

  10. JPL's GNSS Real-Time Earthquake and Tsunami (GREAT) Alert System

    NASA Astrophysics Data System (ADS)

    Bar-Sever, Yoaz; Miller, Mark; Vallisneri, Michele; Khachikyan, Robert; Meyer, Robert

    2017-04-01

    We describe recent developments to the GREAT Alert natural hazard monitoring service from JPL's Global Differential GPS (GDGPS) System. GREAT Alert provides real-time, 1 Hz positioning solutions for hundreds of GNSS tracking sites, from both global and regional networks, aiming to monitor ground motion in the immediate aftermath of earthquakes. We take advantage of the centralized data processing, which is collocated with the GNSS orbit determination operations of the GDGPS System, to combine orbit determination with large-scale point-positioning in a grand estimation scheme, and as a result realize significant improvement to the positioning accuracy compared to conventional stand-alone point positioning techniques. For example, the measured median site (over all sites) real-time horizontal positioning accuracy is 2 cm 1DRMS, and the median real-time vertical accuracy is 4 cm RMS. The GREAT Alert positioning service is integrated with automated global earthquake notices from the United States Geodetic Survey (USGS) to support near-real-time calculations of co-seismic displacements with attendant formal errors based both short-term and long-term error analysis for each individual site. We will show the millimeter-level resolution of co-seismic displacement can be achieved by this system. The co-seismic displacements, in turn, are fed into a JPL geodynamics and ocean models, that estimate the Earthquake magnitude and predict the potential tsunami scale.

  11. Sarcocystis falcatula-associated encephalitis in a free-ranging great horned owl (Bubo virginianus).

    PubMed

    Wünschmann, Arno; Rejmanek, Daniel; Cruz-Martinez, Luis; Barr, Bradd C

    2009-03-01

    A great horned owl (Bubo virginianus) was admitted to a rehabilitation clinic with severe neurologic signs that were unresponsive to supportive care. The animal was euthanatized because of a poor prognosis. Marked granulomatous encephalitis with focal brainstem malacia was detected microscopically. The brainstem was the most severely affected brain location and the only place in which schizonts and merozoites, morphologically compatible with Sarcocystis spp., were detected. Immunohistochemistry with the use of polyclonal antisera indicated the presence of Sarcocystis falcatula. The species identification of the protozoa as S. falcatula was confirmed by polymerase chain reaction. To the author's knowledge, this is the first report of spontaneous S. falcatula-associated encephalitis in a great horned owl.

  12. Taking kangaroo mother care forward in South Africa: The role of district clinical specialist teams.

    PubMed

    Feucht, Ute Dagmar; van Rooyen, Elise; Skhosana, Rinah; Bergh, Anne-Marie

    2015-11-20

    The global agenda for improved neonatal care includes the scale-up of kangaroo mother care (KMC) services. The establishment of district clinical specialist teams (DCSTs) in South Africa (SA) provides an excellent opportunity to enhance neonatal care at district level and ensure translation of policies, including the requirement for KMC implementation, into everyday clinical practice. Tshwane District in Gauteng Province, SA, has been experiencing an increasing strain on obstetric and neonatal services at central, tertiary and regional hospitals in recent years as a result of growing population numbers and rapid up-referral of patients, with limited down-referral of low-risk patients to district-level services. We describe a successful multidisciplinary quality improvement initiative under the leadership of the Tshwane DCST, in conjunction with experienced local KMC implementers, aimed at expanding the district's KMC services. The project subsequently served as a platform for improvement of other areas of neonatal care by means of a systematic approach.

  13. Taking DoD Contracting From Good to Great

    DTIC Science & Technology

    2009-06-01

    alone. 3 Defense AT&L: May-June 2009 Charlie E. Williams Jr., who became the director of the Defense Contract Management Agency on May 4, 2008, oversees...contrac- tors. DCMA accepts approximately 750,000 shipments of supplies and some 1,200 aircraft each year in addition to managing over $100 billion...Air Force Maj. Michelle Brunswick, DAU professor of acquisition management ; James P. McNulty, DAU professor of systems acquisition management ; and

  14. Mobile Technology Applications in Cancer Palliative Care.

    PubMed

    Freire de Castro Silva, Sandro Luís; Gonçalves, Antônio Augusto; Cheng, Cezar; Fernandes Martins, Carlos Henrique

    2018-01-01

    Mobile devices frequently used in other specialties can find great utility in palliative care. For healthcare professionals, the use of mobile technology not only can bring additional resources to the care, but it can actually radically change the cancer remote care practices. The Brazilian National Cancer Institute (INCA) has developed the largest cancer home care program in Latin America, which currently benefits more than 500 patients. The purpose of this paper is to show the development of an ICT environment of mobile applications developed to support the palliative cancer care program at INCA.

  15. Physicians and Students Take to the Streets to Ask: What Do People Want From Their Health Care?

    PubMed

    DiGioia, Kimberly; Nair, Mohit; Shields, Morgan; Saini, Vikas

    2018-06-01

    With the aim of better understanding what the public (as opposed to "patients") wants from health care, this study asked people on the street, "What does the right health care mean to you?" Responses ranged from "Caring about me more than just in the appointment" to "That everyone should see exactly what medical treatment costs." A qualitative analysis revealed that all responses fell into 2 overarching categories: health care at the interpersonal level and health care at the system level. Approximately 66.7% of responses included system-level factors, whereas 59% of responses included interpersonal-level factors. We conclude that the public is cognizant of and concerned about issues that also concern patients and others working to improve health care and, thus, should be engaged in the process to design care in a way that meets their needs and preferences before they become ill or interact with the delivery system.

  16. Health Care Employee Perceptions of Patient-Centered Care: A Photovoice Project

    PubMed Central

    Balbale, Salva Najib; Turcios, Stephanie; LaVela, Sherri L.

    2015-01-01

    Given the importance of health care employees in the delivery of patient-centered care, understanding their unique perspective is essential for quality improvement. The purpose of this study was to use photovoice to evaluate perceptions and experiences around patient-centered care among Veterans Affairs (VA) health care employees. We asked participants to take photographs of salient features in their environment related to patient-centered care. We used the photographs to facilitate dialogue during follow-up interviews. Twelve VA health care employees across two VA sites participated in the project. Although most participants felt satisfied with their work environment and experiences at the VA, several areas for improvement were identified. These included a need for more employee health and wellness initiatives and a need for enhanced opportunities for training and professional growth. Application of photovoice enabled us to learn about employees' unique perspectives around patient-centered care while engaging them in an evaluation of care delivery. PMID:25274626

  17. Obesity and risk taking. A male phenomenon.

    PubMed

    Koritzky, Gilly; Yechiam, Eldad; Bukay, Irit; Milman, Uzi

    2012-10-01

    There is a growing tendency to regard overeating as an addiction, with obesity as its primary symptom. We propose that similar to other addictions, obesity is associated with excessive risk-taking in men, though not in women. To examine this suggestion we conducted two studies, one involving a sample of overweight and normal-weight students, and the other involving obese adults drawn from a dataset of health care clients, and a control sample of normal-weight adults. In both of these studies, we found that overweight and obese men took more risk in a laboratory task than normal-weight men, while overweight and obese women did not differ from normal-weight women in this respect. At the same time, obese women (but not overweight women) displayed higher impulsivity levels than normal-weight women. These findings shed light on the cognitive characteristics of obesity in men, and accent the importance of taking gender into account when developing research paradigms and treatment methods for obesity. Copyright © 2012 Elsevier Ltd. All rights reserved.

  18. Report of the International Board of Inquiry for the Great Lakes Fisheries

    USGS Publications Warehouse

    Gallagher, Hubert R.; Huntsman, A.G.; Taylor, D.J.; Van Oosten, John

    1943-01-01

    This is the report of the International Board of Inquiry relative to the preservation and development of the Great Lakes fisheries as provided by an exchange of notes between Canada and the United States on February 29, 1940. The report aims to present in a very brief manner the background of the establishment of the Board, its program, and the fishery problems that confronted it with particular reference to the international point of view. These problems relate to the following subjects: statistics, the take of fish, fluctuations in the take, development and decline of particular fisheries, extinction and introduction of species, migration and local stock of fish, variety and changes in water conditions, fishing gear, overfishing, sport fishing versus food fish, fish culture and investigations. There is also a supplemental report prepared by the United States members of the Board (see Contribution #101).

  19. Taking a Half Day at a Time:” Patient Perspectives and the HIV Engagement in Care Continuum

    PubMed Central

    Massey, Amina D.; Lopez, Andrea M.; Geng, Elvin H.; Johnson, Mallory O.; Pilcher, Christopher D.; Fielding, Hegla; Dawson-Rose, Carol

    2013-01-01

    Abstract The HIV treatment continuum, or “cascade,” outlines key benchmarks in the successful treatment of HIV-infected individuals. However, the cascade fails to capture important dimensions of the patient experience in that it has been constructed from a provider point of view. In order to understand meaningful steps in the HIV care cascade for individuals diagnosed with HIV through expanded, more routine testing, we conducted in-depth interviews (n=34) with three groups of individuals: those diagnosed with HIV in the emergency department/urgent care clinic who linked to HIV care and exhibited 100% appointment adherence in the first 6 months of HIV care; those diagnosed in the emergency department/urgent care clinic who linked to HIV care and exhibited sporadic appointment adherence in the first 6 months of HIV care, and; hospitalized patients with no outpatient HIV care for at least 6 months. This last group was chosen to supplement data from in-care patients. The engagement in care process was defined by a changing perspective on HIV, one's HIV identity, and the role of health care. The linkage to care experience laid the groundwork for subsequent retention. Interventions to support engagement in care should acknowledge that patient concerns change over time and focus on promoting shifts in perspective. PMID:23565926

  20. The Great Equalizer: Health Care Access and Infant Mortality in Thailand

    PubMed Central

    Gruber, Jonathan; Hendren, Nathaniel; Townsend, Robert M.

    2013-01-01

    This paper analyzes Thailand’s 2001 healthcare reform, “30 Baht”. The program increased funding available to hospitals to care for the poor and reduced copays to 30 Baht (~$0.75). Our estimates suggest the supply-side funding of the program increased healthcare utilization, especially amongst the poor. Moreover, we find significant impacts on infant mortality: prior to 30 Baht poorer provinces had significantly higher infant mortality rates than richer provinces. After 30 Baht this correlation evaporates to zero. The results suggest that increased access to healthcare among the poor can significantly reduce their infant mortality rates. PMID:24772234

  1. Professional advancement of women in health care management: a conceptual model.

    PubMed

    Madsen, M K; Blide, L A

    1992-11-01

    Ragins and Sundstrom suggest three major conclusions based on power and gender differences within organizations. The first is that power develops or detracts as individuals progress along their career track. HIM professionals who accept the challenges that changing roles bring can also develop a new sensitivity to the value of power as a tool. They can use their negotiating skills to avoid being placed in work roles that result in a decrease in power. The second difference between men and women within organizations is that obstacles often impede women's career paths more than men's. Perceptions by women and men of a woman as homemaker and mother create serious conflicts when jobs are demanding and time intensive. Lastly, Ragins and Sundstrom suggest that career progression is influenced by both intrinsic factors (personal and professional) and extrinsic factors (organizational and interpersonal). The interaction between these factors is often driven by gender differences allowing men to progress and succeed, whereas women remain beneath the glass ceiling. HIM professionals, like other women health professionals, are graduating from advanced programs in health care and business administration at a greater rate than ever before in the history of this country. Not all these graduates will be able to acquire top-level administrative positions in the traditional health care institutions (e.g., hospitals). Therefore, if they wish to advance, they may have to move to nontraditional work settings. This is especially true for HIM professionals. The expanding computerized environment in traditional and nontraditional health care settings presents great potential for the development of new roles and responsibilities that have not been identified as male roles. HIM professionals and women in other health care professions who aspire to advance to upper administrative positions in traditional and nontraditional settings must be willing to take the risks inherent in assuming

  2. Comparing the Concept of Caring in Islamic Perspective with Watson and Parse's Nursing Theories

    PubMed Central

    Sadat-Hoseini, Akram-Sadat; Khosropanah, Abdoul-Hosein

    2017-01-01

    Background: In the nursing profession, it is apparent that the definition of caring differs between various perspectives. This article compares the difference of caring in Islamic with the Parse and Watson theories. Materials and Methods: In this study, we use concept analyses of Walker–Avants and compare research methods. Material used is all Islamic documents. Results: According to Islamic documents, there are four major types of caring, namely, (1) God taking care of humans, (2) Humans taking care of themselves, (3) Other humans taking care of humans, and (4) The universe taking care of humans and vice versa. God caring for humans affects the three other types of caring. All three definitions of caring have humanistic and holistic view. According to Watson's and Parse's definition, the development of the caring theory is based on the person's experiences that result from human interactions with, and experiences of, their environment. In Islamic definition, although the caring process is affected by environmental experiences and interactions, human not developed only base the effect of environment; rather, it is developed on the basis of human nature and divine commands. God taking care of humans is specific to Islamic perspective and is not found in other definitions. Islamic perspective maintains that God is the creator of humanity and is in charge of guiding humans. A superior form of human can always be discovered. Conclusions: Thus, nursing implementation in Muslims must be done based on Islamic commands, and Islamic commands are superior to human experiences. However, Islamic commands interpreted with human wisdom and thought can be striving toward excellence. PMID:28584543

  3. Pacific Pediatric Advanced Care Initiative

    DTIC Science & Technology

    2011-01-01

    infusing into the patient via a central venous line 6. After you have made sure the patient is safe, remove air from system. 7. Identify and fix...site. Push blood. Take fluid out of bladder to create a more negative venous pressure History : Day 1 for a 2 month old who had a witnessed...operating room, central supply, pharmacy, respiratory care, Neonatal Intensive Care Unit (NICU) nursing, Pediatric Intensive Care Unit (PICU) nursing, Risk

  4. Ethical considerations in neonatal respiratory care.

    PubMed

    Orzalesi, Marcello; Cuttini, Marina

    2005-01-01

    Recent advances in neonatal care have greatly improved the chances for survival of very sick and/or very preterm neonates and have in fact changed the concept and the limits of viability. However, in some situations, when the infant's demise can only be postponed at the price of great suffering or when survival is associated with severe disabilities and an intolerable life for the patient and the parents, it may be unwise to employ the full armamentarium of modern neonatal intensive care. In those circumstances withholding or withdrawing mechanical ventilation and other life-saving, though invasive and painful, procedures might be a better option. This review examines the ethical principles underlying those difficult decisions, the most frequent circumstances where they should be considered, the role of parents and other parties in the decision-making process and the reported behavior of neonatologists in many American and European neonatal intensive care units. Copyright 2005 S. Karger AG, Basel

  5. Intensive care unit nurses' perceptions of patient participation in the acute phase of chronic obstructive pulmonary disease exacerbation: an interview study.

    PubMed

    Kvangarsnes, Marit; Torheim, Henny; Hole, Torstein; Öhlund, Lennart S

    2013-02-01

    To report a study conducted to explore intensive care unit nurses' perceptions of patient participation in the acute phase of chronic obstructive pulmonary disease exacerbation. An acute exacerbation is a life-threatening situation, which patients often consider to be extremely frightening. Healthcare personnel exercise considerable power in this situation, which challenges general professional notions of patient participation. Critical discourse analysis. In the autumn of 2009, three focus group interviews with experienced intensive care nurses were conducted at two hospitals in western Norway. Two groups had six participants each, and one group had five (N = 17). The transcribed interviews were analysed by means of critical discourse analysis. The intensive care nurses said that an exacerbation is often an extreme situation in which healthcare personnel are exercising a high degree of control and power over patients. Patient participation during exacerbation often takes the form of non-involvement. The participating nurses attached great importance to taking a sensitive approach when meeting patients. The nurses experienced challenging ethical dilemmas. This study shows that patient participation should not be understood in universal terms, but rather in relation to a specific setting and the interactions that occur in this setting. Healthcare personnel must develop skill, understanding, and competence to meet these challenging ethical dilemmas. A collaborative inter-professional approach between physicians and nurses is needed to meet the patients' demand for involvement. © 2012 Blackwell Publishing Ltd.

  6. Taking action against malnutrition in Asian healthcare settings: an initiative of a Northeast Asia Study Group.

    PubMed

    Higashiguchi, Takashi; Arai, Hidenori; Claytor, Ling Hui; Kuzuya, Masafumi; Kotani, Joji; Lee, Shyh-Dye; Michel, Jean-Pierre; Nogami, Tetsushi; Peng, Nanhai

    2017-03-01

    Malnutrition is common in Asia, especially among people who are critically ill and/or older. Study results from China, Japan, and Taiwan show that malnutrition or risk of malnutrition is found in up to 30% of communitydwelling people and as much as 50% of patients admitted to hospitals-with prevalence even higher among those older than 70 years. In Asia, malnutrition takes substantial tolls on health, physical function, and wellbeing of people affected, and it adds huge financial burdens to healthcare systems. Attention to nutrition, including protein intake, can help prevent or delay disease- and age-related disabilities and can speed recovery from illness or surgery. Despite compelling evidence and professional guidelines on appropriate nutrition care in hospital and community settings, patients' malnutrition is often overlooked and under-treated in Asian healthcare, as it is worldwide. Since the problem of malnutrition continues to grow as many Asian populations become increasingly "gray", it is important to take action now. A medical education (feedM.E.) Global Study Group developed a strategy to facilitate best-practice hospital nutrition care: screen-intervene-supervene. As members of a newly formed feedM.E. Northeast Asia Study Group, we endorse this care strategy, guiding clinicians to screen each patient's nutritional status upon hospital admission or at initiation of care, intervene promptly when nutrition care is needed, and supervene or follow-up routinely with adjustment and reinforcement of nutrition care plans, including post-discharge. To encourage best-practice nutrition in Asian patient care settings, our paper includes a simple, stepwise Nutrition Care Pathway (NCP) in multiple languages.

  7. Missing voices: polling and health care.

    PubMed

    Berinsky, Adam J; Margolis, Michele

    2011-12-01

    Examining data on the recent health care legislation, we demonstrate that public opinion polls on health care should be treated with caution because of item nonresponse--or "don't know" answers--on survey questions. Far from being the great equalizer, opinion polls can actually misrepresent the attitudes of the population. First, we show that respondents with lower levels of socioeconomic resources are systematically more likely to give a "don't know" response when asked their opinion about health care legislation. Second, these same individuals are more likely to back health care reform. The result is an incomplete portrait of public opinion on the issue of health care in the United States.

  8. Monitoring quality in Israeli primary care: The primary care physicians' perspective

    PubMed Central

    2012-01-01

    Background Since 2000, Israel has had a national program for ongoing monitoring of the quality of the primary care services provided by the country's four competing non-profit health plans. Previous research has demonstrated that quality of care has improved substantially since the program's inception and that the program enjoys wide support among health plan managers. However, prior to this study there were anecdotal and journalistic reports of opposition to the program among primary care physicians engaged in direct service delivery; these raised serious questions about the extent of support among physicians nationally. Goals To assess how Israeli primary care physicians experience and rate health plan efforts to track and improve the quality of care. Method The study population consisted of primary care physicians employed by the health plans who have responsibility for the quality of care of a panel of adult patients. The study team randomly sampled 250 primary-care physicians from each of the four health plans. Of the 1,000 physicians sampled, 884 met the study criteria. Every physician could choose whether to participate in the survey by mail, e-mail, or telephone. The anonymous questionnaire was completed by 605 physicians – 69% of those eligible. The data were weighted to reflect differences in sampling and response rates across health plans. Main findings The vast majority of respondents (87%) felt that the monitoring of quality was important and two-thirds (66%) felt that the feedback and subsequent remedial interventions improved medical care to a great extent. Almost three-quarters (71%) supported continuation of the program in an unqualified manner. The physicians with the most positive attitudes to the program were over age 44, independent contract physicians, and either board-certified in internal medicine or without any board-certification (i.e., residents or general practitioners). At the same time, support for the program was widespread even

  9. Note Taking on Trial: A Legal Application of Note-Taking Research

    ERIC Educational Resources Information Center

    Kiewra, Kenneth A.

    2016-01-01

    This article is about note taking, but it is not an exhaustive review of note-taking literature. Instead, it portrays the application of note-taking research to an unusual and important area of practice--the law. I was hired to serve as an expert witness on note taking in a legal case that hinged, in part, on the completeness and accuracy of…

  10. Integrated palliative care is about professional networking rather than standardisation of care: A qualitative study with healthcare professionals in 19 integrated palliative care initiatives in five European countries

    PubMed Central

    den Herder-van der Eerden, Marlieke; van Wijngaarden, Jeroen; Preston, Nancy; Linge-Dahl, Lisa; Radbruch, Lukas; Van Beek, Karen; Menten, Johan; Busa, Csilla; Csikos, Agnes; Vissers, Kris; van Gurp, Jelle; Hasselaar, Jeroen

    2018-01-01

    Background: Integrated palliative care aims at improving coordination of palliative care services around patients’ anticipated needs. However, international comparisons of how integrated palliative care is implemented across four key domains of integrated care (content of care, patient flow, information logistics and availability of (human) resources and material) are lacking. Aim: To examine how integrated palliative care takes shape in practice across abovementioned key domains within several integrated palliative care initiatives in Europe. Design: Qualitative group interview design. Setting/participants: A total of 19 group interviews were conducted (2 in Belgium, 4 in the Netherlands, 4 in the United Kingdom, 4 in Germany and 5 in Hungary) with 142 healthcare professionals from several integrated palliative care initiatives in five European countries. The majority were nurses (n = 66; 46%) and physicians (n = 50; 35%). Results: The dominant strategy for fostering integrated palliative care is building core teams of palliative care specialists and extended professional networks based on personal relationships, shared norms, values and mutual trust, rather than developing standardised information exchange and referral pathways. Providing integrated palliative care with healthcare professionals in the wider professional community appears difficult, as a shared proactive multidisciplinary palliative care approach is lacking, and healthcare professionals often do not know palliative care professionals or services. Conclusion: Achieving better palliative care integration into regular healthcare and convincing the wider professional community is a difficult task that will take time and effort. Enhancing standardisation of palliative care into education, referral pathways and guidelines and standardised information exchange may be necessary. External authority (policy makers, insurance companies and professional bodies) may be needed to support integrated

  11. Integrated palliative care is about professional networking rather than standardisation of care: A qualitative study with healthcare professionals in 19 integrated palliative care initiatives in five European countries.

    PubMed

    den Herder-van der Eerden, Marlieke; van Wijngaarden, Jeroen; Payne, Sheila; Preston, Nancy; Linge-Dahl, Lisa; Radbruch, Lukas; Van Beek, Karen; Menten, Johan; Busa, Csilla; Csikos, Agnes; Vissers, Kris; van Gurp, Jelle; Hasselaar, Jeroen

    2018-06-01

    Integrated palliative care aims at improving coordination of palliative care services around patients' anticipated needs. However, international comparisons of how integrated palliative care is implemented across four key domains of integrated care (content of care, patient flow, information logistics and availability of (human) resources and material) are lacking. To examine how integrated palliative care takes shape in practice across abovementioned key domains within several integrated palliative care initiatives in Europe. Qualitative group interview design. A total of 19 group interviews were conducted (2 in Belgium, 4 in the Netherlands, 4 in the United Kingdom, 4 in Germany and 5 in Hungary) with 142 healthcare professionals from several integrated palliative care initiatives in five European countries. The majority were nurses ( n = 66; 46%) and physicians ( n = 50; 35%). The dominant strategy for fostering integrated palliative care is building core teams of palliative care specialists and extended professional networks based on personal relationships, shared norms, values and mutual trust, rather than developing standardised information exchange and referral pathways. Providing integrated palliative care with healthcare professionals in the wider professional community appears difficult, as a shared proactive multidisciplinary palliative care approach is lacking, and healthcare professionals often do not know palliative care professionals or services. Achieving better palliative care integration into regular healthcare and convincing the wider professional community is a difficult task that will take time and effort. Enhancing standardisation of palliative care into education, referral pathways and guidelines and standardised information exchange may be necessary. External authority (policy makers, insurance companies and professional bodies) may be needed to support integrated palliative care practices across settings.

  12. Palliative care--transiting old tradition and values into the modern health care practice.

    PubMed

    Krasuska, Małgorzata E; Stanisławek, Andrzej; Mazurkiewicz, Maria; Daniluk, Jadwiga

    2002-01-01

    Care of the dying patient is care for the patient who is still living, it is helping that patient to live his or her life to the fullest whether at home or hospice, or in hospital. It is care that is not just centered on the individual but includes members of the family. It is focused on improving the quality of patients' life, by incorporating into the professional care most of unique human values, such as respect, empathy, compassion and tender loving care. Palliative care is a broad band of care of indeterminate length, and does not necessarily end with the death of the patient. Until life begins to glow again, some surviving relatives may need support during the bereavement period. Thanks to Dr Elisabeth Kübler-Ross and Dame Cicely Saunders, two great women visionaries and leaders of the emergence of Palliative Care, one of the best things that has happened to medicine in the 20th century, the development of care for dying patients and their families was possible.

  13. Understanding the influence of power and empathic perspective-taking on collaborative natural resource management.

    PubMed

    Wald, Dara M; Segal, Elizabeth A; Johnston, Erik W; Vinze, Ajay

    2017-09-01

    Public engagement in collaborative natural resource management necessitates shared understanding and collaboration. Empathic perspective-taking is a critical facilitator of shared understanding and positive social interactions, such as collaboration. Yet there is currently little understanding about how to reliably generate empathic perspective-taking and collaboration, particularly in situations involving the unequal distribution of environmental resources or power. Here we examine how experiencing the loss or gain of social power influenced empathic perspective-taking and behavior within a computer-mediated scenario. Participants (n = 180) were randomly assigned to each condition: high resources, low resources, lose resources, gain resources. Contrary to our expectations, participants in the perspective-taking condition, specifically those who lost resources, also lost perspective taking and exhibited egoistic behavior. This finding suggests that resource control within the collaborative process is a key contextual variable that influences perspective-taking and collaborative behavior. Moreover, the observed relationship between perspective-taking and egoistic behavior within a collaborative resource sharing exercise suggests that when resource control or access is unequal, interventions to promote perspective-taking deserve careful consideration. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. [The transformation of Friedrich the Great. A psychoanalytic study].

    PubMed

    Lewy, E

    1995-08-01

    The transformation of Frederick the Great. A psychoanalytic study.--As a child and young man, Prince Frederick Hohenzollern, later King Frederick II of Prussia, flatly rejected his father's militaristic, Teutonic code of behaviour with its emphasis on dutiful service, self-abnegation and obedience. Instead he indulged his more "effeminate" leanings, taking an interest in literature, music and the unsoldierly delights provided by the courtly life of the age, and was encouraged in this by both his mother and his sister. This refusal to espouse the manly, paternal principle drove the crown prince into an increasingly vehement conflict with his father, who observed his son's indifference to all things military with growing bitterness, and finally led to a catastrophe in the course of which Frederick's closest friend was executed and he himself only just escaped his father's deadly vengeance. After this crisis, Frederick conformed more and more closely to his father's expectations and instructions and after the latter's death in 1740 developed into a ruler who enhanced Prussia's military and political glory and established a paternalistic principle that not only equalled but indeed exceeded everything that his father had stood for. The author traces in detail Frederick's astounding transformation into the "Frederick the Great" familiar to us from history books, analysing it both psychodynamically and in terms of identity theory. His conclusion is that it was the strength of Frederick's ego--itself the very prerequisite of "greatness"--that saved him from coming to grief over this conflict of identity.

  15. Effect of Economic Assets on Sexual Risk-Taking Intentions Among Orphaned Adolescents in Uganda

    PubMed Central

    Han, Chang-Keun; Neilands, Torsten B.; Ismayilova, Leyla; Sperber, Elizabeth

    2010-01-01

    Objectives. We examined the effect of economic assets on sexual risk-taking intentions among school-going AIDS-orphaned adolescents in rural Uganda. Methods. AIDS-orphaned adolescents from 15 comparable schools were randomly assigned to control (n = 133) or treatment (n = 127) conditions. Treatment participants received child savings accounts, workshops, and mentorship. This economic intervention was in addition to the traditional care and support services for school-going orphaned adolescents (counseling and school supplies) provided to both treatment and control groups. Adolescents in the treatment condition were compared with adolescents in the control condition at baseline and at 10 months after the intervention. Results. After control for sociodemographic factors, child-caregiver/parental communication, and peer pressure, adolescents in the economic intervention group reported a significant reduction in sexual risk-taking intentions compared with adolescents in the control condition. Conclusions. The findings indicate that in Uganda, a country devastated by poverty and disease (including HIV/AIDS), having access to economic assets plays an important role in influencing adolescents' sexual risk-taking intentions. These findings have implications for the care and support of orphaned adolescents, especially in poor African countries devastated by poverty and sexually transmitted diseases. PMID:20075323

  16. [Managerial autonomy in primary care: position of health professionals in Mallorca].

    PubMed

    Tamborero, Gaspar; Esteva, Magdalena; March, Sebastià; Guillén, Mireia

    2015-02-01

    To assess the knowledge, perceptions, expectations and attitudes of Primary Care (PC) professionals in Mallorca on managerial autonomy. Cross-sectional study based on an ad hoc, anonymous questionnaire, distributed online, from June-July 2013. PC Mallorca. PC healthcare professionals (n=1,097). Knowledge of self-management skills, requirements, and future scenarios of the centers with management autonomy (CMA); impact of self-management, commitment and willingness to take risks, and to become a CMA. Response rate: 49.8% (546/1097), with 10.9% showing a high level of knowledge of self-management. The core competencies of a CMA were internal organizational capacity (87.5%) and selection of staff (81.1%). The CMA future was envisaged with motivated and involved professionals (72.6%), efficient results (66%), better quality of care (59.4%), and better training (52.8%). The benefits of self-management were considered important, for individual practitioners and for the improvement of PC in Mallorca (46.8%). The main requirements of the CMA were to have: trained managers (92.6%), budget allocation systems (87.5%), and appropriate management contracts (86.1%). They preferred that the CMA should depend on the Administration (62.7%), and had a personal interest in becoming a CMA (56.9%), but without taking on excessive commitments (waiving statutory regime, financial risk). These data provide hitherto unknown information of great importance, which could contribute to a more rational planning and participatory implementation of CMA in our midst. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  17. Care and secrecy: being a mother of children living with HIV in Burkina Faso.

    PubMed

    Hejoaka, Fabienne

    2009-09-01

    Home care has become a central component of the response to the HIV/AIDS epidemic, displacing caregiving work onto women. While increasing interest has been paid to HIV/AIDS care with a focus on ailing adults and orphan foster care, the issue of caring for children living with HIV has received little attention in the social sciences. Based on ethnographic material gathered in Burkina Faso between November 2005 and December 2006, the aim of this paper was to gain understanding of women who mother and care for children living with HIV in resource-limited countries. The study involved participant observation in community-based organizations in Burkina Faso and semi-structured interviews with 20 women mothering HIV-positive children as well as 15 children infected with HIV, aged between 8 and 18 years. In daily care mothers face many great challenges, ranging from the routine of pill-taking to disturbing discussions with children asking questions about their health or treatment. The results also show how HIV/AIDS-related stigma adds an additional layer to the burden of care, compelling mothers to deal with the tension between secrecy surrounding the disease and the openness required in providing care and receiving social support. As mothers live in fear of disclosure, they have to develop concealment strategies around children's treatment and the nature of the disease. Conversely, some mothers may share their secret with kin members, close relatives or their children to gain social support. As HIV/AIDS care is shaped by secrecy, these findings shed light on mothers' isolation in child care within a context of changing patterns of family bonds and lack of formal psychosocial support addressing child-related issues. Finally, women's engagement in child care invites us to look beyond the essentialist approach of women's vulnerability conveyed by international discourse to characterise the situation of women facing the HIV/AIDS impact.

  18. Health care professional development: Working as a team to improve patient care

    PubMed Central

    El Husseini, Maha; Al Nemri, Abdurrahman; Al Frayh, Abdurrahman; Al Juryyan, Nasir; Faki, Mohamed O; Assiri, Asaad; Al Saadi, Muslim; Shaikh, Farheen; Al Zamil, Fahad

    2014-01-01

    In delivering health care, an effective teamwork can immediately and positively affect patient safety and outcome. The need for effective teams is increasing due to increasing co-morbidities and increasing complexity of specialization of care. Time has gone when a doctor or a dentist or any other health practitioner in whatsoever health organization would be able to solely deliver a quality care that satisfies his or her patients. The evolution in health care and a global demand for quality patient care necessitate a parallel health care professional development with a great focus on patient centred teamwork approach. This can only be achieved by placing the patient in the centre of care and through sharing a wide based culture of values and principles. This will help forming and developing an effective team able to deliver exceptional care to the patients. Aiming towards this goal, motivation of team members should be backed by strategies and practical skills in order to achieve goals and overcome challenges. This article highlights values and principles of working as a team and principles and provides team players with a practical approach to deliver quality patient care. PMID:27493399

  19. Health care professional development: Working as a team to improve patient care.

    PubMed

    Babiker, Amir; El Husseini, Maha; Al Nemri, Abdurrahman; Al Frayh, Abdurrahman; Al Juryyan, Nasir; Faki, Mohamed O; Assiri, Asaad; Al Saadi, Muslim; Shaikh, Farheen; Al Zamil, Fahad

    2014-01-01

    In delivering health care, an effective teamwork can immediately and positively affect patient safety and outcome. The need for effective teams is increasing due to increasing co-morbidities and increasing complexity of specialization of care. Time has gone when a doctor or a dentist or any other health practitioner in whatsoever health organization would be able to solely deliver a quality care that satisfies his or her patients. The evolution in health care and a global demand for quality patient care necessitate a parallel health care professional development with a great focus on patient centred teamwork approach. This can only be achieved by placing the patient in the centre of care and through sharing a wide based culture of values and principles. This will help forming and developing an effective team able to deliver exceptional care to the patients. Aiming towards this goal, motivation of team members should be backed by strategies and practical skills in order to achieve goals and overcome challenges. This article highlights values and principles of working as a team and principles and provides team players with a practical approach to deliver quality patient care.

  20. Practical Approaches for Achieving Integrated Behavioral Health Care in Primary Care Settings

    PubMed Central

    Ratzliff, Anna; Phillips, Kathryn E.; Sugarman, Jonathan R.; Unützer, Jürgen; Wagner, Edward H.

    2016-01-01

    Behavioral health problems are common, yet most patients do not receive effective treatment in primary care settings. Despite availability of effective models for integrating behavioral health care in primary care settings, uptake has been slow. The Behavioral Health Integration Implementation Guide provides practical guidance for adapting and implementing effective integrated behavioral health care into patient-centered medical homes. The authors gathered input from stakeholders involved in behavioral health integration efforts: safety net providers, subject matter experts in primary care and behavioral health, a behavioral health patient and peer specialist, and state and national policy makers. Stakeholder input informed development of the Behavioral Health Integration Implementation Guide and the GROW Pathway Planning Worksheet. The Behavioral Health Integration Implementation Guide is model neutral and allows organizations to take meaningful steps toward providing integrated care that achieves access and accountability. PMID:26698163

  1. Practical Approaches for Achieving Integrated Behavioral Health Care in Primary Care Settings.

    PubMed

    Ratzliff, Anna; Phillips, Kathryn E; Sugarman, Jonathan R; Unützer, Jürgen; Wagner, Edward H

    Behavioral health problems are common, yet most patients do not receive effective treatment in primary care settings. Despite availability of effective models for integrating behavioral health care in primary care settings, uptake has been slow. The Behavioral Health Integration Implementation Guide provides practical guidance for adapting and implementing effective integrated behavioral health care into patient-centered medical homes. The authors gathered input from stakeholders involved in behavioral health integration efforts: safety net providers, subject matter experts in primary care and behavioral health, a behavioral health patient and peer specialist, and state and national policy makers. Stakeholder input informed development of the Behavioral Health Integration Implementation Guide and the GROW Pathway Planning Worksheet. The Behavioral Health Integration Implementation Guide is model neutral and allows organizations to take meaningful steps toward providing integrated care that achieves access and accountability.

  2. Taking care of the newborn dying and their families: Nurses' experiences of neonatal intensive care.

    PubMed

    Almeida, Fabiane de Amorim; Moraes, Mariana Salim de; Cunha, Mariana Lucas da Rocha

    2016-06-01

    To understand the experiences of nurses when caring for dying newborns and their families in the NICU; and redeem their perceptions about acting before the death and grieving process. A descriptive exploratory study with a qualitative approach, developed with nine nurses at the ICU of a hospital in São Paulo (SP), Brazil. Data was collected through semi-structured interviews and analyzed using the Collective Subject Discourse (CSD). Caring for newborns who are dying and their families is very difficult for nurses, due to the intense involvement. They seek strategies to deal with the situation and, before the newborn's death, despite the suffering, express the feeling of accomplishment. Facing death and grief triggers mechanisms that emerge life references, coming across painful issues. Learning to deal with these questions is a daily challenge for nurses of the NICU. Compreender as experiências vivenciadas por enfermeiros ao cuidar de neonatos que estão morrendo e seus familiares na UTIN; e resgatar as suas percepções sobre a atuação diante do processo de morte e luto. Estudo descritivo exploratório, de abordagem qualitativa, desenvolvido com nove enfermeiras da UTIN de um hospital de São Paulo (SP), Brasil. Os dados foram coletados por meio de entrevista semi-estruturada e analisados pela técnica do Discurso de Sujeito Coletivo (DSC). Cuidar de neonatos que estão morrendo e suas famílias é muito difícil para as enfermeiras, devido ao intenso envolvimento. Buscam estratégias para lidar com a situação e, diante do óbito do neonato, apesar do sofrimento, manifestam o sentimento de dever cumprido. Enfrentar a morte e o luto aciona mecanismos que afloram referências de vida, deparando-se com questões dolorosas. Aprender a lidar com essas questões é um desafio diário para os enfermeiros de UTIN.

  3. An ‛Aukward’ Tale: A Genetic Approach to Discover the Whereabouts of the Last Great Auks

    PubMed Central

    Thomas, Jessica E.; Carvalho, Gary R.; Haile, James; Martin, Michael D.; Samaniego Castruita, Jose A.; Niemann, Jonas; Sinding, Mikkel-Holger S.; Sandoval-Velasco, Marcela; Rawlence, Nicolas J.; Fuller, Errol; Fjeldså, Jon; Hofreiter, Michael; Stewart, John R.; Gilbert, M. Thomas P.; Knapp, Michael

    2017-01-01

    One hundred and seventy-three years ago, the last two Great Auks, Pinguinus impennis, ever reliably seen were killed. Their internal organs can be found in the collections of the Natural History Museum of Denmark, but the location of their skins has remained a mystery. In 1999, Great Auk expert Errol Fuller proposed a list of five potential candidate skins in museums around the world. Here we take a palaeogenomic approach to test which—if any—of Fuller’s candidate skins likely belong to either of the two birds. Using mitochondrial genomes from the five candidate birds (housed in museums in Bremen, Brussels, Kiel, Los Angeles, and Oldenburg) and the organs of the last two known individuals, we partially solve the mystery that has been on Great Auk scholars’ minds for generations and make new suggestions as to the whereabouts of the still-missing skin from these two birds. PMID:28617333

  4. Output and inflation components of medical care and other spending changes

    PubMed Central

    Peden, Edgar A.; Lee, Mei Lin

    1991-01-01

    From 1965 to 1990, spending on medical care rose from 5.9 to 12.2 percent of gross national product. This rise was the consequence of greatly expanded government and government subsidized private insurance coverage operating in an environment where payments for insured care by and large covered whatever costs were incurred. As a result, the personal consumption of medical care experienced both output and price average growth rates strikingly above economywide norms. Indeed, the output growth rate in this sector rivaled growth in several goods sectors with greatly expanded supplies. However, whereas goods in the latter sectors have become more accessible through lower relative prices, consumers with insufficient insurance coverage are being crowded out of the market for medical care by higher relative prices. PMID:10122363

  5. The role of demographic compensation theory in incidental take assessments for endangered species

    USGS Publications Warehouse

    McGowan, Conor P.; Ryan, Mark R.; Runge, Michael C.; Millspaugh, Joshua J.; Cochrane, Jean Fitts

    2011-01-01

    Many endangered species laws provide exceptions to legislated prohibitions through incidental take provisions as long as take is the result of unintended consequences of an otherwise legal activity. These allowances presumably invoke the theory of demographic compensation, commonly applied to harvested species, by allowing limited harm as long as the probability of the species' survival or recovery is not reduced appreciably. Demographic compensation requires some density-dependent limits on survival or reproduction in a species' annual cycle that can be alleviated through incidental take. Using a population model for piping plovers in the Great Plains, we found that when the population is in rapid decline or when there is no density dependence, the probability of quasi-extinction increased linearly with increasing take. However, when the population is near stability and subject to density-dependent survival, there was no relationship between quasi-extinction probability and take rates. We note however, that a brief examination of piping plover demography and annual cycles suggests little room for compensatory capacity. We argue that a population's capacity for demographic compensation of incidental take should be evaluated when considering incidental allowances because compensation is the only mechanism whereby a population can absorb the negative effects of take without incurring a reduction in the probability of survival in the wild. With many endangered species there is probably little known about density dependence and compensatory capacity. Under these circumstances, using multiple system models (with and without compensation) to predict the population's response to incidental take and implementing follow-up monitoring to assess species response may be valuable in increasing knowledge and improving future decision making.

  6. Great Lakes

    USGS Publications Warehouse

    Edsall, Thomas A.; Mac, Michael J.; Opler, Paul A.; Puckett Haecker, Catherine E.; Doran, Peter D.

    1998-01-01

    The Great Lakes region, as defined here, includes the Great Lakes and their drainage basins in Minnesota, Wisconsin, Illinois, Indiana, Ohio, Pennsylvania, and New York. The region also includes the portions of Minnesota, Wisconsin, and the 21 northernmost counties of Illinois that lie in the Mississippi River drainage basin, outside the floodplain of the river. The region spans about 9º of latitude and 20º of longitude and lies roughly halfway between the equator and the North Pole in a lowland corridor that extends from the Gulf of Mexico to the Arctic Ocean.The Great Lakes are the most prominent natural feature of the region (Fig. 1). They have a combined surface area of about 245,000 square kilometers and are among the largest, deepest lakes in the world. They are the largest single aggregation of fresh water on the planet (excluding the polar ice caps) and are the only glacial feature on Earth visible from the surface of the moon (The Nature Conservancy 1994a).The Great Lakes moderate the region’s climate, which presently ranges from subarctic in the north to humid continental warm in the south (Fig. 2), reflecting the movement of major weather masses from the north and south (U.S. Department of the Interior 1970; Eichenlaub 1979). The lakes act as heat sinks in summer and heat sources in winter and are major reservoirs that help humidify much of the region. They also create local precipitation belts in areas where air masses are pushed across the lakes by prevailing winds, pick up moisture from the lake surface, and then drop that moisture over land on the other side of the lake. The mean annual frost-free period—a general measure of the growing-season length for plants and some cold-blooded animals—varies from 60 days at higher elevations in the north to 160 days in lakeshore areas in the south. The climate influences the general distribution of wild plants and animals in the region and also influences the activities and distribution of the human

  7. Preliminary road alinement through the Great Kavir in Iran by repetitive ERTS-1 coverage

    NASA Technical Reports Server (NTRS)

    Krinsley, D. B.

    1974-01-01

    Access to the Great Kavir is generally limited to the period August through October when some salt crusts will support limited vehicular movement. The condition of the salt crusts and their parent sediments during the long wet season have been unknown. This absence of information about the surface of the Great Kavir has prevented an intensive study of a possible road alinement which could shorten the present route between northern and central Iran by 760 km. False color diazo composites of bands 4, 5, and 7 were prepared from positives of ERTS-1 MSS images taken of the Great Kavir. These scenes presented a record of the seasonal hydrologic changes that occurred from the dry to the wet season. During the period of maximum inundation and lowest bearing strengths, as inferred from the image of May 12, 1973, it was possible to select a preliminary road alinement that would avoid the wettest or roughest areas and take advantage of the best terrain and shortest distance. The eventual road alinement should be based on a longer record of observation and on-site investigations.

  8. The impact of aging physiology in critical care.

    PubMed

    Walker, Mandi; Spivak, Mark; Sebastian, Mary

    2014-03-01

    Aging physiology greatly impacts care delivery in the geriatric patient population. Consideration should be given to addressing the patient-specific needs regarding the systemic changes seen in the aging patient. Each major body system presents its own unique challenges to the critical care practitioner, and a comprehensive understanding of these changes is necessary to effectively care for this patient population. This article summarizes these changes and provides key points for the practitioner to consider when caring for the aging patient in the critical care arena. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. Subsidizing Care, Supporting Work

    ERIC Educational Resources Information Center

    Hilliard, Thomas

    2011-01-01

    The recent uptick in New York City's economy could provide a huge sigh of relief for the hundreds of thousands of New Yorkers who lost their job in the Great Recession and are still out of work. But many of the city's unemployed will need more than just enhanced skills to take advantage of the new job opportunities; they'll need access to…

  10. New concepts in palliative care in the intensive care unit

    PubMed Central

    Coelho, Cristina Bueno Terzi; Yankaskas, James R.

    2017-01-01

    Some patients admitted to an intensive care unit may face a terminal illness situation, which usually leads to death. Knowledge of palliative care is strongly recommended for the health care providers who are taking care of these patients. In many situations, the patients should be evaluated daily as the introduction of further treatments may not be beneficial to them. The discussions among health team members that are related to prognosis and the goals of care should be carefully evaluated in collaboration with the patients and their families. The adoption of protocols related to end-of-life patients in the intensive care unit is fundamental. A multidisciplinary team is important for determining whether the withdrawal or withholding of advanced care is required. In addition, patients and families should be informed that palliative care involves the best possible care for that specific situation, as well as respect for their wishes and the consideration of social and spiritual backgrounds. Thus, the aim of this review is to present palliative care as a reasonable option to support the intensive care unit team in assisting terminally ill patients. Updates regarding diet, mechanical ventilation, and dialysis in these patients will be presented. Additionally, the hospice-model philosophy as an alternative to the intensive care unit/hospital environment will be discussed. PMID:28977262

  11. A pragmatic guide on how physicians can take over financial control of their clinical practice.

    PubMed

    Jacobs, Volker R; Fischer, Thorsten

    2012-01-01

    Control of clinical cost is becoming increasingly important in health care worldwide. Physicians should accept the limitation of resources and take responsibility to improve their clinical cost-reimbursement ratio. To achieve this, they will need basic education in clinic management to control and adjust costs and reimbursement, without impacting professional quality of care. Rational use of diagnostics and therapy should be implemented and frequently verified. Physicians are the only professionals that are able to integrate economics with health care. This is in the best interest of patients and will improve a physician's position, influence, and professional freedom levels within our hospitals.

  12. Preventing deaths from rising opioid overdose in the US – the promise of naloxone antidote in community-based naloxone take-home programs

    PubMed Central

    Straus, Michele M; Ghitza, Udi E; Tai, Betty

    2013-01-01

    The opioid overdose epidemic is an alarming and serious public health problem in the United States (US) that has been escalating for 11 years. The 2011 National Survey on Drug Use and Health (NSDUH) demonstrated that 1 in 20 persons in the US aged 12 or older reported nonmedical use of prescription painkillers in the past year. Prescription drug overdose is now the leading cause of accidental death in the United States – surpassing motor vehicle accidents. Great efforts have been initiated to curb the overdose crisis. Notable examples of these efforts are (1) the Drug Enforcement Administration’s (DEA) National Take-Back Initiative instituted in 2010; (2) the Prescription Drug Monitoring Programs (PDMPs) implemented in most US states to provide practitioners with point-of-care information regarding a patient’s controlled substance use; (3) the naloxone rescue programs initiated in the community to avert mortality resulting from overdose. The use of naloxone rescue strategies has gained traction as an effective measure to prevent fatal opioid overdose. Many US federal-government agencies are working to make these strategies more accessible to first responders and community participants. This new approach faces many challenges, such as accessibility to naloxone and the equipment and training needed to administer it, but none is more challenging than the fear of legal repercussions. US federal-government agencies, local governments, health care institutions, and community-based organizations have begun to tackle these barriers, and naloxone take-home programs have gained recognition as a feasible and sensible preventive strategy to avoid a fatal result from opioid overdose. Although many challenges still need to be overcome, it is important for federal government research agencies to initiate and support independent and rigorous evaluation of these programs to inform policymakers how effective these programs can be to save lives and curb the opioid overdose

  13. Taking a case study approach to assessing alternative leadership models in health care.

    PubMed

    Harris, Jonathan; Mayo, Paula

    2018-06-14

    Good leadership is essential to patient-centred care and staff satisfaction in the healthcare environment. All members of the healthcare team can be leaders and evidence-based theory should inform their leadership practice. This article uses a case study approach to critically evaluate leadership as exercised by a charge nurse and a student nurse in a clinical scenario. Ineffective leadership styles are identified and alternatives proposed; considerable attention is given to critiquing both 'heroic' and 'post-heroic' transformational leadership theories. The concept of power will also be discussed, as power and leadership are closely related, and the importance of empowering members of the healthcare team through altering organisational structure is emphasised. This article advocates leadership that encourages innovation, enhances patient-centred care, encourages excellence and has ethical integrity. Recommendations of appropriate models of leadership are provided, while existing gaps in the healthcare leadership literature are highlighted.

  14. Aspects of Quality in Greek Day Care Centres.

    ERIC Educational Resources Information Center

    Melhuish, Edward C.; Petrogiannis, Konstantinos

    1996-01-01

    Evaluates the quality of the caregiving environment for young infants in day care centers in Athens (Greece) using three global measures: ITERS, PROFILE, and CCFS. Reveals a great similarity among the three measures. Reports a generally low quality for day care, lower than for other countries with similar research. (DSK)

  15. Jalal A. Aliyev (1928-2016): a great scientist, a great teacher and a great human being.

    PubMed

    Huseynova, Irada M; Allakhverdiev, Suleyman I; Govindjee

    2016-06-01

    Jalal A. Aliyev was a distinguished and respected plant biologist of our time, a great teacher, and great human being. He was a pioneer of photosynthesis research in Azerbaijan. Almost up to the end of his life, he was deeply engaged in research. His work on the productivity of wheat, and biochemistry, genetics and molecular biology of gram (chick pea) are some of his important legacies. He left us on February 1, 2016, but many around the world remember him as he was engaged in international dialog on solving global issues, and in supporting international conferences on ''Photosynthesis Research for Sustainability" in 2011 and 2013.

  16. The Time and Effort in Taking Care for Children with Profound Intellectual and Multiple Disabilities: A Study on Care Load and Support

    ERIC Educational Resources Information Center

    Tadema, Annemarie C.; Vlaskamp, Carla

    2010-01-01

    Raising children with profound intellectual and multiple disabilities is considered to be extremely difficult for parents, but figures on the content and amount of time needed for the caring task of parents is lacking. Data on what the caring task actually means (in terms of amount of time and type of task) is needed to be able to understand the…

  17. What Would It Take? Stakeholders’ Views and Preferences for Implementing a Health Care Manager Program in Community Mental Health Clinics Under Health Care Reform

    PubMed Central

    Cabassa, Leopoldo J.; Gomes, Arminda P.; Lewis-Fernández, Roberto

    2015-01-01

    Health care manager interventions can improve the physical health of people with serious mental illness (SMI). In this study, we used concepts from the theory of diffusion of innovations, the consolidated framework for implementation research and a taxonomy of implementation strategies to examine stakeholders’ recommendations for implementing a health care manager intervention in public mental health clinics serving Hispanics with SMI. A purposive sample of 20 stakeholders was recruited from mental health agencies, primary care clinics, and consumer advocacy organizations. We presented participants a vignette describing a health care manager intervention and used semistructured qualitative interviews to examine their views and recommendations for implementing this program. Interviews were recorded, professionally transcribed, and content analyzed. We found that a blend of implementation strategies that demonstrates local relative advantage, addresses cost concerns, and enhances compatibility to organizations and the client population is critical for moving health care manager interventions into practice. PMID:25542194

  18. Care coordination between specialty care and primary care: a focus group study of provider perspectives on strong practices and improvement opportunities

    PubMed Central

    Kim, Bo; Lucatorto, Michelle A; Hawthorne, Kara; Hersh, Janis; Myers, Raquel; Elwy, A Rani; Graham, Glenn D

    2015-01-01

    Care coordination between the specialty care provider (SCP) and the primary care provider (PCP) is a critical component of safe, efficient, and patient-centered care. Veterans Health Administration conducted a series of focus groups of providers, from specialty care and primary care clinics at VA Medical Centers nationally, to assess 1) what SCPs and PCPs perceive to be current practices that enable or hinder effective care coordination with one another and 2) how these perceptions differ between the two groups of providers. A qualitative thematic analysis of the gathered data validates previous studies that identify communication as being an important enabler of coordination, and uncovers relationship building between specialty care and primary care (particularly through both formal and informal relationship-building opportunities such as collaborative seminars and shared lunch space, respectively) to be the most notable facilitator of effective communication between the two sides. Results from this study suggest concrete next steps that medical facilities can take to improve care coordination, using as their basis the mutual understanding and respect developed between SCPs and PCPs through relationship-building efforts. PMID:25653538

  19. Care coordination between specialty care and primary care: a focus group study of provider perspectives on strong practices and improvement opportunities.

    PubMed

    Kim, Bo; Lucatorto, Michelle A; Hawthorne, Kara; Hersh, Janis; Myers, Raquel; Elwy, A Rani; Graham, Glenn D

    2015-01-01

    Care coordination between the specialty care provider (SCP) and the primary care provider (PCP) is a critical component of safe, efficient, and patient-centered care. Veterans Health Administration conducted a series of focus groups of providers, from specialty care and primary care clinics at VA Medical Centers nationally, to assess 1) what SCPs and PCPs perceive to be current practices that enable or hinder effective care coordination with one another and 2) how these perceptions differ between the two groups of providers. A qualitative thematic analysis of the gathered data validates previous studies that identify communication as being an important enabler of coordination, and uncovers relationship building between specialty care and primary care (particularly through both formal and informal relationship-building opportunities such as collaborative seminars and shared lunch space, respectively) to be the most notable facilitator of effective communication between the two sides. Results from this study suggest concrete next steps that medical facilities can take to improve care coordination, using as their basis the mutual understanding and respect developed between SCPs and PCPs through relationship-building efforts.

  20. Unsettling care: Troubling transnational itineraries of care in feminist health practices.

    PubMed

    Murphy, Michelle

    2015-10-01

    Responding to the call by Maria Puig de la Bellacasa for Science and Technology Studies to take up 'matters of care', this article cautions against equating care with positive feelings and, in contrast, argues for the importance of grappling with the non-innocent histories in which the politics of care already circulates, particularly in transnational couplings of feminism and health. The article highlights these histories by tracing multiple versions of the politics of care in a select set of feminist engagements with the pap smear and cervical cancer. Drawing on postcolonial and indigenous feminist commitments, as well as amplifying Donna Haraway's call to 'stay with the trouble', the article seeks to disturb hegemonic histories and arrangements of race, colonialism, and political economy, while simultaneously valuing divergent multi-local itineraries as relevant to technoscientific matters of care. This call for a politics of 'unsettling' care strives to stir up and put into motion what is sedimented, while embracing the generativity of discomfort, critique, and non-innocence.

  1. Oxytocin is associated with infant-care behavior and motivation in cooperatively breeding marmoset monkeys.

    PubMed

    Finkenwirth, Christa; Martins, Eloisa; Deschner, Tobias; Burkart, Judith M

    2016-04-01

    The neurohormone oxytocin (OT) is positively involved in the regulation of parenting and social bonding in mammals, and may thus also be important for the mediation of alloparental care. In cooperatively breeding marmosets, infants are raised in teamwork by parents and adult and sub-adult non-reproductive helpers (usually older siblings). Despite high intrinsic motivation, which may be mediated by hormonal priming, not all individuals are always equally able to contribute to infant-care due to competition among care-takers. Among the various care-taking behaviors, proactive food sharing may reflect motivational levels best, since it can be performed ad libitum by several individuals even if competition among surplus care-takers constrains access to infants. Our aim was to study the link between urinary OT levels and care-taking behaviors in group-living marmosets, while taking affiliation with other adults and infant age into account. Over eight reproductive cycles, 26 individuals were monitored for urinary baseline OT, care-taking behaviors (baby-licking, -grooming, -carrying, and proactive food sharing), and adult-directed affiliation. Mean OT levels were generally highest in female breeders and OT increased significantly in all individuals after birth. During early infancy, high urinary OT levels were associated with increased infant-licking but low levels of adult-affiliation, and during late infancy, with increased proactive food sharing. Our results show that, in marmoset parents and alloparents, OT is positively involved in the regulation of care-taking, thereby reflecting the changing needs during infant development. This particularly included behaviors that are more likely to reflect intrinsic care motivation, suggesting a positive link between OT and motivational regulation of infant-care. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Taking Care of Business: The Opportunities and Dilemmas for Adult Education in a Changing Economy

    ERIC Educational Resources Information Center

    Scully-Russ, Ellen

    2016-01-01

    The new emphasis on vocational skills provides adult education a new raison d'être and presents new developmental dilemmas to the field of adult education. This chapter examines these tensions in light of significant social change that places underqualified adults at great risk to a vicious cycle of marginalization and how adult education will be…

  3. Sharing is Caring: Minimizing the Disruption with Palliative Care.

    PubMed

    Abu Dabrh, Abd Moain; Shannon, Robert P; Presutti, Richard J

    2018-03-13

    There is an upward trend incidence of multiple chronic life-limiting conditions with a well-documented associated impact on patients and their caregivers. When patients approach the end of life, they are often faced with a challenging multidimensional burden while navigating a complex health care system. Patients and families/caregivers are faced with daily decisions, often with little or no frame of reference or medical knowledge. The "what, how, when, and where" puzzle during this challenging time can be overwhelming for patients and their families, and when clinicians do not contemplate this associated workload's impact on patients and caregivers' capacity for self-care, patients and caregivers scramble to find compensatory solutions, often putting their health care at lower priority. This consequently warrants the underlying importance of palliative care and integrating it into the patients' health care plans earlier. There is increasing evidence from recent trials that supported implementing national policies regarding the early integration of palliative care and its role in improving the quality of life, increasing survival, and supporting patients' and caregivers' values when making decisions about their health care while possibly minimizing the burden of illness. The mission of palliative care is to assess, anticipate, and alleviate the challenges and suffering for patients and their caregivers by providing well-constructed approaches to disease-related physical treatments as well as psychological, financial, and spiritual aspects. Communication among all participants (the patient, family/caregivers, and all involved health care professionals) ought to be timely, thorough, and patient-centric. Palliative medicine arguably represents an example of shared decision-making (SDM)-facilitating a patient-centered, informed decision-making through an empathic conversation that is supported by clinicians' expertise and the best available evidence that takes patients

  4. Utilizing Education and Perspective Taking to Remediate the Stigma of Taking Antidepressants.

    PubMed

    Martinez, Larry R; Xu, Shi; Hebl, Michelle

    2018-05-01

    The incidence of depression has been increasing. One of the best interventions for depression is taking antidepressant medications. However, the stigma of taking antidepressants has been shown to be a barrier not only to seeking an antidepressant regimen but also adhering to it. This may have negative consequences for people who suffer from depression. Thus, in two studies, we investigate the incidence of felt stigma of taking antidepressants among clinically depressed individuals who take antidepressants and the effectiveness of two possible interventions to reduce this stigma among others. Study 1 revealed that stigma toward individuals who take antidepressants is a reality, either because people were not educated about depression and antidepressants, or because they did not show empathy or did not take on perspectives from the victim's point-of-view. Based on these results, we used an experimental design in Study 2 to investigate the effects of education and perspective-taking interventions in diminishing the stigma of taking antidepressants. These results suggest that participant gender played a moderating role in the effectiveness of education and perspective taking, such that a combination of the two interventions resulted in lower stigma for men but not for women. These results suggest that people can be trained (using a simple, low-fidelity intervention) to be more accepting of antidepressant use among their friends, family members, and colleagues, resulting in better outcomes for those who benefit from taking antidepressants.

  5. What would it take? Stakeholders' views and preferences for implementing a health care manager program in community mental health clinics under health care reform.

    PubMed

    Cabassa, Leopoldo J; Gomes, Arminda P; Lewis-Fernández, Roberto

    2015-02-01

    Health care manager interventions can improve the physical health of people with serious mental illness (SMI). In this study, we used concepts from the theory of diffusion of innovations, the consolidated framework for implementation research and a taxonomy of implementation strategies to examine stakeholders' recommendations for implementing a health care manager intervention in public mental health clinics serving Hispanics with SMI. A purposive sample of 20 stakeholders was recruited from mental health agencies, primary care clinics, and consumer advocacy organizations. We presented participants a vignette describing a health care manager intervention and used semistructured qualitative interviews to examine their views and recommendations for implementing this program. Interviews were recorded, professionally transcribed, and content analyzed. We found that a blend of implementation strategies that demonstrates local relative advantage, addresses cost concerns, and enhances compatibility to organizations and the client population is critical for moving health care manager interventions into practice. © The Author(s) 2014.

  6. Corruption in health-care systems and its effect on cancer care in Africa.

    PubMed

    Mostert, Saskia; Njuguna, Festus; Olbara, Gilbert; Sindano, Solomon; Sitaresmi, Mei Neni; Supriyadi, Eddy; Kaspers, Gertjan

    2015-08-01

    At the government, hospital, and health-care provider level, corruption plays a major role in health-care systems in Africa. The returns on health investments of international financial institutions, health organisations, and donors might be very low when mismanagement and dysfunctional structures of health-care systems are not addressed. More funding might even aggravate corruption. We discuss corruption and its effects on cancer care within the African health-care system in a sociocultural context. The contribution of high-income countries in stimulating corruption is also described. Corrupt African governments cannot be expected to take the initiative to eradicate corruption. Therefore, international financial institutions, health organisations, and financial donors should use their power to demand policy reforms of health-care systems in Africa troubled by the issue of corruption. These modifications will ameliorate the access and quality of cancer care for patients across the continent, and ultimately improve the outcome of health care to all patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Great Basin insect outbreaks

    Treesearch

    Barbara Bentz; Diane Alston; Ted Evans

    2008-01-01

    Outbreaks of native and exotic insects are important drivers of ecosystem dynamics in the Great Basin. The following provides an overview of range, forest, ornamental, and agricultural insect outbreaks occurring in the Great Basin and the associated management issues and research needs.

  8. Great Basin aspen ecosystems

    Treesearch

    Dale L. Bartos

    2008-01-01

    The health of quaking aspen (Populus tremuloides) in the Great Basin is of growing concern. The following provides an overview of aspen decline and die-off in areas within and adjacent to the Great Basin and suggests possible directions for research and management.

  9. The hospital-supplier partnership: take care of the relationship first, and individual rewards will follow.

    PubMed

    Sjoerdsma, M

    1995-02-01

    Partnerships and consolidation will continue to occur with increasing frequency within the supplier and health care provider communities as the health care industry strives to lower costs without diminishing quality and service. This article examines what constitutes the ideal hospital-supplier relationship. It asks the question: What does each partner need to do to make the relationship work effectively? It outlines the keys to a win-win proposition and ways to prevent the relationship from breaking down.

  10. Rural long-term care work, gender, and restructuring.

    PubMed

    Leach, Belinda; Joseph, Gillian

    2011-06-01

    Restructuring--the introduction of changes that alter the way health care is delivered for maximum efficiency and least cost--layered with rurality and with rural gender ideologies and practices, results in rural long-term care settings that have particular consequences for the women working in them, and for the residents and communities that they serve. This research investigated how rurality affects the implementation of patient classification in Ontario long-term care homes. Methods involved interviews and focus groups with front-line long-term care workers, administrators, and key participants. The findings revealed that rural long-term care delivery takes place when a restructured work environment intersects with gender ideologies and practices that take on particular characteristics when developed and sustained in a rural context. These factors shape the labor market and working conditions for rural women. We argue that this produces a uniquely rural experience for long-term care workers and conclude that those implementing classification systems must consider contextual factors as well as practical and financial exigencies.

  11. Collaborative care management effectively promotes self-management: patient evaluation of care management for depression in primary care.

    PubMed

    DeJesus, Ramona S; Howell, Lisa; Williams, Mark; Hathaway, Julie; Vickers, Kristin S

    2014-03-01

    Chronic disease management in the primary care setting increasingly involves self-management support from a nurse care manager. Prior research had shown patient acceptance and willingness to work with care managers. This survey study evaluated patient-perceived satisfaction with care management and patient opinions on the effectiveness of care management in promoting self-management. Qualitative and quantitative survey responses were collected from 125 patients (79% female; average age 46; 94% Caucasian) enrolled in care management for depression. Qualitative responses were coded with methods of content analysis by 2 independent analysts. Patients were satisfied with depression care management. Patients felt that care management improved their treatment above and beyond other aspects of their depression treatment (mean score, 6.7 [SD, 2]; 10 = Very much), increased their understanding of depression self-management (mean score, 7.2 [SD, 2]; 10 = Very much), and increased the frequency of self-management goal setting (mean score, 6.9 [SD, 3]; 10 = Very much). Predominant qualitative themes emphasized that patients value emotional, motivational, and relational aspects of the care manager relationship. Patients viewed care managers as caring and supportive, helpful in creating accountability for patients and knowledgeable in the area of depression care. Care managers empower patients to take on an active role in depression self-management. Some logistical challenges associated with a telephonic intervention are described. Care manager training should include communication and motivation strategies, specifically self-management education, as these strategies are valued by patients. Barriers to care management, such as scheduling telephone calls, should be addressed in future care management implementation and study.

  12. The Care management Information system for the home Care Network (SI GESCAD): support for care coordination and continuity of care in the Brazilian Unified health system (SUS).

    PubMed

    Pires, Maria Raquel Gomes Maia; Gottems, Leila Bernarda Donato; Vasconcelos Filho, José Eurico; Silva, Kênia Lara; Gamarski, Ricardo

    2015-06-01

    The present article describes the development of the initial version of the Brazilian Care Management Information System for the Home Care Network (SI GESCAD). This system was created to enhance comprehensive care, care coordination and the continuity of care provided to the patients, family and caretakers of the Home Care (HC) program. We also present a reflection on the contributions, limitations and possibilities of the SI GESCAD within the scope of the Home Care Network of the Brazilian Unified Health System (RAS-AD). This was a study on technology production based on a multi-method protocol. It discussed software engineering and human-computer interaction (HCI) based on user-centered design, as well as evolutionary and interactive software process (prototyping and spiral). A functional prototype of the GESCAD was finalized, which allowed for the management of HC to take into consideration the patient's social context, family and caretakers. The system also proved to help in the management of activities of daily living (ADLs), clinical care and the monitoring of variables associated with type 2 HC. The SI GESCAD allowed for a more horizontal work process for HC teams at the RAS-AD/SUS level of care, with positive repercussions on care coordination and continuity of care.

  13. Healthcare IT system in the midst of and after Great East Japan Earthquake Disaster : Grand design for reconstruction of Tohoku-region healthcare IT system

    NASA Astrophysics Data System (ADS)

    Tanaka, Hiroshi

    In this article, we described what was really going in the disaster medical care at the Great East Japan Earthquake, mainly in Ishinomaki and Kesen-numa areas. As for exchange tools of the disaster information, in contrast to the breakdown of fixed-line and mobile phone, MCA radio system, satellite mobiles and internet, especially SNS, were greatly helpful. Learned from the disaster experiences, we are making the grand design for “disaster-robust” regional healthcare IT systems, which are composed of (1) cloud center storing whole-prefecture medical records, (2) SS-MIX based regional healthcare information systems of “the second medical care zones”, (3) ASP/SaaS typed electronic medical record system for all clinics located at Pacific coastal areas, and (4) wireless communication environment supporting comprehensive care of elderly for daily living activities.

  14. [Palliative care in Primary Care: presentation of a case].

    PubMed

    Álvarez-Cordovés, M M; Mirpuri-Mirpuri, P G; Gonzalez-Losada, J; Chávez-Díaz, B

    2013-10-01

    We present a case of a patient diagnosed with glioblastoma multiforme refractory to treatment. Glioblastoma multiforme is the most common primary brain tumour and unfortunately the most aggressive, with an estimated mortality of about 90% in the first year after diagnosis. In our case the patient had reached a stage of life where quality of life was importsnt, with palliative care being the only recourse. The family is the mainstay in the provision of care of terminally ill patients, and without their active participation it would be difficult to achieve the objectives in patient care. We must also consider the family of the terminally ill in our care aim, as its members will experience a series of changes that will affect multiple areas where we should take action. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  15. "They Told Me to Take Him Somewhere Else": Caregivers' Experiences Seeking Emergency Dental Care for Their Children.

    PubMed

    Meyer, Beau D; Lee, Jessica Y; Lampiris, Lewis N; Mihas, Paul; Vossers, Sarah; Divaris, Kimon

    2017-05-15

    The purpose of this mixed-methods study was to examine pediatric emergency dental trends in two safety net clinics and care-seeking experiences of young children's caregivers. Administrative data were used to describe and compare emergency first visits of children ages zero to six years in a community-based (CC) and a University-based (UC) safety net clinic from 2010 to 2014. In-person interviews were conducted with 11 caregivers of children ages zero to six presenting for nontrauma-related emergency visits at the UC from January to August 2016. Interviews were transcribed verbatim, coded, and analyzed inductively using Atlas. ti.7.5.9. The UC experienced significantly more emergency first visits (33 percent) than the CC (five percent, P<0.001), and the majority of these UC visits were referrals. Caregivers were dissatisfied with the experienced barriers of access to care and lack of child-centeredness, specifically the referral out of the dental home for emergency dental care. A considerable proportion of children's first visits at dental safety net clinics was emergency related. Children's caregivers voiced issues related to access to care and lack of child-centered care. Discordance was apparent between how professional organizations define the dental home and how caregivers experience it in the context of emergency care.

  16. Informal Caregiving at Working Age: Effects of Job Characteristics and Family Configuration

    ERIC Educational Resources Information Center

    Henz, Ursula

    2006-01-01

    This article addresses the relationship between employment and providing informal care for sick, disabled, or elderly people in Great Britain. Hazard rate models for taking up caring and leaving work when caring are estimated using retrospective family, employment, and caring data from the British Family and Working Lives Survey 1994-1995 for…

  17. Taking Steps Together: A Family- and Community-Based Obesity Intervention for Urban, Multiethnic Children

    ERIC Educational Resources Information Center

    Anderson, John D.; Newby, Rachel; Kehm, Rebecca; Barland, Patricia; Hearst, Mary O.

    2015-01-01

    Objectives: Successful childhood obesity intervention models that build sustainable behavioral change are needed, particularly in low-income, ethnic minority communities disparately affected by this problem. Method: Families were referred to Taking Steps Together (TST) by their primary care provider if at least one child had a body mass index…

  18. [Taking personal responsibility in practice: what does it mean?--Insights into daily clinical routines].

    PubMed

    Hansen, Leonhard

    2012-01-01

    In our society, taking personal responsibility is basically regarded as a key step to adopting a more active lifestyle. In health care, however, personal responsibility is primarily equated with higher levels of financial contribution from patients. Obviously, the individual's responsibility for his or her health and towards the mutually supportive community is a highly emotional and ideological issue, so the debate is usually rather heated. This is, however, at odds with the "empowered patient" concept. In the present paper "personal responsibility in practice" will be understood to include both physician and patient responsibility. Examples will be employed to demonstrate that, on an individual level, physicians are responsible for diagnosing and treating their patients as indicated and that, on a collective level, they are expected to make responsible use of the resources allocated. Here, patient responsibility will be defined as both taking care for one's own health and the individual's obligation to contribute to the maintenance of our solidarity-based health care system. The tensions between solidarity and subsidiarity and personal responsibility, respectively, will be outlined, and a readjustment of the relation between external support and individual strengths, between solidarity and personal responsibility in terms of Sect. 1 of the Social Book Code V will be advocated. Copyright © 2012. Published by Elsevier GmbH.

  19. Need for and use of family leave among parents of children with special health care needs.

    PubMed

    Chung, Paul J; Garfield, Craig F; Elliott, Marc N; Carey, Colleen; Eriksson, Carl; Schuster, Mark A

    2007-05-01

    Parents of children with special health care needs are especially vulnerable to work-family conflicts that family leave benefits might help resolve. We examined leave-taking among full-time-employed parents of children with special health care needs. We identified all children with special health care needs in 2 large inpatient/outpatient systems in Chicago, Illinois, and Los Angeles, California, and randomly selected 800 per site. From November 2003 to January 2004, we conducted telephone interviews with 1105 (87% of eligible and successfully contacted) parents. Among the sample's 574 full-time-employed parents, we examined whether leave benefits predicted missing any work for child illness, missing >4 weeks for child illness, and ability to miss work whenever their child needed them. Forty-eight percent of full-time-employed parents qualified for federal Family and Medical Leave Act benefits; 30% reported employer-provided leave benefits (not including sick leave/vacation). In the previous year, their children averaged 20 missed school/child care days, 12 doctor/emergency department visits, and 1.7 hospitalizations. Although 81% of parents missed work for child illness, 41% reported not always missing work when their child needed them, and 40% of leave-takers reported returning to work too soon. In multivariate regressions, parents who were eligible for Family and Medical Leave Act benefits and aware of their eligibility had 3.0 times greater odds of missing work for child illness than ineligible parents. Parents with >4 weeks of employer-provided leave benefits had 4.7 times greater odds of missing >4 weeks than parents without benefits. Parents with paid leave benefits had 2.8 times greater odds than other parents of missing work whenever their child needed them. Full-time-employed parents of children with special health care needs experience severe work-family conflicts. Although most have leave benefits, many report unmet need for leave. Access to Family and

  20. Reducing the cost of health care capital.

    PubMed

    Silberman, R

    1984-08-01

    Although one may ask four financial experts their opinion on the future of the hospital capital market and receive five answers, the blatant need for financial strategic planning is evident. Clearly, the hospital or system with sound financial management will be better positioned to gain and/or maintain an edge in the competitive environment of the health care sector. The trends of the future include hospitals attempting to: Maximize the efficiency of invested capital. Use the expertise of Board members. Use alternative capital sources. Maximize rate of return on investments. Increase productivity. Adjust to changes in reimbursements. Restructure to use optimal financing for capital needs, i.e., using short-term to build up debt capacity if long-term financing is needed in the future. Take advantage of arbitrage (obtain capital and reinvest it until the funds are needed). Delay actual underwriting until funds are to be used. Better management of accounts receivable and accounts payable to avoid short-term financing for cash flow shortfalls. Use for-profit subsidiaries to obtain venture capital by issuing stock. Use product line management. Use leasing to obtain balance sheet advantages. These trends indicate a need for hospital executives to possess a thorough understanding of the capital formation process. In essence, the bottom line is that the short-term viability and long-term survival of a health care organization will greatly depend on the financial expertise of its decision-makers.

  1. Bioethics and caring.

    PubMed Central

    van Hooft, S

    1996-01-01

    The author agrees with the critiques of moral theory offered by such writers as Bernard Williams and Alasdair MacIntyre, and uses ideas from Heidegger and Levinas to argue that caring is an ontological structure of human existence which takes two forms: caring about on self (which he calls our "self-project") and caring-about-others. This dual form of caring is expressed on four Aristotelian levels of human living which the author describes and illustrates with reference to the phenomenon of pain. It is concluded from this analysis that traditional notions of morality as imposing obligations should give way to an understanding of ethics as the social forms given to our caring for ourselves and for others. A number of implications for ethical theory are sketched out with the conclusion that virtue theory should be preferred and that the model could be worked out more fully to show that virtue theory can be internalist, particularist, pluralist, personalist and objectivist. PMID:8731533

  2. Bioethics and caring.

    PubMed

    van Hooft, S

    1996-04-01

    The author agrees with the critiques of moral theory offered by such writers as Bernard Williams and Alasdair MacIntyre, and uses ideas from Heidegger and Levinas to argue that caring is an ontological structure of human existence which takes two forms: caring about on self (which he calls our "self-project") and caring-about-others. This dual form of caring is expressed on four Aristotelian levels of human living which the author describes and illustrates with reference to the phenomenon of pain. It is concluded from this analysis that traditional notions of morality as imposing obligations should give way to an understanding of ethics as the social forms given to our caring for ourselves and for others. A number of implications for ethical theory are sketched out with the conclusion that virtue theory should be preferred and that the model could be worked out more fully to show that virtue theory can be internalist, particularist, pluralist, personalist and objectivist.

  3. Great Basin Experimental Range: Annotated bibliography

    Treesearch

    E. Durant McArthur; Bryce A. Richardson; Stanley G. Kitchen

    2013-01-01

    This annotated bibliography documents the research that has been conducted on the Great Basin Experimental Range (GBER, also known as the Utah Experiment Station, Great Basin Station, the Great Basin Branch Experiment Station, Great Basin Experimental Center, and other similar name variants) over the 102 years of its existence. Entries were drawn from the original...

  4. Global Health Care Justice, Delivery Doctors and Assisted Reproduction: Taking a Note From Catholic Social Teachings.

    PubMed

    Richie, Cristina

    2015-12-01

    This article will examine the Catholic concept of global justice within a health care framework as it relates to women's needs for delivery doctors in the developing world and women's demands for assisted reproduction in the developed world. I will first discuss justice as a theory, situating it within Catholic social teachings. The Catholic perspective on global justice in health care demands that everyone have access to basic needs before elective treatments are offered to the wealthy. After exploring specific discrepancies in global health care justice, I will point to the need for delivery doctors in the developing world to provide basic assistance to women who hazard many pregnancies as a priority before offering assisted reproduction to women in the developed world. The wide disparities between maternal health in the developing world and elective fertility treatments in the developed world are clearly unjust within Catholic social teachings. I conclude this article by offering policy suggestions for moving closer to health care justice via doctor distribution. © 2014 John Wiley & Sons Ltd.

  5. Adolescent adaptation before, during and in the aftermath of the Great Recession in the USA.

    PubMed

    Johnson, Monica Kirkpatrick; Staff, Jeremy; Patrick, Megan E; Schulenberg, John E

    2017-02-01

    This study examines the impact of the "Great Recession" (from December 2007 to June 2009) on 8th and 10th graders in the USA, using annual nationally representative data from the Monitoring the Future study. Historical changes in youth adjustment (self-esteem, depressed mood, risk taking, aggression and property crime), school achievement (grade point average [GPA], time spent on homework and educational expectations) and structured and unstructured activities (volunteering, employment, sports and evenings out for fun) were examined between 1991 and 2014. Overall, there were only slight changes in mean levels of adjustment, achievement and most youth activities. However, the percentage of youth working during the school year did decline during the Great Recession. Several longer-term trends were also evident, though not directly tied to the Great Recession. These include an increase in GPA, a decrease in time spent on homework, rising educational expectations and more time spent volunteering. Future work should assess how the shift to unpaid work activities (e.g. volunteering and internships) among youth is impacting the transition from school to work in the contemporary economy, and whether the Great Recession had deleterious impacts for younger children or among youth whose parents lost work or had their homes foreclosed. © 2016 International Union of Psychological Science.

  6. Keys to career success in managed care.

    PubMed

    Sandrick, K

    1996-04-01

    Given the prominence that managed care will have in the future U.S. healthcare system, financial managers who want to advance their careers must take steps to hone their managed care knowledge and skills, become accomplished managed care strategists, and identify opportunities to gain expertise in the managed care field. Healthcare Financial Management interviewed a number of managed care experts to obtain their views on how healthcare financial managers can prepare for a career in managed care organizations. The experts agree that one of the keys to future success lies in financial managers' willingness to assume more and different types of responsibility than before as the shift to managed care continues.

  7. [Mental disorders in primary care].

    PubMed

    Herzig, Lilli; Mühlemann, Nicole; Bischoff, Thomas

    2010-05-19

    Mental disorders (depression, anxiety and somatization) are frequent in Primary care and are often associated to physical complaints and to psychosocial stressors. Mental disorders have in this way a specific presentation and in addition patients may present different associations of them. Sometimes it is difficult to recognize them, but it is important to do so and to take rapidly care of these patients. Specific screening questions exist and have been used in a research of the Institute of General Medicine and the Department of Ambulatory Care and Community Medicine (PMU), University of Lausanne, Switzerland.

  8. The attitude of risk taking Islamic junior high school (MTs) students in learning mathematics

    NASA Astrophysics Data System (ADS)

    Yuni, Y.; Darhim; Turmudi

    2018-05-01

    This study aims to determine the risk-taking attitude of students at Islamic Junior High School (MTs) in Bekasi towards learning mathematics. This is a preliminary research to get information about risk taking attitude in order to conduct next research. Data are obtained by providing questionnaires of 20 indicators, which includes be careful in act, having peace of mind, resolute in making decisions and confident in the act. Respondents are as many as 97 students of 7th grade students of MTs and taken with random techniques from two MTs in the city of Bekasi. The research instrument was adopted from DOSPERT developed, adapted to the ability of 7th grade students of MTs. The attitude of risk taking is part of the student's responsibility attitude to the learning of mathematics, either during preparation, process or after learning mathematics. The attitude of risk taking is important to know in order to be trained continuously. Because the trained attitude of risk taking will make students succeed in learning and working later.

  9. 75 FR 29891 - Special Local Regulation; Maggie Fischer Memorial Great South Bay Cross Bay Swim, Great South Bay...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-28

    ...-AA08 Special Local Regulation; Maggie Fischer Memorial Great South Bay Cross Bay Swim, Great South Bay... Lighthouse Dock, Fire Island, NY due to the annual Maggie Fischer Memorial Great South Bay Cross Bay Swim..., Maggie Fischer Memorial Great South Bay Cross Bay Swim, Great South Bay, NY, in the Federal Register (74...

  10. The Practice of Self-Care among Counseling Students

    ERIC Educational Resources Information Center

    Mayorga, Mary G.; Devries, Sabina R.; Wardle, Elizabeth Ann

    2015-01-01

    Self-care behavior is recognized as an important component for the helping professional who practices in the field of counseling or who is training to become a helping professional. Occupational stress and burnout in the field of counseling is of great concern. This study examined the practice of self-care among master level counseling students to…

  11. Factors Associated With Parents' Perceptions of Their Infants' Oral Health Care.

    PubMed

    Daly, Jeanette M; Levy, Steven M; Xu, Yinghui; Jackson, Richard D; Eckert, George J; Levy, Barcey T; Fontana, Margherita

    2016-07-01

    Parents have an important role ensuring their infants receive oral and medical health care. Their decisions affect the well-being of their children. This study used data collected from a longitudinal, prospective study with the aim of developing and validating a caries risk assessment tool. The objectives of this study are to (a) compare parents' perceptions of how well they do in taking care of the infants' teeth and/or gums versus how well they do in taking care of the infants' medical health and (b) determine factors associated with parental perceptions of how well they do in taking care of the infants' teeth and/or gums. A total of 1323 parent/infant pairs were enrolled in the study at Duke University, Indiana University, and the University of Iowa. Through a survey, 283 (21%) of the parents perceived they did an excellent job of both taking care of both the infant's oral and medical health, while 861 (65%) perceived the care of their infant's medical health was better than their care of the teeth and/or gums. In the multivariable model, parents who perceived they provided excellent/very good/good care for the infants' teeth and/or gums were more likely to brush the infant's teeth daily, use toothpaste daily, clean inside the infant's mouth and/or gums daily, and not let the infant have something other than water after brushing and prior to bedtime. Also, those with infants having Medicaid or State Insurance, parents not eating sugary snacks frequently, and parents getting dental checkups at least annually were likely to perceive that they provided excellent/very good/good care for their infant's teeth and/or gums. Parents who provide good infant oral health care are more likely to perceive they provide good care and more likely to have better personal dental health behaviors. This agrees with previous studies concerning older children. © The Author(s) 2016.

  12. Vocational Teachers' Gendered Reflections on Education, Teaching and Care

    ERIC Educational Resources Information Center

    Lahelma, Elina; Lappalainen, Sirpa; Palmu, Tarja; Pehkonen, Leila

    2014-01-01

    In this article, we discuss teachers' reflections on the relation between teaching and care in the two most gender-segregated sectors of vocational upper secondary education in Finland, namely Health and Social services and Transport and Technology. We first discuss the concepts around education, teaching, taking care for and caring about…

  13. Jupiter Great Red Spot

    NASA Image and Video Library

    1997-09-07

    This view of Jupiter Great Red Spot is a mosaic of two images taken by NASA Galileo spacecraft. The Great Red Spot is a storm in Jupiter atmosphere and is at least 300 years-old. The image was taken on June 26, 1996. http://photojournal.jpl.nasa.gov/catalog/PIA00296

  14. Evaluating care from a care ethical perspective:: A pilot study.

    PubMed

    Kuis, Esther E; Goossensen, Anne

    2017-08-01

    Care ethical theories provide an excellent opening for evaluation of healthcare practices since searching for (moments of) good care from a moral perspective is central to care ethics. However, a fruitful way to translate care ethical insights into measurable criteria and how to measure these criteria has as yet been unexplored: this study describes one of the first attempts. To investigate whether the emotional touchpoint method is suitable for evaluating care from a care ethical perspective. An adapted version of the emotional touchpoint interview method was used. Touchpoints represent the key moments to the experience of receiving care, where the patient recalls being touched emotionally or cognitively. Participants and research context: Interviews were conducted at three different care settings: a hospital, mental healthcare institution and care facility for older people. A total of 31 participants (29 patients and 2 relatives) took part in the study. Ethical considerations: The research was found not to be subject to the (Dutch) Medical Research Involving Human Subjects Act. A three-step care ethical evaluation model was developed and described using two touchpoints as examples. A focus group meeting showed that the method was considered of great value for partaking institutions in comparison with existing methods. Reflection and discussion: Considering existing methods to evaluate quality of care, the touchpoint method belongs to the category of instruments which evaluate the patient experience. The touchpoint method distinguishes itself because no pre-defined categories are used but the values of patients are followed, which is an essential issue from a care ethical perspective. The method portrays the insider perspective of patients and thereby contributes to humanizing care. The touchpoint method is a valuable instrument for evaluating care; it generates evaluation data about the core care ethical principle of responsiveness.

  15. From home to 'home': Mapping the caregiver journey in the transition from home care into residential care.

    PubMed

    Hainstock, Taylor; Cloutier, Denise; Penning, Margaret

    2017-12-01

    Family caregivers play a pivotal role in supporting the functional independence and quality of life of older relatives, often taking on a wide variety of care-related activities over the course of their caregiving journey. These activities help family members to remain in the community and age-in-place for as long as possible. However, when needs exceed family capacities to provide care, the older family member may need to transition from one care environment to another (e.g., home care to nursing home care), or one level of care to another (from less intense to more intensive services). Drawing upon qualitative interview data collected in a populous health region in British Columbia, Canada, this study explores the roles and responsibilities of family caregivers for family members making the care transition from home care to residential care. A thematic analysis of the interview transcripts resulted in the development of a conceptual framework to characterize the "Caregiver Journey" as a process that could be divided into at least three phases: 1) Precursors to transition - recognizing frailty in family members and caregivers prior to transition; 2) Preparing to transition into residential nursing home care (RC) and 3) Post-transition: Finding a new balance - where caregivers adjust and adapt to new caregiving responsibilities. Our analyses revealed that the second phase is the most complex involving a consideration of the various activities, and roles that family caregivers take on to prepare for the care transition including: information gathering, advocacy and system navigation. We conclude that there is a need for family caregivers to be better supported during care transitions; notably through ongoing and enhanced investments in strategies to support caregiver communication and education. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  16. Hospital policy on medical futility - does it help in conflict resolution and ensuring good end-of-life care?

    PubMed

    Joseph, Roy

    2011-01-01

    This paper aimed to ascertain if hospital policy on medical futility helps in conflict resolution, and in ensuring good end-of-life care. Literature on the subject published in the last 5 years was identified through Pubmed, and those with empirical data pertaining to the outcomes of interest were examined. A systematic analysis was not possible as papers varied greatly in aims, designs, outcomes and their measures. Instead, the outcomes of representative papers were described and discussed. There is a widespread use of policies and guidelines based on the concept of medical futility. Conflicts are rare and appear to arise primarily from the manner in which policies are implemented. End-of-life care appears to be improving as evidenced by a significant number of deaths occurring following: (i) discussions involving patient, family, healthcare team members; (ii) cessation of intensive care and (iii) cessation of institution of palliative care. Deaths are increasingly taking place in the presence of family and outside the intensive care wards. Finally, post mortem audit of processes and practices indicate (i) compliance but in a limited manner with policies and recommended guidelines, (ii) family satisfaction and (iii) identify areas where improvement in end-of-life (EOL) care can be effected. Key areas are in improving education of, communication with, and documentation by all stakeholders. Hospital policies on medical futility have helped to resolve conflicts and improve end-of-life care. Prospective, multicentre and controlled trials will be useful in determining the value of specific interventions, obtaining generalisable data and facilitating implementation of better end-of-life care models.

  17. The duty to care in an influenza pandemic: a qualitative study of Canadian public perspectives.

    PubMed

    Bensimon, Cécile M; Smith, Maxwell J; Pisartchik, Dmitri; Sahni, Sachin; Upshur, Ross E G

    2012-12-01

    Ever since the emergence of SARS, when we were reminded that the nature of health care practitioners' duty to care is greatly contested, it has remained a polarizing issue. Discussions on the nature and limits of health care practitioners' duty to care during disasters and public health emergencies abounds the literature, ripe with arguments seeking to ground its foundations. However, to date there has been little public engagement on this issue. This study involved three Townhall meetings held between February 2008 and May 2010 in three urban settings in Canada in order to probe lay citizens' views about ethical issues related to pandemic influenza, including issues surrounding the duty to care. Participants included Canadian residents aged 18 and over who were fluent in English. Data were collected through day-long facilitated group discussions using case scenarios and focus group guides. Participant's views were organized according to several themes, including the following main themes (and respective sub-themes): 1. Legitimate limits; a) competing obligations; and b) appeal to personal choice; and 2. Legitimate expectations; a) reciprocity; and b) enforcement and planning. Our findings show that participants moved away from categorical notions of the duty to care towards more equivocal and often normative views throughout deliberations. Our analysis contributes a better understanding of the constitutive nature of the duty to care, defined in part by taking account of public views. This broadened understanding can further inform the articulation of acceptable norms of duty to care and policy development efforts. What is more, it illustrates the urgent need for policy-makers and regulators to get clarity on obligations, responsibilities, and accountability in the execution of HCPs' duty to care during times of universal vulnerability. Copyright © 2012 Elsevier Ltd. All rights reserved.

  18. [Usage survey of care equipment in care service facilities for the elderly].

    PubMed

    Iwakiri, Kazuyuki; Takahashi, Masaya; Sotoyama, Midori; Hirata, Mamoru; Hisanaga, Naomi

    2007-01-01

    Musculoskeletal disorders(MSD)have been increasing recently among care workers. Since providing care workers with appropriate equipment is effective for preventing MSD, we conducted a questionnaire survey in two nursing homes and a healthcare facility for the elderly to clarify equipment usage, problems and points for improvement. A total of 81 care workers(average age 32.2 yr; 63 females, 18 males)participated in the survey. The average number of residents and the average resident's care level were 70.0 and 3.6, respectively. Wheelchair and height adjustable beds were fully available and always used in all facilities. Portable lifts, ceiling lifts and transfer boards were, however, few in all 3 facilities and the proportion of use was 14.8%, 16.0%, and 23.5%, respectively. Participants reported that it is time consuming to move residents from place to place with lifts and there is a danger of dropping a resident. Although approximately 90% of care workers had received education and training on care techniques, the workload on the low back was found to be great. Therefore, we thought that care workers must consistently use care equipment. To achieve such increased usage, we must improve the usability of the equipment.

  19. 50 CFR 14.133 - Care in transit.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... knowledgeable in marine mammal care to provide for the animal's health and well-being. The shipper or... 50 Wildlife and Fisheries 1 2011-10-01 2011-10-01 false Care in transit. 14.133 Section 14.133 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR TAKING...

  20. 50 CFR 14.133 - Care in transit.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... knowledgeable in marine mammal care to provide for the animal's health and well-being. The shipper or... 50 Wildlife and Fisheries 1 2012-10-01 2012-10-01 false Care in transit. 14.133 Section 14.133 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR TAKING...

  1. 50 CFR 14.133 - Care in transit.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... knowledgeable in marine mammal care to provide for the animal's health and well-being. The shipper or... 50 Wildlife and Fisheries 1 2013-10-01 2013-10-01 false Care in transit. 14.133 Section 14.133 Wildlife and Fisheries UNITED STATES FISH AND WILDLIFE SERVICE, DEPARTMENT OF THE INTERIOR TAKING...

  2. [Corruption and health care system].

    PubMed

    Marasović Šušnjara, Ivana

    2014-06-01

    Corruption is a global problem that takes special place in health care system. A large number of participants in the health care system and numerous interactions among them provide an opportunity for various forms of corruption, be it bribery, theft, bureaucratic corruption or incorrect information. Even though it is difficult to measure the amount of corruption in medicine, there are tools that allow forming of the frames for possible interventions.

  3. Care work in changing welfare states: Nordic care workers' experiences.

    PubMed

    Trydegård, Gun-Britt

    2012-06-01

    This article focuses on Nordic eldercare workers and their experiences of working conditions in times of change and reorganisation. In recent years New Public Management-inspired ideas have been introduced to increase efficiency and productivity in welfare services. These reforms have also had an impact on day-to-day care work, which has become increasingly standardized and set out in detailed contracts, leading to time-pressure and an undermining of care workers' professional discretion and autonomy. The empirical data comes from a survey of unionised eldercare workers in home care and residential care in Denmark, Finland, Norway and Sweden ( N  = 2583) and was analysed by bi- and multi-variate methods. The care workers reported that they found their working conditions physically and mentally arduous. They had to a great extent experienced changes for the worse in terms of working conditions and in their opportunity to provide good quality care. In addition, the majority felt they did not receive support from their managers. An alarming finding was that one out of three care workers declared that they had seriously considered quitting their jobs. Care workers with multiple problems at work were much more likely to consider quitting, and the likelihood was increasing with the number of problems reported. Furthermore, care workers lacking support from their managers had double odds of wanting to quit. The Nordic welfare states with growing older populations are facing challenges in retaining care staff in the eldercare services and ensuring they have good working conditions and support in their demanding work.

  4. Do we need a critical care ultrasound certification program? Implications from an Australian medical-legal perspective

    PubMed Central

    2010-01-01

    Medical practitioners have a duty to maintain a certain standard of care in providing their services. With critical care ultrasound gaining popularity in the ICU, it is envisaged that more intensivists will use the tool in managing their patients. Ultrasound, especially echocardiography, can be an 'easy to learn, difficult to manage' skill, and the competency in performing the procedure varies greatly. In view of this, several recommendations for competency statements have been published in recent years to advocate the need for a unified approach to training and certification. In this paper, we take a slightly different perspective, from an Australian medical-legal viewpoint, to argue for the need to implement a critical care ultrasound certification program. We examine various issues that can potentially lead to a breach of the standard of care, hence exposing the practitioners and/or the healthcare institutions to lawsuits in professional negligence or breach of contract. These issues, among others, include the failure to use ultrasound in appropriate situations, the failure of hospitals to ensure practitioners are properly trained in the skills, the failure of practitioners to perform an ultrasound study that is of a reasonable standard, and the failure of practitioners to keep themselves abreast of the latest developments in treatment and management. The implications of these issues and the importance of having a certification process are discussed. PMID:20550724

  5. Do we need a critical care ultrasound certification program? Implications from an Australian medical-legal perspective.

    PubMed

    Huang, Stephen J; McLean, Anthony S

    2010-01-01

    Medical practitioners have a duty to maintain a certain standard of care in providing their services. With critical care ultrasound gaining popularity in the ICU, it is envisaged that more intensivists will use the tool in managing their patients. Ultrasound, especially echocardiography, can be an 'easy to learn, difficult to manage' skill, and the competency in performing the procedure varies greatly. In view of this, several recommendations for competency statements have been published in recent years to advocate the need for a unified approach to training and certification. In this paper, we take a slightly different perspective, from an Australian medical-legal viewpoint, to argue for the need to implement a critical care ultrasound certification program. We examine various issues that can potentially lead to a breach of the standard of care, hence exposing the practitioners and/or the healthcare institutions to lawsuits in professional negligence or breach of contract. These issues, among others, include the failure to use ultrasound in appropriate situations, the failure of hospitals to ensure practitioners are properly trained in the skills, the failure of practitioners to perform an ultrasound study that is of a reasonable standard, and the failure of practitioners to keep themselves abreast of the latest developments in treatment and management. The implications of these issues and the importance of having a certification process are discussed.

  6. Analyzing Short Message Services Application Effect on Diabetic Patients' Self-caring.

    PubMed

    Naghibi, Seyed Abolhassan; Moosazadeh, Mahmood; Zhyanifard, Akram; Jafari Makrani, Zoreh; Yazdani Cherati, Jamshid

    2015-01-01

    Diabetes is the most prevalent metabolic disease with a growing spread rate in word wide. Short message service (SMS) is of the most common public communication networks, which have brought about a broad spectrum of applications like social, cultural and service products in the late decade. The objective of this research is, the investigate of using SMS on diabetes patients self-caring. In an interventional study, 228 diabetes patients have been selected from a community charity. With using of random sampling method, they were divided into two groups of 114 subjects as the control and case. The case group was sent messages reminding them about sports, caring foot, taking insulin and oral tablet for 4 weeks via mobile phone. After 4 weeks, a posttest questionnaire was completed. The data analysis was performed using a descriptive statistic, Chi-square, independent t-test, and paired t-test. There are not significant differences between case and control groups before intervention by studied dependent variables (P > 0.05). Performance score mean of taking care of foot, sport and taking oral tablet and insulin in case group before intervention were 29.90, 10, 11.16 and 3.75 respectively and after intervention were 20.11, 41.36, 13.09 and 4.90, respectively. Furthermore, the performance scores mean difference after intervention, taking care of foot (P < 0.001), sport (P < 0.001), taking oral tablet (P = 0.020) was meaningful in case and control groups. Regarding the study results on using cell phone, to utilize virtual training methods is recommended as an appropriate procedure for different health care, self-caring and follow-up training plans for various groups in society, especially diabetic and chronic patients.

  7. The experience of intensive care nurses caring for patients with delirium: A phenomenological study.

    PubMed

    LeBlanc, Allana; Bourbonnais, Frances Fothergill; Harrison, Denise; Tousignant, Kelly

    2018-02-01

    The purpose of this research was to seek to understand the lived experience of intensive care nurses caring for patients with delirium. The objectives of this inquiry were: 1) To examine intensive care nurses' experiences of caring for adult patients with delirium; 2) To identify factors that facilitate or hinder intensive care nurses caring for these patients. This study utilised an interpretive phenomenological approach as described by van Manen. Individual conversational interviews were conducted with eight intensive care nurses working in a tertiary level, university-affiliated hospital in Canada. The essence of the experience of nurses caring for patients with delirium in intensive care was revealed to be finding a way to help them come through it. Six main themes emerged: It's Exhausting; Making a Picture of the Patient's Mental Status; Keeping Patients Safe: It's aReally Big Job; Everyone Is Unique; Riding It Out With Families and Taking Every Experience With You. The findings contribute to an understanding of how intensive care nurses help patients and their families through this complex and distressing experience. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. How the affordable care act and mental health parity and addiction equity act greatly expand coverage of behavioral health care.

    PubMed

    Beronio, Kirsten; Glied, Sherry; Frank, Richard

    2014-10-01

    The Patient Protection and Affordable Care Act (ACA) will expand coverage of mental health and substance use disorder benefits and federal parity protections to over 60 million Americans. The key to this expansion is the essential health benefit provision in the ACA that requires coverage of mental health and substance use disorder services at parity with general medical benefits. Other ACA provisions that should improve access to treatment include requirements on network adequacy, dependent coverage up to age 26, preventive services, and prohibitions on annual and lifetime limits and preexisting exclusions. The ACA offers states flexibility in expanding Medicaid (primarily to childless adults, not generally eligible previously) to cover supportive services needed by those with significant behavioral health conditions in addition to basic benefits at parity. Through these various new requirements, the ACA in conjunction with Mental Health Parity and Addiction Equity Act (MHPAEA) will expand coverage of behavioral health care by historic proportions.

  9. Planning Nurses in Maternity Care: a Stochastic Assignment Problem

    NASA Astrophysics Data System (ADS)

    Phillipson, Frank

    2015-05-01

    With 23 percent of all births taking place at home, The Netherlands have the highest rate of home births in the world. Also if the birth did not take place at home, it is not unusual for the mother and child to be out of hospital in a few hours after the baby was born. The explanation for both is the very well organised maternity care system. However, getting the right maternity care nurse available on time introduces a complex planning issue that can be recognized as a Stochastic Assignment Problem. In this paper an expert rule based approach is combined with scenario analysis to support the planner of the maternity care agency in his work.

  10. Taking Risks for the Future of Space Weather Forecasting, Research, and Operations

    NASA Astrophysics Data System (ADS)

    Jaynes, A. N.; Baker, D. N.; Kanekal, S. G.; Li, X.; Turner, D. L.

    2017-12-01

    Taking Risks for the Future of Space Weather Forecasting, Research, and Operations The need for highly improved space weather modeling and monitoring is quickly becoming imperative as our society depends ever more on the sensitive technology that builds and connects our world. Instead of relying primarily on tried and true concepts, academic institutions and funding agencies alike should be focusing on truly new and innovative ways to solve this pressing problem. In this exciting time, where student-led groups can launch CubeSats for under a million dollars and companies like SpaceX are actively reducing the cost-cap of access to space, the space physics community should be pushing the boundaries of what is possible to enhance our understanding of the space environment. Taking great risks in instrumentation, mission concepts, operational development, collaborations, and scientific research is the best way to move our field forward to where it needs to be for the betterment of science and society.

  11. Great Lakes Teacher's Guide.

    ERIC Educational Resources Information Center

    Reid, Ron

    The Great Lakes are one of the world's greatest reservoirs of fresh water, the foundation of Ontario's economic development, a primary force in ecological systems, and a base for pleasure and recreation. They are also a magnificent resource for the teachers of Ontario. Study of the Great Lakes can bring to life the factors that shape the ecology…

  12. Great plains, Chapter 11

    Treesearch

    C.M. Clark

    2011-01-01

    The North American Great Plains are the largest contiguous ecoregion in North America, covering 3.5 million square km2, or 16 percent of the continental area (CEC 1997). In the United States, the Great Plains ecoregion encompasses a roughly triangular region (Figure 2.2), bordered on the west by the Rocky Mountains and the southwestern deserts in...

  13. Managing care.

    PubMed

    Sandifer, Q D

    1997-09-01

    The terms 'managed care' and 'disease management' are gaining common usage in the health service but their meaning is not widely understood. Managed care is a generic term describing any health care system that integrates the financing and delivery of medical care. Its growth in the United States has been driven by pressure to control costs, and there is circumstantial evidence that costs are slowing as a result of better management of resources. However, it is not clear how much of this is due to managed care, the selection of more favourable enrollees to health plans or other factors. Research evidence is limited, and that available is constrained by the rapidly changing nature of managed care. In the United States a bewildering variety of managed care arrangements have emerged, although several common characteristics can be identified: limited choice of physician providers; controlled access to secondary care; selective contracting; financial incentives; quality management; and utilization management. All are present in the National Health Service (NHS), which exemplifies a nationalized managed care system. Disease management is an extension of managed care that takes a global approach to patient care by attempting to co-ordinate resources across the entire health care delivery system throughout the life cycle of the disease. This is poorly developed in the NHS, so that the attention of commercial organizations has been attracted. However, concern has been expressed about the implications of commercial involvement: the fragmentation of general medical services; effect of for-profit status; and use of patient-based data. Recent policy developments could allow disease management to develop within the NHS.

  14. Disaster medical assistance in super typhoon Haiyan: Collaboration with the local medical team that resulted in great synergy.

    PubMed

    Kim, Hoon; Ahn, Moo Eob; Lee, Kang Hyun; Kim, Yeong Cheol; Hong, Eun Seok

    2015-03-01

    On 8 November 2013, Typhoon Haiyan made landfalls over the center of the Philippines and devastated the region. Soon aftermath of the disaster, many foreign medical teams (FMTs) headed toward the site, and the Korean team was one of them. This study described the experiences of the team during the initial phase of response, focusing on collaborative efforts with the local medical team. The Korean team was capable of providing primary care, and the Filipino team provided incomplete secondary care which was insufficient for covering the patient load. Not only did the Korean team provide electricity for hospital operation and various materials, but also supplemented medical personnel, who covered the emergency and outpatient departments. Collaborative efforts filled in each other's gap, and resulted in great synergy. Disaster medical relief mission of FMTs should be cooperated with a coordination mechanism. Collaboration with the local resources can be a great opportunity for both parties, and should not be overlooked in any disaster situations.

  15. 75 FR 17706 - FPL Energy Maine Hydro LLC, Complainant v. Great Lakes Hydro America LLC Rumford Falls Hydro LLC...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-07

    ... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. EL10-53-000] FPL Energy Maine Hydro LLC, Complainant v. Great Lakes Hydro America LLC Rumford Falls Hydro LLC, Respondents; Notice of Complaint March 29, 2010. Take notice that on March 26, 2010, pursuant to section 206 of the Federal Energy Regulatory Commission's (Commission...

  16. A Patient-Centered Transitional Care Case Management Program: Taking Case Management to the Streets and Beyond.

    PubMed

    Lovelace, Derenda; Hancock, Diane; Hughes, Sabrina S; Wyche, Phyllis R; Jenkins, Claire; Logan, Cindy

    In 2011, the Hunter Holmes McGuire Veterans Administration Medical Center (VAMC) in Richmond, VA, had a cumulative readmission rate and emergency department (ED) revisits for discharged Veterans of 1 in 5. In 2012, a transitional care program (TCP) was implemented to improve care coordination and outcomes among Veterans, with an emphasis on geriatric patients with chronic disease. This TCP was created with an interdisciplinary approach using intensive case management interventions, with a goal of reducing Veteran ED and hospital revisits by 30%. To examine the impact of the McGuire VAMC TCP on Veteran ED and hospital utilization and costs. Veterans being discharged to home following an inpatient admission, ED visit, and/or short rehab stay. The primary means of identifying patients for the program is through daily screening of the previous 24-hour admission and ED report, which the inpatient nurse practitioner performs. She completes an extensive review of each Veteran's electronic medical record to determine the number of ED visits and inpatient admissions at the VAMC and in the community. Initial criteria for consideration in the program included the following: more than two hospital admissions and/or ED visits in the past 90 days or at high risk for readmission based on a Care Assessment Need score of greater than 95. Two hundred Veterans participated in the program in fiscal year (FY) 2013, with 146 participating in FY 2014. A retrospective chart review of Veterans participating in the TCP in FYs 2013 and 2014 was conducted, with a focus on number of admissions and ED visits 90 days prior to admission to the TCP and 90 days following TCP admission. Average admission and ED costs for this VA were calculated to determine cost savings from pre- to post-90 days of admission and ED visits. Veterans who obtained TCP services in FYs 2013 and 2014 experienced a 67% decrease in hospital admissions and a 61% decrease in ED visits in the 90 days following participation in

  17. Depression in primary care: assessing suicide risk

    PubMed Central

    Ng, Chung Wai Mark; How, Choon How; Ng, Yin Ping

    2017-01-01

    Major depression is a common condition seen in the primary care setting. This article describes the suicide risk assessment of a depressed patient, including practical aspects of history-taking, consideration of factors in deciding if a patient requires immediate transfer for inpatient care and measures to be taken if the patient is not hospitalised. It follows on our earlier article about the approach to management of depression in primary care. PMID:28210741

  18. Perception on Informed Consent Regarding Nursing Care Practices in a Tertiary Care Center.

    PubMed

    Paudel, B; Shrestha, G K

    Background Consent for care procedures is mandatory after receipt of adequate information. It maintains patient's rights and autonomy to make thoughtful decisions. Poor communication often leads to poor health quality. Objective To assess hospitalized patients' perception on informed consent regarding nursing care practices in a tertiary care center. Method This is a descriptive cross-sectional study among 113 admitted patients conducted in February 2012 at Dhulikhel Hospital, Nepal. Patients of various wards were selected using purposive non-probability sampling with at least 3 days of hospitalization. Close ended structured questionnaire was used to assess patients' perception on three different areas of informed consent (information giving, opportunity to make decision and taking prior consent). Result Among the participants 71.6% perceived positively regarding informed consent towards nursing care practices with a mean score of 3.32 ± 1.28. Patients' perception on various areas of informed consent viz. information giving, opportunities to make specific decision and taking prior consent were all positive with mean values of 3.43±1.12, 2.88±1.23, 3.65±1.49 respectively. Comparison of mean perception of informed consent with various variables revealed insignificant correlation (p-value >0.05) for age, educational level and previous hospitalization while it was significant (p-value < 0.05) for communication skills of nurses. Conclusion Majority of patients have positive perception on informed consent towards nursing care practices. Communication skills of nurses affect the perception of patients' regardless of age, education level and past experiences.

  19. Taking Care of Yourself

    MedlinePlus

    ... of reactions. Learn more here. Milk Egg Peanut Tree Nuts Soy Wheat Fish Shellfish Sesame Other Food Allergens Allergy Alerts Research Programs Research Programs We are the world’s largest private source of food allergy research funding. ...

  20. Taking Care of Business.

    ERIC Educational Resources Information Center

    Stone, William E.

    1989-01-01

    Properly designed and properly evaluated, entrepreneurial activities can have many kinds of positive financial and non-financial results for an alumni program. A service or product line that alumni can not get from any other source can benefit the budget and both internal and external goodwill. (MSE)

  1. Taking Care of Yourself

    MedlinePlus

    ... high blood pressure, staying on your medicines is critical to prevent heart attacks, strokes, kidney disease and ... high blood pressure, staying on your medicines is critical to prevent heart attacks, strokes, kidney disease and ...

  2. The role and contributions of geriatric care managers: care recipients' views.

    PubMed

    Ortiz, Judith; Horne, Mary Ann

    2013-01-01

    To assess the value of geriatric care management (GCM) services from the perspective of individuals who receive the care--the "care recipients." The opinions of these older adults-the current users of GCM services--were investigated by means of a cross-sectional mail survey. The study setting was the home of the care recipient of GCM services. This cross-sectional descriptive study applied survey research design. Survey questions were developed related to the following themes about the GCM role and function: (1) overall role, (2) health assistance function, (3) community resources assistance function, (4) advocacy function, and (5) contribution to the care recipients' quality of life. Survey questionnaires were distributed to 179 care recipients of member organizations of the Florida Geriatric Care Management Association. The questionnaires were distributed by mail during the spring of 2012. A second mailing was completed in the fall of 2012. The survey results were analyzed using descriptive statistics. The care recipient survey respondents most frequently described the role of their GCMs as one of a health care professional. The respondents more frequently described the GCM as providing a health assistance and advocacy function. They indicated that the GCM greatly contributed to their quality of life. Geriatric care managers appear to be very valuable in assisting their clients with critical health-related situations, as well as with more routine health care matters. Not only are they called upon to assist with health care emergencies and their clients' hospital stays but they also appear to serve an important role in facilitating physician-patient communications during the care recipient's routine visits to the doctor's office.

  3. Great Barrier Reef, Queensland, Australia

    NASA Technical Reports Server (NTRS)

    1990-01-01

    This detailed view of the Great Barrier Reef, Queensland, Australia (19.5S, 149.5E) shows several small patch reefs within the overall reef system. The Great Barrier Reef, largest in the world, comprises thousands of individual reefs of great variety and are closely monitored by marine ecologists. These reefs are about 6000 years old and sit on top of much older reefs. The most rapid coral growth occurs on the landward side of the reefs.

  4. Health Care Professionals' Understandings of Cross-Cultural Interaction in End-of-Life Care: A Focus Group Study.

    PubMed

    Milberg, Anna; Torres, Sandra; Ågård, Pernilla

    2016-01-01

    The academic debate on cross-cultural interaction within the context of end-of-life care takes for granted that this interaction is challenging. However, few empirical studies have actually focused on what health care professionals think about this interaction. This study aimed to explore health care professionals' understandings of cross-cultural interaction during end-of-life care. Sixty end-of-life care professionals were recruited from eleven care units in Sweden to take part in focus group interviews. These interviews were analyzed using qualitative content analysis. The health care professionals interviewed talked about cross-cultural interaction in end-of-life care as interaction that brings about uncertainty, stress and frustration even though they had limited experience of this type of interaction. The focus group discussions brought attention to four specific challenges that they expected to meet when they care for patients with migrant backgrounds since they took for granted that they would have an ethno-cultural background that is different to their own. These challenges had to do with communication barriers, 'unusual' emotional and pain expressions, the expectation that these patients' families would be 'different' and the anticipation that these patients and their families lack knowledge. At the core of the challenges in question is the idea that cross-cultural interaction means meeting "the unknown". In addition, the end-of-life care professionals interviewed talked about patients whose backgrounds they did not share in homogenizing terms. It is against this backdrop that they worried about their ability to provide end-of-life care that is individualized enough to meet the needs of these patients. The study suggests that end-of-life care professionals who regard cross-cultural interaction in this manner could face actual challenges when caring for patients whose backgrounds they regard as "the unknown" since they anticipate a variety of challenges

  5. Health Care Professionals’ Understandings of Cross-Cultural Interaction in End-of-Life Care: A Focus Group Study

    PubMed Central

    Torres, Sandra; Ågård, Pernilla

    2016-01-01

    Objective The academic debate on cross-cultural interaction within the context of end-of-life care takes for granted that this interaction is challenging. However, few empirical studies have actually focused on what health care professionals think about this interaction. This study aimed to explore health care professionals’ understandings of cross-cultural interaction during end-of-life care. Methods Sixty end-of-life care professionals were recruited from eleven care units in Sweden to take part in focus group interviews. These interviews were analyzed using qualitative content analysis. Results The health care professionals interviewed talked about cross-cultural interaction in end-of-life care as interaction that brings about uncertainty, stress and frustration even though they had limited experience of this type of interaction. The focus group discussions brought attention to four specific challenges that they expected to meet when they care for patients with migrant backgrounds since they took for granted that they would have an ethno-cultural background that is different to their own. These challenges had to do with communication barriers, ‘unusual’ emotional and pain expressions, the expectation that these patients’ families would be ‘different’ and the anticipation that these patients and their families lack knowledge. At the core of the challenges in question is the idea that cross-cultural interaction means meeting “the unknown”. In addition, the end-of-life care professionals interviewed talked about patients whose backgrounds they did not share in homogenizing terms. It is against this backdrop that they worried about their ability to provide end-of-life care that is individualized enough to meet the needs of these patients. Conclusions The study suggests that end-of-life care professionals who regard cross-cultural interaction in this manner could face actual challenges when caring for patients whose backgrounds they regard as

  6. Do Personality Traits Moderate the Impact of Care Receipt on End-of-Life Care Planning?

    PubMed Central

    Ha, Jung-Hwa; Pai, Manacy

    2012-01-01

    Purpose of the Study: This study examines (a) the association between being a care recipient and end-of-life care planning (EOLCP) and (b) the extent to which personality traits moderate the relationship between care receipt and EOLCP. Design and Methods: Data are drawn from the Wisconsin Longitudinal Study, a survey of Wisconsin high school graduates from 1957 to 2004. We used data on EOLCP among older adults in the most recent (2003–2004) wave of this survey. Hierarchical logistic regression models are used to estimate the effects of care receipt and the moderating effects of personality. Results: Compared with their peers who are not receiving care, care recipients are more likely to engage in informal discussion on EOLCP. This association between care receipt and informal EOLCP is strengthened when the individual scores high on openness. Implications: Health practitioners should take into account older adults’ care needs and differing personality traits while helping older adults make successful EOLCP. PMID:22459693

  7. Practical knowledge of experienced nurses in critical care: a qualitative study of their narratives

    PubMed Central

    2014-01-01

    Background Scholars of nursing practices have claimed practical knowledge is source of knowledge in its own right, nevertheless we know little about this knowledge associated with day-to-day practice. The purpose of this study is to describe knowledge that the more experienced nurses the in ICU make use of and discover the components of care it includes. Understanding this knowledge can contribute to improving the working practices of nurses with less experience. Methods We used a phenomenologic and hermeneutic approach to conduct a qualitative study. Open in-depth dialogue interviews were conducted with 13 experienced ICU nurses selected by intentional sampling. Data was compiled on significant stories of their practice. The data analysis enabled units of meaning to be categorised and grouped into topics regarding everyday practical knowledge. Results Knowledge related to everyday practice was evaluated and grouped into seven topics corresponding to how the ICU nurses understand their patient care: 1) Connecting with, calming and situating patients who cannot communicate; 2) Situating and providing relief to patients in transitions of mechanical respiration and non-invasive ventilation; 3) Providing reassurance and guaranteeing the safety of immobilised patients; 4) The “connection” with patients in comas; 5) Taking care of the body; 6) The transition from saving life to palliative care; and 7) How to protect and defend the patient from errors. The components of caretaking that guarantee success include: the calm, care and affection with which they do things; the time devoted to understanding, situating and comforting patients and families; and the commitment they take on with new staff and doctors for the benefit of the patient. Conclusions These results show that stories of experiences describe a contextual practical knowledge that the more experienced nurses develop as a natural and spontaneous response. In critical patients the application of everyday

  8. Risk taking in first and second generation Afro-Caribbean adolescents: an emerging challenge for school nurses.

    PubMed

    Jolly, Kim; Archibald, Cynthia; Liehr, Patricia

    2013-10-01

    School nurses are well positioned to address risk-taking behaviors for adolescents in their care. The purpose of this mixed-method exploratory study was to explore risk taking in Afro-Caribbean adolescents in South Florida, comparing first- to second-generation adolescents. Quantitative and qualitative data were collected from an immigrant group using the adolescent risk-taking instrument to evaluate risk-taking attitudes, behaviors, and self-described riskiest activities. One-hundred and six adolescents participated; 44% were first generation Afro-Caribbean. Data analysis included analysis of variance, frequencies, and content analysis. There were no differences in risk-taking attitudes; smaller percentages of first generation Afro-Caribbean adolescents reported sexual activity, substance use, and violence. Over one third of the sample, regardless of generational status, reported alcohol use, but did not note alcohol or other health-compromising behaviors as "riskiest" activities. It is important to better understand Afro-Caribbean adolescents' perspectives about risky behaviors, and school-based venues offer the best promise for reaching these adolescents.

  9. Great Lakes Initiative (GLI) Clearinghouse

    EPA Pesticide Factsheets

    The Great Lakes Initiative Toxicity Clearinghouse is a central location for information on criteria, toxicity data, exposure parameters and other supporting documents used in developing water quality standards in the Great Lakes watershed.

  10. Biological science in the Great Basin

    USGS Publications Warehouse

    ,

    2005-01-01

    The Great Basin is an expanse of desert and high moun-tains situated between the Rocky Mountains and the Sierra Nevada of the western United States. The most explicit description of the Great Basin is that area in the West where surface waters drain inland. In other words, the Great Basin is comprised of many separate drainage areas - each with no outlet. What at first glance may appear as only a barren landscape, the Great Basin upon closer inspection reveals island mountains, sagebrush seas, and intermittent aquatic habitats, all teeming with an incredible number and variety of plants and animals. Biologists at the USGS are studying many different species and ecosystems in the Great Basin in order to provide information about this landscape for policy and land-management decision-making. The following stories represent a few of the many projects the USGS is conducting in the Great Basin.

  11. Conditional Disease Development extracted from Longitudinal Health Care Cohort Data using Layered Network Construction

    PubMed Central

    Kannan, Venkateshan; Swartz, Fredrik; Kiani, Narsis A.; Silberberg, Gilad; Tsipras, Giorgos; Gomez-Cabrero, David; Alexanderson, Kristina; Tegnèr, Jesper

    2016-01-01

    Health care data holds great promise to be used in clinical decision support systems. However, frequent near-synonymous diagnoses recorded separately, as well as the sheer magnitude and complexity of the disease data makes it challenging to extract non-trivial conclusions beyond confirmatory associations from such a web of interactions. Here we present a systematic methodology to derive statistically valid conditional development of diseases. To this end we utilize a cohort of 5,512,469 individuals followed over 13 years at inpatient care, including data on disability pension and cause of death. By introducing a causal information fraction measure and taking advantage of the composite structure in the ICD codes, we extract an effective directed lower dimensional network representation (100 nodes and 130 edges) of our cohort. Unpacking composite nodes into bipartite graphs retrieves, for example, that individuals with behavioral disorders are more likely to be followed by prescription drug poisoning episodes, whereas women with leiomyoma were more likely to subsequently experience endometriosis. The conditional disease development represent putative causal relations, indicating possible novel clinical relationships and pathophysiological associations that have not been explored yet. PMID:27211115

  12. Conditional Disease Development extracted from Longitudinal Health Care Cohort Data using Layered Network Construction.

    PubMed

    Kannan, Venkateshan; Swartz, Fredrik; Kiani, Narsis A; Silberberg, Gilad; Tsipras, Giorgos; Gomez-Cabrero, David; Alexanderson, Kristina; Tegnèr, Jesper

    2016-05-23

    Health care data holds great promise to be used in clinical decision support systems. However, frequent near-synonymous diagnoses recorded separately, as well as the sheer magnitude and complexity of the disease data makes it challenging to extract non-trivial conclusions beyond confirmatory associations from such a web of interactions. Here we present a systematic methodology to derive statistically valid conditional development of diseases. To this end we utilize a cohort of 5,512,469 individuals followed over 13 years at inpatient care, including data on disability pension and cause of death. By introducing a causal information fraction measure and taking advantage of the composite structure in the ICD codes, we extract an effective directed lower dimensional network representation (100 nodes and 130 edges) of our cohort. Unpacking composite nodes into bipartite graphs retrieves, for example, that individuals with behavioral disorders are more likely to be followed by prescription drug poisoning episodes, whereas women with leiomyoma were more likely to subsequently experience endometriosis. The conditional disease development represent putative causal relations, indicating possible novel clinical relationships and pathophysiological associations that have not been explored yet.

  13. Assessment of Medical Student and Resident/Fellow Knowledge, Comfort, and Training With Sexual History Taking in LGBTQ Patients.

    PubMed

    Hayes, Victoria; Blondeau, Whitney; Bing-You, Robert G

    2015-05-01

    Sexual health is an important aspect of overall health. Barriers to taking an adequate patient sexual history exist. Few studies have explored medical learners' comfort, knowledge, and training surrounding taking sexual histories with lesbian, gay, bisexual, transgender, questioning/queer (LGBTQ) patients specifically. A 10-question survey was offered to medical students and resident/fellows at one US institution. Survey questions reflected participants' knowledge, comfort, and training related to sexual history taking with attention to LGBTQ care. A total of 159 surveys were returned (rate of 42%). A significantly lower level of comfort existed with taking sexual histories and managing sexual health issues in the LGBTQ segment of the patient population versus all patients, especially in the advanced training group. Participants recognized the importance of understanding their patients' overall sexual health, though medical students rated this as more important than the resident/fellow group did. A correlation existed between both comfort with taking sexual histories and discussing safe sexual practices and management of sexual issues, suggesting that further training would be helpful in this area. Twenty percent of the respondents reported receiving no training at all in eliciting sexual histories in LGBTQ patients. The most preferred format in this study for future training was interviewing standardized patients. Medical students and resident/fellows reported a significantly lower level of comfort with sexual history-taking and management of sexual issues in the LGBTQ population. A comprehensive training format that not only views sexual health as an integral part of overall patient health, but also integrates LGBTQ care, is needed in medical education.

  14. Macrodystrophia lipomatosa of foot involving great toe.

    PubMed

    Gaur, A K; Mhambre, A S; Popalwar, H; Sharma, R

    2014-06-01

    Macrodystrophia lipomatosa is a rare form of congenital disorder in which there is localized gigantism characterized by progressive overgrowth of all mesenchymal elements with a disproportionate increase in the fibroadipose tissues. The adipose tissue infiltration involves subcutaneous tissue, periosteum, nerves and bone marrow. Most of the cases reported have hand or foot involvement. Patient seeks medical help for improving cosmesis or to get the size of the involved part reduced in order to reduce mechanical problems. We report a case of macrodystrophia lipomatosa involving medial side of foot with significant enlargement of great toe causing concern for cosmesis and inconvenience due to mechanical problems. The X-rays showed increased soft tissue with more of adipose tissue and increased size of involved digits with widening of ends. Since the patient's mother did not want any surgical intervention he was educated about foot care and proper footwear design was suggested. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. A revolutionary approach to health care cost control: leveraging the power of Web-enabled employee "consumerism".

    PubMed

    Rozzi, M V

    2001-09-01

    The confluence of two trends--health care "consumerism" and employee self-service benefits programs--offers employers a promising opportunity for health care cost control. To take advantage of this opportunity, employers must take a fresh look at the health care cost dilemma and find ways to simultaneously offer employees a new kind of benefit and implement more effective cost-control measures.

  16. 33 CFR 100.124 - Maggie Fischer Memorial Great South Bay Cross Bay Swim, Great South Bay, New York.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Maggie Fischer Memorial Great South Bay Cross Bay Swim, Great South Bay, New York. 100.124 Section 100.124 Navigation and Navigable... NAVIGABLE WATERS § 100.124 Maggie Fischer Memorial Great South Bay Cross Bay Swim, Great South Bay, New York...

  17. 33 CFR 100.124 - Maggie Fischer Memorial Great South Bay Cross Bay Swim, Great South Bay, New York.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... South Bay Cross Bay Swim, Great South Bay, New York. 100.124 Section 100.124 Navigation and Navigable... NAVIGABLE WATERS § 100.124 Maggie Fischer Memorial Great South Bay Cross Bay Swim, Great South Bay, New York. (a) Regulated area. All navigable waters of Great South Bay, NY within a 100 yard radius of each...

  18. The Great Ice Age

    USGS Publications Warehouse

    Ray, Louis L.

    1992-01-01

    The Great Ice Age, a recent chapter in the Earth's history, was a period of recurring widespread glaciations. During the Pleistocene Epoch of the geologic time scale, which began about a million or more years ago, mountain glaciers formed on all continents, the icecaps of Antarctica and Greenland were more extensive and thicker than today, and vast glaciers, in places as much as several thousand feet thick, spread across northern North America and Eurasia. So extensive were these glaciers that almost a third of the present land surface of the Earth was intermittently covered by ice. Even today remnants of the great glaciers cover almost a tenth of the land, indicating that conditions somewhat similar to those which produced the Great Ice Age are still operating in polar and subpolar climates.

  19. The implementation of an end-of-life integrated care pathway in a Chinese population.

    PubMed

    Lo, S-H; Chan, C-Y; Chan, C-H; Sze, W-k; Yuen, K-K; Wong, C-S; Ng, T-Y; Tung, Y

    2009-08-01

    The integrated care pathway is used in end-of-life care to improve quality of care; the Liverpool Care Pathway (LCP) has been used in Europe and North America. Tuen Mun Hospital is a regional hospital in Hong Kong, China. The End-of-life Care Pathway (ECP) based on the concepts used in the Liverpool Care Pathway, was developed, with modification to suit the local condition. Criteria for entry onto the ECP were that the multidisciplinary team agreed the patient was dying, and was at least two of the following: bedbound; semi-comatose; only able to take sips of fluid; no longer able to take tablets. The ECP template replaced all other inpatient documents. The ECP was implemented in the palliative care unit for terminal cancer patients. An audit was performed to review the result. Fifty-one Chinese patients were included in the audit with mean age 64. The median duration of ECP use was 24 hours. All patients had current medication assessed and non-essential drugs were discontinued. The audit result suggested integrated care pathway in end-of-life care could be implemented successfully in an Oriental culture. The acceptance of using the ECP as a standard clinical practice takes time and education. Appropriate template design and supervision are the keys to success.

  20. The Relationship between Empathy-Related Constructs and Care-Based Moral Development in Young Adulthood

    ERIC Educational Resources Information Center

    Skoe, Eva E. A.

    2010-01-01

    This study examined the link between care-based moral reasoning and three different aspects of empathy--perspective taking, sympathy and personal distress. Participants were 30 female and 28 male students, ranging in age from 20 to 42 years. As expected, results showed that perspective taking uniquely predicted care-based moral reasoning levels…

  1. Ethnic differences of medicines-taking in older adults: a cross cultural study in New Zealand.

    PubMed

    Bassett-Clarke, Debbie; Krass, Ines; Bajorek, Beata

    2012-04-01

    The literature identifies many barriers to medicines use, including bio-psycho-social issues, but less is known regarding ethno-cultural barriers, which are important in culturally diverse nations. The aim of this study was to explore ethnic differences in attitudes to medicines and medicines-taking, focusing on the main constituents of the New Zealand (NZ) population: NZ European, Māori (the indigenous people of NZ), Pacific and Asian peoples. A qualitative study involving a series of focus groups was conducted. Participants (>50 years old) taking medicines were recruited from various community-based groups. The focus group discussions were transcribed verbatim and analysed for key themes via manual inductive coding and constant comparison. Twenty focus groups (n=100 participants) were conducted. Three key common themes emerged: (1) conception of a medicine; (2) self-management of medication; and (3) seeking further medicines information. In general, NZ European participants had a very narrow view of what a medicine is, were motivated to source medicines information independently and were very proactive in medicines management. At the other end of the spectrum, Pacific peoples expressed a broad view of what constitutes a medicine, were not motivated to source medicines information independently and were not proactive in medicines management, tending to instead rely on healthcare professionals for answers. The findings from the various ethnic groups highlight differences in attitudes to medicines per se and medicines-taking; these influences on medication-taking behaviour need to be considered in the provision of pharmaceutical care. Ethnic differences in attitudes to medicines and medicines-taking are apparent, although there are some commonalities in terms of needs regarding support and advice around medicines' use. This will help inform the development of resources and communication tools to assist pharmacists in providing pharmaceutical care to diverse patient

  2. Inviting parents to take part in paediatric palliative care research: a mixed-methods examination of selection bias.

    PubMed

    Crocker, Joanna C; Beecham, Emma; Kelly, Paula; Dinsdale, Andrew P; Hemsley, June; Jones, Louise; Bluebond-Langner, Myra

    2015-03-01

    Recruitment to paediatric palliative care research is challenging, with high rates of non-invitation of eligible families by clinicians. The impact on sample characteristics is unknown. To investigate, using mixed methods, non-invitation of eligible families and ensuing selection bias in an interview study about parents' experiences of advance care planning (ACP). We examined differences between eligible families invited and not invited to participate by clinicians using (1) field notes of discussions with clinicians during the invitation phase and (2) anonymised information from the service's clinical database. Families were eligible for the ACP study if their child was receiving care from a UK-based tertiary palliative care service (Group A; N = 519) or had died 6-10 months previously having received care from the service (Group B; N = 73). Rates of non-invitation to the ACP study were high. A total of 28 (5.4%) Group A families and 21 (28.8%) Group B families (p < 0.0005) were invited. Family-clinician relationship appeared to be a key factor associated qualitatively with invitation in both groups. In Group A, out-of-hours contact with family was statistically associated with invitation (adjusted odds ratio 5.46 (95% confidence interval 2.13-14.00); p < 0.0005). Qualitative findings also indicated that clinicians' perceptions of families' wellbeing, circumstances, characteristics, engagement with clinicians and anticipated reaction to invitation influenced invitation. We found evidence of selective invitation practices that could bias research findings. Non-invitation and selection bias should be considered, assessed and reported in palliative care studies. © The Author(s) 2014.

  3. The palliative care scorecard as an innovative approach in long-term care

    PubMed Central

    Esslinger, Adelheid Sussanne; Alzinger, Dagmar; Rager, Edeltraud

    2009-01-01

    Introduction In long-term care facilities professional concepts for palliative care are of great interest as individual needs of clients (residents, relatives, and friends) are in the focus of services. Case Within a long-term care facility of the Red Cross Organization in Germany, we developed a palliative care concept in 2008. It is integrated in the strategy of the whole organization. As the strategic management concept is based on the balanced scorecard, we introduced a palliative care scorecard. The facility offers 200 places for residents. It has established 27 strategic targets to achieve. One of these is to provide individual care. Another one is to integrate relatives of residents. One more deals with the integration of volunteers. We decided to implement a palliative care concept within the target system (e.g. develop individual pain therapy, create and coordinate interdisciplinary palliative care teams). Results The case shows how it is possible to integrate and strengthen the subject of palliative care within the existing management system of the organization. In order to translate the concept into action, it will be necessary to change the organizational culture into an ‘open minded house’. This especially means that all members of the organization have to be trained and sensitized for the matters of care at the end of life. Conclusion The development and implementation of an integrated concept of palliative care, which fits into the existing management system, is the base of a sustainable offer of specialized care for the residents and their social network. Therefore, not only the quality of care and life of the clients, but also the surviving of the facility on the market of care will be assured.

  4. How Do Health Care Providers Diagnose Primary Ovarian Insufficiency (POI)?

    MedlinePlus

    ... Share Facebook Twitter Pinterest Email Print How do health care providers diagnose POI? The key signs of POI ... having periods for 4 months or longer, her health care provider may take these steps to diagnose the ...

  5. Taking PROs and patient-centered care seriously: incremental and disruptive ideas for incorporating PROs in oncology practice.

    PubMed

    Donaldson, Molla Sloane

    2008-12-01

    Using patient-reported outcomes (PROs) in clinical practice poses challenges for health care teams and organizations to respond to individual patient needs in a timely fashion. Well-validated tools and feasibility studies are available, but successful spread will require knowledge of effective technology dissemination in complex health delivery systems. Given what has been learned about effective implementation, it is reasonable to ask whether the broad adoption of PROs can occur incrementally using current models of care to apply PRO technology. Another approach is to start with patient needs and focus on how to meet those needs most effectively using PROs in new ways of organizing health care.

  6. Heartburn treatment in primary care: randomised, double blind study for 8 weeks

    PubMed Central

    Hatlebakk, Jan G; Hyggen, Arild; Madsen, Per H; Walle, Per O; Schulz, Tom; Mowinckel, Petter; Bernklev, Tomm; Berstad, Arnold

    1999-01-01

    Objective To compare the effects and tolerability of omeprazole and cisapride with that of placebo for control of heartburn in primary care patients. Design Randomised, double blind, placebo controlled study. Setting 65 primary care practices in Norway. Participants 483 untreated patients with complaints of heartburn ⩾3 days a week, with at most grade 1 reflux oesophagitis. Interventions Omeprazole 20 mg once daily, cisapride 20 mg twice daily, or placebo for 8 weeks. Main outcome measures Adequate control of heartburn, defined as ⩽1 day of the past 7 days with no more than mild heartburn, after 4 weeks of treatment. Results In the all patients treated analysis, adequate control of heartburn was achieved in 71% of patients taking omeprazole, 22% taking cisapride, and 18% taking placebo after 4 weeks of treatment (omeprazole v cisapride and placebo, P<0.0001; cisapride v placebo, non-significant). Results were comparable in patients with or without reflux oesophagitis. In patients treated with omeprazole only, symptom control was achieved significantly more often in patients positive for Helicobacter pylori. Antacid use was 2-3 times greater in patients taking cisapride or placebo than in those taking omeprazole. Relief of non-reflux symptoms did not significantly differ between the three groups. Significantly more patients taking cisapride reported adverse events than those taking omeprazole or placebo. Conclusions Omeprazole 20 mg once daily was highly effective in relieving heartburn whereas cisapride 20 mg twice daily was not significantly more effective than placebo. Key messagesIn primary care patients, heartburn is commonly treated empiricallyMost randomised clinical trials of treatment for heartburn have been conducted in specialist care, and documentation for empirical treatment is limitedOmeprazole was significantly more effective than cisapride or placebo in controlling heartburn and other symptoms of gastro-oesophageal reflux after 2, 4, and 8 weeks

  7. Caring for dying cancer patients in the Chinese cultural context: A qualitative study from the perspectives of physicians and nurses.

    PubMed

    Dong, Fengqi; Zheng, Ruishuang; Chen, Xuelei; Wang, Yanhui; Zhou, Hongyuan; Sun, Rong

    2016-04-01

    To explore the experiences of Chinese physicians and nurses who care for dying cancer patients in their practical work. This was a qualitative study using semi-structured face-to-face interviews. Fifteen physicians and 22 nurses were recruited from a cancer center in mainland China. The data were analyzed by qualitative thematic analysis. Disclosure of information on death and cancer to dying cancer patients is taboo in traditional Chinese culture, which greatly decreases the physicians' and nurses' effective communication with dying patients in end-of-life (EOL) care. Both physicians and nurses described strong ambitions to give dying cancer patients high-quality care, and they emphasized the importance of maintaining dying patients' hopes in the death-denying cultural context. However, the nurses were more concerned with dying patients' physical comfort and wish fulfillment, while the physicians placed greatest emphasis on patients' rights and symptom management. Both physicians and nurses suffered whilst also benefitting from taking care of dying patients which helped with their personal growth and allowed greater insight into themselves and their clinical practice. Our results also indicated that Chinese physicians and nurses require improved methods of communication on EOL care, as well as needing more support to provide quality EOL care. Chinese physicians and nurses experience a challenge when caring for dying cancer patients in the Chinese cultural context. Flexible and specific education and training in EOL cancer care are required to meet the needs of Chinese physicians and nurses at the cancer center studied. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Nicolaus Copernicus: not only a great astronomer but also a physician.

    PubMed

    Rutkowski, Boleslaw; Muszytowski, Marek; Ostrowski, Janusz

    2011-01-01

    Nicolaus Copernicus (1473-1543), an internationally recognized Polish astronomer, studied liberal arts at the Jagiellonian University in Cracow during the period 1491-1495. Shortly thereafter he was sent by his uncle to Bologna University, where he spent almost 5 years (1496-1501) studying law and philosophy. After his return to Poland, Nicolaus was nominated as canon in the cathedral chapter in Frombork. Next he started to study medicine in the University of Padua, one of the best-known centers of medical education in Europe. He was granted a bachelor degree and after another year, a therapeutic license (veniam practicandi), but never obtained his doctoral degree from Padua, though he was always called doctor of medicine ("medici doctor"). Copernicus returned to Warmia in 1503 and spent almost 40 years there. During the first few years he was the personal "medicus" and secretary of his uncle, Bishop Lucas Watzenrode. After the death of his uncle in 1512, Copernicus became the personal physician to the subsequent 4 Warmian bishops and his confreres from the Warmian chapter in Frombork. Copernicus practiced medicine not only in diagnosing and taking care of his patients but also in personally preparing the prescribed drugs. He was often consulted (consiglia) from several other cities, including Gdańsk, Königsberg, Lubawa, Elblag and Olsztyn. He also collaborated and consulted with Jan Benedict Solfa and Laurence Wille, the official Polish royal physicians at the time. During the epidemics of 1519, Copernicus employed sanitary preventive measures by providing several Warmian and Pomeranian towns with an innovative water supply system. Copernicus is well known as a genius in astronomy, but this great Renaissance man was also a mathematician, engineer, soldier, writer, economist and, last but not least, a practicing physician.

  9. Medical Management and Trauma-Informed Care for Children in Foster Care.

    PubMed

    Schilling, Samantha; Fortin, Kristine; Forkey, Heather

    2015-10-01

    Children enter foster care with a myriad of exposures and experiences, which can threaten their physical and mental health and development. Expanding evidence and evolving guidelines have helped to shape the care of these children over the past two decades. These guidelines address initial health screening, comprehensive medical evaluations, and follow-up care. Information exchange, attention to exposures, and consideration of how the adversities, which lead to foster placement, can impact health is crucial. These children should be examined with a trauma lens, so that the child, caregiver, and community supports can be assisted to view their physical and behavioral health from the perspective of what we now understand about the impact of toxic stress. Health care providers can impact the health of foster children by screening for the negative health consequences of trauma, advocating for trauma-informed services, and providing trauma-informed anticipatory guidance to foster parents. By taking an organized and comprehensive approach, the health care provider can best attend to the needs of this vulnerable population. Copyright © 2015 Mosby, Inc. All rights reserved.

  10. Biological effects-based tools for monitoring impacted surface waters in the Great Lakes: a multiagency program in support of the Great Lakes Restoration Initiative

    USGS Publications Warehouse

    Ekman, Drew R.; Ankley, Gerald T.; Blazer, Vicki; Collette, Timothy W.; Garcia-Reyero, Natàlia; Iwanowicz, Luke R.; Jorgensen, Zachary G.; Lee, Kathy E.; Mazik, Pat M.; Miller, David H.; Perkins, Edward J.; Smith, Edwin T.; Tietge, Joseph E.; Villeneuve, Daniel L.

    2013-01-01

    There is increasing demand for the implementation of effects-based monitoring and surveillance (EBMS) approaches in the Great Lakes Basin to complement traditional chemical monitoring. Herein, we describe an ongoing multiagency effort to develop and implement EBMS tools, particularly with regard to monitoring potentially toxic chemicals and assessing Areas of Concern (AOCs), as envisioned by the Great Lakes Restoration Initiative (GLRI). Our strategy includes use of both targeted and open-ended/discovery techniques, as appropriate to the amount of information available, to guide a priori end point and/or assay selection. Specifically, a combination of in vivo and in vitro tools is employed by using both wild and caged fish (in vivo), and a variety of receptor- and cell-based assays (in vitro). We employ a work flow that progressively emphasizes in vitro tools for long-term or high-intensity monitoring because of their greater practicality (e.g., lower cost, labor) and relying on in vivo assays for initial surveillance and verification. Our strategy takes advantage of the strengths of a diversity of tools, balancing the depth, breadth, and specificity of information they provide against their costs, transferability, and practicality. Finally, a series of illustrative scenarios is examined that align EBMS options with management goals to illustrate the adaptability and scaling of EBMS approaches and how they can be used in management decisions.

  11. Military Child Care: DOD Is Taking Actions to Address Awareness and Availability Barriers

    DTIC Science & Technology

    2012-02-01

    0188 Public reporting burden for the collection of information is estimated to average 1 hour per response, including the time for reviewing...of information if it does not display a currently valid OMB control number. 1 . REPORT DATE FEB 2012 2. REPORT TYPE 3. DATES COVERED 00-00-2012...Deployments related to the wars in Iraq and Afghanistan increased the demand for child care. The extent of military families’ out-of-pocket child

  12. Transcultural nursing as a global care humanizer, diversifier, and unifier.

    PubMed

    Leininger, M M

    1997-01-01

    Three dominant themes of transcultural nursing as a global humanizer, diversifier, and unifier are discussed in relation to their meaning and uses in education, practice, research and consultation. The presenter takes the position that these three dominant themes are essential and imperative to promote, transform, and maintain desired care outcomes which are beneficial, satisfying, and healthy for people of diverse and similar cultures. The three themes are discussed within Leininger's theory of Culture Care Diversity and Universality with focus on the modes of action and decision-making. The author encourages transcultural nurses to take leadership to be an active global humanizer, diversifier, and unifier and transform nursing and health care into the 21st century.

  13. Decision to take osteoporosis medication in patients who have had a fracture and are 'high' risk for future fracture: a qualitative study.

    PubMed

    Sale, Joanna E M; Gignac, Monique A; Hawker, Gillian; Frankel, Lucy; Beaton, Dorcas; Bogoch, Earl; Elliot-Gibson, Victoria

    2011-05-09

    Patients' values and preferences are fundamental tenets of evidence-based practice, yet current osteoporosis (OP) clinical guidelines pay little attention to these issues in therapeutic decision making. This may be in part due to the fact that few studies have examined the factors that influence the initial decision to take OP medication. The purpose of our study was to examine patients' experiences with the decision to take OP medication after they sustained a fracture. A phenomenological qualitative study was conducted with outpatients identified in a university teaching hospital fracture clinic OP program. Individuals aged 65+ who had sustained a fragility fracture within 5 years, were 'high risk' for future fracture, and were prescribed OP medication were eligible. Analysis of interview data was guided by Giorgi's methodology. 21 patients (6 males, 15 females) aged 65-88 years participated. All participants had low bone mass; 9 had OP. Fourteen patients were taking a bisphosphonate while 7 patients were taking no OP medications. For 12 participants, the decision to take OP medication occurred at the time of prescription and involved minimal contemplation (10/12 were on medication). These patients made their decision because they liked/trusted their health care provider. However, 4/10 participants in this group indicated their OP medication-taking status might change. For the remaining 9 patients, the decision was more difficult (4/9 were on medication). These patients were unconvinced by their health care provider, engaged in risk-benefit analyses using other information sources, and were concerned about side effects; 7/9 patients indicated that their OP medication-taking status might change at a later date. Almost half of our older patients who had sustained a fracture found the decision to take OP medication a difficult one. In general, the decision was not considered permanent. Health care providers should be aware of their potential role in patients

  14. Risky business: human factors in critical care.

    PubMed

    Laussen, Peter C; Allan, Catherine K; Larovere, Joan M

    2011-07-01

    Remarkable achievements have occurred in pediatric cardiac critical care over the past two decades. The specialty has become well defined and extremely resource intense. A great deal of focus has been centered on optimizing patient outcomes, particularly mortality and early morbidity, and this has been achieved through a focused and multidisciplinary approach to management. Delivering high-quality and safe care is our goal, and during the Risky Business symposium and simulation sessions at the Eighth International Conference of the Pediatric Cardiac Intensive Care Society in Miami, December 2010, human factors, systems analysis, team training, and lessons learned from malpractice claims were presented.

  15. A 12-week weight reduction intervention for overweight individuals taking antipsychotic medications.

    PubMed

    Green, Carla A; Janoff, Shannon L; Yarborough, Bobbi Jo H; Yarborough, Micah T

    2014-11-01

    People taking antipsychotic medications are at increased risk for obesity, diabetes, and early mortality. Few weight loss interventions have targeted this population. Thirty-six individuals were randomized to an evidence-based 12-week weight loss intervention (PREMIER with DASH diet, n = 18) or to usual care (n = 18) in this feasibility trial. Average attendance was 8.6 of 12 sessions. Intent-to-treat analyses of covariance, adjusted for baseline weight, showed significant changes in weight: Mean weight in intervention participants declined from 213.3 to 206.6 pounds, while control participants' weight was unchanged. It is possible to recruit, assess, intervene with, and retain participants taking antipsychotic medications in a dietary and exercise lifestyle change trial. Participants reported high levels of satisfaction with the intervention.

  16. The FMLA and Psychological Support: Courts Care About "Care" (and Employers Should, Too).

    PubMed

    Bailey, Katherine Stallings

    2017-01-01

    The Family and Medical Leave Act ("FMLA") recognizes an employee's right to take leave to care for a qualifying family member. In light of the Act's remedial nature, the intended scope of the care provision is broad, but its definitional details are sparse. As a result of the attendant interpretive discretion afforded to courts, the Seventh Circuit announced its rejection of the requirement-- first articulated by the Ninth Circuit--that care provided during travel be related to continuing medical treatment. A facial analysis of the resulting circuit split fails to appreciate the fundamental difference between the Seventh and Ninth Circuits' considerations: the distinction between physical and psychological care. Whereas physical care is readily measurable, psychological care is less defined and, consequently, ripe to facilitate FMLA abuse. Efforts to combat this potential lead courts to impose judicially devised limitations on psychological care, but judicial discretion still infuses some uncertainty into proceedings. For employers, the best remedy lies in the FMLA's optional certification provision, which requires medical validation of an employee’s need for leave. In requiring certification, employers should distinguish between physical and psychological care, maximize the FMLA’s informational requirements, and implement complete and consistent request and approval procedures.

  17. Effectiveness of Collaborative Care for Depression in Public-Sector Primary Care Clinics Serving Latinos.

    PubMed

    Lagomasino, Isabel T; Dwight-Johnson, Megan; Green, Jennifer M; Tang, Lingqi; Zhang, Lily; Duan, Naihua; Miranda, Jeanne

    2017-04-01

    Quality improvement interventions for depression care have been shown to be effective for improving quality of care and depression outcomes in settings with primarily insured patients. The aim of this study was to determine the impact of a collaborative care intervention for depression that was tailored for low-income Latino patients seen in public-sector clinics. A total of 400 depressed patients from three public-sector primary care clinics were enrolled in a randomized controlled trial of a tailored collaborative care intervention versus enhanced usual care. Social workers without previous mental health experience served as depression care specialists for the intervention patients (N=196). Depending on patient preference, they delivered a cognitive-behavioral therapy (CBT) intervention or facilitated antidepressant medication given by primary care providers or both. In enhanced usual care, patients (N=204) received a pamphlet about depression, a letter for their primary care provider stating that they had a positive depression screen, and a list of local mental health resources. Intent-to-treat analyses examined clinical and process-of-care outcomes at 16 weeks. Compared with patients in the enhanced usual care group, patients in the intervention group had significantly improved depression, quality of life, and satisfaction outcomes (p<.001 for all). Intervention patients also had significantly improved quality-of-care indicators, including the proportion of patients receiving either psychotherapy or antidepressant medication (77% versus 21%, p<.001). Collaborative care for depression can greatly improve care and outcomes in public-sector clinics. Social workers without prior mental health experience can effectively provide CBT and manage depression care.

  18. Attention regulates anger and fear to predict changes in adolescent risk-taking behaviors

    PubMed Central

    Kim-Spoon, Jungmeen; Holmes, Christopher; Deater-Deckard, Kirby

    2014-01-01

    Background Regulation of negative affect is critical to healthy development in childhood and adolescence. We conducted a longitudinal study examining the moderating role of attention control in the effects of anger and fear on changes in risk-taking behaviors from early to middle adolescence. Method The sample involved participants from the Study of Early Child Care and Youth Development (SECCYD), assessed at 9, 11, and 15 years of age. Composite scores for anger, fear, and attention control were computed using indicators from multiple informants, and risk-taking behaviors were assessed based on adolescents’ self-reports. Results Latent difference score analysis indicated significant moderating effects of attention control showing that increased anger between 9 and 11 years was related to increases in risk-taking behaviors between 11 and 15 years only for adolescents with low attention control but not for adolescents with high attention control. In contrast, significant moderating effects of attention control for the link between fear and risk-taking behaviors suggested increased fear between 9 and 11 years tended to be associated with decreases in risk-taking behaviors between 11 and 15 years only for adolescents with high attention control but not for adolescents with low attention control. Conclusions Attention control regulates the connections between negative affect such as anger and fear with changes in adolescent risk-taking behaviors. Our data suggest the protective role of strong attention control against the development of risk-taking behaviors in adolescence as it demotes the effects of anger and promotes the effects of fear. PMID:25280179

  19. "I'll Take Care of the Flowers!" Researching Agency through Initiatives across Different Learning Environments

    ERIC Educational Resources Information Center

    Kangas, Marjaana; Kopisto, Kaisa; Löfman, Krista; Salo, Laura; Krokfors, Leena

    2017-01-01

    This case study examined how the agency of a fifth-grade pupil appeared across different learning environments in the primary school context. In this study, agency is defined as the initiatives taken by an individual in interactive situations. The research question is: how does a pupil's agency manifest and vary through taking initiatives across…

  20. Causal effects of informal care and health on falls and other accidents among the elderly population in China.

    PubMed

    Wu, Hong; Lu, Naiji; Wang, Chenguang; Tu, Xinming

    2018-03-01

    This article analyzes the causal effects of informal care, mental health, and physical health on falls and other accidents (e.g., traffic accidents) among elderly people. We also examine if there are heterogeneous impacts on elderly of different gender, urban status, and past accident history. To purge potential reversal causal effects, e.g., past accidents induce more future informal care, we use two-stage least squares to identify the impacts. We use longitudinal data from a representative national China Health and Retirement Longitudinal Study of people aged 45 and older in China. A total of 3935 respondents with two-wave data are included in our study. Each respondent is interviewed to measure health status and report their accident history. Mental health is assessed using CES-D questions. Our findings indicate that while informal care decreased the occurrence of accidents, poor health conditions increase the occurrence of accidents. We also find heterogeneous impacts on the occurrence of accidents, varying by gender, urban status, and past accident history. Our findings suggest the following three policy implications. First, policy makers who aim to decrease accidents should take informal care of elders into account. Second, ease of birth policy and postponed retirement policy are urgently needed to meet the demands of informal care. Third, medical policies should attach great importance not only to physical health but also mental health of elderly parents especially for older people with accident history.

  1. Holistic care should be coming your way.

    PubMed

    Wilson, N

    2017-10-27

    In this Opinion article, Nairn Wilson argues that interprofessional, holistic healthcare provision greatly enhances general health and wellbeing. For dentistry-oral healthcare provision to realise its potential in whole patient care, it must be integral to developments in holistic healthcare provision.

  2. Choosing the right health care provider for pregnancy and childbirth

    MedlinePlus

    ... take care of your newborn after delivery. Certified Nurse-Midwives (CNM) Certified nurse-midwives (CNM) are trained in nursing and midwifery. ... midwifery Are certified by the American College of Nurse-Midwives Nurse midwives care for women during pregnancy, ...

  3. Genetic variation in Great Plains Juniperus

    Treesearch

    David F. Van Haverbeke; Rudy M. King

    1990-01-01

    Fifth-year analyses of Great Plains Juniperus seed sources indicate eastern redcedar should be collected in east-central Nebraska for use throughout the Great Plains; Rocky Mountain juniper seed should be collected from northwest Nebraska, or central Montana, for planting southward through the Great Plains into west-central Kansas west of the 100th meridian.

  4. The comprehensiveness care of sickle cell disease.

    PubMed

    Okpala, Iheanyi; Thomas, Veronica; Westerdale, Neil; Jegede, Tina; Raj, Kavita; Daley, Sadie; Costello-Binger, Hilda; Mullen, Jean; Rochester-Peart, Collis; Helps, Sarah; Tulloch, Emense; Akpala, Mary; Dick, Moira; Bewley, Susan; Davies, Mark; Abbs, Ian

    2002-03-01

    Millions of people across the world have sickle cell disease (SCD). Although the true prevalence of SCD in Europe is not certain, London (UK) alone had an estimated 9000 people with the disorder in 1997. People affected by SCD are best managed by a multidisciplinary team of professionals who deliver comprehensive care: a model of healthcare based on interaction of medical and non-medical services with the affected persons. The components of comprehensive care include patient/parent information, genetic counselling, social services, prevention of infections, dietary advice and supplementation, psychotherapy, renal and other specialist medical care, maternal and child health, orthopaedic and general surgery, pain control, physiotherapy, dental and eye care, drug dependency services and specialist sickle cell nursing. The traditional role of haematologists remains to co-ordinate overall management and liase with other specialities as necessary. Co-operation from the affected persons is indispensable to the delivery of comprehensive care. Working in partnership with the hospital or community health service administration and voluntary agencies enhances the success of the multidisciplinary team. Holistic care improves the quality of life of people affected by SCD, and reduces the number as well as length of hospital admissions. Disease-related morbidity is reduced by early detection and treatment of chronic complications. Comprehensive care promotes awareness of SCD among affected persons who are encouraged to take greater control of their own lives, and achieves better patient management than the solo efforts of any single group of professionals. This cost-effective model of care is an option for taking haemoglobinopathy services forward in the new millennium.

  5. Great spotted cuckoo fledglings often receive feedings from other magpie adults than their foster parents: which magpies accept to feed foreign cuckoo fledglings?

    PubMed

    Soler, Manuel; Pérez-Contreras, Tomás; Ibáñez-Álamo, Juan Diego; Roncalli, Gianluca; Macías-Sánchez, Elena; de Neve, Liesbeth

    2014-01-01

    Natural selection penalizes individuals that provide costly parental care to non-relatives. However, feedings to brood-parasitic fledglings by individuals other than their foster parents, although anecdotic, have been commonly observed, also in the great spotted cuckoo (Clamator glandarius)--magpie (Pica pica) system, but this behaviour has never been studied in depth. In a first experiment, we here show that great spotted cuckoo fledglings that were translocated to a distant territory managed to survive. This implies that obtaining food from foreign magpies is a frequent and efficient strategy used by great spotted cuckoo fledglings. A second experiment, in which we presented a stuffed-cuckoo fledgling in magpie territories, showed that adult magpies caring for magpie fledglings responded aggressively in most of the trials and never tried to feed the stuffed cuckoo, whereas magpies that were caring for cuckoo fledglings reacted rarely with aggressive behavior and were sometimes disposed to feed the stuffed cuckoo. In a third experiment we observed feedings to post-fledgling cuckoos by marked adult magpies belonging to four different possibilities with respect to breeding status (i.e. composition of the brood: only cuckoos, only magpies, mixed, or failed breeding attempt). All non-parental feeding events to cuckoos were provided by magpies that were caring only for cuckoo fledglings. These results strongly support the conclusion that cuckoo fledglings that abandon their foster parents get fed by other adult magpies that are currently caring for other cuckoo fledglings. These findings are crucial to understand the co-evolutionary arms race between brood parasites and their hosts because they show that the presence of the host's own nestlings for comparison is likely a key clue to favour the evolution of fledgling discrimination and provide new insights on several relevant points such as learning mechanisms and multiparasitism.

  6. Medication-Taking Practices of Patients on Antiretroviral HIV Therapy: Control, Power, and Intentionality

    PubMed Central

    Panter, Abigail T.; Mouw, Mary S.; Amola, Kemi; Stein, Kathryn E.; Murphy, Joseph S.; Maiese, Eric M.; Wohl, David A.

    2015-01-01

    Abstract Among people living with HIV (PLWH), adherence to antiretroviral therapy (ART) is crucial for health, but patients face numerous challenges achieving sustained lifetime adherence. We conducted six focus groups with 56 PLWH regarding ART adherence barriers and collected sociodemographics and ART histories. Participants were recruited through clinics and AIDS service organizations in North Carolina. Dedoose software was used to support thematic analysis. Participants were 59% male, 77% black, aged 23–67 years, and living with HIV 4–20 years. Discussions reflected the fluid, complex nature of ART adherence. Maintaining adherence required participants to indefinitely assert consistent control across multiple areas including: their HIV disease, their own bodies, health care providers, and social systems (e.g., criminal justice, hospitals, drug assistance programs). Participants described limited control over treatment options, ART's impact on their body, and inconsistent access to ART and subsequent inability to take ART as prescribed. When participants felt they had more decision-making power, intentionally choosing whether and how to take ART was not exclusively a decision about best treating HIV. Instead, through these decisions, participants tried to regain some amount of power and control in their lives. Supportive provider relationships assuaged these struggles, while perceived side-effects and multiple co-morbidities further complicated adherence. Adherence interventions need to better convey adherence as a continuous, changing process, not a fixed state. A perspective shift among care providers could also help address negative consequences of the perceived power struggles and pressures that may drive patients to exert control via intentional medication taking practices. PMID:26505969

  7. Medication-Taking Practices of Patients on Antiretroviral HIV Therapy: Control, Power, and Intentionality.

    PubMed

    Muessig, Kathryn E; Panter, Abigail T; Mouw, Mary S; Amola, Kemi; Stein, Kathryn E; Murphy, Joseph S; Maiese, Eric M; Wohl, David A

    2015-11-01

    Among people living with HIV (PLWH), adherence to antiretroviral therapy (ART) is crucial for health, but patients face numerous challenges achieving sustained lifetime adherence. We conducted six focus groups with 56 PLWH regarding ART adherence barriers and collected sociodemographics and ART histories. Participants were recruited through clinics and AIDS service organizations in North Carolina. Dedoose software was used to support thematic analysis. Participants were 59% male, 77% black, aged 23-67 years, and living with HIV 4-20 years. Discussions reflected the fluid, complex nature of ART adherence. Maintaining adherence required participants to indefinitely assert consistent control across multiple areas including: their HIV disease, their own bodies, health care providers, and social systems (e.g., criminal justice, hospitals, drug assistance programs). Participants described limited control over treatment options, ART's impact on their body, and inconsistent access to ART and subsequent inability to take ART as prescribed. When participants felt they had more decision-making power, intentionally choosing whether and how to take ART was not exclusively a decision about best treating HIV. Instead, through these decisions, participants tried to regain some amount of power and control in their lives. Supportive provider relationships assuaged these struggles, while perceived side-effects and multiple co-morbidities further complicated adherence. Adherence interventions need to better convey adherence as a continuous, changing process, not a fixed state. A perspective shift among care providers could also help address negative consequences of the perceived power struggles and pressures that may drive patients to exert control via intentional medication taking practices.

  8. PVO profile: CARE.

    PubMed

    Bhatt, P

    1994-01-01

    CARE was founded when 22 American humanitarian organizations joined forces to help European survivors of World War II. CARE is now a confederation of eleven national CAREs working together to address poverty and respond to emergencies in 53 countries in Africa, Asia, Latin America, and eastern Europe. The organization supports processes which create competence and become self-sustaining over time, through the provision of technical assistance, training, management skills, and material resources. AIDS become a priority for CARE in the late 1980s and projects now exist in almost 20 countries. They focus upon HIV awareness and prevention involving information, education, communication, and condom distribution targeted to youth, commercial sex workers, transporters, migrants, and health professionals. CARE also has a development wing which focuses upon reducing household and community vulnerability to external pressures such as drought, war, and disease. AIDS may be considered within the purview of CARE's development mandate as a slow-onset emergency which may eventually threaten the very ability of families and communities to survive. CARE is therefore developing a framework to assess cross-cultural development strategies accounting for the vulnerability for communities as a result of increases in HIV prevalence. This effort is being made in the attempt to prepare communities to cope with the potential future devastation of AIDS and will take CARE beyond its more traditional prevention scope of involvement.

  9. 'From activating towards caring': shifts in care approaches at the end of life of people with intellectual disabilities; a qualitative study of the perspectives of relatives, care-staff and physicians.

    PubMed

    Bekkema, Nienke; de Veer, Anke J E; Hertogh, Cees M P M; Francke, Anneke L

    2015-07-25

    Professionals and relatives increasingly have to deal with people with intellectual disabilities (ID) who are in need of end-of-life care. This is a specific type of care that may require a different approach to the focus on participation that currently characterizes the care for people with ID. This paper describes the shifts in care approaches and attitudes that relatives and professionals perceive as the death of a person with ID approaches, as well as the values underlying these shifts. A qualitative design was used to reconstruct the cases of twelve recently deceased people with ID. Relatives and professionals who were closest to the person at the end of their life were interviewed. Interviews were transcribed verbatim and data were analyzed inductively, using elements of thematic analysis. Five shifts were found: 1) adapting to a new strategy of comforting care, taking over tasks and symptom relief, 2) interweaving of emotional and professional involvement, 3) stronger reliance on the joint interpretation of signals expressing distress and pain, 4) magnified feeling of responsibility in medical decisions, 5) intensified caring relationship between 'two families': relatives and care staff. Six relational values were behind these shifts: 'being there' for the person with ID, 'being responsive' to the person's needs, 'reflection' on their own emotions and caring relationships, 'attentiveness' to the ID person's wishes and expressions of distress, 'responsibility' for taking joint decisions in the best interests of the person, and 'openness to cooperation and sharing' the care with others. End-of-life care for people with ID involves curtailing expectations of participation and skill acquirement, and an increase in teamwork featuring intensified comforting care, symptom management and medical decision making. Three caring relationships need to be fostered: the relationship with the person with ID, relationships among professionals and the relationship between

  10. [Research on medical works of Yuan dynasty quoted by Yong le da dian (The Great classic of Yongle reign)].

    PubMed

    Du, Yong

    2003-01-01

    The medical works quoted by Yong le da dian (The Great Classic of Yongle reign) are rather numerous, most of them were lost, and the lives of most of the authors were unknown. By careful investigation, the authors and their lives, circulation of these works, are still pursuable.

  11. Restoring the Great Lakes: DOI stories of success and partnership in implementing the Great Lakes Restoration Initiative

    USGS Publications Warehouse

    ,; ,; ,; ,; ,

    2013-01-01

    The Great Lakes are a monumentally unique national treasure containing nearly ninety-five percent of the United States' fresh surface water. Formed by receding glaciers, the Great Lakes support a thriving, resilient ecosystem rich with fish, wildlife, and abundant natural resources. The Great Lakes also support an array of commercial uses, including shipping, and provide a source of recreation, drinking water, and other critical services that drive the economy of the region and the Nation. Regrettably, activities such as clear cutting of mature forests, over-harvesting of fish populations, industrial pollution, invasive species, and agricultural runoffs have degraded these treasured lakes over the decades creating long-term impacts to the surrounding watershed. Fortunately, the people who live, work, and recreate in the region recognize the critical importance of a healthy Great Lakes ecosystem, and have come together to support comprehensive restoration. To stimulate and promote the goal of a healthy Great Lakes region, President Obama and Congress created the Great Lakes Restoration Initiative (GLRI) in 2009. This program provides the seed money to clean up legacy pollution, restore habitats, protect wildlife, combat invasive species, and address agricultural runoff in the Great Lakes watershed. At the same time GLRI promotes public outreach, education, accountability, and partnerships.

  12. Does age influence the intensity of care in a managed care organization?

    PubMed

    Long, Michael J; Lescoe-Long, Mary

    2005-01-01

    The primary objective of this study was to determine whether an inverse relationship between age and the intensity of care prevailed in an elderly, functionally impaired population enrolled in a managed care organization. The secondary objective was to determine whether those who died during the study were treated more intensively than the survivors. A total of 278 enrollees in a managed care organization who were 75 years and over, had a severe functional disability, excessive hospital or Emergency Department use, volunteered to take part in a 2-year study. Seventy-seven clients died during the study. We calculated indices of outpatient care intensity and hospital care intensity for the study period. With minor exceptions, the results clearly show that, for this group of clients, the intensity of outpatient care was clearly, inversely related to age. The intensity of hospital care was also inversely related to age, thereby ruling out the hypothesis that it was being substituted for outpatient care. The results also clearly show that, for this population, those who died during the study period were treated more intensively than the survivors. We found strong support for our hypotheses. An investigation of the reasons for these findings was beyond the scope of our data.

  13. Borderline personality disorder in the primary care setting.

    PubMed

    Dubovsky, Amelia N; Kiefer, Meghan M

    2014-09-01

    Borderline personality disorder is estimated to be present in approximately 6% of outpatient primary care settings. However, the time and energy spent on this population can greatly exceed what primary care doctors are able to spend. This article gives an overview of borderline personality disorder, including the clinical characteristics, epidemiology, and comorbidities, as well as pharmacologic and most important behavioral management. It is our hope that, with improved understanding of the disorder and skills for managing this population, caring for patients with the disorder can be more satisfying and less taxing for both primary care doctors and their patients. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Navigating in the landscape of care: a critical reflection on theory and practise of care and ethics.

    PubMed

    Skærbæk, Eva

    2011-03-01

    The theory and practise of care is defined and enacted differently in different national as well as cultural contexts, illuminating how differently constructed the personal and societal structures in Europe are. A common trait is however that care work paid or non-paid, private or public is identified with women. To navigate in the landscape of care and ethics requires taking into account the constitutive relation between one's identity, embodiment and position. The author suggests conceiving care as an existential condition of life demanded from all human beings. This will free care from the identification with women and pave a way towards a more gender equal and just society with less gender segregation in the labour market and at the arena of education.

  15. Day Care Deception: What the Child Care Establishment Isn't Telling Us.

    ERIC Educational Resources Information Center

    Robertson, Brian C.

    Over the last generation, parents have felt more and more intimidated by child care "experts" and have increasingly surrendered their role as the primary educators of their children. On the premise that theories of development, often colored by ideological positions on the family and its function in society, should take a back seat to…

  16. Palliative Care in Advanced Cancer Patients: How and When?

    PubMed Central

    Yennurajalingam, Sriram

    2012-01-01

    Cancer patients develop severe physical and psychological symptoms as a result of their disease and treatment. Their families commonly suffer great emotional distress as a result of caregiving. Early palliative care access can improve symptom control and quality of life and reduce the cost of care. Preliminary results show that early palliative care access can also extend survival. Unfortunately, only a minority of cancer centers in the U.S. have the two most important resources for palliative care delivery: outpatient palliative care centers and inpatient palliative care units. In this article, we use a case presentation to discuss the impact of early palliative care access in light of the currently available evidence, and we recommend ways to improve early access to palliative care through education and research. PMID:22252934

  17. How Health Care Organizations Are Using Data on Patients' Race and Ethnicity to Improve Quality of Care

    PubMed Central

    Thorlby, Ruth; Jorgensen, Selena; Siegel, Bruce; Ayanian, John Z

    2011-01-01

    Context: Racial and ethnic disparities in the quality of health care are well documented in the U.S. health care system. Reducing these disparities requires action by health care organizations. Collecting accurate data from patients about their race and ethnicity is an essential first step for health care organizations to take such action, but these data are not systematically collected and used for quality improvement purposes in the United States. This study explores the challenges encountered by health care organizations that attempted to collect and use these data to reduce disparities. Methods: Purposive sampling was used to identify eight health care organizations that collected race and ethnicity data to measure and reduce disparities in the quality and outcomes of health care. Staff, including senior managers and data analysts, were interviewed at each site, using a semi-structured interview format about the following themes: the challenges of collecting and collating accurate data from patients, how organizations defined a disparity and analyzed data, and the impact and uses of their findings. Findings: To collect accurate self-reported data on race and ethnicity from patients, most organizations had upgraded or modified their IT systems to capture data and trained staff to collect and input these data from patients. By stratifying nationally validated indicators of quality for hospitals and ambulatory care by race and ethnicity, most organizations had then used these data to identify disparities in the quality of care. In this process, organizations were taking different approaches to defining and measuring disparities. Through these various methods, all organizations had found some disparities, and some had invested in interventions designed to address them, such as extra staff, extended hours, or services in new locations. Conclusion: If policymakers wish to hold health care organizations accountable for disparities in the quality of the care they

  18. Embedding effective depression care: using theory for primary care organisational and systems change.

    PubMed

    Gunn, Jane M; Palmer, Victoria J; Dowrick, Christopher F; Herrman, Helen E; Griffiths, Frances E; Kokanovic, Renata; Blashki, Grant A; Hegarty, Kelsey L; Johnson, Caroline L; Potiriadis, Maria; May, Carl R

    2010-08-06

    Depression and related disorders represent a significant part of general practitioners (GPs) daily work. Implementing the evidence about what works for depression care into routine practice presents a challenge for researchers and service designers. The emerging consensus is that the transfer of efficacious interventions into routine practice is strongly linked to how well the interventions are based upon theory and take into account the contextual factors of the setting into which they are to be transferred. We set out to develop a conceptual framework to guide change and the implementation of best practice depression care in the primary care setting. We used a mixed method, observational approach to gather data about routine depression care in a range of primary care settings via: audit of electronic health records; observation of routine clinical care; and structured, facilitated whole of organisation meetings. Audit data were summarised using simple descriptive statistics. Observational data were collected using field notes. Organisational meetings were audio taped and transcribed. All the data sets were grouped, by organisation, and considered as a whole case. Normalisation Process Theory (NPT) was identified as an analytical theory to guide the conceptual framework development. Five privately owned primary care organisations (general practices) and one community health centre took part over the course of 18 months. We successfully developed a conceptual framework for implementing an effective model of depression care based on the four constructs of NPT: coherence, which proposes that depression work requires the conceptualisation of boundaries of who is depressed and who is not depressed and techniques for dealing with diffuseness; cognitive participation, which proposes that depression work requires engagement with a shared set of techniques that deal with depression as a health problem; collective action, which proposes that agreement is reached about how

  19. Risk-taking propensity and sensitivity to punishment in adolescents with attention deficit and hyperactivity disorder symptoms and/or reading disability.

    PubMed

    Poon, Kean; Ho, Connie Suk-Han

    2016-01-01

    Many studies reported that adolescents with ADHD/RD more frequently engage in risk-taking behaviors. Very few have examined their risk taking patterns and the impact of their comorbidity. The present study compared the risk-taking propensity, sensitivity to punishment and delinquency outcome in Chinese adolescents with ADHD symptoms (AS) and/or RD using a simulated risk task, the Balloon Analogous Risk Task (BART). Adolescents with AS (n=37), RD (n=35), AS+RD (n=35), and control (n=36) were recruited from local secondary schools. Results showed that adolescents with ADHD, despite their great risk-taking propensity, were sensitive to immediate punishment whereas adolescents with RD were found to display normal risk-taking propensity, yet showed a tendency of being less sensitive to punishment. The comorbidity ADHD+RD group had the highest delinquency score, and exhibited greatest risk taking and least sensitivity to punishment, which provided further support that comorbid condition might have stronger impact on risk taking or even delinquency than the pure groups. The present findings provides a useful picture of the risk taking pattern associated with different groups, allowing for effective matching for future prevention and intervention program. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. What has influenced patient health-care expenditures in Japan?: variables of age, death, length of stay, and medical care.

    PubMed

    Sato, Emi; Fushimi, Kiyohide

    2009-07-01

    This study considers variables related to health-care expenditures associated with aging and long-term hospitalization in Japan. We focused on daily per capita inpatient health-care expenditures, and examined the impact of inpatient characteristics such as sex, age, survived or deceased, length of stay, adult disease, and type of medical care received during the duration of each stay. We analyzed data from the Survey of Medical-Care Activities in Public Health Insurance by multinomial logistic regression analyses. Age of patient had little impact on per capita inpatient health-care expenditures per day. As regards length of stay, inpatient stays of 8-14 days had a little impact on health-care expenditures. This study suggested that these results might be due to the kind of medical care received. More research is needed to determine the appropriate medical services to reduce long-term hospitalization. In the last month of care for patients who died, medical examinations had a great influence on health-care expenditures. This study showed that increasing medical examinations in the end-of-life care needs further investigation.

  1. Telemedicine in wound care: a review.

    PubMed

    Chanussot-Deprez, Caroline; Contreras-Ruiz, José

    2013-02-01

    Telemedicine (TM) is a new, rapidly evolving area and can be of great value in the provision of healthcare to remote and rural populations. Wound healing and wound management are prime candidates for TM. The treatment of skin ulcers requires frequent assessments of local wound status and adjustment of therapy. The availability of reasonably priced photographic equipment and quick electronic transfer of high-quality digital images should make the assessment of wound status by remote experts possible. Several studies showing the feasibility and the usefulness of teleconsultations in dermatology have already been described in the literature, and high accordance for diagnosis and treatment between face-to-face visits and teleconsultations has been reported. Some used digital photographs and sent the image and clinical data via the Internet to a wound care specialist (store and forward), whereas others used a webcam (televideoconferencing). Tele-wound care offers great potential for the future in chronic wound care. By reducing the need to travel long distances to the hospital or to consult with a physician, TM decreases the costs and improves the quality of life for patients with chronic wounds, while still maintaining high standards of wound care. The intent of TM is to reduce, in a clinically equivalent way, the number of visits to a specialized clinic, but not necessarily to eliminate all visits. Further well-designed research is necessary to understand how best to deploy TM services in healthcare.

  2. Safe delivery care practices in western Nepal: Does women's autonomy influence the utilization of skilled care at birth?

    PubMed

    Bhandari, Tulsi Ram; Kutty, V Raman; Sarma, P Sankara; Dangal, Ganesh

    2017-01-01

    Despite various efforts to increase the utilization of skilled birth attendants (SBA), nearly two-thirds of deliveries take place at home without the assistance of SBAs in Nepal. We hypothesized that the ability of women to take decisions about their own lives-women's autonomy-plays an important part in birth choices. To know this, we conducted a community-based cross-sectional study for assessing women's autonomy and utilization of safe delivery care service in Kapilvastu district of Nepal from June to October 2014. We used multivariate modeling to associate socioeconomic factors and women's autonomy with the utilization of safe delivery care services. Just over one-third of women sought institutional delivery care during the birth of their last child. Out of the total deliveries at health facilities, nearly 58% women visited health facility for self-reported emergency obstructive care. Only 6.2% home deliveries were handled by health workers and 14.7% women used the safe delivery kit for home delivery care. Higher levels of women's education had a strong positive association (odds ratio = 24.11, CI = 9.43-61.64) with institutional delivery care. Stratified analysis showed that when the husband is educated, women's education seems to work partly through their autonomy in decision making. Educational status of women emerged as one of the key predictors of the utilization of delivery care services in Kapilvastu district. Economic status of household and husband's education are other dominant predictors of the utilization of safe delivery care services. Improving the economic and educational status may be the way out for improving the proportion of institutional deliveries. Women's autonomy may be an important mediating factor in this pathway.

  3. Employer approaches to preconception care.

    PubMed

    Phillips, Kathryn E; Flood, Georgette

    2008-01-01

    In recent years, the idea of preconception care-education, counseling, and interventions delivered to women before they become pregnant--has gained traction as a critically important health promotion opportunity for women and their families. Employers, as purchasers of health care and as providers of wellness services, have an important role to play in the promotion of preconception care. Large, self-insured employers can craft their medical benefit plans to include evidence-informed preventive health benefits such as preconception care. Employers can also design and implement worksite health promotion programs that address preconception, pregnancy, and postpartum health. And employers of all sizes can educate women and their partners on pregnancy health through tailored communication. This article provides an overview of the business case for preconception care and concrete steps employers can take to support and incent preconception care among their beneficiaries. The article also includes suggestions on ways providers and health professionals support employers in these efforts.

  4. 76 FR 73600 - Taking and Importing Marine Mammals; Taking Marine Mammals Incidental to Missile Launch...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-29

    ... years if NMFS finds, after notification and opportunity for public comment, that the taking will have a... taking. Regulations governing the taking of northern elephant seals (Mirounga angustirostris), Pacific... a period not to exceed 1 year, take of pinnipeds, by harassment, incidental to missile launch...

  5. Is holography ready for yet another life? or make holography great again

    NASA Astrophysics Data System (ADS)

    Trolinger, James D.

    2016-08-01

    Holographic metrology, unlike most other applications of holography, has always thrived and continues to thrive by continuously incorporating new supporting technologies that make it more powerful and useful. Successes, failures, lives, and deaths are examined and recognized as evolutionary steps that position the field where opportunities are as great and as many as ever. This is a story of that evolution. Comparisons and analogies with other applications of holography such as data storage, archiving, the arts, entertainment, advertising, and security and their evolution are interesting. Critical events, successes, mistakes, and coincidences represent milestones of abandonment or failure to deliver in many holography communities that followed a different evolutionary path. Events and new technical developments continue to emerge in supporting fields that can revive and expand all holography applications. New opportunities are described with encouragement to act on them and take some risks. Don't wait until all of the required technology and hardware are available, because good scientists always act before then. The paper is about "making holography great again" and your opportunity to be a part of the upcoming revolution. Although the discussion focuses on holographic metrology, the same principles should apply to other holography communities.

  6. Pressure Injuries in Critical Care: A Survey of Critical Care Nurses.

    PubMed

    Cox, Jill; Schallom, Marilyn

    2017-10-01

    Critical care nurses must be able to skillfully balance the prevention of adverse events such as pressure injuries in an environment with multiple competing and lifesaving technologies that often take precedent. Despite strategies to prevent them, pressure injuries do occur in intensive care unit patients, and consensus is building that some pressure injuries are unavoidable. To determine critical care nurses' attitudes toward prevention of pressure injury and the perceptions of frontline critical care nurses of specific risk factors associated with unavoidable pressure injuries. A descriptive cross-sectional survey design was used. An online survey was posted on the newsletter website of the American Association of Critical-Care Nurses in January 2016. An invitation to participate in the study was emailed to more than 3000 members of the association; 333 nurses responded, for a response rate of approximately 11%. Among the responders, 73% were employed as bedside critical care nurses. More than half (67%) thought that pressure injuries are avoidable, and 66% disagreed that pressure injury prevention was of less interest than other aspects of critical care. The top 2 risk factors for unavoidable pressure injuries were impaired tissue perfusion and impaired tissue oxygenation. Critical care nurses are steadfast stewards of safe patient care and think that pressure injury prevention is a crucial aspect of the care they deliver every day. The findings on risk factors for unavoidable pressure injuries mirrored those of experts and provide a layer of support for these factors. ©2017 American Association of Critical-Care Nurses.

  7. Geriatrics and the triple aim: defining preventable hospitalizations in the long-term care population.

    PubMed

    Ouslander, Joseph G; Maslow, Katie

    2012-12-01

    Reducing preventable hospitalizations is fundamental to the "triple aim" of improving care, improving health, and reducing costs. New federal government initiatives that create strong pressure to reduce such hospitalizations are being or will soon be implemented. These initiatives use quality measures to define which hospitalizations are preventable. Reducing hospitalizations could greatly benefit frail and chronically ill adults and older people who receive long-term care (LTC) because they often experience negative effects of hospitalization, including hospital-acquired conditions, morbidity, and loss of functional abilities. Conversely, reducing hospitalizations could mean that some people will not receive hospital care they need, especially if the selected measures do not adequately define hospitalizations that can be prevented without jeopardizing the person's health and safety. An extensive literature search identified 250 measures of preventable hospitalizations, but the measures have not been validated in the LTC population and generally do not account for comorbidity or the capacity of various LTC settings to provide the required care without hospitalization. Additional efforts are needed to develop measures that accurately differentiate preventable from necessary hospitalizations for the LTC population, are transparent and fair to providers, and minimize the potential for gaming and unintended consequences. As the new initiatives take effect, it is critical to monitor their effect and to develop and disseminate training and resources to support the many community- and institution-based healthcare professionals and emergency department staff involved in decisions about hospitalization for this population. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

  8. Raising Children Who Care.

    ERIC Educational Resources Information Center

    Kohn, Alfie

    2000-01-01

    Presents excerpt from Kohn's 1990 book, asserting that parents are most important to children and need to project a positive view of life. Argues that caring, the absence of physical punishment, guiding and explaining, cooperating, and taking children seriously are required to offset the pressure and negative values that a competitive culture…

  9. Should We Care About Adolescents Who Care for Themselves? What We've Learned and What We Need to Know About Youth in Self-Care.

    PubMed

    Mahoney, Joseph L; Parente, Maria E

    2009-12-01

    This article provides an overview of existing research on the prevalence and predictors of adolescent self-care and on the consequences associated with it. Self-care, in which the young are left unsupervised during out-of-school hours, is a common experience for millions of American youth, and existing studies suggest that this arrangement may represent a risk for the development of behavior problems. However, the behavior problems associated with self-care depend on both individual and environmental factors and are most likely to develop when self-care (1) occurs out of the home, (2) involves permissive parenting and/or low parental monitoring, (3) takes place in neighborhoods with high levels of crime and disorganization, (4) involves adolescents with preexisting behavioral problems, and (5) represents an intensive and persistent arrangement. Following our survey of current research on self-care, we offer recommendations regarding future research and policy.

  10. Physical examination and history-taking skills in a prostate clinic.

    PubMed

    Wareing, Mark

    The proliferation of nurse-led initiatives arising from nurse specialist/practitioner posts in urology is reflected in areas such as the management of bladder cancer, erectile dysfunction, stoma care, and prostate disease. The establishment of the role of urology specialist nurse in one North Oxfordshire hospital led to the development of a nurse-led prostate assessment clinic for male patients with lower urinary tract symptoms arising from benign prostatic hyperplasia. A description of how training was conducted, and the subsequent reappraisal of competency, is given in relation to physical examination and history-taking skills necessary for the development of this initiative.

  11. Sowing the Seeds of Soft Power: The United States and India in the Next Great Game

    DTIC Science & Technology

    2015-12-01

    Pakistan and their relations to the great powers of the day. In this work, we see the divide between India and the United States start after the United...quickly taking shape. If the United States wishes to be a key player in the game, it must start now to use every means at its disposal to shape the...States and the Soviet Union quickly tore the alliance apart. From the start , President Roosevelt disliked the authoritarian Soviet regime and did

  12. The Ambulatory and Home Care Record: A Methodological Framework for Economic Analyses in End-of-Life Care

    PubMed Central

    Guerriere, Denise N.; Coyte, Peter C.

    2011-01-01

    Provision of end-of-life care in North America takes place across a multitude of settings, including hospitals, ambulatory clinics and home settings. As a result, family caregiving is characteristically a major component of care within the home. Accordingly, economic evaluation of the end-of-life care environment must devote equal consideration to resources provided by the public health system as well as privately financed resources, such as time and money provided by family caregivers. This paper addresses the methods used to measure end-of-life care costs. The existing empirical literature will be reviewed in order to assess care costs with areas neglected in this body of literature to be identified. The Ambulatory and Home Care Record, a framework and tool for comprehensively measuring costs related to the provision and receipt of end-of-life care across all health care settings, will be described and proposed. Finally, areas for future work will be identified, along with their potential contribution to this body of knowledge. PMID:21629752

  13. [Kinshicho Model for Community Care by Multifunctional Vertical Integration of Psychiatric Care].

    PubMed

    Kubota, Akira

    2015-01-01

    The future of psychiatric community care in Japan requires a medical team for outpatient care to offer support and take responsibility for a region; respecting human rights and supporting high risk patients who have concluded a long-period of hospitalized or repeated involuntary commitment, and for people who suffer from social withdraws over a long period of time. There are over 3,000 private psychiatric outpatient clinics in Japan. Over 400 of them are multifunctional psychiatric outpatient clinics that provide daycare services and outreach activities. In the future, if systematized those clinics entrusted by an administrative organ with performing as a "community mental health center". Multifunctional vertical integration of psychiatric care is possible in Japan to create a catchment area with 24 hours phone service and continued free access.

  14. Social surveys of old age in Great Britain, 1945-58*

    PubMed Central

    Townsend, Peter

    1959-01-01

    In Great Britain, since the end of the Second World War, the problems of old age have tended to supersede those of poverty and unemployment as the object of social studies. The following article assesses some of the most important findings of 33 surveys conducted between 1945 and 1958 investigating the social needs and circumstances of old people. The fact emerges that family ties are stronger than is perhaps realized and that most of the aged live a reasonably secure life within their families. It is pointed out, however, that a small minority exists whose distress is evident and who do not seem to be contacted by social welfare agencies. These are the housebound and bed-ridden; the “isolates” and “semi-isolates”—old people who are without relatives or whose care puts too great a strain on the relatives they have; and those for whom retirement and the consequent loss of occupation is a source of unhappiness. In a discussion of how the needs of this group can be met, it is suggested that the pattern of home and welfare services should be based less on administrative tradition and more on the way of life of the people. PMID:13839104

  15. The Great Lakes Food Web.

    ERIC Educational Resources Information Center

    Baker, Marjane L.

    1997-01-01

    Presents a play for students in grades four to nine that incorporates the scientific names, physical characteristics, feeding habits, interactions, and interdependence of the plants and animals that make up the Great Lakes food web to facilitate the learning of this complex system. Includes a Great Lakes food web chart. (AIM)

  16. [Is the critical patient competent for decision taking? Psychological and psychopathological reasons of cognitive impairment].

    PubMed

    Bernat-Adell, M D; Ballester-Arnal, R; Abizanda-Campos, R

    2012-01-01

    Emotional factors may lead to cognitive impairment that can adversely affect the capacity of patients to reason, and thereby, limit their participation in decision taking. To analyze critical patient aptitude for decision taking, and to identify variables that may influence competence. An observational descriptive study was carried out. Intensive care unit. Participants were 29 critically ill patients. Social, demographic and psychological variables were analyzed. Functional capacities and psychological reactions during stay in the ICU were assessed. The patients are of the firm opinion that they should have the last word in the taking of decisions; they prefer bad news to be given by the physician; and feel that the presence of a psychologist would make the process easier. Failure on the part of the professional to answer their questions is perceived as the greatest stress factor. Increased depression results in lesser cognitive capacity, and for patients with impaired cognitive capacity, participation in the decision taking process constitutes a burden. The variables anxiety and depression are significantly related to decision taking capacity. Copyright © 2011 Elsevier España, S.L. and SEMICYUC. All rights reserved.

  17. Taking the edge off: why patients choose St. John's Wort.

    PubMed

    Wagner, P J; Jester, D; LeClair, B; Taylor, A T; Woodward, L; Lambert, J

    1999-08-01

    The number of visits to alternative medicine practitioners in this country is estimated at 425 million, which is more than the number of visits to allopathic primary care physicians in 1990. Patients' use of St. John's Wort (SJW) has followed this sweeping trend. The purpose of our study was to examine the reasons people choose to self-medicate with SJW instead of seeking care from a conventional health care provider. We used open-ended interviews with key questions to elicit information. Twenty-two current users of SJW (21 women; 20 white; mean age = 45 years) in a Southern city participated. All interviews were transcribed, and descriptive participant quotes were extracted by a research assistant. Quotes were reviewed for each key question for similarities and contextual themes. Four dominant decision-making themes were consistently noted. These were: (1) Personal Health Care Values: subjects had a history of alternative medicine use and a belief in the need for personal control of health; (2) Mood: all SJW users reported a depressed mood and occasionally irritability, cognitive difficulties, social isolation, and hormonal mood changes; (3) Perceptions of Seriousness of Disease and Risks of Treatment: SJW users reported the self-diagnosis of "minor" depression, high risks of prescription drugs, and a perception of safety with herbal remedies; and (4) Accessibility Issues: subjects had barriers to and lack of knowledge of traditional health care providers and awareness of the ease of use and popularity of SJW. Also of note was the fact that some SJW users did not inform their primary care providers that they were taking the herb (6 of 22). Users reported moderate effectiveness and few side effects of SJW. SJW users report depression, ease of access to alternative medicines, and a history of exposure to and belief in the safety of herbal remedies. Users saw little benefit to providing information about SJW to primary care physicians.

  18. [Refusal of nursing care, the legal perspective].

    PubMed

    Fisman, Jérôme

    2016-10-01

    The refusal of nursing care forms part of the freedom offered to anyone wanting to refuse, consciously and knowingly, any form of nursing care such as washing, the taking of medication or hospitalisation. However, limits are fixed by law as well as by case law. Are we totally free in the expression of our will? Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  19. Managing complaints in health and social care.

    PubMed

    Holmes-Bonney, Kathy

    2010-04-01

    An important aspect of allowing patients to take control of their health care is the introduction of new procedures for dealing with complaints. This article examines the concepts that underpin the new Department of Health regulations on complaints management and what they will mean for health and social care professionals. It also explains why these regulations focus on restorative justice rather than blame when adverse events occur.

  20. Communicating for Quality in School Age Care Services

    ERIC Educational Resources Information Center

    Cartmel, Jennifer; Grieshaber, Susan

    2014-01-01

    School Age Care (SAC) services have existed in Australia for over 100 years but they have tended to take a back seat when compared with provision for school-aged children and those under school age using early childhood education and care (ECEC) services. Many SAC services are housed in shared premises and many children attending preparatory or…

  1. Birth Family Contact for Children in Care: How Much? How Often? Who with?

    ERIC Educational Resources Information Center

    Atwool, Nicola

    2013-01-01

    Irrespective of type of placement, contact with the birth family is one of the more contentious issues in decision-making for children in care. Despite widespread belief that contact with the birth family is beneficial for children and young people in care, this aspect of children's care experience has not received a great deal of attention. In…

  2. Hermeneutic application research - finding a common understanding and consensus on care and caring.

    PubMed

    Koskinen, Camilla; Nyström, Lisbet

    2017-03-01

    To clinically and contextually implement the theoretical and factual knowledge of care and caring that has been developed in the last 30 years is seen as a great challenge in caring science research. Emphasis has been put on problem-solving research methodologies and action research in hopes of narrowing the divide between caring theory and clinical practice. Thus, the intention is now to further action research towards a hermeneutic approach and to put emphasis on hermeneutic application where theory and praxis become one through human dialogue. This article highlights hermeneutic application research as an alternative methodology within participatory-oriented research which presents a new opportunity to unite clinical practice and caring theory. The aim is to contribute to the development of the hermeneutical application research design in its epistemological, ontological and ethical perspective, by articulating and clarifying the central foundations in the application. On the basis of Gadamer's hermeneutical thinking and Levinas ethical thinking, the central foundations in the application research are ethics, creation of a hermeneutical room, dialogue and common understanding and appropriation and action. When theoretical understanding turns into praxis, knowledge also becomes activity and theory and practice become one. Application thus realises the basic idea that praxis and theory are one, and thus, theory of caring can only become evident and implemented in a clinical practice through moments when the participants find a common understanding and consensus on the knowledge of care and caring. © 2015 Nordic College of Caring Science.

  3. Transforming children’s palliative care—from ideas to action: highlights from the first ICPCN conference on children’s palliative care

    PubMed Central

    Downing, J; Marston, J; Muckaden, MA; Boucher, S; Cardoz, M; Nkosi, B; Steel, B; Talawadekar, P; Tilve, P

    2014-01-01

    The International Children’s Palliative Care Network (ICPCN) held its first international conference on children’s palliative care, in conjunction with Tata Memorial Centre, in Mumbai, India, from 10–12 February 2014. The theme of the conference, Transforming children’s palliative care—from ideas to action, reflected the vision of the ICPCN to live in a world where every child who needs it, can access palliative care, regardless of where they live. Key to this is action, to develop service provision and advocate for children’s palliative care. Three pre-conference workshops were held on 9 February, aimed at doctors, nurses, social workers, and volunteers, and focused around the principles of children’s palliative care, and in particular pain and symptom management. The conference brought together 235 participants representing 38 countries. Key themes identified throughout the conference included: the need for advocacy and leadership; for education and research, with great strides having been taken in the development of an evidence base for children’s palliative care, along with the provision of education; the importance of communication and attention to spirituality in children, and issues around clinical care, in particular for neonates. Delegates were continually challenged to transform children’s palliative care in their parts of the world and the conference culminated in the signing of the ICPCN Mumbai Declaration. The Declaration calls upon governments around the world to improve access to quality children’s palliative care services and made a call on the Belgian government not to pass a bill allowing children to be euthanised in that country. The conference highlighted many of the ongoing developments in children’s palliative care around the world, and as she closed the conference, Joan Marston (ICPCN CEO) challenged participants to take positive action and be the champions that the children need, thus transforming children

  4. Enhancing Advocacy for Eye Care at National Levels: What Steps to Take for the Next Decade?

    PubMed Central

    Rabiu, Muhammad Mansur; Al Rajhi, Abdulaziz; Qureshi, Mohammed Babar; Gersbeck, Jennifer

    2012-01-01

    The global initiative for the elimination of avoidable blindness by the year 2020-(VISION 2020- The Right to Sight), established in 1999, is a partnership of nongovernmental organizations (NGOs), governments, bilateral organizations, corporate bodies and the World Health Organization. The goal is to eliminate the major causes of avoidable blindness by the year 2020. Significant progress has been made in the last decade. For example, the adoption of three major World Health Assembly resolutions (WHA 56.26, 59.25 and 62.1) requesting governments to increase support and funding for the prevention of blindness and eye care. Additionally, the approval of the VISION 2020 declaration, development of plans and establishment of prevention of blindness committees and a designation of a coordinator by most participating countries represent other major achievements. Furthermore there has been increased political and professional commitment to the prevention of visual impairment and an increase in the provision of high-quality, sustainable eye care. Most of these achievements have been attributed to the advocacy efforts of VISION 2020 at the international level. The full success of this global initiative will likely depend on the extent to which the WHA resolutions are implemented in each country. However, most ratifying countries have not moved forward with implementation of these resolutions. To date, only few countries have shown consistent government support and funding for eye care pursuant to the resolutions. One of the main reasons for this may be inadequate and inappropriate advocacy for eye care at the national level. As such it is believed that the success of VISION 2020 in the next decade will depend on intense advocacy campaigns at national levels. This review identified some of the countries and health programs that have had fruitful advocacy efforts, to determine the factors that dictated success. The review highlights the factors of successful advocacy in two

  5. Medication-taking behaviours in chronic kidney disease with multiple chronic conditions: a meta-ethnographic synthesis of qualitative studies.

    PubMed

    Bartlett Ellis, Rebecca J; Welch, Janet L

    2017-03-01

    To identify behaviours associated with taking medications and medication adherence reported in qualitative studies of adults with chronic kidney disease and coexisting multiple chronic conditions. To inform medication adherence interventions, information is needed to clarify the nature of the relationships between behaviours that support medication-taking and medication adherence in multiple chronic conditions. Meta-ethnographic review and synthesis. CINAHL Complete, MEDLINE and PsycINFO databases were searched. Five qualitative studies met the inclusion criteria. A meta-ethnographic approach was used for synthesis. Medication-taking behaviours were abstracted from study findings and synthesised according to the contexts in which they occur and interpreted within a new developing framework named the Medication-taking Across the Care Continuum and Adherence-related Outcomes. Twenty categories of medication-taking behaviours occurred in three main contexts: (1) patient-provider clinical encounters, (2) pharmacy encounters and (3) day-to-day management. These behaviours are distinctly different, multilevel and interrelated. Together they represent a process occurring across a continuum. Future medication adherence research should consider using a multilevel ecological view of medication management. Clinical practice and policy development can benefit from further understanding socio-contextual behaviours that occur across the continuum. Nurses should have greater presence in chronic disease management and be positioned to support the day-to-day home management of patients' medications. Healthcare professionals can partner with patients to elucidate how these behaviours are enacted across the care continuum and in day-to-day management to identify opportunities to intervene on specific behaviours and promote medication adherence. © 2016 John Wiley & Sons Ltd.

  6. Mental Health Issues in Foster Care.

    PubMed

    Lohr, W David; Jones, V Faye

    2016-10-01

    Children in foster care have exceptional needs due to their histories of abuse, neglect, and increased exposure to violence. The rates of psychiatric symptoms and disorders, such as attention-deficit/hyperactivity disorder, posttraumatic stress disorder, and reactive attachment disorder, are much higher in children in foster care; furthermore, the rate of these children receiving psychotropic medications is 3 times that of children who are not in foster care. Pediatricians, in their role of providing a medical home, play a central role in safeguarding the physical and mental health of these children. By taking a trauma-informed approach to understanding the unique needs and gaps in their health care, pediatricians can improve the mental health and maximize outcome for children in foster care. [Pediatr Ann. 2016;45(10):e342-e348.]. Copyright 2016, SLACK Incorporated.

  7. Determination of a safe INR for joint injections in patients taking warfarin.

    PubMed

    Bashir, M A; Ray, R; Sarda, P; Li, S; Corbett, S

    2015-11-01

    With an increase in life expectancy in 'developed' countries, the number of elderly patients receiving joint injections for arthritis is increasing. There are legitimate concerns about an increased risk of thromboembolism if anticoagulation is stopped or reversed for such an injection. Despite being a common dilemma, the literature on this issue is scarce. We undertook 2,084 joint injections of the knee and shoulder in 1,714 patients between August 2008 and December 2013. Within this cohort, we noted 41 patients who were taking warfarin and followed them immediately after joint injection in the clinic or radiology department, looking carefully for complications. Then, we sought clinical follow-up, correspondence, and imaging evidence for 4 weeks, looking for complications from these joint injections. We recorded International Normalised Ratio (INR) values before injection. No complications were associated with the procedure after any joint injection. The radiologists who undertook ultrasound-guided injections to shoulders re-scanned the joints looking for haemarthroses: they found none. A similar outcome was noted clinically after injections in the outpatient setting. With a mean INR of 2.77 (range, 1.7-5.5) and a maximum INR within this group of 5.5, joint injections to the shoulder and knee can be undertaken safely in primary or secondary care settings despite the patient taking warfarin.

  8. Taking health needs seriously: against a luck egalitarian approach to justice in health.

    PubMed

    Nielsen, Lasse

    2013-08-01

    In recent works, Shlomi Segall suggests and defends a luck egalitarian approach to justice in health. Concurring with G. A. Cohen's mature position he defends the idea that people should be compensated for "brute luck", i.e. the outcome of actions that it would be unreasonable to expect them to avoid. In his defense of the luck egalitarian approach he seeks to rebut the criticism raised by Norman Daniels that luck egalitarianism is in some way too narrow and in another too wide to uphold justice in health and health care distribution. He points out that a pluralistic outline of luck egalitarianism taking into account the moral requirement of meeting everyone's basic needs can avoid this line of criticism. In this article I argue against the application of such pluralistic luck egalitarianism in matters of health distribution. First of all, Segall has not shown that luck egalitarianism handles well health distributions above a threshold of basic needs. Secondly, his way of avoiding Elizabeth Anderson's abandonment objection is theoretically problematic. Finally, I argue that luck egalitarianism in general fails to acknowledge the moral foundation of health and health care as a basic human entitlement. Thus I conclude that luck egalitarianism fails to take health needs seriously and that it cannot therefore uphold justice in health.

  9. ‘Engage me in taking care of my heart’: a grounded theory study on patient–cardiologist relationship in the hospital management of heart failure

    PubMed Central

    Barello, Serena; Graffigna, Guendalina; Vegni, Elena; Savarese, Mariarosaria; Lombardi, Federico; Bosio, A Claudio

    2015-01-01

    Objective In approaching the study and practice of heart failure (HF) management, authors recognise that the patient–doctor relationship has a central role in engaging patients in their care. This study aims at identifying the features and the levers of HF patient engagement and suggestions for orienting clinical encounters. Design Using a grounded theory approach, we conducted 22 in-depth interviews (13 patients with HF, 5 physicians and 4 caregivers). Data were collected and analysed using open, axial and selective coding procedures according to the grounded theory principles. Settings All interviews were conducted in an office in a university hospital located in a metropolitan area of Milan, Italy. Participants The data comprised a total of 22 patient, hospital cardiologist and caregiver interviews. Patients aged ≥18 years with New York Heart Association (NYHA) Functional Class of II or III were eligible to take part. Patients were recruited primarily through their referral cardiologist. Results The HF patient engagement process develops in four main phases that are characterised by different patients’ emotional, cognitive and behavioural dynamics that contribute to shape the process of a patient's meaning making towards health and illness regarding their care. The emerging model illustrates that HF patient engagement entails a meaning-making process enacted by the patient after the critical event. This implies patients’ ability to give sense to their care experience and to their disease, symptomatology and treatments, and their changes along their illness course. Doctors are recognised as crucial in fostering patients’ engagement along all the phases of the process as they contribute to providing patients with self-continuity and give new meaning to their illness experience. Conclusions This study identifies the core experiential domains and the main levers involved in driving patients with HF to effectively engage in their disease management. The

  10. Child Care Recipes: Food for Health and Fun. From USDA's Child and Adult Care Food Program.

    ERIC Educational Resources Information Center

    Food and Nutrition Service (USDA), Washington, DC.

    Intended to help child care providers show young children how to make healthy food choices, this collection contains standardized recipes and kitchen tips to help providers put together great tasting, nutritious meals that will appeal to young children. The recipe instructions are geared for groups of 25 and 50, and have been tested for product…

  11. Collaboration Takes Center Stage: Interactive Teaching through a Schoolwide Focus on the Performing Arts Leads to Dramatic Improvements in Learning

    ERIC Educational Resources Information Center

    Williamson, Jeff; Zimmerman, Diane

    2009-01-01

    In the Old Adobe Union School District in Petaluma, California, the school staff's goal is to assure that all teachers make the fundamental shift from teacher-centric to learner-centric thinking. For them, this is what distinguishes great teachers from good teachers. They believe this level of expertise takes years to develop and that schools play…

  12. Measuring patients' experiences with palliative care: the Consumer Quality Index Palliative Care.

    PubMed

    Claessen, Susanne J J; Francke, Anneke L; Sixma, Herman J; de Veer, Anke J E; Deliens, Luc

    2012-12-01

    The Consumer Quality Index Palliative Care (CQ-index PC) is a structured questionnaire for measuring the quality of palliative care from the perspective of care users. CQ-indices assess which care aspects need quality improvement by relating answers about actual care experiences to answers about the importance of certain aspects of care. To improve the chance that the new instrument has good content validity, a literature study and individual and group discussions were performed, and a steering committee was consulted to establish the instrument's face and content validity. The questionnaire was administered to patients with a life expectancy of 6 months or less and/or who were receiving palliative treatment. Descriptive analyses were carried out on the items about actual care experiences and the importance of care aspects, and on 'need for improvement' scores. 15 care organisations participated. 133 patients met the inclusion criteria (net response n=85). Patients considered the following aspects the most important: 'offering help in good time in acute situations', 'caregivers having the necessary expertise' and 'caregivers taking the patient seriously'. The three care aspects with the highest 'need for improvement' scores were: 'support when the patient feels depressed', 'support when the patient is anxious' and 'support when the patient has shortness of breath'. The CQ-index PC provides opportunities for care organisations to assess which care aspects have the highest priority for quality improvement within their organisation. Further research is needed to assess whether the instrument has enough discriminative power to assess differences between organisations.

  13. Chronic Care Management evolves towards Integrated Care in Counties Manukau, New Zealand.

    PubMed

    Rea, Harry; Kenealy, Tim; Wellingham, John; Moffitt, Allan; Sinclair, Gary; McAuley, Sue; Goodman, Meg; Arcus, Kim

    2007-04-13

    Despite anecdotes of many chronic care management and integrated care projects around New Zealand, there is no formal process to collect and share relevant learning within (but especially between) District Health Boards (DHBs). We wish to share our experiences and hope to stimulate a productive exchange of ongoing learning. We define chronic care management and integrated care, then summarise current theory and evidence. We describe national policy development (relevant to integrated care, since 2000) including the New Zealand Health Strategy, the NZ Primary Care Strategy, the development of Primary Health Organisations (PHOs), capitation payments, Care Plus, and Services to Improve Access funding. We then describe chronic care management in Counties Manukau, which evolved both prior to and during the international refinement of theory and evidence and the national policy development and implementation. We reflect on local progress to date and opportunities for (and barriers to) future improvements, aided by comparative reflections on the United Kingdom (UK). Our most important messages are addressed as follows: To policymakers and funders--a fragile culture change towards teamwork in the health system is taking place in New Zealand; this change needs to be specifically and actively supported. To PHOs--general practices need help to align their internal (within-practice) financial signals with the new world of capitation and integrated care. To primary and secondary care doctors, nurses, and other carers - systematic chronic care management and integrated care can improve patient quality of life; and if healthcare structures and systems are properly managed to support integration, then healthcare provider professional and personal satisfaction will improve.

  14. Social Justice and Human Caring: A Model of Caring Science as a Hopeful Paradigm for Moral Justice for Humanity.

    PubMed

    Watson, Jean

    2018-04-01

    The only true standard of greatness of any civilization is our sense of social and moral responsibility in translating material wealth to human values and achieving our full potential as a caring society. -The Right Honorable Norman Kirk, Former Prime Minister of New Zealand.

  15. Michigan: The Great Lakes State

    ERIC Educational Resources Information Center

    McKay, Sandra Lee; La Luzerne-Oi, Sally

    2009-01-01

    Although Michigan is often called the "Wolverine State," its more common nickname is the "Great Lakes State." This name comes from the fact that Michigan is the only state in the United States that borders four of the five Great Lakes. Also referred to as the "Water Wonderland," Michigan has 11,000 additional lakes,…

  16. Breaking the barriers of time and space: the dawning of the great age of librarians*

    PubMed Central

    Plutchak, T. Scott

    2012-01-01

    Purpose: This lecture, reflecting on future roles, posits the potential dawning of a “great age of librarians,” if librarians make the conceptual shift of focusing on their own skills and activities rather than on their libraries. Discussion: In the digital age, physical libraries are becoming less relevant to the communities that they serve. Librarians, however, are more necessary than ever in helping members of their communities navigate the increasingly complex information space. To meet their social responsibilities requires that librarians seek new roles and recognize that their most important activities will take place outside of the physical library. Conclusion: A great age of librarians is possible, but not guaranteed. We are at the very beginning of the development of a digital culture that parallels the print culture that has been dominant for five hundred years. Innovative and creative librarians have the potential to shape the development of that culture in ways that will truly serve the needs of their communities. PMID:22272154

  17. Stigma Predicts Treatment Preferences and Care Engagement among Veterans Affairs Primary Care Patients with Depression

    PubMed Central

    Campbell, Duncan G.; Bonner, Laura M.; Bolkan, Cory R.; Lanto, Andrew B.; Zivin, Kara; Waltz, Thomas J.; Klap, Ruth; Rubenstein, Lisa V.; Chaney, Edmund F.

    2016-01-01

    Background Whereas stigma regarding mental health concerns exists, the evidence for stigma as a depression treatment barrier among patients in Veterans Affairs (VA) primary care (PC) is mixed. Purpose To test whether stigma, defined as depression label avoidance, predicted patients' preferences for depression treatment providers, patients' prospective engagement in depression care, and care quality. Methods We conducted cross-sectional and prospective analyses of existing data from 761 VA PC patients with probable major depression. Results Relative to low stigma patients, those with high stigma were less likely to prefer treatment from mental health specialists. In prospective controlled analyses, high stigma predicted lower likelihood of the following: taking medications for mood, treatment by mental health specialists, treatment for emotional concerns in PC, and appropriate depression care. Conclusions High stigma is associated with lower preferences for care from mental health specialists and confers risk for minimal depression treatment engagement. PMID:26935310

  18. The Cultural Boundaries of Perspective-Taking: When and Why Perspective-Taking Reduces Stereotyping.

    PubMed

    Wang, Cynthia S; Lee, Margaret; Ku, Gillian; Leung, Angela K-Y

    2018-06-01

    Research conducted in Western cultures indicates that perspective-taking is an effective social strategy for reducing stereotyping. The current article explores whether and why the effects of perspective-taking on stereotyping differ across cultures. Studies 1 and 2 established that perspective-taking reduces stereotyping in Western but not in East Asian cultures. Using a socioecological framework, Studies 2 and 3 found that relational mobility, that is, the extent to which individuals' social environments provide them opportunities to choose new relationships and terminate old ones, explained our effect: Perspective-taking was negatively associated with stereotyping in relationally mobile (Western) but not in relationally stable (East Asian) environments. Finally, Study 4 examined the proximal psychological mechanism underlying the socioecological effect: Individuals in relationally mobile environments are more motivated to develop new relationships than those in relationally stable environments. Subsequently, when this motivation is high, perspective-taking increases self-target group overlap, which then decreases stereotyping.

  19. Transient global amnesia after taking sibutramine: a case report.

    PubMed

    Fu, Pin-Kuei; Hsu, Hung-Yi; Wang, Pao-Yu

    2010-03-01

    Sibutramine (Meridia in the United States, Reductil in Europe) is approved for weight reduction and weight maintenance. Although amnesia and seizure is listed as a reported adverse event of sibutramine in the US product information, our literature search in the PubMed website database found no published reports of theses adverse events. We report a 39-year-old healthy woman who had an episode of sudden memory loss lasting for several hours after taking sibutramine for 4 days. Cranial computed tomography scan, magnetic resonance imaging, and magnetic resonance angiography of the head all showed normal results. Electroencephalogram showed spike and wave complexes with phase reversal in the left mesial temporal area. Transient global amnesia was suspected clinically and transient epileptic amnesia provoked by sibutramine was also proposed. Three months after this episode, the follow-up electroencephalogram was normal. This patient did not take any anticonvulsant, and there were no more episodes of memory impairment. This case serves to emphasize that sibutramine which was used for weight reduction might induce transient global amnesia or provoke transient epileptic amnesia. Physicians should be careful to monitor for this adverse effect when sibutramine is prescribed.

  20. Study Shows Importance of Early End-of-Life Care Discussions

    Cancer.gov

    Discussions about palliative and end-of-life care are often delayed until late in a patient's life, if they take place at all. Earlier discussions may help to ensure that the care delivered at the end of life is consistent with a patient's preferences.