The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016).

PubMed

Nishida, Osamu; Ogura, Hiroshi; Egi, Moritoki; Fujishima, Seitaro; Hayashi, Yoshiro; Iba, Toshiaki; Imaizumi, Hitoshi; Inoue, Shigeaki; Kakihana, Yasuyuki; Kotani, Joji; Kushimoto, Shigeki; Masuda, Yoshiki; Matsuda, Naoyuki; Matsushima, Asako; Nakada, Taka-Aki; Nakagawa, Satoshi; Nunomiya, Shin; Sadahiro, Tomohito; Shime, Nobuaki; Yatabe, Tomoaki; Hara, Yoshitaka; Hayashida, Kei; Kondo, Yutaka; Sumi, Yuka; Yasuda, Hideto; Aoyama, Kazuyoshi; Azuhata, Takeo; Doi, Kent; Doi, Matsuyuki; Fujimura, Naoyuki; Fuke, Ryota; Fukuda, Tatsuma; Goto, Koji; Hasegawa, Ryuichi; Hashimoto, Satoru; Hatakeyama, Junji; Hayakawa, Mineji; Hifumi, Toru; Higashibeppu, Naoki; Hirai, Katsuki; Hirose, Tomoya; Ide, Kentaro; Kaizuka, Yasuo; Kan'o, Tomomichi; Kawasaki, Tatsuya; Kuroda, Hiromitsu; Matsuda, Akihisa; Matsumoto, Shotaro; Nagae, Masaharu; Onodera, Mutsuo; Ohnuma, Tetsu; Oshima, Kiyohiro; Saito, Nobuyuki; Sakamoto, So; Sakuraya, Masaaki; Sasano, Mikio; Sato, Norio; Sawamura, Atsushi; Shimizu, Kentaro; Shirai, Kunihiro; Takei, Tetsuhiro; Takeuchi, Muneyuki; Takimoto, Kohei; Taniguchi, Takumi; Tatsumi, Hiroomi; Tsuruta, Ryosuke; Yama, Naoya; Yamakawa, Kazuma; Yamashita, Chizuru; Yamashita, Kazuto; Yoshida, Takeshi; Tanaka, Hiroshi; Oda, Shigeto

2018-01-01

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English-language version of these guidelines was created based on the contents of the original Japanese-language version. Members of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two-thirds (>66.6%) majority vote of each of the 19 committee members. A total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J-SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement. We conducted meta-analyses for 29 CQs. Thirty seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5 CQs. Based on the evidence gathered, we were able to formulate Japanese-specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non-specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.

Health care delivery for head-and-neck cancer patients in Alberta: a practice guideline

PubMed Central

Harris, J.R.; Lau, H.; Surgeoner, B.V.; Chua, N.; Dobrovolsky, W.; Dort, J.C.; Kalaydjian, E.; Nesbitt, M.; Scrimger, R.A.; Seikaly, H.; Skarsgard, D.; Webster, M.A.

2014-01-01

Background The treatment of head-and-neck cancer is complex and requires the involvement of various health care professionals with a wide range of expertise. We describe the process of developing a practice guideline with recommendations about the organization and delivery of health care services for head-and-neck cancer patients in Alberta. Methods Outcomes of interest included composition of the health care team, qualification requirements for team members, cancer centre and team member volumes, infrastructure needs, and wait times. A search for existing practice guidelines and a systematic review of the literature addressing the organization and delivery of health care services for head-and-neck cancer patients were conducted. The search included the Standards and Guidelines Evidence (sage) directory of cancer guidelines and PubMed. Results One practice guideline was identified for adaptation. Three additional practice guidelines provided supplementary evidence to inform guideline recommendations. Members of the Alberta Provincial Head and Neck Tumour Team (consisting of various health professionals from across the province) provided expert feedback on the adapted recommendations through an online and in-person review process. Selected experts in head-and-neck cancer from outside the province participated in an external online review. SUMMARY The recommendations outlined in this practice guideline are based on existing guidelines that have been modified to fit the Alberta context. Although specific to Alberta, the recommendations lend credence to similar published guidelines and could be considered for use by groups lacking the resources of appointed guideline panels. The recommendations are meant to be a guide rather than a fixed protocol. The implementation of this practice guideline will depend on many factors, including but not limited to availability of trained personnel, adequate funding of infrastructure, and collaboration with other associations of health care professionals in the province. PMID:25302041

Transportation of Organs by Air: Safety, Quality, and Sustainability Criteria.

PubMed

Mantecchini, L; Paganelli, F; Morabito, V; Ricci, A; Peritore, D; Trapani, S; Montemurro, A; Rizzo, A; Del Sordo, E; Gaeta, A; Rizzato, L; Nanni Costa, A

2016-03-01

The outcomes of organ transplantation activities are greatly affected by the ability to haul organs and medical teams quickly and safely. Organ allocation and usage criteria have greatly improved over time, whereas the same result has not been achieved so far from the transport point of view. Safety and the highest level of service and efficiency must be reached to grant transplant recipients the healthiest outcome. The Italian National Transplant Centre (CNT), in partnership with the regions and the University of Bologna, has promoted a thorough analysis of all stages of organ transportation logistics chains to produce homogeneous and shared guidelines throughout the national territory, capable of ensuring safety, reliability, and sustainability at the highest levels. The mapping of all 44 transplant centers and the pertaining airport network has been implemented. An analysis of technical requirements among organ shipping agents at both national and international level has been promoted. A national campaign of real-time monitoring of organ transport activities at all stages of the supply chain has been implemented. Parameters investigated have been hospital and region of both origin and destination, number and type of organs involved, transport type (with or without medical team), stations of arrival and departure, and shipping agents, as well as actual times of activities involved. National guidelines have been issued to select organ storage units and shipping agents on the basis of evaluation of efficiency, reliability, and equipment with reference to organ type and ischemia time. Guidelines provide EU-level standards on technical equipment of aircrafts, professional requirements of shipping agencies and cabin crew, and requirements on service provision, including pricing criteria. The introduction in the Italian legislation of guidelines issuing minimum requirements on topics such as the medical team, packaging, labeling, safety and integrity, identification, real-time monitoring of temperature, and traceability of the organ during the logistics chain is deemed a valid response to the necessity of improving safety, reliability, and sustainability of organ transplantation activities in Italy. Copyright © 2016 Elsevier Inc. All rights reserved.

Improving the implementation of perioperative safety guidelines using a multifaceted intervention approach: protocol of the IMPROVE study, a stepped wedge cluster randomized trial.

PubMed

Emond, Yvette E J J M; Calsbeek, Hiske; Teerenstra, Steven; Bloo, Gerrit J A; Westert, Gert P; Damen, Johan; Wolff, André P; Wollersheim, Hub C

2015-01-08

This study is initiated to evaluate the effects, costs, and feasibility at the hospital and patient level of an evidence-based strategy to improve the use of Dutch perioperative safety guidelines. Based on current knowledge, expert opinions and expertise of the project team, a multifaceted implementation strategy has been developed. This is a stepped wedge cluster randomized trial including nine representative hospitals across The Netherlands. Hospitals are stratified into three groups according to hospital type and geographical location and randomized in terms of the period for receipt of the intervention. All adult surgical patients meeting the inclusion criteria are assessed for patient outcomes. The implementation strategy includes education, audit and feedback, organizational interventions (e.g., local embedding of the guidelines), team-directed interventions (e.g., multi-professional team training), reminders, as well as patient-mediated interventions (e.g., patient safety cards). To tailor the implementation activities, we developed a questionnaire to identify barriers for effective guideline adherence, based on (a) a theoretical framework for classifying barriers and facilitators, (b) an instrument for measuring determinants of innovations, and (c) 19 semi-structured interviews with perioperative key professionals. Primary outcome is guideline adherence measured at the hospital (i.e., cluster) and patient levels by a set of perioperative Patient Safety Indicators (PSIs), which was developed parallel to the perioperative guidelines. Secondary outcomes at the patient level are in-hospital complications, postoperative wound infections and mortality, length of hospital stay, and unscheduled transfer to the intensive care unit, non-elective readmission to the hospital and unplanned reoperation, all within 30 days after the initial surgery. Also, patient safety culture and team climate will be studied as potential determinants. Finally, a process evaluation is conducted to identify the compliance with the implementation strategy, as well as an economic evaluation to assess the costs. Data sources are registered clinical data and surveys. There is no form of blinding. The perioperative setting is an unexplored area with respect to implementation issues. This study is expected to yield important new evidence about the effects of a multifaceted approach on guideline adherence in the perioperative care setting. Dutch trial registry: NTR3568.

Going DEEP: guidelines for building simulation-based team assessments.

PubMed

Grand, James A; Pearce, Marina; Rench, Tara A; Chao, Georgia T; Fernandez, Rosemarie; Kozlowski, Steve W J

2013-05-01

Whether for team training, research or evaluation, making effective use of simulation-based technologies requires robust, reliable and accurate assessment tools. Extant literature on simulation-based assessment practices has primarily focused on scenario and instructional design; however, relatively little direct guidance has been provided regarding the challenging decisions and fundamental principles related to assessment development and implementation. The objective of this manuscript is to introduce a generalisable assessment framework supplemented by specific guidance on how to construct and ensure valid and reliable simulation-based team assessment tools. The recommendations reflect best practices in assessment and are designed to empower healthcare educators, professionals and researchers with the knowledge to design and employ valid and reliable simulation-based team assessments. Information and actionable recommendations associated with creating assessments of team processes (non-technical 'teamwork' activities) and performance (demonstration of technical proficiency) are presented which provide direct guidance on how to Distinguish the underlying competencies one aims to assess, Elaborate the measures used to capture team member behaviours during simulation activities, Establish the content validity of these measures and Proceduralise the measurement tools in a way that is systematically aligned with the goals of the simulation activity while maintaining methodological rigour (DEEP). The DEEP framework targets fundamental principles and critical activities that are important for effective assessment, and should benefit healthcare educators, professionals and researchers seeking to design or enhance any simulation-based assessment effort.

Diagnosis and treatment of bone metastasis: comprehensive guideline of the Japanese Society of Medical Oncology, Japanese Orthopedic Association, Japanese Urological Association, and Japanese Society for Radiation Oncology.

PubMed

Shibata, H; Kato, S; Sekine, I; Abe, K; Araki, N; Iguchi, H; Izumi, T; Inaba, Y; Osaka, I; Kato, S; Kawai, A; Kinuya, S; Kodaira, M; Kobayashi, E; Kobayashi, T; Sato, J; Shinohara, N; Takahashi, S; Takamatsu, Y; Takayama, K; Takayama, K; Tateishi, U; Nagakura, H; Hosaka, M; Morioka, H; Moriya, T; Yuasa, T; Yurikusa, T; Yomiya, K; Yoshida, M

2016-01-01

Diagnosis and treatment of bone metastasis requires various types of measures, specialists and caregivers. To provide better diagnosis and treatment, a multidisciplinary team approach is required. The members of this multidisciplinary team include doctors of primary cancers, radiologists, pathologists, orthopaedists, radiotherapists, clinical oncologists, palliative caregivers, rehabilitation doctors, dentists, nurses, pharmacists, physical therapists, occupational therapists, medical social workers, etc. Medical evidence was extracted from published articles describing meta-analyses or randomised controlled trials concerning patients with bone metastases mainly from 2003 to 2013, and a guideline was developed according to the Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014. Multidisciplinary team meetings are helpful in diagnosis and treatment. Clinical benefits such as physical or psychological palliation obtained using the multidisciplinary team approaches are apparent. We established a guideline describing each specialty field, to improve understanding of the different fields among the specialists, who can further provide appropriate treatment, and to improve patients' outcomes.

Using POGIL to Help Students Learn to Program

ERIC Educational Resources Information Center

Hu, Helen H.; Shepherd, Tricia D.

2013-01-01

POGIL has been successfully implemented in a scientific computing course to teach science students how to program in Python. Following POGIL guidelines, the authors have developed guided inquiry activities that lead student teams to discover and understand programming concepts. With each iteration of the scientific computing course, the authors…

Human factors design guide update (report number DOT/FAA/CT-96/01) : a revision to chapter 5--automation guidelines.

DOT National Transportation Integrated Search

2001-12-01

This document contains an updated and expanded version of the Automation chapter of the Human Factors Design Guide. A research : team of human factors experts evaluated the existing guidelines for relevance, clarity, and usability. The research team ...

Standards of resuscitation during inter-hospital transportation: the effects of structured team briefing or guideline review - a randomised, controlled simulation study of two micro-interventions.

PubMed

Høyer, Christian B; Christensen, Erika F; Eika, Berit

2011-03-03

Junior physicians are sometimes sent in ambulances with critically ill patients who require urgent transfer to another hospital. Unfamiliar surroundings and personnel, time pressure, and lack of experience may imply a risk of insufficient treatment during transportation as this can cause the physician to loose the expected overview of the situation. While health care professionals are expected to follow complex algorithms when resuscitating, stress can compromise both solo-performance and teamwork. To examine whether inter-hospital resuscitation improved with a structured team briefing between physician and ambulance crew in preparation for transfer vs. review of resuscitation guidelines. The effect parameters were physician team leadership (requesting help, delegating tasks), time to resuscitation key elements (chest compressions, defibrillation, ventilations, medication, or a combination of these termed "the first meaningful action"), and hands-off ratio. 46 physicians graduated within 5 years. A simulation intervention study with a control group and two interventions (structured team briefing or review of guidelines). Scenario: Cardiac arrest during simulated inter-hospital transfer. Forty-six candidates participated: 16 (control), 13 (review), and 17 (team briefing). Reviewing guidelines delayed requesting help to 162 seconds, compared to 21 seconds in control and team briefing groups (p = 0.021). Help was not requested in 15% of cases; never requesting help was associated with an increased hands-off ratio, from 39% if the driver's assistance was requested to 54% if not (p < 0.01). No statistically significant differences were found between groups regarding time to first chest compression, defibrillation, ventilation, drug administration, or the combined "time to first meaningful action". Neither review nor team briefing improved the time to resuscitation key elements. Review led to an eight-fold increase in the delay to requesting help. The association between never requesting help and an increased hands-off ratio underpins the importance of prioritising available resources. Other medical and non-medical domains have benefited from the use of guidelines reviews and structured team briefings. Reviewing guidelines may compromise the ability to focus on aspects such as team leading and delegating tasks and warrants the need for further studies focusing on how to avoid this cognitive impairment.

Standards of resuscitation during inter-hospital transportation: the effects of structured team briefing or guideline review - A randomised, controlled simulation study of two micro-interventions

PubMed Central

2011-01-01

Background Junior physicians are sometimes sent in ambulances with critically ill patients who require urgent transfer to another hospital. Unfamiliar surroundings and personnel, time pressure, and lack of experience may imply a risk of insufficient treatment during transportation as this can cause the physician to loose the expected overview of the situation. While health care professionals are expected to follow complex algorithms when resuscitating, stress can compromise both solo-performance and teamwork. Aim To examine whether inter-hospital resuscitation improved with a structured team briefing between physician and ambulance crew in preparation for transfer vs. review of resuscitation guidelines. The effect parameters were physician team leadership (requesting help, delegating tasks), time to resuscitation key elements (chest compressions, defibrillation, ventilations, medication, or a combination of these termed "the first meaningful action"), and hands-off ratio. Methods Participants: 46 physicians graduated within 5 years. Design: A simulation intervention study with a control group and two interventions (structured team briefing or review of guidelines). Scenario: Cardiac arrest during simulated inter-hospital transfer. Results Forty-six candidates participated: 16 (control), 13 (review), and 17 (team briefing). Reviewing guidelines delayed requesting help to 162 seconds, compared to 21 seconds in control and team briefing groups (p = 0.021). Help was not requested in 15% of cases; never requesting help was associated with an increased hands-off ratio, from 39% if the driver's assistance was requested to 54% if not (p < 0.01). No statistically significant differences were found between groups regarding time to first chest compression, defibrillation, ventilation, drug administration, or the combined "time to first meaningful action". Conclusion Neither review nor team briefing improved the time to resuscitation key elements. Review led to an eight-fold increase in the delay to requesting help. The association between never requesting help and an increased hands-off ratio underpins the importance of prioritising available resources. Other medical and non-medical domains have benefited from the use of guidelines reviews and structured team briefings. Reviewing guidelines may compromise the ability to focus on aspects such as team leading and delegating tasks and warrants the need for further studies focusing on how to avoid this cognitive impairment. PMID:25928019

Variety, Enjoyment, and Physical Activity Participation Among High School Students.

PubMed

Michael, Shannon L; Coffield, Edward; Lee, Sarah M; Fulton, Janet E

2016-02-01

Federal guidelines state that youth should participate in a variety of physical activity (PA) they find enjoyable. Little is known, however, about how variety and enjoyment are associated with PA participation among adolescents. Data came from the 2010 National Youth Physical Activity and Nutrition Survey, a nationally representative survey of adolescents. Path analysis was used to examine the association of a variety of self-reported PA, defined as the number of activities and activity types (ie, team sports/weightlifting, individual activities, and other competitive/recreational sports), on self-reported PA enjoyment and participation. The analysis also examined whether enjoyment mediates the association between a variety of PA and participation. Separate models were estimated for boys and girls. Number of activities was associated with increased PA enjoyment and participation. For boys and girls, team sports/weightlifting was associated with increased participation, and individual activities were indirectly associated with increased participation through enjoyment. For boys, team sports/weightlifting was indirectly related with participation. These findings suggest that participation in a variety of PA is associated with increased PA enjoyment and participation. Providing opportunities for adolescents to engage in a variety of activities might help them identify PA they enjoy and facilitate lifelong PA habits.

A Review of Established Guidelines and Standards for International Education Travel and Exchange Programs for Students. Report of the Department of Education to the Governor and the General Assembly of Virgina. House Document No. 25.

ERIC Educational Resources Information Center

Virginia State General Assembly, Richmond. House.

This study of existing guidelines and standards for international travel by students in local school divisions is the result of a Virginia Department of Education team effort over four months. The interdisciplinary team reviewed guidelines and standards for international travel and student exchange programs from major organizations and developed…

National Health Guidelines in I.R of Iran, an Innovative Approach for Developing Countries

PubMed Central

Esmaeil Akbari, Mohammad; Mohammadi, Gohar; Vosoogh-Moghaddam, Abbas; Rabanikhah, Fahimeh; Javadi, Hamideh; Rostami-Gooran, Narges; Safaei, Asal; Akbari, Atieh

2015-01-01

Background Guidelines have produced and used in complex environment of health care system with its ethical, economical, legal and other aspects; that should be taken into account in any country. Modifying the format and content of guidelines might facilitate their usage and lead to improved quality of care and cost containment. We have produced this tool for explained above purpose. Methods A coordinating national team has settled at the office of minster of health and medical education, supported by a guideline review committee. An innovative and appropriate approach for adapting national health guidelines has consisted of eight steps, have defined For preparing the draft of each guideline a technical team which, including main author, her/his co-workers have nominated. The authors of each topic have systematically searched databases of the proposed Twenty-two International Sites, and then have selected at least five sources of them that were more relevant. The final recommendations have proposed by agreement of technical team and Guideline Review Committee. Results In less than 5 months, more than 500 authors in whole country have selected to prepare guidelines and, approximately 150 guidelines have provided in three volumes of the published and distributed book. Each guideline had a national ID number, constant forever; all topics should be reviewed every 3-5 years. Conclusion National health guideline(s) would be essential means for policy making in health system and increased the cost containment and quality of care. Ministry of Health and Medical Education should provide and distribute the guidelines based on its accountability to legal responsibility. PMID:25960845

National health guidelines in I.R of iran, an innovative approach for developing countries.

PubMed

Esmaeil Akbari, Mohammad; Mohammadi, Gohar; Vosoogh-Moghaddam, Abbas; Rabanikhah, Fahimeh; Javadi, Hamideh; Rostami-Gooran, Narges; Safaei, Asal; Akbari, Atieh

2015-01-01

Guidelines have produced and used in complex environment of health care system with its ethical, economical, legal and other aspects; that should be taken into account in any country. Modifying the format and content of guidelines might facilitate their usage and lead to improved quality of care and cost containment. We have produced this tool for explained above purpose. A coordinating national team has settled at the office of minster of health and medical education, supported by a guideline review committee. An innovative and appropriate approach for adapting national health guidelines has consisted of eight steps, have defined For preparing the draft of each guideline a technical team which, including main author, her/his co-workers have nominated. The authors of each topic have systematically searched databases of the proposed Twenty-two International Sites, and then have selected at least five sources of them that were more relevant. The final recommendations have proposed by agreement of technical team and Guideline Review Committee. In less than 5 months, more than 500 authors in whole country have selected to prepare guidelines and, approximately 150 guidelines have provided in three volumes of the published and distributed book. Each guideline had a national ID number, constant forever; all topics should be reviewed every 3-5 years. National health guideline(s) would be essential means for policy making in health system and increased the cost containment and quality of care. Ministry of Health and Medical Education should provide and distribute the guidelines based on its accountability to legal responsibility.

Designing Academic Audit: Lessons Learned in Europe and Asia.

ERIC Educational Resources Information Center

Dill, David D.

2000-01-01

Reviews lessons learned from early experiments with academic audits in the United Kingdom, Sweden, New Zealand, and Hong Kong in areas such as: focus of audits, selection and training of audit teams, nature of audit self-studies, conduct of audit visits, audit reports, and audit follow-up and enhancement activities. Suggests guidelines for design…

Alaska Secondary Physical Education Model Curriculum Guide. Second Edition.

ERIC Educational Resources Information Center

Alaska State Dept. of Education, Juneau.

Guidelines are offered in this manual for develping a physical education curriculum for grades 9 through 12. The primary objective for the curriculum is the development of physical fitness, and motor and life skills in students. Activities are recommended in the areas of team and individual sports, aquatics and rhythm, and Alaska outdoor…

Alaska Elementary Physical Education Model Curriculum Guide. Second Edition.

ERIC Educational Resources Information Center

Alaska State Dept. of Education, Juneau.

Guidelines are offered in this manual for developing a physical education curriculum for grades one through eight. The primary objective for the curriculum is the development of physical fitness, and also motor and life skills in students. Activities are recommended in the areas of team and individual sports, aquatics, and rhythm and dance. The…

A Developmental Perspective on the Virginia Student Threat Assessment Guidelines

ERIC Educational Resources Information Center

Cornell, Dewey G.

2011-01-01

The Virginia Student Threat Assessment Guidelines were developed to help multidisciplinary school-based teams use a decision tree to evaluate student threats and take appropriate preventive action. A main goal of this approach is to allow school-based teams to recognize and respond to the developmental complexities of children and adolescents…

Improving guideline concordance in multidisciplinary teams: preliminary results of a cluster-randomized trial evaluating the effect of a web-based audit and feedback intervention with outreach visits

PubMed Central

van Engen-Verheul, Mariëtte M.; Gude, Wouter T.; van der Veer, Sabine N.; Kemps, Hareld M.C.; Jaspers, Monique M.W.; de Keizer, Nicolette F.; Peek, Niels

2015-01-01

Despite their widespread use, audit and feedback (A&F) interventions show variable effectiveness on improving professional performance. Based on known facilitators of successful A&F interventions, we developed a web-based A&F intervention with indicator-based performance feedback, benchmark information, action planning and outreach visits. The goal of the intervention was to engage with multidisciplinary teams to overcome barriers to guideline concordance and to improve overall team performance in the field of cardiac rehabilitation (CR). To assess its effectiveness we conducted a cluster-randomized trial in 18 CR clinics (14,847 patients) already working with computerized decision support (CDS). Our preliminary results showed no increase in concordance with guideline recommendations regarding prescription of CR therapies. Future analyses will investigate whether our intervention did improve team performance on other quality indicators. PMID:26958310

Design of a vibration isolation system for a cycle ergometer to be used onboard the Space Shuttle

NASA Technical Reports Server (NTRS)

Pearson, Lillian; Tait, Steven; Trevino, Maurice

1991-01-01

Low frequency vibrations generated during exercise using the cycle ergometer onboard the Space Shuttle are disrupting sensitive microgravity experiments. The design team is asked by NASA/USRA to generate alternatives for the design of a vibration isolation system for the cycle ergometer. It is the design team's objective to present alternative designs and a problem solution for a vibration isolation system for an exercise cycle ergometer to be used onboard the Space Shuttle. In the development of alternative designs, the design team emphasizes passive systems as opposed to active control systems. This decision is made because the team feels that passive systems are less complex than active control systems, external energy sources are not required, and mass is reduced due to the lack of machinery such as servomotors or compressors typical of active control systems. Eleven alternative designs are developed by the design team. From these alternatives, three active control systems are included to compare the benefits of active and passive systems. Also included in the alternatives is an isolation system designed by an independent engineer that was acquired late in the project. The eight alternatives using passive isolation systems are narrowed down by selection criteria to four considered to be the most promising by the design team. A feasibility analysis is performed on these four passive isolation systems. Based on the feasibility analysis, a final design solution is chosen and further developed. From the development of the design, the design team has concluded that passive systems are not effective at isolating vibrations for the low frequencies considered for this project. Recommendations are made for guidelines of passive isolation design and application of such systems.

Trauma facilities in Denmark - a nationwide cross-sectional benchmark study of facilities and trauma care organisation.

PubMed

Weile, Jesper; Nielsen, Klaus; Primdahl, Stine C; Frederiksen, Christian A; Laursen, Christian B; Sloth, Erik; Mølgaard, Ole; Knudsen, Lars; Kirkegaard, Hans

2018-03-27

Trauma is a leading cause of death among adults aged < 44 years, and optimal care is a challenge. Evidence supports the centralization of trauma facilities and the use multidisciplinary trauma teams. Because knowledge is sparse on the existing distribution of trauma facilities and the organisation of trauma care in Denmark, the aim of this study was to identify all Danish facilities that care for traumatized patients and to investigate the diversity in organization of trauma management. We conducted a systematic observational cross-sectional study. First, all hospitals in Denmark were identified via online services and clarifying phone calls to each facility. Second, all trauma care manuals on all facilities that receive traumatized patients were gathered. Third, anesthesiologists and orthopedic surgeons on call at all trauma facilities were contacted via telephone for structured interviews. A total of 22 facilities in Denmark were found to receive traumatized patients. All facilities used a trauma care manual and all had a multidisciplinary trauma team. The study found three different trauma team activation criteria and nine different compositions of teams who participate in trauma care. Training was heterogeneous and, beyond the major trauma centers, databases were only maintained in a few facilities. The study established an inventory of the existing Danish facilities that receive traumatized patients. The trauma team activation criteria and the trauma teams were heterogeneous in both size and composition. A national database for traumatized patients, research on nationwide trauma team activation criteria, and team composition guidelines are all called for.

SPSP Phase III Recruiting, Selecting, and Developing Secure Power Systems Professionals. Individual and Team Performance Guidelines

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

O'Neil, Lori Ross; Conway, T. J.; Tobey, D. H.

The Secure Power Systems Professional Phase III final report was released last year which an appendix of Individual and Team Performance Guidelines. This new report is that appendix broken out as a standalone document to assist utilities in recruiting and developing Secure Power Systems Professionals at their site.

Improvement of Project Portfolio Management in an Information Technology Consulting Company

NASA Astrophysics Data System (ADS)

Kaewta, S.; Chutima, P.

2014-06-01

The scope of this research is to improve the efficiency of multiple project management in an information technology consulting company through the adaptation of the project portfolio management technique. The project management information system (PMIS) is implemented to establish effective communication channels so that internal and external teams as well as all relevant stakeholders can be employed to negotiate their work schedules. In addition, all activities created by multiple teams can be systematically reviewed and combined into a single checklist to be used as an agreed working plan for all team members. A general guideline for project portfolio management in information technology consulting companies is also proposed, which could results in a higher level of project on-time delivery.

Implementation of concussion guidelines in community Australian Football and Rugby League-The experiences and challenges faced by coaches and sports trainers.

PubMed

Kemp, Joanne L; Newton, Joshua D; White, Peta E; Finch, Caroline F

2016-04-01

While guidelines outlining the appropriate management of sport-related concussion have been developed and adapted for use within community sport, it remains unknown how they are experienced by those responsible for implementing them. Longitudinal study. 111 coaches and sports trainers from community-level Australian Football and Rugby League teams completed pre- and post-season surveys assessing their attitudes towards using concussion guidelines. Participants also provided post-season feedback regarding their experiences in using the guidelines. 71% of participants reported using the guidelines in the preceding season. Post-season attitude was related to pre-season attitude (p=0.002), football code (p=0.015), and team role (p=0.045). An interaction between team role and guideline use (p=0.012) was also found, with coaches who had used the guidelines, and sports trainers who had not, reporting more positive post-season attitudes towards using the concussion guidelines. Implementation challenges included disputing of decisions about return-to-play by players, parents, and coaches, and a perceived lack of time. Recommendations for improved guideline materials included using larger fonts and providing for witnessing of advice given to players. This is the first study to examine the implementation of concussion guidelines in community sport. Training of coaches/sports trainers needs enhancement. In addition, new education should be developed for parents/players about the importance of the return-to-play advice given to them by those who follow these guidelines. Information provided by those who attempted to use the guidelines will assist the refinement of implementation and dissemination processes around concussion guidelines across sports. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Publication ethics from the ground up.

PubMed

DeTora, Lisa; Foster, Cate; Nori, Mukund; Simcoe, Donna; Skobe, Catherine; Toroser, Dikran

2018-02-01

It is relatively easy to begin policy documents with a general assertion that ethics will be followed. Less obvious is how to ensure that day-to-day activities are consonant with ethical standards. We suggest that using day-to-day publication activities as the driver for building policies and procedures can promote ethical practices from the ground up. Although basic principles of ethical publication practice may seem straightforward to some, for others this information may require explanation, interpretation and context. Effective policy development includes big-picture items as well as more day-to-day tactical responsibilities such as those discussed below. Research questions, disciplinary practices, applications and team structures may vary. Thus, no single publication plan or policy solution is right for all teams. It is up to team members to review guidelines for best practices and find the optimal implementation for their situations. Experts in publication management, planning and writing can help large teams manage publication activities. These experts have an obligation to maintain and enhance their skills continually. A strong acumen in publication best practices will allow these publication professionals to better address any possible ethical dilemmas in the future. © 2018 The Authors. International Journal of Clinical Practice Published by John Wiley & Sons Ltd.

Applying the knowledge to action framework to plan a strategy for implementing breast cancer screening guidelines: an interprofessional perspective.

PubMed

Munce, Sarah; Kastner, Monika; Cramm, Heidi; Lal, Shalini; Deschêne, Sarah-Maude; Auais, Mohammad; Stacey, Dawn; Brouwers, Melissa

2013-09-01

Integrated knowledge translation (IKT) interventions may be one solution to improving the uptake of clinical guidelines. IKT research initiatives are particularly relevant for breast cancer research and initiatives targeting the implementation of clinical guidelines and guideline implementation initiatives, where collaboration with an interdisciplinary team of practitioners, patients, caregivers, and policy makers is needed for producing optimum patient outcomes. The objective of this paper was to describe the process of developing an IKT strategy that could be used by guideline developers to improve the uptake of their new clinical practice guidelines on breast cancer screening. An interprofessional group of students as well as two faculty members met six times over three days at the KT Canada Summer Institute in 2011. The team used all of the phases of the action cycle in the Knowledge to Action Framework as an organizing framework. While the entire framework was used, the step involving assessing barriers to knowledge use was judged to be particularly relevant in anticipating implementation problems and being able to inform the specific KT interventions that would be appropriate to mitigate these challenges and to accomplish goals and outcomes. This activity also underscored the importance of group process and teamwork in IKT. We propose that an a priori assessment of barriers to knowledge use (i.e., level and corresponding barriers), along with the other phases of the Knowledge to Action Framework, is a strategic approach for KT strategy development, implementation, and evaluation planning and could be used in the future planning of KT strategies.

The Special Education Core Curriculum Manual, Basic Level. Learning Skills, Oral Language, Reading, Mathematics.

ERIC Educational Resources Information Center

Margolis, Leonard

The manual is designed to serve as a guideline for teachers and child study teams who have the primary responsibility for the education of handicapped children in four areas--learning skills, oral language, reading, and mathematics. Sections for each of the above areas are subdivided into the following objectives and activities: gross motor…

Manufacturing process applications team (MATeam)

NASA Technical Reports Server (NTRS)

Bangs, E. R.; Meyer, J. D.

1978-01-01

Activities of the manufacturing applications team (MATeam) in effecting widespread transfer of NASA technology to aid in the solution of manufacturing problems in the industrial sector are described. During the program's first year of operation, 450 companies, industry associations, and government agencies were contacted, 150 manufacturing problems were documented, and 20 potential technology transfers were identified. Although none of the technology transfers has been commercialized and put in use, several are in the applications engineering phase, and others are in the early stages of implementation. The technology transfer process is described and guidelines used for the preparation of problems statements are included.

How to Suceed in Team Teaching--By Really Trying. Occasional Paper No. 13.

ERIC Educational Resources Information Center

Nolan, Robert R.; Roper, Susan Stavert

This paper provides guidelines in three areas for organizing and working in teaching teams: (1) getting started; (2) making the most of team meetings; and (3) minimizing team problems. Getting started requires a number of key decisions: (1) on what basis should team members be selected? (2) what should be the size of the team? (3) what areas…

Guidelines for the Statement and Assessment of Student Competencies. Teacher Education Forum Series. Vol. 1, No. 10.

ERIC Educational Resources Information Center

Bullock, Terry; And Others

This paper, prepared by the Division of Teacher Education Evaluation Team at Indiana University, presents a set of proposed student competencies and ways to assess them. It also contains the guidelines developed by the evaluation team to help teacher education projects and programs in developing competencies and measurement procedures, as well as…

Variety, Enjoyment, and Physical Activity Participation Among High School Students

PubMed Central

Michael, Shannon L.; Coffield, Edward; Lee, Sarah M.; Fulton, Janet E.

2017-01-01

Background Federal guidelines state that youth should participate in a variety of physical activity (PA) they find enjoyable. Little is known, however, about how variety and enjoyment are associated with PA participation among adolescents. Methods Data came from the 2010 National Youth Physical Activity and Nutrition Survey, a nationally representative survey of adolescents. Path analysis was used to examine the association of a variety of self-reported PA, defined as the number of activities and activity types (ie, team sports/weightlifting, individual activities, and other competitive/recreational sports), on self-reported PA enjoyment and participation. The analysis also examined whether enjoyment mediates the association between a variety of PA and participation. Separate models were estimated for boys and girls. Results Number of activities was associated with increased PA enjoyment and participation. For boys and girls, team sports/weightlifting was associated with increased participation, and individual activities were indirectly associated with increased participation through enjoyment. For boys, team sports/weightlifting was indirectly related with participation. Conclusions These findings suggest that participation in a variety of PA is associated with increased PA enjoyment and participation. Providing opportunities for adolescents to engage in a variety of activities might help them identify PA they enjoy and facilitate lifelong PA habits. PMID:26107142

General Guidelines on Criteria for Adoption or Rejection of Evaluated Libraries and Data by the Nuclear Data Team

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

Neudecker, Denise; Conlin, Jeremy Lloyd; Gray, Mark Girard

This memo contains general guidelines on what documentation and tools need to be in place as well as format and data testing requirements such that evaluated nuclear data sets or entire libraries can be adopted by the nuclear data team. Additional requirements beyond this memo might apply for specific nuclear data observables. These guidelines were established based on discussions between J.L. Conlin, M.G. Gray, A.P. McCartney, D. Neudecker, D.K. Parsons and M.C. White.

Dazed and confused: sports medicine, conflicts of interest, and concussion management.

PubMed

Partridge, Brad

2014-03-01

Professional sports with high rates of concussion have become increasingly concerned about the long-term effects of multiple head injuries. In this context, return-to-play decisions about concussion generate considerable ethical tensions for sports physicians. Team doctors clearly have an obligation to the welfare of their patient (the injured athlete) but they also have an obligation to their employer (the team), whose primary interest is typically success through winning. At times, a team's interest in winning may not accord with the welfare of an injured player, particularly when it comes to decisions about returning to play after injury. Australia's two most popular professional football codes-rugby league and Australian Rules football-have adopted guidelines that prohibit concussed players from continuing to play on the same day. I suggest that conflicts of interest between doctors, patients, and teams may present a substantial obstacle to the proper adherence of concussion guidelines. Concussion management guidelines implemented by a sport's governing body do not necessarily remove or resolve conflicts of interest in the doctor-patient-team triad. The instigation of a concussion exclusion rule appears to add a fourth party to this triad (the National Rugby League or the Australian Football League). In some instances, when conflicts of interest among stakeholders are ignored or insufficiently managed, they may facilitate attempts at circumventing concussion management guidelines to the detriment of player welfare.

Adapting heart failure guidelines for nursing care in home health settings: challenges and solutions.

PubMed

Radhakrishnan, Kavita; Topaz, Maxim; Masterson Creber, Ruth

2014-07-01

Nurses provide most of home health services for patients with heart failure, and yet there are no evidence-based practice guidelines developed for home health nurses. The purpose of this article was to review the challenges and solutions for adapting generally available HF clinical practice guidelines to home health nursing. Appropriate HF guidelines were identified and home health nursing-relevant guidelines were extracted by the research team. In addition, a team of nursing academic and practice experts evaluated the extracted guidelines and reached consensus through Delphi rounds. We identified 172 recommendations relevant to home health nursing from the American Heart Association and Heart Failure Society of America guidelines. The recommendations were divided into 5 groups (generic, minority populations, normal ejection fraction, reduced ejection fraction, and comorbidities) and further subgroups. Experts agreed that 87% of the recommendations selected by the research team were relevant to home health nursing and rejected 6% of the selected recommendations. Experts' opinions were split on 7% of guideline recommendations. Experts mostly disagreed on recommendations related to HF medication and laboratory prescription as well as HF patient assessment. These disagreements were due to lack of patient information available to home health nurses as well as unclear understanding of scope of practice regulations for home health nursing. After 2 Delphi rounds over 8 months, we achieved 100% agreement on the recommendations. The finalized guideline included 153 recommendations. Guideline adaptation projects should include a broad scope of nursing practice recommendations from which home health agencies can customize relevant recommendations in accordance with available information and state and agency regulations.

The Good Clinical Practice guideline and its interpretation - perceptions of clinical trial teams in sub-Saharan Africa.

PubMed

Vischer, N; Pfeiffer, C; Joller, A; Klingmann, I; Ka, A; Kpormegbe, S K; Burri, C

2016-08-01

To explore the advantages and challenges of working with the Good Clinical Practice (GCP)-International Conference of Harmonization (ICH) E6 guideline and its interpretation from the perspective of clinical trial teams based in sub-Saharan Africa. We conducted 60 key informant interviews with clinical trial staff at different levels in clinical research centres in Kenya, Ghana, Burkina Faso and Senegal and thematically analysed the responses. Clinical trial teams perceived working with ICH-GCP as highly advantageous and regarded ICH-GCP as applicable to their setting and efficiently applied. Only for informed consent did some clinical trial staff (one-third) perceive the guideline as insufficiently applicable. Specific challenges included meeting the requirements for written and individual consent, conditions for impartial witnesses for illiterates or legally acceptable representatives for children, guaranteeing voluntary participation and ensuring full understanding of the consent given. It was deemed important to have ICH-GCP compliance monitored by relevant ethics committees and regulatory authorities, without having guidelines applied overcautiously. Clinical trial teams in sub-Saharan Africa perceived GCP as a helpful guideline, despite having been developed by northern organisations and despite the high administrative burden of implementing it. To mitigate consent challenges, we suggest adapting GCP and making use of the flexibility it offers. © 2016 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

A Clinical Framework to Facilitate Risk Stratification When Considering an Active Surveillance Alternative to Immediate Biopsy and Surgery in Papillary Microcarcinoma.

PubMed

Brito, Juan P; Ito, Yasuhiro; Miyauchi, Akira; Tuttle, R Michael

2016-01-01

The 2015 American Thyroid Association thyroid cancer management guidelines endorse an active surveillance management approach as an alternative to immediate biopsy and surgery in subcentimeter thyroid nodules with highly suspicious ultrasonographic characteristics and in cytologically confirmed very low risk papillary thyroid cancer (PTC). However, the guidelines provide no specific recommendations with regard to the optimal selection of patients for an active surveillance management approach. This article describes a risk-stratified clinical decision-making framework that was developed by the thyroid cancer disease management team at Memorial Sloan Kettering Cancer Center as the lessons learned from Kuma Hospital in Japan were applied to a cohort of patients with probable or proven papillary microcarcinoma (PMC) who were being evaluated for an active surveillance management approach in the United States. A risk-stratified approach to the evaluation of patients with probable or proven PMC being considered for an active surveillance management approach requires an evaluation of three interrelated but distinct domains: (i) tumor/neck ultrasound characteristics (e.g., size of the primary tumor, the location of the tumor within the thyroid gland); (ii) patient characteristics (e.g., age, comorbidities, willingness to accept observation); and (iii) medical team characteristics (e.g., availability and experience of the multidisciplinary team). Based on an analysis of the critical factors within each of these domains, patients with probable or proven PTC can then be classified as ideal, appropriate, or inappropriate candidates for active surveillance. Risk stratification utilizing the proposed decision-making framework will improve the ability of clinicians to recognize individual patients with proven or probable PMC who are most likely to benefit from an active surveillance management option while at the same time identifying patients with proven or probable PMC that would be better served with an upfront biopsy and surgical management approach.

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016).

PubMed

Nishida, Osamu; Ogura, Hiroshi; Egi, Moritoki; Fujishima, Seitaro; Hayashi, Yoshiro; Iba, Toshiaki; Imaizumi, Hitoshi; Inoue, Shigeaki; Kakihana, Yasuyuki; Kotani, Joji; Kushimoto, Shigeki; Masuda, Yoshiki; Matsuda, Naoyuki; Matsushima, Asako; Nakada, Taka-Aki; Nakagawa, Satoshi; Nunomiya, Shin; Sadahiro, Tomohito; Shime, Nobuaki; Yatabe, Tomoaki; Hara, Yoshitaka; Hayashida, Kei; Kondo, Yutaka; Sumi, Yuka; Yasuda, Hideto; Aoyama, Kazuyoshi; Azuhata, Takeo; Doi, Kent; Doi, Matsuyuki; Fujimura, Naoyuki; Fuke, Ryota; Fukuda, Tatsuma; Goto, Koji; Hasegawa, Ryuichi; Hashimoto, Satoru; Hatakeyama, Junji; Hayakawa, Mineji; Hifumi, Toru; Higashibeppu, Naoki; Hirai, Katsuki; Hirose, Tomoya; Ide, Kentaro; Kaizuka, Yasuo; Kan'o, Tomomichi; Kawasaki, Tatsuya; Kuroda, Hiromitsu; Matsuda, Akihisa; Matsumoto, Shotaro; Nagae, Masaharu; Onodera, Mutsuo; Ohnuma, Tetsu; Oshima, Kiyohiro; Saito, Nobuyuki; Sakamoto, So; Sakuraya, Masaaki; Sasano, Mikio; Sato, Norio; Sawamura, Atsushi; Shimizu, Kentaro; Shirai, Kunihiro; Takei, Tetsuhiro; Takeuchi, Muneyuki; Takimoto, Kohei; Taniguchi, Takumi; Tatsumi, Hiroomi; Tsuruta, Ryosuke; Yama, Naoya; Yamakawa, Kazuma; Yamashita, Chizuru; Yamashita, Kazuto; Yoshida, Takeshi; Tanaka, Hiroshi; Oda, Shigeto

2018-01-01

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 and published in the Journal of JSICM , [2017; Volume 24 (supplement 2)] 10.3918/jsicm.24S0001 and Journal of Japanese Association for Acute Medicine [2017; Volume 28, (supplement 1)] http://onlinelibrary.wiley.com/doi/10.1002/jja2.2017.28.issue-S1/issuetoc.This abridged English edition of the J-SSCG 2016 was produced with permission from the Japanese Association of Acute Medicine and the Japanese Society for Intensive Care Medicine. Members of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ) and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two-thirds (> 66.6%) majority vote of each of the 19 committee members. A total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J-SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation, and its supporting evidence were also added to each recommendation statement. We conducted meta-analyses for 29 CQs. Thirty-seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for five CQs. Based on the evidence gathered, we were able to formulate Japanese-specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non-specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.

Differences in ball speed and three-dimensional kinematics between male and female handball players during a standing throw with run-up.

PubMed

Serrien, Ben; Clijsen, Ron; Blondeel, Jonathan; Goossens, Maggy; Baeyens, Jean-Pierre

2015-01-01

The purpose of this paper was to examine differences in ball release speed and throwing kinematics between male and female team-handball players in a standing throw with run-up. Other research has shown that this throwing type produces the highest ball release speeds and comparing groups with differences in ball release speed can suggest where this difference might come from. If throwing technique differs, perhaps gender-specific coordination- and strength-training guidelines are in order. Measurements of three-dimensional kinematics were performed with a seven-camera VICON motion capture system and subsequent joint angles and angular velocities calculations were executed in Mathcad. Data-analysis with Statistical Parametric Mapping allowed us to examine the entire time-series of every variable without having to reduce the data to certain scalar values such as minima/maxima extracted from the time-series. Statistical Parametric Mapping enabled us to detect several differences in the throwing kinematics (12 out of 20 variables had one or more differences somewhere during the motion). The results indicated two distinct strategies in generating and transferring momentum through the kinematic chain. Male team-handball players showed more activity in the transverse plane (pelvis and trunk rotation and shoulder horizontal abduction) whereas female team-handball players showed more activity in the sagital plane (trunk flexion). Also the arm cocking maneuver was quite different. The observed differences between male and female team handball players in the motions of pelvis, trunk and throwing arm can be important information for coaches to give feedback to athletes. Whether these differences contribute to the observed difference in ball release speed is at the present unclear and more research on the relation with anthropometric profile needs to be done. Kinematic differences might suggest gender-specific training guidelines in team-handball.

Impact of the Provider and Healthcare team Adherence to Treatment Guidelines (PHAT-G) intervention on adherence to national obesity clinical practice guidelines in a primary care centre.

PubMed

Barnes, Emily R; Theeke, Laurie A; Mallow, Jennifer

2015-04-01

Obesity is significantly underdiagnosed and undertreated in primary care settings. The purpose of this clinical practice change project was to increase provider adherence to national clinical practice guidelines for the diagnosis and treatment of obesity in adults. Based upon the National Institutes of Health guidelines for the diagnosis and treatment of obesity, a clinical change project was implemented. Guided by the theory of planned behaviour, the Provider and Healthcare team Adherence to Treatment Guidelines (PHAT-G) intervention includes education sessions, additional provider resources for patient education, a provider reminder system and provider feedback. Primary care providers did not significantly increase on documentation of diagnosis and planned management of obesity for patients with body mass index (BMI) greater than or equal to 30. Medical assistants increased recording of height, weight and BMI in the patient record by 13%, which was significant. Documentation of accurate BMI should lead to diagnosis of appropriate weight category and subsequent care planning. Future studies will examine barriers to adherence to clinical practice guidelines for obesity. Interventions are needed that include inter-professional team members and may be more successful if delivered separately from routine primary care visits. © 2015 John Wiley & Sons, Ltd.

Implementation of the Crisis Resolution Team model in adult mental health settings: a systematic review.

PubMed

Wheeler, Claire; Lloyd-Evans, Brynmor; Churchard, Alasdair; Fitzgerald, Caroline; Fullarton, Kate; Mosse, Liberty; Paterson, Bethan; Zugaro, Clementina Galli; Johnson, Sonia

2015-04-08

Crisis Resolution Teams (CRTs) aim to offer an alternative to hospital admission during mental health crises, providing rapid assessment, home treatment, and facilitation of early discharge from hospital. CRTs were implemented nationally in England following the NHS Plan of 2000. Single centre studies suggest CRTs can reduce hospital admissions and increase service users' satisfaction: however, there is also evidence that model implementation and outcomes vary considerably. Evidence on crucial characteristics of effective CRTs is needed to allow team functioning to be optimised. This review aims to establish what evidence, if any, is available regarding the characteristics of effective and acceptable CRTs. A systematic review was conducted. MEDLINE, Embase, PsycINFO, CINAHL and Web of Science were searched to November 2013. A further web-based search was conducted for government and expert guidelines on CRTs. We analysed studies separately as: comparing CRTs to Treatment as Usual; comparing two or more CRT models; national or regional surveys of CRT services; qualitative studies of stakeholders' views regarding best practice in CRTs; and guidelines from government and expert organisations regarding CRT service delivery. Quality assessment and narrative synthesis were conducted. Statistical meta-analysis was not feasible due to the variety of design of retrieved studies. Sixty-nine studies were included. Studies varied in quality and in the composition and activities of the clinical services studied. Quantitative studies suggested that longer opening hours and the presence of a psychiatrist in the team may increase CRTs' ability to prevent hospital admissions. Stakeholders emphasised communication and integration with other local mental health services; provision of treatment at home; and limiting the number of different staff members visiting a service user. Existing guidelines prioritised 24-hour, seven-day-a-week CRT service provision (including psychiatrist and medical prescriber); and high quality of staff training. We cannot draw confident conclusions about the critical components of CRTs from available quantitative evidence. Clearer definition of the CRT model is required, informed by stakeholders' views and guidelines. Future studies examining the relationship of overall CRT model fidelity to outcomes, or evaluating the impact of key aspects of the CRT model, are desirable. Prospero CRD42013006415 .

Using "get with the guidelines" to improve cardiovascular secondary prevention.

PubMed

LaBresh, Kenneth A; Gliklich, Richard; Liljestrand, James; Peto, Randolph; Ellrodt, A Gray

2003-10-01

"Get With The Guidelines (GWTG)" was developed and piloted by the American Heart Association (AHA), New England Affiliate; MassPRO, Inc.; and other organizations to reduce the gap in the application of secondary prevention guidelines in hospitalized cardiovascular disease patients. Collaborative learning programs and technology solutions were created for the project. The interactive Web-based patient management tool (PMT) was developed using quality measures derived from the AHA/American College of Cardiology secondary prevention guidelines. It provided data entry, embedded reminders and guideline summaries, and online reports of quality measure performance, including comparisons with the aggregate performance of all hospitals. Multidisciplinary teams from 24 hospitals participated in the 2000-2001 pilot. Four collaborative learning sessions and monthly conference calls supported team interaction. Best-practices sharing and the use of an Internet tool enabled hospitals to change systems and collect data on 1,738 patients. The GWTG program, a template of learning sessions with didactic presentations, best-practices sharing, and collaborative multidisciplinary team meetings supported by the Internet-based data collection and reporting system, can be extended to multiple regions without requiring additional development. Following the completion of the pilot, the AHA adopted GWTG as a national program.

A crisis resolution and home treatment team in Norway: a longitudinal survey study Part 2. Provision of professional services

PubMed Central

2012-01-01

Background Crisis resolution and home treatment (CRHT) is an emerging mode of delivering acute mental health care in the community. There is a paucity of knowledge regarding the workings of CRHT in the literature. This is the second paper in a series of three from the longitudinal survey of patients of a CRHT team in Norway, which was aimed at describing the characteristics of patients served, professional services provided, and clinical outcomes. This report focuses on the provision of professional services by the team. Methods The project was a descriptive, quantitative study based on the patient data from a longitudinal survey of one CRHT team in Norway. The participants of the survey, a total of 363 patients, constituted the complete registration of patients of this team in the period from February 2008 to July 2009. Results The average length of service by the team was about 15 days, and those with depression as the major symptom had the longest mean length of stay on the team. The team was engaged in providing a variety of services including individual treatments involving multiple professionals, group treatment meetings, and coordination activities involving external service sectors. While the type of professionals providing individual treatment was not associated with the severity level of clinical problems, those receiving various group treatment meetings had more serious level of clinical symptoms than those not receiving group treatment meetings. In addition coordination activities involving healthcare professionals and social services in the community were in line with the patients' clinical and social needs. The results of the study show that the team functioned effectively in addressing the general guidelines for the functioning of CRHT teams. PMID:22958549

Team Learning to Narrow the Gap between Healthcare Knowledge and Practice

ERIC Educational Resources Information Center

Anand, Tejwansh S.

2014-01-01

This study explored team-based learning in teams of healthcare professionals working on making meaning of evidence-based clinical guidelines in their field to apply them within their practice setting. The research based team learning models posited by Kasl, Marsick, and Dechant (1997) and Edmondson, Dillon, and Roloff (2007) were used as the…

Does enrollment in multidisciplinary team-based primary care practice improve adherence to guideline-recommended processes of care? Quebec's Family Medicine Groups, 2002-2010.

PubMed

Diop, Mamadou; Fiset-Laniel, Julie; Provost, Sylvie; Tousignant, Pierre; Borgès Da Silva, Roxane; Ouimet, Marie-Jo; Latimer, Eric; Strumpf, Erin

2017-04-01

We investigated whether multidisciplinary team-based primary care practice improves adherence to process of care guidelines, in the absence of financial incentives related to pay-for-performance. We conducted a natural experiment including 135,119 patients, enrolled with a general practitioner (GP) in a multidisciplinary team Family Medicine Group (FMG) or non-FMG practice, using longitudinal data from Quebec's universal insurer over the relevant time period (2000-2010). All study subjects had diabetes, chronic obstructive pulmonary disease, or heart failure and were followed over a 7-year period, 2 years prior to enrollment and 5 years after. We constructed indicators on adherence to disease-specific guidelines and composite indicators across conditions. We evaluated the effect of FMGs using propensity score methods and Difference-in-Differences (DD) models. Rates of adherence to chronic disease guidelines increased for both FMG and non-FMG patients after enrollment, but not differentially so. Adherence to prescription-related guidelines improved less for FMG patients (DD [95% CI]=-2.83% [-4.08%, -1.58%]). We found no evidence of an FMG effect on adherence to consultation-related guidelines, (DD [95% CI]=-0.24% [-2.24%; 1.75%]). We found no evidence that FMGs increased adherence to the guidelines we evaluated. Future research is needed to assess why this reform did not improve performance on these quality-of-care indicators. Copyright © 2017 Elsevier B.V. All rights reserved.

American Bar Association Supplementary Guidelines for the Mitigation Function of Defense Teams in Death Penalty Cases: implications for social work.

PubMed

Andrews, Arlene Bowers

2012-04-01

When a client faces a penalty of death, defense attorneys may call on social workers in many capacities: mitigation specialist, expert witness, consulting specialist, direct witness, or defense-initiated victim outreach worker. The American Bar Association set forth standards for capital defense attorneys, which led an interdisciplinary team to produce the "Supplementary Guidelines for the Mitigation Function of Defense Teams in Death Penalty Cases" to promote the exceptional competence and diligence required when the consequence is life or death. This article summarizes the "Supplementary Guidelines," with implications for social work practice--that is, professional responsibility, competence, interviewing skill, knowledge of behavioral and mental impairment, records review, life history compilation, data interpretation, witness support, law-related knowledge, and testimony. The social work, which is scrutinized in a court of law, requires cultural competence, diverse oral and written communication skills, diligence, and the highest ethical standards.

Neighborhood Team Policing: Prescriptive Package.

ERIC Educational Resources Information Center

Bloch, Peter B.; Specht, David

The manual for neighborhood team policing, a method of decentralizing police departments, presents guidelines for putting a team policing system into effect. Noticeable results of this type of this type organization have been an increased effectiveness in crime control, improved police-community relations, and improved police morale. Chapter 1…

77 FR 15722 - North Pacific Fishery Management Council; Public Notice

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-16

.... SUMMARY: The North Pacific Fishery Management Council's (Council's) Groundfish Plan Teams and Crab Plan Team will hold a workshop on Assessment/Management Issues Related to Recruitment, April 4-5, 2012 at... Council; telephone: (907) 271-2809. SUPPLEMENTARY INFORMATION: The Plan Teams will develop guidelines on...

Guidelines for Energy-Efficient Sustainable Schools.

ERIC Educational Resources Information Center

Nicklas, Michael; Bailey, Gary; Rosemain, Pascale; Olin, Samuel

These guidelines present optional strategies to be considered in designing schools to be more energy efficient and sustainable. The guidelines are organized by the following design and construction process: site selection; selection of A & E design team; programming and goal setting; schematic design; design development; construction…

Evaluating correlates of adolescent physical activity duration towards National Health Objectives: analysis of the Colorado Youth Risk Behavioral Survey, 2005.

PubMed

Nkansah-Amankra, Stephen; Diedhiou, Abdoulaye; Agbanu, Harry L K; Toma-Drane, Mariana; Dhawan, Ashish

2011-06-01

While numerous studies have examined the relationships among correlates of physical activity (PA), less attention has been given to identifying the correlates of low PA duration. The main objective of the current study was to examine correlates of low PA duration, team sports participation and smoking behaviors among adolescents. Data from the 2005 Colorado Youth Behavioral Risk Survey were analyzed using Cox proportional hazard models. We evaluated associations between two measures of low PA duration, assessed as per Healthy People 2010 (HP2010) objectives and 2008 Physical Activity Guidelines (PAG) for Americans, and smoking behaviors, participation in the physical education (PE) and team sports, controlling for age, gender and other behavioral characteristics. Forty percent and 70%, respectively, of adolescents did not meet the 2008 PAG and HP2010 objectives. After adjustment, smoking remained associated with failure to meet the 2008 PAG. However, no significant relationship was found with low PA duration as per the HP2010 objectives. The risk of low PA was higher among girls for both outcome measures. Likewise, adolescents who reported no participation in team sports presented a 7-fold higher risk of low PA as per the 2008 PAG and 51% higher risk of low PA as per the HP2010 objectives compared with the group with team sports participation. Regular participation in school PE and team sports may represent an important avenue for increasing PA duration and reducing smoking behaviors among adolescents.

Multiprofessional teamwork in work-related medical rehabilitation for patients with chronic musculoskeletal disorders.

PubMed

Schwarz, Betje; Neuderth, Silke; Gutenbrunner, Christoph; Bethge, Matthias

2015-01-01

Systematic reviews indicate the effectiveness of multimodal rehabilitation. In Germany this has been shown, in particular, for work-related medical rehabilitation. A recently published guideline on work-related medical rehabilitation supports the dissemination of these programmes. The feasibility of this guideline was examined in a multicentre study. This paper presents findings on the relevance of multiprofessional teamwork for the implementation of successful work-related medical rehabilitation. Focus groups were conducted with 7 inpatient orthopaedic rehabilitation teams and examined using qualitative content analysis. Multiprofessional teamwork emerged inductively as a meaningful theme. All teams described multiprofessional teamwork as a work-related medical rehabilitation success factor, referring to its relevance for holistic treatment of multifactorially impaired patients. Although similar indicators of successful multiprofessional teamwork were named, the teams realized multiprofessional teamwork differently. We found 3 team types, corresponding to multidisciplinary, interdisciplinary and transdisciplinary team models. These types and models constitute a continuum of collaborative practice, which seems to be affected by context-related factors. The significance of multiprofessional teamwork for successful multimodal rehabilitation was underlined. Indicators of ideal multiprofessional teamwork and contextual facilitators were specified. The contingency approach to teamwork, as well as the assumption of multiprofessional teamwork as a continuum of collaborative practice, is supported. Stronger consideration of multiprofessional teamwork in the work-related medical rehabilitation guideline is indicated.

Safety of Intravenous Thrombolytic Use in Four Emergency Departments without Acute Stroke Teams

PubMed Central

Scott, Phillip A.; Frederiksen, Shirley M.; Kalbfleisch, John D.; Xu, Zhenzhen; Meurer, William J.; Caveney, Angela F.; Sandretto, Annette; Holden, Ann B.; Haan, Mary N.; Hoeffner, Ellen G.; Ansari, Sameer A.; Lambert, David P.; Jaggi, Michael; Barsan, William G.; Silbergleit, Robert

2010-01-01

Objectives To evaluate safety of intravenous tissue plasminogen activator (tPA) delivered without dedicated thrombolytic stroke teams. Methods This was a retrospective, observational study of patients treated between 1996 and 2005 at four southeastern Michigan hospital emergency departments (EDs) with a prospectively defined comparison to the National Institute of Neurological Disorders and Stroke (NINDS) tPA stroke study cohort. Main outcome measures were mortality, intracerebral hemorrhage (ICH), systemic hemorrhage, neurologic recovery, and guideline violations. Results Two hundred seventy-three consecutive stroke patients were treated by 95 emergency physicians using guidelines and local neurology resources. One-year mortality was 27.8%. Unadjusted Cox model relative risk of mortality compared to the NINDS tPA treatment and placebo groups was 1.20 (95% confidence interval [CI] = 0.87 to 1.64) and 1.04 (95% CI = 0.76 to 1.41), respectively. Rate of significant ICH by computed tomography criteria was 6.6% (OR 1.03, 95% CI = 0.56 to 1.90 compared to NINDS tPA treatment group). The proportion of symptomatic ICH by two other pre-specified sets of clinical criteria was 4.8% and 7.0%. Rate of any ICH within 36 hours of treatment was 9.9% (relative risk [RR] 0.94, 95% CI = 0.58 to 1.51 compared to NINDS tPA group). Occurrence of major systemic hemorrhage (requiring transfusion) was 1.1%. Functional recovery by the modified Rankin Scale score (mRS 0 to 2) at discharge occurred in 38% of patients with a premorbid disability mRS < 2. Guideline deviations occurred in the ED in 26% of patients and in 25% of patients following admission. Conclusions In these EDs there was no evidence of increased risk with respect to mortality, ICH, systemic hemorrhage, or worsened functional outcome when tPA was administered without dedicated thrombolytic stroke teams. Additional effort is needed to improve guideline compliance. PMID:21040107

Community-based preventive activities in the Public Dental Service in Norway.

PubMed

Widström, E; Tillberg, A; Byrkjeflot, L I; Stein, L; Skudutyte-Rysstad, R

2018-05-01

The purpose of this study was to describe community-based preventive interventions undertaken by the dental team outside the dental clinics in Norway, from the dental hygienists' and the dentists' perspective, with the main focus on target groups and existing guidelines and routines for these activities. A secondary aim was to identify the personnel responsible for developing the local guidelines and the knowledge sources for the guidelines. With the assistance of the Chief Dental Officers in 15 Public Dental Service (PDS) regions, questionnaires were emailed to the local clinics (n = 421). In each, the most experienced dental hygienist and dentist were asked to respond; 215 dentists and 166 and dental hygienists responded (60%). Almost 40% of the respondents reported that their clinic had guidelines on community-based activities conducted outside the clinics. Dental hygienists and local chief dentists were responsible for planning them. The main target groups were young children and the dependent elderly; the majority of the activities were carried out at child welfare centres and for personnel at nursing homes or for home care nurses. At the regional and local level, a more strategic and coordinated approach to the provision of community-based activities is needed, including assessment of oral health needs among population groups. Continuous documentation and evaluation of results are necessary for optimal use of available resources and to facilitate an evidence-based approach. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The Special Education Prevocational Level Manual: Project V.I.E.W. (Vocational Instruction and Experience Workshop). Assembly Skills, Woodworking Skills, Graphic Arts Skills, Measurement Skills, Plastic Skills, Horticulture Skills.

ERIC Educational Resources Information Center

Northern Valley Regional High School District, Closter, NJ.

Designed as a guideline for teachers and child study teams in a prevocational program for handicapped students, the manual presents goals, objectives and sample activities including the elements of career awareness, prevocational instruction, job simulation, and readiness for formal vocational instruction. Six sections are addressed: (1) assembly…

Obstetrical brachial plexus injury (OBPI): Canada's national clinical practice guideline

PubMed Central

Coroneos, Christopher J; Voineskos, Sophocles H; Christakis, Marie K; Thoma, Achilleas; Bain, James R; Brouwers, Melissa C

2017-01-01

Objective The objective of this study was to establish an evidence-based clinical practice guideline for the primary management of obstetrical brachial plexus injury (OBPI). This clinical practice guideline addresses 4 existing gaps: (1) historic poor use of evidence, (2) timing of referral to multidisciplinary care, (3) Indications and timing of operative nerve repair and (4) distribution of expertise. Setting The guideline is intended for all healthcare providers treating infants and children, and all specialists treating upper extremity injuries. Participants The evidence interpretation and recommendation consensus team (Canadian OBPI Working Group) was composed of clinicians representing each of Canada's 10 multidisciplinary centres. Outcome measures An electronic modified Delphi approach was used for consensus, with agreement criteria defined a priori. Quality indicators for referral to a multidisciplinary centre were established by consensus. An original meta-analysis of primary nerve repair and review of Canadian epidemiology and burden were previously completed. Results 7 recommendations address clinical gaps and guide identification, referral, treatment and outcome assessment: (1) physically examine for OBPI in newborns with arm asymmetry or risk factors; (2) refer newborns with OBPI to a multidisciplinary centre by 1 month; (3) provide pregnancy/birth history and physical examination findings at birth; (4) multidisciplinary centres should include a therapist and peripheral nerve surgeon experienced with OBPI; (5) physical therapy should be advised by a multidisciplinary team; (6) microsurgical nerve repair is indicated in root avulsion and other OBPI meeting centre operative criteria; (7) the common data set includes the Narakas classification, limb length, Active Movement Scale (AMS) and Brachial Plexus Outcome Measure (BPOM) 2 years after birth/surgery. Conclusions The process established a new network of opinion leaders and researchers for further guideline development and multicentre research. A structured referral form is available for primary care, including referral recommendations. PMID:28132014

Management of patients with sore throats in relation to guidelines: an interview study in Sweden.

PubMed

Hedin, Katarina; Strandberg, Eva Lena; Gröndal, Hedvig; Brorsson, Annika; Thulesius, Hans; André, Malin

2014-12-01

To explore how a group of Swedish general practitioners (GPs) manage patients with a sore throat in relation to current guidelines as expressed in interviews. Qualitative content analysis was used to analyse semi-structured interviews. Swedish primary care. A strategic sample of 25 GPs. Perceived management of sore throat patients. It was found that nine of the interviewed GPs were adherent to current guidelines for sore throat and 16 were non-adherent. The two groups differed in terms of guideline knowledge, which was shared within the team for adherent GPs while idiosyncratic knowledge dominated for the non-adherent GPs. Adherent GPs had no or low concerns for bacterial infections and differential diagnosis whilst non-adherent GPs believed that in patients with a sore throat any bacterial infection should be identified and treated with antibiotics. Patient history and examination was mainly targeted by adherent GPs whilst for non-adherent GPs it was often redundant. Non-adherent GPs reported problems getting patients to abstain from antibiotics, whilst no such problems were reported in adherent GPs. This interview study of sore throat management in a strategically sampled group of Swedish GPs showed that while two-thirds were non-adherent and had a liberal attitude to antibiotics one-third were guideline adherent with a restricted view on antibiotics. Non-adherent GPs revealed significant knowledge gaps. Adherent GPs had discussed guidelines within the primary care team while non-adherent GPs had not. Guideline implementation thus seemed to be promoted by knowledge shared in team discussions.

Ethics in research.

PubMed

Bevan, Joan C

2007-04-01

This review will examine research ethics in the context of globalization of clinical trials and recent rapid developments in bioscience. It will focus on international ethical guidelines and the functions of research ethics review boards in research governance. Consent issues in genetic research, which must comply with privacy laws by protecting confidentiality and privacy of personal health data, will be discussed. There has been a rapid expansion of genomic and proteonomic research and biotechnology in the last decade. International ethical guidelines have been updated and the bioscience industry has developed ethics policies. At the same time, problems in academic anesthesia in the US and UK have been identified, leading to recommendations to train physician-scientists in anesthesia to stimulate research activity in the future. Anesthesiologists are joining interdisciplinary research teams and the concept of evidence-based translational research is emerging. Anesthesiologists are moving towards participation in interdisciplinary research teams. They are well placed to speed the translation of research discovery into clinical practice and provide evidence-based perioperative care. This review provides the ethical framework that anesthesiologists will need to meet the challenges of this changing pattern of practice.

Guidelines on CV networking information flow optimization for Texas.

DOT National Transportation Integrated Search

2017-03-01

Recognizing the fundamental role of information flow in future transportation applications, the research team investigated the quality and security of information flow in the connected vehicle (CV) environment. The research team identified key challe...

An International Approach to Enhancing a National Guideline on Driving and Dementia.

PubMed

Rapoport, Mark J; Chee, Justin N; Carr, David B; Molnar, Frank; Naglie, Gary; Dow, Jamie; Marottoli, Richard; Mitchell, Sara; Tant, Mark; Herrmann, Nathan; Lanctôt, Krista L; Taylor, John-Paul; Donaghy, Paul C; Classen, Sherrilene; O'Neill, Desmond

2018-03-12

The purpose of this study was to update a national guideline on assessing drivers with dementia, addressing limitations of previous versions which included a lack of developmental rigor and stakeholder involvement. An international multidisciplinary team reviewed 104 different recommendations from 12 previous guidelines on assessing drivers with dementia in light of a recent review of the literature. Revised guideline recommendations were drafted by consensus. A preliminary draft was sent to specialist physician and occupational therapy groups for feedback, using an a priori definition of 90% agreement as consensus. The research team drafted 23 guideline recommendations, and responses were received from 145 stakeholders. No recommendation was endorsed by less than 80% of respondents, and 14 (61%) of the recommendations were endorsed by more than 90%.The recommendations are presented in the manuscript. The revised guideline incorporates the perspectives of consensus of an expert group as well as front-line clinicians who regularly assess drivers with dementia. The majority of the recommendations were based on evidence at the level of expert opinion, revealing gaps in the evidence and future directions for research.

[Multidisciplinary practice guideline 'Marfan syndrome'].

PubMed

Hilhorst-Hofstee, Yvonne

2013-01-01

Marfan syndrome is a multi-system disorder of dominant inheritance in which the cardiovasculature, in particular the aorta, the eyes and the skeleton are affected. Diagnostic assessment and treatment of patients who are suspected of or have Marfan syndrome should preferably be done by multidisciplinary teams such as those found in specialised Marfan syndrome centres. The practice guideline is intended for all care givers involved with the recognition, diagnosis, consultations and the medicinal and surgical treatment of Marfan patients; it includes referral criteria and information on the referral process. A diagnosis of Marfan syndrome is based on international criteria in which aortic root dilatation and dissection, ectopia lentis, an affected first-degree family member and a pathogenic FBN1 mutation are the cardinal features. Alternative diagnoses are also included in the practice guideline. Recommendations are given for the monitoring and treatment of Marfan patients during pregnancy and delivery. Advice on lifestyle is mainly focussed on sports activities.

Improving guideline adherence through intensive quality improvement and the use of a National Quality Register in Sweden for acute myocardial infarction.

PubMed

Peterson, Anette; Carlhed, Rickard; Lindahl, Bertil; Lindström, Gunilla; Aberg, Christina; Andersson-Gäre, Boel; Bojestig, Mats

2007-01-01

Data from the Swedish National Register in Cardiac Care have shown over the last 10 years an enduring gap between optimal treatment of acute myocardial infarction (AMI) according to current guidelines and the treatment actually given. We performed a controlled, prospective study in order to evaluate the effects of applying a multidisciplinary team-based improvement methodology to the use of evidence-based treatments in AMI, together with the use of a modified National Quality Register. The project engaged 25% of the Swedish hospitals. Multidisciplinary teams from 20 hospitals participating in the National Register in Cardiac Care, ranging from small to large hospitals, were trained in continuous quality improvement methodology. Twenty matched hospitals served as controls. Our efforts were focused on finding and applying tools and methods to increase adherence to the national guidelines for 5 different treatments for AMI. For measurement, specially designed quality control charts were made available in the National Register for Cardiac Care. To close the gap, an important issue for the teams was to get all 5 treatments in place. Ten of the hospitals in the study group reduced the gap in 5 of 5 treatments by 50%, while none of the control hospitals did so. This first, controlled prospective study of a registry supported by multidisciplinary team-based improvement methodology showed that this approach led to rapidly improved adherence to AMI guidelines in a broad spectrum of hospitals and that National Quality Registers can be helpful tools.

General practitioner diagnosis and management of acute knee injuries: summary of an evidence-based guideline.

PubMed

Robb, Gillian; Reid, Duncan; Arroll, Bruce; Jackson, Rod T; Goodyear-Smith, Felicity

2007-02-16

To summarise evidence and key recommendations for general practitioner diagnosis and management of acute soft-tissue knee injuries, based on the New Zealand guideline. A multidisciplinary team developed the guideline by critically appraising and grading retrieved literature using the Graphic Appraisal Tools for Epidemiology, Clinical decision rules and the Scottish Intercollegiate Guideline Network. Recommendations were derived from resulting evidence tables. For both diagnosis and management there is a paucity of good evidence to support diagnosis and treatment of internal derangements of the knee, hence some aspects of the guideline are guideline team consensus. Good evidence supports the use of the Ottawa Knee rules to guide decisions about the use of X-ray, and the Lachman test in diagnosing anterior cruciate ligament (ACL) tears. Evidence supports inclusion of proprioceptive training in rehabilitation programmes following ACL reconstruction and in people with ACL-deficient knees. There is good evidence that ultrasound is of little benefit, and there is no evidence that physiotherapy be routinely advocated following meniscectomy. This guideline provides an evidence-based framework for diagnosis and management of internal derangements of the knee following acute injury. Moreover, its development highlights significant gaps in the evidence base and identifies priorities for new research.

Caries risk assessment in young adults using Public Dental Service guidelines and the Cariogram--a comparative study.

PubMed

Petersson, Gunnel Hänsel; Ericson, Ewa; Isberg, Per-Erik; Twetman, Svante

2013-01-01

To investigate the caries risk profiles in young adults and to compare the risk classification using the Public Dental Service (PDS) guidelines with a risk assessment program, the Cariogram. All 19-year-old patients registered at eight public dental clinics were invited to participate (n = 1699). The study group who completed the baseline examination consisted of 1295 subjects representing 10% of all 19 year-olds attending dental care at the PDS in Skåne, Sweden. A risk classification of each patient was made by the patient's regular team according to the PDS guidelines. A research team collected whole saliva samples and information from a questionnaire and a structured interview in order to calculate risk according to the Cariogram model. The mean DFS value was 4.9 and 23% of the patients were registered as caries-free (DFS = 0). The PDS risk classification was predominantly based on past caries and/or present caries activity. The majority was classified as 'some risk', while 16.7% were assessed as being of 'high' or 'very high risk'. The corresponding value for the two highest risk groups in the Cariogram model was 17.4%. The agreement between the two models was found acceptable (77.5%) for those assessed as low risk, while discrepancies were disclosed among those classified with higher risks. Although the proportion of subjects assessed with high or very high risk was similar using the PDS guidelines and the Cariogram model, the agreement between the models was fair. An acceptable agreement was only disclosed for the low risk category.

Teachers' Manual: Using Teams-Games-Tournament (TGT) in the Physical Science Classroom.

ERIC Educational Resources Information Center

Hollifield, John H.; Leavey, Marshall B.

This teacher's manual provides general and specific guidelines for use of Teams-Games-Tournaments (TGT) Physical Science Curriculum materials at the junior high-middle school level. TGT is an innovative instructional model which focuses on the learning of basic skills, information, and concepts, rewarding students in small teams rather than at the…

Impact of electronic clinical decision support on adherence to guideline-recommended treatment for hyperlipidaemia, atrial fibrillation and heart failure: protocol for a cluster randomised trial

PubMed Central

Kessler, Maya Elizabeth; Cook, David A; Kor, Daryl Jon; McKie, Paul M; Pencille, Laurie J; Scheitel, Marianne R; Chaudhry, Rajeev

2017-01-01

Introduction Clinical practice guidelines facilitate optimal clinical practice. Point of care access, interpretation and application of such guidelines, however, is inconsistent. Informatics-based tools may help clinicians apply guidelines more consistently. We have developed a novel clinical decision support tool that presents guideline-relevant information and actionable items to clinicians at the point of care. We aim to test whether this tool improves the management of hyperlipidaemia, atrial fibrillation and heart failure by primary care clinicians. Methods/analysis Clinician care teams were cluster randomised to receive access to the clinical decision support tool or passive access to institutional guidelines on 16 May 2016. The trial began on 1 June 2016 when access to the tool was granted to the intervention clinicians. The trial will be run for 6 months to ensure a sufficient number of patient encounters to achieve 80% power to detect a twofold increase in the primary outcome at the 0.05 level of significance. The primary outcome measure will be the percentage of guideline-based recommendations acted on by clinicians for hyperlipidaemia, atrial fibrillation and heart failure. We hypothesise care teams with access to the clinical decision support tool will act on recommendations at a higher rate than care teams in the standard of care arm. Ethics and dissemination The Mayo Clinic Institutional Review Board approved all study procedures. Informed consent was obtained from clinicians. A waiver of informed consent and of Health Insurance Portability and Accountability Act (HIPAA) authorisation for patients managed by clinicians in the study was granted. In addition to publication, results will be disseminated via meetings and newsletters. Trial registration number NCT02742545. PMID:29208620

Implementation of Water Safety Plans (WSPs): A Case Study in the Coastal Area in Semarang City, Indonesia

NASA Astrophysics Data System (ADS)

Budiyono; Ginandjar, P.; Saraswati, L. D.; Pangestuti, D. R.; Martini; Jati, S. P.

2018-02-01

An area of 508.28 hectares in North Semarang is flooded by tidal inundation, including Bandarharjo village, which could affect water quality in the area. People in Bandarharjo use safe water from deep groundwater, without disinfection process. More than 90% of water samples in the Bandaharjo village had poor bacteriological quality. The aimed of the research was to describe the implementation of Water Safety Plans (WSPs) program in Bandarharjo village. This was a descriptive study with steps for implementations adopted the guidelines and tools of the World Health Organization. The steps consist of introducing WSPs program, team building, training the team, examination of water safety before risk assessment, risk assessment, minor repair I, examination of water safety risk, minor repair II (after monitoring). Data were analyzed using descriptive methods. WSPs program has been introduced and formed WSPs team, and the training of the team has been conducted. The team was able to conduct risks assessment, planned the activities, examined water quality, conduct minor repair and monitoring at the source, distribution, and households connection. The WSPs program could be implemented in the coastal area in Semarang, however regularly supervision and some adjustment are needed.

Seismic design guidelines for highway bridges

NASA Astrophysics Data System (ADS)

Mayes, R. L.; Sharpe, R. L.

1981-10-01

Guidelines for the seismic design of highway bridges are given. The guidelines are the recommendations of a team of nationally recognized experts which included consulting engineers, academicians, State highway, and Federal agency representatives from throughout the United States. The guidelines are comprehensive in nature and they embody several new concepts which are significant departures from existing design provisions. An extensive commentary documenting the basis for the guidelines and an example demonstrating their use are included. A draft of the guidelines was used to seismically redesign twenty-one bridges. A summary of the redesigns is included.

Guidelines for research recruitment of underserved populations (EERC).

PubMed

Matsuda, Yui; Brooks, Jada L; Beeber, Linda S

2016-11-01

Despite concerted efforts to establish health equity, significant disparities persist. One roadblock to eliminating health disparities is the inadequate recruitment of underserved populations, which prevents researchers from creating culturally-tailored interventions. To further develop the science of recruitment, we argue that a systematic approach should be applied to research participant recruitment. Given the lack of practical and comprehensive recruitment conceptual frameworks or guidelines in the literature, the authors propose newly synthesized guidelines for research recruitment of underserved populations: EERC (evaluate, engage, reflect, and carefully match). The EERC guidelines are delineated, and the application of these guidelines is illustrated through a study recently conducted by the authors. The guidelines consist of the following four components: 1. Evaluate the composition of the research team; 2. Engage fully with the community by working with key informants and cultural insiders; 3. Reflect the unique cultural characteristics of the community in the research conduct; and 4. Carefully use a matching technique. The application component of the article demonstrates concrete examples of how the guidelines can enhance research recruitment for an underserved population. The authors intend these guidelines to be broadly applicable for research teams regardless of research design or characteristics of the underserved population. Application of these guidelines in nursing and health science will contribute to increasing research recruitment of underserved populations, with the goal of reducing health disparities and achieving health equity for all persons. Copyright © 2016 Elsevier Inc. All rights reserved.

Following a natural experiment of guideline adaptation and early implementation: a mixed-methods study of facilitation

PubMed Central

2012-01-01

Background Facilitation is emerging as an important strategy in the uptake of evidence. However, it is not entirely clear from a practical perspective how facilitation occurs to help move research evidence into nursing practice. The Canadian Partnership Against Cancer, also known as the 'Partnership,' is a Pan-Canadian initiative supporting knowledge translation activity for improved care through guideline use. In this case-series study, five self-identified groups volunteered to use a systematic methodology to adapt existing clinical practice guidelines for Canadian use. With 'Partnership' support, local and external facilitators provided assistance for groups to begin the process by adapting the guidelines and planning for implementation. Methods To gain a more comprehensive understanding of the nature of facilitation, we conducted a mixed-methods study. Specifically, we examined the role and skills of individuals actively engaged in facilitation as well as the actual facilitation activities occurring within the 'Partnership.' The study was driven by and builds upon a focused literature review published in 2010 that examined facilitation as a role and process in achieving evidence-based practice in nursing. An audit tool outlining 46 discrete facilitation activities based on results of this review was used to examine the facilitation noted in the documents (emails, meeting minutes, field notes) of three nursing-related cases participating in the 'Partnership' case-series study. To further examine the concept, six facilitators were interviewed about their practical experiences. The case-audit data were analyzed through a simple content analysis and triangulated with participant responses from the focus group interview to understand what occurred as these cases undertook guideline adaptation. Results The analysis of the three cases revealed that almost all of the 46 discrete, practical facilitation activities from the literature were evidenced. Additionally, case documents exposed five other facilitation-related activities, and a combination of external and local facilitation was apparent. Individuals who were involved in the case or group adapting the guideline(s) also performed facilitation activities, both formally and informally, in conjunction with or in addition to appointed external and local facilitators. Conclusions Facilitation of evidence-based practice is a multifaceted process and a team effort. Communication and relationship-building are key components. The practical aspects of facilitation explicated in this study validate what has been previously noted in the literature and expand what is known about facilitation process and activity. PMID:22309743

[Recommendations for the management of the child with allergic diseases at school].

PubMed

Saranz, Ricardo J; Lozano, Alejandro; Mariño, Andrea; Boudet, Raúl V; Sarraquigne, María Paula; Cáceres, María Elena; Bandín, Gloria; Lukin, Alicia; Skrie, Víctor; Cassaniti, María Cristina; Agüero, Claudio; Chorny, Marta; Reichbach, Débora S; Arnolt, Roque Gustavo; Cavallo, Aldo

2015-06-01

Allergic diseases cause great impact on the health related quality of life in children and adolescents, resulting in increased school absenteeism and deficiencies in school performance. Although the bibliographic framework on allergic diseases is wide, in our country, there are no guidelines for proper management of the allergic child at school. It is necessary to establish guidelines for coordinated action among the educational community, the families, the pediatrician, the health team and governmental and non-governmental authorities. This position paper aims to provide information about the impact of allergic diseases on school activities, establish standards of competence of the various stakeholders at school and consider the legal framework for the intervention of the school staff about the child with allergies at school.

Developing team leadership to facilitate guideline utilization: planning and evaluating a 3-month intervention strategy.

PubMed

Gifford, Wendy; Davies, Barbara; Tourangeau, Ann; Lefebre, Nancy

2011-01-01

Research describes leadership as important to guideline use. Yet interventions to develop current and future leaders for this purpose are not well understood. To describe the planning and evaluation of a leadership intervention to facilitate nurses' use of guideline recommendations for diabetic foot ulcers in home health care. Planning the intervention involved a synthesis of theory and research (qualitative interviews and chart audits). One workshop and three follow-up teleconferences were delivered at two sites to nurse managers and clinical leaders (n=15) responsible for 180 staff nurses. Evaluation involved workshop surveys and interviews. Highest rated intervention components (four-point scale) were: identification of target indicators (mean 3.7), and development of a team leadership action plan (mean 3.5). Pre-workshop barriers assessment rated lowest (mean 2.9). Three months later participants indicated their leadership performance had changed as a result of the intervention, being more engaged with staff and clear about implementation goals. Creating a team leadership action plan to operationalize leadership behaviours can help in delivery of evidence-informed care. Access to clinical data and understanding team leadership knowledge and skills prior to formal training will assist nursing management in tailoring intervention strategies to identify needs and gaps. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

Physical activity levels during youth sport practice: does coach training or experience have an influence?

PubMed

Schlechter, Chelsey R; Rosenkranz, Richard R; Milliken, George A; Dzewaltowski, David A

2017-01-01

This study examined moderate-to-vigorous physical activity (MVPA) levels in youth during flag football practice and compared youth MVPA in practices led by trained or untrained, and by experienced or inexperienced, coaches. Boys (n = 111, mean age = 7.9 ± 1.2 years) from 14 recreation-level flag football teams wore an accelerometer during two practices. Each team's volunteer head coach reported prior training and coaching experience. Mixed-model team-adjusted means showed the proportion of practice time spent in sedentary (13 ± 1%), MVPA (34 ± 2%) and vigorous (12 ± 1%) activity. Practice contributed ~20 min of MVPA towards public health guidelines. There was no significant difference in percentage time spent in MVPA between teams with trained (mean = 33.3%, 95% CI = 29.4%, 37.2%) and untrained coaches (mean = 35.9%, 95% CI = 25.5%, 42.4%) or between experienced (mean = 34.1%, 95% CI = 30.2%, 38.0%) and inexperienced coaches (mean = 33.8, 95% CI = 27.9%, 39.7%). Although sport provides a setting for youth to accrue MVPA, two-thirds of practice was spent sedentarily or in light activity. Participation in a coach training programme was not associated with higher MVPA. Further research is needed to inform volunteer coach training programmes that provide coaches with skills necessary to increase the percentage of practice time spent in MVPA.

Setting standards for the prevention and management of travellers' diarrhoea in elite athletes: an audit of one team during the Youth Commonwealth Games in India.

PubMed

Tillett, E; Loosemore, M

2009-12-01

Devise and implement evidence-based guidelines for the prevention and management of travellers' diarrhoea (TD), and establish the incidence of TD during an elite sporting trip to India. Literature review and audit. Youth Commonwealth Games in India 2008. All members of the Team England Squad. Hygiene guidelines included only drinking bottled water, eating hot food and regular hand washing with alcohol gel. Ciprofloxacin was offered to non-athlete team members as prophylaxis but not to athletes due to its possible association with tendon disease. Following implementation of these guidelines, the incidence of travellers' diarrhoea (TD) in the whole squad was 24/122 (20%), compared with 7/14 (50%) on the reconnaissance trip (preguidelines). In those taking prophylactic ciprofloxacin, the incidence was 4/33 (12%), compared with 20/89 (23%) in those not taking ciprofloxacin. No athlete missed their event due to TD. The incidence of TD was less during the event than on the reconnaissance trip. The relative contribution to this reduction in strict hygiene guidelines as compared with potentially improved catering hygiene arrangements is unknown. Prophylactic ciprofloxacin also reduced the incidence of TD but it is probably not appropriate for use in elite athletes. Rifaximin may be an alternative for this group.

Implementing clinical guidelines in stroke: a qualitative study of perceived facilitators and barriers.

PubMed

Donnellan, Claire; Sweetman, S; Shelley, E

2013-08-01

Clinical guidelines are frequently used as a mechanism for implementing evidence-based practice. However research indicates that health professionals vary in the extent to which they adhere to these guidelines. This study aimed to study the perceptions of stakeholders and health professionals on the facilitators and barriers to implementing national stroke guidelines in Ireland. Qualitative interviews using focus groups were conducted with stakeholders (n=3) and multidisciplinary team members from hospitals involved in stroke care (n=7). All focus group interviews were semi-structured, using open-ended questions. Data was managed and analysed using NVivo 9 software. The main themes to emerge from the focus groups with stakeholders and hospital multidisciplinary teams were very similar in terms of topics discussed. These were resources, national stroke guidelines as a tool for change, characteristics of national stroke guidelines, advocacy at local level and community stroke care challenges. Facilitators perceived by stakeholders and health professionals included having dedicated resources, user-friendly guidelines relevant at local level and having supportive advocates on the ground. Barriers were inadequate resources, poor guideline characteristics and insufficient training and education. This study highlights health professionals' perspectives regarding many key concepts which may affect the implementation of stroke care guidelines. The introduction of stroke clinical guidelines at a national level is not sufficient to improve health care quality as they should be incorporated in a quality assurance cycle with education programmes and feedback from surveys of clinical practice. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Factors Impacting Habitable Volume Requirements for Long Duration Missions

NASA Technical Reports Server (NTRS)

Simon, Matthew; Neubek, Deborah; Whitmire, Alexandria

2012-01-01

One possible next leap in human space exploration for the National Aeronautics and Space Administration (NASA) is a mission to a near Earth asteroid (NEA). In order to achieve such an ambitious goal, a space habitat will need to accommodate a crew of four for the 380-day round trip. The Human Spaceflight Architecture Team (HAT) developed a conceptual design for such a habitat. The team identified activities that would be performed inside a long-duration, deep space habitat, and the capabilities needed to support such a mission. A list of seven functional activities/capabilities was developed: individual and group crew care, spacecraft and mission operations, subsystem equipment, logistics and resupply, and contingency operations. The volume for each activity was determined using NASA STD-3001 and the companion Human Integration Design Handbook (HIDH). Although, the sum of these volumes produced an over-sized spacecraft, the team evaluated activity frequency and duration to identify functions that could share a common volume without conflict, reducing the total volume by 24%. After adding 10% for growth, the resulting functional pressurized volume was calculated to be a minimum of 268 m3 (9,464 ft3) distributed over the functions. The work was validated through comparison to Mir, Skylab, the International Space Station (ISS), Bigelow Aerospace s proposed habitat module, and NASA s Trans-Hab concept. Using HIDH guidelines, the team developed an internal layout that (a) minimized the transit time between related crew stations, (b) accommodated expected levels of activity at each station, (c) isolated stations when necessary for health, safety, performance, and privacy, and (d) provided a safe, efficient, and comfortable work and living environment.

Developing a Habitat for Long Duration, Deep Space Missions

NASA Technical Reports Server (NTRS)

Rucker, Michelle A.; Thompson, Shelby

2012-01-01

One possible next leap in human space exploration for the National Aeronautics and Space Administration (NASA) is a mission to a near Earth asteroid (NEA). In order to achieve such an ambitious goal, a space habitat will need to accommodate a crew of four for the 380-day round trip. The Human Spaceflight Architecture Team (HAT) developed a conceptual design for such a habitat. The team identified activities that would be performed inside a long-duration, deep space habitat, and the capabilities needed to support such a mission. A list of seven functional activities/capabilities was developed: individual and group crew care, spacecraft and mission operations, subsystem equipment, logistics and resupply, and contingency operations. The volume for each activity was determined using NASA STD-3001 and the companion Human Integration Design Handbook (HIDH). Although, the sum of these volumes produced an over-sized spacecraft, the team evaluated activity frequency and duration to identify functions that could share a common volume without conflict, reducing the total volume by 24%. After adding 10% for growth, the resulting functional pressurized volume was calculated to be a minimum of 268 cu m (9,464 cu ft) distributed over the functions. The work was validated through comparison to Mir, Skylab, the International Space Station (ISS), Bigelow Aerospace s proposed habitat module, and NASA s Trans-Hab concept. Using HIDH guidelines, the team developed an internal layout that (a) minimized the transit time between related crew stations, (b) accommodated expected levels of activity at each station, (c) isolated stations when necessary for health, safety, performance, and privacy, and (d) provided a safe, efficient, and comfortable work and living environment.

Two minutes CPR versus five cycles CPR prior to reanalysis of the cardiac rhythm: A prospective, randomized simulator-based trial.

PubMed

Weichert, Veronika; Sellmann, Timur; Wetzchewald, Dietmar; Gasch, Bernd; Hunziker, Sabina; Marsch, Stephan

2015-11-01

While the 2005 cardiopulmonary resuscitation (CPR) guidelines recommended to provide CPR for five cycles before the next cardiac rhythm check, the current 2010 guideline now recommend to provide CPR for 2 min. Our aim was to compare adherence to both targets in a simulator-based randomized trial. 119 teams, consisting of three to four physicians each, were randomized to receive a graphical display of the simplified circular adult BLS algorithm with the instruction to perform CPR for either 2 min or five cycles 30:2. Subsequently teams had to treat a simulated unwitnessed cardiac arrest. Data analysis was performed using video-recordings obtained during simulations. The primary endpoint was adherence, defined as being within ±20% of the instructed target (i.e. 96-144s in the 2 min teams and 4-6 cycles in the fivex30:2 teams). 22/62 (35%) of the "two minutes" teams and 48/57 (84%) of the "five×30:2″ teams provided CPR within a range of ± 20% of their instructed target (P<0.0001). The median time of CPR prior to rhythm check was 91s and 87s, respectively, (P=0.59) with a significant larger variance (P=0.023) in the "two minutes" group. This randomized simulator-based trial found better adherence and less variance to an instruction to continue CPR for five cycles before the next cardiac rhythm check compared to continuing CPR for 2 min. Avoiding temporal targets whenever possible in guidelines relating to stressful events appears advisable. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Predictors of In-Hospital Mortality After Rapid Response Team Calls in a 274 Hospital Nationwide Sample.

PubMed

Shappell, Claire; Snyder, Ashley; Edelson, Dana P; Churpek, Matthew M

2018-07-01

Despite wide adoption of rapid response teams across the United States, predictors of in-hospital mortality for patients receiving rapid response team calls are poorly characterized. Identification of patients at high risk of death during hospitalization could improve triage to intensive care units and prompt timely reevaluations of goals of care. We sought to identify predictors of in-hospital mortality in patients who are subjects of rapid response team calls and to develop and validate a predictive model for death after rapid response team call. Analysis of data from the national Get with the Guidelines-Medical Emergency Team event registry. Two-hundred seventy four hospitals participating in Get with the Guidelines-Medical Emergency Team from June 2005 to February 2015. 282,710 hospitalized adults on surgical or medical wards who were subjects of a rapid response team call. None. The primary outcome was death during hospitalization; candidate predictors included patient demographic- and event-level characteristics. Patients who died after rapid response team were older (median age 72 vs 66 yr), were more likely to be admitted for noncardiac medical illness (70% vs 58%), and had greater median length of stay prior to rapid response team (81 vs 47 hr) (p < 0.001 for all comparisons). The prediction model had an area under the receiver operating characteristic curve of 0.78 (95% CI, 0.78-0.79), with systolic blood pressure, time since admission, and respiratory rate being the most important variables. Patients who die following rapid response team calls differ significantly from surviving peers. Recognition of these factors could improve postrapid response team triage decisions and prompt timely goals of care discussions.

Teamwork in Task Analysis. Training Manual V. Evaluation of the Marine Corps Task Analysis Program. Technical Report No. 9.

ERIC Educational Resources Information Center

Kuriloff, Arthur H.; Yoder, Dale

This training manual provides guidelines for effective teamwork and work-team maintenance and development. It was designed for use in the Marine Corps Task Analysis program, in which staff members are organized to form a work-team whose continuing performance as an effective team is crucial for success of the project. Chapter 1, the major portion…

Debating Real-World Issues.

ERIC Educational Resources Information Center

Koenig, Maureen

2001-01-01

Presents three different scientific issues to students and uses debate as a way of gaining information. Involves information collection on the topic, team preparation, and debate between teams. Includes debate format and presentation guidelines, suggestions for debate questions, information on areas to explore when preparing to debate the question…

Situation awareness in airway facilities : replacement of maintenance control centers with operations control centers.

DOT National Transportation Integrated Search

2000-01-01

This document contains an updated and expanded version of the Automation chapter of the Human Factors Design Guide. A research team of human factors experts evaluated the existing guidelines for relevance, clarity, and usability. The research team dr...

Design and implementation of an inpatient disease management program.

PubMed

Cooper, G S; Armitage, K B; Ashar, B; Costantini, O; Creighton, F A; Raiz, P; Wong, R C; Carlson, M D

2000-07-01

To describe the development and implementation of an inpatient disease management program. Prospective observational study. On the basis of opportunities for improving quality or efficiency of inpatient and emergency department care, 4 diagnoses, including congestive heart failure (CHF), gastrointestinal hemorrhage, community-acquired pneumonia and sickle-cell crisis were selected for implementation of a disease management program. For each diagnosis, a task force assembled a disease management team led by a "physician champion" and nurse care manager and identified opportunities for improvement through medical literature review and interviews with caregivers. A limited number of disease-specific guidelines and corresponding interventions were selected with consensus of the team and disseminated to caregivers. Physician and nurse team leaders were actively involved in patient care to facilitate adherence to guidelines. For quarter 2 to 4 of 1997, there were improvements in angiotensin-converting enzyme inhibitor use, daily weight compliance, assessment of left ventricular function, hospital costs, and length of stay for care-managed patients with CHF. Differences in utilization-related outcomes persisted even after adjustment for severity of illness. For the other 3 diagnoses, the observational period was shorter (quarter 4 only), and hence preliminary data showed similar hospital costs and length of stay for care-managed and noncare-managed patients. An interdisciplinary approach to inpatient disease management resulted in substantial improvements in both quality and efficiency of care for patients with CHF. Additional data are needed to determine the program's impact on outcomes of other targeted diagnoses.

Effectiveness of implementation interventions in improving physician adherence to guideline recommendations in heart failure: a systematic review

PubMed Central

Shanbhag, Deepti; Graham, Ian D; Harlos, Karen; Haynes, R. Brian; Gabizon, Itzhak; Connolly, Stuart J; Van Spall, Harriette Gillian Christine

2018-01-01

Background The uptake of guideline recommendations that improve heart failure (HF) outcomes remains suboptimal. We reviewed implementation interventions that improve physician adherence to these recommendations, and identified contextual factors associated with implementation success. Methods We searched databases from January 1990 to November 2017 for studies testing interventions to improve uptake of class I HF guidelines. We used the Cochrane Effective Practice and Organisation of Care and Process Redesign frameworks for data extraction. Primary outcomes included: proportion of eligible patients offered guideline-recommended pharmacotherapy, self-care education, left ventricular function assessment and/or intracardiac devices. We reported clinical outcomes when available. Results We included 38 studies. Provider-level interventions (n=13 studies) included audit and feedback, reminders and education. Organisation-level interventions (n=18) included medical records system changes, multidisciplinary teams, clinical pathways and continuity of care. System-level interventions (n=3) included provider/institutional incentives. Four studies assessed multi-level interventions. We could not perform meta-analyses due to statistical/conceptual heterogeneity. Thirty-two studies reported significant improvements in at least one primary outcome. Clinical pathways, multidisciplinary teams and multifaceted interventions were most consistently successful in increasing physician uptake of guidelines. Among randomised controlled trials (RCT) (n=10), pharmacist and nurse-led interventions improved target dose prescriptions. Eleven studies reported clinical outcomes; significant improvements were reported in three, including a clinical pathway, a multidisciplinary team and a multifaceted intervention. Baseline assessment of barriers, staff training, iterative intervention development, leadership commitment and policy/financial incentives were associated with intervention effectiveness. Most studies (n=20) had medium risk of bias; nine RCTs had low risk of bias. Conclusion Our study is limited by the quality and heterogeneity of the primary studies. Clinical pathways, multidisciplinary teams and multifaceted interventions appear to be most consistent in increasing guideline uptake. However, improvements in process outcomes were rarely accompanied by improvements in clinical outcomes. Our work highlights the need for improved research methodology to reliably assess the effectiveness of implementation interventions. PMID:29511005

Effectiveness of implementation interventions in improving physician adherence to guideline recommendations in heart failure: a systematic review.

PubMed

Shanbhag, Deepti; Graham, Ian D; Harlos, Karen; Haynes, R Brian; Gabizon, Itzhak; Connolly, Stuart J; Van Spall, Harriette Gillian Christine

2018-03-06

The uptake of guideline recommendations that improve heart failure (HF) outcomes remains suboptimal. We reviewed implementation interventions that improve physician adherence to these recommendations, and identified contextual factors associated with implementation success. We searched databases from January 1990 to November 2017 for studies testing interventions to improve uptake of class I HF guidelines. We used the Cochrane Effective Practice and Organisation of Care and Process Redesign frameworks for data extraction. Primary outcomes included: proportion of eligible patients offered guideline-recommended pharmacotherapy, self-care education, left ventricular function assessment and/or intracardiac devices. We reported clinical outcomes when available. We included 38 studies. Provider-level interventions (n=13 studies) included audit and feedback, reminders and education. Organisation-level interventions (n=18) included medical records system changes, multidisciplinary teams, clinical pathways and continuity of care. System-level interventions (n=3) included provider/institutional incentives. Four studies assessed multi-level interventions. We could not perform meta-analyses due to statistical/conceptual heterogeneity. Thirty-two studies reported significant improvements in at least one primary outcome. Clinical pathways, multidisciplinary teams and multifaceted interventions were most consistently successful in increasing physician uptake of guidelines. Among randomised controlled trials (RCT) (n=10), pharmacist and nurse-led interventions improved target dose prescriptions. Eleven studies reported clinical outcomes; significant improvements were reported in three, including a clinical pathway, a multidisciplinary team and a multifaceted intervention. Baseline assessment of barriers, staff training, iterative intervention development, leadership commitment and policy/financial incentives were associated with intervention effectiveness. Most studies (n=20) had medium risk of bias; nine RCTs had low risk of bias. Our study is limited by the quality and heterogeneity of the primary studies. Clinical pathways, multidisciplinary teams and multifaceted interventions appear to be most consistent in increasing guideline uptake. However, improvements in process outcomes were rarely accompanied by improvements in clinical outcomes. Our work highlights the need for improved research methodology to reliably assess the effectiveness of implementation interventions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Strategy Guideline. Proper Water Heater Selection

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

Hoeschele, M.; Springer, D.; German, A.

2015-04-09

This Strategy Guideline on proper water heater selection was developed by the Building America team Alliance for Residential Building Innovation to provide step-by-step procedures for evaluating preferred cost-effective options for energy efficient water heater alternatives based on local utility rates, climate, and anticipated loads.

Strategy Guideline: Proper Water Heater Selection

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

Hoeschele, M.; Springer, D.; German, A.

2015-04-01

This Strategy Guideline on proper water heater selection was developed by the Building America team Alliance for Residential Building Innovation to provide step-by-step procedures for evaluating preferred cost-effective options for energy efficient water heater alternatives based on local utility rates, climate, and anticipated loads.

Implementation of asthma guidelines to West Australian community pharmacies: an exploratory, quasi-experimental study

PubMed Central

Trevenen, Michelle; Murray, Kevin; Kendall, Peter A; Schneider, Carl R; Clifford, Rhonda

2016-01-01

Objectives Pharmacy assistants are often the first point of contact for patients presenting in community pharmacies. The current role of pharmacy assistants in the supply of asthma-reliever medications (short-acting β-agonists) was identified as a barrier to appropriate guideline-based care. The aim of this research was to devise and evaluate a team-based intervention to formalise the role of pharmacy assistants and to improve asthma guideline-based care in community pharmacy. Design A controlled pre-post intervention study was conducted in 336 metropolitan pharmacies located in Perth, Western Australia. Pharmacies were stratified into 2 groups (187 intervention and 149 control) based on known confounders for asthma control. The intervention was designed using a common-sense approach and resources developed included a checklist, videos and web page. Delivery was via workshops (25 pharmacies) or academic detailing (162 pharmacies). Pharmacy practice was assessed preintervention and postintervention via covert simulated patient methodology. Primary outcome measures included patient medical referral, device use demonstration and counselling, internal referral and/or direct involvement of a pharmacist in consultations. Results There was a significant increase in patient medical referral in intervention pharmacies from 32% to 47% (p=0.0007) from preintervention to postintervention, while control pharmacies showed a non-significant decrease from 50% to 44% (p=0.22). Device counselling was not routinely carried out at any stage or in any cohort of this research and no significant changes in internal referral were observed. Conclusions Increases in medical referral indicate that asthma guideline compliance can be improved in community pharmacy if implementation employs a team-based approach and involves pharmacy assistants. However, results were variable and the intervention did not improve practice related to device counselling or internal referral/pharmacist involvement. Undertaking more workshops may have improved results. Guideline implementation in community pharmacy should consider the role of pharmacy assistants and how to overcome logistical barriers to pharmacy participation in implementation activities. PMID:27580836

User systems guidelines for software projects

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

Abrahamson, L.

1986-04-01

This manual presents guidelines for software standards which were developed so that software project-development teams and management involved in approving the software could have a generalized view of all phases in the software production procedure and the steps involved in completing each phase. Guidelines are presented for six phases of software development: project definition, building a user interface, designing software, writing code, testing code, and preparing software documentation. The discussions for each phase include examples illustrating the recommended guidelines. 45 refs. (DWL)

Achieving performance breakthroughs in an HMO business process through quality planning.

PubMed

Hanan, K B

1993-01-01

Kaiser Permanente's Georgia Region commissioned a quality planning team to design a new process to improve payments to its suppliers and vendors. The result of the team's effort was a 73 percent reduction in cycle time. This team's experiences point to the advantages of process redesign as a quality planning model, as well as some general guidelines for its most effective use in teams. If quality planning project teams are carefully configured, sufficiently expert in the existing process, and properly supported by management, organizations can achieve potentially dramatic improvements in process performance using this approach.

Athletes Off the Field: A Model for Team Building and Leadership Development through Service Learning. Linking Learning with Life.

ERIC Educational Resources Information Center

Haughey, Laurie

This booklet provides step-by-step guidelines for developing a leadership-through-service-learning component for a school athletic team. It is based on a program called LIFE LINE (Leaders in Football and Education) founded in 1996 as a peer leadership group that would increase team unity and success both on and off the field. The guide summarizes…

Establishing 'quality of life' parameters using behavioural guidelines for humane euthanasia of captive non-human primates.

PubMed

Lambeth, Sp; Schapiro, Sj; Bernacky, Bj; Wilkerson, Gk

2013-09-01

Chronic pain and distress are universally accepted conditions that may adversely affect an animal's quality of life (QOL) and lead to the humane euthanasia of an animal. At most research institutions and zoological parks in the USA, a veterinarian, who has physically examined the animal and reviewed the clinical records, ultimately decides when an animal has reached a humane endpoint. To aid in the difficult process of interpreting pain and distress, we have developed specific behavioural guidelines, in addition to standard clinical information, to help define unique characteristics and traits of primates to assess and promote discussion of an individual primate's QOL, and thereby, to assist in the decision-making process regarding euthanasia. These guidelines advocate the creation of a QOL team when the animal is diagnosed with a life-threatening or debilitating chronic condition, or at the time the animal is entered into a terminal study. The team compiles a list of characteristics unique to that individual animal by utilising a questionnaire and a behavioural ethogram. This list enables the team to quantitatively assess any deviations from the established normal behavioural repertoire of that individual. Concurrently, the QOL team determines the number of behavioural deviations that are needed to trigger an immediate discussion of the necessity for humane euthanasia of the animal. The team remains intact once created, and revisits the animal's condition as frequently as deemed necessary. This process improves animal welfare by continuing the quest to optimally define QOL for captive primates, and potentially for all captive animals.

Establishing ‘quality of life’ parameters using behavioural guidelines for humane euthanasia of captive non-human primates

PubMed Central

Lambeth, SP; Schapiro, SJ; Bernacky, BJ; Wilkerson, GK

2014-01-01

Chronic pain and distress are universally accepted conditions that may adversely affect an animal’s quality of life (QOL) and lead to the humane euthanasia of an animal. At most research institutions and zoological parks in the USA, a veterinarian, who has physically examined the animal and reviewed the clinical records, ultimately decides when an animal has reached a humane endpoint. To aid in the difficult process of interpreting pain and distress, we have developed specific behavioural guidelines, in addition to standard clinical information, to help define unique characteristics and traits of primates to assess and promote discussion of an individual primate’s QOL, and thereby, to assist in the decision-making process regarding euthanasia. These guidelines advocate the creation of a QOL team when the animal is diagnosed with a life-threatening or debilitating chronic condition, or at the time the animal is entered into a terminal study. The team compiles a list of characteristics unique to that individual animal by utilising a questionnaire and a behavioural ethogram. This list enables the team to quantitatively assess any deviations from the established normal behavioural repertoire of that individual. Concurrently, the QOL team determines the number of behavioural deviations that are needed to trigger an immediate discussion of the necessity for humane euthanasia of the animal. The team remains intact once created, and revisits the animal’s condition as frequently as deemed necessary. This process improves animal welfare by continuing the quest to optimally define QOL for captive primates, and potentially for all captive animals. PMID:25505822

Impact of electronic health record clinical decision support on the management of pediatric obesity.

PubMed

Shaikh, Ulfat; Berrong, Jeanette; Nettiksimmons, Jasmine; Byrd, Robert S

2015-01-01

Clinicians vary significantly in their adherence to clinical guidelines for overweight/obesity. This study assessed the impact of electronic health record-based clinical decision support in improving the diagnosis and management of pediatric obesity. The study team programmed a point-of-care alert linked to a checklist and standardized documentation templates to appear during health maintenance visits for overweight/obese children in an outpatient teaching clinic and compared outcomes through medical record reviews of 574 (287 control and 287 intervention) visits. The results demonstrated a statistically significant increase in the diagnosis of overweight/obesity, scheduling of follow-up appointments, frequency of ordering recommended laboratory investigations, and assessment and counseling for nutrition and physical activity. Although clinical guideline adherence increased significantly, it was far from universal. It is unknown if modest improvements in adherence to clinical guidelines translate to improvements in children's health. However, this intervention was relatively easy to implement and produced measurable improvements in health care delivery. © 2014 by the American College of Medical Quality.

Management of Cancer Cachexia and Guidelines Implementation in a Comprehensive Cancer Center: A Physician-Led Cancer Nutrition Program Adapted to the Practices of a Country.

PubMed

Senesse, Pierre; Isambert, Agnès; Janiszewski, Chloé; Fiore, Stéphanie; Flori, Nicolas; Poujol, Sylvain; Arroyo, Eric; Courraud, Julie; Guillaumon, Vanessa; Mathieu-Daudé, Hélène; Colasse, Sophie; Baracos, Vickie; de Forges, Hélène; Thezenas, Simon

2017-09-01

Cancer-associated cachexia is correlated with survival, side-effects, and alteration of the patients' well-being. We implemented an institution-wide multidisciplinary supportive care team, a Cancer Nutrition Program (CNP), to screen and manage cachexia in accordance with the guidelines and evaluated the impact of this new organization on nutritional care and funding. We estimated the workload associated with nutrition assessment and cachexia-related interventions and audited our clinical practice. We then planned, implemented, and evaluated the CNP, focusing on cachexia. The audit showed a 70% prevalence of unscreened cachexia. Parenteral nutrition was prescribed to patients who did not meet the guideline criteria in 65% cases. From January 2009 to December 2011, the CNP team screened 3078 inpatients. The screened/total inpatient visits ratio was 87%, 80%, and 77% in 2009, 2010, and 2011, respectively. Cachexia was reported in 74.5% (n = 2253) patients, of which 94.4% (n = 1891) required dietary counseling. Over three years, the number of patients with artificial nutrition significantly decreased by 57.3% (P < 0.001), and the qualitative inpatients enteral/parenteral ratio significantly increased: 0.41 in 2009, 0.74 in 2010, and 1.52 in 2011. Between 2009 and 2011, the CNP costs decreased significantly for inpatients nutritional care from 528,895€ to 242,272€, thus financing the nutritional team (182,520€ per year). Our results highlight the great benefits of implementing nutritional guidelines through a physician-led multidisciplinary team in charge of nutritional care in a comprehensive cancer center. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

The PBIS Team Handbook: Setting Expectations and Building Positive Behavior

ERIC Educational Resources Information Center

Baker, Beth; Ryan, Char

2014-01-01

This handbook provides solid, detailed guidelines for implementing and sustaining schoolwide positive behavior interventions and supports (PBIS). Full of engaging anecdotes from expert PBIS coaches, this comprehensive resource helps PBIS teams overcome the obstacles of staff buyin and offers solutions for sustaining a successful program at your…

Specialist Teams Needed to Support Youth.

ERIC Educational Resources Information Center

Mellin, Laurel M.

1991-01-01

Presents seven reasons why it is important for health specialist teams to take action supporting the prevention and treatment of childhood obesity. The article offers guidelines to help parents assist their children in maintaining positive eating, exercise, and self-esteem patterns, noting sensitive intervention is preferable to imposed diets. (SM)

The "S.W.A.T." Concept.

ERIC Educational Resources Information Center

Williamson, Bob; And Others

1985-01-01

Describes Statistical Work Analysis Teams (S.W.A.T.), which marry the two factors necessary for successful statistical analysis with the personal nature of attribute data into a single effort. Discusses S.W.A.T. project guidelines, implementation of the first S.W.A.T. projects, team training, and project completion. (CT)

Implementation of a pharmacist-led antimicrobial management team in a community teaching hospital: use of pharmacy residents and pharmacy students in a prospective audit and feedback approach.

PubMed

Laible, Brad R; Nazir, Jawad; Assimacopoulos, Aris P; Schut, Jennifer

2010-12-01

Antimicrobial stewardship is an important process proven to combat antimicrobial resistance, improve patient outcomes, and reduce costs. The Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) have provided guidelines for the provision of antimicrobial stewardship. According to these recommendations, antimicrobial stewardship teams should be multidisciplinary in nature, with core members consisting of an infectious disease physician and an infectious disease-trained clinical pharmacist. Due to limited resources, our institution chose to implement a pharmacist-led antimicrobial stewardship service on 1 medical/surgical ward, with the existing clinical pharmacist and 3 infectious disease physicians as core members. This clinical pharmacist was not trained in infectious disease specialty, and stewardship activities were only one part of his daily activities. Pharmacy residents and students were extensively utilized to assist in the stewardship process. Approximately two thirds of stewardship recommendations were accepted using primarily a prospective audit and feedback approach.

Changing panorama for surveillance of device-associated healthcare infections: Challenges faced in implementation of current guidelines.

PubMed

Gupta, Renu; Sharma, Sangeeta; Saxena, Sonal

2018-01-01

Healthcare-associated infections (HAI) are preventable in up to 30% of patients with evidence-based infection prevention and control (IPC) activities. IPC activities require effective surveillance to generate data for the HAI rates, defining priority areas, identifying processes amenable for improvement and institute interventions to improve patient's safety. However, uniform, accurate and standardised surveillance methodology using objective definitions can only generate meaningful data for effective execution of IPC activities. The highly exhaustive, complex and ever-evolving infection surveillance methodology pose a challenge for effective data capture, analysis and interpretation by ground level personnel. The present review addresses the gaps in knowledge and day-to-day challenges in surveillance faced by infection control team for effective implementation of IPC activities.

Guidelines for direct radionuclide cystography in children.

PubMed

Fettich, Jure; Colarinha, Paula; Fischer, Sibylle; Frökier, Jörgen; Gordon, Isky; Hahn, Klaus; Kabasakal, Levent; Mann, Mike; Mitjavila, Mercedes; Olivier, Pierre; Piepsz, Amy; Porn, Ute; Roca, Isabel; Sixt, Rune; van Velzen, Jeannette

2003-05-01

These guidelines, which summarise the views of the Paediatric Committee of the European Association of Nuclear Medicine, provide a framework which may prove helpful to nuclear medicine teams in daily practice. They contain information on the indications, acquisition, processing and interpretation of direct radioisotope cystography in children. The guidelines should be taken in the context of "good practice" and any local/national rules which apply to nuclear medicine examinations.

[Trends in breast cancer treatment in the elderly at a breast cancer outpatient clinic: guidelines followed better].

PubMed

Hamaker, Marije E; Schreurs, W Hermien; van Slooten, Henk Jan; Uppelschoten, Jeroen M; Smorenburg, Carolien H

2009-01-01

To investigate the treatment of resectable breast cancer in elderly patients at Alkmaar Medical Centre, Alkmaar, the Netherlands, before and after the introduction of a multidisciplinary breast cancer consultation (MDC) with the breast cancer team in February 2006. Retrospective. The treatment of patients aged 70 and over with newly diagnosed stage I and II resectable breast cancer was monitored during the period 2002-2007. A total of 84% of the 232 studied patients were treated surgically. Adjuvant treatment with radiotherapy, hormone therapy and chemotherapy was given to 88, 91 and 5 patients, respectively. The percentage of patients who underwent first-line surgery decreased significantly, mainly because fewer patients aged 80 or over received surgery. The number of patients given radiotherapy in accordance with guidelines increased, while for hormonal therapy the number remained more or less the same. Recording of decisions that involved deviation from treatment guidelines improved in the study period. In 2002-2007, the breast cancer team became more aware of treatment guidelines and deviations from guidelines were better accounted for. In the elderly, the guidelines for adjuvant radiotherapy were followed better, but there was a remarkable decrease in primary surgical treatment of patients, particularly in patients aged 80 and over. Comorbidity and patients' preferences played an important role in this.

Enhancing system-wide implementation of opioid prescribing guidelines in primary care: protocol for a stepped-wedge quality improvement project.

PubMed

Zgierska, Aleksandra E; Vidaver, Regina M; Smith, Paul; Ales, Mary W; Nisbet, Kate; Boss, Deanne; Tuan, Wen-Jan; Hahn, David L

2018-06-05

Systematic implementation of guidelines for opioid therapy management in chronic non-cancer pain can reduce opioid-related harms. However, implementation of guideline-recommended practices in routine care is subpar. The goal of this quality improvement (QI) project is to assess whether a clinic-tailored QI intervention improves the implementation of a health system-wide, guideline-driven policy on opioid prescribing in primary care. This manuscript describes the protocol for this QI project. A health system with 28 primary care clinics caring for approximately 294,000 primary care patients developed and implemented a guideline-driven policy on long-term opioid therapy in adults with opioid-treated chronic non-cancer pain (estimated N = 3980). The policy provided multiple recommendations, including the universal use of treatment agreements, urine drug testing, depression and opioid misuse risk screening, and standardized documentation of the chronic pain diagnosis and treatment plan. The project team drew upon existing guidelines, feedback from end-users, experts and health system leadership to develop a robust QI intervention, targeting clinic-level implementation of policy-directed practices. The resulting multi-pronged QI intervention included clinic-wide and individual clinician-level educational interventions. The QI intervention will augment the health system's "routine rollout" method, consisting of a single educational presentation to clinicians in group settings and a separate presentation for staff. A stepped-wedge design will enable 9 primary care clinics to receive the intervention and assessment of within-clinic and between-clinic changes in adherence to the policy items measured by clinic-level electronic health record-based measures and process measures of the experience with the intervention. Developing methods for a health system-tailored QI intervention required a multi-step process to incorporate end-user feedback and account for the needs of targeted clinic team members. Delivery of such tailored QI interventions has the potential to enhance uptake of opioid therapy management policies in primary care. Results from this study are anticipated to elucidate the relative value of such QI activities.

Development of an Official Guideline for the Economic Evaluation of Drugs/Medical Devices in Japan.

PubMed

Shiroiwa, Takeru; Fukuda, Takashi; Ikeda, Shunya; Takura, Tomoyuki; Moriwaki, Kensuke

2017-03-01

In Japan, cost-effectiveness evaluation was implemented on a trial basis from fiscal year 2016. The results will be applied to the future repricing of drugs and medical devices. On the basis of a request from the Central Social Insurance Medical Council (Chuikyo), our research team drafted the official methodological guideline for trial implementation. Here, we report the process of developing and the contents of the official guideline for cost-effectiveness evaluation. The guideline reflects discussions at the Chuikyo subcommittee (e.g., the role of quality-adjusted life-year) and incorporates our academic perspective. Team members generated research questions for each section of the guideline and discussions on these questions were carried out. A draft guideline was prepared and submitted to the Ministry of Health, Labour and Welfare (MHLW), and then to the subcommittee. The draft guideline was revised on the basis of the discussions at the subcommitte, if appropriate. Although the "public health care payer's perspective" is standard in this guideline, other perspectives can be applied as necessary depending on the objective of analysis. On the basis of the discussions at the subcommittee, quality-adjusted life-year will be used as the basic outcome. A discount rate of 2% per annum for costs and outcomes is recommended. The final guideline was officially approved by the Chuikyo general assembly in February 2016. This is the first officially approved guideline for the economic evaluation of drugs and medical devices in Japan. The guideline is expected to improve the quality and comparability of submitted cost-effectiveness data for decision making. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Reviewing a Reading Program: Professional Development Module. Participant's Guide

ERIC Educational Resources Information Center

Kosanovich, Marcia; Jordan, Georgia; Arndt, Elissa; Van Sciver, Mary; Wahl, Michelle; Rissman, Lila

2008-01-01

The Curriculum and Instructional Projects Team at the Florida Center for Reading Research (FCRR) developed "Guidelines for Reviewing a Reading Program" ("Guidelines") to assist reviewers in determining if a program is consistent with the scientific research on reading. Based on that work, the Center on Instruction Reading Strand developed this…

Establishment of heart teams in Portugal.

PubMed

Sousa Uva, M; Leite Moreira, A; Gavina, C; Pereira, H; Lopes, M G

2014-01-01

Whenever several therapeutic options exist, multidisciplinary decision-making is beneficial for the patient and for society at large. The main obstacles to the establishment of heart teams in Portugal are organizational and logistical. Implementing a heart team approach entails definition of the situations requiring multidisciplinary discussion, creation of clear lines of communication, written protocols and obtaining patient informed consent. The European Society of Cardiology guidelines define the clinical scenarios where intervention of the heart team is recommended. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

National Athletic Trainers' Association Releases New Guidelines for Exertional Heat Illnesses: What School Nurses Need to Know.

PubMed

VanScoy, Rachel M; DeMartini, Julie K; Casa, Douglas J

2016-05-01

Exertional heat illnesses (EHI) occur in various populations and settings. Within a school setting, there are student athletes who take part in physical activity where the risk of EHI is increased. The National Athletic Trainers' Association (NATA) released an updated position statement on EHI in September of 2015. This article is a summary of the position statement. The sports medicine team, including school nurses and athletic trainers, provides quality health care to these physically active individuals. Thus, it is important for school nurses to understand the prevention, recognition, and treatment of EHI. © 2016 The Author(s).

Team Physicians, Sports Medicine, and the Law: An Update.

PubMed

Koller, Dionne L

2016-04-01

The recognition of sports medicine and promulgation of practice guidelines for team physicians will push general medical malpractice standards to evolve into a more specialized standard of care for those who practice in this area. To the extent that practicing medicine in the sports context involves calculations that do not arise in typical medical practice, the sports medicine community can help elucidate those issues and create appropriate guidelines that can serve to inform athlete-patients and educate courts. Doing so will help best set the terms by which those who practice sports medicine are judged. Copyright © 2016 Elsevier Inc. All rights reserved.

Integrating CHWs as Part of the Team Leading Diabetes Group Visits: A Randomized Controlled Feasibility Study.

PubMed

Vaughan, Elizabeth M; Johnston, Craig A; Cardenas, Victor J; Moreno, Jennette P; Foreyt, John P

2017-12-01

Purpose The purpose of the study was to evaluate the feasibility of integrating Community Health Workers (CHWs) as part of the team leading diabetes group visits. Methods This was a randomized controlled study that integrated CHWs as part of the team leading diabetes group visits for low-income Hispanic adults (n = 50). Group visits met for 3 hours each month for a 6-month duration. Main measures included baseline and 6-month clinical outcomes (ie, A1C, lipids), concordance with 8 standard of care guidelines (ie, screens for cervical, breast, and colon cancer) from the US Preventive Task Force and American Diabetes Association, and participant acceptability. Results Compared to control participants, the intervention group resulted in significantly better clinical outcomes or guideline concordance for the following areas: target A1C levels, retinal eye exams, diabetes foot exams, mammograms, and urine microalbumin. Significantly more individuals in the control group gained weight, whereas a greater number of participants in the intervention group lost weight. Intervention participants found the group visits highly acceptable. Conclusions Integrating CHWs as part a comprehensive diabetes group visit program is a feasible and effective system-level intervention to improve glycemic control and achieve guideline concordance.

Trauma care in Africa: a status report from Botswana, guided by the World Health Organization's "Guidelines for Essential Trauma Care".

PubMed

Hanche-Olsen, Terje Peder; Alemu, Lulseged; Viste, Asgaut; Wisborg, Torben; Hansen, Kari S

2012-10-01

Trauma represents a significant and increasing challenge to health care systems all over the world. This study aimed to evaluate the trauma care capabilities of Botswana, a middle-income African country, by applying the World Health Organization's Guidelines for Essential Trauma Care. All 27 government (16 primary, 9 district, 2 referral) hospitals were surveyed. A questionnaire and checklist, based on "Guidelines for Essential Trauma Care" and locally adapted, were developed as situation analysis tools. The questionnaire assessed local trauma organization, capacity, and the presence of quality improvement activity. The checklist assessed physical availability of equipment and timely availability of trauma-related skills. Information was collected by interviews with hospital administrators, key personnel within trauma care, and through on-site physical inspection. Hospitals in Botswana are reasonably well supplied with human and physical resources for trauma care, although deficiencies were noted. At the primary and district levels, both capacity and equipment for airway/breathing management and vascular access was limited. Trauma administrative functions were largely absent at all levels. No hospital in Botswana had any plans for trauma education, separate from or incorporated into other improvement activities. Team organization was nonexistent, and training activities in the emergency room were limited. This study draws a picture of trauma care capabilities of an entire African country. Despite good organizational structures, Botswana has room for substantial improvement. Administrative functions, training, and human and physical resources could be improved. By applying the guidelines, this study creates an objective foundation for improved trauma care in Botswana.

Teamwork: The Name of the Game in Recruitment.

ERIC Educational Resources Information Center

Bennett, Linda L.

This manual offers hints, guidelines, and suggestions for reaching prospective students for vocational training. Its main premise centers around alerting, encouraging, and assisting the student. A team effort is promoted; each staff member must be a part of the whole recruitment team. A section on advance planning focuses on analysis of the school…

Toward Group Problem Solving Guidelines for 21st Century Teams

ERIC Educational Resources Information Center

Ranieri, Kathryn L.

2004-01-01

Effective problem-solving skills are critical in dealing with ambiguous and often complex issues in the present-day leaner and globally diverse organizations. Yet respected, well-established problem-solving models may be misaligned within the current work environment, particularly within a team context. Models learned from a more bureaucratic,…

ABC versus CAB for cardiopulmonary resuscitation: a prospective, randomized simulator-based trial.

PubMed

Marsch, Stephan; Tschan, Franziska; Semmer, Norbert K; Zobrist, Roger; Hunziker, Patrick R; Hunziker, Sabina

2013-09-06

After years of advocating ABC (Airway-Breathing-Circulation), current guidelines of cardiopulmonary resuscitation (CPR) recommend CAB (Circulation-Airway-Breathing). This trial compared ABC with CAB as initial approach to CPR from the arrival of rescuers until the completion of the first resuscitation cycle. 108 teams, consisting of two physicians each, were randomized to receive a graphical display of either the ABC algorithm or the CAB algorithm. Subsequently teams had to treat a simulated cardiac arrest. Data analysis was performed using video recordings obtained during simulations. The primary endpoint was the time to completion of the first resuscitation cycle of 30 compressions and two ventilations. The time to execution of the first resuscitation measure was 32 ± 12 seconds in ABC teams and 25 ± 10 seconds in CAB teams (P = 0.002). 18/53 ABC teams (34%) and none of the 55 CAB teams (P = 0.006) applied more than the recommended two initial rescue breaths which caused a longer duration of the first cycle of 30 compressions and two ventilations in ABC teams (31 ± 13 vs.23 ± 6 sec; P = 0.001). Overall, the time to completion of the first resuscitation cycle was longer in ABC teams (63 ± 17 vs. 48 ± 10 sec; P <0.0001). This randomized controlled trial found CAB superior to ABC with an earlier start of CPR and a shorter time to completion of the first 30:2 resuscitation cycle. These findings endorse the change from ABC to CAB in international resuscitation guidelines.

Monitoring, documenting and reporting the quality of antibiotic use in the Netherlands: a pilot study to establish a national antimicrobial stewardship registry.

PubMed

Berrevoets, Marvin Ah; Ten Oever, Jaap; Sprong, Tom; van Hest, Reinier M; Groothuis, Ingeborg; van Heijl, Inger; Schouten, Jeroen A; Hulscher, Marlies E; Kullberg, Bart-Jan

2017-08-15

The Dutch Working Party on Antibiotic Policy is developing a national antimicrobial stewardship registry. This registry will report both the quality of antibiotic use in hospitals in the Netherlands and the stewardship activities employed. It is currently unclear which aspects of the quality of antibiotic use are monitored by antimicrobial stewardship teams (A-teams) and can be used as indicators for the stewardship registry. In this pilot study we aimed to determine which stewardship objectives are eligible for the envisioned registry. We performed an observational pilot study among five Dutch hospitals. We assessed which of the 14 validated stewardship objectives (11 process of care recommendations and 3 structure of care recommendations) the A-teams monitored and documented in individual patients. They provided, where possible, data to compute quality indicator (QI) performance scores in line with recently developed QIs to measure appropriate antibiotic use in hospitalized adults for the period of January 2015 through December 2015 RESULTS: All hospitals had a local antibiotic guideline describing recommended antimicrobial use. All A-teams monitored the performance of bedside consultations in Staphylococcus aureus bacteremia and the prescription of restricted antimicrobials. Documentation and reporting were the best for the use of restricted antimicrobials: 80% of the A-teams could report data. Lack of time and the absence of an electronic medical record system enabling documentation during the daily work flow were the main barriers hindering documentation and reporting. Five out of 11 stewardship objectives were actively monitored by A-teams. Without extra effort, 4 A-teams could report on the quality of use of restricted antibiotics. Therefore, this aspect of antibiotic use should be the starting point of the national antimicrobial stewardship registry. Our registry is expected to become a powerful tool to evaluate progress and impact of antimicrobial stewardship programs in hospitals.

Evaluating Emergency Department Asthma Management Practices in Florida Hospitals.

PubMed

Nowakowski, Alexandra C H; Carretta, Henry J; Dudley, Julie K; Forrest, Jamie R; Folsom, Abbey N

2016-01-01

To assess gaps in emergency department (ED) asthma management at Florida hospitals. Survey instrument with open- and closed-ended questions. Topics included availability of specific asthma management modalities, compliance with national guidelines, employment of specialized asthma care personnel, and efforts toward performance improvement. Emergency departments at 10 large hospitals in the state of Florida. Clinical care providers and health administrators from participating hospitals. Compliance with national asthma care guideline standards, provision of specific recommended treatment modalities and resources, employment of specialized asthma care personnel, and engagement in performance improvement efforts. Our results suggest inconsistency among sampled Florida hospitals' adherence to national standards for treatment of asthma in EDs. Several hospitals were refining their emergency care protocols to incorporate guideline recommendations. Despite a lack of formal ED protocols in some hospitals, adherence to national guidelines for emergency care nonetheless remained robust for patient education and medication prescribing, but it was weaker for formal care planning and medical follow-up. Identified deficiencies in emergency asthma care present a number of opportunities for strategic mitigation of identified gaps. We conclude with suggestions to help Florida hospitals achieve success with ED asthma care reform. Team-based learning activities may offer an optimal strategy for sharing and implementing best practices.

New insights into managing the risk of hypoglycaemia associated with intermittent high-intensity exercise in individuals with type 1 diabetes mellitus: implications for existing guidelines.

PubMed

Guelfi, Kym J; Jones, Timothy W; Fournier, Paul A

2007-01-01

Exercise is generally recommended for individuals with type 1 diabetes mellitus since it is associated with numerous physiological and psychological benefits. However, participation in exercise can also increase the risk of experiencing severe hypoglycaemia, a potentially life-threatening condition, both during exercise and for up to 31 hours of recovery. Fortunately, this risk of exercise-induced hypoglycaemia can be managed by adjusting the dosage of self-administered exogenous insulin and nutritional intake to maintain blood glucose levels within the normal physiological range. In order to provide evidence-based guidelines to allow individuals with type 1 diabetes to safely participate in a range of physical activities, much previous research has focused on understanding the metabolic and hormonal responses to exercise. Consequently, it is well established that moderate- and high-intensity exercise have a contrasting effect on blood glucose levels and require different management strategies to maintain euglycaemia. On the other hand, the response of blood glucose levels to a combination of moderate- and high-intensity exercise, a pattern of physical activity referred to as intermittent high-intensity exercise (IHE) has received little research attention. This is despite the fact that this type of exercise characterises the activity patterns of most team and field sports as well as spontaneous play in children. The lack of previous research into the glucoregulatory responses to IHE is reflected in existing guidelines, which either do not address IHE, or suggest similar management strategies for blood glucose levels during and after IHE as for moderate- or high-intensity exercise alone. It is important, however, to appreciate that there are fundamental differences in the metabolic responses to intermittent exercise compared with other types of exercise. Recently, a series of investigations into the glucoregulatory responses to IHE that replicates the work-to-recovery ratios observed in team and field sports have been conducted. The findings of these studies do not support the existing recommendations for managing blood glucose levels during IHE. Hence, the purpose of this article is to discuss the results of these recent studies, which provide new insight into the management of blood glucose levels during and after IHE and have implications for current guidelines aimed at minimising the risk of hypoglycaemia. These findings, along with future investigations, should provide valuable information for health professionals and individuals with type 1 diabetes on the management of blood glucose levels during and after exercise to allow for safe participation in intermittent activities along with their peers.

Reactor Decommissioning - Balancing Remote and Manual Activities - 12159

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

Cole, Matt

2012-07-01

Nuclear reactors come in a wide variety of styles, size, and ages. However, during decommissioned one issue they all share is the balancing of remotely and manually activities. For the majority of tasks there is a desire to use manual methods because remote working can be slower, more expensive, and less reliable. However, because of the unique hazards of nuclear reactors some level of remote activity will be necessary to provide adequate safety to workers and properly managed and designed it does not need to be difficult nor expensive. The balance of remote versus manual work can also affect themore » amount and types of waste that is generated. S.A.Technology (SAT) has worked on a number of reactor decommissioning projects over the last two decades and has a range of experience with projects using remote methods to those relying primarily on manual activities. This has created a set of lessons learned and best practices on how to balance the need for remote handling and manual operations. Finding a balance between remote and manual operations on reactor decommissioning can be difficult but by following certain broad guidelines it is possible to have a very successfully decommissioning. It is important to have an integrated team that includes remote handling experts and that this team plans the work using characterization efforts that are efficient and realistic. The equipment need to be simple, robust and flexible and supported by an on-site team committed to adapting to day-to-day challenges. Also, the waste strategy needs to incorporate the challenges of remote activities in its planning. (authors)« less

A comparison of guidelines for the treatment of schizophrenia.

PubMed

Milner, Karen K; Valenstein, Marcia

2002-07-01

Although the clinical and administrative rationales for the use of guidelines in the treatment of schizophrenia are convincing, meaningful implementation has been slow. Guideline characteristics themselves influence whether implementation occurs. The authors examine three widely distributed guidelines and one set of algorithms to compare characteristics that are likely to influence implementation, including their degree of scientific rigor, comprehensiveness, and clinical applicability (ease of use, timeliness, specificity, and ease of operationalizing). The three guidelines are the Expert Consensus Guideline Series' "Treatment of Schizophrenia"; the American Psychiatric Association's "Practice Guideline for the Treatment of Patients With Schizophrenia"; and the Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations. The algorithms are those of the Texas Medication Algorithm Project (TMAP). The authors outline the strengths of each and suggest how a future guideline might build on these strengths.

Guidelines for Conducting an Ethnic Heritage Search.

ERIC Educational Resources Information Center

Williams, Maxine Patrick

Based on the work of a 22-member research team in the San Diego Community College District, this booklet offers guidelines for developing cultural awareness and presents instruments for conducting an ethnic heritage search, i.e., a systematic examination of a culture to, for example, reveal reasons for customs or practices or clarify the modes of…

Handbook of Procedural Guidelines for Implementation of Special Education Curriculum: Critical Skills/Community-Based and Special Education Curriculum Guide.

ERIC Educational Resources Information Center

Riverside County Office of Education, CA. Div. of Special Schools and Services.

The special education procedural handbook and the special education curriculum guide provide guidelines for teachers and other school personnel. The procedural handbook covers the following areas: individual education program process (IEP) and program placement, individual education program team, administrative placements, parent interviews,…

Minimal impact of a care pathway for geriatric hip fracture patients.

PubMed

Panella, Massimiliano; Seys, Deborah; Sermeus, Walter; Bruyneel, Luk; Lodewijckx, Cathy; Deneckere, Svin; Sermon, An; Nijs, Stefaan; Boto, Paulo; Vanhaecht, Kris

2018-06-04

Adherence to guidelines for patients with proximal femur fracture is suboptimal. To evaluate the effect of a care pathway for the in-hospital management of older geriatric hip fracture patients on adherence to guidelines and patient outcomes. The European Quality of Care Pathways study is a cluster randomized controlled trial. 26 hospitals in Belgium, Italy and Portugal. Older adults with a proximal femur fracture (n = 514 patients) were included. Hospitals treating older adults (>65) with a proximal femur fracture were randomly assigned to an intervention group, i.e. implementation of a care pathway, or control group, i.e. usual care. Thirteen patient outcomes and 24 process indicators regarding in-hospital management, as well as three not-recommended care activities were measured. Adjusted and unadjusted regression analyses were conducted using intention-to-treat procedures. In the intervention group 301 patients in 15 hospitals were included, and in the control group 213 patients in 11 hospitals. Sixty-five percent of the patients were older than 80 years. The implementation of this care pathway had no significant impact on the thirteen patient outcomes. The preoperative management improved significantly. Eighteen of 24 process indicators improved, but only two improved significantly. Only for a few teams a geriatrician was an integral member of the treatment team. Implementation of a care pathway improved compliance to evidence, but no significant effect on patient outcomes was found. The impact of the collaboration between surgeons and geriatricians on adherence to guidelines and patient outcomes should be studied. ClinicalTrials.gov: NCT00962910. Copyright © 2018 Elsevier Ltd. All rights reserved.

Evaluating the effect of a web-based quality improvement system with feedback and outreach visits on guideline concordance in the field of cardiac rehabilitation: rationale and study protocol.

PubMed

van Engen-Verheul, Mariëtte M; de Keizer, Nicolette F; van der Veer, Sabine N; Kemps, Hareld M C; Scholte op Reimer, Wilma J M; Jaspers, Monique W M; Peek, Niels

2014-12-31

Implementation of clinical practice guidelines into daily care is hampered by a variety of barriers related to professional knowledge and collaboration in teams and organizations. To improve guideline concordance by changing the clinical decision-making behavior of professionals, computerized decision support (CDS) has been shown to be one of the most effective instruments. However, to address barriers at the organizational level, additional interventions are needed. Continuous monitoring and systematic improvement of quality are increasingly used to achieve change at this level in complex health care systems. The study aims to assess the effectiveness of a web-based quality improvement (QI) system with indicator-based performance feedback and educational outreach visits to overcome organizational barriers for guideline concordance in multidisciplinary teams in the field of cardiac rehabilitation (CR). A multicenter cluster-randomized trial with a balanced incomplete block design will be conducted in 18 Dutch CR clinics using an electronic patient record with CDS at the point of care. The intervention consists of (i) periodic performance feedback on quality indicators for CR and (ii) educational outreach visits to support local multidisciplinary QI teams focussing on systematically improving the care they provide. The intervention is supported by a web-based system which provides an overview of the feedback and facilitates development and monitoring of local QI plans. The primary outcome will be concordance to national CR guidelines with respect to the CR needs assessment and therapy indication procedure. Secondary outcomes are changes in performance of CR clinics as measured by structure, process and outcome indicators, and changes in practice variation on these indicators. We will also conduct a qualitative process evaluation (concept-mapping methodology) to assess experiences from participating CR clinics and to gain insight into factors which influence the implementation of the intervention. To our knowledge, this will be the first study to evaluate the effect of providing performance feedback with a web-based system that incorporates underlying QI concepts. The results may contribute to improving CR in the Netherlands, increasing knowledge on facilitators of guideline implementation in multidisciplinary health care teams and identifying success factors of multifaceted feedback interventions. NTR3251.

Computer-mediated interdisciplinary teams: theory and reality.

PubMed

Vroman, Kerryellen; Kovacich, Joann

2002-05-01

The benefit of experience, tempered with the wisdom of hindsight and 5 years of text-based, asynchronous, computer-mediated, interdisciplinary team communications, provides the energy, insights and data shared in this article. Through the theoretical lens of group dynamics and the epistemology of interdisciplinary teaming, we analyze the interactions of a virtual interdisciplinary team to provide an understanding and appreciation of collaborative interdisciplinary communication in the context of interactive technologies. Whilst interactive technologies may require new patterns of language similar to that of learning a foreign language, what is communicated in the interdisciplinary team process does not change. Most important is the recognition that virtual teams, similar to their face-to-face counterparts, undergo the same challenges of interdisciplinary teaming and group developmental processes of formation: forming, storming, norming, performing, and transforming. After examining these dynamics of communication and collaboration in the context of the virtual team, the article concludes with guidelines facilitating interdisciplinary team computer-mediated communication.

Diet and diabetes.

PubMed

Deed, Gary; Barlow, John; Kawol, Dev; Kilov, Gary; Sharma, Anita; Hwa, Liew Yu

2015-05-01

Guidelines for the prevention and management of type 2 diabetes mellitus (T2DM) reinforce lifestyle management, yet advice to guide general practitioners on principles around dietary choices is needed. This article provides current evidence regarding the differing diets in diabetes prevention and management once T2DM arises, including the role in management of complications such as hypoglycaemia. Diets should incorporate weight maintenance or loss, while complementing changes in physical activity to optimise the metabolic effects of dietary advice. Using a structured, team-care approach supports pragmatic and sustainable individualised plans, while incorporating current evidence-based dietary approaches.

A unit-level perspective on the long-term sustainability of a nursing best practice guidelines program: An embedded multiple case study.

PubMed

Fleiszer, Andrea R; Semenic, Sonia E; Ritchie, Judith A; Richer, Marie-Claire; Denis, Jean-Louis

2016-01-01

Best practice guidelines are a tool for narrowing research-to-practice gaps and improving care outcomes. There is some empirical understanding of guideline implementation in nursing settings, yet there has been almost no consideration of the longer-term sustainability of guideline-based practice improvements. Many healthcare innovations are not sustained, underscoring the need for knowledge about how to promote their survival. To understand how a nursing best practice guidelines program was sustained on acute healthcare center nursing units. We undertook a qualitative descriptive case study of an organization-wide nursing best practice guidelines program with four embedded nursing unit subcases. The setting was a large, tertiary/quaternary urban health center in Canada. The nursing department initiated a program to enhance patient safety through the implementation of three guidelines: falls prevention, pressure ulcer prevention, and pain management. We selected four inpatient unit subcases that had differing levels of program sustainability at an average of almost seven years post initial program implementation. Data sources included 39 key informant interviews with nursing leaders/administrators and frontline nurses; site visits; and program-related documents. Data collection and content analysis were guided by a framework for the sustainability of healthcare innovations. Program sustainability was characterized by three elements: benefits, routinization, and development. Seven key factors most accounted for the differences in the level of program sustainability between subcases. These factors were: perceptions of advantages, collaboration, accountability, staffing, linked levels of leadership, attributes of formal unit leadership, and leaders' use of sustainability activities. Some prominent relationships between characteristics and factors explained long-term program sustainability. Of primary importance was the extent to which unit leaders used sustainability-oriented activities in both regular and responsive ways to attend to the relationships between sustainability characteristics and factors. Continued efforts are required to ensure long-term program sustainability on nursing units. Persistent and adaptive orchestration of sustainability-oriented activities by formal unit leadership teams is necessary for maintaining best practice guidelines over the long term. Leaders should consider a broad conceptualization of sustainability, beyond guideline-based benefits and routinization, because the development of unit capacity in response to changing circumstances appears essential. Copyright © 2015 Elsevier Ltd. All rights reserved.

Implementing change in primary care practices using electronic medical records: a conceptual framework.

PubMed

Nemeth, Lynne S; Feifer, Chris; Stuart, Gail W; Ornstein, Steven M

2008-01-16

Implementing change in primary care is difficult, and little practical guidance is available to assist small primary care practices. Methods to structure care and develop new roles are often needed to implement an evidence-based practice that improves care. This study explored the process of change used to implement clinical guidelines for primary and secondary prevention of cardiovascular disease in primary care practices that used a common electronic medical record (EMR). Multiple conceptual frameworks informed the design of this study designed to explain the complex phenomena of implementing change in primary care practice. Qualitative methods were used to examine the processes of change that practice members used to implement the guidelines. Purposive sampling in eight primary care practices within the Practice Partner Research Network-Translating Researching into Practice (PPRNet-TRIP II) clinical trial yielded 28 staff members and clinicians who were interviewed regarding how change in practice occurred while implementing clinical guidelines for primary and secondary prevention of cardiovascular disease and strokes. A conceptual framework for implementing clinical guidelines into primary care practice was developed through this research. Seven concepts and their relationships were modelled within this framework: leaders setting a vision with clear goals for staff to embrace; involving the team to enable the goals and vision for the practice to be achieved; enhancing communication systems to reinforce goals for patient care; developing the team to enable the staff to contribute toward practice improvement; taking small steps, encouraging practices' tests of small changes in practice; assimilating the electronic medical record to maximize clinical effectiveness, enhancing practices' use of the electronic tool they have invested in for patient care improvement; and providing feedback within a culture of improvement, leading to an iterative cycle of goal setting by leaders. This conceptual framework provides a mental model which can serve as a guide for practice leaders implementing clinical guidelines in primary care practice using electronic medical records. Using the concepts as implementation and evaluation criteria, program developers and teams can stimulate improvements in their practice settings. Investing in collaborative team development of clinicians and staff may enable the practice environment to be more adaptive to change and improvement.

Improved Clinical Performance and Teamwork of Pediatric Interprofessional Resuscitation Teams With a Simulation-Based Educational Intervention.

PubMed

Gilfoyle, Elaine; Koot, Deanna A; Annear, John C; Bhanji, Farhan; Cheng, Adam; Duff, Jonathan P; Grant, Vincent J; St George-Hyslop, Cecilia E; Delaloye, Nicole J; Kotsakis, Afrothite; McCoy, Carolyn D; Ramsay, Christa E; Weiss, Matthew J; Gottesman, Ronald D

2017-02-01

To measure the effect of a 1-day team training course for pediatric interprofessional resuscitation team members on adherence to Pediatric Advanced Life Support guidelines, team efficiency, and teamwork in a simulated clinical environment. Multicenter prospective interventional study. Four tertiary-care children's hospitals in Canada from June 2011 to January 2015. Interprofessional pediatric resuscitation teams including resident physicians, ICU nurse practitioners, registered nurses, and registered respiratory therapists (n = 300; 51 teams). A 1-day simulation-based team training course was delivered, involving an interactive lecture, group discussions, and four simulated resuscitation scenarios, each followed by a debriefing. The first scenario of the day (PRE) was conducted prior to any team training. The final scenario of the day (POST) was the same scenario, with a slightly modified patient history. All scenarios included standardized distractors designed to elicit and challenge specific teamwork behaviors. Primary outcome measure was change (before and after training) in adherence to Pediatric Advanced Life Support guidelines, as measured by the Clinical Performance Tool. Secondary outcome measures were as follows: 1) change in times to initiation of chest compressions and defibrillation and 2) teamwork performance, as measured by the Clinical Teamwork Scale. Correlation between Clinical Performance Tool and Clinical Teamwork Scale scores was also analyzed. Teams significantly improved Clinical Performance Tool scores (67.3-79.6%; p < 0.0001), time to initiation of chest compressions (60.8-27.1 s; p < 0.0001), time to defibrillation (164.8-122.0 s; p < 0.0001), and Clinical Teamwork Scale scores (56.0-71.8%; p < 0.0001). A positive correlation was found between Clinical Performance Tool and Clinical Teamwork Scale (R = 0.281; p < 0.0001). Participation in a simulation-based team training educational intervention significantly improved surrogate measures of clinical performance, time to initiation of key clinical tasks, and teamwork during simulated pediatric resuscitation. A positive correlation between clinical and teamwork performance suggests that effective teamwork improves clinical performance of resuscitation teams.

Development of a South African integrated syndromic respiratory disease guideline for primary care.

PubMed

English, René G; Bateman, Eric D; Zwarenstein, Merrick F; Fairall, Lara R; Bheekie, Angeni; Bachmann, Max O; Majara, Bosielo; Ottmani, Salah-Eddine; Scherpbier, Robert W

2008-09-01

The Practical Approach to Lung Health in South Africa (PALSA) initiative aimed to develop an integrated symptom- and sign-based (syndromic) respiratory disease guideline for nurse care practitioners working in primary care in a developing country. A multidisciplinary team developed the guideline after reviewing local barriers to respiratory health care provision, relevant health care policies, existing respiratory guidelines, and literature. Guideline drafts were evaluated by means of focus group discussions. Existing evidence-based guideline development methodologies were tailored for development of the guideline. A locally-applicable guideline based on syndromic diagnostic algorithms was developed for the management of patients 15 years and older who presented to primary care facilities with cough or difficulty breathing. PALSA has developed a guideline that integrates and presents diagnostic and management recommendations for priority respiratory diseases in adults using a symptom- and sign-based algorithmic guideline for nurses in developing countries.

Social media and professionalism: a retrospective content analysis of Fitness to Practise cases heard by the GDC concerning social media complaints.

PubMed

Neville, P

2017-09-08

Introduction Since 2013, all General Dental Council (GDC) registrants' online activities have been regulated by the GDC's social media guidelines. Failure to comply with these guidelines results in a Fitness to Practise (FtP) complaint being investigated.Aims This study explores the prevalence of social media related FtP cases investigated by the GDC from 1 September 2013 to 21 June 2016.Method Documentary analysis of social media related FtP cases published on the GDC's website was undertaken. All cases that met the study's inclusion criteria were analysed using a quantitative content analysis framework.Findings It was found that 2.4% of FtP cases published on the GDC website during that period were related to breaches of the social media guidelines. All of the cases investigated were proven and upheld. Most of those named in the complaints were dental nurses and the most common type of complaint was inappropriate Facebook comments.Conclusions The low incidence rate should be interpreted with caution, being illustrative of the types of issues that might arise rather than the volume. The GDC will need to remain vigilant in this area and ensure that social media awareness training is an active part of CPD for all the dental team.

Team-Based Simulation: Toward Developing Ethical Guidelines among American and Israeli Teachers in Jewish Schools

ERIC Educational Resources Information Center

Shapira-Lishchinsky, Orly; Glanz, Jeffrey; Shaer, Anat

2016-01-01

This study attempts to explore Israeli and American teachers' perceptions based on their ethical dilemmas in Jewish schools. A cross-national study was undertaken in Jewish schools, examining fifty teachers from Israel and fifty-one teachers from the United States. Designed with team-based simulations, this study revealed strong similarities…

Invasive Group A Streptococcal Infection in High School Football Players, New York City, 2003

PubMed Central

Lee, Elsie; Bambino, Maribeth; Ackelsberg, Joel; Weiss, Don; Sathyakumar, Chiminyan; Kornblum, John; Barbot, Oxiris; Johnson, Dwight; Kaplan, Edward L.; Layton, Marcelle

2005-01-01

After being notified that 2 high school football teammates were hospitalized with confirmed or suspected invasive group A streptococcal infections, we conducted an investigation of possible spread among other team members. This investigation highlights a need for guidelines on management of streptococcal and other infectious disease outbreaks in team sport settings. PMID:15705342

"Yes, we can!" review on team confidence in sports.

PubMed

Fransen, Katrien; Mertens, Niels; Feltz, Deborah; Boen, Filip

2017-08-01

During the last decade, team confidence has received more and more attention in the sport psychology literature. Research has demonstrated that athletes who are more confident in their team's abilities exert more effort, set more challenging goals, are more resilient when facing adversities, and ultimately perform better. This article reviews the existing literature in order to provide more clarity in terms of the conceptualization and the operationalization of team confidence. We thereby distinguish between collective efficacy (i.e., process-oriented team confidence) and team outcome confidence (i.e., outcome-oriented team confidence). In addition, both the sources as well as the outcomes of team confidence will be discussed. Furthermore, we will go deeper into the dispersion of team confidence and we will evaluate the current guidelines on how to measure both types of team confidence. Building upon this base, the article then highlights interesting avenues for future research in order to further improve both our theoretical knowledge on team confidence and its application to the field. Copyright © 2017 Elsevier Ltd. All rights reserved.

Barriers to Translation of Physical Activity into the Lung Cancer Model of Care. A Qualitative Study of Clinicians' Perspectives.

PubMed

Granger, Catherine L; Denehy, Linda; Remedios, Louisa; Retica, Sarah; Phongpagdi, Pimsiri; Hart, Nicholas; Parry, Selina M

2016-12-01

Evidence-based clinical practice guidelines recommend physical activity for people with lung cancer, however evidence has not translated into clinical practice and the majority of patients do not meet recommended activity levels. To identify factors (barriers and enablers) that influence clinicians' translation of the physical activity guidelines into practice. Qualitative study involving 17 participants (three respiratory physicians, two thoracic surgeons, two oncologists, two nurses, and eight physical therapists) who were recruited using purposive sampling from five hospitals in Melbourne, Victoria, Australia. Nine semistructured interviews and a focus group were conducted, transcribed verbatim, and independently cross-checked by a second researcher. Thematic analysis was used to analyze data. Five consistent themes emerged: (1) the clinicians perception of patient-related physical and psychological influences (including symptoms and comorbidities) that impact on patient's ability to perform regular physical activity; (2) the influence of the patient's past physical activity behavior and their perceived relevance and knowledge about physical activity; (3) the clinicians own knowledge and beliefs about physical activity; (4) workplace culture supporting or hindering physical activity; and (5) environmental and structural influences in the healthcare system (included clinicians time, staffing, protocols and services). Clinicians described potential strategies, including: (1) the opportunity for nurse practitioners to act as champions of regular physical activity and triage referrals for physical activity services; (2) opportunistically using the time when patients are in hospital after surgery to discuss physical activity; and (3) for all members of the multidisciplinary team to provide consistent messages to patients about the importance of physical activity. Key barriers to implementation of the physical activity guidelines in lung cancer are diverse and include both clinician- and healthcare system-related factors. A combined approach to target a number of these factors should be used to inform research, improve clinical services, and develop policies aiming to increase physical activity and improve survivorship outcomes for patients with lung cancer.

Preventing Indoor Air Quality Problems in Educational Facilities: Guidelines for Hot, Humid Climates. Revised.

ERIC Educational Resources Information Center

Odom, J. David; DuBose, George

This manual addresses the errors that occur during new construction that subsequently contribute to indoor air quality (IAQ) problems in newly constructed buildings in hot and humid climates, and offers guidelines for preventing them during the design and construction phases. It defines the roles and responsibilities of the design team, the…

Guidelines for radioiodinated MIBG scintigraphy in children.

PubMed

Olivier, Pierre; Colarinha, Paula; Fettich, Jure; Fischer, Sibylle; Frökier, Jörgen; Giammarile, Francesco; Gordon, Isky; Hahn, Klaus; Kabasakal, Levent; Mann, Mike; Mitjavila, Mercedes; Piepsz, Amy; Porn, Ute; Sixt, Rune; van Velzen, Jeannette

2003-05-01

These guidelines on the use of radioiodinated (99m)Tc-MIBG scintigraphy in children, which summarise the views of the Paediatric Committee of the European Association of Nuclear Medicine, provide a framework which may prove helpful to nuclear medicine teams in daily practice. They have been influenced by the conclusions of the "Consensus Guidelines for MIBG Scintigraphy" (Paris, November 6, 1997) of the European Neuroblastoma Group and by those of the Oncological Committee of the French Society of Nuclear Medicine. The guidelines should be taken in the context of "good practice" and any local/national rules which apply to nuclear medicine examinations.

Control measures to trace ≤ 15-year-old contacts of index cases of active pulmonary tuberculosis

PubMed Central

Oliveira, Cláudia Di Lorenzo; de Melo, Angelita Cristine; de Oliveira, Lílian Ruth Silva; Froede, Emerson Lopes; Camargos, Paulo

2015-01-01

This was descriptive study carried out in a medium-sized Brazilian city. In ≤ 15-year-old contacts of index cases of active pulmonary tuberculosis, we assessed compliance with the Brazilian national guidelines for tuberculosis control. We interviewed 43 contacts and their legal guardians. Approximately 80% of the contacts were not assessed by the municipal public health care system, and only 21% underwent tuberculin skin testing. The results obtained with the Chi-square Automatic Interaction Detector method suggest that health care teams have a biased attitude toward assessing such contacts and underscore the need for training health professionals regarding tuberculosis control programs. PMID:26578137

Management Approaches for Enterocutaneous Fistulas.

PubMed

Heimroth, Jamie; Chen, Eric; Sutton, Erica

2018-03-01

There are very few clinical studies that highlight a definitive and comprehensive guideline for the management of enterocutaneous fistulas. Most accepted guidelines are found in textbooks and are taken from expert advice and case reports. The goal of this review is to highlight advancements relevant to the management of enterocutaneous fistulas from the recent two to three years. Although strong evidence-based guidelines are lacking, the consensus is that a multidisciplinary team working with a clear treatment plan targeting multiple aspects of management can maximize patient outcomes.

Measure Guideline: High Efficiency Natural Gas Furnaces

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

Brand, L.; Rose, W.

2012-10-01

This Measure Guideline covers installation of high-efficiency gas furnaces. Topics covered include when to install a high-efficiency gas furnace as a retrofit measure, how to identify and address risks, and the steps to be used in the selection and installation process. The guideline is written for Building America practitioners and HVAC contractors and installers. It includes a compilation of information provided by manufacturers, researchers, and the Department of Energy as well as recent research results from the Partnership for Advanced Residential Retrofit (PARR) Building America team.

Measure Guideline. High Efficiency Natural Gas Furnaces

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

Brand, L.; Rose, W.

2012-10-01

This measure guideline covers installation of high-efficiency gas furnaces, including: when to install a high-efficiency gas furnace as a retrofit measure; how to identify and address risks; and the steps to be used in the selection and installation process. The guideline is written for Building America practitioners and HVAC contractors and installers. It includes a compilation of information provided by manufacturers, researchers, and the Department of Energy as well as recent research results from the Partnership for Advanced Residential Retrofit (PARR) Building America team.

DOE's Computer Incident Advisory Capability (CIAC)

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

Schultz, E.

1990-09-01

Computer security is essential in maintaining quality in the computing environment. Computer security incidents, however, are becoming more sophisticated. The DOE Computer Incident Advisory Capability (CIAC) team was formed primarily to assist DOE sites in responding to computer security incidents. Among CIAC's other responsibilities are gathering and distributing information to DOE sites, providing training workshops, coordinating with other agencies, response teams, and vendors, creating guidelines for incident handling, and developing software tools. CIAC has already provided considerable assistance to DOE sites faced with virus infections and worm and hacker attacks, has issued over 40 information bulletins, and has developed andmore » presented a workshop on incident handling. CIAC's experience in helping sites has produced several lessons learned, including the need to follow effective procedures to avoid virus infections in small systems and the need for sound password management and system administration in networked systems. CIAC's activity and scope will expand in the future. 4 refs.« less

FMEA team performance in health care: A qualitative analysis of team member perceptions.

PubMed

Wetterneck, Tosha B; Hundt, Ann Schoofs; Carayon, Pascale

2009-06-01

: Failure mode and effects analysis (FMEA) is a commonly used prospective risk assessment approach in health care. Failure mode and effects analyses are time consuming and resource intensive, and team performance is crucial for FMEA success. We evaluate FMEA team members' perceptions of FMEA team performance to provide recommendations to improve the FMEA process in health care organizations. : Structured interviews and survey questionnaires were administered to team members of 2 FMEA teams at a Midwest Hospital to evaluate team member perceptions of FMEA team performance and factors influencing team performance. Interview transcripts underwent content analysis, and descriptive statistics were performed on questionnaire results to identify and quantify FMEA team performance. Theme-based nodes were categorized using the input-process-outcome model for team performance. : Twenty-eight interviews and questionnaires were completed by 24 team members. Four persons participated on both teams. There were significant differences between the 2 teams regarding perceptions of team functioning and overall team effectiveness that are explained by difference in team inputs and process (e.g., leadership/facilitation, team objectives, attendance of process owners). : Evaluation of team members' perceptions of team functioning produced useful insights that can be used to model future team functioning. Guidelines for FMEA team success are provided.

Implementation of asthma guidelines to West Australian community pharmacies: an exploratory, quasi-experimental study.

PubMed

Watkins, Kim; Trevenen, Michelle; Murray, Kevin; Kendall, Peter A; Schneider, Carl R; Clifford, Rhonda

2016-08-31

Pharmacy assistants are often the first point of contact for patients presenting in community pharmacies. The current role of pharmacy assistants in the supply of asthma-reliever medications (short-acting β-agonists) was identified as a barrier to appropriate guideline-based care. The aim of this research was to devise and evaluate a team-based intervention to formalise the role of pharmacy assistants and to improve asthma guideline-based care in community pharmacy. A controlled pre-post intervention study was conducted in 336 metropolitan pharmacies located in Perth, Western Australia. Pharmacies were stratified into 2 groups (187 intervention and 149 control) based on known confounders for asthma control. The intervention was designed using a common-sense approach and resources developed included a checklist, videos and web page. Delivery was via workshops (25 pharmacies) or academic detailing (162 pharmacies). Pharmacy practice was assessed preintervention and postintervention via covert simulated patient methodology. Primary outcome measures included patient medical referral, device use demonstration and counselling, internal referral and/or direct involvement of a pharmacist in consultations. There was a significant increase in patient medical referral in intervention pharmacies from 32% to 47% (p=0.0007) from preintervention to postintervention, while control pharmacies showed a non-significant decrease from 50% to 44% (p=0.22). Device counselling was not routinely carried out at any stage or in any cohort of this research and no significant changes in internal referral were observed. Increases in medical referral indicate that asthma guideline compliance can be improved in community pharmacy if implementation employs a team-based approach and involves pharmacy assistants. However, results were variable and the intervention did not improve practice related to device counselling or internal referral/pharmacist involvement. Undertaking more workshops may have improved results. Guideline implementation in community pharmacy should consider the role of pharmacy assistants and how to overcome logistical barriers to pharmacy participation in implementation activities. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Management of acute ischaemic stroke at Nasser Hospital, Gaza Strip: a clinical audit.

PubMed

Alkhatib, Mohammed N; Abd-Alghafoor, Tamer; Elmassry, AlaaEldeen; Albarqouni, Loai; Böttcher, Bettina; Alfaqawi, Maha

2018-02-21

Stroke is a leading cause of morbidity and mortality worldwide. The aim of this study was to assess the standard of care for patients with acute ischaemic stroke at the internal medicine department of Nasser Hospital, Gaza Strip. For this retrospective clinical audit, we selected a random sample of 100 medical records for patients with stroke who were admitted to Nasser Hospital between January and August, 2016. Clinical practice was compared with the recommendations in the 2013 American Heart Association and American Stroke Association guidelines. Patient confidentiality was maintained, and ethical approval was obtained from the Palestinian Ministry of Health. Five patient records were not coded and therefore excluded. Of the remaining 95 patients, 51 (54%) were men with a mean age of 67 years (SD 14). 53 patients presented with dysarthria. The duration of stroke symptoms before admission was not reported in 86 (91%) records. A complete blood count and renal function tests were done for all patients, lipid profiling for 87 (92%) patients, electrocardiography for 85 (89%) patients, carotid duplex ultrasound for 32 (34%) patients, and CT scan for all patients. None of the patients had continuous cardiac monitoring or an assessment of swallowing function, and 70 (74%) patients received immediate anti-platelet therapy (325 mg aspirin). 80 (85%) patients received venous thromboembolism prophylaxis. 41 (43%) patients were given antibiotics without a recorded indication. None of the patients received thrombolytic therapy. As recommended in the guidelines, 41 (43%) patients did not receive anti-hypertensive agents on the first day of hospitalisation. 46 (48%) patients had diabetes, and glycaemic control was achieved by day 3 in 26 (57%) patients. No Palestinian guidelines exist for the management of patients with acute ischaemic stroke, and in most cases management was based on personal experience rather than evidence. The development of evidence-based guidelines is mandatory to improve management of ischaemic stroke. Furthermore, implementing staff education activities, regular clinical audit, and team feedback would encourage adherence to such guidelines. Combined with the establishment of a specialised stroke unit and development of a multidisciplinary team approach, patient outcome could be improved further. None. Copyright © 2018 Elsevier Ltd. All rights reserved.

Big data and tactical analysis in elite soccer: future challenges and opportunities for sports science.

PubMed

Rein, Robert; Memmert, Daniel

2016-01-01

Until recently tactical analysis in elite soccer were based on observational data using variables which discard most contextual information. Analyses of team tactics require however detailed data from various sources including technical skill, individual physiological performance, and team formations among others to represent the complex processes underlying team tactical behavior. Accordingly, little is known about how these different factors influence team tactical behavior in elite soccer. In parts, this has also been due to the lack of available data. Increasingly however, detailed game logs obtained through next-generation tracking technologies in addition to physiological training data collected through novel miniature sensor technologies have become available for research. This leads however to the opposite problem where the shear amount of data becomes an obstacle in itself as methodological guidelines as well as theoretical modelling of tactical decision making in team sports is lacking. The present paper discusses how big data and modern machine learning technologies may help to address these issues and aid in developing a theoretical model for tactical decision making in team sports. As experience from medical applications show, significant organizational obstacles regarding data governance and access to technologies must be overcome first. The present work discusses these issues with respect to tactical analyses in elite soccer and propose a technological stack which aims to introduce big data technologies into elite soccer research. The proposed approach could also serve as a guideline for other sports science domains as increasing data size is becoming a wide-spread phenomenon.

UK national guidelines on the management of syphilis 2015.

PubMed

Kingston, M; French, P; Higgins, S; McQuillan, O; Sukthankar, A; Stott, C; McBrien, B; Tipple, C; Turner, A; Sullivan, A K; Radcliffe, Keith; Cousins, Darren; FitzGerald, Mark; Fisher, Martin; Grover, Deepa; Higgins, Stephen; Kingston, Margaret; Rayment, Michael; Sullivan, Ann

2016-05-01

These guidelines are an update for 2015 of the 2008 UK guidelines for the management of syphilis. The writing group have piloted the new BASHH guideline methodology, notably using the GRADE system for assessing evidence and making recommendations. We have made significant changes to the recommendations for screening infants born to mothers with positive syphilis serology and to facilitate accurate and timely communication between the teams caring for mother and baby we have developed a birth plan. Procaine penicillin is now an alternative, not preferred treatment, for all stages of syphilis except neurosyphilis, but the length of treatment for this is shortened. Other changes are summarised at the start of the guideline. © The Author(s) 2016.

Peripheral amiodarone-related phlebitis: an institutional nursing guideline to reduce patient harm.

PubMed

Spiering, Mary

2014-01-01

Intravenous amiodarone is one of the most widely used antiarrythmics for the treatment of atrial fibrillation with rapid ventricular response. Peripheral amiodarone infusion, however, often causes pain during infusion and subsequent phlebitis.Data collection on a cardiac telemetry unit revealed a high rate of phlebitis. A multidisciplinary team developed and implemented amiodarone peripheral infusion guidelines. The pre-guideline phlebitis rate was 85% and post-guideline rate was 38%, representing a 47% change or improvement. An additional finding was that the severity of phlebitis was reduced, as well. The results of this study suggest that the implementation of a peripheral amiodarone infusion guideline reduced the incidence and severity of amiodarone-related phlebitis in the cardiac population.

Team-Based Learning in a Subsection of a Veterinary Course as Compared to Standard Lectures

ERIC Educational Resources Information Center

Malone, Erin; Spieth, Amie

2012-01-01

Team-Based Learning (TBL) maximizes class time for student practice in complex problems using peer learning in an instructor-guided format. Generally entire courses are structured using the comprehensive guidelines of TBL. We used TBL in a subsection of a veterinary course to determine if it remained effective in this format. One section of the…

Before the Emergency: A Framework for Evaluating Emergency Preparedness Alternatives at Higher Education Institutions

DTIC Science & Technology

2010-09-01

Operations and Procedures • Logistics and Facilities • Training • Exercises, Evaluation and Corrective Actions • Crisis Communications ...Assessment Team BCA Benefit-cost analysis CEO Chief Executive Officer CERT Community Emergency Response Team CFR Code of Federal Regulations...CHDS Center for Homeland Defense and Security CPG 101 Comprehensive Preparedness Guidelines 101 CPP Community Preparedness and Participation CPW

American Bar Association Supplementary Guidelines for the Mitigation Function of Defense Teams in Death Penalty Cases: Implications for Social Work

ERIC Educational Resources Information Center

Andrews, Arlene Bowers

2012-01-01

When a client faces a penalty of death, defense attorneys may call on social workers in many capacities: mitigation specialist, expert witness, consulting specialist, direct witness, or defense-initiated victim outreach worker. The American Bar Association set forth standards for capital defense attorneys, which led an interdisciplinary team to…

Some guidance on preparing validation plans for the DART Full System Models.

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

Gray, Genetha Anne; Hough, Patricia Diane; Hills, Richard Guy

2009-03-01

Planning is an important part of computational model verification and validation (V&V) and the requisite planning document is vital for effectively executing the plan. The document provides a means of communicating intent to the typically large group of people, from program management to analysts to test engineers, who must work together to complete the validation activities. This report provides guidelines for writing a validation plan. It describes the components of such a plan and includes important references and resources. While the initial target audience is the DART Full System Model teams in the nuclear weapons program, the guidelines are generallymore » applicable to other modeling efforts. Our goal in writing this document is to provide a framework for consistency in validation plans across weapon systems, different types of models, and different scenarios. Specific details contained in any given validation plan will vary according to application requirements and available resources.« less

Self-reported physical activity and preaccession fitness testing in U.S. Army applicants.

PubMed

Gubata, Marlene E; Cowan, David N; Bedno, Sheryl A; Urban, Nadia; Niebuhr, David W

2011-08-01

The Assessment of Recruit Motivation and Strength (ARMS) study evaluated a physical fitness screening test for Army applicants before basic training. This report examines applicants' self-reported physical activity as a predictor of objective fitness measured by ARMS. In 2006, the ARMS study administered a fitness test and physical activity survey to Army applicants during their medical evaluation, using multiple logistic regression for comparison. Among both men and women, "qualified" and "exceeds-body-fat" subjects who met American College of Sports Medicine adult physical activity guidelines were more likely to pass the fitness test. Overall, subjects who met physical activity recommendations, watched less television, and played on sports teams had a higher odds of passing the ARMS test after adjustment for age, race, and smoking status. This study demonstrates that self-reported physical activity was associated with physical fitness and may be used to identify those at risk of failing a preaccession fitness test.

Congenital Heart Disease: Guidelines of Care for Children with Special Health Care Needs.

ERIC Educational Resources Information Center

Minnesota State Dept. of Health, Minneapolis. Services for Children with Handicaps.

These guidelines were written to help families coordinate the health care that may be needed by a child with congenital heart disease. The booklet begins with general information about congenital heart disease. It then discusses the goals of health care, the health care team, the importance of periodic health care, and record keeping procedures.…

Guidelines for supportive care in multiple myeloma 2011.

PubMed

Snowden, John A; Ahmedzai, Sam H; Ashcroft, John; D'Sa, Shirley; Littlewood, Timothy; Low, Eric; Lucraft, Helen; Maclean, Rhona; Feyler, Sylvia; Pratt, Guy; Bird, Jennifer M

2011-07-01

Supportive care plays an increasingly important role in the modern management of multiple myeloma. While modern treatments have significantly prolonged overall and progression free survival through improved disease control, the vast majority of patients remain incurable, and live with the burden of the disease itself and the cumulative side effects of treatments. Maintenance of quality of life presents challenges at all stages of the disease from diagnosis through the multiple phases of active treatment to the end of life. Written on behalf of the British Committee for Standards in Haematology (BCSH) and the UK Myeloma Forum (UKMF), these evidence based guidelines summarize the current national consensus for supportive and symptomatic care in multiple myeloma in the following areas; pain management, peripheral neuropathy, skeletal complications, infection, anaemia, haemostasis and thrombosis, sedation, fatigue, nausea, vomiting, anorexia, constipation, diarrhoea, mucositis, bisphosphonate-induced osteonecrosis of the jaw, complementary therapies, holistic needs assessment and end of life care. Although most aspects of supportive care can be supervised by haematology teams primarily responsible for patients with multiple myeloma, multidisciplinary collaboration involving specialists in palliative medicine, pain management, radiotherapy and surgical specialities is essential, and guidance is provided for appropriate interdisciplinary referral. These guidelines should be read in conjunction with the BCSH/UKMF Guidelines for the Diagnosis and Management of Multiple Myeloma 2011. © 2011 Blackwell Publishing Ltd.

Quality Improvement in Acute Ischemic Stroke Care in Taiwan: The Breakthrough Collaborative in Stroke

PubMed Central

Chern, Chang-Ming; Lee, Tsong-Hai; Tang, Sung-Chun; Tsai, Li-Kai; Liao, Hsun-Hsiang; Chang, Hang; LaBresh, Kenneth A.; Lin, Hung-Jung; Chiou, Hung-Yi; Chiu, Hou-Chang; Lien, Li-Ming

2016-01-01

In the management of acute ischemic stroke, guideline adherence is often suboptimal, particularly for intravenous thrombolysis or anticoagulation for atrial fibrillation. We sought to improve stroke care quality via a collaborative model, the Breakthrough Series (BTS)-Stroke activity, in a nationwide, multi-center activity in Taiwan. A BTS Collaborative, a short-term learning system for a large number of multidisciplinary teams from hospitals, was applied to enhance acute ischemic stroke care quality. Twenty-four hospitals participated in and submitted data for this stroke quality improvement campaign in 2010–2011. Totally, 14 stroke quality measures, adopted from the Get With The Guideline (GWTG)-Stroke program, were used to evaluate the performance and outcome of the ischemic stroke patients. Data for a one-year period from 24 hospitals with 13,181 acute ischemic stroke patients were analyzed. In 14 hospitals, most stroke quality measures improved significantly during the BTS-activity compared with a pre-BTS-Stroke activity period (2006–08). The rate of intravenous thrombolysis increased from 1.2% to 4.6%, door-to-needle time ≤60 minutes improved from 7.1% to 50.8%, symptomatic hemorrhage after intravenous thrombolysis decreased from 11.0% to 5.6%, and anticoagulation therapy for atrial fibrillation increased from 32.1% to 64.1%. The yearly composite measures of five stroke quality measures revealed significant improvements from 2006 to 2011 (75% to 86.3%, p<0.001). The quarterly composite measures also improved significantly during the BTS-Stroke activity. In conclusion, a BTS collaborative model is associated with improved guideline adherence for patients with acute ischemic stroke. GWTG-Stroke recommendations can be successfully applied in countries besides the United States. PMID:27487190

Quality Improvement in Acute Ischemic Stroke Care in Taiwan: The Breakthrough Collaborative in Stroke.

PubMed

Hsieh, Fang-I; Jeng, Jiann-Shing; Chern, Chang-Ming; Lee, Tsong-Hai; Tang, Sung-Chun; Tsai, Li-Kai; Liao, Hsun-Hsiang; Chang, Hang; LaBresh, Kenneth A; Lin, Hung-Jung; Chiou, Hung-Yi; Chiu, Hou-Chang; Lien, Li-Ming

2016-01-01

In the management of acute ischemic stroke, guideline adherence is often suboptimal, particularly for intravenous thrombolysis or anticoagulation for atrial fibrillation. We sought to improve stroke care quality via a collaborative model, the Breakthrough Series (BTS)-Stroke activity, in a nationwide, multi-center activity in Taiwan. A BTS Collaborative, a short-term learning system for a large number of multidisciplinary teams from hospitals, was applied to enhance acute ischemic stroke care quality. Twenty-four hospitals participated in and submitted data for this stroke quality improvement campaign in 2010-2011. Totally, 14 stroke quality measures, adopted from the Get With The Guideline (GWTG)-Stroke program, were used to evaluate the performance and outcome of the ischemic stroke patients. Data for a one-year period from 24 hospitals with 13,181 acute ischemic stroke patients were analyzed. In 14 hospitals, most stroke quality measures improved significantly during the BTS-activity compared with a pre-BTS-Stroke activity period (2006-08). The rate of intravenous thrombolysis increased from 1.2% to 4.6%, door-to-needle time ≤60 minutes improved from 7.1% to 50.8%, symptomatic hemorrhage after intravenous thrombolysis decreased from 11.0% to 5.6%, and anticoagulation therapy for atrial fibrillation increased from 32.1% to 64.1%. The yearly composite measures of five stroke quality measures revealed significant improvements from 2006 to 2011 (75% to 86.3%, p<0.001). The quarterly composite measures also improved significantly during the BTS-Stroke activity. In conclusion, a BTS collaborative model is associated with improved guideline adherence for patients with acute ischemic stroke. GWTG-Stroke recommendations can be successfully applied in countries besides the United States.

AAFP and ISFM feline-friendly handling guidelines.

PubMed

Rodan, Ilona; Sundahl, Eliza; Carney, Hazel; Gagnon, Anne-Claire; Heath, Sarah; Landsberg, Gary; Seksel, Kersti; Yin, Sophia

2011-05-01

The number of pet cats is increasing in most countries, often outnumbering pet dogs, yet cats receive less veterinary care than their canine counterparts.(1) Clients state the difficulty of getting the cat into a carrier at home, driving to the clinic, and dealing with the fearful cat at the veterinary clinic as reasons for fewer visits.(2) Educating and preparing the client and the veterinary team with regard to respectful feline handling is necessary in order to avoid stress and accomplish the goal of good health care. Without such preparation, feline stress may escalate into fear or fear-associated aggression. The resulting stress may alter results of the physical examination and laboratory tests, leading to incorrect diagnoses (eg, diabetes mellitus) and unnecessary treatments.(3-5) Without compassionate and respectful handling by the veterinary team, clients may feel the team lacks skills and compassion, or does not understand cats. Injury may occur to the cat, client and/or veterinary team.(6) Clients who want to avoid stress for their cat may avoid veterinary visits or choose another practice instead. The use of feline-friendly handling techniques should reduce these problems. Handling is most successful when the veterinary team adapts the approach to each individual cat and situation. The goal of these guidelines is to provide useful information for handling cats that can lead to: ✜ Reduced fear and pain for the cat. ✜ Reinforced veterinarian-client-cat bond, trust and confidence, and thus better lifelong medical care for the cat. ✜ Improved efficiency, productivity and job satisfaction for the veterinary team. ✜ Increased client compliance. ✜ Timely reporting and early detection of medical and behavioral concerns. ✜ Fewer injuries to clients and the veterinary team. ✜ Reduced anxiety for the client. Copyright © 2011 Elsevier Inc. All rights reserved.

Consensus statement on the anticipation and prevention of acute postoperative pain: multidisciplinary RADAR approach.

PubMed

Vickers, A; Bali, S; Baxter, A; Bruce, G; England, J; Heafield, R; Langford, R; Makin, R; Power, I; Trim, J

2009-10-01

There has been considerable investment in efforts to improve postoperative pain management, including the introduction of acute pain teams. There have also been a number of guidelines published on postoperative pain management and there is widespread agreement on how pain should be practically managed. Despite these advances, there is no apparent improvement in the number of patients experiencing moderately severe or extreme pain after surgery. This highlights significant scope for improvement in acute postoperative pain management. In January 2009, a multidisciplinary UK expert panel met to define and agree a practical framework to encourage implementation of the numerous guidelines and fundamentals of pain management at a local level. The panel recognised that to do this, there was a need to organise the information and guidelines into a simplified, accessible and easy-to-implement system based on their practical clinical experience. Given the volume of literature in this area, the Chair recommended that key international guidelines from professional bodies should be distributed and then reviewed during the meeting to form the basis of the framework. Consensus was reached by unanimous agreement of all ten participants. This report provides a framework for the key themes, including consensus recommendations based upon practical experience agreed during the meeting, with the aim of consolidating the key guidelines to provide a fundamental framework which is simple to teach and implement in all areas. Key priorities that emerged were: Responsibility, Anticipation, Discussion, Assessment and Response. This formed the basis of RADAR, a novel framework to help pain specialists educate the wider care team on understanding and prioritising the management of acute pain. Acute postoperative pain can be more effectively managed if it is prioritised and anticipated by a well-informed care team who are educated with regard to appropriate analgesic options and understand what the long-term benefits of pain relief are. The principles of RADAR provide structure to help with training and implementation of good practice, to achieve effective postoperative pain management.

Oncology care provider perspectives on exercise promotion in people with cancer: an examination of knowledge, practices, barriers, and facilitators.

PubMed

Nadler, Michelle; Bainbridge, Daryl; Tomasone, Jennifer; Cheifetz, Oren; Juergens, Rosalyn A; Sussman, Jonathan

2017-07-01

Despite the reported benefits of physical activity in alleviating the impact of cancer and its treatments, oncology care providers (OCPs) are not routinely discussing exercise with their patients, suggesting a knowledge to action gap. We sought to determine OCP's knowledge, beliefs, barriers, and facilitators to exercise discussion. A survey was administered to OCPs at the cancer center in Hamilton, Ontario. Questions comprised of demographics, knowledge and beliefs regarding exercise guidelines, and barriers and facilitators to exercise discussion. Analysis of survey responses was descriptive. Pearson's chi-squared test was used to examine select associations. There were 120 respondents (61% response rate) representing a diversity of professions. Approximately, 80% of OCPs were not aware of any exercise guidelines in cancer and self-reported poor knowledge on when, how, and which patients to refer to exercise programs. OCPs who reported meeting Canada's Physical Activity guidelines were significantly more likely to identify correct guidelines (p = 0.023) and to report good knowledge on how to provide exercise counseling (p = 0.014). Across OCP groups, barriers to exercise discussion included poor knowledge, lack of time, and safety concerns. Most felt that educational sessions and having an exercise specialist on the clinical team would be beneficial. OCPs have low knowledge regarding exercise counseling, but believe that discussing exercise is a multidisciplinary task and expressed a desire for further training. Interventions will require a multi-pronged approach including education for OCPs and guidance on assessment for exercise safety.

Rural Latino youth park use: characteristics, park amenities, and physical activity.

PubMed

Perry, Cynthia K; Saelens, Brain E; Thompson, Beti

2011-06-01

Less than half of youth engage in sufficient physical activity to achieve health benefits. Key environmental factors of park and recreation spaces may influence youth physical activity. We sought to ascertain youth characteristics and behaviors that attract youth to parks with specific amenities and encourage physical activity while at the parks in a rural, predominantly Latino community. We examined the quality of amenities in the 13 parks and recreation spaces that middle school aged youth have access to in their community using the Environmental Assessment of Parks and Recreation Spaces (EAPRS) tool. Middle school students completed surveys in the school classroom (n = 1,102) regarding park use, physical activity, and intrapersonal characteristics (e.g., motivators). We used logistic regression to identify correlates of any park use, use of higher quality field and court parks, and active and sedentary park use. Younger age, participation in an after school activity, and identification of a team as a motivator were positively associated with any park use. Use of higher quality court and field parks was associated with participation in an after school activity and being Latino. The odds of being active in the parks were greater for boys and Latinos. Older age and alcohol use are correlated with being sedentary at the park, while odds of being sedentary at the park were lower for boys and youth who met physical activity guidelines. Organized team activities may encourage active use of higher quality fields and courts parks by Latino youth; thereby, increasing their level of physical activity.

Clinical Practice Guideline Selection, Development, Implementation, and Evaluation

DTIC Science & Technology

2000-02-01

interventions for a particular diagnosis” (Henning, 1997) developed by members of the hospital staff. They can be Clinical Practice Guidelines6 conceptualized...health care environment , it is more important than ever for health care organizations to select the most cost-effective procedures, and to continuously...of the studies regarding the targeted illness/injury will enable this team to identify those interventions strongly supported by significant

Compliance with AAPM Practice Guideline 1.a: CT Protocol Management and Review — from the perspective of a university hospital

PubMed Central

Bour, Robert K.; Pozniak, Myron; Ranallo, Frank N.

2015-01-01

The purpose of this paper is to describe our experience with the AAPM Medical Physics Practice Guideline 1.a: “CT Protocol Management and Review Practice Guideline”. Specifically, we will share how our institution's quality management system addresses the suggestions within the AAPM practice report. We feel this paper is needed as it was beyond the scope of the AAPM practice guideline to provide specific details on fulfilling individual guidelines. Our hope is that other institutions will be able to emulate some of our practices and that this article would encourage other types of centers (e.g., community hospitals) to share their methodology for approaching CT protocol optimization and quality control. Our institution had a functioning CT protocol optimization process, albeit informal, since we began using CT. Recently, we made our protocol development and validation process compliant with a number of the ISO 9001:2008 clauses and this required us to formalize the roles of the members of our CT protocol optimization team. We rely heavily on PACS‐based IT solutions for acquiring radiologist feedback on the performance of our CT protocols and the performance of our CT scanners in terms of dose (scanner output) and the function of the automatic tube current modulation. Specific details on our quality management system covering both quality control and ongoing optimization have been provided. The roles of each CT protocol team member have been defined, and the critical role that IT solutions provides for the management of files and the monitoring of CT protocols has been reviewed. In addition, the invaluable role management provides by being a champion for the project has been explained; lack of a project champion will mitigate the efforts of a CT protocol optimization team. Meeting the guidelines set forth in the AAPM practice guideline was not inherently difficult, but did, in our case, require the cooperation of radiologists, technologists, physicists, IT, administrative staff, and hospital management. Some of the IT solutions presented in this paper are novel and currently unique to our institution. PACS number: 87.57.Q PMID:26103176

Work release during disaster: a registered nurses' rights and responsibilities and employer guidelines.

PubMed

2007-01-01

Recent events of multiple federal, state and regional response teams has heightened the visibility of nurses as disaster team members. It is vital that nurses become knowledgeable and competent to participate as disaster and emergency team members. Nurses should possess knowledge and skills that assist the team response and recovery efforts. In times of disaster, whether from the pandemic influenza or a hurricane, nurses are responsible for safeguarding patients by caring for and advocating for their health and welfare. Employers of nurses and nurses have the responsibility to work collaboratively with governmental agencies and private industry for the overall good of the health of the community whenever large influxes of patients require care simultaneously.

Report of the Peer Review Panel on the early site suitability evaluation of the Potential Repository Site at Yucca Mountain, Nevada; Yucca Mountain Site Characterization Project

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

NONE

1992-01-01

The US Department of Energy (DOE) Yucca mountain Site Characterization Project Office (YMPO) assigned Science Applications International Corporation (SAIC), the Technical and Management Support Services (T&MSS) contractor to the YmPo, the task of conducting an Early Site Suitability Evaluation (ESSE) of the Yucca mountain site as a potential site for a high-level radioactive waste repository. First, the assignment called for the development of a method to evaluate a single site against the DOE General Guidelines for Recommendation of Sites for Nuclear Waste Repositories, 10 CFR Part 960. Then, using this method, an evaluation team, the ESSE Core Team, of seniormore » YMP scientists, engineers, and technical experts, evaluated new information obtained about the site since publication of the final Environmental Assessment (DOE, 1986) to determine if new suitability/unsuitability findings could be recommended. Finally, the Core Team identified further information and analyses needed to make final determinations for each of the guidelines. As part of the task, an independent peer review of the ESSE report has been conducted. Expertise was solicited that covered the entire spectrum of siting guidelines in 10 CFR Part 960 in order to provide a complete, in-depth critical review of the data evaluated and cited in the ESSE report, the methods used to evaluate the data, and the conclusions and recommendations offered by the report. Fourteen nationally recognized technical experts (Table 2) served on the Peer Review Panel. The comments from the Panel and the responses prepared by the ESSE Core Team, documented on formal Comment Response Forms, constitute the body of this document.« less

Implementation of clinical practice guidelines for ventilator-associated pneumonia: a multicenter prospective study.

PubMed

Sinuff, Tasnim; Muscedere, John; Cook, Deborah J; Dodek, Peter M; Anderson, William; Keenan, Sean P; Wood, Gordon; Tan, Richard; Haupt, Marilyn T; Miletin, Michael; Bouali, Redouane; Jiang, Xuran; Day, Andrew G; Overvelde, Janet; Heyland, Daren K

2013-01-01

Ventilator-associated pneumonia is an important cause of morbidity and mortality in critically ill patients. Evidence-based clinical practice guidelines for the prevention, diagnosis, and treatment of ventilator-associated pneumonia may improve outcomes, but optimal methods to ensure implementation of guidelines in the intensive care unit are unclear. Hence, we determined the effect of educational sessions augmented with reminders, and led by local opinion leaders, as strategies to implement evidence-based ventilator-associated pneumonia guidelines on guideline concordance and ventilator-associated pneumonia rates. Two-year prospective, multicenter, time-series study conducted between June 2007 and December 2009. Eleven ICUs (ten in Canada, one in the United States); five academic and six community ICUs. At each site, 30 adult patients mechanically ventilated >48 hrs were enrolled during four data collection periods (baseline, 6, 15, and 24 months). Guideline recommendations for the prevention, diagnosis, and treatment of ventilator-associated pneumonia were implemented using a multifaceted intervention (education, reminders, local opinion leaders, and implementation teams) directed toward the entire multidisciplinary ICU team. Clinician exposure to the intervention was assessed at 6, 15, and 24 months after the introduction of this intervention. The main outcome measure was aggregate concordance with the 14 ventilator-associated pneumonia guideline recommendations. One thousand three hundred twenty patients were enrolled (330 in each study period). Clinician exposure to the multifaceted intervention was high and increased during the study: 86.7%, 93.3%, 95.8%, (p < .001), as did aggregate concordance (mean [SD]): 50.7% (6.1), 54.4% (7.1), 56.2% (5.9), 58.7% (6.7) (p = .007). Over the study period, ventilator-associated pneumonia rates decreased (events/330 patients): 47 (14.2%), 34 (10.3%), 38 (11.5%), 29 (8.8%) (p = .03). A 2-yr multifaceted intervention to enhance ventilator-associated pneumonia guideline uptake was associated with a significant increase in guideline concordance and a reduction in ventilator-associated pneumonia rates.

Health care globalization: a need for virtual leadership.

PubMed

Holland, J Brian; Malvey, Donna; Fottler, Myron D

2009-01-01

As health care organizations expand and move into global markets, they face many leadership challenges, including the difficulty of leading individuals who are geographically dispersed. This article provides global managers with guidelines for leading and motivating individuals or teams from a distance while overcoming the typical challenges that "virtual leaders" and "virtual teams" face: employee isolation, confusion, language barriers, cultural differences, and technological breakdowns. Fortunately, technological advances in communications have provided various methods to accommodate geographically dispersed or "global virtual teams." Health care leaders now have the ability to lead global teams from afar by becoming "virtual leaders" with a responsibility to lead a "virtual team." Three models of globalization presented and discussed are outsourcing of health care services, medical tourism, and telerobotics. These models require global managers to lead virtually, and a positive relationship between the virtual leader and the virtual team member is vital in the success of global health care organizations.

Surgical workload of a foreign medical team after Typhoon Haiyan.

PubMed

Read, David J; Holian, Annette; Moller, Cea-Cea; Poutawera, Vaughan

2016-05-01

On 8 November 2013, Typhoon Haiyan struck the Philippines causing widespread loss of lives and infrastructures. At the request of the Government of the Philippines, the Australian Government deployed a surgical field hospital to the city of Tacloban for 4 weeks. This paper describes the establishment of the hospital, the surgical workload and handover to the local health system upon the end of deployment. A Microsoft excel database was utilized throughout the deployment, recording demographics, relationship to the typhoon and surgical procedure performed. Over the 21 days of surgical activity, the Australian field hospital performed 222 operations upon 131 persons. A mean of 10.8 procedures were performed per day (range 3-20). The majority (70.2%) of procedures were soft tissue surgery. Diabetes was present in 22.9% and 67.9% were typhoon-related. The Australian Medical Assistance Team field hospital adhered to the World Health Organization guidelines for foreign medical teams, in ensuring informed consent, appropriate anaesthesia and surgery, and worked collaboratively with local surgeons, ensuring adequate documentation and clinical handover. This paper describes the experience of a trained, equipped and collaborative surgical foreign medical team in Tacloban in the aftermath of Typhoon Haiyan. Sepsis from foot injuries in diabetic patients constituted an unexpected majority of the workload. New presentations of typhoon-related injuries were presented throughout the deployment. © 2015 Royal Australasian College of Surgeons.

A stratified response system for the emergency management of the severely injured.

PubMed

Lloyd, D A; Patterson, M; Robson, J; Phillips, B

2001-01-01

A decade ago, there were justifiable criticisms of the delivery of emergency care for injured patients in accident and emergency departments in the UK. To address this, a trauma management system was developed in 1991 at Alder Hey Hospital, Liverpool. This includes a trauma team, communication system, management guidelines and quality assurance. On admission to the accident and emergency department, injured patients are triaged to one of three levels of injury severity, and a multidisciplinary team lead by a paediatric surgeon or senior accident and emergency department physician is activated. The level of injury severity determines the composition of the trauma team. A care pathway based on ATLS/APLS principles has been developed. The response process as well patient management are documented and reviewed at a monthly audit meeting. Currently, more than 80% of eligible patients are managed using the trauma system, with an over-triage rate of about 25%. Regular modifications to the trauma system since its inception in 1991 have resulted in an efficient and effective management structure. Stratification of the trauma response has minimised unnecessary use of the multidisciplinary trauma team and ensures that mobilisation and use of hospital staff and resources are tailored to the needs of the injured patient. Although developed in a specialist children's hospital, the system could be adapted for any acute hospital.

Medical ethics in pediatric critical care.

PubMed

Orioles, Alberto; Morrison, Wynne E

2013-04-01

Ethically charged situations are common in pediatric critical care. Most situations can be managed with minimal controversy within the medical team or between the team and patients/families. Familiarity with institutional resources, such as hospital ethics committees, and national guidelines, such as publications from the American Academy of Pediatrics, American Medical Association, or Society of Critical Care Medicine, are an essential part of the toolkit of any intensivist. Open discussion with colleagues and within the multidisciplinary team can also ensure that when difficult situations arise, they are addressed in a proactive, evidence-based, and collegial manner. Copyright © 2013 Elsevier Inc. All rights reserved.

"That's not how we do it": managing the inherited medical practice team.

PubMed

Hills, Laura

2013-01-01

Most medical practice managers who take a new job will inherit an existing team. Those first few days on the job are critical because they can determine whether or not the new manager will succeed. This article provides a game plan for new medical practice managers so they get off on the right foot with their inherited teams. It suggests strategies for learning about the team's culture and for demonstrating visibly that there is a new manager in the job. It offers guidelines about introducing the new manager to the inherited team, discussing past experiences, and establishing new expectations. This article further provides practical tips for serving as a role model, gaining allies, and dealing with troublemakers quickly and effectively. It suggests strategies for speaking about the previous practice manager and for creating excitement with the inherited team. Finally, this article offers a set of 15 questions a new manager can ask members of the inherited team to get to know them, an additional 25-point team assessment instrument, and a step-by-step strategy for raising the bar for mediocre, lackluster, or dysfunctional inherited teams.

Clinical practice guidelines for the management of metastatic colorectal cancer: a consensus statement of the Hellenic Society of Medical Oncologists (HeSMO)

PubMed Central

Dervenis, Christos; Xynos, Evaghelos; Sotiropoulos, George; Gouvas, Nikolaos; Boukovinas, Ioannis; Agalianos, Christos; Androulakis, Nikolaos; Athanasiadis, Athanasios; Christodoulou, Christos; Chrysou, Evangelia; Emmanouilidis, Christos; Georgiou, Panagiotis; Karachaliou, Niki; Katopodi, Ourania; Kountourakis, Panteleimon; Kyriazanos, Ioannis; Makatsoris, Thomas; Papakostas, Pavlos; Papamichael, Demetris; Pechlivanides, George; Pentheroudakis, Georgios; Pilpilidis, Ioannis; Sgouros, Joseph; Tekkis, Paris; Triantopoulou, Charina; Tzardi, Maria; Vassiliou, Vassilis; Vini, Louiza; Xynogalos, Spyridon; Ziras, Nikolaos; Souglakos, John

2016-01-01

There is discrepancy and failure to adhere to current international guidelines for the management of metastatic colorectal cancer (CRC) in hospitals in Greece and Cyprus. The aim of the present document is to provide a consensus on the multidisciplinary management of metastastic CRC, considering both special characteristics of our Healthcare System and international guidelines. Following discussion and online communication among the members of an executive team chosen by the Hellenic Society of Medical Oncology (HeSMO), a consensus for metastastic CRC disease was developed. Statements were subjected to the Delphi methodology on two voting rounds by invited multidisciplinary international experts on CRC. Statements reaching level of agreement by ≥80% were considered as having achieved large consensus, whereas statements reaching 60-80% moderate consensus. One hundred and nine statements were developed. Ninety experts voted for those statements. The median rate of abstain per statement was 18.5% (range: 0-54%). In the end of the process, all statements achieved a large consensus. The importance of centralization, care by a multidisciplinary team, adherence to guidelines, and personalization is emphasized. R0 resection is the only intervention that may offer substantial improvement in the oncological outcomes. PMID:27708505

Carcinoma of unknown primary: key radiological issues from the recent National Institute for Health and Clinical Excellence guidelines

PubMed Central

Taylor, M B; Bromham, N R; Arnold, S E

2012-01-01

Carcinoma of unknown primary origin (CUP) accounts for 3–5% of cancer cases and is the fourth most common cause of cancer death in the UK. CUP management is challenging, partly owing to the heterogeneity of the condition and its presentation, but also owing to the lack of dedicated clinical services for these patients. The recent National Institute for Health and Clinical Excellence (NICE) guidelines on metastatic malignancy of unknown primary origin were developed to improve the co-ordination of diagnostic and clinical services at hospitals treating cancer patients in England and Wales, in particular by the setting up of CUP teams to manage these patients. Radiologists have a vital role in the diagnosis of these patients and should work closely with the CUP team to streamline the diagnostic pathway. This article summarises areas of the NICE guidelines relevant to radiology and discusses the radiological management of patients with CUP, including initial investigation, the importance of biopsy, the management of specific presentations, special investigations and organisational issues. PMID:22374278

Differences in conative characteristics and perceived group cohesion of the basketball players playing in different positions in the team.

PubMed

Sindik, Josko; Nazor, Damir

2011-09-01

Identification of differences in individual conative characteristics and in perceived group cohesion of the basketball players playing in different positions in the team could provide guidelines for a better selection of basketball players and better coaching work. The aim of our study was to determine the differences in relation to the positions of guards and forwards/centres, and the four major positions in the team. The final sample of subjects (74 basketball players) is selected from the initial sample of 107 subjects, selected from nine men's senior basketball teams that played in A-1 Croatian men's basketball league championship in 2006/2007. The results showed no statistically significant difference between basketball players who play in different positions in the team, neither in relation to two basic positions in the team (guards as opposed to forwards/centres), nor in relation to the four positions in the team (point guard, shooting guard, small forward, power forward/centre).

Human Factors Planning Guidelines

DOT National Transportation Integrated Search

1996-01-01

To ensure human factors considerations are fully incorporated in the system : development, the Integrated Product Team (IPT) or Program Manager initiates a : Human Factors Program (HFP) that addresses the human performance and human : resource parame...

Putting evidence into practice: a quality activity of proactive pain relief for postpartum perineal pain.

PubMed

Swain, J; Dahlen, H G

2013-03-01

Perineal pain associated with perineal trauma is often underestimated. Offering regular pain relief may be advantageous compared to waiting for women to request it. Changing clinical practice in a sustained way needs a whole of team approach. To reduce women's pain following perineal trauma in the first 48 h following childbirth and to undertake this as multidisciplinary, quality activity. In November 2008 a questionnaire was distributed to 18 new mothers who had sustained perineal trauma during the birth in order to assess pain levels in the first 48 h and to investigate pain management therapies used. Following this survey a multidisciplinary project team undertook a series of brainstorming sessions, reviewed the literature and undertook staff surveys to identify key factors impacting on women's perineal pain. A process of decision making led to education and support of women and staff. An evidence based guideline, which involved prescribing regular pain relief for women and offering an ice pack within 1h of giving birth was implemented, and a brochure was designed for women. A follow up questionnaire was distributed in June 2010 to 18 women and pain scores before and after the change in policy were compared. Prior to the practice change in 2008 67% of the women surveyed rated their pain as 'moderate' to 'a lot' 48 h following the birth. Following the change in practice and implementation of a new guideline a second survey in 2010 at 48 h postpartum found 60% of women in the post intervention group rated their perineal pain as 'a lot' to 'moderate'. There had been a 33% increase in women's use of pain relief options compared to the pre-intervention survey. The practice change was sustained and adopted by all the staff. By taking a multidisciplinary quality activity an effective practice change was facilitated that appeared to decrease women's perineal pain in the 48 h following birth. Copyright © 2012 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

The Montana ALE (Autonomous Lunar Excavator) Systems Engineering Report

NASA Technical Reports Server (NTRS)

Hull, Bethanne J.

2012-01-01

On May 2 1-26, 20 12, the third annual NASA Lunabotics Mining Competition will be held at the Kennedy Space Center in Florida. This event brings together student teams from universities around the world to compete in an engineering challenge. Each team must design, build and operate a robotic excavator that can collect artificial lunar soil and deposit it at a target location. Montana State University, Bozeman, is one of the institutions selected to field a team this year. This paper will summarize the goals of MSU's lunar excavator project, known as the Autonomous Lunar Explorer (ALE), along with the engineering process that the MSU team is using to fulfill these goals, according to NASA's systems engineering guidelines.

Pre-deployment Heat Acclimatization Guidelines for Disaster Responders.

PubMed

Brearley, Matt B

2016-02-01

Minimal preparation time is a feature of responding to sudden onset disasters. While equipment and supplies are prepared for deployment at short notice, less is known of the physical preparation of medical responders. With many disaster-prone areas classified as tropical regions, there is potential for responders to endure a combination of high ambient temperatures and relative humidity during deployment. Heat acclimatization, defined as the physiological and perceptual adaptations to frequent elevations of core body temperature (Tc), is a key strategy to improve tolerance of hot conditions by medical responders. Pre-deployment heat acclimatization guidelines were developed based upon the duration of physical training and the subjective rate of perceived exertion (session RPE). An objective of individual training sessions was the perception of body temperature as warm to hot. The guidelines were implemented for Team Bravo (2nd rotation) of the Australian Medical Assistance Team (AusMAT) deployed to Tacloban, Philippines following Typhoon Haiyan in November 2013. The guidelines were distributed electronically five to seven days prior to deployment and were followed by a consultation. A group training session in hot conditions was undertaken prior to departure. The AusMAT responders to utilize the guidelines were based in cool or temperate climates that required extra layers of clothing, training during warmer parts of the days, or warm indoor conditions to achieve session objectives. Responders reported the guidelines were simple to use, applicable to their varied training regimens, and had improved their confidence to work in the heat despite not completing the entire 14 day period. The pre-deployment heat acclimatization guidelines provided AusMAT responders the ability to quantify their physical training and promoted physiological adaptations to maximize health, safety, and performance during deployment. While maintaining year-round heat acclimatization is considered essential for medical responders, these guidelines may facilitate beneficial adaptations once notified of deployment.

Consensus Statement of the Indian Academy of Pediatrics on Evaluation and Management of Autism Spectrum Disorder.

PubMed

Dalwai, Samir; Ahmed, Shabina; Udani, Vrajesh; Mundkur, Nandini; Kamath, S S; C Nair, M K

2017-05-15

Autism Spectrum Disorder (ASD) is a clinically heterogenous condition with a wide range of etiological factors and causing significant public health burden. ASD poses a serious developmental disadvantage to the child in the form of poor schooling, social function and adult productivity. Thus, framing evidence-based national guidelines is a pressing need. The meeting on formulation of national consensus guidelines on neurodevelopmental disorders was organized by Indian Academy of Paediatrics in Mumbai on 18th and 19th December 2015. The invited experts included Pediatricians, Developmental Pediatricians, Psychiatrists, Remedial Educators, Pediatric Neurologists and Clinical Psychologists. The participants framed guidelines after extensive discussions. Thereafter, a committee was established to review the points discussed in the meeting. To provide consensus guidelines on evaluation and management of ASD in children in India. Intervention should begin as early as possible. A definitive diagnosis is not necessary for commencing intervention. Intervention should target core features of autism i.e. deficits in social communication and interaction, and restricted repetitive patterns of behavior, activities and/ or interests. Intervention should be specific, evidence-based, structured and appropriate to the developmental needs of the child. Management of children should be provided through interdisciplinary teams, coordinated by the Pediatrician. Management of co-morbidities is critical to effectiveness of treatment. Pharmacotherapy may be offered to children when there is a specific target symptom or co-morbid condition.

Barriers and facilitators to the implementation of an evidence-based electronic minimum dataset for nursing team leader handover: A descriptive survey.

PubMed

Spooner, Amy J; Aitken, Leanne M; Chaboyer, Wendy

2017-11-15

There is widespread use of clinical information systems in intensive care units however, the evidence to support electronic handover is limited. The study aim was to assess the barriers and facilitators to use of an electronic minimum dataset for nursing team leader shift-to-shift handover in the intensive care unit prior to its implementation. The study was conducted in a 21-bed medical/surgical intensive care unit, specialising in cardiothoracic surgery at a tertiary referral hospital, in Queensland, Australia. An established tool was modified to the intensive care nursing handover context and a survey of all 63 nursing team leaders was undertaken. Survey statements were rated using a 6-point Likert scale with selections from 'strongly disagree' to 'strongly agree', and open-ended questions. Descriptive statistics were used to summarise results. A total of 39 team leaders responded to the survey (62%). Team leaders used general intensive care work unit guidelines to inform practice however they were less familiar with the intensive care handover work unit guideline. Barriers to minimum dataset uptake included: a tool that was not user friendly, time consuming and contained too much information. Facilitators to minimum dataset adoption included: a tool that was user friendly, saved time and contained relevant information. Identifying the complexities of a healthcare setting prior to the implementation of an intervention assists researchers and clinicians to integrate new knowledge into healthcare settings. Barriers and facilitators to knowledge use focused on usability, content and efficiency of the electronic minimum dataset and can be used to inform tailored strategies to optimise team leaders' adoption of a minimum dataset for handover. Copyright © 2017 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

Make time to move

MedlinePlus

... weeknight. Join a team. Softball, basketball, hockey, and soccer are not just for kids. Look for recreational ... us Disclaimers Copyright Privacy Accessibility Quality Guidelines Viewers & Players MedlinePlus Connect for EHRs For Developers U.S. National ...

Core guidelines for the discharge home of the child on long term assisted ventilation in the United Kingdom

PubMed Central

Jardine, E.; Wallis, C.

1998-01-01

Paediatric home ventilation is a feasible option and can be successful in a wide range of conditions and ages. Advances in ventilator technology and an ethos of optimism for home care has increased the possibilities for discharging chronically ventilated children from intensive care units and acute medical beds. With careful planning the process can succeed, but difficulties often thwart the responsible team, especially when attempting discharge for the first time. These core guidelines aim to assist a smooth, swift and successful transfer. They were developed by a working party of interested professionals spanning a wide range of health care disciplines and represent a synthesis of views accumulated from the experiences of individual teams throughout the UK. Three case scenarios provide further illustrative detail and guidance.

 PMID:10319058

Advanced Clinical Decision Support for Transport of the Critically Ill Patient

DTIC Science & Technology

2013-12-01

algorithms, status asthmaticus and status epilepticus , are to "go live" for use on pediatric critical care transport by the end of October. (Appendices 5...additional algorithms ( status asthmaticus and status epilepticus , Appendices 5 and 6). 8) Plans for validation testing to other transport teams...Practice Guideline Status Epilepticus Clinical Practice Guideline 17 d .s:. ... > 0 Cf :~f t t) ’ U t I .!! ~ .. z ~ i ~ t 0 - : i l

Supportive Care Treatment Guidelines: Value, Limitations, and Opportunities

PubMed Central

Peterson, Douglas E.; Bensadoun, Rene-Jean; Lalla, Rajesh V.; McGuire, Deborah B.

2013-01-01

Evidence-based guidelines in clinical oncology practice are now prominent, with emphasis on clinical, health outcome and economic perspectives. Given the complexity of cancer management, a multidisciplinary approach is essential. Evidence-based guidelines to address supportive cancer care have merged expert opinion, systematic evaluation of clinical and research data, and meta-analyses of clinical trials. Production of supportive care guidelines by the interdisciplinary team is dependent on sufficient high-quality research studies. Once published, it is essential they be customized at institutional and national levels. Implementation in clinical practice is perhaps the greatest challenge. Optimal management occurs through integration of country-specific issues, including care access, healthcare resources, information technology, and national coordination of healthcare practices. The purpose of this article is to: (1) provide an overview of interdisciplinary cancer management using evidence-based guidelines; (2) delineate the theory and practice of guideline dissemination, utilization and outcome assessment; and (3) recommend future research strategies to maximize guidelines use in clinical practice. PMID:21600365

[ESC guidelines on atrial fibrillation 2016 : Summary of the most relevant recommendations and modifications].

PubMed

Eckardt, L; Häusler, K G; Ravens, U; Borggrefe, M; Kirchhof, P

2016-12-01

The first European Society of Cardiology (ESC) guidelines on atrial fibrillation (AF) developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS) were published in August 2016. These guidelines replace the revised guidelines from 2012 and contain some interesting new aspects. The topics range from the pathophysiology through diagnostics, therapy and stroke prevention up to special clinical situations, such as atrial fibrillation in cardiopathy, sport and pregnancy. Early screening, patient informed consent, individualized therapy and the modification of factors promoting atrial fibrillation are of particular importance. The guidelines recommend the establishment of AF heart teams, containing specialists from various disciplines. The guidelines also underline the importance of non-vitamin K‑dependent oral anticoagulants (NOAC) for stroke prevention compared to standard anticoagulants with vitamin K antagonists. For symptomatic and especially paroxysmal atrial fibrillation, the guidelines emphasize the importance of an antiarrhythmic treatment with catheter ablation and/or pharmaceutical antiarrhythmic therapy in addition to a frequency regulating therapy.

The management of scabies outbreaks in residential care facilities for the elderly in England: a review of current health protection guidelines.

PubMed

White, L C J; Lanza, S; Middleton, J; Hewitt, K; Freire-Moran, L; Edge, C; Nicholls, M; Rajan-Iyer, J; Cassell, J A

2016-11-01

Commonly thought of as a disease of poverty and overcrowding in resource-poor settings globally, scabies is also an important public health issue in residential care facilities for the elderly (RCFE) in high-income countries such as the UK. We compared and contrasted current local Health Protection Team (HPT) guidelines for the management of scabies outbreaks in RCFE throughout England. We performed content analysis on 20 guidelines, and used this to create a quantitative report of their variation in key dimensions. Although the guidelines were generally consistent on issues such as the treatment protocols for individual patients, there was substantial variation in their recommendations regarding the prophylactic treatment of contacts, infection control measures and the roles and responsibilities of individual stakeholders. Most guidelines did not adequately address the logistical challenges associated with mass treatment in this setting. We conclude that the heterogeneous nature of the guidelines reviewed is an argument in favour of national guidelines being produced.

Impact of the Canadian Diabetes Association guideline dissemination strategy on clinician knowledge and behaviour change outcomes.

PubMed

Yu, Catherine H; Lillie, Erin; Mascarenhas-Johnson, Alekhya; Gall Casey, Carolyn; Straus, Sharon E

2018-04-04

Implementation of clinical practice guideline (CPG) into clinical practice remains limited. Using the Knowledge-To-Action framework, a guideline dissemination and implementation strategy for the Canadian Diabetes Association's 2013 CPG was developed and launched to clinicians and people with diabetes. The RE-AIM framework guided evaluation of this strategy clinician; we report here one aspect of the effectiveness dimension using mixed methods. We measured impact of the strategy on clinican knowledge and behaviour change constructs using evaluation forms, national online survey and individual interviews. After attending a lecture, clinician confidence (n = 915) increased (3.7(SD 0.7) to 4.5 (SD 0.6) on a 5-point scale (p < 0.001)), with 55% (n = 505) intending to make a practice change (e.g. clinical management regarding glycemic control). Ninety-four percent of survey respondents (n = 907) were aware of the guidelines, attributed to communications from professional associations, continuing professional development events, and colleagues. Forty to 98% of respondents (total n 462-485) were correct in their interpretation of CPG messages, and 33-65%(total n 351-651) reported that they had made changes to their practice. Interviews with 28 clinicians revealed that organizational credibility, online access to tools, clarity of tool content, and education sessions facilitated uptake; lack of time, team-based consensus, and seamless integration into care and patient complexity were barriers. The complexity of diabetes care requires systemic adoption of organization of care interventions, including interprofessional collaboration and consensus. Augmenting our strategy to include scalable models for professional development, integration of guidelines into electronic medical records, and expansion of our target audience to include health care teams and patients, may optimize guideline uptake. Copyright © 2018 Elsevier B.V. All rights reserved.

Sewage epidemiology and illicit drug research: the development of ethical research guidelines.

PubMed

Prichard, Jeremy; Hall, Wayne; de Voogt, Pim; Zuccato, Ettore

2014-02-15

To discuss the need to develop ethical guidelines for researchers using sewage epidemiology to monitor drug use in the general population and specific precincts, including prisons, schools and workplaces. Describe current applications of sewage epidemiology, identify potential ethical risks associated with this science, and identify key means by which these risks may be mitigated through proportionate ethical guidance that allows this science to be fully developed. A rapidly advancing field of research is sewage epidemiology (SE) - the analysis of wastewater samples to monitor illicit drug use and other substances. Typically this research involves low ethical risks because individual participants cannot be identified and, consequently, review has been waived by human research ethics committees. In the absence of such oversight, ethical research guidelines are recommended for SE teams, peer reviewers and journal editors; guidelines will assist them to mitigate any risks in general population studies and studies of prisons, schools and workplaces. Potential harms include the stigmatisation of participants and, in the prison setting, austere policy responses to SE data that impact negatively upon inmate-participants. The risk of harm can be managed through research planning, awareness of the socio-political context in which results will be interpreted (or, in the case of media, sensationalised) and careful relations with industry partners. Ethical guidelines should be developed in consultation with SE scholars and be periodically amended. They should include publication processes that safeguard scientific rigour and be promulgated through existing research governance structures. Guidelines will assist to promote an ethical research culture among SE teams and scholars involved in the publication process and this will work to protect the reputation of the field. Copyright © 2014 Elsevier B.V. All rights reserved.

Organizational structures and communications on the SH 130 project.

DOT National Transportation Integrated Search

2006-03-01

This product summarizes the findings from research analyzing SH 130 organizational structures and communication flows. A set of guidelines pertaining to team organization and communication improvement and the design-build environment is also included...

Building Performance Optimization while Empowering Occupants Toward Environmentally Sustainable Behavior through Continuous Monitoring and Diagnostics

DTIC Science & Technology

2016-12-01

investment at the PaANG installation. In compliance with the NIST handbook’s guidelines, the team used the actual energy prices of the buildings...Costing Manual for the Federal Energy Management Program. For example, the team used the actual energy price and the measured energy consumption at the...least 30% of a DOD building’s HVAC and plug load annual energy consumption can be saved through continuous diagnostics and controls, while empowering

Evaluation and Customization of WHO Safety Checklist for Patient Safety in Otorhinolaryngology.

PubMed

Dabholkar, Yogesh; Velankar, Haritosh; Suryanarayan, Sneha; Dabholkar, Twinkle Y; Saberwal, Akanksha A; Verma, Bhavika

2018-03-01

The WHO has designed a safe surgery checklist to enhance communication and awareness of patient safety during surgery and to minimise complications. WHO recommends that the check-list be evaluated and customised by end users as a tool to promote safe surgery. The aim of present study was to evaluate the impact of WHO safety checklist on patient safety awareness in otorhinolaryngology and to customise it for the speciality. A prospective structured questionnaire based study was done in ENT operating room for duration of 1 month each for cases, before and after implementation of safe surgery checklist. The feedback from respondents (surgeons, nurses and anaesthetists) was used to arrive at a customised checklist for otolaryngology as per WHO guidelines. The checklist significantly improved team member's awareness of patient's identity (from 17 to 86%) and each other's identity and roles (from 46 to 94%) and improved team communication (from 73 to 92%) in operation theatre. There was a significant improvement in preoperative check of equipment and critical events were discussed more frequently. The checklist could be effectively customised to suit otolaryngology needs as per WHO guidelines. The modified checklist needs to be validated by otolaryngology associations. We conclude from our study that the WHO Surgical safety check-list has a favourable impact on patient safety awareness, team-work and communication of operating team and can be customised for otolaryngology setting.

The importance of the pharmacist's expanding role on the diabetes team: reinforcing nutritional guidelines for improved glycemic control.

PubMed

Johnson, L C; Beach, E

1997-10-01

The role of the pharmacist on the diabetes care team is expanding due to the increasing number of patients diagnosed with diabetes, limited health care dollars, and the education related to and required for patients by managed care organizations and insurance companies. In the past, training of patients in diabetes self-management skills has been inadequate, and this continues to be the case. Clinical pharmacists, in cooperation with physicians, have increased opportunities to provide education about medications and may include instructions for patients regarding the interaction of food consumed with changes in blood glucose levels. Because of monthly refills on prescribed medications, a patient's interaction with the pharmacist in the setting of a commercial pharmacy is more frequent than with any other member of the diabetes team. This contact offers an ideal educational opportunity. The action and efficacy of medications that affect the pancreas, hepatic glucose production, the utilization of glucose by muscle cells, and the absorption of glucose from the intestines are influenced directly by the meal plan. Nutritional guidelines, meal planning for the Type I and Type II patient, use of the exchange system, carbohydrate counting, artificial sweeteners, alcoholic beverages, and suggestions for guiding patients to establish eating habits that lead to improved diabetes control are important issues for every member of the diabetes team to address. The reinforcement of dietary principles may occur in the educational setting of the hospital or the clinic or within the commercial pharmacy setting. When the team presents accurate and current information, continuity of care and improved patient understanding are achieved.

Rationale and methodology of a collaborative learning project in congenital cardiac care

PubMed Central

Wolf, Michael J.; Lee, Eva K.; Nicolson, Susan C.; Pearson, Gail D.; Witte, Madolin K.; Huckaby, Jeryl; Gaies, Michael; Shekerdemian, Lara S.; Mahle, William T.

2018-01-01

Background Collaborative learning is a technique through which individuals or teams learn together by capitalizing on one another’s knowledge, skills, resources, experience, and ideas. Clinicians providing congenital cardiac care may benefit from collaborative learning given the complexity of the patient population and team approach to patient care. Rationale and development Industrial system engineers first performed broad-based time-motion and process analyses of congenital cardiac care programs at 5 Pediatric Heart Network core centers. Rotating multidisciplinary team site visits to each center were completed to facilitate deep learning and information exchange. Through monthly conference calls and an in-person meeting, we determined that duration of mechanical ventilation following infant cardiac surgery was one key variation that could impact a number of clinical outcomes. This was underscored by one participating center’s practice of early extubation in the majority of its patients. A consensus clinical practice guideline using collaborative learning was developed and implemented by multidisciplinary teams from the same 5 centers. The 1-year prospective initiative was completed in May 2015, and data analysis is under way. Conclusion Collaborative learning that uses multidisciplinary team site visits and information sharing allows for rapid structured fact-finding and dissemination of expertise among institutions. System modeling and machine learning approaches objectively identify and prioritize focused areas for guideline development. The collaborative learning framework can potentially be applied to other components of congenital cardiac care and provide a complement to randomized clinical trials as a method to rapidly inform and improve the care of children with congenital heart disease. PMID:26995379

Postmatch recovery of physical performance and biochemical markers in team ball sports: a systematic review

PubMed Central

Brink, Michel S; Kosse, Silke J; Lemmink, Koen A P M

2018-01-01

Background Insufficient postmatch recovery in elite players may cause an increased risk of injuries, illnesses and non-functional over-reaching. Objective To evaluate postmatch recovery time courses of physical performance and biochemical markers in team ball sport players. Study design Systematic review. Data sources PubMed and Web of Science. Eligibility criteria for selecting studies This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Critical Review Form for Quantitative Studies was used to evaluate quality. Studies were included if they met the following criteria: (1) original research evaluated players’ physical recovery postmatch; (2) team/intermittent sports; and (3) at least two postmeasurements were compared with baseline values. Results Twenty-eight studies were eligible. Mean methodological quality was 11.2±1.11. Most used performance tests and biochemical markers were the countermovement jump test, sprint tests and creatine kinase (CK), cortisol (C) and testosterone (T), respectively. Summary/conclusions The current evidence demonstrates that underlying mechanisms of muscle recovery are still in progress while performance recovery is already reached. CK recovery time courses are up to ≥72 hours. Soccer and rugby players need more time to recover for sprint performance, CK and C in comparison to other team ball sports. There are more high-quality studies needed regarding recovery in various team sports and recovery strategies on an individual level should be evaluated. Clinical relevance Ongoing insufficient recovery can be prevented by the use of the presented recovery time courses as specific practical recovery guidelines. PMID:29527320

Rationale and methodology of a collaborative learning project in congenital cardiac care.

PubMed

Wolf, Michael J; Lee, Eva K; Nicolson, Susan C; Pearson, Gail D; Witte, Madolin K; Huckaby, Jeryl; Gaies, Michael; Shekerdemian, Lara S; Mahle, William T

2016-04-01

Collaborative learning is a technique through which individuals or teams learn together by capitalizing on one another's knowledge, skills, resources, experience, and ideas. Clinicians providing congenital cardiac care may benefit from collaborative learning given the complexity of the patient population and team approach to patient care. Industrial system engineers first performed broad-based time-motion and process analyses of congenital cardiac care programs at 5 Pediatric Heart Network core centers. Rotating multidisciplinary team site visits to each center were completed to facilitate deep learning and information exchange. Through monthly conference calls and an in-person meeting, we determined that duration of mechanical ventilation following infant cardiac surgery was one key variation that could impact a number of clinical outcomes. This was underscored by one participating center's practice of early extubation in the majority of its patients. A consensus clinical practice guideline using collaborative learning was developed and implemented by multidisciplinary teams from the same 5 centers. The 1-year prospective initiative was completed in May 2015, and data analysis is under way. Collaborative learning that uses multidisciplinary team site visits and information sharing allows for rapid structured fact-finding and dissemination of expertise among institutions. System modeling and machine learning approaches objectively identify and prioritize focused areas for guideline development. The collaborative learning framework can potentially be applied to other components of congenital cardiac care and provide a complement to randomized clinical trials as a method to rapidly inform and improve the care of children with congenital heart disease. Copyright © 2016 Elsevier Inc. All rights reserved.

APpropriAteness of percutaneous Coronary interventions in patients with ischaemic HEart disease in Italy: the APACHE pilot study

PubMed Central

Marino, Marcello; Crimi, Gabriele; Maiorana, Florinda; Rizzotti, Diego; Lettieri, Corrado; Bettari, Luca; Zuccari, Marco; Sganzerla, Paolo; Tresoldi, Simone; Adamo, Marianna; Ghiringhelli, Sergio; Sponzilli, Carlo; Pasquetto, Giampaolo; Pavei, Andrea; Pedon, Luigi; Bassan, Luciano; Bollati, Mario; Camisasca, Paola; Trabattoni, Daniela; Brancati, Marta; Poli, Arnaldo; Panciroli, Claudio; Lettino, Maddalena; Tarelli, Giuseppe; Tarantini, Giuseppe; De Luca, Leonardo; Varbella, Ferdinando; Musumeci, Giuseppe; De Servi, Stefano

2017-01-01

Objectives To first explore in Italy appropriateness of indication, adherence to guideline recommendations and mode of selection for coronary revascularisation. Design Retrospective, pilot study. Setting 22 percutaneous coronary intervention (PCI)-performing hospitals (20 patients per site), 13 (59%) with on-site cardiac surgery. Participants 440 patients who received PCI for stable coronary artery disease (CAD) or non-ST elevation acute coronary syndrome were independently selected in a 4:1 ratio with half diabetics. Primary and secondary outcome measures Proportion of patients who received appropriate PCI using validated appropriate use scores (ie, AUS≥7). Also, in patients with stable CAD, we examined adherence to the following European Society of Cardiology recommendations: (A) per cent of patients with complex coronary anatomy treated after heart team discussion; (B) per cent of fractional flow reserve-guided PCI for borderline stenoses in patients without documented ischaemia; (C) per cent of patients receiving guideline-directed medical therapy at the time of PCI as well as use of provocative test of ischaemia according to pretest probability (PTP) of CAD. Results Of the 401 mappable PCIs (91%), 38.7% (95% CI 33.9 to 43.6) were classified as appropriate, 47.6% (95% CI 42.7 to 52.6) as uncertain and 13.7% (95% CI 10.5% to 17.5%) as inappropriate. Median PTP in patients with stable CAD without known coronary anatomy was 69% (78% intermediate PTP, 22% high PTP). Ischaemia testing use was similar (p=0.71) in patients with intermediate (n=140, 63%) and with high PTP (n=40, 66%). In patients with stable CAD (n=352) guideline adherence to the three recommendations explored was: (A) 11%; (B) 25%; (C) 23%. AUS was higher in patients evaluated by the heart team as compared with patients who were not (7 (6.8) vs 5 (4.7); p=0.001). Conclusions Use of heart team approaches and adherence to guideline recommendations on coronary revascularisation in a real-world setting is limited. This pilot study documents the feasibility of measuring appropriateness and guideline adherence in clinical practice and identifies substantial opportunities for quality improvement. Trial registration number NCT02748603. PMID:28877948

Describing team development within a novel GP-led urgent care centre model: a qualitative study.

PubMed

Morton, Sarah; Ignatowicz, Agnieszka; Gnani, Shamini; Majeed, Azeem; Greenfield, Geva

2016-06-23

Urgent care centres (UCCs) co-located within an emergency department were developed to reduce the numbers of inappropriate emergency department admissions. Since then various UCC models have developed, including a novel general practitioner (GP)-led UCC that incorporates both GPs and emergency nurse practitioners (ENPs). Traditionally these two groups do not work alongside each other within an emergency setting. Although good teamwork is crucial to better patient outcomes, there is little within the literature about the development of a team consisting of different healthcare professionals in a novel healthcare setting. Our aim was therefore to describe staff members' perspectives of team development within the GP-led UCC model. Open-ended semistructured interviews, analysed using thematic content analysis. GP-led urgent care centres in two academic teaching hospitals in London. 15 UCC staff members including six GPs, four ENPs, two receptionists and three managers. Overall participants were positive about the interprofessional team that had developed and recognised that this process had taken time. Hierarchy within the UCC setting has diminished with time, although some residual hierarchical beliefs do appear to remain. Staff appreciated interdisciplinary collaboration was likely to improve patient care. Eight key facilitating factors for the team were identified: appointment of leaders, perception of fair workload, education on roles/skill sets and development of these, shared professional understanding, interdisciplinary working, ED collaboration, clinical guidelines and social interactions. A strong interprofessional team has evolved within the GP-led UCCs over time, breaking down traditional professional divides. Future implementation of UCC models should pro-actively incorporate the eight facilitating factors identified from the outset, to enable effective teams to develop more quickly. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Review of child development teams.

PubMed Central

Zahir, M; Bennett, S

1994-01-01

Since the Court report was published in 1976 there has been a consensus that the needs of children with disabilities are best met by child development teams. This study explored the structure, facilities, and organisational elements of child development teams operating in the South East Thames region by means of a structured interview with senior professionals involved with organising services for children with disabilities in 14 of 15 health districts in the region. Although all districts had a designated child development team, not all core professionals were adequately represented and four of 14 districts had no child development centre. The quality of buildings and facilities was variable. Teams that did not have a physical base in the form of a centre had fewer staff in the service and poorer facilities. There is a need for further consensus work about broad guidelines on the requirements of child development teams. These will help to inform purchasing authorities about the needs of children with disabilities living in their districts. PMID:8135568

Serving our communities better. Guidelines for planning and developing integrated delivery networks.

PubMed

Prybil, L; Golden, P; Ballance, X

1995-04-01

In 1994 the Daughters of Charity National Health System-East Central (DCNHS-East Central) adopted 11 guidelines to help corporate staff and local leaders plan and develop integrated networks. Guideline 1 emphasizes needs-based strategic planning. Guideline 2 focuses on the community-based network planning process, recommending a team approach and ongoing communication with the local ordinary. In guidelines 3 through 5, the DCNHS-East Central Board of Directors spells out key issues that must be covered in proposals ultimately presented for governance action. Guideline 6 presents three core elements that should characterize all CBNs in which DCNHS-East Central institutions participate. Guideline 7 emphasizes that all CBN proposals and agreements must be clear with respect to the Catholic identity of DCNHS-East Central institutions. Guidelines 8 and 9 require that proposed changes to traditional policies and management practices be explicit in CBN proposals. The tenth guideline requires that all CBN proposals indicate an explicit evaluation function. The final guideline underscores that regardless of the strategic fit or how well a CBN is designed, it is unlikely to succeed unless both internal and external relationships are based on a solid foundation of honesty, mutual respect, and trust.

ATC automation concepts

NASA Technical Reports Server (NTRS)

Erzberger, Heinz

1990-01-01

Information on the design of human-centered tools for terminal area air traffic control (ATC) is given in viewgraph form. Information is given on payoffs and products, guidelines, ATC as a team process, automation tools for ATF, and the traffic management advisor.

Case study guidelines.

DOT National Transportation Integrated Search

2017-03-01

In TxDOT project 0-6817, Review and Evaluation of Current Gross Vehicle Weights and Axle : Load Limits, the project team reviewed the estimated costs imposed by use of overweight (OW) : vehicles and ways to allocate costs to different vehicle classes...

Determining Need for School-Based Physical Therapy Under IDEA: Commonalities Across Practice Guidelines.

PubMed

Vialu, Carlo; Doyle, Maura

2017-10-01

The Individuals with Disabilities Education Act (IDEA) includes physical therapy (PT) as a related service that may be provided to help students with disabilities benefit from their education. However, the IDEA does not provide specific guidance for the provision of school-based PT, resulting in variations in practice across the United States. The authors examined 22 state and local education agency guidelines available online to find commonalities related to the determination of a student's need for PT. Seven commonalities found: educational benefit, team decision, need for PT expertise, establishment of Individualized Education Program (IEP) goal before determining need for PT, distinction between medical and educational PT, the student's disability adversely affects education, and the student's potential for improvement. These commonalities are discussed in relation to current PT and special education literature. This article suggests applying these commonalities as procedural requirements and questions for discussion during an IEP team meeting.

Toward a zero VAP rate: personal and team approaches in the ICU.

PubMed

Fox, Maria Y

2006-01-01

In a fast-paced setting like the intensive care unit (ICU), nurses must have appropriate tools and resources in order to implement appropriate and timely interventions. Ventilator-associated pneumonia (VAP) is a costly and potentially fatal outcome for ICU patients that requires timely interventions. Even with established guidelines and care protocols, nurses do not always incorporate best practice interventions into their daily plan of care. Despite the plethora of information and guidelines about how to apply interventions in order to save lives, managers of ICUs are challenged to involve the bedside nurse and other ICU team members to apply these bundles of interventions in a proactive, rather than reactive, manner in order to prevent complications of care. The purpose of this article is to illustrate the success of 2 different methods utilized to improve patient care in the ICU. The first method is a personal process improvement model, and the second method is a team approach model. Both methods were utilized in order to implement interventions in a timely and complete manner to prevent VAP and its related problem, hospital-associated pneumonia, in the ICU setting. Success with these 2 methods has spurred an interest in other patient care initiatives.

Clinical practice guidelines for the surgical management of colon cancer: a consensus statement of the Hellenic and Cypriot Colorectal Cancer Study Group by the HeSMO*

PubMed Central

Xynos, Evaghelos; Gouvas, Nikolaos; Triantopoulou, Charina; Tekkis, Paris; Vini, Louiza; Tzardi, Maria; Boukovinas, Ioannis; Androulakis, Nikolaos; Athanasiadis, Athanasios; Christodoulou, Christos; Chrysou, Evangelia; Dervenis, Christos; Emmanouilidis, Christos; Georgiou, Panagiotis; Katopodi, Ourania; Kountourakis, Panteleimon; Makatsoris, Thomas; Papakostas, Pavlos; Papamichael, Demetris; Pentheroudakis, Georgios; Pilpilidis, Ioannis; Sgouros, Joseph; Vassiliou, Vassilios; Xynogalos, Spyridon; Ziras, Nikolaos; Karachaliou, Niki; Zoras, Odysseas; Agalianos, Christos; Souglakos, John

2016-01-01

Despite considerable improvement in the management of colon cancer, there is a great deal of variation in the outcomes among European countries, and in particular among different hospital centers in Greece and Cyprus. Discrepancy in the approach strategies and lack of adherence to guidelines for the management of colon cancer may explain the situation. The aim was to elaborate a consensus on the multidisciplinary management of colon cancer, based on European guidelines (ESMO and EURECCA), and also taking into account local special characteristics of our healthcare system. Following discussion and online communication among members of an executive team, a consensus was developed. Statements entered the Delphi voting system on two rounds to achieve consensus by multidisciplinary international experts. Statements with an agreement rate of ≥80% achieved a large consensus, while those with an agreement rate of 60-80% a moderate consensus. Statements achieving an agreement of <60% after both rounds were rejected and not presented. Sixty statements on the management of colon cancer were subjected to the Delphi methodology. Voting experts were 109. The median rate of abstain per statement was 10% (range: 0-41%). In the end of the voting process, all statements achieved a consensus by more than 80% of the experts. A consensus on the management of colon cancer was developed by applying the Delphi methodology. Guidelines are proposed along with algorithms of diagnosis and treatment. The importance of centralization, care by a multidisciplinary team, and adherence to guidelines is emphasized. PMID:26752945

Measure Guideline: Summary of Interior Ducts in New Construction, Including an Efficient, Affordable Method to Install Fur-Down Interior Ducts

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

Beal, D.; McIlvaine , J.; Fonorow, K.

2011-11-01

This document illustrates guidelines for the efficient installation of interior duct systems in new housing, including the fur-up chase method, the fur-down chase method, and interior ducts positioned in sealed attics or sealed crawl spaces. This document illustrates guidelines for the efficient installation of interior duct systems in new housing. Interior ducts result from bringing the duct work inside a home's thermal and air barrier. Architects, designers, builders, and new home buyers should thoroughly investigate any opportunity for energy savings that is as easy to implement during construction, such as the opportunity to construct interior duct work. In addition tomore » enhanced energy efficiency, interior ductwork results in other important advantages, such as improved indoor air quality, increased system durability and increased homeowner comfort. While the advantages of well-designed and constructed interior duct systems are recognized, the implementation of this approach has not gained a significant market acceptance. This guideline describes a variety of methods to create interior ducts including the fur-up chase method, the fur-down chase method, and interior ducts positioned in sealed attics or sealed crawl spaces. As communication of the intent of an interior duct system, and collaboration on its construction are paramount to success, this guideline details the critical design, planning, construction, inspection, and verification steps that must be taken. Involved in this process are individuals from the design team; sales/marketing team; and mechanical, insulation, plumbing, electrical, framing, drywall and solar contractors.« less

[Outpatient specialist medical care: what is possible, what will come?].

PubMed

Tschuschke, C; Uhthoff, H

2013-08-01

The guidelines on outpatient specialist medical treatment (ASV) according to § 116b of the Social Act were published by the Federal Joint Committee on 21 March 2013. The guidelines regulate the framework conditions for the new area of healthcare and the requirements for potential participants. The ASV guidelines are designed to ultimately bridge the sectorial borders for the treatment of rare diseases and those with unusual courses. In the past the reforms in § 116b have not fulfilled the criteria expected by the legislation. The reforms have already led to an increase in the costs for medical services by a factor of 50 within 6 years. The spectrum of diseases to be treated has remained practically unchanged. The healthcare providers must now fulfil a catalogue of prerequisites which will be formulated by the Federal Joint Committee for each entity in the still to be provided annexes to the guidelines in order to be approved on notification by the extended National Committee. The guidelines are based on the prototype further education regulations according to the old law. An important detail is the obligatory formation of cooperation and teams for all participants outside the traditional sectorial limits. Each partner must perform the duties at least 1 day in the week at the site of the team leader. Specific and organizational requirements, extent of treatment and lower limits will be regulated by the still to be formulated annexes. Costing and business effectiveness will be tested by the medical services. No patient has yet been treated under the ASV but the winner is already known: bureaucracy.

Current challenges in adherence to clinical guidelines for antibiotic prophylaxis in surgery.

PubMed

Khan, Sohail Ahmad; Rodrigues, Gabrial; Kumar, Pramod; Rao, Padma G M

2006-06-01

To study the impact of guidelines on surgical antibiotic prophylaxis in clinical practice, barriers involved in adherence to guidelines and how to overcome the same. Literature pertaining to prophylactic antibiotic usage was searched. Medscape, Medline, Cochrane, Surgical Infection Prevention (SIP) project databases were reviewed. Recent articles from relevant journals, texts, and standard guidelines were also studied. Local guidelines seem more likely to be accepted and followed than those developed nationally. Major barriers involved in adherence to guidelines include lack of awareness about the guidelines, general perception of guideline as a bureaucratic rather than educational tool. Some practitioners perceive guidelines as "cookbook medicine" that does not permit them to make their own medical decisions. Other barriers are complex, multi-step systems that create confusion, decrease accountability. Methods for guideline adherence include surveillance and data analysis, new systems to facilitate documentation and improving workflow, education regarding current evidence-based guidelines and promoting the development of local guidelines or protocol, development and implementation of reminders to facilitate adherence to the local guidelines. A multidisciplinary steering team of surgeons, infectious disease specialists, pharmacists, anesthesiologists, microbiologists and nurses should develop local guidelines suitable to their institution and methods for adherence to prevent the surgical site infections. The gap between evidence-based guidelines and practice must be addressed in order to achieve optimal practice in this domain.

An Evidence-based Guideline for the air medical transportation of prehospital trauma patients.

PubMed

Thomas, Stephen H; Brown, Kathleen M; Oliver, Zoë J; Spaite, Daniel W; Lawner, Benjamin J; Sahni, Ritu; Weik, Tasmeen S; Falck-Ytter, Yngve; Wright, Joseph L; Lang, Eddy S

2014-01-01

Decisions about the transportation of trauma patients by helicopter are often not well informed by research assessing the risks, benefits, and costs of such transport. The objective of this evidence-based guideline (EBG) is to recommend a strategy for the selection of prehospital trauma patients who would benefit most from aeromedical transportation. A multidisciplinary panel was recruited consisting of experts in trauma, EBG development, and emergency medical services (EMS) outcomes research. Representatives of the Federal Interagency Committee on Emergency Medical Services (FICEMS), the National Highway Traffic Safety Administration (NHTSA) (funding agency), and the Children's National Medical Center (investigative team) also contributed to the process. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to guide question formulation, evidence retrieval, appraisal/synthesis, and formulate recommendations. The process followed the National Evidence-Based Guideline Model Process, which has been approved by the Federal Interagency Committee on EMS and the National EMS Advisory Council. Two strong and three weak recommendations emerged from the process, all supported only by low or very low quality evidence. The panel strongly recommended that the 2011 CDC Guideline for the Field Triage of Injured Patients be used as the initial step in the triage process, and that ground emergency medical services (GEMS) be used for patients not meeting CDC anatomic, physiologic, and situational high-acuity criteria. The panel issued a weak recommendation to use helicopter emergency medical services (HEMS) for higher-acuity patients if there is a time-savings versus GEMS, or if an appropriate hospital is not accessible by GEMS due to systemic/logistical factors. The panel strongly recommended that online medical direction should not be required for activating HEMS. Special consideration was given to the potential need for local adaptation. Systematic and transparent methodology was used to develop an evidence-based guideline for the transportation of prehospital trauma patients. The recommendations provide specific guidance regarding the activation of GEMS and HEMS for patients of varying acuity. Future research is required to strengthen the data and recommendations, define optimal approaches for guideline implementation, and determine the impact of implementation on safety and outcomes including cost.

The conduct of Australian Indigenous primary health care research focusing on social and emotional wellbeing: a systematic review.

PubMed

Farnbach, Sara; Eades, Anne-Maree; Gwynn, Josephine D; Glozier, Nick; Hackett, Maree L

2018-06-14

Objectives and importance of study: Values and ethics: guidelines for ethical conduct in Aboriginal and Torres Strait Islander health research (Values and ethics) describes key values that should underpin Aboriginal and Torres Strait Islander (Indigenous)-focused health research. It is unclear how research teams address this document in primary health care research. We systematically review the primary health care literature focusing on Indigenous social and emotional wellbeing (SEWB) to identify how Values and ethics and community preferences for standards of behaviour (local protocols) are addressed during research. Systematic review in accordance with PRISMA Guidelines and MOOSE Guidelines for Meta-Analyses and Systematic Reviews of Observational Studies. We searched four databases and one Indigenous-specific website for qualitative, quantitative and mixed-method studies published since Values and ethics was implemented (2003). Included studies were conducted in primary health care services, focused on Indigenous SEWB and were conducted by research teams. Using standard data extraction forms, we identified actions taken (reported by authors or identified by us) relating to Values and ethics and local protocols. A total of 25 studies were included. Authors of two studies explicitly mentioned the Values and ethics document, but neither reported how their actions related to the document's values. In more than half the studies, we identified at least three actions relating to the values. Some actions related to multiple values, including use of culturally sensitive research processes and involving Indigenous representatives in the research team. Local protocols were rarely reported. Addressing Values and ethics appears to improve research projects. The academic community should focus on culturally sensitive research processes, relationship building and developing the Indigenous research workforce, to facilitate acceptable research that affects health outcomes. For Values and ethics to achieve its full impact and to improve learning between research teams, authors should be encouraged to report how the principles are addressed during research, including barriers and enablers that are encountered.

Reengineering health care: management systems for survivors.

PubMed

Griffith, J R

1994-01-01

To survive in the coming era, health care organizations must support the powerful concepts of continuous quality improvement with better internal management systems that include: (1) new processes for making decisions from mission to clinical guidelines; (2) hoshin planning, which emphasizes strong financial management and innovation to meet customer needs; (3) new organizations that make cross-disciplinary teams as important as traditional clinical support services; and (4) expanded information covering several new dimensions, including enhanced analytic capability, and supporting both traditional organization and cross-disciplinary teams.

Simulation-based education for building clinical teams

PubMed Central

Marshall, Stuart D; Flanagan, Brendan

2010-01-01

Failure to work as an effective team is commonly cited as a cause of adverse events and errors in emergency medicine. Until recently, individual knowledge and skills in managing emergencies were taught, without reference to the additional skills required to work as part of a team. Team training courses are now becoming commonplace, however their strategies and modes of delivery are varied. Just as different delivery methods of traditional education can result in different levels of retention and transfer to the real world, the same is true in team training of the material in different ways in traditional forms of education may lead to different levels of retention and transfer to the real world, the same is true in team training. As team training becomes more widespread, the effectiveness of different modes of delivery including the role of simulation-based education needs to be clearly understood. This review examines the basis of team working in emergency medicine, and the components of an effective emergency medical team. Lessons from other domains with more experience in team training are discussed, as well as the variations from these settings that can be observed in medical contexts. Methods and strategies for team training are listed, and experiences in other health care settings as well as emergency medicine are assessed. Finally, best practice guidelines for the development of team training programs in emergency medicine are presented. PMID:21063559

Strategies to overcome barriers to implementing osteoporosis and fracture prevention guidelines in long-term care: a qualitative analysis of action plans suggested by front line staff in Ontario, Canada.

PubMed

Alamri, Sultan H; Kennedy, Courtney C; Marr, Sharon; Lohfeld, Lynne; Skidmore, Carly J; Papaioannou, Alexandra

2015-08-01

Osteoporosis is a major global health problem, especially among long-term care (LTC) facilities. Despite the availability of effective clinical guidelines to prevent osteoporosis and bone fractures, few LTC homes actually adhere to these practical recommendations. The purpose of this study was to identify barriers to the implementation of evidence-based practices for osteoporosis and fracture prevention in LTC facilities and elicit practical strategies to address these barriers. We performed a qualitative analysis of action plans formulated by Professional Advisory Committee (PAC) teams at 12 LTC homes in the intervention arm of the Vitamin D and Osteoporosis Study (ViDOS) in Ontario, Canada. PAC teams were comprised of medical directors, administrators, directors of care, pharmacists, dietitians, and other staff. Thematic content analysis was performed to identify the key themes emerging from the action plans. LTC teams identified several barriers, including lack of educational information and resources prior to the ViDOS intervention, difficulty obtaining required patient information for fracture risk assessment, and inconsistent prescribing of vitamin D and calcium at the time of admission. The most frequently suggested recommendations was to establish and adhere to standard admission orders regarding vitamin D, calcium, and osteoporosis therapies, improve the use of electronic medical records for osteoporosis and fracture risk assessment, and require bone health as a topic at quarterly reviews and multidisciplinary conferences. This qualitative study identified several important barriers and practical recommendations for improving the implementation of osteoporosis and fracture prevention guidelines in LTC settings.

Surviving sepsis: a trust-wide approach. A multi-disciplinary team approach to implementing evidence-based guidelines.

PubMed

Gerber, Karin

2010-01-01

To share an experience of examining the true extent of the number of patients with severe sepsis being admitted, and the overall compliance with existing treatment guidelines in a district general hospital (DGH). Because of its aggressive, multi-factorial nature, sepsis is a rapid killer. Mortality associated with severe sepsis remains unacceptably high: 30-50%. When shock is present, mortality is reported to be even higher: 50-60%. The rapid diagnosis and management of sepsis is vital to successful treatment. The International Surviving Sepsis Campaign (SSC) was developed to help meet the challenges of sepsis and to improve its management, diagnosis and treatment. The overall aim is to reduce mortality from sepsis by 25% by 2009. Data on the number of patients admitted with severe sepsis to the DGH were previously unknown. The aim of the baseline audits was to determine the true extent of the problem and baseline mortality rates, resulting in an action plan to provide evidence-based care to patients with sepsis regardless of where in the hospital they were located. It was found that 11% of the patients audited presented with signs of severe sepsis and demonstrated elements of poor compliance with some elements of existing treatment guidelines as set out by the resuscitation component of the Surviving Sepsis Care Bundle. As an international campaign introduced predominantly within critical care, within this DGH the SSC teams' innovative approach has resulted in: * Better educated staff; * Objectives agreed within multi-disciplinary teams; * The appropriate assessment of resources; * Standardization of practice in terms of patients presenting with severe sepsis.

An Interprofessional Approach to Reducing the Risk of Falls Through Enhanced Collaborative Practice

PubMed Central

Eckstrom, Elizabeth; Neal, Margaret B.; Cotrell, Vicki; Casey, Colleen M.; McKenzie, Glenise; Morgove, Megan W.; DeLander, Gary E.; Simonson, William; Lasater, Kathie

2016-01-01

Falls are the leading cause of accidental deaths in older adults and are a growing public health concern. The American Geriatrics Society/British Geriatrics Society (AGS/BGS) published guidelines for falls screening and risk reduction, yet few primary care providers report following any guidelines for falls prevention. This manuscript describes a project that engaged an interprofessional (IP) teaching team to support IP clinical teams to reduce fall risk in older adults via implementation of the AGS/BGS guidelines. Twenty-five IP clinical teams with representatives from medicine, nursing, pharmacy, and social work were recruited from ambulatory, long-term care, hospital, and home health settings for a structured intervention: a 4-hour training workshop plus “coaching” for implementation for one year. The workshop focused on evidence-based strategies to decrease the risk of falls, including screening for falls; assessing gait, balance, orthostatics and other medical conditions; exercise including tai chi; vitamin D supplementation; medication review and reduction; and environmental assessment. Quantitative and qualitative data were collected via chart review, coaching plans and field notes, and post-intervention structured interviews of participants. Site visits and coaching field notes confirmed uptake of the strategies. Chart reviews showed a significant improvement in adoption of all falls prevention strategies except vitamin D supplementation. Long-term care facilities were more likely to address environmental concerns and add tai chi classes while ambulatory settings were more likely to initiate falls screening. The intervention demonstrated that interprofessional practice change to target falls prevention can be incorporated into primary care and long-term care settings. PMID:27467774

Improving the fundamentals of care for older people in the acute hospital setting: facilitating practice improvement using a Knowledge Translation Toolkit.

PubMed

Wiechula, Rick; Kitson, Alison; Marcoionni, Danni; Page, Tammy; Zeitz, Kathryn; Silverston, Heidi

2009-12-01

This paper reports on a structured facilitation program where seven interdisciplinary teams conducted projects aimed at improving the care of the older person in the acute sector. Aims  To develop and implement a structured intervention known as the Knowledge Translation (KT) Toolkit to improve the fundamentals of care for the older person in the acute care sector. Three hypotheses were tested: (i) frontline staff can be facilitated to use existing quality improvement tools and techniques and other resources (the KT Toolkit) in order to improve care of older people in the acute hospital setting; (ii) fundamental aspects of care for older people in the acute hospital setting can be improved through the introduction and use of specific evidence-based guidelines by frontline staff; and (iii) innovations can be introduced and improvements made to care within a 12-month cycle/timeframe with appropriate facilitation. Methods  Using realistic evaluation methodology the impact of a structured facilitation program (the KT Toolkit) was assessed with the aim of providing a deeper understanding of how a range of tools, techniques and strategies may be used by clinicians to improve care. The intervention comprised three elements: the facilitation team recruited for specific knowledge, skills and expertise in KT, evidence-based practice and quality and safety; the facilitation, including a structured program of education, ongoing support and communication; and finally the components of the toolkit including elements already used within the study organisation. Results  Small improvements in care were shown. The results for the individual projects varied from clarifying issues of concern and planning ongoing activities, to changing existing practices, to improving actual patient outcomes such as reducing functional decline. More importantly the study described how teams of clinicians can be facilitated using a structured program to conduct practice improvement activities with sufficient flexibility to meet the individual needs of the teams. Conclusions  The range of tools in the KT Toolkit were found to be helpful, but not all tools needed to be used to achieve successful results. Facilitation of the teams was a central feature of the KT Toolkit and allowed clinicians to retain control of their projects; however, finding the balance between structuring the process and enabling teams to maintain ownership and control was an ongoing challenge. Clinicians may not have the requisite skills and experience in basic standard setting, audit and evaluation and it was therefore important to address this throughout the project. In time this builds capacity throughout the organisation. Identifying evidence to support practice is a challenge to clinicians. Evidence-based guidelines often lack specificity and were found to be difficult to assimilate easily into everyday practice. Evidence to inform practice needs to be provided in a variety of forms and formats that allow clinicians to easily identify the source of the evidence and then develop local standards specific to their needs. The work that began with this project will continue - all teams felt that the work was only starting rather than concluding. This created momentum, motivation and greater ownership of improvements at local level. © 2009 The Authors. Journal Compilation © Blackwell Publishing Asia Pty Ltd.

Clinical Competency in Podiatric Medicine.

ERIC Educational Resources Information Center

Lanham, Richard H., Jr.

1979-01-01

The Council on Podiatry Education evaluates colleges of podiatric medicine with on-site accreditation teams, and has established criteria and guidelines for colleges of podiatric medicine. A Delphi technique survey, need for defining competency, and establishment of educational objectives are discussed. (MLW)

Strategy Guideline. Modeling Enclosure Design in Above-Grade Walls

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

J. Lstiburek; Ueno, K.; Musunuru, S.

2016-02-01

The Strategy Guideline, written by the U.S. Department of Energy's research team Building Science Corporation, 1) describes how to model and interpret results of models for above-grade walls, and 2) analyzes the failure thresholds and criteria for above-grade walls. A library of above-grade walls with historically successful performance was used to calibrate WUFI (Wärme und Feuchte instationär) software models. The information is generalized for application to a broad population of houses within the limits of existing experience.

Characterizing Teamwork in Cardiovascular Care Outcomes: A Network Analytics Approach.

PubMed

Carson, Matthew B; Scholtens, Denise M; Frailey, Conor N; Gravenor, Stephanie J; Powell, Emilie S; Wang, Amy Y; Kricke, Gayle Shier; Ahmad, Faraz S; Mutharasan, R Kannan; Soulakis, Nicholas D

2016-11-01

The nature of teamwork in healthcare is complex and interdisciplinary, and provider collaboration based on shared patient encounters is crucial to its success. Characterizing the intensity of working relationships with risk-adjusted patient outcomes supplies insight into provider interactions in a hospital environment. We extracted 4 years of patient, provider, and activity data for encounters in an inpatient cardiology unit from Northwestern Medicine's Enterprise Data Warehouse. We then created a provider-patient network to identify healthcare providers who jointly participated in patient encounters and calculated satisfaction rates for provider-provider pairs. We demonstrated the application of a novel parameter, the shared positive outcome ratio, a measure that assesses the strength of a patient-sharing relationship between 2 providers based on risk-adjusted encounter outcomes. We compared an observed collaboration network of 334 providers and 3453 relationships to 1000 networks with shared positive outcome ratio scores based on randomized outcomes and found 188 collaborative relationships between pairs of providers that showed significantly higher than expected patient satisfaction ratings. A group of 22 providers performed exceptionally in terms of patient satisfaction. Our results indicate high variability in collaboration scores across the network and highlight our ability to identify relationships with both higher and lower than expected scores across a set of shared patient encounters. Satisfaction rates seem to vary across different teams of providers. Team collaboration can be quantified using a composite measure of collaboration across provider pairs. Tracking provider pair outcomes over a sufficient set of shared encounters may inform quality improvement strategies such as optimizing team staffing, identifying characteristics and practices of high-performing teams, developing evidence-based team guidelines, and redesigning inpatient care processes. © 2016 American Heart Association, Inc.

Impact of a Non-small Cell Lung Cancer Educational Program for Interdisciplinary Teams.

PubMed

Murgu, Septimiu; Rabito, Robb; Lasko, Greg; Jackson, Chad; Mino-Kenudson, Mari; Ettinger, David S; Ramalingam, Suresh S; Edell, Eric S

2018-04-01

Successful implementation of non-small cell lung cancer (NSCLC) evidence-based guideline recommendations requires effective educational programs that target all clinicians from interdisciplinary teams. This study describes and evaluates the Engaging an Interdisciplinary Team for NSCLC (GAIN 3.0) experiential learning-based educational curriculum. GAIN 3.0 was designed to enhance interdisciplinary collaboration for effective NSCLC diagnosis, assessment, and treatment. The program used a flipped classroom model that included an e-learning component prior to a live 6-hour interactive program. The interactive program included hands-on simulations, small group workshops, gamification, and case discussions. Participants included academic and community members of multidisciplinary lung cancer teams. Assessments included an online baseline survey, a pretest and posttest, a program evaluation, a long-term survey (LTS), and on-site faculty evaluation of participants. Of 416 attendees to 13 live GAIN 3.0 programs (nine in the United States and four in Europe), 304 (73%) completed the pretest and 187 (45%) completed the posttest. Out of a perfect score of 12 points, program participants had a mean test score of 6.3 ± 2.1 on the pretest (52%) and 7.8 ± 2.1 on the posttest (65%) (P = .03). There was an overall knowledge increase of 13% from pretest to posttest. Most LTS respondents (65%) rated the GAIN 3.0 live programs as "high impact." On the LTS, the areas with the greatest gains in participants who had very high confidence were communication across disciplines, use of a team-based approach, and personalized treatment. GAIN 3.0 was a highly successful interdisciplinary activity that improved participants' knowledge, competence, and likely the clinical care provided to patients with NSCLC. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Diabetes and hypertension guidelines and the primary health care practitioner in Barbados: knowledge, attitudes, practices and barriers--a focus group study.

PubMed

Adams, O Peter; Carter, Anne O

2010-12-03

Audits have shown numerous deficiencies in the quality of hypertension and diabetes primary care in Barbados, despite distribution of regional guidelines. This study aimed to evaluate the knowledge, attitudes and practices, and the barriers faced by primary care practitioners in Barbados concerning the recommendations of available diabetes and hypertension guidelines. Focus groups using a moderator's manual were conducted at all 8 public sector polyclinics, and 5 sessions were held for private practitioners. Polyclinic sessions were attended by 63 persons (17 physicians, 34 nurses, 3 dieticians, 3 podiatrists, 5 pharmacists, and 1 other), and private sector sessions by 20 persons (12 physicians, 1 nurse, 3 dieticians, 2 podiatrists and 2 pharmacists). Practitioners generally thought they gave a good quality of care. Commonwealth Caribbean Medical Research Council 1995 diabetes and 1998 hypertension guidelines, and the Ministry of Health 2001 diabetes protocol had been seen by 38%, 32% and 78% respectively of polyclinic practitioners, 67%, 83%, and 33% of private physicians, and 25%, 0% and 38% of non-physician private practitioners. Current guidelines were considered by some to be outdated, unavailable, difficult to remember and lacking in advice to tackle barriers. Practitioners thought that guidelines should be circulated widely, promoted with repeated educational sessions, and kept short. Patient oriented versions of the guidelines were welcomed. Patient factors causing barriers to ideal outcome included denial and fear of stigma; financial resources to access an appropriate diet, exercise and monitoring equipment; confusion over medication regimens, not valuing free medication, belief in alternative medicines, and being unable to change habits. System barriers included lack of access to blood investigations, clinic equipment and medication; the lack of human resources in polyclinics; and an uncoordinated team approach. Patients faced cultural barriers with regards to meals, exercise, appropriate body size, footwear, medication taking, and taking responsibility for one's health; and difficulty getting time off work to attend clinic. Guidelines need to be promoted repeatedly, and implemented with strategies to overcome barriers. Their development and implementation must be guided by input from all providers on the primary health care team.

The Ottawa Model of Research Use: a guide to clinical innovation in the NICU.

PubMed

Hogan, Debora L; Logan, Jo

2004-01-01

To improve performance of a neonatal transport team by implementing a research-based family assessment instrument. Objectives included providing a structure for evaluating families and fostering the healthcare relationship. Neonatal transports are associated with family crises. Transport teams require a comprehensive framework to accurately assess family responses to adversity and tools to guide their practice toward parental mastery of the event. Currently, there are no assessment tools that merge family nursing expertise with neonatal transport. A family assessment tool grounded in contemporary family nursing theory and research was developed by a clinical nurse specialist. The Ottawa Model of Research Use guided the process of piloting the innovation with members of a transport team. Focus groups, interviews, and surveys were conducted to create profiles of barriers and facilitators to research use by team members. Tailored research transfer strategies were enacted based on the profile results. Formative evaluations demonstrated improvements in team members' perceptions of their knowledge, family centeredness, and ability to assess and intervene with families. The family assessment tool is currently being incorporated into Clinical Practice Guidelines for Transport and thus will be considered standard care. Use of a family assessment tool is an effective way of appraising families and addressing suffering. The Ottawa Model of Research Use provided a framework for implementing the clinical innovation. A key role of the clinical nurse specialist is to influence nursing practice by fostering research use by practitioners. When developing and implementing a clinical innovation, input from end users and consumers is pivotal. Incorporating the innovation into a practice guideline provides a structure to imbed research evidence into practice.

Enhance your team-based qualitative research.

PubMed

Fernald, Douglas H; Duclos, Christine W

2005-01-01

Qualitative research projects often involve the collaborative efforts of a research team. Challenges inherent in teamwork include changes in membership and differences in analytical style, philosophy, training, experience, and skill. This article discusses teamwork issues and tools and techniques used to improve team-based qualitative research. We drew on our experiences in working on numerous projects of varying, size, duration, and purpose. Through trials of different tools and techniques, expert consultation, and review of the literature, we learned to improve how we build teams, manage information, and disseminate results. Attention given to team members and team processes is as important as choosing appropriate analytical tools and techniques. Attentive team leadership, commitment to early and regular team meetings, and discussion of roles, responsibilities, and expectations all help build more effective teams and establish clear norms. As data are collected and analyzed, it is important to anticipate potential problems from differing skills and styles, and how information and files are managed. Discuss analytical preferences and biases and set clear guidelines and practices for how data will be analyzed and handled. As emerging ideas and findings disperse across team members, common tools (such as summary forms and data grids), coding conventions, intermediate goals or products, and regular documentation help capture essential ideas and insights. In a team setting, little should be left to chance. This article identifies ways to improve team-based qualitative research with more a considered and systematic approach. Qualitative researchers will benefit from further examination and discussion of effective, field-tested, team-based strategies.

A qualitative analysis of communication between members of a hospital-based multidisciplinary lung cancer team.

PubMed

Rowlands, S; Callen, J

2013-01-01

The aim of the study was to explore how patient information is communicated between health professionals within a multidisciplinary hospital-based lung cancer team and to identify mechanisms to improve these communications. A qualitative method was employed using semi-structured in-depth interviews with a representative sample (n = 22) of members of a multidisciplinary hospital-based lung cancer team including medical, nursing and allied health professionals. Analysis was undertaken using a thematic grounded theory approach to derive key themes to describe communication patterns within the team and how communication could be improved. Two themes with sub-themes were identified: (1) characteristics of communication between team members including the impact of role on direction of communications, and doctors' dominance in communications; and (2) channels of communication including, preference for face-to-face and the suboptimal roles of the Multidisciplinary Team Meeting and the hospital medical record as mediums for communication. Traditional influences of role delineation and the dominance of doctors were found to impact on communication within the multidisciplinary hospital-based lung cancer team. Existing guidelines on implementation of multidisciplinary cancer care fail to address barriers to effective team communication. The paper-based medical record does not support team communications and alternative electronic solutions need to be used. © 2012 Blackwell Publishing Ltd.

INCOG recommendations for management of cognition following traumatic brain injury, part II: attention and information processing speed.

PubMed

Ponsford, Jennie; Bayley, Mark; Wiseman-Hakes, Catherine; Togher, Leanne; Velikonja, Diana; McIntyre, Amanda; Janzen, Shannon; Tate, Robyn

2014-01-01

Traumatic brain injury, due to its diffuse nature and high frequency of injury to frontotemporal and midbrain reticular activating systems, may cause disruption in many aspects of attention: arousal, selective attention, speed of information processing, and strategic control of attention, including sustained attention, shifting and dividing of attention, and working memory. An international team of researchers and clinicians (known as INCOG) convened to develop recommendations for the management of attentional problems. The experts selected recommendations from published guidelines and then reviewed literature to ensure that recommendations were current. Decision algorithms incorporating the recommendations based on inclusion and exclusion criteria of published trials were developed. The team then prioritized recommendations for implementation and developed audit criteria to evaluate adherence to these best practices. The recommendations and discussion highlight that metacognitive strategy training focused on functional everyday activities is appropriate. Appropriate use of dual task training, environmental modifications, and cognitive behavioral therapy is also discussed. There is insufficient evidence to support mindfulness meditation and practice on de-contextualized computer-based tasks for attention. Administration of the medication methylphenidate should be considered to improve information-processing speed. The INCOG recommendations for rehabilitation of attention provide up-to-date guidance for clinicians treating people with traumatic brain injury.

Keeping Track of Your Blood Sugar

MedlinePlus

... after you join a sports team at school. People who use an insulin pump or who follow a plan ... Editorial Policy Permissions Guidelines Privacy Policy & Terms of ... is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor. © ...

I-74 Iowa/Illinois corridor study : aesthetic design guideline, April 6, 2009.

DOT National Transportation Integrated Search

2009-04-06

The Illinois and Iowa Departments of Transportation : (DOT) and the I-74 Advisory Committee are : committed to strengthening the cultural and : environmental value and the aesthetic interest of the : I-74 Corridor. : The consultant design team, worki...

Measure Guideline. Incorporating Thick Layers of Exterior Rigid Insulation on Walls

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

Lstiburek, Joseph; Baker, Peter

This measure guideline, written by the U.S. Department of Energy’s Building America team Building Science Corporation, provides information about the design and construction of wall assemblies that use layers of rigid exterior insulation thicker than 1-½ in. and that require a secondary cladding attachment location exterior to the insulation. The guideline is separated into several distinct sections that cover: (1) fundamental building science principles relating to the use of exterior insulation on wall assemblies; (2) design principles for tailoring this use to the specific project goals and requirements; and (3) construction detailing to increase understanding about implementing the various designmore » elements.« less

Evaluation of parenteral nutrition-associated liver disease in infants with necrotizing enterocolitis before and after the implementation of feeding guidelines.

PubMed

Tillman, Emma M; Norman, Johanna L; Huang, Eunice Y; Lazar, Linda F; Crill, Catherine M

2014-04-01

In 2009, an intestinal rehabilitation team implemented feeding guidelines for infants following gastrointestinal surgery at our institution. The purpose of this study was to determine the effect of enteral feeding guidelines on the incidence of parenteral nutrition (PN)-associated liver disease (PNALD) in infants with surgically managed necrotizing enterocolitis (NEC). This retrospective study included infants treated during 18-month time periods before and after the implementation of feeding guidelines. PNALD diagnosis was based on serum direct bilirubin >2 mg/dL after ≥14 days of PN exposure. Of the 140 infants identified, 64 were surgically managed and included in the analysis. The duration of PN and the time nil per os (NPO) were significantly reduced after guideline implementation from a median of 106 days to 65 days (P = .03) and from 29 days to 16 days (P = .02), respectively. The incidence of PNALD decreased from 73% before guideline implementation to 42% after guideline implementation (P = .01). Implementation of feeding guidelines resulted in decreased time NPO and duration of PN support. Significantly fewer infants developed PNALD after guideline implementation. These data suggest that feeding guidelines may expedite the transition from PN to enteral nutrition and may improve outcomes.

Exertional heat illness incidence and on-site medical team preparedness in warm weather

NASA Astrophysics Data System (ADS)

Hosokawa, Yuri; Adams, William M.; Belval, Luke N.; Davis, Robert J.; Huggins, Robert A.; Jardine, John F.; Katch, Rachel K.; Stearns, Rebecca L.; Casa, Douglas J.

2018-03-01

To investigate the influence of estimated wet bulb globe temperature (WBGT) and the International Institute of Race Medicine (IIRM) activity modification guidelines on the incidence of exertional heat stroke (EHS) and heat exhaustion (HEx) and the ability of an on-site medical team to treat those afflicted. Medical records of EHS and HEx patients over a 17-year period from the New Balance Falmouth Road Race were examined. Climatologic data from nearby weather stations were obtained to calculate WBGT with the Australian Bureau of Meteorology (WBGTA) and Liljegren (WBGTL) models. Incidence rate (IR) of EHS, HEx, and combined total of EHS and HEx (COM) were calculated, and linear regression analyses were performed to assess the relationship between IR and WBGTA or WBGTL. One-way ANOVA was performed to compare differences in EHS, HEx, and COM incidence to four alert levels in the IIRM guidelines. Incidence of EHS, HEx, and COM was 2.12, 0.98, and 3.10 cases per 1000 finishers. WBGTA explained 48, 4, and 46% of the variance in EHS, HEx, and COM IR; WBGTL explained 63, 13, and 69% of the variance in EHS, HEx, and COM IR. Main effect of WBGTA and WBGTL on the alert levels were observed in EHS and COM IR (p < 0.05). The cumulative number of EHS patients treated did not exceed the number of cold water immersion tubs available to treat them. EHS IR increased as WBGT and IIRM alert level increased, indicating the need for appropriate risk mitigation strategies and on-site medical treatment.

Exertional heat illness incidence and on-site medical team preparedness in warm weather.

PubMed

Hosokawa, Yuri; Adams, William M; Belval, Luke N; Davis, Robert J; Huggins, Robert A; Jardine, John F; Katch, Rachel K; Stearns, Rebecca L; Casa, Douglas J

2018-03-29

To investigate the influence of estimated wet bulb globe temperature (WBGT) and the International Institute of Race Medicine (IIRM) activity modification guidelines on the incidence of exertional heat stroke (EHS) and heat exhaustion (HEx) and the ability of an on-site medical team to treat those afflicted. Medical records of EHS and HEx patients over a 17-year period from the New Balance Falmouth Road Race were examined. Climatologic data from nearby weather stations were obtained to calculate WBGT with the Australian Bureau of Meteorology (WBGT A ) and Liljegren (WBGT L ) models. Incidence rate (IR) of EHS, HEx, and combined total of EHS and HEx (COM) were calculated, and linear regression analyses were performed to assess the relationship between IR and WBGT A or WBGT L . One-way ANOVA was performed to compare differences in EHS, HEx, and COM incidence to four alert levels in the IIRM guidelines. Incidence of EHS, HEx, and COM was 2.12, 0.98, and 3.10 cases per 1000 finishers. WBGT A explained 48, 4, and 46% of the variance in EHS, HEx, and COM IR; WBGT L explained 63, 13, and 69% of the variance in EHS, HEx, and COM IR. Main effect of WBGT A and WBGT L on the alert levels were observed in EHS and COM IR (p < 0.05). The cumulative number of EHS patients treated did not exceed the number of cold water immersion tubs available to treat them. EHS IR increased as WBGT and IIRM alert level increased, indicating the need for appropriate risk mitigation strategies and on-site medical treatment.

Decision-Making in Pediatric Transport Team Dispatch Using Script Concordance Testing.

PubMed

Rajapreyar, Prakadeshwari; Marcdante, Karen; Zhang, Liyun; Simpson, Pippa; Meyer, Michael T

2017-11-01

Our objective was to compare decision-making in dispatching pediatric transport teams by Medical Directors of pediatric transport teams (serving as experts) to that of Pediatric Intensivists and Critical Care fellows who often serve as Medical Control physicians. Understanding decision-making around team composition and dispatch could impact clinical management, cost effectiveness, and educational needs. Survey was developed using Script Concordance Testing guidelines. The survey contained 15 transport case vignettes covering 20 scenarios (45 questions). Eleven scenarios assessed impact of intrinsic patient factors (e.g., procedural needs), whereas nine assessed extrinsic factors (e.g., weather). Pediatric Critical Care programs accredited by the Accreditation Council for Graduate Medical Education (the United States). Pediatric Intensivists and senior Critical Care fellows at Pediatric Critical Care programs were the target population with Transport Medical Directors serving as the expert panel. None. Survey results were scored per Script Concordance Testing guidelines. Concordance within groups was assessed using simple percentage agreement. There was little concordance in decision-making by Transport Medical Directors (median Script Concordance Testing percentage score [interquartile range] of 33.9 [30.4-37.3]). In addition, there was no statistically significant difference between the median Script Concordance Testing scores among the senior fellows and Pediatric Intensivists (31.1 [29.6-33.2] vs 29.7 [28.3-32.3], respectively; p = 0.12). Transport Medical Directors were more concordant on reasoning involving intrinsic patient factors rather than extrinsic factors (10/21 vs 4/24). Our study demonstrates pediatric transport team dispatch decision-making discordance by pediatric critical care physicians of varying levels of expertise and experience. Script Concordance Testing at a local level may better elucidate standards in medical decision-making within pediatric critical care physicians. The development of a curriculum, which provides education and trains our workforce on the logistics of pediatric transport team dispatch, would help standardize practice and evaluate outcomes based on decision-making.

NHF-McMaster Guideline on Care Models for Haemophilia Management.

PubMed

Pai, M; Key, N S; Skinner, M; Curtis, R; Feinstein, M; Kessler, C; Lane, S J; Makris, M; Riker, E; Santesso, N; Soucie, J M; Yeung, C H T; Iorio, A; Schünemann, H J

2016-07-01

This guideline was developed to identify evidence-based best practices in haemophilia care delivery, and discuss the range of care providers and services that are most important to optimize outcomes for persons with haemophilia (PWH) across the United States. The guideline was developed following specific methods described in detail in this supplement and based on the GRADE (Grading of Recommendations, Assessment, Development and Evaluation approach). Direct evidence from published literature and the haemophilia community, as well as indirect evidence from other chronic diseases, were reviewed, synthesized and applied to create evidence-based recommendations. The Guideline panel suggests that the integrated care model be used over non-integrated care models for PWH (conditional recommendation, moderate certainty in the evidence). For PWH with inhibitors and those at high risk for inhibitor development, the same recommendation was graded as strong, with moderate certainty in the evidence. The panel suggests that a haematologist, a specialized haemophilia nurse, a physical therapist, a social worker and round-the-clock access to a specialized coagulation laboratory be part of the integrated care team, over an integrated care team that does not include all of these components (conditional recommendation, very low certainty in the evidence). Based on available evidence, the integrated model of care in its current structure, is suggested for optimal care of PWH. There is a need for further appropriately designed studies that address unanswered questions about specific outcomes and the optimal structure of the integrated care delivery model in haemophilia. © 2016 John Wiley & Sons Ltd.

Ketamine reduces the need for intubation in patients with acute severe mental illness and agitation requiring transport to definitive care: An observational study.

PubMed

Parsch, Cathrin S; Boonstra, Adrianne; Teubner, David; Emmerton, Wade; McKenny, Brian; Ellis, Daniel Y

2017-06-01

The aim of this study was to review mental health patients transported by a dedicated statewide critical care retrieval team before and after the implementation of a ketamine sedation guideline. This is a a retrospective cohort study of mental health patients with acute behavioural disturbance, transported between January 2010 and December 2015. A total of 78 patients were transported in the study period, 50 before and 28 after implementation of the ketamine guideline in June 2013. The introduction of the ketamine guideline was associated with a significant reduction in intubation for transport (36.00 vs 7.14%) (odds ratio 0.14, 95% confidence interval 0.02-0.71, P < 0.01). The likelihood of utilising ketamine for non-intubated patients (n = 58) was higher in the period after implementation (37.50 vs 84.62%, odds ratio 9.17, 95% confidence interval 2.54-33.08, P < 0.005). The incidence of complications in our series was low. The implementation of a ketamine clinical practice guideline for agitated mental health patients was associated with an increase in the number of patients receiving ketamine as part of their sedation regime and a reduction in the number of patients requiring intubation for transport. Appropriately trained critical care retrieval teams should consider ketamine as part of the sedation regime for agitated mental health patients. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Labor Dystocia: Uses of Related Nomenclature.

PubMed

Neal, Jeremy L; Ryan, Sharon L; Lowe, Nancy K; Schorn, Mavis N; Buxton, Margaret; Holley, Sharon L; Wilson-Liverman, Angela M

2015-01-01

Labor dystocia (slow or difficult labor or birth) is the most commonly diagnosed aberration of labor and the most frequently documented indication for primary cesarean birth. Yet, dystocia remains a poorly specified diagnostic category, with determinations often varying widely among clinicians. The primary aims of this review are to 1) summarize definitions of active labor and dystocia, as put forth by leading professional obstetric and midwifery organizations in world regions wherein English is the majority language and 2) describe the use of dystocia and related terms in contemporary research studies. Major national midwifery and obstetric organizations from qualifying United Nations-member sovereign nations and international organizations were searched to identify guidelines providing definitions of active labor and dystocia or related terms. Research studies (2000-2013) were systematically identified via PubMed, MEDLINE, and CINAHL searches to describe the use of dystocia and related terms in contemporary scientific publications. Only 6 organizational guidelines defined dystocia or related terms. Few research teams (n = 25 publications) defined dystocia-related terms with nonambiguous clinical parameters that can be applied prospectively. There is heterogeneity in the nomenclature used to describe dystocia, and when a similar term is shared between guidelines or research publications, the underlying definition of that term is sometimes inconsistent between documents. Failure to define dystocia in evidence-based, well-described, clinically meaningful terms that are widely acceptable to and reproducible among clinicians and researchers is concerning at both national and global levels. This failure is particularly problematic in light of the major contribution of this diagnosis to primary cesarean birth rates. © 2015 by the American College of Nurse-Midwives.

Measuring the cost of care in benign prostatic hyperplasia using time-driven activity-based costing (TDABC).

PubMed

Kaplan, A L; Agarwal, N; Setlur, N P; Tan, H J; Niedzwiecki, D; McLaughlin, N; Burke, M A; Steinberg, K; Chamie, K; Saigal, C S

2015-03-01

Determining '"value'" in health care, defined as outcomes per unit cost, depends on accurately measuring cost. We used time-driven activity-based costing (TDABC) to determine the cost of care in men with benign prostatic hyperplasia (BPH) - a common urologic condition. We implemented TDABC across the entire care pathway for BPH including primary and specialist care in both inpatient and outpatient settings. A team of expert stakeholders created detailed process maps, determined space and product costs, and calculated personnel capacity cost rates. A model pathway was derived from practice guidelines and calculated costs were applied. Although listed as 'optional' in practice guidelines, invasive diagnostic testing can increase costs by 150% compared with the standalone urology clinic visit. Of five different surgical options, a 400% cost discrepancy exists between the most and least expensive treatments. TDABC can be used to measure cost across an entire care pathway in a large academic medical center. Sizable cost variation exists between diagnostic and surgical modalities for men with BPH. As financial risk is shifted toward providers, understanding the cost of care will be vital. Future work is needed to determine outcome discrepancy between the diagnostic and surgical modalities in BPH. Copyright © 2014 Elsevier Inc. All rights reserved.

Developing guidelines for return to play: consensus and evidence-based approaches.

PubMed

Echemendia, Ruben J; Giza, Christopher C; Kutcher, Jeffrey S

2015-01-01

Sports-related concussions are commonplace at all levels of play and across all age groups. The dynamic, evolving nature of this injury coupled with a lack of objective biomarkers creates a challenging management issue for the sports medicine team. Athletes who return to play following a concussion are known to be at higher risk for an additional brain injury, which necessitates a careful, informed return to play (RTP) process. The goal of this paper is to outline historical attempts at developing RTP guidelines and trace their evolution over time, culminating in a discussion of the process and outcomes of the most recent consensus statements/guidelines published by the international Concussion In Sport Group (CISG), the American Academy of Neurology (AAN), the National Athletic Trainers' Association, and the 2013 Team Physician Consensus Statement Update. An evaluation of the pros and cons of these guidelines is presented along with suggestions for future directions. In addition, the Institute of Medicine recently conducted a comprehensive report outlining the current state of evidence regarding youth concussions, which provides specific recommendations for future research. The different methodologies utilized in the development of consensus statements have distinct advantages and disadvantages, and both approaches add value to the everyday management of sports concussions. Importantly, the overall approach for management of sports concussion is remarkably similar using either consensus-based or formal evidence-based methods, which adds confidence to the current guidelines and allows practitioners to focus on accepted standards of clinical care. Moving forward, careful study designs need to be utilized to avoid bias in selection of research subjects, collection of data, and interpretation of results. Although useful, clinicians must venture beyond consensus statements to examine reviews of the literature that are published in much greater frequency than consensus statements.

Belgian guidelines for economic evaluations: second edition.

PubMed

Thiry, Nancy; Neyt, Mattias; Van De Sande, Stefaan; Cleemput, Irina

2014-12-01

The aim of this study was to present the updated methodological guidelines for economic evaluations of healthcare interventions (drugs, medical devices, and other interventions) in Belgium. The update of the guidelines was performed by three Belgian health economists following feedback from users of the former guidelines and personal experience. The updated guidelines were discussed with a multidisciplinary team consisting of other health economists, assessors of reimbursement request files, representatives of Belgian databases and representatives of the drugs and medical devices industry. The final document was validated by three external validators that were not involved in the previous discussions. The guidelines give methodological guidance for the following components of an economic evaluation: literature review, perspective of the evaluation, definition of the target population, choice of the comparator, analytic technique and study design, calculation of costs, valuation of outcomes, definition of the time horizon, modeling, handling uncertainty and discounting. We present a reference case that can be considered as the minimal requirement for Belgian economic evaluations of health interventions. These guidelines will improve the methodological quality, transparency and uniformity of the economic evaluations performed in Belgium. The guidelines will also provide support to the researchers and assessors performing or evaluating economic evaluations.

Management of respiratory tract infections in young children-A qualitative study of primary care providers' perspectives.

PubMed

Biezen, Ruby; Brijnath, Bianca; Grando, Danilla; Mazza, Danielle

2017-03-07

Respiratory tract infections in young children are the most common cause of general practice visits in Australia. Despite the availability of clinical practice guidelines, the treatment and management of respiratory tract infections in young children is inconsistent. The aim of the study was to explore the management of respiratory tract infections in young children from a multi-disciplinary perspective using across-sectional qualitative research design based on the theoretical domains framework and the Capability, Opportunity and Motivation-B model. In-depth interviews were conducted with 30 primary care providers to explore their knowledge, views and management of respiratory tract infections in young children. Interviews focused on symptomatic management, over-the-counter medications and antibiotic use, and data were thematically analysed. Our findings showed that factors such as primary care providers' time constraints, parental anxiety, general practitioners' perception of what parents want, perceived parental pressure, and fear of losing patients were some of the reasons why primary care providers did not always adhere to guideline recommendations. Primary care providers also provided conflicting advice to parents concerning over-the-counter medications and when children should resume normal activities. Overall, this study showed that complex interactions involving emotional and psychological factors influenced the decision making process of primary care providers' management of respiratory tract infections in young children. A team care approach with consistent advice, and improved communication between primary care providers and parents is vital to overcome some of these barriers and improve guideline adherence. The findings of this research will inform the development of interventions to better manage respiratory tract infections in young children. CLINICIANS SWAYED BY PARENTAL ANXIETY AND PRESSURE: The emotions and psychology of both parents and clinicians influence how respiratory tract infections (RTIs) are managed in young children. Researchers in Australia, led by Ruby Biezen from Monash University, interviewed 30 primary care clinicians about their views on how to care for children with RTIs, such as the common cold. The interviews focused on symptomatic management, over-the-counter medications and antibiotic use. Despite the availability of best-practice guidelines, clinicians did not always follow the recommendations owing to factors such as time constraints, parental anxiety, perceived parental pressure, and fear of losing patients. These are some of the reasons why clinicians sometimes advise or prescribe unnecessary medications. The authors suggest that a team approach involving multiple healthcare professionals who deliver consistent advice could improve guideline adherence.

Antimicrobial stewardship activities: a survey of Queensland hospitals.

PubMed

Avent, Minyon L; Hall, Lisa; Davis, Louise; Allen, Michelle; Roberts, Jason A; Unwin, Sean; McIntosh, Kylie A; Thursky, Karin; Buising, Kirsty; Paterson, David L

2014-11-01

In 2011, the Australian Commission on Safety and Quality in Health Care (ACSQHC) recommended that all hospitals in Australia must have an Antimicrobial Stewardship (AMS) program by 2013. Nevertheless, little is known about current AMS activities. This study aimed to determine the AMS activities currently undertaken, and to identify gaps, barriers to implementation and opportunities for improvement in Queensland hospitals. The AMS activities of 26 facilities from 15 hospital and health services in Queensland were surveyed during June 2012 to address strategies for effective AMS: implementing clinical guidelines, formulary restriction, reviewing antimicrobial prescribing, auditing antimicrobial use and selective reporting of susceptibility results. The response rate was 62%. Nineteen percent had an AMS team (a dedicated multidisciplinary team consisting of a medically trained staff member and a pharmacist). All facilities had access to an electronic version of Therapeutic Guidelines: Antibiotic, with a further 50% developing local guidelines for antimicrobials. One-third of facilities had additional restrictions. Eighty-eight percent had advice for restricted antimicrobials from in-house infectious disease physicians or clinical microbiologists. Antimicrobials were monitored with feedback given to prescribers at point of care by 76% of facilities. Deficiencies reported as barriers to establishing AMS programs included: pharmacy resources, financial support by hospital management, and training and education in antimicrobial use. Several areas for improvement were identified: reviewing antimicrobial prescribing with feedback to the prescriber, auditing, and training and education in antimicrobial use. There also appears to be a lack of resources to support AMS programs in some facilities. WHAT IS KNOWN ABOUT THE TOPIC?: The ACSQHC has recommended that all hospitals implement an AMS program by 2013 as a requirement of Standard 3 (Preventing and Controlling Healthcare-Associated Infections) of the National Safety and Quality Health Service Standards. The intent of AMS is to ensure appropriate prescribing of antimicrobials as part of the broader systems within a health service organisation to prevent and manage healthcare-associated infections, and improve patient safety and quality of care. This criterion also aligns closely with Standard 4: Medication Safety. Despite this recommendation, little is known about what AMS activities are undertaken in these facilities and what additional resources would be required in order to meet these national standards. WHAT DOES THE PAPER ADD?: This is the first survey that has been conducted of public hospital and health services in Queensland, a large decentralised state in Australia. This paper describes what AMS activities are currently being undertaken, identifies practice gaps, barriers to implementation and opportunities for improvement in Queensland hospitals. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS?: Several areas for improvement such as reviewing antimicrobial prescribing with feedback to the prescriber, auditing, and training and education in antimicrobial use have been identified. In addition, there appears to be a lack of resources to support AMS programs in some facilities.

The New Progress of the Starry Sky Project of China

NASA Astrophysics Data System (ADS)

Wang, Xiaohua

2015-08-01

Since the 28th General Assembly of IAU, the SSPC team made new progress:1. Enhanced the function of the SSPC team-- Established the contact with IAU C50, IUCN Dark Skies Advisory Group, AWB and IDA,and undertakes the work of the IDA Beijing Chapter.-- Got supports from China’s National Astronomical Observatories, Beijing Planetarium, and Shanghai Science and Technology Museum.-- Signed cooperation agreements with Lighting Research Center, English Education Group and law Firm; formed the team force.2. Put forward a proposal to national top institutionThe SSPC submitted the first proposal about dark sky protection to the Chinese People’s Political Consultative Conference.3. Introduced the Criteria and Guideline of dark sky protectionThe SSPC team translated 8 documents of IDA, and provided a reference basis for Chinese dark sky protection.4. Actively establish dark sky places-- Plan a Dark Sky Reserve around Ali astronomical observatory (5,100m elevation) in Tibet. China’s Xinhua News Agency released the news.-- Combining with Hangcuo Lake, a National Natural Reserve and Scenic in Tibet, to plan and establish the Dark Sky Park.-- Cooperated with Shandong Longgang Tourism Group to construct the Dream Sky Theme Park in the suburbs of Jinan city.In the IYL 2015, the SSPC is getting further development:First, make dark sky protection enter National Ecological Strategy of “Beautiful China”. We call on: “Beautiful China” needs “Beautiful Night Sky” China should care the shared starry sky, and left this resource and heritage for children.Second, hold “Cosmic Light” exhibition in Shanghai Science and Technology Museum on August.Third, continue to establish Dark Sky Reserve, Park and Theme Park. We want to make these places become the bases of dark sky protection, astronomical education and ecological tourism, and develop into new cultural industry.Fourth, actively join international cooperation.Now, “Blue Sky, White Cloud and Starry Sky “have become the common pursuit of Chinese society. In order to obtain this goal, the SSPC team would like to pay more efforts.

Building professional capacity in ITS : guidelines for staffing, hiring, and designing ideal project teams

DOT National Transportation Integrated Search

1999-04-01

This guide is intended to help decision makers develop strategies and programs for building and maintaining organizational professional capacity. The guide covers seven different types of local, state and federal agencies and their involvement in twe...

76 FR 30229 - Shipping Coordinating Committee; Notice of Committee Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-24

.... --Strategy and planning. --Organizational reforms. --Resource management. --Technical Co-operation Fund--biennial allocation to support the ITCP Programme for 2012-2013. --Results-based budget. --Voluntary IMO... FSS Code for communication equipment for fire-fighting teams. --Development of guidelines for use of...

Interprofessional population health advocacy: Developing and implementing a panel management curriculum in five Veterans Administration primary care practices.

PubMed

Dulay, Maya; Bowen, Judith L; Weppner, William G; Eastburn, Abigail; Poppe, Anne P; Spanos, Pete; Wojtaszek, Danielle; Printz, Destiny; Kaminetzky, Catherine P

2018-05-10

Health care systems expect primary care clinicians to manage panels of patients and improve population health, yet few have been trained to do so. An interprofessional panel management (PM) curriculum is one possible strategy to address this training gap and supply future primary care practices with clinicians and teams prepared to work together to improve the health of individual patients and populations. This paper describes a Veterans Administration (VA) sponsored multi-site interprofessional PM curriculum development effort. Five VA Centers of Excellence in Primary Care Education collaborated to identify a common set of interprofessionally relevant desired learning outcomes (DLOs) for the PM and to develop assessment instruments for monitoring trainees' PM learning. Authors cataloged teaching and learning activities across sites. Results from pilot testing were systematically discussed leading to iterative revisions of curricular elements. Authors completed a retrospective self-assessment of curriculum implementation for the academic year 2015-16 using a 5-point scale: contemplation (score = 0), pilot (1), action (2), maintenance (3), and embedded (4). Implementation scores were analyzed using descriptive statistics. DLOs were organized into five categories (individual patients, populations, guidelines/measures, teamwork, and improvement) along with a developmental continuum and mapped to program competencies. Instruction and implementation varied across sites based on resources and priorities. Between 2015 and 2016, 159 trainees (internal medicine residents, nurse practitioner students and residents, pharmacy residents, and psychology post-doctoral fellows) participated in the PM curriculum. Curriculum implementation scores for guidelines/measures and improvement DLOs were similar for all trainees; scores for individual patients, populations, and teamwork DLOs were more advanced for nurse practitioner and physician trainees. In conclusion, collaboratively identified DLOs for PM guided development of assessment instruments and instructional approaches for panel management activities in interprofessional teams. This PM curriculum and associated tools provide resources for educators in other settings.

A cross sectional observational study of research activity of allied health teams: is there a link with self-reported success, motivators and barriers to undertaking research?

PubMed

Wenke, Rachel J; Mickan, Sharon; Bisset, Leanne

2017-02-06

Team-based approaches to research capacity building (RCB) may be an efficient means to promote allied health research participation and activity. In order to tailor such interventions, a clearer understanding of current patterns of research participation within allied health teams is needed. Different self-report measures exist which evaluate a team's research capacity and participation, as well as associated barriers and motivators. However, it remains unclear how such measures are associated with a team's actual research activity (e.g., journal publications, funding received). In response, this observational study aimed to identify the research activity, self-reported success, and motivations and barriers to undertaking research of eight allied health professional (AHP) teams and to explore whether any relationships exist between the self-reported measures and actual research activity within each team. A total of 95 AHPs from eight teams completed the research capacity and culture survey to evaluate team success, barriers and motivators to undertaking research, and an audit of research activity from January 2013 to August 2014 was undertaken within each team. Kendell's correlation coefficients were used to determine the association between research activity (i.e., number of journal publications, ethically approved projects and funding received) and the self-reported measures. Seven out of eight teams rated their teams as having average success in research and demonstrated some form of research activity including at least two ethically approved projects. Research activity varied between teams, with funding received ranging from $0 to over $100,000, and half the teams not producing any journal publications. Team motivators demonstrated a stronger association with research activity compared to barriers, with the motivator "enhancing team credibility" being significantly associated with funding received. No significant association between self-reported research success and actual research activity was identified. Preliminary findings suggest that self-report measures of research success may not always correspond to actual research activity, and a combination of both these measures may be useful when planning RCB interventions. Variation in activity between teams and organisations should also be considered when tailoring RCB interventions. Reinforcing intrinsically motivating rewards of research may also be useful in promoting research participation for some teams.

Design and implementation of a simulation exercise for teaching confidentiality of patient information.

PubMed

Snyder, J R

1982-05-01

Allied health students, making the transition from a purely academic to a professional school setting, are suddenly faced with judgment decisions about disclosure of medical information. Obscure guidelines and new interpersonal relationships with other members of the health care team complicate this transition and pose a threat to confidentiality of patient information. This article describes the design and implementation of a simulation exercise to reinforce lecture guidelines specifying disclosure of medical information without risk to the patient or student. The simulation is comprised of 10 critical incidents calling for responses ranging from logical to judgmental. Although written primarily for medical technologists, with emphasis on limitations governing release of patient laboratory data, the simulation approach is presented here as a model for other allied health professions. The use of a latent image format provides learners with positive or negative reinforcement as they learn the consequences of their decisions. The simulation activity described is easily adapted to small group discussion or computer-assisted instruction. While the simulation appears to be an accurate representation of reality, peer and real-life pressures could not be totally simulated.

Performance nutrition guidelines for international rugby sevens tournaments.

PubMed

Dziedzic, Christine E; Higham, Dean G

2014-06-01

Rugby sevens is an abbreviated version of rugby union, played by teams of seven players over 7-min halves. International competitions are usually played in a tournament format. While shorter in duration, the movement demands of rugby sevens per min of match time are greater than rugby union, resulting in an accentuated load on players. This load can be repeated up to six times over a typical 2- or 3-day competition period. The potential cumulative effect of inadequate carbohydrate, protein and/or fluid intake over the course of a tournament is the greatest nutrition-related concern for players. Nutritional strategies before and during competition are suggested to replenish substrate stores, maintain fluid balance and promote recovery between matches. The use of ergogenic aids known to enhance intermittent, high-intensity activity and/or the execution of motor skills may be advantageous to rugby sevens performance and is discussed. This review provides a best-practice model of nutritional support for international rugby sevens competition based on our current understanding of the sport combined with pragmatic guidelines and considerations for the practitioner.

Suicide prevention for psychoanalytic institutes and societies.

PubMed

Kernberg, Otto F

2012-08-01

What follows are guidelines for rescue teams dedicated to suicide prevention for psychoanalytic institutes and societies. They provide a general orientation and presuppose intensive individual and organizational training by the rescue teams. Some general notes of caution: suicide prevention is a complex, delicate effort that requires specific training, experience, knowledge, patience, and courage. It is a well-known fact that drowning persons may resist rescue efforts, thereby posing the danger of drowning the rescuer along with themselves. Similarly, expect desperate, blind resistance to your efforts, particularly when the suicidal temptation is urgent and overwhelming.

The relationship between intraoperative teamwork and management skills in patient care.

PubMed

Phitayakorn, Roy; Minehart, Rebecca D; Hemingway, Maureen W; Pian-Smith, May C M; Petrusa, Emil

2015-11-01

Optimal team performance in the operating room (OR) requires a combination of interactions among OR professionals and adherence to clinical guidelines. Theoretically, it is possible that OR teams could communicate very well but fail to follow acceptable standards of patient care and vice versa. OR simulations offer an ideal research environment to study this relationship. The goal of this study was to determine the relationship between ratings of OR teamwork and communication with adherence to patient care guidelines in a simulated scenarios of malignant hyperthermia (MH). An interprofessional research team (2 anesthesiologists, 1 surgeon, an OR nurse, and a social scientist) reviewed videos of 5 intraoperative teams managing a simulated patient who manifested MH while undergoing general anesthesia for an epigastric herniorraphy in a high-fidelity, in situ OR. Participant teams consisted of 2 residents from anesthesiology, 1 from surgery, 1 OR nurse, and 1 certified surgical technician. Teamwork and communication were assessed with 4 published tools: Anesthesiologists' Non-Technical Skills (ANTS), Scrub Practitioners List of Intra-operative Non-Technical Skills (SPLINTS), Non-Technical Skills for Surgeons (NOTSS), and Objective Teamwork Assessment System (OTAS). We developed an evidence-based MH checklist to assess overall patient care. Interrater agreement for teamwork tools was moderate. Average rater agreement was 0.51 For ANTS, 0.67 for SPLINTS, 0.51 for NOTSS, and 0.70 for OTAS. Observer agreement for the MH checklist was high (0.88). Correlations between teamwork and MH checklist were not significant. Teams were different in percent of the MH actions taken (range, 50-91%; P = .006). In this pilot study, intraoperative teamwork and communication were not related to overall patient care management. Separating nontechnical and technical skills when teaching OR teamwork is artificial and may even be damaging, because such an approach could produce teams with excellent communication skills as they unsuccessfully manage the patient. OR simulations offer a unique opportunity to research how to best integrate both of these domains to improve patient care. Copyright © 2015 Elsevier Inc. All rights reserved.

A Deficiency of Nutrition Education and Practice in Cardiology.

PubMed

Devries, Stephen; Agatston, Arthur; Aggarwal, Monica; Aspry, Karen E; Esselstyn, Caldwell B; Kris-Etherton, Penny; Miller, Michael; O'Keefe, James H; Ros, Emilio; Rzeszut, Anne K; White, Beth A; Williams, Kim A; Freeman, Andrew M

2017-11-01

Nutrition is one of the foundations of cardiovascular guidelines for risk reduction and treatment. However, little is known about whether cardiologists, cardiology fellows-in-training, and cardiovascular team members have the nutrition education and knowledge necessary to implement these guidelines. The aim of this study was to describe the educational experiences, attitudes, and practices relating to nutrition among cardiovascular professionals. Surveys completed by cardiologists, fellows-in-training, and cardiovascular team members inquired about their personal dietary habits, history of nutrition education, and attitudes regarding nutrition interventions. A total of 930 surveys were completed. Among cardiologists, 90% reported receiving no or minimal nutrition education during fellowship training, 59% reported no nutrition education during internal medicine training, and 31% reported receiving no nutrition education in medical school. Among cardiologists, 8% described themselves as having "expert" nutrition knowledge. Nevertheless, fully 95% of cardiologists believe that their role includes personally providing patients with at least basic nutrition information. The percentage of respondents who ate ≥5 servings of vegetables and fruits per day was: 20% (cardiologists), 21% (fellows-in-training), and 26% (cardiovascular team members). A large proportion of cardiovascular specialists have received minimal medical education and training in nutrition, and current trainees continue to experience significant education and training gaps. Copyright © 2017 Elsevier Inc. All rights reserved.

An Interprofessional Approach to Reducing the Risk of Falls Through Enhanced Collaborative Practice.

PubMed

Eckstrom, Elizabeth; Neal, Margaret B; Cotrell, Vicki; Casey, Colleen M; McKenzie, Glenise; Morgove, Megan W; DeLander, Gary E; Simonson, William; Lasater, Kathie

2016-08-01

Falls are the leading cause of accidental deaths in older adults and are a growing public health concern. The American Geriatrics Society (AGS) and British Geriatrics Society (BGS) published guidelines for falls screening and risk reduction, yet few primary care providers report following any guidelines for falls prevention. This article describes a project that engaged an interprofessional teaching team to support interprofessional clinical teams to reduce fall risk in older adults by implementing the AGS/BGS guidelines. Twenty-five interprofessional clinical teams with representatives from medicine, nursing, pharmacy, and social work were recruited from ambulatory, long-term care, hospital, and home health settings for a structured intervention: a 4-hour training workshop plus coaching for implementation for 1 year. The workshop focused on evidence-based strategies to decrease the risk of falls, including screening for falls; assessing gait, balance, orthostatic blood pressure, and other medical conditions; exercise including tai chi; vitamin D supplementation; medication review and reduction; and environmental assessment. Quantitative and qualitative data were collected using chart reviews, coaching plans and field notes, and postintervention structured interviews of participants. Site visits and coaching field notes confirmed uptake of the strategies. Chart reviews showed significant improvement in adoption of all falls prevention strategies except vitamin D supplementation. Long-term care facilities were more likely to address environmental concerns and add tai chi classes, and ambulatory settings were more likely to initiate falls screening. The intervention demonstrated that interprofessional practice change to target falls prevention can be incorporated into primary care and long-term care settings. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Developing leadership capacity for guideline use: a pilot cluster randomized control trial.

PubMed

Gifford, Wendy A; Davies, Barbara L; Graham, Ian D; Tourangeau, Ann; Woodend, A Kirsten; Lefebre, Nancy

2013-02-01

The importance of leadership to influence nurses' use of clinical guidelines has been well documented. However, little is known about how to develop and evaluate leadership interventions for guideline use. The purpose of this study was to pilot a leadership intervention designed to influence nurses' use of guideline recommendations when caring for patients with diabetic foot ulcers in home care nursing. This paper reports on the feasibility of implementing the study protocol, the trial findings related to nursing process outcomes, and leadership behaviors. A mixed methods pilot study was conducted with a post-only cluster randomized controlled trial and descriptive qualitative interviews. Four units were randomized to control or experimental groups. Clinical and management leadership teams participated in a 12-week leadership intervention (workshop, teleconferences). Participants received summarized chart audit data, identified goals for change, and created a team leadership action. Criteria to assess feasibility of the protocol included: design, intervention, measures, and data collection procedures. For the trial, chart audits compared differences in nursing process outcomes. 8-item nursing assessments score. Secondary outcome: 5-item score of nursing care based on goals for change identified by intervention participants. Qualitative interviews described leadership behaviors that influenced guideline use. Conducting this pilot showed some aspects of the study protocol were feasible, while others require further development. Trial findings observed no significant difference in the primary outcome. A significant increase was observed in the 5-item score chosen by intervention participants (p = 0.02). In the experimental group more relations-oriented leadership behaviors, audit and feedback and reminders were described as leadership strategies. Findings suggest that a leadership intervention has the potential to influence nurses' use of guideline recommendations, but further work is required to refine the intervention and outcome measures. A taxonomy of leadership behaviors is proposed to inform future research. © 2012 The authors. World Views on Evidence-Based Nursing © Sigma Theta Tau International.

From PALSA PLUS to PALM PLUS: adapting and developing a South African guideline and training intervention to better integrate HIV/AIDS care with primary care in rural health centers in Malawi

PubMed Central

2011-01-01

Background Only about one-third of eligible HIV/AIDS patients receive anti-retroviral treatment (ART). Decentralizing treatment is crucial to wider and more equitable access, but key obstacles are a shortage of trained healthcare workers (HCW) and challenges integrating HIV/AIDS care with other primary care. This report describes the development of a guideline and training program (PALM PLUS) designed to integrate HIV/AIDS care with other primary care in Malawi. PALM PLUS was adapted from PALSA PLUS, developed in South Africa, and targets middle-cadre HCWs (clinical officers, nurses, and medical assistants). We adapted it to align with Malawi's national treatment protocols, more varied healthcare workforce, and weaker health system infrastructure. Methods/Design The international research team included the developers of the PALSA PLUS program, key Malawi-based team members and personnel from national and district level Ministry of Health (MoH), professional associations, and an international non-governmental organization. The PALSA PLUS guideline was extensively revised based on Malawi national disease-specific guidelines. Advice and input was sought from local clinical experts, including middle-cadre personnel, as well as Malawi MoH personnel and representatives of Malawian professional associations. Results An integrated guideline adapted to Malawian protocols for adults with respiratory conditions, HIV/AIDS, tuberculosis, and other primary care conditions was developed. The training program was adapted to Malawi's health system and district-level supervision structure. PALM PLUS is currently being piloted in a cluster-randomized trial in health centers in Malawi (ISRCTN47805230). Discussion The PALM PLUS guideline and training intervention targets primary care middle-cadre HCWs with the objective of improving HCW satisfaction and retention, and the quality of patient care. Successful adaptations are feasible, even across health systems as different as those of South Africa and Malawi. PMID:21791048

Computational prediction of multidisciplinary team decision-making for adjuvant breast cancer drug therapies: a machine learning approach.

PubMed

Lin, Frank P Y; Pokorny, Adrian; Teng, Christina; Dear, Rachel; Epstein, Richard J

2016-12-01

Multidisciplinary team (MDT) meetings are used to optimise expert decision-making about treatment options, but such expertise is not digitally transferable between centres. To help standardise medical decision-making, we developed a machine learning model designed to predict MDT decisions about adjuvant breast cancer treatments. We analysed MDT decisions regarding adjuvant systemic therapy for 1065 breast cancer cases over eight years. Machine learning classifiers with and without bootstrap aggregation were correlated with MDT decisions (recommended, not recommended, or discussable) regarding adjuvant cytotoxic, endocrine and biologic/targeted therapies, then tested for predictability using stratified ten-fold cross-validations. The predictions so derived were duly compared with those based on published (ESMO and NCCN) cancer guidelines. Machine learning more accurately predicted adjuvant chemotherapy MDT decisions than did simple application of guidelines. No differences were found between MDT- vs. ESMO/NCCN- based decisions to prescribe either adjuvant endocrine (97%, p = 0.44/0.74) or biologic/targeted therapies (98%, p = 0.82/0.59). In contrast, significant discrepancies were evident between MDT- and guideline-based decisions to prescribe chemotherapy (87%, p < 0.01, representing 43% and 53% variations from ESMO/NCCN guidelines, respectively). Using ten-fold cross-validation, the best classifiers achieved areas under the receiver operating characteristic curve (AUC) of 0.940 for chemotherapy (95% C.I., 0.922-0.958), 0.899 for the endocrine therapy (95% C.I., 0.880-0.918), and 0.977 for trastuzumab therapy (95% C.I., 0.955-0.999) respectively. Overall, bootstrap aggregated classifiers performed better among all evaluated machine learning models. A machine learning approach based on clinicopathologic characteristics can predict MDT decisions about adjuvant breast cancer drug therapies. The discrepancy between MDT- and guideline-based decisions regarding adjuvant chemotherapy implies that certain non-clincopathologic criteria, such as patient preference and resource availability, are factored into clinical decision-making by local experts but not captured by guidelines.

A guideline for adults with an indwelling urinary catheter in different health care Settings - methodological procedures

PubMed

Barbezat, Isabelle; Willener, Rita; Jenni, Giovanna; Hürlimann, Barbara; Geese, Franziska; Spichiger, Elisabeth

2017-07-01

Background: People with an indwelling urinary catheter often suffer from complications and health care professionals are regularly confronted with questions about catheter management. Clinical guidelines are widely accepted to promote evidence-based practice. In the literature, the adaptation of a guideline is described as a valid alternative to the development of a new one. Aim: To translate a guideline for the care for adults with an indwelling urinary catheter in the acute and long term care setting as well as for home care. To adapt the guideline to the Swiss context. Method: In a systematic and pragmatic process, clinical questions were identified, guidelines were searched and evaluated regarding clinical relevance and quality. After each step, the next steps were defined. Results: An English guideline was translated, adapted to the local context and supplemented. The adapted guideline was reviewed by experts, adapted again and approved. After 34 months and an investment of a total of 145 man working days, a guideline for the care for people with an indwelling urinary catheter is available for both institutions. Conclusions: Translation and adaptation of a guideline was a valuable alternative to the development of a new one; nevertheless, the efforts necessary should not be underestimated. For such a project, sufficient professional and methodological resources should be made available to achieve efficient guideline work by a constant team.

Protocol for audit of current Filipino practice in rehabilitation of stroke inpatients.

PubMed

Gonzalez-Suarez, Consuelo B; Dizon, Janine Margarita R; Grimmer, Karen; Estrada, Myrna S; Liao, Lauren Anne S; Malleta, Anne-Rochelle D; Tan, Ma Elena R; Marfil, Vero; Versales, Cristina S; Suarez, Jimah L; So, Kleon C; Uyehara, Edgardo D

2015-01-01

Stroke is one of the leading medical conditions in the Philippines. Over 500,000 Filipinos suffer from stroke annually. Provision of evidence-based medical and rehabilitation management for stroke patients has been a challenge due to existing environmental, social, and local health system issues. Thus, existing western guidelines on stroke rehabilitation were contextualized to draft recommendations relevant to the local Philippine setting. Prior to fully implementing the guidelines, an audit of current practice needs to be undertaken, thus the purpose of this audit protocol. A clinical audit of current practices in stroke rehabilitation in the Philippines will be undertaken. A consensus list of data items to be captured was identified by the audit team during a 2-day meeting in 2012. These items, including patient demographics, type of stroke, time to referral for rehabilitation management, length of hospital stay, and other relevant descriptors of stroke management were included as part of the audit. Hospitals in the Philippines will be recruited to take part in the audit activity. Recruitment will be via the registry of the Philippine Academy of Rehabilitation Medicine, where 90% of physiatrists (medical doctors specialized in rehabilitation medicine) are active members and are affiliated with various hospitals in the Philippines. Data collectors will be identified and trained in the audit process. A pilot audit will be conducted to test the feasibility of the audit protocol, and refinements to the protocol will be undertaken as necessary. The comprehensive audit process will take place for a period of 3 months. Data will be encoded using MS Excel(®). Data will be reported as means and percentages as appropriate. Subgroup analysis will be undertaken to look into differences and variability of stroke patient descriptors and rehabilitation activities. This audit study is an ambitious project, but given the "need" to conduct the audit to identify "gaps" in current practice, and the value it can bring to serve as a platform for implementation of evidence-based stroke management in the Philippines to achieve best patient and health outcomes, the audit team is more than ready to take up the challenge.

Does an electronic cognitive aid have an effect on the management of severe gynaecological TURP syndrome? A prospective, randomised simulation study.

PubMed

St Pierre, Michael; Breuer, Georg; Strembski, Dieter; Schmitt, Christopher; Luetcke, Bjoern

2017-05-30

Lack of familiarity with the content of current guidelines is a major factor associated with non-compliance by clinicians. It is conceivable that cognitive aids with regularly updated medical content can guide clinicians' task performance by evidence-based practices, even if they are unfamiliar with the actual guideline. Acute hyponatraemia as a consequence of TURP syndrome is a rare intraoperative event, and current practice guidelines have changed from slow correction to rapid correction of serum sodium levels. The primary objective of this study was to compare the management of a simulated severe gynaecological transurethral resection of the prostate (TURP) syndrome under spinal anaesthesia with either: an electronic cognitive aid, or with management from memory alone. The secondary objective was to assess the clinical relevance and participant perception of the usefulness of the cognitive aid. Anaesthetic teams were allocated to control (no cognitive aid; n = 10) or intervention (cognitive aid provided; n = 10) groups. We identified eight evidence-based management tasks for severe TURP syndrome from current guidelines and subdivided them into acute heart failure (AHF)/pulmonary oedema tasks (5) and acute hyponatraemia tasks (3). Implementation of the treatment steps was measured by scoring task items in a binary fashion (yes/no). To assess whether or not the cognitive aid had prompted a treatment step, participants from the cognitive aid group were questioned during debriefing on every single treatment step. At the end of the simulation, session participants were asked to complete a survey. Teams in the cognitive aid group considered evidence-based treatment steps significantly more often than teams of the control group (96% vs. 50% for 'AHF/pulmonary oedema' p < 0.001; 79% vs. 12% for 'acute hyponatraemia' p < 0.001). Without the cognitive aid, performance would have been comparable across both groups. Nurses, trainees, and consultants derived equal benefit from the cognitive aid. The cognitive aid improved the implementation of evidence-based practices in a simulated intraoperative scenario. Cognitive aids with current medical content could help to close the translational gap between guideline publication and implementation in acute patient care. It is important that the cognitive aid should be familiar, in a format that has been used in practice and training.

Essential features influencing collaboration in team-based non-specific back pain rehabilitation: Findings from a mixed methods study

PubMed Central

Hellman, Therese; Jensen, Irene; Bergström, Gunnar; Brämberg, Elisabeth Björk

2016-01-01

ABSTRACT The aim of the study presented in this article was to explore how professionals, without guidelines for implementing interprofessional teamwork, experience the collaboration within team-based rehabilitation for people with back pain and how this collaboration influences their clinical practice. This study employed a mixed methods design. A questionnaire was answered by 383 participants and 17 participants were interviewed. The interviews were analysed using content analysis. The quantitative results showed that the participants were satisfied with their team-based collaboration. Thirty percent reported that staff changes in the past year had influenced their clinical practice, of which 57% reported that these changes had had negative consequences. The qualitative findings revealed that essential features for an effective collaboration were shared basic values and supporting each other. Furthermore, aspects such as having enough time for reflection, staff continuity, and a shared view of the team members’ roles were identified as aspects which influenced the clinical practice. Important clinical implications for nurturing and developing a collaboration in team-based rehabilitation are to create shared basic values and a unified view of all team members’ roles and their contributions to the team. These aspects need to be emphasised on an ongoing basis and not only when the team is formed. PMID:27152534

Conceptual and statistical issues in couples observational research: Rationale and methods for design decisions.

PubMed

Baucom, Brian R W; Leo, Karena; Adamo, Colin; Georgiou, Panayiotis; Baucom, Katherine J W

2017-12-01

Observational behavioral coding methods are widely used for the study of relational phenomena. There are numerous guidelines for the development and implementation of these methods that include principles for creating new and adapting existing coding systems as well as principles for creating coding teams. While these principles have been successfully implemented in research on relational phenomena, the ever expanding array of phenomena being investigated with observational methods calls for a similar expansion of these principles. Specifically, guidelines are needed for decisions that arise in current areas of emphasis in couple research including observational investigation of related outcomes (e.g., relationship distress and psychological symptoms), the study of change in behavior over time, and the study of group similarities and differences in the enactment and perception of behavior. This article describes conceptual and statistical considerations involved in these 3 areas of research and presents principle- and empirically based rationale for design decisions related to these issues. A unifying principle underlying these guidelines is the need for careful consideration of fit between theory, research questions, selection of coding systems, and creation of coding teams. Implications of (mis)fit for the advancement of theory are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Critical Care Delivery: The Importance of Process of Care and ICU Structure to Improved Outcomes: An Update From the American College of Critical Care Medicine Task Force on Models of Critical Care.

PubMed

Weled, Barry J; Adzhigirey, Lana A; Hodgman, Tudy M; Brilli, Richard J; Spevetz, Antoinette; Kline, Andrea M; Montgomery, Vicki L; Puri, Nitin; Tisherman, Samuel A; Vespa, Paul M; Pronovost, Peter J; Rainey, Thomas G; Patterson, Andrew J; Wheeler, Derek S

2015-07-01

In 2001, the Society of Critical Care Medicine published practice model guidelines that focused on the delivery of critical care and the roles of different ICU team members. An exhaustive review of the additional literature published since the last guideline has demonstrated that both the structure and process of care in the ICU are important for achieving optimal patient outcomes. Since the publication of the original guideline, several authorities have recognized that improvements in the processes of care, ICU structure, and the use of quality improvement science methodologies can beneficially impact patient outcomes and reduce costs. Herein, we summarize findings of the American College of Critical Care Medicine Task Force on Models of Critical Care: 1) An intensivist-led, high-performing, multidisciplinary team dedicated to the ICU is an integral part of effective care delivery; 2) Process improvement is the backbone of achieving high-quality ICU outcomes; 3) Standardized protocols including care bundles and order sets to facilitate measurable processes and outcomes should be used and further developed in the ICU setting; and 4) Institutional support for comprehensive quality improvement programs as well as tele-ICU programs should be provided.

It's Salsa Time! A Team Activity

ERIC Educational Resources Information Center

Crowne, Kerri Anne

2017-01-01

This article provides information on a team-building activity in which student teams make salsa. I usually use this exercise on the day that I form teams to provide an opportunity for teams to work on something that is not graded prior to completing the graded team assignment. The activity is built on several theories, such as social learning,…

[The practice guideline 'Treatment of tobacco addiction'].

PubMed

Allard, R H B

2005-06-01

The practice guidelines 'Treatment of tobacco dependence' are drawn up by collaboration of all medical and paramedical professional associations and aim at assisting patients who would like to quit smoking. The dental team has a barrier-free opportunity to discuss smoking habits. The relation between smoking and oral health is quite obvious. Dental practitioners should ask about smoking habits regularly and smokers should be advised at least once a year to stop smoking. More intensive strategies for treatment of tobacco addiction in dental settings will be developed in the near future.

Herpes rugbiorum: a review on scrum pox and rugby player guidelines.

PubMed

Alamri, Yassar A S

2011-07-08

Sports, especially contact ones, have long been associated with an increased risk of contracting a communicable disease. Viral infections, in particular, have had an increased attention, due to their adverse effects on athletes' performance. As world sport events have now become more organised and diverse, athletes are now exposed to a wider range of pathogens. With the upcoming Rugby World Cup in 2011 taking place in New Zealand, team-doctors should keep a 'careful' eye on potential infectious outbreaks and make sure to adhere to guidelines accessed through fact sheets.

[The impact of 2010 international consensus on CPR and ECC science with treatment recommendations on Japan].

PubMed

Miyake, Yasufumi

2011-04-01

New guidelines on cardiopulmonary resuscitation(CPR) and emergency cardiovascular care (ECC) were published in October 2010 from International Liaison Committee on Resuscitation (ILCOR). Changes of these guidelines will have dramatic effects on Japan. Starting with chest compressions first will increase by-stander CPR. Cases of recovery of spontaneous heartbeat could increase as a result. Intensive care and radical treatments for cardiovascular emergency and brain damage after cardiopulmonary arrest would be essential. Education, implementation and teams (EIT) will be the third subject.

Media Standards.

ERIC Educational Resources Information Center

North Clackamas School District 12, Milwaukie, OR.

Guidelines for library media services for the North Clackamas School District were developed by two teams representing the elementary, junior high, and senior high schools. These minimum standards describe the goals and objectives for library media services to students, staff, and community; the operation of the media centers; and the audiovisual…

Working Together To Prevent Violence.

ERIC Educational Resources Information Center

Gauthier, Erin K.; Reynolds, Doug

1999-01-01

By cooperating with other district staff, law enforcement, fire and rescue personnel, and social services, educators can prevail over school violence. First steps are developing a well-trained team, an effective crisis-response plan, and an alternative site to accommodate students. Guidelines and Web sites are provided. (MLH)

Enhancing pediatric clinical competency with high-fidelity simulation.

PubMed

Birkhoff, Susan D; Donner, Carol

2010-09-01

In today's tertiary pediatric hospital setting, the increased complexity of patient care demands seamless coordination and collaboration among multidisciplinary team members. In an effort to enhance patient safety, clinical competence, and teamwork, simulation-based learning has become increasingly integrated into pediatric clinical practice as an innovative educational strategy. The simulated setting provides a risk-free environment where learners can incorporate cognitive, psychomotor, and affective skill acquisition without fear of harming patients. One pediatric university hospital in Southeastern Pennsylvania has enhanced the traditional American Heart Association (AHA) Pediatric Advanced Life Support (PALS) course by integrating high-fidelity simulation into skill acquisition, while still functioning within the guidelines and framework of the AHA educational standards. However, very little research with reliable standardized testing methods has been done to measure the effect of simulation-based learning. This article discusses the AHA guidelines for PALS, evaluation of PALS and nursing clinical competencies, communication among a multidisciplinary team, advantages and disadvantages of simulation, incorporation of high-fidelity simulation into pediatric practice, and suggestions for future practice. Copyright 2010, SLACK Incorporated.

2015 AAHA Canine and Feline Behavior Management Guidelines.

PubMed

Hammerle, Marcy; Horst, Christine; Levine, Emily; Overall, Karen; Radosta, Lisa; Rafter-Ritchie, Marcia; Yin, Sophia

2015-01-01

The 2015 AAHA Canine and Feline Behavior Management Guidelines were developed to provide practitioners and staff with concise, evidence-based information to ensure that the basic behavioral needs of feline and canine patients are understood and met in every practice. Some facility in veterinary behavioral and veterinary behavioral medicine is essential in modern veterinary practice. More cats and dogs are affected by behavioral problems than any other condition. Behavioral problems result in patient suffering and relinquishment and adversely affect staff morale. These guidelines use a fully inclusive team approach to integrate basic behavioral management into everyday patient care using standardized behavioral assessments; create a low-fear and low-stress environment for patients, staff and owners; and create a cooperative relationship with owners and patients so that the best care can be delivered. The guidelines' practical, systematic approach allows veterinary staff to understand normal behavior and recognize and intervene in common behavioral problems early in development. The guidelines emphasize that behavioral management is a core competency of any modern practice.

Development of a guideline for treatment of deep and superficial venous thrombosis in the emergency department.

PubMed

Tosone, Nancy C; Costanzo, Cindy

2012-01-01

Patients with DVT, aged 45.64 years, often present to the ED, with an annual cost of $1.5-$3.2 billion per year. This paper describes the process used to implement an evidence-based guideline on deep venous thrombosis (DVT) for the emergency department (ED). Specific aims were to (a) conduct an organizational assessment of DVT treatment practices; (b) compare organizational results with evidence-based treatment guidelines; (c) develop recommendations for the treatment of DVT for ED discharge; and (d) conduct an interdisciplinary evaluation of the evidence-based guideline. A retrospective review of 149 records of adults in an urban Midwestern ED in 2010 was undertaken. Differences in provider practices were identified. A guideline was developed that included clinical management, social/financial concerns, patient education, anticoagulation monitoring, and outpatient follow-up. Implementation and evaluation were accomplished through electronic and paper communication, medical record monitoring, and patient call back. Evaluation also included simulation exercises with an interdisciplinary team.

Pharmacists' perceptions of professionalism on social networking sites.

PubMed

Benetoli, Arcelio; Chen, Timothy F; Schaefer, Marion; Chaar, Betty; Aslani, Parisa

Social networking sites (SNS) are a new venue for communication, and health care professionals, like the general population, are using them extensively. However, their behavior on SNS may influence public perceptions about their professionalism. This study explored how pharmacists separate professional and personal information and activities on SNS, their perceptions of professional behavior on SNS, and opinions on guidelines in this area. In-depth, semi-structured interviews were conducted with international practising pharmacists (n = 31) recruited from a range of countries (n = 9). Initially, pharmacists known to the research team were invited, and thereafter, participants were recruited using a snowballing technique. The interviews lasted from 30 to 120 min. All interviews were recorded, transcribed verbatim, and thematically analyzed. A majority of participants mixed professional and personal information and activities on SNS, and about one third adopted a separation strategy where professional information and activities were clearly separated from personal ones (e.g. two different SNS accounts, or one particular SNS for professional use and another platform for personal purposes). Most participants expressed concern over how pharmacists present themselves and behave in SNS when they reported (un)professional behaviors of peers they had observed. Examples of perceived unprofessional behaviors included revealing details of personal life and activities; open complaints about the pharmacy sector, co-workers, physicians, and patients; inappropriate description of pharmacists' roles and activities; and breaches of patient confidentiality. Positive professional behaviors, such as expression of compassion for patients, examples of effective patient management, promotion of pharmacists' role, and correction of misleading health information being spread online were also observed. There was no consensus on having professional social media guidelines. Some preferred SNS to be unregulated while most believed certain guidance was needed to maintain high professional standards in the online environment. A definitive strategy to separate professional and personal information and activities on SNS was not adopted by most pharmacists. E-professionalism issues could negatively impact on the standing of individual practitioners and the profession. Most agreed that education about SNS use would be beneficial; however, support for guidelines or regulations for pharmacists' use of SNS was not unanimous. Copyright © 2016 Elsevier Inc. All rights reserved.

Cystic fibrosis on the Internet: a survey of site adherence to AMA guidelines.

PubMed

Anselmo, Mark A; Lash, Katherine M; Stieb, Elisabeth S; Haver, Kenan E

2004-07-01

The Internet permits unprecedented and mostly unrestricted access to medical knowledge; however, concerns exist regarding viewer privacy, accountability of authorship, accuracy of information, and patient safety. To address these issues, the American Medical Association (AMA) has developed guidelines concerning web site content and visitor rights. Cystic fibrosis (CF) is the most common genetically inherited lethal disease in North America. Many Internet sites that provide information on CF have been developed, although adherence to validated guidelines for online health information is not required. The purpose of this study was to assess systematically web sites with content pertaining to CF for adherence to the published AMA guidelines. The search term "cystic fibrosis" was entered into a commonly used search engine (Google), and the first 100 eligible sites were reviewed. Each site was examined for adherence to the AMA Guidelines for Medical and Health Information Sites on the Internet using a series of adapted questions. There were 15 questions divided into the following main categories: 1) site structure and viewer privacy, 2) author accountability, 3) scientific citation, and 4) patient safety. The number of positives for each question was tabulated. With respect to site structure, fewer than half (45%) of the reviewed sites indicated a date of last revision. Only 11 (11%) carried an explicit privacy policy. A responsible author or group was listed in only 43 (43%) of 100 sites. Presented data regarding CF was supported by references, sources, or expert review in only 38 (38%) of 100 sites. A medical disclaimer noting that information provided does not substitute for evaluation by a health care team was evident in only 37 (37%) sites. The majority of easily accessible CF informational web sites do not adhere to guidelines published by the AMA. Patients and families who use the Internet as a CF information resource should examine the web sites carefully and be familiar with the guidelines established by the AMA. Personal information is not protected, and few sites provide explicit privacy guarantees. Finally, CF care teams should inquire about Internet use by patients and families and be prepared to discuss findings from the Internet to heighten patient safety and awareness.

The Ethics of Penile Transplantation: Preliminary Recommendations.

PubMed

Caplan, Arthur L; Kimberly, Laura L; Parent, Brendan; Sosin, Michael; Rodriguez, Eduardo D

2017-06-01

For men with significant genitourinary injury, penile transplantation is being considered as an option when reconstruction is not feasible or proves unacceptable to the injured patient. A review of the literature was conducted to assess the current state of penile reconstruction and transplantation options, as well as to evaluate scholarly research addressing the ethical dimensions of penile transplantation. The state of penile transplantation is elementary. If reconstruction is not a possibility, proceeding ethically with research on penile vascularized composite allotransplantation will require the articulation of guidelines. To date, very little has been published in the scholarly literature assessing the ethics of penile transplantation. Guidelines should be developed to address penile transplantation and must cover the donation of tissue, consent, subject selection, qualifications of the surgical team, and management of both failure and patient dissatisfaction. Unless guidelines are established and disseminated, penile transplants should not be undertaken. The preliminary recommendations suggested in this article may help to inform development of guidelines.

The CanPain SCI Clinical Practice Guidelines for Rehabilitation Management of Neuropathic Pain after Spinal Cord: screening and diagnosis recommendations.

PubMed

Mehta, S; Guy, S D; Bryce, T N; Craven, B C; Finnerup, N B; Hitzig, S L; Orenczuk, S; Siddall, P J; Widerström-Noga, E; Casalino, A; Côté, I; Harvey, D; Kras-Dupuis, A; Lau, B; Middleton, J W; Moulin, D E; O'Connell, C; Parrent, A G; Potter, P; Short, C; Teasell, R; Townson, A; Truchon, C; Wolfe, D; Bradbury, C L; Loh, E

2016-08-01

Clinical practice guidelines. To develop the first Canadian clinical practice guidelines for screening and diagnosis of neuropathic pain in people with spinal cord injury (SCI). The guidelines are relevant for inpatient and outpatient SCI rehabilitation settings in Canada. The CanPainSCI Working Group reviewed evidence to address clinical questions regarding screening and diagnosis of neuropathic pain after SCI. A consensus process was followed to achieve agreement on recommendations and clinical considerations. Twelve recommendations, based on expert consensus, were developed for the screening and diagnosis of neuropathic pain after SCI. The recommendations address methods for assessment, documentation tools, team member accountability, frequency of screening and considerations for diagnostic investigation. Important clinical considerations accompany each recommendation. The expert Working Group developed recommendations for the screening and diagnosis of neuropathic pain after SCI that should be used to inform practice.

Guideline Implementation: Surgical Smoke Safety.

PubMed

Fencl, Jennifer L

2017-05-01

Research conducted during the past four decades has demonstrated that surgical smoke generated from the use of energy-generating devices in surgery contains toxic and biohazardous substances that present risks to perioperative team members and patients. Despite the increase in information available, however, perioperative personnel continue to demonstrate a lack of knowledge of these hazards and lack of compliance with recommendations for evacuating smoke during surgical procedures. The new AORN "Guideline for surgical smoke safety" provides guidance on surgical smoke management. This article focuses on key points of the guideline to help perioperative personnel promote smoke-free work environments; evacuate surgical smoke; and develop education programs and competency verification tools, policies and procedures, and quality improvement initiatives related to controlling surgical smoke. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Practical Guidelines for Qualitative Research Using Online Forums

PubMed Central

Im, Eun-Ok; Chee, Wonshik

2012-01-01

With an increasing number of Internet research in general, the number of qualitative Internet studies has recently increased. Online forums are one of the most frequently used qualitative Internet research methods. Despite an increasing number of online forum studies, very few articles have been written to provide practical guidelines to conduct an online forum as a qualitative research method. In this paper, practical guidelines in using an online forum as a qualitative research method are proposed based on three previous online forum studies. First, the three studies are concisely described. Practical guidelines are proposed based on nine idea categories related to issues in the three studies: (a) a fit with research purpose and questions; (b) logistics; (c) electronic versus conventional informed consent process; (d) structure and functionality of online forums; (e) interdisciplinary team; (f) screening methods; (g) languages; (h) data analysis methods; and (i) getting participants’ feedback. PMID:22918135

Practical guidelines for qualitative research using online forums.

PubMed

Im, Eun-Ok; Chee, Wonshik

2012-11-01

With an increasing number of Internet research in general, the number of qualitative Internet studies has recently increased. Online forums are one of the most frequently used qualitative Internet research methods. Despite an increasing number of online forum studies, very few articles have been written to provide practical guidelines to conduct an online forum as a qualitative research method. In this article, practical guidelines in using an online forum as a qualitative research method are proposed based on three previous online forum studies. First, the three studies are concisely described. Practical guidelines are proposed based on nine idea categories related to issues in the three studies: (a) a fit with research purpose and questions, (b) logistics, (c) electronic versus conventional informed consent process, (d) structure and functionality of online forums, (e) interdisciplinary team, (f) screening methods, (g) languages, (h) data analysis methods, and (i) getting participants' feedback.

Soft Tissue Sarcoma, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology.

PubMed

von Mehren, Margaret; Randall, R Lor; Benjamin, Robert S; Boles, Sarah; Bui, Marilyn M; Ganjoo, Kristen N; George, Suzanne; Gonzalez, Ricardo J; Heslin, Martin J; Kane, John M; Keedy, Vicki; Kim, Edward; Koon, Henry; Mayerson, Joel; McCarter, Martin; McGarry, Sean V; Meyer, Christian; Morris, Zachary S; O'Donnell, Richard J; Pappo, Alberto S; Paz, I Benjamin; Petersen, Ivy A; Pfeifer, John D; Riedel, Richard F; Ruo, Bernice; Schuetze, Scott; Tap, William D; Wayne, Jeffrey D; Bergman, Mary Anne; Scavone, Jillian L

2018-05-01

Soft tissue sarcomas (STS) are rare solid tumors of mesenchymal cell origin that display a heterogenous mix of clinical and pathologic characteristics. STS can develop from fat, muscle, nerves, blood vessels, and other connective tissues. The evaluation and treatment of patients with STS requires a multidisciplinary team with demonstrated expertise in the management of these tumors. The complete NCCN Guidelines for STS provide recommendations for the diagnosis, evaluation, and treatment of extremity/superficial trunk/head and neck STS, as well as intra-abdominal/retroperitoneal STS, gastrointestinal stromal tumors, desmoid tumors, and rhabdomyosarcoma. This portion of the NCCN Guidelines discusses general principles for the diagnosis, staging, and treatment of STS of the extremities, superficial trunk, or head and neck; outlines treatment recommendations by disease stage; and reviews the evidence to support the guidelines recommendations. Copyright © 2018 by the National Comprehensive Cancer Network.

Development of an instrument for the evaluation of advanced life support performance.

PubMed

Peltonen, L-M; Peltonen, V; Salanterä, S; Tommila, M

2017-10-01

Assessing advanced life support (ALS) competence requires validated instruments. Existing instruments include aspects of technical skills (TS), non-technical skills (NTS) or both, but one instrument for detailed assessment that suits all resuscitation situations is lacking. This study aimed to develop an instrument for the evaluation of the overall ALS performance of the whole team. This instrument development study had four phases. First, we reviewed literature and resuscitation guidelines to explore items to include in the instrument. Thereafter, we interviewed resuscitation team professionals (n = 66), using the critical incident technique, to determine possible additional aspects associated with the performance of ALS. Second, we developed an instrument based on the findings. Third, we used an expert panel (n = 20) to assess the validity of the developed instrument. Finally, we revised the instrument based on the experts' comments and tested it with six experts who evaluated 22 video recorded resuscitations. The final version of the developed instrument had 69 items divided into adherence to guidelines (28 items), clinical decision-making (5 items), workload management (12 items), team behaviour (8 items), information management (6 items), patient integrity and consideration of laymen (4 items) and work routines (6 items). The Cronbach's α values were good, and strong correlations between the overall performance and the instrument were observed. The instrument may be useful for detailed assessment of the team's overall performance, but the numerous items make the use demanding. The instrument is still under development, and more research is needed to determine its psychometric properties. © 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

The role of nontechnical skills in simulated trauma resuscitation.

PubMed

Briggs, Alexandra; Raja, Ali S; Joyce, Maurice F; Yule, Steven J; Jiang, Wei; Lipsitz, Stuart R; Havens, Joaquim M

2015-01-01

Trauma team training provides instruction on crisis management through debriefing and discussion of teamwork and leadership skills during simulated trauma scenarios. The effects of team leader's nontechnical skills (NTSs) on technical performance have not been thoroughly studied. We hypothesized that team's and team leader's NTSs correlate with technical performance of clinical tasks. Retrospective cohort study. Brigham and Women's Hospital, STRATUS Center for Surgical Simulation A total of 20 teams composed of surgical residents, emergency medicine residents, emergency department nurses, and emergency services assistants underwent 2 separate, high-fidelity, simulated trauma scenarios. Each trauma scenario was recorded on video for analysis and divided into 4 consecutive sections. For each section, 2 raters used the Non-Technical Skills for Surgeons framework to assess NTSs of the team. To evaluate the entire team's NTS, 2 additional raters used the Modified Non-Technical Skills Scale for Trauma system. Clinical performance measures including adherence to guidelines and time to perform critical tasks were measured independently. NTSs performance by both teams and team leaders in all NTS categories decreased from the beginning to the end of the scenario (all p < 0.05). There was significant correlation between team's and team leader's cognitive skills and critical task performance, with correlation coefficients between 0.351 and 0.478 (p < 0.05). The NTS performance of the team leader highly correlated with that of the entire team, with correlation coefficients between 0.602 and 0.785 (p < 0.001). The NTSs of trauma teams and team leaders deteriorate as clinical scenarios progress, and the performance of team leaders and teams is highly correlated. Cognitive NTS scores correlate with critical task performance. Increased attention to NTSs during trauma team training may lead to sustained performance throughout trauma scenarios. Decision making and situation awareness skills are critical for both team leaders and teams and should be specifically addressed to improve performance. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Parents' discursive resources: analysis of discourses in Swedish, Danish and Norwegian health care guidelines for children with diabetes type 1.

PubMed

Boman, Ase; Borup, Ina; Povlsen, Lene; Dahlborg-Lyckhage, Elisabeth

2012-06-01

The incidence of diabetes type 1 in children, the most common metabolic disorder in childhood, increases worldwide, with highest incidence in Scandinavia. Having diabetes means demands in everyday life, and the outcome of the child's treatment highly depends on parents' engagement and involvement. The aim of this study was to explore and describe discourses in health care guidelines for children with diabetes type 1, in Sweden, Norway and Denmark during 2007-2010, with a focus on how parents were positioned. As method a Foucauldian approach to discourse analysis was applied, and a six-stage model was used to perform the analysis. The findings shows a Medical, a Pedagogic and a Public Health discourse embedded in the hegemonic Expert discourse. The Expert discourse positioned parents as dependent on expert knowledge, as recipients of education, as valuable and responsible for their child's health through practicing medical skills. This positioning may place parents on a continuum from being deprived of their own initiatives to being invited to take an active part and could result in feelings of guilt and uncertainty, but also of security and significance. From this study we conclude that guidelines rooted in the Expert discourse may reduce opportunities for parents' voices to be heard and may overlook their knowledge. By broadening the selection of authors of the guidelines to include patients and all professionals in the team, new discourses could emerge and the parents' voice might be more prominent. © 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011 Nordic College of Caring Science.

Lack of knowledge of physical activity guidelines: can physical activity promotion campaigns do better?

PubMed

Knox, Emily C L; Esliger, Dale W; Biddle, Stuart J H; Sherar, Lauren B

2013-12-05

To identify the prevalence of knowledge of the current UK physical activity guidelines which were introduced in 2011 and prior physical activity guidelines (30 min on 5 days each week) within two large samples of UK adult's. To investigate whether knowledge of physical activity guidelines differs according to demographics such as ethnicity, age, education and employment status. Descriptive cross-sectional study comparing two distinctive adult samples. National survey and online-administered survey conducted in England. The 2007 Health Survey for England provides data on knowledge of physical activity guidelines from 2860 UK adults (56% women, 89% white, 63% under 45 years old). In 2013, an online survey was disseminated and data were collected from 1797 UK adults on knowledge of the most recent physical activity guidelines. The 2013 sample was 70% women, 92% white and 57% under 45 years old. All adults in both samples were >18 years old and without illnesses/disorders likely to restrict physical activity. Knowledge of physical activity guidelines in 2007 and 2013. Demographic correlates of knowledge of moderate-to-vigorous physical activity guidelines. 18% of the 2013 sample accurately recalled the current physical activity guidelines compared with 11% of the 2007 sample who accurately recalled the previous guidelines. The differences in knowledge of physical activity guidelines existed for marital status, gender, age, education and employment status within both 2007 and 2013 samples (p<0.05). Men with lower education and employment status (unemployed including student and retired) and older adults were less likely to know physical activity guidelines (p<0.05). Knowledge of physical activity guidelines remained higher in the 2013 sample after controlling for demographic differences (p<0.05). Disadvantaged population groups are less knowledgeable about physical activity guidelines. Although knowledge of physical activity guidelines appears to have increased in recent years demographic disparities are still evident. Efforts are needed to promote health information among these groups.

Electronic Communities of Practice: Guidelines from a Project

ERIC Educational Resources Information Center

Ho, Kendall; Jarvis-Selinger, Sandra; Norman, Cameron D.; Li, Linda C.; Olatunbosun, Tunde; Cressman, Celine; Nguyen, Anne

2010-01-01

The timely incorporation of health research into the routine practice of individual health practitioners and interprofessional teams is a widely recognized and ongoing challenge. Health professional engagement and learning is an important cog in the wheel of knowledge translation; passive dissemination of evidence through journals and clinical…

Interactive Videodisc Design and Production Workshop Guide.

ERIC Educational Resources Information Center

Campbell, J. Olin; And Others

This "how to" workshop guide provides an overview of the entire videodisc authoring and production process through six individual modules. Focusing on project planning, the first module provides guidelines, procedures, and job aids to help each instructional development team member effectively use the videodisc medium. The second module…

Disciplining Students with Emotional and Behavioral Disorders: A Legal Update.

ERIC Educational Resources Information Center

Yell, Mitchell L.; And Others

1995-01-01

This article explicates the current legislation, case law, and administrative law governing the discipline of students with disabilities. Guidelines are offered that divide disciplinary procedures into three categories: permitted, controlled, and prohibited. The role of the Individualized Education Program team in planning proactive disciplinary…

An Administrator's Guide to Installing a Telephone System.

ERIC Educational Resources Information Center

Forbes, Phyllis Rossiter

1986-01-01

Guidelines for administrators concerning installation of a new campus telephone system address these issues: where to start; location and emergency power; the project team; paperwork; communication among those involved in installation; working with the local operating company; existing wiring; the external cable plant; special needs; and training…

A Framework for Teaching Tactical Game Knowledge.

ERIC Educational Resources Information Center

Wilson, Gail E.

2002-01-01

Provides an example of a framework of generic knowledge, designed for teachers, that describes and explains the foundational tactical aspects of invasive team-game play. The framework consists of four modules: participants and their roles, objectives, action principles, and action options. Guidelines to help instructors design practical activities…

Frequency of medical emergency team activation prior to pediatric cardiopulmonary resuscitation.

PubMed

Jayaram, Natalie; Chan, Maya L; Tang, Fengming; Parshuram, Christopher S; Chan, Paul S

2017-06-01

Medical Emergency Teams (METs) are designed to respond to signs of clinical decline in order to prevent cardiopulmonary arrest and reduce mortality. The frequency of MET activation prior to pediatric cardiopulmonary resuscitation (CPR) is unknown. Within the Get With The Guidelines-Resuscitation Registry (GWTG-R), we identified children with bradycardia or cardiac arrest requiring CPR on the general inpatient or telemetry floors from 2007 to 2013. We examined the frequency with which CPR outside the ICU was preceded by a MET evaluation. In cases where MET evaluation did not occur, we examined the frequency of severely abnormal vital signs at least 1hour prior to CPR that could have prompted a MET evaluation but did not. Of 215 children from 23 hospitals requiring CPR, 48 (22.3%) had a preceding MET evaluation. Children with MET evaluation prior to CPR were older (6.8±6.5 vs. 3.1±4.7 years of age, p<0.001) and were more likely to have metabolic/electrolyte abnormalities (18.8% vs. 5.4%, p=0.006), sepsis (16.7% vs. 4.8%, p=0.01), or malignancy (22.9% vs. 5.4%, p<0.001). Among patients who did not have a MET called and with information on vital signs, 55/141 (39.0%) had at least one abnormal vital sign that could have triggered a MET. The majority of pediatric patients requiring CPR for bradycardia or cardiac arrest do not have a preceding MET evaluation despite a significant number meeting criteria that could have triggered the MET. This suggests opportunities to more efficiently use MET teams in routine care. Copyright © 2017 Elsevier B.V. All rights reserved.

Nuts and bolts of running a pulmonary embolism response team: results from an organizational survey of the National PERT™ Consortium members.

PubMed

Barnes, Geoffrey; Giri, Jay; Courtney, D Mark; Naydenov, Soophia; Wood, Todd; Rosovsky, Rachel; Rosenfield, Kenneth; Kabrhel, Christopher

2017-08-01

Pulmonary embolism response teams (PERT) are developing rapidly to operationalize multi-disciplinary care for acute pulmonary embolism patients. Our objective is to describe the core components of PERT necessary for newly developing programs. An online organizational survey of active National PERT™ Consortium members was performed between April and June 2016. Analysis, including descriptive statistics and Kruskal-Wallis tests, was performed on centers self-reporting a fully operational PERT program. The survey response rate was 80%. Of the 31 institutions that responded (71% academic), 19 had fully functioning PERT programs. These programs were run by steering committees (17/19, 89%) more often than individual physicians (2/19, 11%). Most PERT programs involved 3-5 different specialties (14/19, 74%), which did not vary based on hospital size or academic affiliation. Of programs using multidisciplinary discussions, these occurred via phone or conference call (12/18, 67%), with a minority of these utilizing 'virtual meeting' software (2/12, 17%). Guidelines for appropriate activations were provided at 16/19 (84%) hospitals. Most PERT programs offered around-the-clock catheter-based or surgical care (17/19, 89%). Outpatient follow up usually occurred in personal physician clinics (15/19, 79%) or dedicated PERT clinics (9/19, 47%), which were only available at academic institutions. PERT programs can be implemented, with similar structures, at small and large, community and academic medical centers. While all PERT programs incorporate team-based multi-disciplinary care into their core structure, several different models exist with varying personnel and resource utilization. Understanding how different PERT programs impact clinical care remains to be investigated.

Summary of International Guidelines for Physical Activity Following Pregnancy

PubMed Central

Evenson, Kelly R.; Mottola, Michelle F.; Owe, Katrine M.; Rousham, Emily K.; Brown, Wendy J.

2014-01-01

Postpartum physical activity can improve mood, maintain cardiorespiratory fitness, improve weight control, promote weight loss, and reduce depression and anxiety. This review summarizes current guidelines for postpartum physical activity worldwide. PubMed (MedLINE) was searched for country-specific government and clinical guidelines on physical activity following pregnancy through the year 2013. Only the most recent guideline was included in the review. An abstraction form facilitated extraction of key details and helped to summarize results. Six guidelines were identified from five countries (Australia, Canada, Norway, United Kingdom, United States). All guidelines were embedded within pregnancy-related physical activity recommendations. All provided physical activity advice related to breastfeeding and three remarked about physical activity following Caesarean delivery. Recommended physical activities mentioned in the guidelines included aerobic (3/6), pelvic floor exercise (3/6), strengthening (2/6), stretching (2/6), and walking (2/6). None of the guidelines discussed sedentary behavior. The guidelines that were identified lacked specificity for physical activity. Greater clarity in guidelines would be more useful to both practitioners and the women they serve. Postpartum physical activity guidelines have the potential to assist women to initiate or resume physical activity following childbirth, so that they can transition to meeting recommended levels of physical activity. Health care providers have a critical role in encouraging women to be active at this time, and the availability of more explicit guidelines may assist them to routinely include physical activity advice in their postpartum care. PMID:25112589

Comparing team-based and mixed active-learning methods in an ambulatory care elective course.

PubMed

Zingone, Michelle M; Franks, Andrea S; Guirguis, Alexander B; George, Christa M; Howard-Thompson, Amanda; Heidel, Robert E

2010-11-10

To assess students' performance and perceptions of team-based and mixed active-learning methods in 2 ambulatory care elective courses, and to describe faculty members' perceptions of team-based learning. Using the 2 teaching methods, students' grades were compared. Students' perceptions were assessed through 2 anonymous course evaluation instruments. Faculty members who taught courses using the team-based learning method were surveyed regarding their impressions of team-based learning. The ambulatory care course was offered to 64 students using team-based learning (n = 37) and mixed active learning (n = 27) formats. The mean quality points earned were 3.7 (team-based learning) and 3.3 (mixed active learning), p < 0.001. Course evaluations for both courses were favorable. All faculty members who used the team-based learning method reported that they would consider using team-based learning in another course. Students were satisfied with both teaching methods; however, student grades were significantly higher in the team-based learning course. Faculty members recognized team-based learning as an effective teaching strategy for small-group active learning.

Physical activity and sports team participation: associations with academic outcomes in middle school and high school students.

PubMed

Fox, Claudia K; Barr-Anderson, Daheia; Neumark-Sztainer, Dianne; Wall, Melanie

2010-01-01

Previous studies have found that higher physical activity levels are associated with greater academic achievement among students. However, it remains unclear whether associations are due to the physical activity itself or sports team participation, which may involve requirements for maintaining certain grades, for example. The purpose of this study is to examine the associations between sports team participation, physical activity, and academic outcomes in middle and high school students. Data were drawn from Project EAT (Eating Among Teens), a survey of middle and high school students (n = 4746). Students self-reported their weekly hours of physical activity, sports team participation, and academic letter grades. Two statistical models were considered: first, 2 separate regression analyses with grade point average (GPA) as the outcome and either sports team participation or physical activity as the predictor; second, a single regression with GPA as the outcome and both sports team participation and physical activity as the simultaneous predictors. For high school girls, both physical activity and sports team participation were each independently associated with a higher GPA. For high school boys, only sports team participation was independently associated with a higher GPA. For middle school students, the positive association between physical activity and GPA could not be separated from the relationship between sports team participation and a higher GPA. Regardless of whether academic success was related to the physical activity itself or to participation on sports teams, findings indicated positive associations between physical activity involvement and academic achievement among students.

National clinical practice guidelines for allergen immunotherapy: An international assessment applying AGREE-II.

PubMed

Larenas-Linnemann, D E S; Antolín-Amérigo, D; Parisi, C; Nakonechna, A; Luna-Pech, J A; Wedi, B; Davila, I; Gómez, M; Levin, M; Ortega Martell, J A; Klimek, L; Rosario, N; Muraro, A M; Agache, I; Bousquet, J; Sheikh, A; Pfaar, O

2018-03-01

Since 1988, numerous allergen immunotherapy guidelines (AIT-GLs) have been developed by national and international organizations to guide physicians in AIT. Even so, AIT is still severely underused. To evaluate AIT-GLs with AGREE-II, developed in 2010 by McMaster University methodologists to comprehensively evaluate GL quality. Allergist, from different continents, knowledgeable in AIT and AGREE-II trained were selected into the project team. The project received methodologists' guidance. AIT-GLs in any language were sought from 1980 to 2016; AIT-GLs were AGREE II-evaluated by at least 2 team members, independently; discrepancies were resolved in a second round, by team discussion or methodologists' consulting. We found 31 AIT-GLs (15 post-2010), ranging from local consensus reports to international position papers (EAACI, AAAAI-ACAAI, WAO). Pre-2010 GLs scored 1.6-4.6 (23%-67%) and post-2010 GLs scored 2.1-6 (30%-86%), on a 7-point Likert scale. The highest scores went to: German-Austrian-Swiss (6.0), Mexican (5.1), and the AAAAI/ACAAI AIT-GL (4.7). These were also the only 3 GLs that received "yes" of both evaluators to the item: "I would recommend this GL for use." The domains of "Stakeholder involvement" and "Rigor of Development" only scored 3/7, and "Applicability" scored the lowest. Strikingly, newer GLs only scored clearly better in "Editorial independence" and "Global evaluation." In AIT-GLs, there is still a lot of room for improvement, especially in domains crucial for the dissemination. For some GLs, the "Scientific rigor" domain flawed. When resources are limited, transculturizing a high-quality GL might be preferable over developing a GL from zero. Our study and AGREE-II could help to select the best candidate. We here evaluate allergen immunotherapy guideline (AIT-GL) quality. Only high-quality AIT-GLs should be consulted for AIT management decisions. In low-resource settings, transculturization of these is preferred over developing low-quality guidelines. © 2017 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

Catheter use and infection reduction in plastic surgery

PubMed Central

Barnes, Zach J; Mahabir, Raman C

2013-01-01

BACKGROUND: Catheter-associated urinary tract infections (CAUTI) are the most common hospital-associated infection and can result in increased health care costs, morbidity and even mortality. In 2009, The Scott & White Memorial Hospital/Texas A&M Health Science Center (Texas, USA) system’s CAUTI rate placed it in the upper quartile (ie, highest rate) for the country, necessitating a system-wide change. OBJECTIVE: To design and implement a guideline to reduce the incidence of CAUTI. METHODS: A multidisciplinary team was formed and completed both a root cause analysis and a review of the available literature. Consolidating the best evidence, the team formulated a best practice guideline detailing the proper indications for insertion of, improper use of and techniques to minimize infection with catheters. Included as part of this protocol was nursing and patient education, changes in identifying patients with a catheter and automatic termination orders. Three-, six- and 12-month reviews identifying additional opportunities for improvement at the end of 2010 were completed. RESULTS: In 2009, the hospital’s CAUTI rate was 1.46 per 1000 catheter days. In 2011 – the first complete year of the finalized guideline – the hospital’s CAUTI rate was 0.52 per 1000 catheter days, ranking the institution in the bottom quartile (ie, lowest rate) for the country. The surgery and plastic surgery subgroup analyses also demonstrated statistically significant reduction in both catheter use and CAUTI. CONCLUSION: The incidence of CAUTI was successfully reduced at The Texas A&M Healthcare Center. The guideline, its development and how it applies to plastic surgery patients are discussed. PMID:24431946

Vascular Access Guidelines: Summary, Rationale, and Controversies.

PubMed

Sequeira, Adrian; Naljayan, Mihran; Vachharajani, Tushar J

2017-03-01

Dialysis vascular access management in the United States changed significantly after National Kidney Foundation-Kidney Disease Outcome Quality Initiative (NKF-KDOQI) clinical practice guidelines were first published in 1997. The Centers for Medicare and Medicaid Service adopted these guidelines and in collaboration with the End-Stage Renal Disease Networks established the Fistula First Breakthrough Initiative (FFBI) in 2003 to improve the rate of arteriovenous fistula use over arteriovenous graft and central venous catheter in the dialysis population. The implementation of guidelines and FFBI has led to a significant increase in the arteriovenous fistula use in the prevalent dialysis population. The guidelines are criticized for being opinion based and often impractical. Over the past 2 decades, the patient population undergoing dialysis has become older with complex comorbidities and challenges for creating an ideal vascular access. Advancing knowledge about access pathophysiology, improved treatment options, and improved process of care with team approach model point toward diminishing relevance of few of the existing guidelines. Moreover, several guidelines remain controversial and may be leading to clinical decisions that may be unfavorable to the patients. The review discusses the historical aspect of vascular access care in the United States and evolution of current practice standards and controversies surrounding few of these guidelines in the current time. Published by Elsevier Inc.

The Role of Communication During Trauma Activations: Investigating the Need for Team and Leader Communication Training.

PubMed

Raley, Jessica; Meenakshi, Rani; Dent, Daniel; Willis, Ross; Lawson, Karla; Duzinski, Sarah

Fatal errors due to miscommunication among members of trauma teams are 2 to 4 times more likely to occur than in other medical teams, yet most trauma team members do not receive communication effectiveness training. A needs assessment was conducted to examine trauma team members' miscommunication experiences and research scientists' evaluations of live trauma activations. The purpose of this study is to demonstrate that communication training is necessary and highlight specific team communication competencies that trauma teams should learn to improve communication during activations. Data were collected in 2 phases. Phase 1 required participants to complete a series of surveys. Phase 2 included live observations and assessments of pediatric trauma activations using the assessment of pediatric resuscitation team assessments (APRC-TA) and assessment of pediatric resuscitation leader assessments (APRC-LA). Data were collected at a southwestern pediatric hospital. Trauma team members and leaders completed surveys at a meeting and were observed while conducting activations in the trauma bay. Trained research scientists and clinical staff used the APRC-TA and APRC-LA to measure trauma teams' medical performance and communication effectiveness. The sample included 29 healthcare providers who regularly participate in trauma activations. Additionally, 12 live trauma activations were assessed monday to friday from 8am to 5pm. Team members indicated that communication training should focus on offering assistance, delegating duties, accepting feedback, and controlling emotional expressions. Communication scores were not significantly different from medical performance scores. None of the teams were coded as effective medical performance and ineffective team communication and only 1 team was labeled as ineffective leader communication and effective medical performance. Communication training may be necessary for trauma teams and offer a deeper understanding of the communication competencies that should be addressed. The APRC-TA and APRC-LA both include team communication competencies that could be used as a guide to design training for trauma team members and leaders. Researchers should also continue to examine recommendations for improved team and leader communication during activations using in-depth interviews and focus groups. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Deprescribing benzodiazepine receptor agonists: Evidence-based clinical practice guideline.

PubMed

Pottie, Kevin; Thompson, Wade; Davies, Simon; Grenier, Jean; Sadowski, Cheryl A; Welch, Vivian; Holbrook, Anne; Boyd, Cynthia; Swenson, Robert; Ma, Andy; Farrell, Barbara

2018-05-01

To develop an evidence-based guideline to help clinicians make decisions about when and how to safely taper and stop benzodiazepine receptor agonists (BZRAs); to focus on the highest level of evidence available and seek input from primary care professionals in the guideline development, review, and endorsement processes. The overall team comprised 8 clinicians (1 family physician, 2 psychiatrists, 1 clinical psychologist, 1 clinical pharmacologist, 2 clinical pharmacists, and 1 geriatrician) and a methodologist; members disclosed conflicts of interest. For guideline development, a systematic process was used, including the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Evidence was generated by conducting a systematic review of BZRA deprescribing trials for insomnia, as well as performing a review of reviews of the harms of continued BZRA use and narrative syntheses of patient preferences and resource implications. This evidence and GRADE quality of evidence ratings were used to generate recommendations. The team refined guideline content and recommendations through consensus and synthesized clinical considerations to address front-line clinician questions. The draft guideline was reviewed by clinicians and stakeholders. We recommend that deprescribing (tapering slowly) of BZRAs be offered to elderly adults (≥ 65 years) who take BZRAs, regardless of duration of use, and suggest that deprescribing (tapering slowly) be offered to adults aged 18 to 64 who have used BZRAs for more than 4 weeks. These recommendations apply to patients who use BZRAs to treat insomnia on its own (primary insomnia) or comorbid insomnia where potential underlying comorbidities are effectively managed. This guideline does not apply to those with other sleep disorders or untreated anxiety, depression, or other physical or mental health conditions that might be causing or aggravating insomnia. Benzodiazepine receptor agonists are associated with harms, and therapeutic effects might be short term. Tapering BZRAs improves cessation rates compared with usual care without serious harms. Patients might be more amenable to deprescribing conversations if they understand the rationale (potential for harm), are involved in developing the tapering plan, and are offered behavioural advice. This guideline provides recommendations for making decisions about when and how to reduce and stop BZRAs. Recommendations are meant to assist with, not dictate, decision making in conjunction with patients. Copyright© the College of Family Physicians of Canada.

Awareness and knowledge of the youth 2008 Physical Activity Guidelines for Americans.

PubMed

DeBastiani, Summer Dawn; Carroll, Dianna D; Cunningham, Melissa; Lee, Sarah; Fulton, Janet

2014-03-01

To measure parental awareness of government physical activity guidelines and knowledge of the amount of physical activity recommended for youth (ie, 60 minutes per day, 7 days per week) as specified in the 2008 Physical Activity Guidelines for Americans. A cross-sectional national sample of adults responded to physical activity guideline questions added to the HealthStyles survey in 2009 (n = 1552). The prevalence of parents aware of government physical activity guidelines and knowledgeable of the youth physical activity guideline, specifically, was estimated overall and by parental demographic characteristics (sex, education, income level, race/ethnicity, age group, marital status) and body mass index. In 2009, 34.8% of parents reported being aware of physical activity guidelines, and 9.7% were knowledgeable of the amount of physical activity recommended for youth. Many parents lack awareness and knowledge of the youth physical activity guidelines. The low prevalence estimates suggest the 2008 Physical Activity Guidelines for Americans has not been effectively disseminated. These results may also indicate a need for effective communication strategies to educate and inform parents, an important influencer of children's health behaviors.

Are all sport activities equal? A systematic review of how youth psychosocial experiences vary across differing sport activities.

PubMed

Evans, M Blair; Allan, Veronica; Erickson, Karl; Martin, Luc J; Budziszewski, Ross; Côté, Jean

2017-02-01

Models of sport development often support the assumption that young athletes' psychosocial experiences differ as a result of seemingly minor variations in how their sport activities are designed (eg, participating in team or individual sport; sampling many sports or specialising at an early age). This review was conducted to systematically search sport literature and explore how the design of sport activities relates to psychosocial outcomes. Systematic search, followed by data extraction and synthesis. The Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were applied and a coding sheet was used to extract article information and code for risk of bias. Academic databases and manual search of peer-reviewed journals. Search criteria determined eligibility primarily based on the sample (eg, ages 7 through 17 years) and study design (eg, measured psychosocial constructs). 35 studies were located and were classified within three categories: (1) sport types, (2) sport settings, and (3) individual patterns of sport involvement. These studies represented a wide range of scores when assessed for risk of bias and involved an array of psychosocial constructs, with the most prevalent investigations predicting outcomes such as youth development, self-esteem and depression by comparing (1) team or individual sport participants and (2) youth with varying amounts of sport involvement. As variations in sport activities impact youth sport experiences, it is vital for researchers to carefully describe and study these factors, while practitioners may use the current findings when designing youth sport programmes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

A systematic review of team formulation in clinical psychology practice: Definition, implementation, and outcomes.

PubMed

Geach, Nicole; Moghaddam, Nima G; De Boos, Danielle

2018-06-01

Team formulation is promoted by professional practice guidelines for clinical psychologists. However, it is unclear whether team formulation is understood/implemented in consistent ways - or whether there is outcome evidence to support the promotion of this practice. This systematic review aimed to (1) synthesize how team formulation practice is defined and implemented by practitioner psychologists and (2) analyse the range of team formulation outcomes in the peer-reviewed literature. Seven electronic bibliographic databases were searched in June 2016. Eleven articles met inclusion criteria and were quality assessed. Extracted data were synthesized using content analysis. Descriptions of team formulation revealed three main forms of instantiation: (1) a structured, consultation approach; (2) semi-structured, reflective practice meetings; and (3) unstructured/informal sharing of ideas through routine interactions. Outcome evidence linked team formulation to a range of outcomes for staff teams and service users, including some negative outcomes. Quality appraisal identified significant issues with evaluation methods; such that, overall, outcomes were not well-supported. There is weak evidence to support the claimed beneficial outcomes of team formulation in practice. There is a need for greater specification and standardization of 'team formulation' practices, to enable a clearer understanding of any relationships with outcomes and implications for best-practice implementations. Under the umbrella term of 'team formulation', three types of practice are reported: (1) highly structured consultation; (2) reflective practice meetings; and (3) informal sharing of ideas. Outcomes linked to team formulation, including some negative outcomes, were not well evidenced. Research using robust study designs is required to investigate the process and outcomes of team formulation practice. © 2017 The British Psychological Society.

Task shifting and integration of HIV care into primary care in South Africa: The development and content of the streamlining tasks and roles to expand treatment and care for HIV (STRETCH) intervention

PubMed Central

2011-01-01

Background Task shifting and the integration of human immunodeficiency virus (HIV) care into primary care services have been identified as possible strategies for improving access to antiretroviral treatment (ART). This paper describes the development and content of an intervention involving these two strategies, as part of the Streamlining Tasks and Roles to Expand Treatment and Care for HIV (STRETCH) pragmatic randomised controlled trial. Methods: Developing the intervention The intervention was developed following discussions with senior management, clinicians, and clinic staff. These discussions revealed that the establishment of separate antiretroviral treatment services for HIV had resulted in problems in accessing care due to the large number of patients at ART clinics. The intervention developed therefore combined the shifting from doctors to nurses of prescriptions of antiretrovirals (ARVs) for uncomplicated patients and the stepwise integration of HIV care into primary care services. Results: Components of the intervention The intervention consisted of regulatory changes, training, and guidelines to support nurse ART prescription, local management teams, an implementation toolkit, and a flexible, phased introduction. Nurse supervisors were equipped to train intervention clinic nurses in ART prescription using outreach education and an integrated primary care guideline. Management teams were set up and a STRETCH coordinator was appointed to oversee the implementation process. Discussion Three important processes were used in developing and implementing this intervention: active participation of clinic staff and local and provincial management, educational outreach to train nurses in intervention sites, and an external facilitator to support all stages of the intervention rollout. The STRETCH trial is registered with Current Control Trials ISRCTN46836853. PMID:21810242

Integrating the Science of Team Training: Guidelines for Continuing Education

ERIC Educational Resources Information Center

Weaver, Sallie J.; Rosen, Michael A.; Salas, Eduardo; Baum, Karyn D.; King, Heidi B.

2010-01-01

The provision of high-quality, efficient care results from the coordinated, cooperative efforts of multiple technically competent health care providers working in concert over time, spanning disciplinary and professional boundaries. Accordingly, the role of medical education must include the development of providers who are both expert clinicians…

Healthy School Meals: Promotion Ideas That Work.

ERIC Educational Resources Information Center

Minnesota State Dept. of Children, Families, and Learning, Roseville. Food and Nutrition Service.

"Healthy School Meals: Promotion Ideas That Work" is a Minnesota program based on the USDA's Team Nutrition program. The program's goal is to improve the health of children through school meals and nutrition education. This is accomplished by empowering schools to serve meals meeting the Dietary Guidelines for Americans, and motivating…

International Marketing: A Teaching Prospectus.

ERIC Educational Resources Information Center

Terzin, Margaret A.

Three designs for a course in international marketing are described. The first requires a team of three to four students to research a designated country according to specific guidelines to determine which American products would sell best in that country. This project requires a written paper and an oral presentation. The five areas investigated…

Human immunodeficiency virus infection and diffuse polyneuropathy. Implications for rehabilitation medicine.

PubMed Central

Mukand, J. A.

1991-01-01

Patients at various stages of human immunodeficiency virus (HIV) infection require rehabilitation services. These patients present problems for each of the disciplines in a rehabilitation team, and all team members must confront the psychosocial and ethical issues involved with the disease. Patients with HIV infection may have polyneuropathy with multisystem involvement, including dysphagia, autonomic dysfunction, respiratory failure, bowel and bladder dysfunction, generalized weakness, a painful sensory neuropathy, and depression. Guidelines are presented for determining if inpatient rehabilitation or other settings are appropriate. Case management is a valuable strategy for the rehabilitation of patients with this complicated disorder. PMID:1866948

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

Not Available

The Department of Energy Order DOE 5000.4A establishes DOE`s policy and guidelines regarding Laboratory Directed Research and Development (LDRD) at its multiprogram laboratories. As described in 5000.4A, LDRD is ``research and development of a creative and innovative nature which is selected by the Laboratory Director or his or her designee, for the purpose of maintaining the scientific and technological vitality of the Laboratory and to respond to scientific and technological opportunities in conformance with the guidelines in this Order. LDRD includes activities previously defined as ER&D, as well as other discretionary research and development activities not provided for in amore » DOE program.`` Consistent with the Mission Statement and Strategic Plan provided in PNL`s Institutional Plan, the LDRD investments are focused on developing new and innovative approaches in research related to our ``core competencies.`` Currently, PNL`s core competencies have been identified as integrated environmental research; process technology; energy systems research. In this report, the individual summaries of Laboratory-level LDRD projects are organized according to these core competencies. The largest proportion of Laboratory-level LDRD funds is allocated to the core competency of integrated environmental research. A significant proportion of PNL`s LDRD funds are also allocated to projects within the various research centers that are proposed by individual researchers or small research teams. The projects are described in Section 2.0. The projects described in this report represent PNL`s investment in its future and are vital to maintaining the ability to develop creative solutions for the scientific and technical challenges faced by DOE and the nation. In accordance with DOE guidelines, the report provides an overview of PNL`s LDRD program and the management process used for the program and project summaries for each LDRD project.« less

Team building: a leadership strategy.

PubMed

San Juan, S P

1998-01-01

This paper will present the importance of teamwork, as well as those behavioral science principles relative to team-building in an organization. Characteristics of an effective work team and some important dimensions of supervisory leadership including inputs on how members of a task group can contribute to team-building will be described. Some guidelines for supervisors and employees in connection with teamwork will be discussed. Human beings of every age are finding their time consumed by the demands of organizations to which they "belong" and still are badgered to join other groups during a lifetime. In the International College of Dentists, Philippine Section, where we pride ourselves to be a part of, membership is defined. We are supposed to be endowed with group consciousness, a sense of purpose, an interaction among ourselves, and interdependence in the satisfaction of our needs in a unitary manner. In essence, we are linked by some common, identifiable characteristics bound by the element of teamwork for the achievement of a common desirable goal. A leadership style that emphasizes team-building, therefore ensures not only that a job gets done, but it is done efficiently, effectively and harmoniously.

A study of information flow in hospice interdisciplinary team meetings

PubMed Central

DEMIRIS, GEORGE; WASHINGTON, KARLA; OLIVER, DEBRA PARKER; WITTENBERG-LYLES, ELAINE

2009-01-01

The aim of this study was to explore the information flow of hospice interdisciplinary meetings focusing on information access, exchange and documentation. The study participants were members of four hospice interdisciplinary teams in the Midwestern United States. Team members included a diverse range of professionals including physicians, nurses, social workers, bereavement counselors, and others. A total of 81 patient care discussions were videotaped and transcribed. A content analysis revealed several themes that needed to be addressed to improve the overall information flow, such as access to and recording of information, documentation of services, obtaining information from absent team members, data redundancy and updating of recorded information. On average, 5% of all utterances when discussing a patient case were focused on soliciting information from the member who had access to the patient chart. In 12.3% of all discussions, members referred to an absent member who could have provided additional information. In 8.6% of all discussions the same facts were repeated three times or more. Based on the findings we propose guidelines that can address potential informational gaps and enhance team communication in hospice. PMID:19012142

Likelihood of cesarean delivery after applying leading active labor diagnostic guidelines.

PubMed

Neal, Jeremy L; Lowe, Nancy K; Phillippi, Julia C; Ryan, Sharon L; Knupp, Amy M; Dietrich, Mary S; Thung, Stephen F

2017-06-01

Friedman, the United Kingdom's National Institute for Health and Care Excellence (NICE), and the American College of Obstetricians and Gynecologists/Society for Maternal-Fetal Medicine (ACOG/SMFM) support different active labor diagnostic guidelines. Our aims were to compare likelihoods for cesarean delivery among women admitted before vs in active labor by diagnostic guideline (within-guideline comparisons) and between women admitted in active labor per one or more of the guidelines (between-guideline comparisons). Active labor diagnostic guidelines were retrospectively applied to cervical examination data from nulliparous women with spontaneous labor onset (n = 2573). Generalized linear models were used to determine outcome likelihoods within- and between-guideline groups. At admission, 15.7%, 48.3%, and 10.1% of nulliparous women were in active labor per Friedman, NICE, and ACOG/SMFM diagnostic guidelines, respectively. Cesarean delivery was more likely among women admitted before vs in active labor per the Friedman (AOR 1.75 [95% CI 1.08-2.82] or NICE guideline (AOR 2.55 [95% CI 1.84-3.53]). Between guidelines, cesarean delivery was less likely among women admitted in active labor per the NICE guideline, as compared with the ACOG/SMFM guideline (AOR 0.55 [95% CI 0.35-0.88]). Many nulliparous women are admitted to the hospital before active labor onset. These women are significantly more likely to have a cesarean delivery. Diagnosing active labor before admission or before intervention to speed labor may be one component of a multi-faceted approach to decreasing the primary cesarean rate in the United States. The NICE diagnostic guideline is more inclusive than Friedman or ACOG/SMFM guidelines and its use may be the most clinically useful for safely lowering cesarean rates. © 2017 Wiley Periodicals, Inc.

Implementing guidelines and training initiatives to improve cross-cultural communication in primary care consultations: a qualitative participatory European study.

PubMed

Teunissen, E; Gravenhorst, K; Dowrick, C; Van Weel-Baumgarten, E; Van den Driessen Mareeuw, F; de Brún, T; Burns, N; Lionis, C; Mair, F S; O'Donnell, C; O'Reilly-de Brún, M; Papadakaki, M; Saridaki, A; Spiegel, W; Van Weel, C; Van den Muijsenbergh, M; MacFarlane, A

2017-02-10

Cross-cultural communication in primary care is often difficult, leading to unsatisfactory, substandard care. Supportive evidence-based guidelines and training initiatives (G/TIs) exist to enhance cross cultural communication but their use in practice is sporadic. The objective of this paper is to elucidate how migrants and other stakeholders can adapt, introduce and evaluate such G/TIs in daily clinical practice. We undertook linked qualitative case studies to implement G/TIs focused on enhancing cross cultural communication in primary care, in five European countries. We combined Normalisation Process Theory (NPT) as an analytical framework, with Participatory Learning and Action (PLA) as the research method to engage migrants, primary healthcare providers and other stakeholders. Across all five sites, 66 stakeholders participated in 62 PLA-style focus groups over a 19 month period, and took part in activities to adapt, introduce, and evaluate the G/TIs. Data, including transcripts of group meetings and researchers' fieldwork reports, were coded and thematically analysed by each team using NPT. In all settings, engaging migrants and other stakeholders was challenging but feasible. Stakeholders made significant adaptations to the G/TIs to fit their local context, for example, changing the focus of a G/TI from palliative care to mental health; or altering the target audience from General Practitioners (GPs) to the wider multidisciplinary team. They also progressed plans to deliver them in routine practice, for example liaising with GP practices regarding timing and location of training sessions and to evaluate their impact. All stakeholders reported benefits of the implemented G/TIs in daily practice. Training primary care teams (clinicians and administrators) resulted in a more tolerant attitude and more effective communication, with better focus on migrants' needs. Implementation of interpreter services was difficult mainly because of financial and other resource constraints. However, when used, migrants were more likely to trust the GP's diagnoses and GPs reported a clearer understanding of migrants' symptoms. Migrants, primary care providers and other key stakeholders can work effectively together to adapt and implement G/TIs to improve communication in cross-cultural consultations, and enhance understanding and trust between GPs and migrant patients.

A National Survey of the Nursing Care of Infants With Prenatal Substance Exposure in Canadian NICUs.

PubMed

Marcellus, Lenora; Loutit, Tara; Cross, Shannon

2015-10-01

Many communities are reporting increases in the number of infants requiring NICU care. Practices continue to vary and there is limited available evidence about nursing care. The purpose of this study was to describe current nursing care practices for infants with prenatal substance exposure in the NICU setting and during transition to the community. Findings from this study were compared with an earlier Canadian survey (by Marcellus in 2002) to identify shifts in clinical nursing practice for this population. This was a cross-sectional descriptive survey design. A 68-item survey composed of multiple-choice and open-ended questions was administered through FluidSurveys online software. A convenience sample of 62 clinical managers or clinical educators in hospitals with active maternal-infant clinical units with 500 deliveries or more annually and/or pediatric hospitals with a separate designated neonatal service (ie, Level 2 and 3 units) was chosen. A greater number of NICUs are using clinical guidelines to support the standardization of quality care. Improvements in nursing practice were identified and these included the consistent use of a withdrawal scoring tool and provision of education for team members in orientation. A decline in routine discharge planning meetings and routine parent teaching plans was discovered. This survey has improved understanding of the current state of nursing care for infants with prenatal substance exposure and their families during this critical time of transition. The purpose of the survey was to compare findings with the 2002 study by Marcellus to identify any improved practices and describe current state nursing care practices in the NICU. Practice changes over the last decade have included keeping mothers and infants together, expanding concepts of the team, integrating programs and services across hospital and community settings, and creating opportunities for NICU teams to learn more about substance use, mental health, violence, and trauma. Focus on discharge planning, parent teaching, and creation and implementation of national/hospital guidelines is essential for consistent evidence-based quality patient care.

Applying established guidelines to team-based learning programs in medical schools: a systematic review.

PubMed

Burgess, Annette W; McGregor, Deborah M; Mellis, Craig M

2014-04-01

Team-based learning (TBL), a structured form of small-group learning, has gained popularity in medical education in recent years. A growing number of medical schools have adopted TBL in a variety of combinations and permutations across a diversity of settings, learners, and content areas. The authors conducted this systematic review to establish the extent, design, and practice of TBL programs within medical schools to inform curriculum planners and education designers. The authors searched the MEDLINE, PubMed, Web of Knowledge, and ERIC databases for articles on TBL in undergraduate medical education published between 2002 and 2012. They selected and reviewed articles that included original research on TBL programs and assessed the articles according to the seven core TBL design elements (team formation, readiness assurance, immediate feedback, sequencing of in-class problem solving, the four S's [significant problem, same problem, specific choice, and simultaneous reporting], incentive structure, and peer review) described in established guidelines. The authors identified 20 articles that satisfied the inclusion criteria. They found significant variability across the articles in terms of the application of the seven core design elements and the depth with which they were described. The majority of the articles, however, reported that TBL provided a positive learning experience for students. In the future, faculty should adhere to a standardized TBL framework to better understand the impact and relative merits of each feature of their program.

A Mobile App Development Guideline for Hospital Settings: Maximizing the Use of and Minimizing the Security Risks of "Bring Your Own Devices" Policies

PubMed Central

Pelletier, Alexandra; Sunthara, Gajen; Gujral, Nitin; Mittal, Vandna; Bourgeois, Fabienne C

2016-01-01

Background Hospitals today are introducing new mobile apps to improve patient care and workflow processes. Mobile device adoption by hospitals fits with present day technology behavior; however, requires a deeper look into hospital device policies and the impact on patients, staff, and technology development. Should hospitals spend thousands to millions of dollars to equip all personnel with a mobile device that is only used in a hospital environment? Allowing health care professionals to use personal mobile devices at work, known as bring-your-own-device (BYOD), has the potential to support both the hospital and its employees to deliver effective and efficient care. Objective The objectives of this research were to create a mobile app development guideline for a BYOD hospital environment, apply the guideline to the development of an in-house mobile app called TaskList, pilot the TaskList app within Boston Children’s Hospital (BCH), and refine the guideline based on the app pilot. TaskList is an Apple operating system (iOS)-based app designed for medical residents to monitor, create, capture, and share daily collaborative tasks associated with patients. Methods To create the BYOD guidelines, we developed TaskList that required the use of mobile devices among medical resident. The TaskList app was designed in four phases: (1) mobile app guideline development, (2) requirements gathering and developing of TaskList fitting the guideline, (3) deployment of TaskList using BYOD with end-users, and (4) refinement of the guideline based on the TaskList pilot. Phase 1 included understanding the existing hospital BYOD policies and conducting Web searches to find best practices in software development for a BYOD environment. Phase 1 also included gathering subject matter input from the Information Services Department (ISD) at BCH. Phase 2 involved the collaboration between the Innovation Acceleration Program at BCH, the ISD Department and the TaskList Clinical team in understanding what features should be built into the app. Phase 3 involved deployment of TaskList on a clinical floor at BCH. Lastly, Phase 4 gathered the lessons learned from the pilot to refine the guideline. Results Fourteen practical recommendations were identified to create the BCH Mobile Application Development Guideline to safeguard custom applications in hospital BYOD settings. The recommendations were grouped into four categories: (1) authentication and authorization, (2) data management, (3) safeguarding app environment, and (4) remote enforcement. Following the guideline, the TaskList app was developed and then was piloted with an inpatient ward team. Conclusions The Mobile Application Development guideline was created and used in the development of TaskList. The guideline is intended for use by developers when addressing integration with hospital information systems, deploying apps in BYOD health care settings, and meeting compliance standards, such as Health Insurance Portability and Accountability Act (HIPAA) regulations. PMID:27169345

A Mobile App Development Guideline for Hospital Settings: Maximizing the Use of and Minimizing the Security Risks of "Bring Your Own Devices" Policies.

PubMed

Al Ayubi, Soleh U; Pelletier, Alexandra; Sunthara, Gajen; Gujral, Nitin; Mittal, Vandna; Bourgeois, Fabienne C

2016-05-11

Hospitals today are introducing new mobile apps to improve patient care and workflow processes. Mobile device adoption by hospitals fits with present day technology behavior; however, requires a deeper look into hospital device policies and the impact on patients, staff, and technology development. Should hospitals spend thousands to millions of dollars to equip all personnel with a mobile device that is only used in a hospital environment? Allowing health care professionals to use personal mobile devices at work, known as bring-your-own-device (BYOD), has the potential to support both the hospital and its employees to deliver effective and efficient care. The objectives of this research were to create a mobile app development guideline for a BYOD hospital environment, apply the guideline to the development of an in-house mobile app called TaskList, pilot the TaskList app within Boston Children's Hospital (BCH), and refine the guideline based on the app pilot. TaskList is an Apple operating system (iOS)-based app designed for medical residents to monitor, create, capture, and share daily collaborative tasks associated with patients. To create the BYOD guidelines, we developed TaskList that required the use of mobile devices among medical resident. The TaskList app was designed in four phases: (1) mobile app guideline development, (2) requirements gathering and developing of TaskList fitting the guideline, (3) deployment of TaskList using BYOD with end-users, and (4) refinement of the guideline based on the TaskList pilot. Phase 1 included understanding the existing hospital BYOD policies and conducting Web searches to find best practices in software development for a BYOD environment. Phase 1 also included gathering subject matter input from the Information Services Department (ISD) at BCH. Phase 2 involved the collaboration between the Innovation Acceleration Program at BCH, the ISD Department and the TaskList Clinical team in understanding what features should be built into the app. Phase 3 involved deployment of TaskList on a clinical floor at BCH. Lastly, Phase 4 gathered the lessons learned from the pilot to refine the guideline. Fourteen practical recommendations were identified to create the BCH Mobile Application Development Guideline to safeguard custom applications in hospital BYOD settings. The recommendations were grouped into four categories: (1) authentication and authorization, (2) data management, (3) safeguarding app environment, and (4) remote enforcement. Following the guideline, the TaskList app was developed and then was piloted with an inpatient ward team. The Mobile Application Development guideline was created and used in the development of TaskList. The guideline is intended for use by developers when addressing integration with hospital information systems, deploying apps in BYOD health care settings, and meeting compliance standards, such as Health Insurance Portability and Accountability Act (HIPAA) regulations.

Transition management - An analysis of strategic considerations for effective implementation

NASA Technical Reports Server (NTRS)

Hunsucker, John L.; Loos, David

1989-01-01

Six managerial guidelines are identified for facilitating successful change in an organization. They are: (1) the need for a catalyst to initiate change; (2) the setting of organizational goals which take into account the impact of technical, political, and cultural factors; (3) requiring a transition team to guide the change; (4) a demonstration by top management of a commitment to the change as well as their acting as change agents; (5) the utilization of employee participation and good communication to help overcome employee resistance; and (6) the evaluation of the change program as important to the success of present and future change programs. A description of each guideline is presented, and its importance is examined. Available options are also presented for management to deal with each of the guidelines.

Are the resources adoptive for conducting team-based diabetes management clinics? An explorative study at primary health care centers in Muscat, Oman.

PubMed

Al-Alawi, Kamila; Johansson, Helene; Al Mandhari, Ahmed; Norberg, Margareta

2018-05-08

AimThe aim of this study is to explore the perceptions among primary health center staff concerning competencies, values, skills and resources related to team-based diabetes management and to describe the availability of needed resources for team-based approaches. The diabetes epidemic challenges services available at primary health care centers in the Middle East. Therefore, there is a demand for evaluation of the available resources and team-based diabetes management in relation to the National Diabetes Management Guidelines. A cross-sectional study was conducted with 26 public primary health care centers in Muscat, the capital of Oman. Data were collected from manual and electronic resources as well as a questionnaire that was distributed to the physician-in-charge and diabetes management team members.FindingsThe study revealed significant differences between professional groups regarding how they perceived their own competencies, values and skills as well as available resources related to team-based diabetes management. The perceived competencies were high among all professions. The perceived team-related values and skills were also generally high but with overall lower recordings among the nurses. This pattern, along with the fact that very few nurses have specialized qualifications, is a barrier to providing team-based diabetes management. Participants indicated that there were sufficient laboratory resources; however, reported that pharmacological, technical and human resources were lacking. Further work should be done at public primary diabetes management clinics in order to fully implement team-based diabetes management.

Medical curricula and preventing childhood obesity: pooling the resources of medical students and primary care to inform curricula.

PubMed

Wylie, Ann; Furmedge, Daniel S; Appleton, Amber; Toop, Helen; Coats, Tom

2009-03-01

The study aimed to firstly provide a small self-selecting group of medical students with the opportunity to explore current approaches and opportunities addressing the prevention of childhood obesity and, secondly, to consider what aspects could be part of the taught curriculum. Medical students in their third and fourth year were invited to self-design special study modules (SSMs) exploring interventions and processes addressing the growing concern about childhood obesity. One student looked at the role of the primary care teams, two looked at community-based opportunities to improve physical activity in urban areas where there is significant deprivation and one student explored the complex role of the media as a social determinant of dietary patterns and sedentary behaviour. Primary care health professionals questioned their role in regard to raising the topic of obesity in the consultation and had limited awareness of current NICE guidelines and local interventions for referral. Local authority physical activity programmes have an important role in preventing and tackling obesity and although the media are regulated, there is limited impact on reducing obesity. Conversely, the influence of the media is complex and enables medical students and teachers to be aware of some of the social determinants influencing health-related behaviour. About a third of UK GP practices have some role in medical undergraduate education. It will therefore be inevitable that students will encounter GPs working with prevention and management of childhood obesity, however limited, and this will increasingly be part of the teaching agenda, whether formal and planned or opportunistic. Curricula could include being familiar with the evidence that informs NICE guidelines, observing these guidelines being implemented and their limitations, awareness of local schemes for referral to prevent or treat obesity and the influence of wider determinants on diet and physical activity behaviour, including the media.

Patterns of care in Dutch postmenopausal patients with hormone-sensitive early breast cancer participating in the Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial.

PubMed

van Nes, J G H; Seynaeve, C; Maartense, E; Roumen, R M H; de Jong, R S; Beex, L V A M; Meershoek-Klein Kranenbarg, W M; Putter, H; Nortier, J W R; van de Velde, C J H

2010-05-01

The Tamoxifen and Exemestane Adjuvant Multinational (TEAM) trial investigates the efficacy and safety of adjuvant exemestane alone and in sequence after tamoxifen in postmenopausal women with hormone-sensitive early breast cancer. As there was a nationwide participation in The Netherlands, we studied the variations in patterns of care in the Comprehensive Cancer Centre Regions (CCCRs) and compliance with national guidelines. Clinicopathological characteristics, carried out local treatment strategies and adjuvant chemotherapy data were collected. From 2001 to January 2006, 2754 Dutch patients were randomised to the study. Mean age of patients was 65 years (standard deviation 9). Tumours were < or =2 cm in 46% (within CCCRs 39%-50%), node-negative disease varied from 25% to 45%, and PgR status was determined in 75%-100% of patients. Mastectomy was carried out in 55% (45%-70%), sentinel lymph node procedure in 68% (42%-79%) and axillary lymph node dissections in 77% (67%-83%) of patients, all different between CCCRs (P < 0.0001). Adjuvant chemotherapy was given in 15%-70% of eligible patients (P < 0.001). In spite of national guidelines, breast cancer treatment on specific issues widely varied between the various Dutch regions. These data provide valuable information for breast cancer organisations indicating (lack of) guideline adherence and areas for breast cancer care improvement.

Evaluating the uptake of Canada's new physical activity and sedentary behavior guidelines on service organizations' websites.

PubMed

Gainforth, Heather L; Berry, Tanya; Faulkner, Guy; Rhodes, Ryan E; Spence, John C; Tremblay, Mark S; Latimer-Cheung, Amy E

2013-06-01

New evidence-based physical activity and sedentary behavior guidelines for Canadians were launched in 2011. As a consequence, service organizations that promote physical activity directly to the public needed to change their promotion materials to reflect the new guidelines. Little is known about the rate at which service organizations adopt and integrate new evidence-based guidelines and determinants of guideline adoption. In this natural observational study, we evaluated the rate of online adoption of the new guidelines among key service organizations that promote physical activity and examined participation in a booster webinar as a supplemental dissemination strategy. One hundred fifty nine service organization websites were coded by one of six raters prior to the release of the new guidelines as well as at 3, 6, and 9 months after the release. Online adoption of the guidelines increased during the coding period with 51 % of organizations posting the guidelines or related information on their websites. Organizations' engagement in a webinar was associated with their adoption of the guidelines. The release of new Canadian Physical Activity and Sedentary Behaviour Guidelines led to increased guideline adoption on service organizations' websites. However, adoption was not universal. In order for the uptake of the new guidelines to be successful, further efforts need to be taken to ensure that service organizations present physical activity guidelines on their websites. Comprehensive, active dissemination strategies tailored to address organizational barriers are needed to ensure online guideline adoption.

Delayed Rapid Response Team Activation Is Associated With Increased Hospital Mortality, Morbidity, and Length of Stay in a Tertiary Care Institution.

PubMed

Barwise, Amelia; Thongprayoon, Charat; Gajic, Ognjen; Jensen, Jeffrey; Herasevich, Vitaly; Pickering, Brian W

2016-01-01

To identify whether delays in rapid response team activation contributed to worse patient outcomes (mortality and morbidity). Retrospective observational cohort study including all rapid response team activations in 2012. Tertiary academic medical center. All those 18 years old or older who had a rapid response team call activated. Vital sign data were abstracted from individual patient electronic medical records for the 24 hours before the rapid response team activation took place. Patients were considered to have a delayed rapid response team activation if more than 1 hour passed between the first appearance in the record of an abnormal vital sign meeting rapid response team criteria and the activation of an rapid response team. None. A total of 1,725 patients were included in the analysis. Data were compared between those who had a delayed rapid response team activation and those who did not. Fifty seven percent patients met the definition of delayed rapid response team activation. Patients in high-frequency physiologic monitored environments were more likely to experience delay than their floor counterparts. In the no-delay group, the most common reasons for rapid response team activation were tachycardia/bradycardia at 29% (217/748), respiratory distress/low SpO2 at 28% (213/748), and altered level of consciousness at 23% (170/748) compared with respiratory distress/low SpO2 at 43% (423/977), tachycardia/bradycardia at 33% (327/977), and hypotension at 27% (261/977) in the delayed group. The group with no delay had a higher proportion of rapid response team calls between 8:00 and 16:00, whereas those with delay had a higher proportion of calls between midnight and 08:00. The delayed group had higher hospital mortality (15% vs 8%; adjusted odds ratio, 1.6; p = 0.005); 30-day mortality (20% vs 13%; adjusted odds ratio, 1.4; p = 0.02); and hospital length of stay (7 vs 6 d; relative prolongation, 1.10; p = 0.02) compared with the no-delay group. Delays in rapid response team activation occur frequently and are independently associated with worse patient mortality and morbidity outcomes.

Different Teams, Same Conclusions? A Systematic Review of Existing Clinical Guidelines for the Assessment and Treatment of Tinnitus in Adults

PubMed Central

Fuller, Thomas E.; Haider, Haula F.; Kikidis, Dimitris; Lapira, Alec; Mazurek, Birgit; Norena, Arnaud; Rabau, Sarah; Lardinois, Rachelle; Cederroth, Christopher R.; Edvall, Niklas K.; Brueggemann, Petra G.; Rosing, Susanne N.; Kapandais, Anestis; Lungaard, Dorte; Hoare, Derek J.; Cima, Rilana F. F

2017-01-01

Background: Though clinical guidelines for assessment and treatment of chronic subjective tinnitus do exist, a comprehensive review of those guidelines has not been performed. The objective of this review was to identify current clinical guidelines, and compare their recommendations for the assessment and treatment of subjective tinnitus in adults. Method: We systematically searched a range of sources for clinical guidelines (as defined by the Institute of Medicine, United States) for the assessment and/or treatment of subjective tinnitus in adults. No restrictions on language or year of publication were applied to guidelines. Results: Clinical guidelines from Denmark, Germany, Sweden, The Netherlands, and the United States were included in the review. There was a high level of consistency across the guidelines with regard to recommendations for audiometric assessment, physical examination, use of a validated questionnaire(s) to assess tinnitus related distress, and referral to a psychologist when required. Cognitive behavioral treatment for tinnitus related distress, use of hearing aids in instances of hearing loss and recommendations against the use of medicines were consistent across the included guidelines. Differences between the guidelines centered on the use of imaging in assessment procedures and sound therapy as a form of treatment for tinnitus distress respectively. Conclusion: Given the level of commonality across tinnitus guidelines from different countries the development of a European guideline for the assessment and treatment of subjective tinnitus in adults seems feasible. This guideline would have the potential to benefit the large number of clinicians in countries where clinical guidelines do not yet exist, and would support standardization of treatment for patients across Europe. PMID:28275357

Different Teams, Same Conclusions? A Systematic Review of Existing Clinical Guidelines for the Assessment and Treatment of Tinnitus in Adults.

PubMed

Fuller, Thomas E; Haider, Haula F; Kikidis, Dimitris; Lapira, Alec; Mazurek, Birgit; Norena, Arnaud; Rabau, Sarah; Lardinois, Rachelle; Cederroth, Christopher R; Edvall, Niklas K; Brueggemann, Petra G; Rosing, Susanne N; Kapandais, Anestis; Lungaard, Dorte; Hoare, Derek J; Cima, Rilana F F

2017-01-01

Background: Though clinical guidelines for assessment and treatment of chronic subjective tinnitus do exist, a comprehensive review of those guidelines has not been performed. The objective of this review was to identify current clinical guidelines, and compare their recommendations for the assessment and treatment of subjective tinnitus in adults. Method: We systematically searched a range of sources for clinical guidelines (as defined by the Institute of Medicine, United States) for the assessment and/or treatment of subjective tinnitus in adults. No restrictions on language or year of publication were applied to guidelines. Results: Clinical guidelines from Denmark, Germany, Sweden, The Netherlands, and the United States were included in the review. There was a high level of consistency across the guidelines with regard to recommendations for audiometric assessment, physical examination, use of a validated questionnaire(s) to assess tinnitus related distress, and referral to a psychologist when required. Cognitive behavioral treatment for tinnitus related distress, use of hearing aids in instances of hearing loss and recommendations against the use of medicines were consistent across the included guidelines. Differences between the guidelines centered on the use of imaging in assessment procedures and sound therapy as a form of treatment for tinnitus distress respectively. Conclusion: Given the level of commonality across tinnitus guidelines from different countries the development of a European guideline for the assessment and treatment of subjective tinnitus in adults seems feasible. This guideline would have the potential to benefit the large number of clinicians in countries where clinical guidelines do not yet exist, and would support standardization of treatment for patients across Europe.

Implementation of NCCN Palliative Care Guidelines by member institutions.

PubMed

Albizu-Rivera, Alexandra; Portman, Diane G; Thirlwell, Sarah; Codada, Shirley N; Donovan, Kristine A

2016-02-01

Increasingly, evidence suggests the integration of palliative care (PC) with standard oncologic care can yield substantial benefits. As part of an effort to improve the PC of cancer patients, the National Comprehensive Cancer Network (NCCN) has developed clinical practice guidelines for PC that promote access to quality, evidence-based PC. This study sought to characterize current implementation of the guidelines by NCCN member institutions. Institutional representatives appointed to the NCCN Palliative Care Guidelines Panel were asked to complete an online survey in the spring of 2014. The survey focused on availability of PC services, screening and referral practices for PC, PC education, and quality improvement programs. The survey was completed by representatives from 21 of 25 NCCN member institutions (84 %). A majority routinely provides PC services via interdisciplinary teams; 52 % routinely inform patients of the availability, elements, and benefits of PC. The guidelines are most often used to guide clinical practice; only 10 % reported using the guidelines to formally screen for PC needs and/or make referrals to PC specialists. Among the 62 % of institutions that screen any patients using any available criteria, when a patient screens positive for PC needs, a referral to a PC specialist is made less than half the time. Implementation of PC Guidelines is incomplete and various aspects of the guidelines, such as the recommendation to screen all patients for PC needs, are applied inconsistently. Despite this, most institutions provide PC services in a manner consistent with the guidelines. Greater implementation of the guidelines' recommendations is needed.

Measure accurately, Act rapidly, and Partner with patients: An intuitive and practical three-part framework to guide efforts to improve hypertension control.

PubMed

Boonyasai, Romsai T; Rakotz, Michael K; Lubomski, Lisa H; Daniel, Donna M; Marsteller, Jill A; Taylor, Kathryn S; Cooper, Lisa A; Hasan, Omar; Wynia, Matthew K

2017-07-01

Hypertension is the leading cause of cardiovascular disease in the United States and worldwide. It also provides a useful model for team-based chronic disease management. This article describes the M.A.P. checklists: a framework to help practice teams summarize best practices for providing coordinated, evidence-based care to patients with hypertension. Consisting of three domains-Measure Accurately; Act Rapidly; and Partner With Patients, Families, and Communities-the checklists were developed by a team of clinicians, hypertension experts, and quality improvement experts through a multistep process that combined literature review, iterative feedback from a panel of internationally recognized experts, and pilot testing among a convenience sample of primary care practices in two states. In contrast to many guidelines, the M.A.P. checklists specifically target practice teams, instead of individual clinicians, and are designed to be brief, cognitively easy to consume and recall, and accessible to healthcare workers from a range of professional backgrounds. ©2017 Wiley Periodicals, Inc.

NASA Perspective and Modeling of Thermal Runaway Propagation Mitigation in Aerospace Batteries

NASA Technical Reports Server (NTRS)

Shack, P.; Iannello, C.; Rickman, S.; Button, R.

2014-01-01

NASA has traditionally sought to reduce the likelihood of a single cell thermal runaway (TR) in their aerospace batteries to an absolute minimum by employing rigorous screening program of the cells. There was generally a belief that TR propagation resulting in catastrophic failure of the battery was a forgone conclusion for densely packed aerospace lithium-ion batteries. As it turns out, this may not be the case. An increasing number of purportedly TR propagation-resistant batteries are appearing among NASA partners in the commercial sector and the Department of Defense. In the recent update of the battery safety standard (JSC 20793) to address this paradigm shift, the NASA community included requirements for assessing TR severity and identifying simple, low-cost severity reduction measures. Unfortunately, there are no best-practice guidelines for this work in the Agency, so the first project team attempting to meet these requirements would have an undue burden placed upon them. A NASA engineering Safety Center (NESC) team set out to perform pathfinding activities for meeting those requirements. This presentation will provide contextual background to this effort, as well as initial results in attempting to model and simulate TR heat transfer and propagation within battery designs.

Development of guidelines for the surveillance of invasive mosquitoes in Europe

PubMed Central

2013-01-01

Background The recent notifications of autochthonous cases of dengue and chikungunya in Europe prove that the region is vulnerable to these diseases in areas where known mosquito vectors (Aedes albopictus and Aedes aegypti) are present. Strengthening surveillance of these species as well as other invasive container-breeding aedine mosquito species such as Aedes atropalpus, Aedes japonicus, Aedes koreicus and Aedes triseriatus is therefore required. In order to support and harmonize surveillance activities in Europe, the European Centre for Disease Prevention and Control (ECDC) launched the production of ‘Guidelines for the surveillance of invasive mosquitoes in Europe’. This article describes these guidelines in the context of the key issues surrounding invasive mosquitoes surveillance in Europe. Methods Based on an open call for tender, ECDC granted a pan-European expert team to write the guidelines draft. It content is founded on published and grey literature, contractor’s expert knowledge, as well as appropriate field missions. Entomologists, public health experts and end users from 17 EU/EEA and neighbouring countries contributed to a reviewing and validation process. The final version of the guidelines was edited by ECDC (Additional file 1). Results The guidelines describe all procedures to be applied for the surveillance of invasive mosquito species. The first part addresses strategic issues and options to be taken by the stakeholders for the decision-making process, according to the aim and scope of surveillance, its organisation and management. As the strategy to be developed needs to be adapted to the local situation, three likely scenarios are proposed. The second part addresses all operational issues and suggests options for the activities to be implemented, i.e. key procedures for field surveillance of invasive mosquito species, methods of identification of these mosquitoes, key and optional procedures for field collection of population parameters, pathogen screening, and environmental parameters. In addition, methods for data management and analysis are recommended, as well as strategies for data dissemination and mapping. Finally, the third part provides information and support for cost estimates of the planned programmes and for the evaluation of the applied surveillance process. Conclusion The ‘Guidelines for the surveillance of invasive mosquitoes in Europe’ aim at supporting the implementation of tailored surveillance of invasive mosquito species of public health importance. They are intended to provide support to professionals involved in mosquito surveillance or control, decision/policy makers, stakeholders in public health and non-experts in mosquito surveillance. Surveillance also aims to support control of mosquito-borne diseases, including integrated vector control, and the guidelines are therefore part of a tool set for managing mosquito-borne disease risk in Europe. PMID:23866915

Diagnosis and management practices for gestational diabetes mellitus in Australia: Cross-sectional survey of the multidisciplinary team.

PubMed

Meloncelli, Nina; Barnett, Adrian; Pelly, Fiona; de Jersey, Susan

2018-04-18

Gestational diabetes mellitus (GDM) is one of the most common pregnancy disorders; however, if well managed, women with GDM experience similar pregnancy outcomes to those without. Currently, there is limited evidence on actual management practices across Australia or how multidisciplinary teams interact to optimise care. To examine the current screening, diagnostic, task and role perceptions and management practices, as reported by members of the GDM multidisciplinary team. A 64-item electronic survey containing multiple choice, Likert scale and open-ended questions was developed for this cross-sectional observational study and advertised through health professional organisations and Queensland Health facilities in May and June, 2017. The 183 survey respondents included 45 diabetes educators, 43 dietitians, 21 endocrinologists/diabetes specialists, 14 obstetricians and 21 midwives. Although almost 90% reported using updated diagnostic guidelines, less than two-thirds used GDM management guidelines. While 68% reported using the same blood glucose targets for GDM management, there was variation to what criteria prompted the commencement of medication to control blood glucose levels. There was a good consensus concerning the health professional responsible for tasks such as medical nutrition therapy, gestational weight gain and self-blood glucose monitoring education and ultrasound use. Other tasks appeared to be the role of almost any member of the GDM multidisciplinary team. The survey results indicate there is a need for consistent evidence on how to best manage GDM and that role identity, access to specialist knowledge and best practice need to be clearly defined within GDM models of care. © 2018 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

The Guideline Implementability Decision Excellence Model (GUIDE-M): a mixed methods approach to create an international resource to advance the practice guideline field.

PubMed

Brouwers, Melissa C; Makarski, Julie; Kastner, Monika; Hayden, Leigh; Bhattacharyya, Onil

2015-03-15

Practice guideline (PG) implementability refers to PG features that promote their use. While there are tools and resources to promote PG implementability, none are based on an evidence-informed and multidisciplinary perspective. Our objectives were to (i) create a comprehensive and evidence-informed model of PG implementability, (ii) seek support for the model from the international PG community, (iii) map existing implementability tools on to the model, (iv) prioritize areas for further investigation, and (v) describe how the model can be used by PG developers, users, and researchers. A mixed methods approach was used. Using our completed realist review of the literature of seven different disciplines as the foundation, an iterative consensus process was used to create the beta version of the model. This was followed by (i) a survey of international stakeholders (guideline developers and users) to gather feedback and to refine the model, (ii) a content analysis comparing the model to existing PG tools, and (iii) a strategy to prioritize areas of the model for further research by members of the research team. The Guideline Implementability for Decision Excellence Model (GUIDE-M) is comprised of 3 core tactics, 7 domains, 9 subdomains, 44 attributes, and 40 subattributes and elements. Feedback on the beta version was received from 248 stakeholders from 34 countries. The model was rated as logical, relevant, and appropriate. Seven PG tools were selected and compared to the GUIDE-M: very few tools targeted the Contextualization and Deliberations domain. Also, fewer of the tools addressed PG appraisal than PG development and reporting functions. These findings informed the research priorities identified by the team. The GUIDE-M provides an evidence-informed international and multidisciplinary conceptualization of PG implementability. The model can be used by PG developers to help them create more implementable recommendations, by clinicians and other users to help them be better consumers of PGs, and by the research community to identify priorities for further investigation.

Using systems thinking to support clinical system transformation.

PubMed

Best, Allan; Berland, Alex; Herbert, Carol; Bitz, Jennifer; van Dijk, Marlies W; Krause, Christina; Cochrane, Douglas; Noel, Kevin; Marsden, Julian; McKeown, Shari; Millar, John

2016-05-16

Purpose - The British Columbia Ministry of Health's Clinical Care Management initiative was used as a case study to better understand large-scale change (LSC) within BC's health system. Using a complex system framework, the purpose of this paper is to examine mechanisms that enable and constrain the implementation of clinical guidelines across various clinical settings. Design/methodology/approach - Researchers applied a general model of complex adaptive systems plus two specific conceptual frameworks (realist evaluation and system dynamics mapping) to define and study enablers and constraints. Focus group sessions and interviews with clinicians, executives, managers and board members were validated through an online survey. Findings - The functional themes for managing large-scale clinical change included: creating a context to prepare clinicians for health system transformation initiatives; promoting shared clinical leadership; strengthening knowledge management, strategic communications and opportunities for networking; and clearing pathways through the complexity of a multilevel, dynamic system. Research limitations/implications - The action research methodology was designed to guide continuing improvement of implementation. A sample of initiatives was selected; it was not intended to compare and contrast facilitators and barriers across all initiatives and regions. Similarly, evaluating the results or process of guideline implementation was outside the scope; the methods were designed to enable conversations at multiple levels - policy, management and practice - about how to improve implementation. The study is best seen as a case study of LSC, offering a possible model for replication by others and a tool to shape further dialogue. Practical implications - Recommended action-oriented strategies included engaging local champions; supporting local adaptation for implementation of clinical guidelines; strengthening local teams to guide implementation; reducing change fatigue; ensuring adequate resources; providing consistent communication especially for front-line care providers; and supporting local teams to demonstrate the clinical value of the guidelines to their colleagues. Originality/value - Bringing a complex systems perspective to clinical guideline implementation resulted in a clear understanding of the challenges involved in LSC.

Building an Undergraduate STEM Team Using Team-Based Learning Leading to the Production of a Storyboard Appropriate for Elementary Students

NASA Astrophysics Data System (ADS)

Cutright, Teresa J.; Evans, Edward; Brantner, Justin S.

2014-06-01

A unique undergraduate team that spans five different engineering disciplines, chemistry, biology, and mathematics was formed. The team was formed to promote cross-disciplinary learning, to improve retention, and to prepare the students for the kind of problems they will face in their careers. This paper describes the variety of activities used over 2 years to tie the team together, as well as afford opportunities to develop team-building skills. The activities described highlight the critical elements of a faculty leader whose own work is interdisciplinary, correct balance of disciplines in the team, and sufficient time for team development. The use of external feedback was essential for all activities. Clearly defined goals and hard deadlines were critical for the completion of individual activities, as well as developing a healthy team environment. Although the student cohort has learned from the activities, more time is needed to assess whether the students have become a fully efficient team. Furthermore, an additional cohort would be needed to assess whether the approach was able to assist with student's interest in STEM and their desire to help other people.

Managing distributed software development in the Virtual Astronomical Observatory

NASA Astrophysics Data System (ADS)

Evans, Janet D.; Plante, Raymond L.; Boneventura, Nina; Busko, Ivo; Cresitello-Dittmar, Mark; D'Abrusco, Raffaele; Doe, Stephen; Ebert, Rick; Laurino, Omar; Pevunova, Olga; Refsdal, Brian; Thomas, Brian

2012-09-01

The U.S. Virtual Astronomical Observatory (VAO) is a product-driven organization that provides new scientific research capabilities to the astronomical community. Software development for the VAO follows a lightweight framework that guides development of science applications and infrastructure. Challenges to be overcome include distributed development teams, part-time efforts, and highly constrained schedules. We describe the process we followed to conquer these challenges while developing Iris, the VAO application for analysis of 1-D astronomical spectral energy distributions (SEDs). Iris was successfully built and released in less than a year with a team distributed across four institutions. The project followed existing International Virtual Observatory Alliance inter-operability standards for spectral data and contributed a SED library as a by-product of the project. We emphasize lessons learned that will be folded into future development efforts. In our experience, a well-defined process that provides guidelines to ensure the project is cohesive and stays on track is key to success. Internal product deliveries with a planned test and feedback loop are critical. Release candidates are measured against use cases established early in the process, and provide the opportunity to assess priorities and make course corrections during development. Also key is the participation of a stakeholder such as a lead scientist who manages the technical questions, advises on priorities, and is actively involved as a lead tester. Finally, frequent scheduled communications (for example a bi-weekly tele-conference) assure issues are resolved quickly and the team is working toward a common vision.

Guidelines for Physical Activity during Pregnancy: Comparisons From Around the World

PubMed Central

Evenson, Kelly R.; Barakat, Ruben; Brown, Wendy J.; Dargent-Molina, Patricia; Haruna, Megumi; Mikkelsen, Ellen M.; Mottola, Michelle F.; Owe, Katrine M.; Rousham, Emily K.; Yeo, SeonAe

2013-01-01

Introduction Women attain numerous benefits from physical activity during pregnancy. However, due to physical changes that occur during pregnancy, special precautions are also needed. This review summarizes current guidelines for physical activity among pregnant women worldwide. Methods We searched PubMed (MedLINE) for country-specific governmental and clinical guidelines on physical activity during pregnancy through the year 2012. We cross-referenced with articles referring to guidelines, with only the most recent included. An abstraction form was used to extract key details and summarize. Results In total, 11 guidelines were identified from nine countries (Australia, Canada, Denmark, France, Japan, Norway, Spain, United Kingdom, United States). Most guidelines supported moderate intensity physical activity during pregnancy (10/11) and indicated specific frequency (9/11) and duration/time (9/11) recommendations. Most guidelines provided advice on initiating an exercise program during pregnancy (10/11). Six guidelines included absolute and relative contraindications to exercise. All guidelines generally ruled-out sports with risks of falls, trauma, or collisions. Six guidelines included indications for stopping exercise during pregnancy. Conclusion This review contrasted pregnancy-related physical activity guidelines from around the world, and can help to inform new guidelines as they are created or updated, and facilitate the development of a worldwide guideline. PMID:25346651

Continuing professional development: best practices.

PubMed

Filipe, Helena P; Silva, Eduardo D; Stulting, Andries A; Golnik, Karl C

2014-01-01

Continuing professional development (CPD) involves not only educational activities to enhance medical competence in medical knowledge and skills, but also in management, team building, professionalism, interpersonal communication, technology, teaching, and accountability. This paper aims at reviewing best practices to promote effective CPD. Principles and guidelines, as already defined by some professional societies and world organizations, are emphasized as core actions to best enhance an effective lifelong learning after residency. The personal learning plan (PLP) is discussed as the core of a well-structured CPD and we describe how it should be created. Fundamental CPD principles and how they are integrated in the framework of every physician's professional life will be described. The value of systematic and comprehensive CPD documentation and assessment is emphasized. Accreditation requirements and professional relationships with commercial sponsors are discussed.

Special Education Services: A Manual of Policies, Procedures and Guidelines.

ERIC Educational Resources Information Center

British Columbia Dept. of Education, Victoria.

This document is intended to guide special education policy in British Columbia (Canada) and stresses the basic elements of Individual Education Plans, school-based teams, district-wide planning, and resource sharing. After an introduction on how to use the guide (including a glossary of terms), the manual is divided into eight sections that…

Can You Build It? Using Manipulatives to Assess Student Understanding of Food-Web Concepts

ERIC Educational Resources Information Center

Grumbine, Richard

2012-01-01

This article outlines an exercise that assesses student knowledge of food-web and energy-flow concepts. Students work in teams and use manipulatives to build food-web models based on criteria assigned by the instructor. The models are then peer reviewed according to guidelines supplied by the instructor.

Guidelines for Transferring Residential Courses into Web

ERIC Educational Resources Information Center

Tüzün, Hakan; Çinar, Murat

2016-01-01

This study shared unique design experiences by examining the process of transferring residential courses to the Web, and proposed a design model for individuals who want to transfer their courses into this environment. The formative research method was used in the study, and two project teams' processes of putting courses, which were being taught…

Earth Science Content Guidelines Grades K-12.

ERIC Educational Resources Information Center

American Geological Inst., Alexandria, VA.

Teams of teachers, other science educators, and scientists selected from a national search for project writers have proposed using the following set of questions to guide the inclusion of earth science content into the kindergarten through grade 12 curriculum. The Essential Questions are organized in a K-12 sequence by six content areas: (1) Solid…

ADHD in the Schools: Assessment and Intervention Strategies. Second Edition

ERIC Educational Resources Information Center

DuPaul, George J.; Stoner, Gary

2004-01-01

This popular reference and text provides essential guidance for school-based professionals meeting the challenges of ADHD at any grade level. Comprehensive and practical, the book includes several reproducible assessment tools and handouts. A team-based approach to intervention is emphasized in chapters offering research-based guidelines for: (1)…

Leadership Styles of College and University Athletic Directors and the Presence of NCAA Transgender Policy

ERIC Educational Resources Information Center

Bowden, Randall; McCauley, Kayleigh

2016-01-01

In September 2011, the National Collegiate Athletic Association (NCAA) announced the "Policy on Transgender Inclusion." It provides guidelines for transgender student athletes to participate in sex-separated athletic teams according to their gender identity. The "2012 LGBTQ National College Athlete Report," the first of its…

Co-Operation is Not Enough: Teacher Educators as Curriculum Developers in Times of Change

ERIC Educational Resources Information Center

Hoydalsvik, Torhild Erika Lillemark

2017-01-01

The purpose of this exploratory two site case study is to examine how teacher educators, student teachers and programme leaders experience their 'curriculum developer role' in times of change, against the background of a new national guideline for preschool teacher education being implemented in Norway. The multidisciplinary team approach…

A Community of Practice Approach to Learning Programming

ERIC Educational Resources Information Center

Chen, Gwo-Dong; Li, Liang-Yi; Wang, Chin-Yea

2012-01-01

In programming courses, teaching students who have varied levels of knowledge and skills the requisite competencies to perform in real-world software development teams is indeed difficult. To address this problem, this paper proposes a community of practice (CoP) approach and provides some guidelines to simulate a real-world CoP in a blended…

School Crisis Management Manual: Guidelines for Administrators. Second Edition.

ERIC Educational Resources Information Center

Smith, Judie

This three-part manual is intended for principals and other administrators responsible for developing and managing school crisis plans. Part 1, preparation for a school crisis, includes sections on the selection and training of members of the school crisis team, steps in developing a school crisis plan, and four crisis scenarios to train team…

Guidelines for Reliable DC/DC Converters for Space Use

NASA Technical Reports Server (NTRS)

Plante, Jeannette; Shue, Jack

2008-01-01

NESC saw the need to study the persistent failure of DC/DC Converters during ground testing and in flight, motivated investigation of causes and mitigation options. Research indicated misapplication and device quality to be root causes. The study took 20 months. Team included multiple NASA Centers : JPL, JSC, MSFC, GSFC Project Background

Guidelines for Successful Parent Involvement: Working with Parents of Students with Disabilities

ERIC Educational Resources Information Center

Staples, Kelli E.; Diliberto, Jennifer A.

2010-01-01

According to the Individuals With Disabilities Education Improvement Act (IDEA), school systems must ensure that the individualized education program (IEP) team includes the parent of the child with a disability. Teachers often report the challenges of getting parents to attend IEP meetings often assuming parents' lack of interest with involvement…

Recovery from Large-Scale Crises: Guidelines for Crisis Teams and Administrators

ERIC Educational Resources Information Center

Communique, 2018

2018-01-01

The United States has recently experienced numerous large-scale crises that resulted in high death tolls and extensive property damage. Critical incidents such as suicide contagion, natural disasters, or mass casualty events have the potential to cause traumatic reactions and significantly affect children's sense of safety and security. School…

Blanco Webcams | CTIO

Science.gov Websites

the slit, then the DECam image is being occluded. The small circle is the field of view of DECam on Meetings Upcoming Colloquia Sky Conditions CTIO Site Conditions TASCA RASICAM Infrared Sky Image CTIO Guidelines Library Facilities Outreach NOAO-S EPO Program team Art of Darkness Image Gallery EPO/CADIAS

Utilization of Design Principles for Hybrid Learning Configurations by Interprofessional Design Teams

ERIC Educational Resources Information Center

Cremers, Petra H. M.; Wals, Arjen E. J.; Wesselink, Renate; Mulder, Martin

2017-01-01

Educational design research yields design knowledge, often in the form of design principles or guidelines that provide the rationale or "know-why" for the design of educational interventions. As such, design principles can be utilized by designers in contexts other than the research context in which they were generated. Although research…

[Feasibility of consultation - liaison psychiatry in a large general hospital: quantitative description of services and personnel expenditure].

PubMed

Windhager, Elmar; Thaler, Katharina; Selberis-Vahl, Wilia Vasiliki; Friedl-Wörgetter, Petra; Windhager, Isabella; Zauner, Katharina

2015-01-01

The integration of psychiatric departments in general hospitals lead to an increasing demand of psychiatric consultation, which often overstrains personnel resources of short staffed psychiatric services. To provide consulting service, as it is demanded by guidelines, a multidisciplinary consulting team could be a possible solution. A retrospective descriptive analysis of all consultations made by the psychosocial consultation and liaison service at the general hospital Wels-Grieskirchen in the years 2012 and 2013. There was an increase in referrals overall of 22 % from 2012 to 2013. The largest increase was observed in the group of psychiatrists, who carried out 33.1 % of all consultations. Most consultations, 39.5 %, were done by the group of clinical psychologists, partly substituting medical attendance. Taking together both occupational groups, the expected number of consultations of at least 3 % of all admissions could be achieved. A multidisciplinary consulting team consisting of psychiatrists, psychologists, psychosomatic physicians and social workers staffed with 5.11-6.79 full-time personnel is able to provide psychosocial consultation service at a quantitative level required by international guidelines.

An improvement project within urological care.

PubMed

Khatami, Annelie; Rosengren, Kristina

2015-01-01

The purpose of this paper is to describe staff experiences in an on-going improvement project regarding patients with ureteral stones. A qualitative descriptive study based on eight group interviews and 48 narratives, was performed. Data were analysed using qualitative content analysis. Trustworthiness was ensured by using a well-documented improvement process method during six months. The results formed three categories: an absent comprehensive view; complexity; and vulnerability within the organisation. A holistic perspective regarding urological care at the micro-, meso- and macro-levels is needed to improve planning and caring processes. This study includes one team (six members, different health professionals) within the same urology department. Results show that staff need information, such as guidelines and support throughout the improvement work to deliver high-quality care. Moreover, there is a need for evidence-based guidelines at national level to support improvement work. Healthcare staff need to pay attention to all team member needs to improve urological care. Organisational and managerial aspect are needed to support clear and common goals regarding healthcare improvement work. Urological improvement projects, generally, are lacking, which is why this study is important to improve nephrolithiasis patient care.

[Debriefing of hospital professional staff after fire in a bar in Volendam].

PubMed

Huyse, F J; Bierens, J J; Broekman, H; Girbes, A R; Patka, P; Pompe, E A

2001-12-01

A fire disaster in a bar on New Year's Eve 2001 in Volendam, which led to 200 victims, resulted in active participation of regional hospitals, including the academic hospital of the Free University of Amsterdam. In the first hour, more than 100 members of personnel were mobilised in this hospital. Nine doctors and nurses worked as members of medical teams at the site of the disaster; the others triaged 16 patients in the emergency room and treated 13 patients in the intensive care unit. After 4.5 hours, the influx of victims stopped and accordingly the disaster plan was deactivated. During the subsequent days, debriefings were organised on request of the hospital staff and personnel involved. These concluded that specific adjustments to hospital procedures were needed, such as a total admission stop for a few days, to prevent mental burn-out of personnel and to maintain the standard quality of care. Hospital disaster plans do not usually have specific guidelines for the emotional preparation of personnel during and immediately after a disaster, nor do they include specific guidelines for the evaluation of its emotional impact in terms of the quality of care delivered. These elements should be incorporated into every disaster plan.

Using Qualitative Research to Inform Development of Professional Guidelines: A Case Study of the Society of Critical Care Medicine Family-Centered Care Guidelines.

PubMed

Coombs, Maureen A; Davidson, Judy E; Nunnally, Mark E; Wickline, Mary A; Curtis, J Randall

2017-08-01

To explore the importance, challenges, and opportunities using qualitative research to enhance development of clinical practice guidelines, using recent guidelines for family-centered care in the ICU as an example. In developing the Society of Critical Care Medicine guidelines for family-centered care in the neonatal ICU, PICU, and adult ICU, we developed an innovative adaptation of the Grading of Recommendations, Assessments, Development and Evaluations approach to explicitly incorporate qualitative research. Using Grading of Recommendations, Assessments, Development and Evaluations and the Council of Medical Specialty Societies principles, we conducted a systematic review of qualitative research to establish family-centered domains and outcomes. Thematic analyses were undertaken on study findings and used to support Population, Intervention, Comparison, Outcome question development. We identified and employed three approaches using qualitative research in these guidelines. First, previously published qualitative research was used to identify important domains for the Population, Intervention, Comparison, Outcome questions. Second, this qualitative research was used to identify and prioritize key outcomes to be evaluated. Finally, we used qualitative methods, member checking with patients and families, to validate the process and outcome of the guideline development. In this, a novel report, we provide direction for standardizing the use of qualitative evidence in future guidelines. Recommendations are made to incorporate qualitative literature review and appraisal, include qualitative methodologists in guideline taskforce teams, and develop training for evaluation of qualitative research into guideline development procedures. Effective methods of involving patients and families as members of guideline development represent opportunities for future work.

The requirements of a specialist Breast Centre.

PubMed

Wilson, A R M; Marotti, L; Bianchi, S; Biganzoli, L; Claassen, S; Decker, T; Frigerio, A; Goldhirsch, A; Gustafsson, E G; Mansel, R E; Orecchia, R; Ponti, A; Poortmans, P; Regitnig, P; Rosselli Del Turco, M; Rutgers, E J Th; van Asperen, C; Wells, C A; Wengström, Y; Cataliotti, L

2013-11-01

In recognition of the advances and evidence based changes in clinical practice that have occurred in recent years and taking into account the knowledge and experience accumulated through the voluntary breast unit certification programme, Eusoma has produced this up-dated and revised guidelines on the requirements of a Specialist Breast Centre (BC). The content of these guidelines is based on evidence from the recent relevant peer reviewed literature and the consensus of a multidisciplinary team of European experts. The guidelines define the requirements for each breast service and for the specialists who work in specialist Breast Centres. The guidelines identify the minimum requirements needed to set up a BC, these being an integrated Breast Centre, dealing with a sufficient number of cases to allow effective working and continuing expertise, dedicated specialists working with a multidisciplinary approach, providing all services throughout the patients pathway and data collection and audit. It is essential that the BC also guarantees the continuity of care for patients with advanced (metastatic) disease offering treatments according to multidisciplinary competencies and a high quality palliative care service. The BC must ensure that comprehensive support and expertise may be needed, not only through the core BC team, but also ensure that all other medical and paramedical expertise that may be necessary depending on the individual case are freely available, referring the patient to the specific care provider depending on the problem. Applying minimum requirements and quality indicators is essential to improve organisation, performance and outcome in breast care. Efficacy and compliance have to be constantly monitored to evaluate the quality of patient care and to allow appropriate corrective actions leading to improvements in patient care. Copyright © 2013 Elsevier Ltd. All rights reserved.

Practical Diagnosis and Management of Dementia Due to Alzheimer’s Disease in the Primary Care Setting: An Evidence-Based Approach

PubMed Central

Kerwin, Diana R.

2013-01-01

Objective: To review evidence-based guidance on the primary care of Alzheimer’s disease and clinical research on models of primary care for Alzheimer’s disease to present a practical summary for the primary care physician regarding the assessment and management of the disease. Data Sources: References were obtained via search using keywords Alzheimer’s disease AND primary care OR collaborative care OR case finding OR caregivers OR guidelines. Articles were limited to English language from January 1, 1990, to January 1, 2013. Study Selection: Articles were reviewed and selected on the basis of study quality and pertinence to this topic, covering a broad range of data and opinion across geographical regions and systems of care. The most recent published guidelines from major organizations were included. Results: Practice guidelines contained numerous points of consensus, with most advocating a central role for the primary care physician in the detection, diagnosis, and treatment of Alzheimer’s disease. Review of the literature indicated that optimal medical and psychosocial care for people with Alzheimer’s disease and their caregivers may be best facilitated through collaborative models of care involving the primary care physician working within a wider interdisciplinary team. Conclusions: Evidence-based guidelines assign the primary care physician a critical role in the care of people with Alzheimer’s disease. Research on models of care suggests the need for an appropriate medical/nonmedical support network to fulfill this role. Given the diversity and breadth of services required and the necessity for close coordination, nationwide implementation of team-based, collaborative care programs may represent the best option for improving care standards for patients with Alzheimer’s disease. PMID:24392252

Can Telemedicine Improve Adherence to Resuscitation Guidelines for Critically Ill Children at Community Hospitals? A Randomized Controlled Trial Using High-Fidelity Simulation.

PubMed

Yang, Chris P; Hunt, Elizabeth A; Shilkofski, Nicole; Dudas, Robert; Egbuta, Chinyere; Schwartz, Jamie M

2017-07-01

Children transferred from community hospitals lacking specialized pediatric care are more seriously ill than those presenting to pediatric centers. Pediatric consultation and adherence to management guidelines improve outcomes. The aims of the study were (1) to assess whether telemedicine consultation in critical situations is feasible and (2) to compare the impact of pediatric critical care medicine (PCCM) consultation via telemedicine versus telephone on community hospital adherence to resuscitation guidelines through a randomized controlled telemedicine trial. In situ, high-fidelity simulation scenarios of critically ill children presenting to a community hospital and progressing to cardiopulmonary arrest were performed. Scenarios were randomized to PCCM consultation via telephone (control) or telemedicine (intervention). Primary outcome measure was proportion of teams who successfully defibrillated in 180 seconds or less from presentation of pulseless ventricular tachycardia. The following 30 scenarios were completed: 15 control and 15 intervention. Only 11 (37%) of 30 teams, defibrillated in 180 seconds or less from presentation of pulseless ventricular tachycardia; control: 6 (40%) of 15 versus intervention: 5 (33%) of 15, P = 0.7. Request for or use of backboard during cardiopulmonary resuscitation occurred in 24 (80%) of 30 scenarios; control: 9 (60%) of 15 versus intervention: 15 (100%) of 15, P = 0.006. Request for or use of stepstool during cardiopulmonary resuscitation occurred in 6 (20%) of 30 scenarios; control: 1 (7%) of 15 versus intervention: 5 (33%) of 15, P = 0.07. This study demonstrates the feasibility of using telemedicine to support acute management of children who present to community hospitals. Neither study arm adhered to current resuscitation guidelines and telemedicine consultation with PCCM experts was not associated with improvement. However, further research on optimizing telemedicine impact on the quality of pediatric care at community hospitals is warranted.

Establishing Obstetric Anesthesiology Practice Guidelines in the Republic of Armenia: A Global Health Collaboration.

PubMed

Yuill, Gordon; Amroyan, Ashot; Millar, Simon; Vardapetyan, Emil; Habib, Ashraf S; Owen, Medge D

2017-08-01

Disparity exists in anesthesia practices between high- and low-to-middle income countries, and awareness has been raised within the global health community to improve the standards of anesthesia care and patient safety. The establishment of international collaborations and appropriate practice guidelines may help address clinical care deficiencies. This report's aim was to assess the impact of a multiyear collaboration on obstetric anesthesia practices in the Republic of Armenia. An invited multinational team of physicians conducted six visits to Armenia between 2006 and 2015 to observe current practice and establish standards of obstetric anesthesia care. The Armenian Society of Anaesthesiologists and Intensive Care specialists collected data on the numbers of vaginal delivery, cesarean delivery, and neuraxial anesthesia use in maternity units during the period. Data were analyzed with the Fisher exact or chi-square test, as appropriate. Neuraxial anesthesia use for cesarean delivery increased significantly (P < 0.0001) in all 10 maternity hospitals within the capital city of Yerevan. For epidural labor analgesia, there was sustained or increased use in only two hospitals. For hospitals located outside the capital city, there was a similar increase in the use of neuraxial anesthesia for cesarean delivery that was greater in hospitals that were visited by an external team (P < 0.0001); however, use of epidural labor analgesia was not increased significantly. Over the course of the collaboration, guidelines for obstetric anesthesia were drafted and approved by the Armenian Ministry of Health. Collaboration between Armenian anesthesiologists and dedicated visiting physicians to update and standardize obstetric anesthesia practices led to national practice guidelines and sustained improvements in clinical care in the Republic of Armenia.

Activation of a medical emergency team using an electronic medical recording-based screening system*.

PubMed

Huh, Jin Won; Lim, Chae-Man; Koh, Younsuck; Lee, Jury; Jung, Youn-Kyung; Seo, Hyun-Suk; Hong, Sang-Bum

2014-04-01

To evaluate the efficacy of a medical emergency team activated using 24-hour monitoring by electronic medical record-based screening criteria followed by immediate intervention by a skilled team. Retrospective cohort study. Academic tertiary care hospital with approximately 2,700 beds. A total of 3,030 events activated by a medical emergency team from March 1, 2008, to February 28, 2010. None. We collected data for all medical emergency team activations: patient characteristics, trigger type for medical emergency team (electronic medical record-based screening vs calling criteria), interventions during each event, outcomes of the medical emergency team intervention, and 28-day mortality after medical emergency team activation. We analyzed data for 2009, when the medical emergency team functioned 24 hours a day, 7 days a week (period 2), compared with that for 2008, when the medical emergency team functioned 12 hours a day, 7 days a week (period 1). The commonest cause of medical emergency team activation was respiratory distress (43.6%), and the medical emergency team performed early goal-directed therapy (21.3%), respiratory care (19.9%), and difficult airway management (12.3%). For patients on general wards, 51.3% (period 1) and 38.4% (period 2) of medical emergency team activations were triggered by the electronic medical record-based screening system (electronic medical record-triggered group). In 23.4%, activation occurred because of an abnormality in laboratory screening criteria. The commonest activation criterion from electronic medical record-based screening was respiratory rate (39.4%). Over half the patients were treated in the general ward, and one third of the patients were transferred to the ICU. The electronic medical record-triggered group had lower ICU admission with an odds ratio of 0.35 (95% CI, 0.22-0.55). In surgical patients, the electronic medical record-triggered group showed the lower 28-day mortality (10.5%) compared with the call-triggered group (26.7%) or the double-triggered group (33.3%) (odds ratio 0.365 with 95% CI, 0.154-0.867, p = 0.022). We successful managed the medical emergency team with electronic medical record-based screening criteria and a skilled intervention team. The electronic medical record-triggered group had lower ICU admission than the call-triggered group or the double-triggered group. In surgical patients, the electronic medical record-triggered group showed better outcome than other groups.

Activity Profiles in International Women's Team Handball Using PlayerLoad.

PubMed

Wik, Eirik H; Luteberget, Live S; Spencer, Matt

2017-08-01

Team handball matches place diverse physical demands on players, which may result in fatigue and decreased activity levels. However, previous speed-based methods of quantifying player activity may not be sensitive for capturing short-lasting team-handball-specific movements. To examine activity profiles of a women's team handball team and individual player profiles, using inertial measurement units. Match data were obtained from 1 women's national team in 9 international matches (N = 85 individual player samples), using the Catapult OptimEye S5. PlayerLoad/min was used as a measure of intensity in 5- and 10-min periods. Team profiles were presented as relative to the player's match means, and individual profiles were presented as relative to the mean of the 5-min periods with >60% field time. A high initial intensity was observed for team profiles and for players with ≥2 consecutive periods of play. Substantial declines in PlayerLoad/min were observed throughout matches for the team and for players with several consecutive periods of field time. These trends were found for all positional categories. Intensity increased substantially in the final 5 min of the first half for team profiles. Activity levels were substantially lower in the 5 min after a player's most intense period and were partly restored in the subsequent 5-min period. Possible explanations for the observed declines in activity profiles for the team and individual players include fatigue, situational factors, and pacing. However, underlying mechanisms were not accounted for, and these assumptions are therefore based on previous team-sport studies.

WHO Expert Committee on Specifications for Pharmaceutical Preparations. Fiftieth report.

PubMed

2016-01-01

The Expert Committee on Specifications for Pharmaceutical Preparations works towards clear, independent and practical standards and guidelines for the quality assurance of medicines. Standards are developed by the Committee through worldwide consultation and an international consensus-building process. The following new guidelines were adopted and recommended for use. Good pharmacopoeial practices; FIP-WHO technical guidelines: points to consider in the provision by health-care professionals of children-specific preparations that are not available as authorized products; Guidance on good manufacturing practices for biological products; Guidance on good manufacturing practices: inspection report, including Appendix 1: Model inspection report; Guidance on good data and record management practices; Good trade and distribution practices for starting materials; Guidelines on the conduct of surveys of the quality of medicines; Collaborative procedure between the World Health Organization (WHO) prequalification team and national regulatory authorities in the assessment and accelerated national registration of WHO-prequalified pharmaceutical products and vaccines; Guidance for organizations performing in vivo bioequivalence studies; and World Health Organization (WHO) general guidance on variations to multisource pharmaceutical products.

Will the right Robin patient rise, please? Definitions and criteria during management of Robin sequence patients in the Netherlands and Belgium.

PubMed

Basart, Hanneke; Kruisinga, Frea H; Breugem, Corstiaan C; Don Griot, J Peter W; Hennekam, Raoul C; Van der Horst, Chantal M A M

2015-01-01

Robin Sequence (RS) is characterized by micrognathia and upper airway obstruction (UAO), with or without cleft palate, causing respiratory and feeding problems. Management options are: positioning; nasopharyngeal airway (NPA); tongue-lip adhesion (TLA); mandibular distraction (MDO); and tracheostomy. Controversy exists in literature regarding RS definition and management. Here we describe definitions, management strategies and criteria in opting for management strategies, used by Dutch and Belgian cleft teams. A specifically designed questionnaire was sent to members of all 16 Dutch and Belgian cleft teams. 14 cleft teams returned 35 questionnaires. All used micrognathia as definition criterion, 93.4% cleft palate, 51.5%glossoptosis and 45.7% UAO. Six different RS definitions were used; even within a single team >1 definition was used. All teams used different management strategies: all used positioning, 10 NPA, 6 TLA, 7 MDO, 8 tracheostomy, 5 refer patients with invasive treatment indication. Criteria in opting management modalities were: O2-saturation (89.3%), clinical presentation (86.2%), growth and feeding problems (69.0%), polysomnography (62.1%), and differed within teams. The Dutch and Belgian cleft teams use variable RS definitions, different management modalities and criteria in choosing management strategies. A single, strict definition and evidence-based management guidelines should be formulated for optimal patient care. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Physical Activity Guidelines

MedlinePlus

... use this site. health.gov Physical Activity Guidelines Physical Activity Physical activity is key to improving the health of the Nation. Based on the latest science, the Physical Activity Guidelines for Americans is an essential resource for ...

No. 354-Canadian HIV Pregnancy Planning Guidelines.

PubMed

Loutfy, Mona; Kennedy, V Logan; Poliquin, Vanessa; Dzineku, Frederick; Dean, Nicola L; Margolese, Shari; Symington, Alison; Money, Deborah M; Hamilton, Scot; Conway, Tracey; Khan, Sarah; Yudin, Mark H

2018-01-01

The objective of the Canadian HIV Pregnancy Planning Guidelines is to provide clinical information and recommendations for health care providers to assist Canadians affected by HIV with their fertility, preconception, and pregnancy planning decisions. These guidelines are evidence- and community-based and flexible and take into account diverse and intersecting local/population needs based on the social determinants of health. EVIDENCE: Literature searches were conducted by a librarian using the Medline, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase databases for published articles in English and French related to HIV and pregnancy and HIV and pregnancy planning for each section of the guidelines. The full search strategy is available upon request. The evidence obtained was reviewed and evaluated by the Infectious Diseases Committee of the SOGC under the leadership of the principal authors, and recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care and through use of the Appraisal of Guidelines Research and Evaluation instrument for the development of clinical guidelines. Guideline implementation should assist the practitioner in developing an evidence-based approach for the prevention of unplanned pregnancy, preconception, fertility, and pregnancy planning counselling in the context of HIV infection. These guidelines have been reviewed and approved by the Infectious Disease Committee and the Executive and Council of the SOGC. Canadian Institutes of Health Research Grant Planning and Dissemination grant (Funding Reference # 137186), which funded a Development Team meeting in 2016. Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.

Australian Football League concussion guidelines: what do community players think?

PubMed

White, Peta E; Donaldson, Alex; Sullivan, S John; Newton, Joshua; Finch, Caroline F

2016-01-01

Preventing concussion in sport is a global challenge. To assess community-level adult male Australian Football players' views on following the Australian Football League's (AFL) concussion guidelines. 3 focus groups, each comprising 6 players from 1 regional league, were conducted until saturation of issues raised. Discussions followed a semistructured script and were audio-recorded and transcribed verbatim. Thematic analysis was conducted by 2 coders independently. Identified advantages of the guidelines included highlighting the seriousness of concussion; changing the culture around playing with concussion and shifting return-to-play decision responsibility from players to others. Disadvantages included players being removed from play unnecessarily; removal of players' rights to decide if they are fit to play and players changing their behaviours to avoid being removed from play. Identified facilitators to guideline use included local league enforcement; broad information dissemination and impartial medically trained staff to assess concussion. Identified barriers to guideline use included players' desire to play at all costs; external pressure that encouraged players to return to play prematurely; and inconvenience and cost. Players generally understand that the AFL concussion guidelines protect their long-term welfare. However, their desire to play at all costs and help their team win is a common barrier to reporting concussion and adhering to guidelines. Leagues should take a lead role by mandating and enforcing the use of the guidelines and educating coaches, game day medical providers and players. The return-to-play component of the guidelines is complex and needs further consideration in the context of community sport.

Integrating palliative care into disease management guidelines.

PubMed

Emanuel, Linda; Alexander, Carla; Arnold, Robert M; Bernstein, Richard; Dart, Richard; Dellasantina, Christopher; Dykstra, Lee; Tulsky, James

2004-12-01

Palliative care should not be reserved for those who are close to dying; as a comprehensive approach to minimizing illness-related suffering, it is appropriate for patients with significant illness from the time of diagnosis on. The American Hospice Foundation Guidelines Committee's initiative aims to provide a practical approach for guideline writers and others to integrate palliative care into disease management and care services whenever it is relevant. A consensus approach was used to design recommendations for upgrading existing disease management and service guidelines to include palliative care. A template is described for identifying stages in disease management guidelines when integration of palliative care is appropriate: (1) Introductory sections to disease management guidelines should include prognosis and other disease consequences; (2) Diagnostic sections should include recommendations for conducting a whole patient assessment; (3) Treatment sections should include discernment of patient goals for care, continuous goal reassessment, palliative care interventions to reduce suffering as needed, and treatment decisions should include discussion of the type of expected improvement. Service guidelines should note the role of interdisciplinary team care as well as palliative care consultative or care services; (4) Sections that conclude the care provided to incurable patients should not end without recommendations on grief and bereavement care, and care during the last hours of living. The American Hospice Foundation Guidelines Committee recommends integration of relevant aspects of palliative care in introductory, diagnostic, treatment, and closing sections of management guidelines for all significant illnesses.

Economic modelling of diagnostic and treatment pathways in National Institute for Health and Care Excellence clinical guidelines: the Modelling Algorithm Pathways in Guidelines (MAPGuide) project.

PubMed

Lord, J; Willis, S; Eatock, J; Tappenden, P; Trapero-Bertran, M; Miners, A; Crossan, C; Westby, M; Anagnostou, A; Taylor, S; Mavranezouli, I; Wonderling, D; Alderson, P; Ruiz, F

2013-12-01

National Institute for Health and Care Excellence (NICE) clinical guidelines (CGs) make recommendations across large, complex care pathways for broad groups of patients. They rely on cost-effectiveness evidence from the literature and from new analyses for selected high-priority topics. An alternative approach would be to build a model of the full care pathway and to use this as a platform to evaluate the cost-effectiveness of multiple topics across the guideline recommendations. In this project we aimed to test the feasibility of building full guideline models for NICE guidelines and to assess if, and how, such models can be used as a basis for cost-effectiveness analysis (CEA). A 'best evidence' approach was used to inform the model parameters. Data were drawn from the guideline documentation, advice from clinical experts and rapid literature reviews on selected topics. Where possible we relied on good-quality, recent UK systematic reviews and meta-analyses. Two published NICE guidelines were used as case studies: prostate cancer and atrial fibrillation (AF). Discrete event simulation (DES) was used to model the recommended care pathways and to estimate consequent costs and outcomes. For each guideline, researchers not involved in model development collated a shortlist of topics suggested for updating. The modelling teams then attempted to evaluate options related to these topics. Cost-effectiveness results were compared with opinions about the importance of the topics elicited in a survey of stakeholders. The modelling teams developed simulations of the guideline pathways and disease processes. Development took longer and required more analytical time than anticipated. Estimates of cost-effectiveness were produced for six of the nine prostate cancer topics considered, and for five of eight AF topics. The other topics were not evaluated owing to lack of data or time constraints. The modelled results suggested 'economic priorities' for an update that differed from priorities expressed in the stakeholder survey. We did not conduct systematic reviews to inform the model parameters, and so the results might not reflect all current evidence. Data limitations and time constraints restricted the number of analyses that we could conduct. We were also unable to obtain feedback from guideline stakeholders about the usefulness of the models within project time scales. Discrete event simulation can be used to model full guideline pathways for CEA, although this requires a substantial investment of clinical and analytic time and expertise. For some topics lack of data may limit the potential for modelling. There are also uncertainties over the accessibility and adaptability of full guideline models. However, full guideline modelling offers the potential to strengthen and extend the analytical basis of NICE's CGs. Further work is needed to extend the analysis of our case study models to estimate population-level budget and health impacts. The practical usefulness of our models to guideline developers and users should also be investigated, as should the feasibility and usefulness of whole guideline modelling alongside development of a new CG. This project was funded by the Medical Research Council and the National Institute for Health Research through the Methodology Research Programme [grant number G0901504] and will be published in full in Health Technology Assessment; Vol. 17, No. 58. See the NIHR Journals Library website for further project information.

Performance of health workers in the management of seriously sick children at a Kenyan tertiary hospital: before and after a training intervention.

PubMed

Irimu, Grace W; Gathara, David; Zurovac, Dejan; Kihara, Harrison; Maina, Christopher; Mwangi, Julius; Mbori-Ngacha, Dorothy; Todd, Jim; Greene, Alexandra; English, Mike

2012-01-01

Implementation of WHO case management guidelines for serious common childhood illnesses remains a challenge in hospitals in low-income countries. The impact of locally adapted clinical practice guidelines (CPGs) on the quality-of-care of patients in tertiary hospitals has rarely been evaluated. We conducted, in Kenyatta National Hospital, an uncontrolled before and after study with an attempt to explore intervention dose-effect relationships, as CPGs were disseminated and training was progressively implemented. The emergency triage, assessment and treatment plus admission care (ETAT+) training and locally adapted CPGs targeted common, serious childhood illnesses. We compared performance in the pre-intervention (2005) and post-intervention periods (2009) using quality indicators for three diseases: pneumonia, dehydration and severe malnutrition. The indicators spanned four domains in the continuum of care namely assessment, classification, treatment, and follow-up care in the initial 48 hours of admission. In the pre-intervention period patients' care was largely inconsistent with the guidelines, with nine of the 15 key indicators having performance of below 10%. The intervention produced a marked improvement in guideline adherence with an absolute effect size of over 20% observed in seven of the 15 key indicators; three of which had an effect size of over 50%. However, for all the five indicators that required sustained team effort performance continued to be poor, at less than 10%, in the post-intervention period. Data from the five-year period (2005-09) suggest some dose dependency though the adoption rate of the best-practices varied across diseases and over time. Active dissemination of locally adapted clinical guidelines for common serious childhood illnesses can achieve a significant impact on documented clinical practices, particularly for tasks that rely on competence of individual clinicians. However, more attention must be given to broader implementation strategies that also target institutional and organisational aspects of service delivery to further enhance quality-of-care.

Is provider type associated with cancer screening and prevention: advanced practice registered nurses, physician assistants, and physicians

PubMed Central

2014-01-01

Background Physician recommendations for cancer screening and prevention are associated with patient compliance. However, time constraints may limit physicians’ ability to provide all recommended preventive services, especially with increasing demand from the Affordable Care Act in the United States. Team-based practice that includes advanced practice registered nurses and physician assistants (APRN/PA) may help meet this demand. This study investigates the relationship between an APRN/PA visit and receipt of guideline-consistent cancer screening and prevention recommendations. Methods Data from the 2010 National Health Interview Survey were analyzed with multivariate logistic regression to assess provider type seen and receipt of guideline-consistent cancer screening and prevention recommendations (n = 26,716). Results In adjusted analyses, women who saw a primary care physician (PCP) and an APRN/PA or a PCP without an APRN/PA in the past 12 months were more likely to be compliant with cervical and breast cancer screening guidelines than women who did not see a PCP or APRN/PA (all p < 0.0001 for provider type). Women and men who saw a PCP and an APRN/PA or a PCP without an APRN/PA were also more likely to receive guideline consistent colorectal cancer screening and advice to quit smoking and participate in physical activity than women and men who did not see a PCP or APRN/PA (all p < 0.01 for provider type). Conclusions Seeing a PCP alone, or in conjunction with an APRN/PA is associated with patient receipt of guideline-consistent cancer prevention and screening recommendations. Integrating APRN/PA into primary care may assist with the delivery of cancer prevention and screening services. More intervention research efforts are needed to explore how APRN/PA will be best able to increase cancer screening, HPV vaccination, and receipt of behavioral counseling, especially during this era of healthcare reform. PMID:24685149

Non-Critical-Care Nurses' Perceptions of Facilitators and Barriers to Rapid Response Team Activation.

PubMed

Jenkins, Sheryl Henry; Astroth, Kim Schafer; Woith, Wendy Mann

2015-01-01

Rapid response teams can save lives but are only effective when activated. We surveyed 50 nurses for their perceptions of facilitators and barriers to activation. Findings showed that participants need more education on their role and when to activate the rapid response team. Nurses who comprise the team need help building their communication skills. We recommend nursing professional development specialists increase the frequency of offerings and expand the focus on roles, activation criteria, and communication skills.

Facilitating the implementation of the American College of Surgeons/Association of Program Directors in Surgery phase III skills curriculum: training faculty in the assessment of team skills.

PubMed

Hull, Louise; Arora, Sonal; Stefanidis, Dimitrios; Sevdalis, Nick

2015-11-01

Effective teamwork is critical to safety in the operating room; however, implementation of phase III of the American College of Surgeons (ACS) and Association of Program Directors in Surgery (APDS) Curriculum that focuses on team-based skills remains worryingly low. Training and assessing the complexities of teamwork is challenging. The objective of this study was to establish guidelines and recommendations for training faculty in assessing/debriefing team skills. A multistage survey-based consensus study was completed by 108 experts responsible for training and assessing surgical residents from the ACS Accredited Educational Institutes. Experts agreed that a program to teach faculty to assess team-based skills should include training in the recognition of teamwork skills, practice rating these skills, and training in the provision of feedback/debriefing. Agreement was reached that faculty responsible for conducting team-based skills assessment should be revalidated every 2 years and stringent proficiency criteria should be met. Faculty development is critical to ensure high-quality, standardized training and assessment. Training faculty to assess team-based skills has the potential to facilitate the effective implementation of phase III of the ACS and APDS Curriculum. Copyright © 2015 Elsevier Inc. All rights reserved.

Technology as Teammate: Examining the Role of External Cognition in Support of Team Cognitive Processes

PubMed Central

Fiore, Stephen M.; Wiltshire, Travis J.

2016-01-01

In this paper we advance team theory by describing how cognition occurs across the distribution of members and the artifacts and technology that support their efforts. We draw from complementary theorizing coming out of cognitive engineering and cognitive science that views forms of cognition as external and extended and integrate this with theorizing on macrocognition in teams. Two frameworks are described that provide the groundwork for advancing theory and aid in the development of more precise measures for understanding team cognition via focus on artifacts and the technologies supporting their development and use. This includes distinctions between teamwork and taskwork and the notion of general and specific competencies from the organizational sciences along with the concepts of offloading and scaffolding from the cognitive sciences. This paper contributes to the team cognition literature along multiple lines. First, it aids theory development by synthesizing a broad set of perspectives on the varied forms of cognition emerging in complex collaborative contexts. Second, it supports research by providing diagnostic guidelines to study how artifacts are related to team cognition. Finally, it supports information systems designers by more precisely describing how to conceptualize team-supporting technology and artifacts. As such, it provides a means to more richly understand process and performance as it occurs within sociotechnical systems. Our overarching objective is to show how team cognition can both be more clearly conceptualized and more precisely measured by integrating theory from cognitive engineering and the cognitive and organizational sciences. PMID:27774074

Technology as Teammate: Examining the Role of External Cognition in Support of Team Cognitive Processes.

PubMed

Fiore, Stephen M; Wiltshire, Travis J

2016-01-01

In this paper we advance team theory by describing how cognition occurs across the distribution of members and the artifacts and technology that support their efforts. We draw from complementary theorizing coming out of cognitive engineering and cognitive science that views forms of cognition as external and extended and integrate this with theorizing on macrocognition in teams. Two frameworks are described that provide the groundwork for advancing theory and aid in the development of more precise measures for understanding team cognition via focus on artifacts and the technologies supporting their development and use. This includes distinctions between teamwork and taskwork and the notion of general and specific competencies from the organizational sciences along with the concepts of offloading and scaffolding from the cognitive sciences. This paper contributes to the team cognition literature along multiple lines. First, it aids theory development by synthesizing a broad set of perspectives on the varied forms of cognition emerging in complex collaborative contexts. Second, it supports research by providing diagnostic guidelines to study how artifacts are related to team cognition. Finally, it supports information systems designers by more precisely describing how to conceptualize team-supporting technology and artifacts. As such, it provides a means to more richly understand process and performance as it occurs within sociotechnical systems. Our overarching objective is to show how team cognition can both be more clearly conceptualized and more precisely measured by integrating theory from cognitive engineering and the cognitive and organizational sciences.

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.

An Overview of the Quality Function Deployment (QFD) Technique

NASA Technical Reports Server (NTRS)

Sherif, Josef S.; Tran, Tuyet-Lan

1995-01-01

QFD is a product planning tool and a process methodology that enables all organizations, departments, and individuals in a business or a project to systematically focus on the critical performance, functions, and/or characteristics of a product that are the most important to the customer. It is part of the Total Quality Management (TQM) concept.. This presentation describes the objectives of QFD, the process for implementing the technique, the benefits derived from proper implementation, the kinds of systems where QFD is best utilized, what the success factors are, how QFD works, some guidelines for selection of a QFD team, and the functional roles of key team members.

Photovoltaic system criteria documents. Volume 1: Guidelines for evaluating the management and operations planning of photovoltaic applications

NASA Technical Reports Server (NTRS)

Koenig, John C.; Billitti, Joseph W.; Tallon, John M.

1979-01-01

Guidelines are provided to the Field Centers for organization, scheduling, project and cost control, and performance in the areas of project management and operations planning for Photovoltaics Test and Applications. These guidelines may be used in organizing a T and A Project Team for system design/test, site construction and operation, and as the basis for evaluating T and A proposals. The attributes are described for project management and operations planning to be used by the Field Centers. Specifically, all project management and operational issues affecting costs, schedules and performance of photovoltaic systems are addressed. Photovoltaic tests and applications include residential, intermediate load center, central station, and stand-alone systems. The sub-categories of system maturity considered are: Initial System Evaluation Experiments (ISEE); System Readiness Experiments (SRE); and Commercial Readiness Demonstration Projects (CRDP).

Sepsis and Shock Response Team: Impact of a Multidisciplinary Approach to Implementing Surviving Sepsis Campaign Guidelines and Surviving the Process.

PubMed

Grek, Ami; Booth, Sandra; Festic, Emir; Maniaci, Michael; Shirazi, Ehsan; Thompson, Kristine; Starbuck, Angela; Mcree, Chad; Naessens, James M; Moreno Franco, Pablo

The Surviving Sepsis Campaign guidelines are designed to decrease mortality through consistent application of a 7-element bundle. This study evaluated the impact of improvement in bundle adherence using a time-series analysis of compliance with the bundle elements before and after interventions intended to improve the process, while also looking at hospital mortality. This article describes interventions used to improve bundle compliance and hospital mortality in patients admitted through the emergency department with sepsis, severe sepsis, or septic shock. Quality improvement methodology was used to develop high-impact interventions that led to dramatically improved adherence to the Surviving Sepsis Campaign guidelines bundle. Improved performance was associated with a significant decrease in the in-hospital mortality of severe sepsis patients presenting to the emergency department.

Factors affecting speech pathologists' implementation of stroke management guidelines: a thematic analysis.

PubMed

Miao, Melissa; Power, Emma; O'Halloran, Robyn

2015-01-01

Although clinical practice guidelines can facilitate evidence-based practice and improve the health outcomes of stroke patients, they continue to be underutilised. There is limited research into the reasons for this, especially in speech pathology. This study provides the first in-depth, qualitative examination of the barriers and facilitators that speech pathologists perceive and experience when implementing guidelines. A maximum variation sample of eight speech pathologists participated in a semi-structured interview concerning the implementation of the National Stroke Foundation's Clinical Guidelines for Stroke Management 2010. Interviews were transcribed, thematically analysed and member checked before overall themes were identified. Three main themes and ten subthemes were identified. The first main theme, making implementation explicit, reflected the necessity of accessing and understanding guideline recommendations, and focussing specifically on implementation in context. In the second theme, demand versus ability to change, the size of changes required was compared with available resources and collaboration. The final theme, Speech pathologist motivation to implement guidelines, demonstrated the influence of individual perception of the guidelines and personal commitment to improved practice. Factors affecting implementation are complex, and are not exclusively barriers or facilitators. Some potential implementation strategies are suggested. Further research is recommended. In most Western nations, stroke remains the single greatest cause of disability, including communication and swallowing disabilities. Although adherence to stroke clinical practice guidelines improves stroke patient outcomes, guidelines continue to be underutilised, and the reasons for this are not well understood. This is the first in-depth qualitative study identifying the complex barriers and facilitators to guideline implementation as experienced by speech pathologists in stroke care. Suggested implementation strategies include local monitoring of guideline implementation (e.g. team meetings, audits), increasing collaboration on implementation projects (e.g. managerial involvement, networking), and seeking speech pathologist input into guideline development.

Failure Mode and Effect Analysis (FMEA) may enhance implementation of clinical practice guidelines: An experience from the Middle East.

PubMed

Babiker, Amir; Amer, Yasser S; Osman, Mohamed E; Al-Eyadhy, Ayman; Fatani, Solafa; Mohamed, Sarar; Alnemri, Abdulrahman; Titi, Maher A; Shaikh, Farheen; Alswat, Khalid A; Wahabi, Hayfaa A; Al-Ansary, Lubna A

2018-02-01

Implementation of clinical practice guidelines (CPGs) has been shown to reduce variation in practice and improve health care quality and patients' safety. There is a limited experience of CPG implementation (CPGI) in the Middle East. The CPG program in our institution was launched in 2009. The Quality Management department conducted a Failure Mode and Effect Analysis (FMEA) for further improvement of CPGI. This is a prospective study of a qualitative/quantitative design. Our FMEA included (1) process review and recording of the steps and activities of CPGI; (2) hazard analysis by recording activity-related failure modes and their effects, identification of actions required, assigned severity, occurrence, and detection scores for each failure mode and calculated the risk priority number (RPN) by using an online interactive FMEA tool; (3) planning: RPNs were prioritized, recommendations, and further planning for new interventions were identified; and (4) monitoring: after reduction or elimination of the failure mode. The calculated RPN will be compared with subsequent analysis in post-implementation phase. The data were scrutinized from a feedback of quality team members using a FMEA framework to enhance the implementation of 29 adapted CPGs. The identified potential common failure modes with the highest RPN (≥ 80) included awareness/training activities, accessibility of CPGs, fewer advocates from clinical champions, and CPGs auditing. Actions included (1) organizing regular awareness activities, (2) making CPGs printed and electronic copies accessible, (3) encouraging senior practitioners to get involved in CPGI, and (4) enhancing CPGs auditing as part of the quality sustainability plan. In our experience, FMEA could be a useful tool to enhance CPGI. It helped us to identify potential barriers and prepare relevant solutions. © 2017 John Wiley & Sons, Ltd.

Prevalence and impact of obesity in people with haemophilia: Review of literature and expert discussion around implementing weight management guidelines.

PubMed

Kahan, S; Cuker, A; Kushner, R F; Maahs, J; Recht, M; Wadden, T; Willis, T; Majumdar, S; Ungar, D; Cooper, D

2017-11-01

Obesity affects more than 35% of Americans, increasing the risk of more than 200 comorbid conditions, impaired quality of life and premature mortality. This review aimed to summarize literature published over the past 15 years regarding the prevalence and impact of obesity in people with haemophilia (PWH) and to discuss implementing general guidelines for weight management in the context of the haemophilia comprehensive care team. Although few studies have assessed the effects of obesity on haemophilia-specific outcomes, existing evidence indicates an important impact of weight status on lower extremity joint range of motion and functional disability, with potentially important effects on overall quality of life. Data regarding bleeding tendency in PWH with coexisting obesity are largely inconclusive; however, some individuals may experience reduced joint bleeds following moderate weight loss. Additionally, conventional weight-based dosing of factor replacement therapy leads to increased treatment costs for PWH with obesity or overweight, suggesting pharmacoeconomic benefits of weight loss. Evidence-based recommendations for weight loss include behavioural strategies to reduce caloric intake and increase physical activity, pharmacotherapy and surgical therapy in appropriate patients. Unique considerations in PWH include bleed-related risks with physical activity; thus, healthcare professionals should advise patients on types and intensities of, and approaches to, physical activity, how to adjust treatment to accommodate exercise and how to manage potential activity-related bleeding. Increasing awareness of these issues may improve identification of PWH with coexisting obesity and referral to appropriate specialists, with potentially wide-ranging benefits in overall health and well-being. © 2017 The Authors. Haemophilia Published by John Wiley & Sons Ltd.

Resources to handle childhood asthma in Spain: The role of plans and guides and the participation of nurses.

PubMed

Úbeda-Sansano, M I; Cano-Garcinuño, A; Rueda-Esteban, S; Praena-Crespo, M

2018-05-05

Describe the assistance provided to asthmatic patients by Primary Care Paediatricians (PCP) in Spain and the material and human resources available for diagnosis and follow-up. A cross-sectional descriptive study using an on-line survey, sent to PCP regarding the availability of diagnostic resources, carrying out programmed and educational activities, collaboration of nursing staff and their relationship with existing institutional plans to care for children with asthma. A latent class model (LCM) was used to describe the differences among paediatricians based on the variables studied. Of the 708 answers, 675 were considered valid; 76% of the paediatricians had a spirometer, 75% specific IgE, 17% prick-test, 95% had placebo inhalers and 97% inhalation chambers. 57% performed programmed activities with their patients, while 56% shared their care of asthmatic patients with their nursing staff, but only 25% of the nurses were involved in the follow-up and 12% in education. LCM identified four patterns. The two groups with greater access to diagnostic resources counted on institutional plans/guidelines. However, the only variable differentiating the groups with more programmed and educational activities was the participation of nurses. The availability of asthma plans/guidelines and resources for diagnosis and follow-up is not sufficient to improve important aspects of primary care for children with asthma. Organisational changes are necessary to include programmed asthma-related visits and paediatric teams with greater involvement of the nurses when caring for these patients. Copyright © 2018 SEICAP. Published by Elsevier España, S.L.U. All rights reserved.

Guide Dog Teams in the United States: Annual Number Trained and Active, 1993-1999.

ERIC Educational Resources Information Center

Eames, Ed; Eames, Toni; Diament, Sara

2001-01-01

A study investigated the number of guide dog teams that have been trained and are active in the United States from 1993-1999. Results found 1,556 guide dog teams were trained in 1999, an increase of 7%, and that there were 9,000 active teams, an increase of 10% since 1993. (Contains eight references.) (CR)

International Energy Agency's Heat Pump Centre (IEA-HPC) Annual National Team Working Group Meeting

NASA Astrophysics Data System (ADS)

Broders, M. A.

1992-09-01

The traveler, serving as Delegate from the United States Advanced Heat Pump National Team, participated in the activities of the fourth IEA-HPC National Team Working Group meeting. Highlights of this meeting included review and discussion of 1992 IEA-HPC activities and accomplishments, introduction of the Switzerland National Team, and development of the 1993 IEA-HPC work program. The traveler also gave a formal presentation about the Development and Activities of the IEA Advanced Heat Pump U.S. National Team.

Critical Airway Team: A Retrospective Study of an Airway Response System in a Pediatric Hospital.

PubMed

Sterrett, Emily C; Myer, Charles M; Oehler, Jennifer; Das, Bobby; Kerrey, Benjamin T

2017-12-01

Objective Study the performance of a pediatric critical airway response team. Study Design Case series with chart review. Setting Freestanding academic children's hospital. Subjects and Methods A structured review of the electronic medical record was conducted for all activations of the critical airway team. Characteristics of the activations and patients are reported using descriptive statistics. Activation of the critical airway team occurred 196 times in 46 months (March 2012 to December 2015); complete data were available for 162 activations (83%). For 49 activations (30%), patients had diagnoses associated with difficult intubation; 45 (28%) had a history of difficult laryngoscopy. Results Activation occurred at least 4 times per month on average (vs 3 per month for hospital-wide codes). The most common reasons for team activation were anticipated difficult intubation (45%) or failed intubation attempt (20%). For 79% of activations, the team performed an airway procedure, most commonly direct laryngoscopy and tracheal intubation. Bronchoscopy was performed in 47% of activations. Surgical airway rescue was attempted 4 times. Cardiopulmonary resuscitation occurred in 41 activations (25%). Twenty-nine patients died during or following team activation (18%), including 10 deaths associated with the critical airway event. Conclusion Critical airway team activation occurred at least once per week on average. Direct laryngoscopy, tracheal intubation, and bronchoscopic procedures were performed frequently; surgical airway rescue was rare. Most patients had existing risk factors for difficult intubation. Given our rate of serious morbidity and mortality, primary prevention of critical airway events will be a focus of future efforts.

Diabetes Mellitus Standards of Care.

PubMed

Mays, Lucy

2015-12-01

Diabetes is a worldwide epidemic with a high cost regarding consumption of health care resources and is associated with high levels of morbidity and mortality. The complex nature of diabetes requires the use of evidence-based guidelines regarding diabetes management. These evidence-based guidelines are lengthy and do not readily translate into nursing care. As an integral component of the interprofessional team, the nurse must provide a thorough assessment of patients with diabetes and work to achieve individual patient treatment goals. Evaluation of patient progress toward treatment goals with regular/frequent follow-up is necessary to promote effective self-management of diabetes. Copyright © 2015 Elsevier Inc. All rights reserved.

[Clinical guidelines for diagnosis, treatment and monitoring of patients with non-invasive breast cancer].

PubMed

Brnijć, Zoran; Brkljacić, Boris; Drinković, Ivan; Jakić-Razumović, Jasminka; Kardum-Skelin, Ika; Krajina, Zdenko; Margaritoni, Marko; Strnad, Marija; Sarcević, Bozena; Tomić, Snjezana; Zic, Rado

2012-01-01

Breast cancer is the most common malignancy in women. Early diagnosis and more effective treatment of invasive breast cancer resulted in significant mortality reduction, improvement of survival and the quality of life of the patients. The management od non-invasive breast cancer, on the contrary, is still controversial and the problem of overdiagnosis and overtreatment of patients come to evidence. In the following text a multidisciplinary team of experts brings the first consensus guidelines aimed to standardize and optimize the criteria and management in diagnosis, treatment and monitoring of non-invasive breast cancer patients in the Republic of Croatia.

Recommendations and consensus on the treatment of peritoneal metastases of colorectal origin: a systematic review of national and international guidelines.

PubMed

Klaver, C E L; Groenen, H; Morton, D G; Laurberg, S; Bemelman, W A; Tanis, P J

2017-03-01

This systematic review aimed to provide an overview of (inter)national guidelines on the treatment of peritoneal metastases of colorectal cancer origin (PMCRC) and to determine the degree of consensus and available evidence with identification of topics for future research. A systematic search of MEDLINE, Embase, PubMed as well as Tripdatabase, National Guideline Clearinghouse, BMJ Best Practice and Guidelines International Network was performed to identify (inter)national guidelines and consensus statements from oncological or surgical societies on PMCRC. The quality of guidelines was assessed using the AGREE-II score. Topics followed by recommendations were extracted from the guidelines. The recommendations, highest level of supporting evidence and the degree of consensus were determined for each topic. Twenty-one guidelines were included, in most (15) of which cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) was recommended in selected patients based on level 1b evidence. Substantial consensus was also reached on the benefit of multidisciplinary team discussion and the achievability of a (near) complete cytoreduction (CC0-1) without supporting evidence. Both evidence and consensus were lacking regarding other aspects including preoperative positron emission tomography/CT, second look surgery in high risk patients, the optimal patient selection for CRS/HIPEC, procedural aspects of HIPEC and (perioperative) systemic therapy. In currently available guidelines, evidence and consensus on the treatment strategy for PMCRC are lacking. Updates of guidelines are ongoing and future (randomized) clinical trials should contribute to multidisciplinary and international consensus on treatment strategies for PMCRC. Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.

Delivering high quality hip fracture rehabilitation: the perspective of occupational and physical therapy practitioners.

PubMed

Leland, Natalie E; Lepore, Michael; Wong, Carin; Chang, Sun Hwa; Freeman, Lynn; Crum, Karen; Gillies, Heather; Nash, Paul

2018-03-01

The majority of post-acute hip fracture rehabilitation in the US is delivered in skilled nursing facilities (SNFs). Currently, there are limited guidelines that equip occupational and physical therapy practitioners with a summary of what constitutes evidence-based high quality rehabilitation. Thus, this study aimed to identify rehabilitation practitioners' perspectives on the practices that constitute high quality hip fracture rehabilitation. Focus groups were conducted with 99 occupational and physical therapy practitioners working in SNFs in southern California. Purposive sampling of facilities was conducted to capture variation in key characteristics known to impact care delivery for this patient population (e.g., financial resources, staffing, and patient case-mix). Questions aimed to elicit practitioners' perspectives on high quality hip fracture rehabilitation practices. Each session was audio-recorded and transcribed. Data were systematically analyzed using a modified grounded theory approach. Seven themes emerged: objectives of care; first 72 h; positioning, pain, and precautions; use of standardized assessments; episode of care practices; facilitating insight into progress; and interdisciplinary collaboration. Clinical guidelines are critical tools to facilitate clinical decision-making and achieve desired patient outcomes. The findings of this study highlight the practitioners' perspective on what constitutes high quality hip fracture rehabilitation. This work provides critical information to advance the development of stakeholder-driven rehabilitation clinical guidelines. Future research is needed to verify the findings from other stakeholders (e.g., patients), ensure the alignment of our findings with current evidence, and develop measures for evaluating their delivery and relationship to desired outcomes. Implications for Rehabilitation This study highlights occupational and physiotherapy therapy practitioners' perspectives on the cumulative best practices that reflect high quality care, which should be delivered during hip fracture rehabilitation. While this study was limited to two professions within the broader interdisciplinary team, consistently occupational and physiotherapy therapy practitioners situated their role and practices within the team, emphasizing that high quality care was driven by collaboration among all members of the team as well as the patient and caregivers. Future research needs to evaluate the (a) frequency at which these practices are delivered and the relationship to patient-centered outcomes, and (b) perspectives of rehabilitation practitioners working in other PAC settings, patients, caregivers, as well as the other members of the interdisciplinary PAC team.

The Use of Team-Building Activities to Build a Better Resident.

PubMed

Ireland, James D; Deloney, Linda A; Renfroe, Shyann; Jambhekar, Kedar

We implemented team building activities to build a better resident during our orientation process and we have refined the choice of activities each year since. Resident satisfaction with their team building actives provided feedback to improve the following years' experience. While there is no definite way to demonstrate the effectiveness of our team building initiative, our expectation is it will improve the residency experience and work environment, and ultimately, result in better patient care. We focus on five aspects of team building - personal history sharing, creativity and imagination, common bonds, cooperation, and shared experience. The purpose of this paper is to recommend activities in each of these areas based on our experience. Published by Elsevier Inc.

Unlocking the effects of gender faultlines on team creativity: is activation the key?

PubMed

Pearsall, Matthew J; Ellis, Aleksander P J; Evans, Joel M

2008-01-01

The purpose of this study was to use faultline theory to examine the effects of gender diversity on team creativity. Results from 80 teams working on an idea generation task indicated that the activation of gender faultlines negatively affected the number and overall creativity of ideas. However, gender faultlines that were not activated had no effect. Results also indicated that the relationship between activated gender faultlines and team creativity was partially mediated by the level of conflict within the team. Specifically, emotional conflict partially mediated the effects of activated gender faultlines on the number of ideas generated. Implications are discussed, as well as possible limitations and directions for future research. 2008 APA

Cardiopulmonary resuscitation standards for clinical practice and training in the UK.

PubMed

Gabbott, David; Smith, Gary; Mitchell, Sarah; Colquhoun, Michael; Nolan, Jerry; Soar, Jasmeet; Pitcher, David; Perkins, Gavin; Phillips, Barbara; King, Ben; Spearpoint, Ken

2005-07-01

The Royal College of Anaesthetists, the Royal College of Physicians, the Intensive Care Society and the Resuscitation Council (UK) have published new resuscitation standards. The document provides advice to UK healthcare organisations, resuscitation committees and resuscitation officers on all aspects of the resuscitation service. It includes sections on resuscitation training, resuscitation equipment, the cardiac arrest team, cardiac arrest prevention, patient transfer, post-resuscitation care, audit and research. The document makes several recommendations. Healthcare institutions should have, or be represented on, a resuscitation committee that is responsible for all resuscitation issues. Every institution should have at least one resuscitation officer responsible for teaching and conducting training in resuscitation techniques. Staff with patient contact should be given regular resuscitation training appropriate to their expected abilities and roles. Clinical staff should receive regular training in the recognition of patients at risk of cardiopulmonary arrest and the measures required for the prevention of cardiopulmonary arrest. Healthcare institutions admitting acutely ill patients should have a resuscitation team, or its equivalent, available at all times. Clear guidelines should be available indicating how and when to call for the resuscitation team. Cardiopulmonary arrest should be managed according to current national guidelines. Resuscitation equipment should be available throughout the institution for clinical use and for training. The practice of resuscitation should be audited to maintain and improve standards of care. A do not attempt resuscitation (DNAR) policy should be compiled, communicated to relevant members of staff, used and audited regularly. Funding must be provided to support an effective resuscitation service.

Cardiopulmonary resuscitation standards for clinical practice and training in the UK.

PubMed

Gabbott, David; Smith, Gary; Mitchell, Sarah; Colquhoun, Michael; Nolan, Jerry; Soar, Jasmeet; Pitcher, David; Perkins, Gavin; Phillips, Barbara; King, Ben; Spearpoint, Ken

2005-01-01

The Royal College of Anaesthetists, the Royal College of Physicians, the Intensive Care Society and the Resuscitation Council (UK) have published new resuscitation standards. The document provides advice to UK healthcare organisations, resuscitation committees and resuscitation officers on all aspects of the resuscitation service. It includes sections on resuscitation training, resuscitation equipment, the cardiac arrest team, cardiac arrest prevention, patient transfer, post resuscitation care, audit and research. The document makes several recommendations. Healthcare institutions should have, or be represented on, a resuscitation committee that is responsible for all resuscitation issues. Every institution should have at least one resuscitation officer responsible for teaching and conducting training in resuscitation techniques. Staff with patient contact should be given regular resuscitation training appropriate to their expected abilities and roles. Clinical staff should receive regular training in the recognition of patients at risk of cardiopulmonary arrest and the measures required for the prevention of cardiopulmonary arrest. Healthcare institutions admitting acutely ill patients should have a resuscitation team, or its equivalent, available at all times. Clear guidelines should be available indicating how and when to call for the resuscitation team. Cardiopulmonary arrest should be managed according to current national guidelines. Resuscitation equipment should be available throughout the institution for clinical use and for training. The practice of resuscitation should be audited to maintain and improve standards of care. A do not attempt resuscitation (DNAR) policy should be compiled, communicated to relevant members of staff, used and audited regularly. Funding must be provided to support an effective resuscitation service.

Team Nutrition School Activity Planner. A How-To Guide for Team Nutrition Schools and Supporters.

ERIC Educational Resources Information Center

Food and Consumer Service (USDA), Washington, DC.

This "how-to" guide for Team Nutrition fairs and tasting activities helps Team Nutrition supporters and schools understand how to work together to improve the health and education of children. Team Nutrition is the implementation tool for the U.S. Department of Agriculture's School Meals Initiative for Healthy Children. Section 1 of the guide…

Uterine transplantation: Review in human research.

PubMed

Favre-Inhofer, A; Rafii, A; Carbonnel, M; Revaux, A; Ayoubi, J M

2018-06-01

Uterine transplantation is the solution to treat absolute uterine fertility. In this review, we present the historical, medical, technical, psychological and ethical perspectives in human uterine transplantation research. We reviewed the PubMed database following PRISMA guidelines and added data presented by several research teams during the first international congress on uterine transplantation. Copyright © 2018. Published by Elsevier Masson SAS.

Computer Decision Support to Improve Autism Screening and Care in Community Pediatric Clinics

ERIC Educational Resources Information Center

Bauer, Nerissa S.; Sturm, Lynne A.; Carroll, Aaron E.; Downs, Stephen M.

2013-01-01

An autism module was added to an existing computer decision support system (CDSS) to facilitate adherence to recommended guidelines for screening for autism spectrum disorders in primary care pediatric clinics. User satisfaction was assessed by survey and informal feedback at monthly meetings between clinical staff and the software team. To assess…

Mastering the Diversity Challenge: Easy On-the-Job Applications for Measurable Results.

ERIC Educational Resources Information Center

Lebo, Fern

This book provides practical, step-by-step guidelines and gives important reasons why managing diversity is good for overall business. It identifies issues specific to designated groups and provides effective techniques for creating a level playing field, as well as specific on-the-job applications for running meetings, building a team, opening…

[A scale for the assessment of the risk of pressure sores in paediatric intensive care].

PubMed

Weigel, Virginie

2014-01-01

Pressure sores are a frequent complication in paediatric intensive care. A multi-disciplinary nursing team has drawn up an assessment scale for the risk of pressure sores and has put in place guidelines for caring for children in intensive care. Prevention actions are thereby adapted to each young patient.

The impact of structuring multidisciplinary team conferences mediated by ICT in the treatment of patients with rheumatic diseases.

PubMed

Verhoef, J; Toussaint, P J; Vliet Vlieland, T P M; Zwetsloot-Schonk, J H M

2004-01-01

Communication processes are pervasive in the daily practice of health professionals. Reorganizing these daily practices by introducing ICT, inevitably effects one or more communication processes. Understanding exactly what these effects are, is a major problem in designing and implementing ICT-applications. In this paper we present an analysis of these effects, based on a theory of communication processes. The concept of 'decoupling' is pivotal in our analysis. Based on the identified effects, and some preconditions that have to be met in order for these effects to take place, we derive a number of guidelines for reorganizing communication processes by means of applying ICT. The application of these quidelines will be demonstrated and discussed in the context of the reorganization of a team conference at the Rehabilitation Clinic of the Rheumatology Department of the Leiden University Medical Center (RCRD/LUMC), a multidisciplinary team care setting.

Evaluation of leadership skills during the simulation education course for the initial management of blunt trauma.

PubMed

Schott, Eric; Brautigam, Robert T; Smola, Jacqueline; Burns, Karyl J

2012-04-01

Leadership skills of senior residents, trauma fellows, and a nurse practitioner were assessed during simulation training for the initial management of blunt trauma. This was a pilot, observational study, that in addition to skill development and assessment also sought to determine the need for a dedicated leadership training course for surgical residents. The study evaluated the leadership skills and adherence to Advance Trauma Life Support (ATLS) guidelines of the team leaders during simulation training. The team leaders' performances on criteria regarding prearrival planning, critical actions based on ATLS, injury identification, patient management, and communication were evaluated for each of five blunt-trauma scenarios. Although there was a statistically significant increase in leadership skills for performing ATLS critical actions, P < 0.05, there were 10 adverse events. A structured simulation program dedicated to developing skills for team leadership willbe a worthwhile endeavor at our institution.

Optimising calcium monitoring post thyroid and parathyroid surgery

PubMed Central

Rayner, Eleanor; Williams, Nerida; Dunn, Julie

2014-01-01

There is a risk of hypocalcaemia following total thyroidectomy and parathyroidectomy surgery, with the nadir being two to five days post operatively.[1] This project examined and improved the post-operative monitoring of serum calcium in patients undergoing these procedures at the Royal Devon and Exeter (RD&E) Hospital over a ten month period in 2013. A retrospective audit was undertaken, identifying whether serum calcium was monitored according to guideline; ie measured within the first 24 hours of surgery and daily thereafter until the patient was normocalcaemic.[2–3] The audit showed an overall compliance in 79% (n = 34) of cases. Of the non-compliant cases (n=9), seven also suffered hypocalcaemia. The current process was mapped by a flow chart and used as a basis for discussing experiences and identifying areas for improvement. Interventions implemented included a patient leaflet, a process flow chart displayed in the team office and in the weekend handover book, standard text for use in discharge summaries describing the process to GPs, the issuing of prescriptions or actual supplements for patients felt to be at high risk of hypocalcaemia, and finally education to the wider surgical junior doctor team. Percentage compliance with guidelines was compared before and after intervention with a re-audit undertaken in April 2014. Significant improvement was shown, with 100% of re-audit cases compliant (n=41), and all seven cases of hypocalcaemia were managed in full compliance with guideline. PMID:26732097

The use of instructional design guidelines to increase effectiveness of postpartum hemorrhage simulation training.

PubMed

de Melo, Brena C P; Falbo, Ana R; Muijtjens, Arno M M; van der Vleuten, Cees P M; van Merriënboer, Jeroen J G

2017-04-01

To compare learning outcomes of postpartum hemorrhage simulation training based on either instructional design guidelines or best practice. A pretest-post-test non-equivalent groups study was conducted among obstetrics and gynecology residents in Recife, Brazil, from June 8 to August 30, 2013. The instructional design group included 13 teams, whereas the best practice group included seven teams. A standardized task checklist was used for scenario analysis and the proportion of correctly executed tasks compared (post-test minus pretest). The instructional design group scored higher than the best practice group for total number of tasks completed (median difference 0.46 vs 0.17; P<0.001; effect size [r]=0.72). Similar results were observed for communication (median difference 0.56 vs 0.22; P=0.004; r=0.58), laboratory evaluation (median difference 0.83 vs 0.00; P<0.001; r=0.76), and mechanical management (median difference 0.25 vs -0.15; P=0.048; r=0.39). Speed of learning was also increased. The median differences were 0.20 for the instructional design group compared with 0.05 for the best practice group at 60 seconds (P=0.015; r=0.49), and 0.49 versus 0.26 (P=0.001; r=0.65) at 360 seconds. The use of simulation training for postpartum hemorrhage that was based on instructional design guidelines yielded better learning outcomes than did training based on best practice. © 2016 International Federation of Gynecology and Obstetrics.

Planning a pharmacy-led medical mission trip, part 2: servant leadership and team dynamics.

PubMed

Brown, Dana A; Brown, Daniel L; Yocum, Christine K

2012-06-01

While pharmacy curricula can prepare students for the cognitive domains of pharmacy practice, mastery of the affective aspects can prove to be more challenging. At the Gregory School of Pharmacy, medical mission trips have been highly effective means of impacting student attitudes and beliefs. Specifically, these trips have led to transformational changes in student leadership capacity, turning an act of service into an act of influence. Additionally, building team unity is invaluable to the overall effectiveness of the trip. Pre-trip preparation for teams includes activities such as routine team meetings, team-building activities, and implementation of committees, as a means of promoting positive team dynamics. While in the field, team dynamics can be fostered through activities such as daily debriefing sessions, team disclosure times, and provision of medical services.

Practice guidelines need to address the 'how' and the 'what' of implementation.

PubMed

McKillop, Ann; Crisp, Jackie; Walsh, Kenneth

2012-01-01

The aim of this study was to explore the realities of everyday nursing practice associated with the implementation of a guideline for the assessment and management of cardiovascular risk. The use of clinical practice guidelines is pivotal to improving health outcomes. However, the implementation of guidelines into practice is complex, unpredictable and, in spite of much investigation, remains resistant to explanation of what works and why. Exploration of the nature of guideline implementation has the potential to illuminate the complexities of guideline implementation by focussing on the nature of practice. Nurses are well placed at the front line of primary health care to contribute to an understanding of how guideline implementation plays out in their everyday practice. Qualitative description was used, involving focus groups and interviews with 32 participants (20 nurses, four doctors, five managers and three funder/planners), to explore the use of a guideline in everyday primary health-care practice. Thematic analysis of data was managed through an inductive process of familiarisation, coding, categorising and generation of themes. Four themes were generated from the data portraying the realities of guideline implementation for primary health-care nurses: self-managing patient, everyday nursing practice, developing new relationships in the health team and impact on health-care delivery. The findings reveal that, even with the best of intentions to implement the guideline, health professionals were frustrated and at a loss as to how to achieve that in practice. Consequently, cardiovascular risk assessment and management was uneven and fragmented. Primary health-care practice environments vary so much that solutions to the difficulties of implementing evidence into practice requires context-specific solution-finding through collaborative teamwork. Furthermore, the attention of guideline developers, health-care policymakers, funders and researchers requires direct focus on the 'how' and the 'what' of evidence implementation.

The right care, every time: improving adherence to evidence-based guidelines.

PubMed

Runnacles, Jane; Roueché, Alice; Lachman, Peter

2018-02-01

Guidelines are integral to reducing variation in paediatric care by ensuring that children receive the right care, every time. However, for reasons discussed in this paper, clinicians do not always follow evidence-based guidelines. Strategies to improve guideline usage tend to focus on dissemination and education. These approaches, however, do not address some of the more complex factors that influence whether a guideline is used in clinical practice. In this article, part of the Equipped Quality Improvement series, we outline the literature on barriers to guideline adherence and present practical solutions to address these barriers. Examples outlined include the use of care bundles, integrated care pathways and quality improvement collaboratives. A sophisticated information technology system can improve the use of evidence-based guidelines and provide organisations with valuable data for learning and improvement. Key to success is the support of an organisation that places reliability of service delivery as the way business is done. To do this requires leadership from clinicians in multidisciplinary teams and a system of continual improvement. By learning from successful approaches, we believe that all healthcare organisations can ensure the right care for each patient, every time. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Developing Guidelines on the Assessment and Treatment of Delirium in Older Adults at the End of Life

PubMed Central

Brajtman, Susan; Wright, David; Hogan, David B.; Allard, Pierre; Bruto, Venera; Burne, Deborah; Gage, Laura; Gagnon, Pierre R.; Sadowski, Cheryl A.; Helsdingen, Sherri; Wilson, Kimberley

2011-01-01

Background and Purpose Delirium at the end of life is common and can have serious consequences on an older person’s quality of life and death. In spite of the importance of detecting, diagnosing, and managing delirium at the end of life, comprehensive clinical practice guidelines (CPG) are lacking. Our objective was to develop CPG for the assessment and treatment of delirium that would be applicable to seniors receiving end-of-life care in diverse settings. Methods Using as a starting point the 2006 Canadian Coalition for Seniors’ Mental Health CPG on the assessment and treatment of delirium, a team of palliative care researchers and clinicians partnered with members of the original guideline development group to adapt the guidelines for an end-of-life care context. This process was supported by an extensive literature review. The final guidelines were reviewed by external experts. Results Comprehensive CPG on the assessment and treatment of delirium in older adults at the end of life were developed and can be downloaded from http://www.ccsmh.ca. Conclusions Further research is needed on the implementation and evaluation of these adapted delirium guidelines for older patients receiving end-of-life care in various palliative care settings. PMID:23251311

A scalable architecture for incremental specification and maintenance of procedural and declarative clinical decision-support knowledge.

PubMed

Hatsek, Avner; Shahar, Yuval; Taieb-Maimon, Meirav; Shalom, Erez; Klimov, Denis; Lunenfeld, Eitan

2010-01-01

Clinical guidelines have been shown to improve the quality of medical care and to reduce its costs. However, most guidelines exist in a free-text representation and, without automation, are not sufficiently accessible to clinicians at the point of care. A prerequisite for automated guideline application is a machine-comprehensible representation of the guidelines. In this study, we designed and implemented a scalable architecture to support medical experts and knowledge engineers in specifying and maintaining the procedural and declarative aspects of clinical guideline knowledge, resulting in a machine comprehensible representation. The new framework significantly extends our previous work on the Digital electronic Guidelines Library (DeGeL) The current study designed and implemented a graphical framework for specification of declarative and procedural clinical knowledge, Gesher. We performed three different experiments to evaluate the functionality and usability of the major aspects of the new framework: Specification of procedural clinical knowledge, specification of declarative clinical knowledge, and exploration of a given clinical guideline. The subjects included clinicians and knowledge engineers (overall, 27 participants). The evaluations indicated high levels of completeness and correctness of the guideline specification process by both the clinicians and the knowledge engineers, although the best results, in the case of declarative-knowledge specification, were achieved by teams including a clinician and a knowledge engineer. The usability scores were high as well, although the clinicians' assessment was significantly lower than the assessment of the knowledge engineers.

The PhOCoe Model--ergonomic pattern mapping in participatory design processes.

PubMed

Silva e Santos, Marcello

2012-01-01

The discipline and practice of human factors and ergonomics is quite rich in terms of the availability of analysis, development and evaluation tools and methods for its various processes. However, we lack effective instruments to either map or regulate comprehensively and effectively, cognitive and organizational related impacts, especially the environmental ones. Moreover, when ergonomic transformations through design - such as a new workstation design or even an entire new facility - is at play, ergonomics professionals tend to stay at bay, relying solely on design professionals and engineers. There is vast empirical evidence showing that participation of ergonomists as project facilitators, may contribute to an effective professional synergy amongst the various stakeholders in a multidisciplinary venue. When that happens, everyone wins - users and designers alike -because eventual conflicts, raised up in the midst of options selection, are dissipated in exchange for more convergent design alternatives. This paper presents a method for participatory design, in which users are encouraged to actively participate in the whole design process by sharing their real work activities with the design team. The negotiated results inferred from the ergonomic action and translated into a new design, are then compiled into a "Ergonomic Pattern Manual". This handbook of ergonomics-oriented design guidelines contains essential guidelines to be consulted in recurrent design project situations in which similar patterns might be used. The main drive is simple: nobody knows better than workers themselves what an adequate workplace design solution (equipment, workstation, office layout) should be.

Effect of CRM team leader training on team performance and leadership behavior in simulated cardiac arrest scenarios: a prospective, randomized, controlled study.

PubMed

Fernandez Castelao, Ezequiel; Boos, Margarete; Ringer, Christiane; Eich, Christoph; Russo, Sebastian G

2015-07-24

Effective team leadership in cardiopulmonary resuscitation (CPR) is well recognized as a crucial factor influencing performance. Generally, leadership training focuses on task requirements for leading as well as non-leading team members. We provided crisis resource management (CRM) training only for designated team leaders of advanced life support (ALS) trained teams. This study assessed the impact of the CRM team leader training on CPR performance and team leader verbalization. Forty-five teams of four members each were randomly assigned to one of two study groups: CRM team leader training (CRM-TL) and additional ALS-training (ALS add-on). After an initial lecture and three ALS skill training tutorials (basic life support, airway management and rhythm recognition/defibrillation) of 90-min each, one member of each team was randomly assigned to act as the team leader in the upcoming CPR simulation. Team leaders of the CRM-TL groups attended a 90-min CRM-TL training. All other participants received an additional 90-min ALS skill training. A simulated CPR scenario was videotaped and analyzed regarding no-flow time (NFT) percentage, adherence to the European Resuscitation Council 2010 ALS algorithm (ADH), and type and rate of team leader verbalizations (TLV). CRM-TL teams showed shorter, albeit statistically insignificant, NFT rates compared to ALS-Add teams (mean difference 1.34 (95% CI -2.5, 5.2), p = 0.48). ADH scores in the CRM-TL group were significantly higher (difference -6.4 (95% CI -10.3, -2.4), p = 0.002). Significantly higher TLV proportions were found for the CRM-TL group: direct orders (difference -1.82 (95% CI -2.4, -1.2), p < 0.001); undirected orders (difference -1.82 (95% CI -2.8, -0.9), p < 0.001); planning (difference -0.27 (95% CI -0.5, -0.05) p = 0.018) and task assignments (difference -0.09 (95% CI -0.2, -0.01), p = 0.023). Training only the designated team leaders in CRM improves performance of the entire team, in particular guideline adherence and team leader behavior. Emphasis on training of team leader behavior appears to be beneficial in resuscitation and emergency medical course performance.

Transition to adult care in pediatric solid-organ transplant: development of a practice guideline.

PubMed

Gold, Anna; Martin, Kathy; Breckbill, Katie; Avitzur, Yaron; Kaufman, Miriam

2015-06-01

Transition to adult-centered care is becoming an increasingly important area of practice in pediatric organ transplant. Standardized, best-practice guidelines are needed to assist transplant practitioners in providing optimal transitional care for this population of patients. To describe the development and implementation of a practice guideline for the transitional care of pediatric transplant recipients. A quality improvement project was undertaken in a pediatric multiorgan transplant program setting. Strategies employed included (1) creation of an interdisciplinary working group, (2) survey of transition-related practices and learning needs of transplant practitioners, (3) review of the literature and existing transition-related materials, and (4) creation of transition guidelines. An interdisciplinary survey of transplant practitioners at our institution identified practice strengths related to transitional care and learning needs. Review of relevant literature and other materials revealed limited but emerging research related to the transition of pediatric transplant recipients from pediatric to adult care. Existing transition tools were examined and applicable items identified. A practice guideline for use with pediatric transplant recipients transitioning to adult care was developed. Strategies to educate staff about the guideline and promote ongoing guideline use were implemented. Preparing pediatric transplant recipients and their families for transition to adult-centered care is an emerging challenge for transplant teams. These guidelines provide practitioners with a developmentally sensitive overview of important transition-related domains and strategies directed toward patients and their caregivers, who may experience the process of transition differently. Dissemination of the pediatric transplant transition guideline will make transition information more widely available to transplant practitioners.

Australian Football League concussion guidelines: what do community players think?

PubMed Central

White, Peta E; Donaldson, Alex; Sullivan, S John; Newton, Joshua

2016-01-01

Background Preventing concussion in sport is a global challenge. To assess community-level adult male Australian Football players’ views on following the Australian Football League's (AFL) concussion guidelines. Methods 3 focus groups, each comprising 6 players from 1 regional league, were conducted until saturation of issues raised. Discussions followed a semistructured script and were audio-recorded and transcribed verbatim. Thematic analysis was conducted by 2 coders independently. Results Identified advantages of the guidelines included highlighting the seriousness of concussion; changing the culture around playing with concussion and shifting return-to-play decision responsibility from players to others. Disadvantages included players being removed from play unnecessarily; removal of players’ rights to decide if they are fit to play and players changing their behaviours to avoid being removed from play. Identified facilitators to guideline use included local league enforcement; broad information dissemination and impartial medically trained staff to assess concussion. Identified barriers to guideline use included players’ desire to play at all costs; external pressure that encouraged players to return to play prematurely; and inconvenience and cost. Conclusions Players generally understand that the AFL concussion guidelines protect their long-term welfare. However, their desire to play at all costs and help their team win is a common barrier to reporting concussion and adhering to guidelines. Leagues should take a lead role by mandating and enforcing the use of the guidelines and educating coaches, game day medical providers and players. The return-to-play component of the guidelines is complex and needs further consideration in the context of community sport. PMID:28890801

The external leadership of self-managing teams: intervening in the context of novel and disruptive events.

PubMed

Morgeson, Frederick P

2005-05-01

Relatively little empirical research has been conducted on external leaders of self-managing teams. The integration of functional leadership theory with research on team routines suggests that leaders can intervene in teams in several different ways, and the effectiveness of this intervention depends on the nature of the events the team encounters. External team leaders from 3 organizations first described a series of events (N=117), and leaders and team members then completed surveys to quantitatively describe the events. Results indicated that leader preparation and supportive coaching were positively related to team perceptions of leader effectiveness, with preparation becoming more strongly related to effectiveness as event novelty increased. More active leader intervention activities (active coaching and sense making) were negatively related to satisfaction with leadership yet were positively related to effectiveness as events became more disruptive.

[Infective endocarditis : Update on prophylaxis, diagnosis, and treatment].

PubMed

Dietz, S; Lemm, H; Janusch, M; Buerke, M

2016-05-01

The diagnosis of infective endocarditis is often delayed in clinical practice. Timely diagnosis and rapid antibiotic treatment is important. Higher age of patients, new risk factors, and increasing use of intravascular prosthetic materials resulted in changes in microbial spectrum. Nowadays, nonspecific symptoms, critically ill patients, and immunocompromised patients require a high level of diagnostic expertise.The new guidelines from the European Society of Cardiology provide various diagnostic algorithms and recommendations for antibiotic treatment. The new guidelines also recommend the formation of an endocarditis team with various medical disciplines, including a cardiac surgeon, to improve treatment because in half of all endocarditis patients, antibiotic therapy alone does not result in successful management of the infection. If complications occur, early surgical treatment should be performed.In this overview, diagnostic strategies and therapeutic approaches for the treatment of infectious endocarditis according to the current guidelines and aspects of surgical treatment are provided.

Family Presence During Resuscitation: A Double-Edged Sword.

PubMed

Hassankhani, Hadi; Zamanzadeh, Vahid; Rahmani, Azad; Haririan, Hamidreza; Porter, Joanne E

2017-03-01

To illuminate the meaning of the lived experiences of resuscitation team members with the presence of the patient's family during resuscitation in the cultural context of Iran. An interpretative phenomenology was used to discover the lived experiences of the nurses and physicians of Tabriz hospitals, Iran, with family presence during resuscitation (FPDR). A total of 12 nurses and 9 physicians were interviewed over a 6-month period. The interviews were audio recorded and semistructured, and were transcribed verbatim. Van Manen's technique was used for data analysis. Two major themes and 10 subthemes emerged, including destructive presence (cessation of resuscitation, interference in resuscitation, disruption to the resuscitation team's focus, argument with the resuscitation team, and adverse mental image in the family) and supportive presence (trust in the resuscitation team, collaboration with the resuscitation team, alleviating the family's concern and settling their nerves, increasing the family's satisfaction, and reducing conflict with resuscitation team members). Participants stated that FPDR may work as a double-edged sword for the family and resuscitation team, hurting or preserving quality. It is thus recommended that guidelines be created to protect patients' and families' rights, while considering the positive aspects of the phenomenon for hospitals. A liaison support person would act to decrease family anxiety levels and would be able to de-escalate any potentially aggressive or confrontational events during resuscitation. Well-trained and expert cardiopulmonary resuscitation team members do not have any stress in the presence of family during resuscitation. Resuscitation events tend to be prolonged when family members are allowed to be present. © 2017 Sigma Theta Tau International.

Team Learning and Team Composition in Nursing

ERIC Educational Resources Information Center

Timmermans, Olaf; Van Linge, Roland; Van Petegem, Peter; Elseviers, Monique; Denekens, Joke

2011-01-01

Purpose: This study aims to explore team learning activities in nursing teams and to test the effect of team composition on team learning to extend conceptually an initial model of team learning and to examine empirically a new model of ambidextrous team learning in nursing. Design/methodology/approach: Quantitative research utilising exploratory…

Adherence to active play and electronic media guidelines in preschool children: gender and parental education considerations.

PubMed

Loprinzi, Paul D; Schary, David P; Cardinal, Bradley J

2013-01-01

The primary purpose of the present study was to examine adherence to current active play and electronic media use guidelines in a sample of US preschool-aged children and to examine whether differences occurred across gender and parental education. 164 parents completed an on-line survey to estimate preschool children's active play and sedentary behaviors. For weekdays, 50% of the sample met the active play guideline with this increasing to 65% during the weekend. With respect to electronic media use, 90% of the sample met guidelines during the week, with the percentage meeting guidelines dropping to 78% during the weekend. A greater percentage of preschool children from high parental education families (83.4 ± 3.3) met electronic media use guidelines on the weekends, compared to preschool children from low parental education families (59.4 ± 8.1) (p = 0.002). Our findings indicate that a substantial portion of preschool children are not meeting active play guidelines and that adherence to active play and electronic media use guidelines may be influenced by parental education.

An Implementation of Active Learning: Assessing the Effectiveness of the Team Infomercial Assignment

ERIC Educational Resources Information Center

Matveev, Alexei V.; Milter, Richard G.

2010-01-01

This article examines the effectiveness of the team infomercial assignment as an active learning tool in undergraduate courses. The structure and three phases of the team infomercial assignment, as well as student evaluations and feedback, are presented. We investigated student experiences working on the team infomercial assignment, the common…

42 CFR 485.916 - Condition of participation: Treatment team, person-centered active treatment plan, and...

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 5 2014-10-01 2014-10-01 false Condition of participation: Treatment team, person... Health Centers (CMHCs) § 485.916 Condition of participation: Treatment team, person-centered active treatment plan, and coordination of services. The CMHC must designate an interdisciplinary treatment team...

The Impact of an Antimicrobial Utilization Program on Antimicrobial Use at a Large Teaching Hospital: A Randomized Controlled Trial

PubMed Central

Camins, Bernard C.; King, Mark D.; Wells, Jane B.; Googe, Heidi L.; Patel, Manish; Kourbatova, Ekaterina V.; Blumberg, Henry M.

2009-01-01

Background Multidisciplinary antimicrobial utilization teams (AUT) have been proposed as a mechanism for improving antimicrobial use, but data on their efficacy remain limited. Objective To determine the impact of an AUT on antimicrobial use at a teaching hospital. Design Randomized controlled intervention trial. Setting A 953-bed public university-affiliated urban teaching hospital. Patients Patients who were prescribed selected antimicrobial agents (piperacillin-tazobactam, levofloxacin, or vancomycin) by internal medicine ward teams. Intervention Twelve internal medicine teams were randomized monthly: 6 teams to intervention group (academic detailing by the AUT), and 6 teams to a control group given indication-based guidelines for prescription of broad spectrum antimicrobials (standard of care) during a 10-month study period. Measurements Proportion of appropriate empiric, definitive (therapeutic), and end antimicrobial (overall) usage. Results A total of 784 new prescriptions of piperacillin-tazobactam, levofloxacin, and vancomycin were reviewed. The proportion of appropriate antimicrobial prescriptions written by the intervention teams was significantly higher than prescribed by the control teams: 82% vs. 73% for empiric (RR=1.14, 95% CI 1.04–1.24), 82% vs. 43% for definitive (RR=1.89, 95% CI 1.53–2.33), and 94% vs. 70% for end antimicrobial usage (RR=1.34, 95% CI 1.25–1.43). In a multivariate analysis, teams that received feedback from the AUT alone (aRR=1.37, 95% CI 1.27–1.48) or from both the AUT and the ID consult service (aRR=2.28, 95% CI 1.64–3.19) were significantly more likely to prescribe end antimicrobial usage appropriately compared to control teams. Conclusions A multidisciplinary AUT which provides feedback to prescribing physicians was an effective method in improving antimicrobial use. PMID:19712032

Prevalence of Low High-density Lipoprotein Cholesterol Among Adults, by Physical Activity: United States, 2011-2014.

PubMed

Zwald, Marissa L; Akinbami, Lara J; Fakhouri, Tala H I; Fryar, Chryl D

2017-03-01

Data from the National Health and Nutrition Examination Survey •The prevalence of low high-density lipoprotein (HDL) cholesterol was significantly higher among adults who did not meet recommended physical activity guidelines (21.0%) than adults who met the guidelines (17.7%). •Low HDL cholesterol prevalence differed significantly for both men and women by adherence to physical activity guidelines. •Prevalence of low HDL cholesterol declined as age increased for both those who did and did not meet the physical activity guidelines. •Non-Hispanic white and non-Hispanic black adults who did not meet the physical activity guidelines had a higher prevalence than those who met the guidelines. •Low HDL cholesterol prevalence declined with increasing education level regardless of adherence to physical activity guidelines. Regular physical activity can improve cholesterol levels among adults, including increasing high-density lipoprotein (HDL) cholesterol (1). HDL cholesterol is known as "good" cholesterol because high levels can reduce cardiovascular disease risk (2). The 2008 Physical Activity Guidelines for Americans recommend that adults engage in 150 minutes or more of moderate-intensity aerobic activity per week, 75 minutes of vigorous-intensity aerobic activity per week, or an equivalent combination (3). Adherence to these guidelines is expected to decrease the prevalence of low HDL cholesterol levels (4-8). This report presents national data for 2011-2014 on low HDL cholesterol prevalence among U.S. adults aged 20 and over, by whether they met these guidelines. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Nurse awareness of clinical research: a survey in a Japanese University Hospital

PubMed Central

2014-01-01

Background Clinical research plays an important role in establishing new treatments and improving the quality of medical practice. Since the introduction of the concept of clinical research coordinators (CRC) in Japan, investigators and CRC work as a clinical research team that coordinates with other professionals in clinical trials leading to drug approval (registration trials). Although clinical nurses collaborate with clinical research teams, extended clinical research teams that include clinical nurses may contribute to the ethical and scientific pursuit of clinical research. Methods As knowledge of clinical research is essential for establishing an extended clinical research team, we used questionnaires to survey the knowledge of clinical nurses at Tokushima University Hospital. Five-point and two-point scales were used. Questions as for various experiences were also included and the relationship between awareness and experiences were analyzed. Results Among the 597 nurses at Tokushima University Hospital, 453 (75.9%) responded to the questionnaires. In Japan, registration trials are regulated by pharmaceutical affairs laws, whereas other types of investigator-initiated research (clinical research) are conducted based on ethical guidelines outlined by the ministries of Japan. Approximately 90% of respondents were aware of registration trials and clinical research, but less than 40% of the nurses were aware of their difference. In clinical research terminology, most respondents were aware of informed consent and related issues, but ≤50% were aware of other things, such as the Declaration of Helsinki, ethical guidelines, Good Clinical Practice, institutional review boards, and ethics committees. We found no specific tendency in the relationship between awareness and past experiences, such as nursing patients who were participating in registration trials and/or clinical research or taking a part in research involving patients as a nursing student or a nurse. Conclusions These findings suggest that clinical nurses have only limited knowledge on clinical research and the importance to have chances to make nurses aware of clinical research-related issues is suggested to establish an extended research team. Because of the study limitations, further study is warranted to determine the role of clinical nurses in establishing a suitable infrastructure for ethical pursuit of clinical research. PMID:24989623

Serving up Success! Team Nutrition Days, 1997.

ERIC Educational Resources Information Center

Food and Nutrition Service (USDA), Washington, DC.

This publication presents success stories and actual activities from Team Nutrition Days 1997 to serve as a starting point for other schools wanting to create their own nutrition education activities. Team Nutrition Days was a 1-week celebration that used innovative, interactive activities to teach children that nutrition is the link between…

[Chemical and biological terrorism: psychological aspects, and guidelines for psychiatric preparedness].

PubMed

Bleich, Avi; Kutz, Ilan

2002-05-01

Chemical or biological terror may cause mass casualties, but the major damage of such a threat is related mainly to psychological terror. Anxiety and panic that accompany chemical or biological threat, may affect mass populations, disrupt their lives, and enormously increase the demands from the medical systems. In the case of real attack, such an increased demands may be critical, especially to the functional ability of hospitals. The Israeli experience, during the Persian Gulf war, concerning preparations to chemical attacks at the national level, was unique in its nature. In addition, the Scud missiles attacks, accompanied with non-conventional threat, supplied valuable information on the populations behavior, and on the needed preparations for similar threats. In the case of chemical or biological threat or attack, the main task of the psychiatrist is to treat stress and anxiety casualties. At the same time, he should be aware of the possibility that the psychological & behavioral symptoms may reflect organic brain damage due to the pathogenic agent, and that such a differential diagnosis may be life saving for the patient. Stress casualties will be referred from the ER, and treated by the mental health team, at a specifically designed "center for stress casualties". In addition, the psychiatrist will consult the medical teams, or sometimes directly intervene, with combined casualties, at other locations of the hospital. At the regional or community level, one should plane and exercise deployment and activation of multi-professional teams, including mental health, in existing installations designed for screening, treatment, and temporary containment of casualties. It is recommended that the head of the local authority, will be responsible for the preparations and activation of this formation. A planned and rational usage of the media may have a critical influence on the ability of the authorities to manage the crisis situation and on shaping the behavior of the population. In certain scenarios, the media may even serve as the main tool for calming and instructing the people being isolated at their homes.

What Performance Analysts Need to Know About Research Trends in Association Football (2012-2016): A Systematic Review.

PubMed

Sarmento, Hugo; Clemente, Filipe Manuel; Araújo, Duarte; Davids, Keith; McRobert, Allistair; Figueiredo, António

2018-04-01

Evolving patterns of match analysis research need to be systematically reviewed regularly since this area of work is burgeoning rapidly and studies can offer new insights to performance analysts if theoretically and coherently organized. The purpose of this paper was to conduct a systematic review of published articles on match analysis in adult male football, identify and organize common research topics, and synthesize the emerging patterns of work between 2012 and 2016, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The Web of Science database was searched for relevant published studies using the following keywords: 'football' and 'soccer', each one associated with the terms 'match analysis', 'performance analysis', 'notational analysis', 'game analysis', 'tactical analysis' and 'patterns of play'. Of 483 studies initially identified, 77 were fully reviewed and their outcome measures extracted and analyzed. Results showed that research mainly focused on (1) performance at set pieces, i.e. corner kicks, free kicks, penalty kicks; (2) collective system behaviours, captured by established variables such as team centroid (geometrical centre of a set of players) and team dispersion (quantification of how far players are apart), as well as tendencies for team communication (establishing networks based on passing sequences), sequential patterns (predicting future passing sequences), and group outcomes (relationships between match-related statistics and final match scores); and (3) activity profile of players, i.e. playing roles, effects of fatigue, substitutions during matches, and the effects of environmental constraints on performance, such as heat and altitude. From the previous review, novel variables were identified that require new measurement techniques. It is evident that the complexity engendered during performance in competitive soccer requires an integrated approach that considers multiple aspects. A challenge for researchers is to align these new measures with the needs of the coaches through a more integrated relationship between coaches and researchers, to produce practical and usable information that improves player performance and coach activity.

Quantifying the performance of individual players in a team activity.

PubMed

Duch, Jordi; Waitzman, Joshua S; Amaral, Luís A Nunes

2010-06-16

Teamwork is a fundamental aspect of many human activities, from business to art and from sports to science. Recent research suggest that team work is of crucial importance to cutting-edge scientific research, but little is known about how teamwork leads to greater creativity. Indeed, for many team activities, it is not even clear how to assign credit to individual team members. Remarkably, at least in the context of sports, there is usually a broad consensus on who are the top performers and on what qualifies as an outstanding performance. In order to determine how individual features can be quantified, and as a test bed for other team-based human activities, we analyze the performance of players in the European Cup 2008 soccer tournament. We develop a network approach that provides a powerful quantification of the contributions of individual players and of overall team performance. We hypothesize that generalizations of our approach could be useful in other contexts where quantification of the contributions of individual team members is important.

Project Application Guidelines for Alcohol and Other Drug Abuse Program Funding. Student Services, Prevention, and Wellness Team. Bulletin No. 95202.

ERIC Educational Resources Information Center

Wisconsin State Dept. of Public Instruction, Madison. Bureau for Pupil Services.

This publication provides information and application forms for alcohol and other drug abuse (AODA) funding. The contents include the following: Framework for Student Services, Prevention and Wellness; Abstracts of AODA Grants; Timetable for Grants; Criteria Applicable to all State AODA Grants; Criteria Specific to Aoda Program Grant; AODA…

Guidelines for Evaluating the Thermal Environment of Enclosed Spaces

DTIC Science & Technology

2009-09-01

space. Three studies of concrete tanks and metal containers, the High Mobility Multipurpose Wheeled Vehicle; and the Bradley Fighting Vehicle, are...24 13 The initial CST-WMD training site was a concrete casting site. The teams practiced entry and evacuation...Environmental Medicine (USARIEM) studies. Examples are presented from three case studies: one that involved monitoring large concrete septic tanks

Systemwide Aviation/Aerospace Education Program Review. Aviation/Aerospace Task Force's Report to the Oklahoma State Regents for Higher Education.

ERIC Educational Resources Information Center

Oklahoma State Regents for Higher Education, Oklahoma City.

A program review was done of all aviation/aerospace-related higher education programs in Oklahoma. A team of nine experts reviewed statistics on the state's public and private programs, conducted a survey of institutions on industry status and projected training needs, and visited all 10 program locations. The project applied guidelines to…

Designing Services and Programs for High-Ability Learners. A Guidebook for Gifted Education

ERIC Educational Resources Information Center

Purcell, Jeanne H., Ed.; Eckert, Rebecca D., Ed.

2005-01-01

This book will help the reader every step of the way with detailed guidelines, practical tips, templates, action plans, and suggestions for strategic planning teams as well as for the sole practitioner. Consolidating the sage advice and up-to-date research of 29 leaders in the field, this comprehensive and highly practical guide takes the…

JPRS Report Soviet Union Political Affairs.

DTIC Science & Technology

1990-07-27

consciousness. Under these conditions the unresolved state of many social, political, and national problems acquired a special urgency . Meanwhile, the...whole. These errors consist entirely of crude distortions of party policy guidelines. And the tragic mistakes of recent years represent depar - tures...kolkhozes, medical institutions and even the soccer team. And so, there is a great discrepancy between words and actions with respect to mutual

Guidelines for the Administration of Educational Programs for Students Who Are Deaf/Hard of Hearing, Visually Impaired, or Deafblind

ERIC Educational Resources Information Center

Bruce, Susan; Ferrell, Kay; Luckner, John L.

2016-01-01

This paper presents the essential programming components resulting from a systematic review of research studies, legislation, and policy documents on the topic of administration issues in educational programming for students who are deaf/hard of hearing, visually impaired, or deafblind. It is recommended that educational teams should include a…

The role and structure of the multidisciplinary team in the management of advanced Parkinson’s disease with a focus on the use of levodopa–carbidopa intestinal gel

PubMed Central

Pedersen, Stephen W; Suedmeyer, Martin; Liu, Louis W C; Domagk, Dirk; Forbes, Alison; Bergmann, Lars; Onuk, Koray; Yegin, Ashley; van Laar, Teus

2017-01-01

A multidisciplinary team (MDT) approach is increasingly recommended in Parkinson’s disease (PD) treatment guidelines, but no standard of care exists for such an approach, and the guidelines do not provide clarification on how it should be implemented. This paper reviews evidence of MDT interventions in people with PD and provides expert clinical perspectives for an MDT approach, with a focus on advanced PD and levodopa–carbidopa intestinal gel (carbidopa–levodopa enteral suspension in the USA). The key recommendations are to enable the best possible treatment of people with PD locally by facilitating a close structured collaboration of different health care professionals working in a fixed network structure; to refer people with PD to established MDT centers in a timely manner; to establish regular meetings for the MDT enabling interdisciplinary exchange and learning; to optimize individual treatment and carefully evaluate available treatment options; to ensure treatment decisions are agreed jointly between people with PD, their caregivers, family, and health care professional; and to include specialists outside of neurology from adjuvant medical departments as necessary when implementing advanced therapies. PMID:28115853

Physical activity during pregnancy: impact of applying different physical activity guidelines.

PubMed

Smith, Katie M; Campbell, Christina G

2013-01-01

Multiple guidelines and definitions of physical activity (PA) have been used to study the benefits of activity during pregnancy. The different guidelines lead to a wide range of prevalence estimates and this has led to conflicting reports about activity patterns during pregnancy. A longitudinal study was conducted to assess PA using a pattern-recognition monitor for a 7-day period at week 18 (n = 55) and week 35 (n = 66) of pregnancy. The amount of activity performed and the number of women meeting six different PA guidelines were evaluated. Adherence to PA guidelines ranged from 5 to 100% and 9 to 100% at weeks 18 and 35, respectively. All women achieved the 500 MET-minute guideline and nearly all women accumulated ≥150 minutes of weekly moderate-vigorous physical activity (MVPA) at both time points. Only 22% and 26% participated in ≥3 sessions of MVPA lasting ≥30 minutes at both time points and this further declined to 5% and 9% when the guideline was increased to ≥5 sessions of 30 minutes. The amount of PA during pregnancy varied drastically depending on which guideline was used. Further research is warranted to clearly identify the patterns of activity that are associated with healthy pregnancy outcomes.

Physical Activity during Pregnancy: Impact of Applying Different Physical Activity Guidelines

PubMed Central

Smith, Katie M.; Campbell, Christina G.

2013-01-01

Multiple guidelines and definitions of physical activity (PA) have been used to study the benefits of activity during pregnancy. The different guidelines lead to a wide range of prevalence estimates and this has led to conflicting reports about activity patterns during pregnancy. A longitudinal study was conducted to assess PA using a pattern-recognition monitor for a 7-day period at week 18 (n = 55) and week 35 (n = 66) of pregnancy. The amount of activity performed and the number of women meeting six different PA guidelines were evaluated. Adherence to PA guidelines ranged from 5 to 100% and 9 to 100% at weeks 18 and 35, respectively. All women achieved the 500 MET-minute guideline and nearly all women accumulated ≥150 minutes of weekly moderate-vigorous physical activity (MVPA) at both time points. Only 22% and 26% participated in ≥3 sessions of MVPA lasting ≥30 minutes at both time points and this further declined to 5% and 9% when the guideline was increased to ≥5 sessions of 30 minutes. The amount of PA during pregnancy varied drastically depending on which guideline was used. Further research is warranted to clearly identify the patterns of activity that are associated with healthy pregnancy outcomes. PMID:23476778

Team Up at Home. Team Nutrition Activity Booklet. Fun Nutrition Activities for the Family.

ERIC Educational Resources Information Center

Food and Consumer Service (USDA), Washington, DC.

This guide booklet helps parents teach their children about healthy nutrition at home. It is part of the U.S. Department of Agriculture's Team Nutrition, which is designed to improve the health and education of children and which actively involves children and their families in nutrition education activities in the school, community, and home. The…

[Attendance and the change in the praxis of rehabilitation: a study of Centers of Reference in Rehabilitation in the network of the Unified Health System in Belo Horizonte, State of Minas Gerais, Brazil].

PubMed

Mitre, Sandra Minardi; Andrade, Eli Iola Gurgel; Cotta, Rosângela Minardi Mitre

2013-07-01

The rehabilitation centers have emerged and become legitimized in the biomedical model, which from the implementation of attendance, namely the operational guidelines of the national policy of humanization in care and management of the Unified Health System (SUS), have been seeking changes to ensure humanized access and the resolution of health problems. The aim of this study was to analyze the attendance in Rehabilitation Centers of Reference (CCR) of SUS in Belo Horizonte (MG), from the perspectives of professionals and patients. Using a qualitative approach, the research was carried out from August 9 to December 27, 2010, in three CRRs. For data collection, focus groups were conducted with 21 professionals and interviews with 30 patients. This study showed that the current biomedical model in the view of professionals restricts its activities in attendance, limiting the participation and autonomy of patients. The attendance has led to reflections and questions when broadening the vision and governability of the teams. The results reveal the need to equip teams for the construction of innovative practices through ongoing education and the creation of protected spaces for reflection and discussion.

A pragmatic cluster randomized controlled trial of early intervention for chronic obstructive pulmonary disease by practice nurse-general practitioner teams: Study Protocol

PubMed Central

2012-01-01

Background Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of disability, hospitalization, and premature mortality. General practice is well placed to diagnose and manage COPD, but there is a significant gap between evidence and current practice, with a low level of awareness and implementation of clinical practice guidelines. Under-diagnosis of COPD is a world-wide problem, limiting the benefit that could potentially be achieved through early intervention strategies such as smoking cessation, dietary advice, and exercise. General practice is moving towards more structured chronic disease management, and the increasing involvement of practice nurses in delivering chronic care. Design A pragmatic cluster randomised trial will test the hypothesis that intervention by a practice nurse-general practitioner (GP) team leads to improved health-related quality of life and greater adherence with clinical practice guidelines for patients with newly-diagnosed COPD, compared with usual care. Forty general practices in greater metropolitan Sydney Australia will be recruited to identify patients at risk of COPD and invite them to attend a case finding appointment. Practices will be randomised to deliver either practice nurse-GP partnership care, or usual care, to patients newly-diagnosed with COPD. The active intervention will involve the practice nurse and GP working in partnership with the patient in developing and implementing a care plan involving (as appropriate), smoking cessation, immunisation, pulmonary rehabilitation, medication review, assessment and correction of inhaler technique, nutritional advice, management of psycho-social issues, patient education, and management of co-morbidities. The primary outcome measure is health-related quality of life, assessed with the St George’s Respiratory Questionnaire 12 months after diagnosis. Secondary outcome measures include validated disease-specific and general health related quality of life measures, smoking and immunisation status, medications, inhaler technique, and lung function. Outcomes will be assessed by project officers blinded to patients’ randomization groups. Discussion This study will use proven case-finding methods to identify patients with undiagnosed COPD in general practice, where improved care has the potential for substantial benefit in health and healthcare utilization. The study provides the capacity to trial a new model of team-based assessment and management of newly diagnosed COPD in Australian primary care. Trial registration ACTRN12610000592044\\ PMID:22958678

Interprofessional collaborative practice within cancer teams: Translating evidence into action. A mixed methods study protocol

PubMed Central

2010-01-01

Background A regional integrated cancer network has implemented a program (educational workshops, reflective and mentoring activities) designed to support the uptake of evidence-informed interprofessional collaborative practices (referred to in this text as EIPCP) within cancer teams. This research project, which relates to the Registered Nurses' Association of Ontario (RNAO) Best Practice Guidelines and other sources of research evidence, represents a unique opportunity to learn more about the factors and processes involved in the translation of evidence-based recommendations into professional practices. The planned study seeks to address context-specific challenges and the concerns of nurses and other stakeholders regarding the uptake of evidence-based recommendations to effectively promote and support interprofessional collaborative practices. Aim This study aims to examine the uptake of evidence-based recommendations from best practice guidelines intended to enhance interprofessional collaborative practices within cancer teams. Design The planned study constitutes a practical trial, defined as a trial designed to provide comprehensive information that is grounded in real-world healthcare dynamics. An exploratory mixed methods study design will be used. It will involve collecting quantitative data to assess professionals' knowledge and attitudes, as well as practice environment factors associated with effective uptake of evidence-based recommendations. Semi-structured interviews will be conducted concurrently with care providers to gather qualitative data for describing the processes involved in the translation of evidence into action from both the users' (n = 12) and providers' (n = 24) perspectives. The Graham et al. Ottawa Model of Research Use will serve to construct operational definitions of concepts, and to establish the initial coding labels to be used in the thematic analysis of the qualitative data. Quantitative and qualitative results will be merged during interpretation to provide complementary perspectives of interrelated contextual factors that enhance the uptake of EIPCP and changes in professional practices. Discussion The information obtained from the study will produce new knowledge on the interventions and sources of support most conducive to the uptake of evidence and building of capacity to sustain new interprofessional collaborative practice patterns. It will provide new information on strategies for overcoming barriers to evidence-informed interventions. The findings will also pinpoint critical determinants of 'what works and why' taking into account the interplay between evidence, operational, relational micro-processes of care, uniqueness of patients' needs and preferences, and the local context. PMID:20626858

Using UAVs to Conduct Student-led Research Projects

NASA Astrophysics Data System (ADS)

Olds, S. E.; Lewis, P. M., Jr.

2016-12-01

Recreational drones can inspire students to initiate research projects. These "toys" have a low cost (<$100), low weight (< 250 g, so do not require FAA registration), and an ability to carry small instrument packages, making them an ideal platform for conducting innovative investigations. This session describes an initiative by the Federation of Earth Science Information Partners (ESIP) Education Committee to compile and distribute a free e-book that will encourage learners to use drones for science investigations. Our goal is to inspire learners to use UAVs to carry scientific instruments and/or capture imagery to conduct local-scale investigations. Experiments such as discovering their vehicle's maximum payload help learners understand what sensors they can use (or build) to conduct research. The e-book will encourage learners to practice UAV civility and safety through a pre-flight checklist and flying guidelines, and to consider science objectives and flight team roles in performing investigations. Activities also advocate for robust data and metadata-collection practices. Suggested activities encompass repeat photography investigations as well as engineering design skills such as designing a camera mount to obtain nadir or oblique imagery. Learners can also move to more sophisticated research using photogrammetric skills such as taking overlapping photographs to create 3D structure from motion (SfM) models. To encourage the use of onboard sensors, the team worked with an engineer to build a 33-gram prototype environmental logger called SABEL (Shelley [Olds] and Bob [Ellis]'s Environmental Logger). Assembled on an Arduino board, SABEL collects temperature, humidity, and GPS position. This presentation will provide examples of student-led investigations, instructions for building the SABEL sensor package, and the status of the new e-book compilation of student-focused activities using recreational drones to pursue science, math, engineering, and technology research investigations.

[Comments on the seven clinical questions & answers in Japanese gastric treatment guidelines of the 4th edition].

PubMed

Xu, J M

2017-03-23

Japanese gastric cancer treatment guidelines of the 4th Edition proposed solutions to 7 clinically contentious questions. However, the solutions to question 1-3 are not complete and may cause ambiguity. In order to avoid the wrong choice of surgical resection, the solutions to question 1-3 should be clearly defined. For question 1-3, we suggest provisos be added such as patients with resectable M1 disease and without any other non-curable factors, after whose status and tumor biological behavior being fully understood and being fully discussed by a multidisciplinary team, can be recommended to receive comprehensive treatment including surgical resection.

Clinical practice guidelines for the management of acute limb compartment syndrome following trauma.

PubMed

Wall, Christopher J; Lynch, Joan; Harris, Ian A; Richardson, Martin D; Brand, Caroline; Lowe, Adrian J; Sugrue, Michael

2010-03-01

Acute compartment syndrome is a serious and not uncommon complication of limb trauma. The condition is a surgical emergency, and is associated with significant morbidity if not managed appropriately. There is variation in management of acute limb compartment syndrome in Australia. Clinical practice guidelines for the management of acute limb compartment syndrome following trauma were developed in accordance with Australian National Health and Medical Research Council recommendations. The guidelines were based on critically appraised literature evidence and the consensus opinion of a multidisciplinary team involved in trauma management who met in a nominal panel process. Recommendations were developed for key decision nodes in the patient care pathway, including methods of diagnosis in alert and unconscious patients, appropriate assessment of compartment pressure, timing and technique of fasciotomy, fasciotomy wound management, and prevention of compartment syndrome in patients with limb injuries. The recommendations were largely consensus based in the absence of well-designed clinical trial evidence. Clinical practice guidelines for the management of acute limb compartment syndrome following trauma have been developed that will support consistency in management and optimize patient health outcomes.

Failure to activate the in-hospital emergency team: causes and outcomes.

PubMed

Barbosa, Vera; Gomes, Ernestina; Vaz, Senio; Azevedo, Gustavo; Fernandes, Gonçalo; Ferreira, Amélia; Araujo, Rui

2016-01-01

To determine the incidence of afferent limb failure of the in-hospital Medical Emergency Team, characterizing it and comparing the mortality between the population experiencing afferent limb failure and the population not experiencing afferent limb failure. A total of 478 activations of the Medical Emergency Team of Hospital Pedro Hispano occurred from January 2013 to July 2015. A sample of 285 activations was obtained after excluding incomplete records and activations for patients with less than 6 hours of hospitalization. The sample was divided into two groups: the group experiencing afferent limb failure and the group not experiencing afferent limb failure of the Medical Emergency Team. Both populations were characterized and compared. Statistical significance was set at p ≤ 0.05. Afferent limb failure was observed in 22.1% of activations. The causal analysis revealed significant differences in Medical Emergency Team activation criteria (p = 0.003) in the group experiencing afferent limb failure, with higher rates of Medical Emergency Team activation for cardiac arrest and cardiovascular dysfunction. Regarding patient outcomes, the group experiencing afferent limb failure had higher immediate mortality rates and higher mortality rates at hospital discharge, with no significant differences. No significant differences were found for the other parameters. The incidence of cardiac arrest and the mortality rate were higher in patients experiencing failure of the afferent limb of the Medical Emergency Team. This study highlights the need for health units to invest in the training of all healthcare professionals regarding the Medical Emergency Team activation criteria and emergency medical response system operations.

Reducing Teenage Binge Drinking and Drunk Driving on the Reservation: The Pikanii Action Team

ERIC Educational Resources Information Center

Still Smoking, Dorothy; Bull Shoe, Debbie Whitegrass

2012-01-01

The Pikanii Action Team project addressed the issues of teenage drinking and drunk driving on the Blackfeet Reservation. Basing their actions on locally-generated research, the Pikanii Action Team conducted a series of activities and initiatives to promote public awareness and action related to high-risk activities related to drinking. The team's…

Parent-child attitude congruence on type and intensity of physical activity: testing multiple mediators of sedentary behavior in older children.

PubMed

Anderson, Cheryl B; Hughes, Sheryl O; Fuemmeler, Bernard F

2009-07-01

This study examined parent-child attitudes on value of specific types and intensities of physical activity, which may explain gender differences in child activity, and evaluated physical activity as a mechanism to reduce time spent in sedentary behaviors. A community sample of 681 parents and 433 children (mean age 9.9 years) reported attitudes on importance of vigorous and moderate intensity team and individually performed sports/activities, as well as household chores. Separate structural models (LISREL 8.7) for girls and boys tested whether parental attitudes were related to child TV and computer via child attitudes, sport team participation, and physical activity, controlling for demographic factors. Child 7-day physical activity, sport teams, weekly TV, computer. Parent-child attitude congruence was more prevalent among boys, and attitudes varied by ethnicity, parent education, and number of children. Positive parent-child attitudes for vigorous team sports were related to increased team participation and physical activity, as well as reduced TV and computer in boys and girls. Value of moderate intensity household chores, such as cleaning house and doing laundry, was related to decreased team participation and increased TV in boys. Only organized team sports, not general physical activity, was related to reduced TV and computer. Results support parents' role in socializing children's achievement task values, affecting child activity by transferring specific attitudes. Value of vigorous intensity sports provided the most benefits to activity and reduction of sedentary behavior, while valuing household chores had unexpected negative effects.

Consequences of team charter quality: Teamwork mental model similarity and team viability in engineering design student teams

NASA Astrophysics Data System (ADS)

Conway Hughston, Veronica

Since 1996 ABET has mandated that undergraduate engineering degree granting institutions focus on learning outcomes such as professional skills (i.e. solving unstructured problems and working in teams). As a result, engineering curricula were restructured to include team based learning---including team charters. Team charters were diffused into engineering education as one of many instructional activities to meet the ABET accreditation mandates. However, the implementation and execution of team charters into engineering team based classes has been inconsistent and accepted without empirical evidence of the consequences. The purpose of the current study was to investigate team effectiveness, operationalized as team viability, as an outcome of team charter implementation in an undergraduate engineering team based design course. Two research questions were the focus of the study: a) What is the relationship between team charter quality and viability in engineering student teams, and b) What is the relationship among team charter quality, teamwork mental model similarity, and viability in engineering student teams? Thirty-eight intact teams, 23 treatment and 15 comparison, participated in the investigation. Treatment teams attended a team charter lecture, and completed a team charter homework assignment. Each team charter was assessed and assigned a quality score. Comparison teams did not join the lecture, and were not asked to create a team charter. All teams completed each data collection phase: a) similarity rating pretest; b) similarity posttest; and c) team viability survey. Findings indicate that team viability was higher in teams that attended the lecture and completed the charter assignment. Teams with higher quality team charter scores reported higher levels of team viability than teams with lower quality charter scores. Lastly, no evidence was found to support teamwork mental model similarity as a partial mediator of the team charter quality on team viability relationship. Foci for future research opportunities include using: a) online data collection methods to improve participant adherence to similarity rating instructions; b) story or narratives during pre- and posttest similarity rating data collection to create common levels of contextual perception; and c) support to ensure charters are integrated into the full project life cycle, not just a pre-project one time isolated activity. Twenty five sections, on average, of EDSGN 100 are taught each spring and fall semester. Consistent instructor expectations are set for the technical aspects of the course. However, ideas to foster team effectiveness are often left to the discretion of the individual instructor. Implementing empirically tested team effectiveness instructional activities would bring consistency to EDGSN 100 curriculum. Other instructional activities that would be of benefit to engineering educators include qualitative inquiry---asking intrateam process questions (at the mid-point of the project) and in-class reflection---dedicated time, post project, to discuss what went well/not well within the team.

Compliance with a pediatric clinical practice guideline for intravenous fluid and electrolyte administration.

PubMed

Hurdowar, Amanda; Urmson, Lynn; Bohn, Desmond; Geary, Denis; Laxer, Ronald; Stevens, Polly

2009-01-01

The occurrence of acute hyponatremia associated with cerebral edema in hospitalized children has been increasingly recognized, with over 50 cases of neurological morbidity and mortality reported in the past decade. This condition most commonly occurs in previously healthy children where maintenance intravenous (IV) fluids have been prescribed in the form of hypotonic saline (e.g., 0.2 or 0.3 NaCl). In response to similar problems at The Hospital for Sick Children (six identified through hospital morbidity and mortality reviews and safety reports prior to fall 2007), an interdisciplinary clinician group from our institution developed a clinical practice guideline (CPG) to guide fluid and electrolyte administration for pediatric patients. This article reviews the evaluation of one patient safety improvement to change the prescribing practice for IV fluids in an acute care pediatric hospital, including the removal of the ability to prescribe hypotonic IV solutions with a sodium concentration of < 75 mmol/L. The evaluation of key components of the CPG included measuring practice and process changes pre- and post-implementation. The evaluation showed that the use of restricted IV fluids was significantly reduced across the organization. Success factors of this safety initiative included the CPG development, forcing functions, reminders, team engagement and support from the hospital leadership. A key learning was that a project leader with considerable dedicated time is required during the implementation to develop change concepts, organize and liaise with stakeholders and measure changes in practice. This project highlights the importance of active implementation for policy and guideline documents.

Enhancing Key Competencies of Health Professionals in the Assessment and Care of Adults at Risk of Suicide Through Education and Technology.

PubMed

Ryan, Kathryn; Tindall, Claudia; Strudwick, Gillian

This article describes efforts undertaken to improve the clinical competencies of health professionals in the area of suicide risk assessment, documentation, and care planning. Best practices that fit the mental health and addictions setting were identified from the Registered Nurses' Association of Ontario Best Practice Guideline on Assessment and Care of Adults at Risk for Suicidal Ideation and Behaviour. A variety of methods were used to implement the guidelines at the Centre for Addiction and Mental Health in Toronto, Ontario, Canada. These included 3 in-person educational modules, an e-learning module, and the creation of an electronic health record suicide risk assessment documentation form. Results showed that interprofessional team members improved their suicide awareness and increased their confidence and knowledge in suicide risk assessment and the identification of interventions for clients at risk. Organizational level performance and quality improvement activities after implementation of the education and the electronic suicide risk assessment documentation form are being implemented through a collaboration between performance improvement, clinical education and informatics, and professional practice. The success of an interprofessional educational program of this nature is dependent on the collaboration of a number of stakeholders from a variety of areas of the organization.

The Impact of System Factors on Quality and Safety in Arterial Surgery: A Systematic Review.

PubMed

Lear, R; Godfrey, A D; Riga, C; Norton, C; Vincent, C; Bicknell, C D

2017-07-01

A systems approach to patient safety proposes that a wide range of factors contribute to surgical outcome, yet the impact of team, work environment, and organisational factors, is not fully understood in arterial surgery. The aim of this systematic review is to summarize and discuss what is already known about the impact of system factors on quality and safety in arterial surgery. A systematic review of original research papers in English using MEDLINE, Embase, PsycINFO, and Cochrane databases, was performed according to PRISMA guidelines. Independent reviewers selected papers according to strict inclusion and exclusion criteria, and using predefined data fields, extracted relevant data on team, work environment, and organisational factors, and measures of quality and/or safety, in arterial procedures. Twelve papers met the selection criteria. Study endpoints were not consistent between papers, and most failed to report their clinical significance. A variety of tools were used to measure team skills in five papers; only one paper measured the relationship between team factors and patient outcomes. Two papers reported that equipment failures were common and had a significant impact on operating room efficiency. The influence of hospital characteristics on failure-to-rescue rates was tested in one large study, although their conclusions were limited to the American Medicare population. Five papers implemented changes in the patient pathway, but most studies failed to account for potential confounding variables. A small number of heterogenous studies have evaluated the relationship between system factors and quality or safety in arterial surgery. There is some evidence of an association between system factors and patient outcomes, but there is more work to be done to fully understand this relationship. Future research would benefit from consistency in definitions, the use of validated assessment tools, measurement of clinically relevant endpoints, and adherence to national reporting guidelines. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Cancer multidisciplinary team meetings in practice: Results from a multi-institutional quantitative survey and implications for policy change.

PubMed

Rankin, Nicole M; Lai, Michelle; Miller, Danielle; Beale, Philip; Spigelman, Allan; Prest, Gabrielle; Turley, Kim; Simes, John

2018-02-01

Multidisciplinary care is advocated as best practice in cancer care. Relatively little is documented about multidisciplinary team (MDT) meeting functioning, decision making and the use of evidence to support decision making in Australia. This descriptive study aimed to examine team functioning, the role of team meetings and evidence use in MDTs whose institutions are members of Sydney Catalyst Translational Cancer Research Centre. We designed a structured 40-item survey instrument about topics that included meeting purpose, organization, resources and documentation; caseload estimates; use of evidence and quality assurance; patient involvement and supportive care needs; and open-ended items about the MDTs strengths and weaknesses. Participants were invited to participate via email and the survey was administered online. Data were analyzed using descriptive and comparative statistics. Thirty-seven MDTs from seven hospitals participated (100% response) and represented common (70%) and rare tumor groups (30%). MDT meeting purpose was reported as treatment (100%) or diagnostic decision making (88%), or for education purposes (70%). Most MDTs based treatment decisions on group consensus (92%), adherence to clinical practice guidelines (57%) or other evidence-based medicine sources (33%). The majority of MDTs discussed only a proportion of new patients at each meeting emphasizing the importance of educational aspects for other cases. Barriers exist in the availability of data to enable audit and reflection on evidence-based practice. MDT strengths included collaboration and quality discussion about patients. MDT meetings focus on treatment decision making, with group consensus playing a significant role in translating research evidence from guidelines into clinical decision making. With a varying proportion of patients discussed in each MDT meeting, a wider audit of multidisciplinary care would enable more accurate assessments of whether treatment recommendations are in accordance with best-practice evidence. © 2017 John Wiley & Sons Australia, Ltd.

Multidisciplinary Training on Spiritual Care for Patients in Palliative Care Trajectories Improves the Attitudes and Competencies of Hospital Medical Staff: Results of a Quasi-Experimental Study.

PubMed

van de Geer, Joep; Veeger, Nic; Groot, Marieke; Zock, Hetty; Leget, Carlo; Prins, Jelle; Vissers, Kris

2018-02-01

Patients value health-care professionals' attention to their spiritual needs. However, this is undervalued in health-care professionals' education. Additional training is essential for implementation of a national multidisciplinary guideline on spiritual care (SC) in palliative care (PC). Aim of this study is to measure effects of a training program on SC in PC based on the guideline. A pragmatic multicenter trial using a quasi-experimental pretest-posttest design as part of an action research study. Eight multidisciplinary teams in regular wards and 1 team of PC consultants, in 8 Dutch teaching hospitals, received questionnaires before training about perceived barriers for SC, spiritual attitudes and involvement, and SC competencies. The effect on the barriers on SC and SC competencies were measured both 1 and 6 months after the training. For nurses (n = 214), 7 of 8 barriers to SC were decreased after 1 month, but only 2 were still after 6 months. For physicians (n = 41), the training had no effect on the barriers to SC. Nurses improved in 4 of 6 competencies after both 1 and 6 months. Physicians improved in 3 of 6 competencies after 1 month but in only 1 competency after 6 months. Concise SC training programs for clinical teams can effect quality of care, by improving hospital staff competencies and decreasing the barriers they perceive. Differences in the effects of the SC training on nurses and physicians show the need for further research on physicians' educational needs on SC.

NASA technology applications team: Applications of aerospace technology

NASA Technical Reports Server (NTRS)

1993-01-01

This report covers the activities of the Research Triangle Institute (RTI) Technology Applications Team for the period 1 October 1992 through 30 September 1993. The work reported herein was supported by the National Aeronautics and Space Administration (NASA), Contract No. NASW-4367. Highlights of the RTI Applications Team activities over the past year are presented in Section 1.0. The Team's progress in fulfilling the requirements of the contract is summarized in Section 2.0. In addition to our market-driven approach to applications project development, RTI has placed increased effort on activities to commercialize technologies developed at NASA Centers. These Technology Commercialization efforts are summarized in Section 3.0. New problem statements prepared by the Team in the reporting period are presented in Section 4.0. The Team's transfer activities for ongoing projects with the NASA Centers are presented in Section 5.0. Section 6.0 summarizes the status of four add-on tasks. Travel for the reporting period is described in Section 7.0. The RTI Team staff and consultants and their project responsibilities are listed in Appendix A. Appendix B includes Technology Opportunity Announcements and Spinoff! Sheets prepared by the Team while Appendix C contains a series of technology transfer articles prepared by the Team.

Tracking dynamic team activity

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

Tambe, M.

1996-12-31

AI researchers are striving to build complex multi-agent worlds with intended applications ranging from the RoboCup robotic soccer tournaments, to interactive virtual theatre, to large-scale real-world battlefield simulations. Agent tracking - monitoring other agent`s actions and inferring their higher-level goals and intentions - is a central requirement in such worlds. While previous work has mostly focused on tracking individual agents, this paper goes beyond by focusing on agent teams. Team tracking poses the challenge of tracking a team`s joint goals and plans. Dynamic, real-time environments add to the challenge, as ambiguities have to be resolved in real-time. The central hypothesismore » underlying the present work is that an explicit team-oriented perspective enables effective team tracking. This hypothesis is instantiated using the model tracing technology employed in tracking individual agents. Thus, to track team activities, team models are put to service. Team models are a concrete application of the joint intentions framework and enable an agent to track team activities, regardless of the agent`s being a collaborative participant or a non-participant in the team. To facilitate real-time ambiguity resolution with team models: (i) aspects of tracking are cast as constraint satisfaction problems to exploit constraint propagation techniques; and (ii) a cost minimality criterion is applied to constrain tracking search. Empirical results from two separate tasks in real-world, dynamic environments one collaborative and one competitive - are provided.« less

The forgotten guidelines: cross-sectional analysis of participation in muscle strengthening and balance & co-ordination activities by adults and older adults in Scotland.

PubMed

Strain, Tessa; Fitzsimons, Claire; Kelly, Paul; Mutrie, Nanette

2016-10-21

In 2011, the UK physical activity guidelines were updated to include recommendations for muscle strengthening and balance & coordination (at least two sessions of relevant activities per week). However, monitoring and policy efforts remain focussed on aerobic activity. This study aimed to assess differences by gender and age in the a) prevalence of muscle strengthening and balance & co-ordination guidelines, and b) participation in guideline-specific activities. The sample for the muscle strengthening analyses was 10,488 adult (16-64 years) and 3857 older adult (≥65 years) 2012-2014 Scottish Health Survey respondents. The balance & co-ordination analyses used only the older adult responses. Differences by gender and (where possible) age in guideline prevalence and activity participation were assessed using logistic regression and t-tests. Thirty-one percent of men and 24 % of women met the muscle strengthening guideline, approximately half that of published figures for aerobic physical activity. Nineteen percent of older men and 12 % of older women met the balance & co-ordination guidelines. The oldest age groups were less likely to meet both guidelines compared to the youngest age groups. Differences by gender were only evident for muscle strengthening: more men met the guidelines than women in all age groups, with the largest difference amongst 16-24 year olds (55 % men compared with 40 % women). Participation in relevant activities differed by gender for both guidelines. 'Workout at gym' was the most popular activity to improve muscle strength for men (18 % participated), while swimming was for women (15 % participated). Golf was the most popular activity to improve balance & co-ordination for older men (11 % participated) and aerobics was for older women (6 % participated). Participation decreased in most muscle strengthening activities for both men and women. One exception was golf, where participation levels were as high amongst older men as in younger age groups, although overall levels were low (3 % of all men). Physical activity policy should aim to increase prevalence of these 'forgotten' guidelines, particularly amongst young women (for muscle strengthening) and older age groups (both guidelines). Gender and age participation differences should be considered when designing population-level interventions.

The Development and Content of the "2008 Physical Activity Guidelines for Americans"

ERIC Educational Resources Information Center

Buchner, David M.

2014-01-01

The U.S. Department of Health and Human Services' "2008 Physical Activity Guidelines for Americans" represents a major milestone in public health efforts to address inactivity. These comprehensive federal physical activity guidelines affirm the strong scientific evidence for the health benefits of regular physical activity. The…

[Prevention in the building sites of the District of Sondrio].

PubMed

Pellei, B; Pattarin, R

2006-01-01

Building is one of the most important activities inside the local productive reality; the PSAL Service has therefore had to face the sector intervention prearranging a specific methodology, which would aim at involving all the people in charge of roles and authority in this field, finding out a way that, starting from the epidemiological evaluation of accidents, would become positive making the shared preventive standards, into which the watch activity, the training of the employers, workers and professionals, the effective involvement of public contract giving stations would be concentrated, well-grounded. The first results of such an important engagement are ripening: there are still some mortal accidents but as far as the other cases are concerned we point out that all the points on which the watch activity has been concentrated (fall of people and of gravel from high points, contact with working elements of the installations, etc.) are constantly decreasing. The estimation of the risk priority has been carried out under mandate from the Procura della Repubblica resulting in the establishment of a table in which all the main working conditions with a high risk of people and gravel fall from high points, transformed into a special Criminal Investigation Department Directive on the cases on which to concentrate the intervention and in the presence of which to distrain upon/to operate sequestration. The involvement of various people in charge of prevention in the yard has occurred during the District Commission of Coordination ex art. 27 DLgs626/94 (ex article 27 Law626/94) which, thanks to a proper Building Working Team, has divided the above mentioned Directive of the Procura della Repubblica into guidelines addressed to each component and consequently into the training of the categories involved. Therefore, a guideline for the building constructors has been produced in 2000; such guideline has been adapted to professionals in 2001; a series of enterprises concerning capillary agreement with the Local administration in order to point out the essential problems regarding prevention inside the administrative procedures concerning the management of the public contracts in the field of security are being carried out since 2002.

Consumer response to healthy eating, physical activity and weight-related recommendations: a systematic review.

PubMed

Boylan, S; Louie, J C Y; Gill, T P

2012-07-01

Strong evidence linking poor diet and lack of physical activity to risk of obesity and related chronic disease has supported the development and promotion of guidelines to improve population health. Still, obesity continues to escalate as a major health concern, and so the impact of weight-related guidelines on behaviour is unclear. The aim of this review was to examine consumer response to weight-related guidelines. A systematic literature search was performed using Medline, PsycInfo, ProQuest Central and additional searches using Google and reference lists. Of the 1,765 articles identified, 46 relevant titles were included. Most studies examined attitudes towards content, source, tailoring and comprehension of dietary guidelines. Many respondents reported that guidelines were confusing, and that simple, clear, specific, realistic, and in some cases, tailored guidelines are required. Recognition of guidelines did not signify understanding nor did perceived credibility of a source guarantee utilization of guidelines. There was a lack of studies assessing: the impact of guidelines on behaviour; responses to physical activity guidelines; responses among males and studies undertaken in developing countries. Further research is needed, in particular regarding responses to physical activity guidelines and guidelines in different populations. Communication professionals should assist health professionals in the development of accurate and effective weight-related guidelines. © 2012 The Authors. obesity reviews © 2012 International Association for the Study of Obesity.

Quality of Author Guidelines in Nursing Journals

PubMed Central

Nicoll, Leslie H.; Chinn, Peggy L.; Conklin, Jamie L.; McCarty, Midori; Amarasekara, Sathya

2018-01-01

Abstract Purpose The aims of this study were to (a) describe the information provided in author guidelines in nursing journals, (b) assess the completeness of this information, and (c) identify the extent and types of reporting guidelines used in nursing journals. Design Content analysis of author guidelines for 245 nursing journals included in the Directory of Nursing Journals maintained at the International Academy of Nursing Editors website. Methods Using Research Electronic Data Capture, data on 19 criteria for completeness were extracted from published author guidelines. Additional details about journal requirements, such as allowed length of manuscripts and format for the abstract, were also recorded. Reliability was established by simultaneous review of 25 journals (10%) by the research assistant and a senior member of the research team. Findings Author guidelines were easily accessible at journal websites or through links to download the information. A majority (73.5%) had completeness scores of 75% or higher; six journals had guidelines that were 100% complete. Half of the journals used the American Psychological Association reference style, and 26.3% used the American Medical Association style. Less than one fourth had stated requirements to use reporting guidelines such as Consolidated Standards of Reporting Trials (CONSORT) and Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA). Conclusions Author guidelines for nursing journals are generally complete and informative. Although specific reporting guidelines such as CONSORT and PRISMA improve the accuracy and completeness of manuscripts on various types of studies, most nursing journals do not indicate use of these for manuscript preparation. Editors who want to improve their author guidelines should use the 19 criteria for completeness as a gauge for updating and revision. Clinical Relevance Nurses rely on the published literature to inform their practice and ensure that it is based on evidence. Guidelines for publishing in the scholarly literature assist clinicians and scholars to ensure that published articles are complete, current, concise, and accurate. PMID:29645403

Quality of Author Guidelines in Nursing Journals.

PubMed

Oermann, Marilyn H; Nicoll, Leslie H; Chinn, Peggy L; Conklin, Jamie L; McCarty, Midori; Amarasekara, Sathya

2018-04-12

The aims of this study were to (a) describe the information provided in author guidelines in nursing journals, (b) assess the completeness of this information, and (c) identify the extent and types of reporting guidelines used in nursing journals. Content analysis of author guidelines for 245 nursing journals included in the Directory of Nursing Journals maintained at the International Academy of Nursing Editors website. Using Research Electronic Data Capture, data on 19 criteria for completeness were extracted from published author guidelines. Additional details about journal requirements, such as allowed length of manuscripts and format for the abstract, were also recorded. Reliability was established by simultaneous review of 25 journals (10%) by the research assistant and a senior member of the research team. Author guidelines were easily accessible at journal websites or through links to download the information. A majority (73.5%) had completeness scores of 75% or higher; six journals had guidelines that were 100% complete. Half of the journals used the American Psychological Association reference style, and 26.3% used the American Medical Association style. Less than one fourth had stated requirements to use reporting guidelines such as Consolidated Standards of Reporting Trials (CONSORT) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Author guidelines for nursing journals are generally complete and informative. Although specific reporting guidelines such as CONSORT and PRISMA improve the accuracy and completeness of manuscripts on various types of studies, most nursing journals do not indicate use of these for manuscript preparation. Editors who want to improve their author guidelines should use the 19 criteria for completeness as a gauge for updating and revision. Nurses rely on the published literature to inform their practice and ensure that it is based on evidence. Guidelines for publishing in the scholarly literature assist clinicians and scholars to ensure that published articles are complete, current, concise, and accurate. © 2018 The Authors. Journal of Nursing Scholarship published by Wiley Periodicals, Inc. on behalf of Sigma Theta Tau International The Honor Society of Nursing.

AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY PROTOCOL FOR STANDARDIZED PRODUCTION OF CLINICAL PRACTICE GUIDELINES, ALGORITHMS, AND CHECKLISTS - 2017 UPDATE.

PubMed

Mechanick, Jeffrey I; Pessah-Pollack, Rachel; Camacho, Pauline; Correa, Ricardo; Figaro, M Kathleen; Garber, Jeffrey R; Jasim, Sina; Pantalone, Kevin M; Trence, Dace; Upala, Sikarin

2017-08-01

Clinical practice guideline (CPG), clinical practice algorithm (CPA), and clinical checklist (CC, collectively CPGAC) development is a high priority of the American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE). This 2017 update in CPG development consists of (1) a paradigm change wherein first, environmental scans identify important clinical issues and needs, second, CPA construction focuses on these clinical issues and needs, and third, CPG provide CPA node/edge-specific scientific substantiation and appended CC; (2) inclusion of new technical semantic and numerical descriptors for evidence types, subjective factors, and qualifiers; and (3) incorporation of patient-centered care components such as economics and transcultural adaptations, as well as implementation, validation, and evaluation strategies. This third point highlights the dominating factors of personal finances, governmental influences, and third-party payer dictates on CPGAC implementation, which ultimately impact CPGAC development. The AACE/ACE guidelines for the CPGAC program is a successful and ongoing iterative exercise to optimize endocrine care in a changing and challenging healthcare environment. AACE = American Association of Clinical Endocrinologists ACC = American College of Cardiology ACE = American College of Endocrinology ASeRT = ACE Scientific Referencing Team BEL = best evidence level CC = clinical checklist CPA = clinical practice algorithm CPG = clinical practice guideline CPGAC = clinical practice guideline, algorithm, and checklist EBM = evidence-based medicine EHR = electronic health record EL = evidence level G4GAC = Guidelines for Guidelines, Algorithms, and Checklists GAC = guidelines, algorithms, and checklists HCP = healthcare professional(s) POEMS = patient-oriented evidence that matters PRCT = prospective randomized controlled trial.

Development of practice guidelines for psychological interventions in the rehabilitation of patients with oncological disease (breast, prostate, or colorectal cancer): Methods and results.

PubMed

Reese, Christina; Weis, Joachim; Schmucker, Dieter; Mittag, Oskar

2017-10-01

The goal of this project was to develop evidence- and consensus-based practice guidelines for psychological interventions in the rehabilitation of patients with oncological disease (breast, prostate, or colorectal cancer). First of all, we conducted a literature search and survey of all oncological rehabilitation centers in Germany (N = 145) to obtain a thorough perspective of the recent evidence, guidelines, the structural framework, and practice of psychological services in oncological rehabilitation. Next, an expert workshop was held with national experts from scientific departments, clinicians from rehabilitation centers, and patients. In this workshop, we drafted and agreed upon an initial version of the practice guidelines. Afterwards, the practice guidelines were sent to all head physicians and senior psychologists at oncological rehabilitation centers in Germany for approval (N = 280 questionnaires). In addition, key recommendations were discussed with a group of rehabilitation patients. Finally, the practice guidelines were revised by the expert panel and made available online to the public. The practice guidelines have been widely accepted by both the expert panel and the surveyed clinicians and patients. They include recommendations for psycho-oncological interventions that should be offered to all rehabilitation patients with breast, prostate, or colorectal cancer. They also comprise recommendations for specific problem areas concerning psychological functions, body functions, and environmental and personal factors. The practice guidelines provide detailed recommendations for high-quality psychosocial care in an oncological rehabilitation context. It is their aim to guide the multidisciplinary team, especially psychologists and physicians, in their daily practice. Copyright © 2016 John Wiley & Sons, Ltd.

Feasibility and effectiveness of a disease and care management model in the primary health care system for patients with heart failure and diabetes (Project Leonardo).

PubMed

Ciccone, Marco Matteo; Aquilino, Ambrogio; Cortese, Francesca; Scicchitano, Pietro; Sassara, Marco; Mola, Ernesto; Rollo, Rodolfo; Caldarola, Pasquale; Giorgino, Francesco; Pomo, Vincenzo; Bux, Francesco

2010-05-06

Project Leonardo represented a feasibility study to evaluate the impact of a disease and care management (D&CM) model and of the introduction of "care manager" nurses, trained in this specialized role, into the primary health care system. Thirty care managers were placed into the offices of 83 general practitioners and family physicians in the Apulia Region of Italy with the purpose of creating a strong cooperative and collaborative "team" consisting of physicians, care managers, specialists, and patients. The central aim of the health team collaboration was to empower 1,160 patients living with cardiovascular disease (CVD), diabetes, heart failure, and/or at risk of cardiovascular disease (CVD risk) to take a more active role in their health. With the support of dedicated software for data collection and care management decision making, Project Leonardo implemented guidelines and recommendations for each condition aimed to improve patient health outcomes and promote appropriate resource utilization. Results show that Leonardo was feasible and highly effective in increasing patient health knowledge, self-management skills, and readiness to make changes in health behaviors. Patient skill-building and ongoing monitoring by the health care team of diagnostic tests and services as well as treatment paths helped promote confidence and enhance safety of chronic patient management at home. Physicians, care managers, and patients showed unanimous agreement regarding the positive impact on patient health and self-management, and attributed the outcomes to the strong "partnership" between the care manager and the patient and the collaboration between the physician and the care manager. Future studies should consider the possibility of incorporating a patient empowerment model which considers the patient as the most important member of the health team and care managers as key health care collaborators able to enhance and support services to patients provided by physicians in the primary health care system.

The impact of primary care reform on health system performance in Canada: a systematic review.

PubMed

Carter, Renee; Riverin, Bruno; Levesque, Jean-Frédéric; Gariepy, Geneviève; Quesnel-Vallée, Amélie

2016-07-30

We aimed to synthesize the evidence of a causal effect and draw inferences about whether Canadian primary care reforms improved health system performance based on measures of health service utilization, processes of care, and physician productivity. We searched the Embase, PubMed and Web of Science databases for records from 2000 to September 2015. We based our risk of bias assessment on the Grading of Recommendations Assessment, Development and Evaluation guidelines. Full-text studies were synthesized and organized according to the three outcome categories: health service utilization, processes of care, and physician costs and productivity. We found moderate quality evidence that team-based models of care led to reductions in emergency department use, but the evidence was mixed for hospital admissions. We also found low quality evidence that team-based models, blended capitation models and pay-for-performance incentives led to small and sometimes non-significant improvements in processes of care. Studies examining new payment models on physician costs and productivity were of high methodological quality and provided a coherent body of evidence assessing enhanced fee-for-service and blended capitation payment models. A small number of studies suggested that team-based models contributed to reductions in emergency department use in Quebec and Alberta. Regarding processes of diabetes care, studies found higher rates of testing for blood glucose levels, retinopathy and cholesterol in Alberta's team-based primary care model and in practices eligible for pay-for-performance incentives in Ontario. However pay-for-performance in Ontario was found to have null to moderate effects on other prevention and screening activities. Although blended capitation payment in Ontario contributed to decreases in the number of services delivered and patients seen per day, the number of enrolled patients and number of days worked in a year was similar to that of enhanced fee-for-service practices.

Development of an Enhanced Recovery After Surgery Guideline and Implementation Strategy Based on the Knowledge-to-action Cycle.

PubMed

McLeod, Robin S; Aarts, Mary-Anne; Chung, Frances; Eskicioglu, Cagla; Forbes, Shawn S; Conn, Lesley Gotlib; McCluskey, Stuart; McKenzie, Marg; Morningstar, Beverly; Nadler, Ashley; Okrainec, Allan; Pearsall, Emily A; Sawyer, Jason; Siddique, Naveed; Wood, Trevor

2015-12-01

Enhanced Recovery After Surgery (ERAS) protocols have been shown to increase recovery, decrease complications, and reduce length of stay. However, they are difficult to implement. To develop and implement an ERAS clinical practice guideline (CPG) at multiple hospitals. A tailored strategy based on the Knowledge-to-action (KTA) cycle was used to develop and implement an ERAS CPG at 15 academic hospitals in Canada. This included an initial audit to identify gaps and interviews to assess barriers and enablers to implementation. Implementation included development of an ERAS guideline by a multidisciplinary group, communities of practice led by multidiscipline champions (surgeons, anesthesiologists, and nurses) both provincially and locally, educational tools, and clinical pathways as well as audit and feedback. The initial audit revealed there was greater than 75% compliance in only 2 of 18 CPG recommendations. Main themes identified by stakeholders were that the CPG must be based on best evidence, there must be increased communication and collaboration among perioperative team members, and patient education is essential. ERAS and Pain Management CPGs were developed by a multidisciplinary team and have been adopted at all hospitals. Preliminary data from more than 1000 patients show that the uptake of recommended interventions varies but despite this, mean length of stay has decreased with low readmission rates and adverse events. On the basis of short-term findings, our results suggest that a tailored implementation strategy based on the KTA cycle can be used to successfully implement an ERAS program at multiple sites.

Team-Building Activities in Dance Classes and Discoveries from Reflective Essays

ERIC Educational Resources Information Center

Hanrahan, Stephanie J.; Pedro, Rachel A.

2017-01-01

The purpose of this study was to determine students' perceptions of team-building activities within a university Latin dance course. Students (N = 30) completed an evaluation of the team-building activities and wrote reflective essays about their experiences in the course. The course consisted of twenty 90-minute classes. In the third class…

A Video Analysis of Intra- and Interprofessional Leadership Behaviors Within "The Burns Suite": Identifying Key Leadership Models.

PubMed

Sadideen, Hazim; Weldon, Sharon-Marie; Saadeddin, Munir; Loon, Mark; Kneebone, Roger

2016-01-01

Leadership is particularly important in complex highly interprofessional health care contexts involving a number of staff, some from the same specialty (intraprofessional), and others from different specialties (interprofessional). The authors recently published the concept of "The Burns Suite" (TBS) as a novel simulation tool to deliver interprofessional and teamwork training. It is unclear which leadership behaviors are the most important in an interprofessional burns resuscitation scenario, and whether they can be modeled on to current leadership theory. The purpose of this study was to perform a comprehensive video analysis of leadership behaviors within TBS. A total of 3 burns resuscitation simulations within TBS were recorded. The video analysis was grounded-theory inspired. Using predefined criteria, actions/interactions deemed as leadership behaviors were identified. Using an inductive iterative process, 8 main leadership behaviors were identified. Cohen's κ coefficient was used to measure inter-rater agreement and calculated as κ = 0.7 (substantial agreement). Each video was watched 4 times, focusing on 1 of the 4 team members per viewing (senior surgeon, senior nurse, trainee surgeon, and trainee nurse). The frequency and types of leadership behavior of each of the 4 team members were recorded. Statistical significance to assess any differences was assessed using analysis of variance, whereby a p < 0.05 was taken to be significant. Leadership behaviors were triangulated with verbal cues and actions from the videos. All 3 scenarios were successfully completed. The mean scenario length was 22 minutes. A total of 362 leadership behaviors were recorded from the 12 participants. The most evident leadership behaviors of all team members were adhering to guidelines (which effectively equates to following Advanced Trauma and Life Support/Emergency Management of Severe Burns resuscitation guidelines and hence "maintaining standards"), followed by making decisions. Although in terms of total frequency the senior surgeon engaged in more leadership behaviors compared with the entire team, statistically there was no significant difference between all 4 members within the 8 leadership categories. This analysis highlights that "distributed leadership" was predominant, whereby leadership was "distributed" or "shared" among team members. The leadership behaviors within TBS also seemed to fall in line with the "direction, alignment, and commitment" ontology. Effective leadership is essential for successful functioning of work teams and accomplishment of task goals. As the resuscitation of a patient with major burns is a dynamic event, team leaders require flexibility in their leadership behaviors to effectively adapt to changing situations. Understanding leadership behaviors of different team members within an authentic simulation can identify important behaviors required to optimize nontechnical skills in a major resuscitation. Furthermore, attempting to map these behaviors on to leadership models can help further our understanding of leadership theory. Collectively this can aid the development of refined simulation scenarios for team members, and can be extrapolated into other areas of simulation-based team training and interprofessional education. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Cassini Attitude Control Operations - Guidelines Levied on Science to Extend Reaction Wheel Life

NASA Technical Reports Server (NTRS)

Mittelsteadt, Carson O.

2011-01-01

The Cassini spacecraft was launched on October 15, 1997 and arrived at Saturn on June 30, 2004. It has performed detailed observations and remote sensing of Saturn, its rings, and its satellites since that time. Cassini deployed the European-built Huygens probe, which descended through the Titan atmosphere (Saturn's largest moon) and landed on its surface on January 14, 2005. The Cassini mission has recently been approved by NASA to continue through September of 2017. This 7-year extension is called the Solstice mission and it presents challenges to the spacecraft operations team and its ability to maintain the health of the spacecraft. To keep the spacecraft healthy for 7 more years, the spacecraft team must carefully manage hydrazine use (about 48% of the 132 kg launch load remains as of January 2011). A vital part of conserving hydrazine is to use the reaction wheel assembly (RWA) control system for precise pointing and slews wherever possible. In any given week, the Cassini spacecraft is commanded to use RWA control about 99% of the time, with about 1% of the time requiring reaction control system (RCS) thruster control (to perform Delta V course corrections or to bias the RWA momentum). Such extensive use of the RWA hardware throughout the mission requires that the RWAs be operated in a way that minimizes degradation in the RWA electronics, DC motor, and spin bearing for each reaction wheel. Three consumables in particular have been identified for the RWAs: (1) Total number of revolutions for each RWA. (2) Time spent at very low wheel speeds. At these low speeds, good elasto-hydrodynamic (EHD) film lubrication may be compromised. (3) Total number of on/off power cycles. The second of these consumables, minimizing the time spent at very low wheel speeds, is especially important to keep the spin bearing healthy and well-lubricated. These consumables are actively managed by the attitude control operations team throughout the mission. One vital management technique is to predict individual RWA momentum (given the pointing and slews that are needed to collect the best science) and to bias the RWA momentum in a way that reduces both the total number of revolutions as well as the time spent below EHD wheel speed. Another strategy to protect RWA health is to alter the planned pointing of the spacecraft (which can affect science collection) so that the RWA consumables are conserved. This paper focuses on why this second technique is needed, and discusses how guidelines have been developed by the attitude control team which affects the planned science pointing, so that science data can be most optimally collected while still minimizing RWA consumable usage.

A status of the Turbine Technology Team activities

NASA Technical Reports Server (NTRS)

Griffin, Lisa W.

1992-01-01

The recent activities of the Turbine Technology Team of the Consortium for Computational Fluid Dynamics (CFD) Application in Propulsion Technology is presented. The team consists of members from the government, industry, and universities. The goal of this team is to demonstrate the benefits to the turbine design process attainable through the application of CFD. This goal is to be achieved by enhancing and validating turbine design tools for improved loading and flowfield definition and loss prediction, and transferring the advanced technology to the turbine design process. In order to demonstrate the advantages of using CFD early in the design phase, the Space Transportation Main Engine (STME) turbines for the National Launch System (NLS) were chosen on which to focus the team's efforts. The Turbine Team activities run parallel to the STME design work.

International variations in clinical practice guidelines for palliative sedation: a systematic review.

PubMed

Abarshi, Ebun; Rietjens, Judith; Robijn, Lenzo; Caraceni, Augusto; Payne, Sheila; Deliens, Luc; Van den Block, Lieve

2017-09-01

Palliative sedation is a highly debated medical practice, particularly regarding its proper use in end-of-life care. Worldwide, guidelines are used to standardise care and regulate this practice. In this review, we identify and compare national/regional clinical practice guidelines on palliative sedation against the European Association for Palliative Care (EAPC) palliative sedation Framework and assess the developmental quality of these guidelines using the Appraisal Guideline Research and Evaluation (AGREE II) instrument. Using the PRISMA criteria, we searched multiple databases (PubMed, CancerLit, CINAHL, Cochrane Library, NHS Evidence and Google Scholar) for relevant guidelines, and selected those written in English, Dutch and Italian; published between January 2000 and March 2016. Of 264 hits, 13 guidelines-Belgium, Canada (3), Ireland, Italy, Japan, the Netherlands, Norway, Spain, Europe, and USA (2) were selected. 8 contained at least 9/10 recommendations published in the EAPC Framework; 9 recommended 'pre-emptive discussion of the potential role of sedation in end-of-life care'; 9 recommended 'nutrition/hydration while performing sedation' and 8 acknowledged the need to 'care for the medical team'. There were striking differences in terminologies used and in life expectancy preceding the practice. Selected guidelines were conceptually similar, comparing closely to the EAPC Framework recommendations, albeit with notable variations. Based on AGREE II, 3 guidelines achieved top scores and could therefore be recommended for use in this context. Also, domains 'scope and purpose' and 'editorial independence' ranked highest and lowest, respectively-underscoring the importance of good reportage at the developmental stage. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Modeling and Analysis of Multidiscipline Research Teams at NASA Langley Research Center: A Systems Thinking Approach

NASA Technical Reports Server (NTRS)

Waszak, Martin R.; Barthelemy, Jean-Francois; Jones, Kenneth M.; Silcox, Richard J.; Silva, Walter A.; Nowaczyk, Ronald H.

1998-01-01

Multidisciplinary analysis and design is inherently a team activity due to the variety of required expertise and knowledge. As a team activity, multidisciplinary research cannot escape the issues that affect all teams. The level of technical diversity required to perform multidisciplinary analysis and design makes the teaming aspects even more important. A study was conducted at the NASA Langley Research Center to develop a model of multidiscipline teams that can be used to help understand their dynamics and identify key factors that influence their effectiveness. The study sought to apply the elements of systems thinking to better understand the factors, both generic and Langley-specific, that influence the effectiveness of multidiscipline teams. The model of multidiscipline research teams developed during this study has been valuable in identifying means to enhance team effectiveness, recognize and avoid problem behaviors, and provide guidance for forming and coordinating multidiscipline teams.

Using a Betabinomial distribution to estimate the prevalence of adherence to physical activity guidelines among children and youth.

PubMed

Garriguet, Didier

2016-04-01

Estimates of the prevalence of adherence to physical activity guidelines in the population are generally the result of averaging individual probability of adherence based on the number of days people meet the guidelines and the number of days they are assessed. Given this number of active and inactive days (days assessed minus days active), the conditional probability of meeting the guidelines that has been used in the past is a Beta (1 + active days, 1 + inactive days) distribution assuming the probability p of a day being active is bounded by 0 and 1 and averages 50%. A change in the assumption about the distribution of p is required to better match the discrete nature of the data and to better assess the probability of adherence when the percentage of active days in the population differs from 50%. Using accelerometry data from the Canadian Health Measures Survey, the probability of adherence to physical activity guidelines is estimated using a conditional probability given the number of active and inactive days distributed as a Betabinomial(n, a + active days , β + inactive days) assuming that p is randomly distributed as Beta(a, β) where the parameters a and β are estimated by maximum likelihood. The resulting Betabinomial distribution is discrete. For children aged 6 or older, the probability of meeting physical activity guidelines 7 out of 7 days is similar to published estimates. For pre-schoolers, the Betabinomial distribution yields higher estimates of adherence to the guidelines than the Beta distribution, in line with the probability of being active on any given day. In estimating the probability of adherence to physical activity guidelines, the Betabinomial distribution has several advantages over the previously used Beta distribution. It is a discrete distribution and maximizes the richness of accelerometer data.

Influence of body mass index, gender, and Hispanic ethnicity on physical activity in urban children.

PubMed

Wright, Kynna N

2011-04-01

This community-based participatory research study examined the association between overweight status and activity among Hispanic urban, school-age children. In a sample of 140 children, activities were assessed using the Youth Risk Behavior Survey's questions about physical activity (PA) and team sports. Thirty-nine percent were overweight (body mass index [BMI] >85%). Normal-weight children had higher levels of PA and team sports. Females had lower levels of PA and team sports. Significant associations included BMI and sports team participation, and BMI and Hispanic ethnicity. Nurses should be aware that Hispanic urban children are at risk for lower activity. © 2011, Wiley Periodicals, Inc.

A hypermedia reference system to the Forest Ecosystem Management Assessment team report and some related publications.

Treesearch

K.M. Reynolds; H.M. Rauscher; C.V. Worth

1995-01-01

The hypermedia system, ForestEM, was developed in HyperWriter for use in Microsoft Windows. ForestEM version 1.0 includes text and figures from the FEMAT report and the Record of Decision and Standards and Guidelines. Hypermedia introduces two fundamental changes to knowledge management. The first is the capability to interactively store and retrieve large amounts of...

Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers

DTIC Science & Technology

1998-01-01

commitment, including the endorse- ment and visible involvement of top management , provides the motivation and resources to deal effec- tively with workplace...program to ensure that all managers , supervisors, and employ- ees understand their obligations. • Appropriate allocation of authority and resources to...operations, employee assistance, security, occupational safety and health, legal, and human resources staff. The team or coordinator can review injury

Pediatric portal hypertension

PubMed Central

Vogel, Clarissa Barbon

2017-01-01

Abstract: Pediatric portal hypertension management is a team approach between the patient, the patient's family, the primary caregiver, and specialty providers. Evidence-based practice guidelines have not been established in pediatrics. This article serves as a review for the primary care NP in the management of pediatric portal hypertension, discussing the etiology, pathophysiology, and clinical presentation of pediatric portal hypertension, diagnostic tests, and treatment and management options. PMID:28406835

Exertional Heat Illnesses and Environmental Conditions During High School Football Practices.

PubMed

Tripp, Brady L; Eberman, Lindsey E; Smith, Michael Seth

2015-10-01

Guidelines for preventing exertional heat illnesses (EHIs) during extreme heat stress should be specific to regional environments, age, and sport and should be based on evidence of reducing the risk. Each year in the United States, over 1 million high school football players practice in the August heat; however, no published data describe the incidence of EHIs in these athletes. To describe the environmental conditions and incidence of EHIs during high school football practices over a 3-month period. Descriptive epidemiology study. For a 3-month period (August-October), athletic trainers at 12 high schools in North Central Florida recorded the practice time and length, environmental conditions (wet-bulb globe temperature), and incidences of EHIs in varsity football athletes. Athletes suffered 57 total EHIs during 29,759 athlete-exposures (AEs) for the 3-month data collection period (rate = 1.92/1000 AEs). August accounted for the majority of all EHIs, with 82.5% (47/57) and the highest rate (4.35/1000 AEs). Of total heat illnesses, heat cramps accounted for 70.2% (40/57), heat exhaustion 22.8% (13/57), and heat syncope 7.0% (4/57). The odds ratio indicated that athletes in August practices that lasted longer than the recommended 3 hours were 9.84 times more likely to suffer a heat illness than those in practices lasting ≤3 hours. The highest rate of EHIs was during August. Practices in August that exceeded the recommended 3 hours were associated with a greater risk of heat illnesses. The overall rate of EHIs was lower for the high school football athletes observed in the study compared with that reported for collegiate football athletes in the region. The low rates of EHIs recorded suggest that the prevention guidelines employed by sports medicine teams are appropriate for the region and population. Team physicians and athletic trainers should employ evidence-based, region- and population-specific EHI prevention guidelines. Sports medicine teams, coaches, and athletes should be aware of the increased risk of EHIs during August practices and the risk of prolonged practices during August. © 2015 The Author(s).

The comparative effectiveness of a team-based versus group-based physical activity intervention for cancer survivors.

PubMed

Carter, Cindy L; Onicescu, Georgiana; Cartmell, Kathleen B; Sterba, Katherine R; Tomsic, James; Alberg, Anthony J

2012-08-01

Physical activity benefits cancer survivors, but the comparative effectiveness of a team-based delivery approach remains unexplored. The hypothesis tested was that a team-based physical activity intervention delivery approach has added physical and psychological benefits compared to a group-based approach. A team-based sport accessible to survivors is dragon boating, which requires no previous experience and allows for diverse skill levels. In a non-randomized trial, cancer survivors chose between two similarly structured 8-week programs, a dragon boat paddling team (n = 68) or group-based walking program (n = 52). Three separate intervention rounds were carried out in 2007-2008. Pre-post testing measured physical and psychosocial outcomes. Compared to walkers, paddlers had significantly greater (all p < 0.01) team cohesion, program adherence/attendance, and increased upper-body strength. For quality-of-life outcomes, both interventions were associated with pre-post improvements, but with no clear-cut pattern of between-intervention differences. These hypothesis-generating findings suggest that a short-term, team-based physical activity program (dragon boat paddling) was associated with increased cohesion and adherence/attendance. Improvements in physical fitness and psychosocial benefits were comparable to a traditional, group-based walking program. Compared to a group-based intervention delivery format, the team-based intervention delivery format holds promise for promoting physical activity program adherence/attendance in cancer survivors.

Childhood Socioeconomic Disadvantage, Occupational, Leisure-Time, and Household Physical Activity, and Diabetes in Adulthood.

PubMed

Tsenkova, Vera K; Lee, Chioun; Boylan, Jennifer Morozink

2017-10-01

Regular physical activity is a key way to prevent disease. However, we have a limited understanding of the socioeconomic precursors and glucoregulatory sequelae of engaging in physical activity in different domains. We examined the associations among life course socioeconomic disadvantage; meeting the physical activity guidelines with leisure-time physical activity, occupational physical activity, or household physical activity; and prediabetes and diabetes in the Midlife in the United States national study (N = 986). Childhood disadvantage was associated with lower odds of meeting the guidelines with leisure-time physical activity (odds ratio = 0.75; 95% confidence interval, 0.65-0.86). Adulthood disadvantage was associated with higher odds of meeting the guidelines with occupational physical activity (odds ratio = 1.94; 95% confidence interval, 1.49-2.53). Importantly, while meeting the guidelines with leisure-time physical activity was associated with lower odds of prediabetes and diabetes, we found no evidence for associations among occupational physical activity, household physical activity, and glucoregulation. Current US physical activity guidelines do not differentiate between physical activity for leisure or work, assuming that physical activity in any domain confers comparable health benefits. We documented important differences in the associations among lifetime socioeconomic disadvantage, physical activity domain, and diabetes, suggesting that physical activity domain potentially belongs in the guidelines, similar to other characteristics of activity (eg, type, intensity).

Pharmacological management of anticancer agent extravasation: A single institutional guideline.

PubMed

Kimmel, Jaime; Fleming, Patrick; Cuellar, Sandra; Anderson, Jennifer; Haaf, Christina Mactal

2018-03-01

Although the risk of extravasation of a chemotherapy (anticancer) medication is low, the complications associated with these events can have a significant impact on morbidity and health care costs. Institutions that administer anticancer agents should ideally have a current guideline on the proper management of the inadvertent administration of these toxic medications into tissues surrounding blood vessels. It is imperative that the health care team involved in administering drugs used to treat cancer be educated on the risk factors, preventative strategies and treatment of anticancer extravasations, as well as practice safe and proper administration techniques. Anticancer agents are generally divided into classes based on their ability to cause tissue damage. The review of current published guidelines and available literature reveals a lack of consensus on how these medications should be classified. In addition, many recently approved drugs for the treatment of cancer may lack data to support their classification and management of extravasation events. The treatment of the majority of extravasations of anticancer agents involves nonpharmacological measures, potentially in the ambulatory care setting. Antidotes are available for the extravasation of a minority of vesicant agents in order to mitigate tissue damage. Due to the limited data and lack of consensus in published guidelines, a working group was established to put forth an institutional guideline on the management of anticancer extravasations.

[How practical guidelines can be applied in poor countries? Example of the introduction of a bronchoscopy unit in Cambodia].

PubMed

Couraud, S; Chan, S; Avrillon, V; Horn, K; Try, S; Gérinière, L; Perrot, É; Guichon, C; Souquet, P-J; Ny, C

2013-10-01

According to UN, Cambodia is one of the poorest countries in the World. Respiratory diseases are current public health priorities. In this context, a new bronchoscopy unit (BSU) was created in the respiratory medicine department of Preah Kossamak hospital (PKH) thanks to a tight cooperation between a French and a Cambodian team. Aim of this study was to describe conditions of introduction of this equipment. Two guidelines for practice are available. They are respectively edited by the French and British societies of pulmonology. These guidelines were reviewed and compared to the conditions in which BS was introduced in PKH. Each item from guidelines was combined to a categorical value: "applied", "adapted" or "not applied". In 2009, 54 bronchoscopies were performed in PKH, mainly for suspicion of infectious or tumour disease. In total, 52% and 46% of the French and British guideline items respectively were followed in this Cambodian unit. Patient safety items are those highly followed. By contrast "staff safety" items were those weakly applied. Implementation of EBS in developing countries seems feasible in good conditions of quality and safety for patients. However, some recommendations cannot be applied due to local conditions. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

The Associations of Youth Physical Activity and Screen Time with Fatness and Fitness: The 2012 NHANES National Youth Fitness Survey

PubMed Central

Laurson, Kelly R.; Kim, Youngwon; Saint-Maurice, Pedro F.; Welk, Gregory J.

2016-01-01

The purpose of the study is to examine the associations of youth physical activity and screen time with weight status and cardiorespiratory fitness in children and adolescents, separately, utilizing a nationally representative sample. A total of 1,113 participants (692 children aged 6–11 yrs; 422 adolescents aged 12–15 yrs) from the 2012 NHANES National Youth Fitness Survey. Participants completed physical activity and screen time questionnaires, and their body mass index and cardiorespiratory fitness (adolescents only) were assessed. Adolescents completed additional physical activity questions to estimate daily MET minutes. Children not meeting the screen time guideline had 1.69 times the odds of being overweight/obese compared to those meeting the screen time guideline, after adjusting for physical activity and other control variables. Among adolescent, screen time was significantly associated with being overweight/obese (odds ratio = 1.82, 95% confidence interval: 1.06–3.15), but the association attenuated toward the borderline of being significant after controlling for physical activity. Being physically active was positively associated with cardiorespiratory fitness, independent of screen time among adolescents. In joint association analysis, children who did not meet physical activity nor screen time guidelines had 2.52 times higher odds of being overweight/obese than children who met both guidelines. Adolescents who did not meet the screen time guideline had significantly higher odds ratio of being overweight/obese regardless of meeting the physical activity guideline. Meeting the physical activity guideline was also associated with cardiorespiratory fitness regardless of meeting the screen time guideline in adolescents. Screen time is a stronger factor than physical activity in predicting weight status in both children and adolescents, and only physical activity is strongly associated with cardiorespiratory fitness in adolescents. PMID:26820144

Evaluating a Research Training Programme for People with Intellectual Disabilities Participating in Inclusive Research: The Views of Participants.

PubMed

Fullana, Judit; Pallisera, Maria; Català, Elena; Puyalto, Carolina

2017-07-01

This article presents the results of evaluating a research training programme aimed at developing the skills of people with intellectual disabilities to actively participate in inclusive research. The present authors opted for a responsive approach to evaluation, using a combination of interviews, questionnaires and focus groups to gather information on the views of students, trainers and members of the research team regarding how the programme progressed, the learning achieved and participants' satisfaction with the programme. The evaluation showed that most of the participants were satisfied with the programme and provided guidelines for planning contents and materials, demonstrating the usefulness of these types of programme in constructing the research group and empowering people with intellectual disabilities to participate in research. The evaluation revealed that the programme had been a positive social experience that fostered interest in lifelong learning for people with intellectual disabilities. © 2016 John Wiley & Sons Ltd.

Retirement security: It's not just about the money.

PubMed

James, Jacquelyn Boone; Matz-Costa, Christina; Smyer, Michael A

2016-01-01

Retirement security is not just about the money. Although there are many guidelines for financial security, there are few for crafting a rewarding life in the new era of longevity and health. With the meaning of "retirement" being actively redefined, there is a gap between what older adults want and need and what their employers and policymakers are offering. Retirement security in its broadest sense requires programs and policies that encourage and support flexible work that allow some choice and control over when, where, and how work gets done, and which work tasks are assumed by which employees or work teams, self-employment, and formal and informal volunteer work. This article has 3 purposes: (a) to summarize the current context of retirement, (b) to identify barriers to psychological security in later life, and (c) to suggest how psychologists can support the rewriting of the retirement chapter for future retirees. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Establishing a virtual learning environment: a nursing experience.

PubMed

Wood, Anya; McPhee, Carolyn

2011-11-01

The use of virtual worlds has exploded in popularity, but getting started may not be easy. In this article, the authors, members of the corporate nursing education team at University Health Network, outline their experience with incorporating virtual technology into their learning environment. Over a period of several months, a virtual hospital, including two nursing units, was created in Second Life®, allowing more than 500 nurses to role-play in a safe environment without the fear of making a mistake. This experience has provided valuable insight into the best ways to develop and learn in a virtual environment. The authors discuss the challenges of installing and building the Second Life® platform and provide guidelines for preparing users and suggestions for crafting educational activities. This article provides a starting point for organizations planning to incorporate virtual worlds into their learning environment. Copyright 2011, SLACK Incorporated.

[Neonatal complications related to shoulder dystocia].

PubMed

Lopez, E; de Courtivron, B; Saliba, E

2015-12-01

To describe neonatal complications related to shoulder dystocia. This systematic evidence review is based on PubMed search, Cochrane library and experts' recommendations. The risks of brachial plexus birth injury, clavicle and humeral fracture, perinatal asphyxia, hypoxic-ischemic encephalopathy and perinatal mortality are increased after shoulder dystocia. The medical team should be able to provide neonatal resuscitation in the delivery room in case of perinatal asphyxia following shoulder dystocia, according to national and international guidelines. The initial clinical examination should search for complications such as brachial plexus birth injury or clavicle fracture. The risk of perinatal complications is increased in newborn after shoulder dystocia. The medical team should be able to manage these complications. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Supporting 'Baby Friendly': a quality improvement initiative for the management of transitional neonatal hypoglycaemia.

PubMed

Stewart, Claire Elizabeth; Sage, Emma Louise Maitland; Reynolds, Peter

2016-07-01

We describe a quality improvement initiative conducted in a medium-sized district general hospital with a neonatal intensive care unit, which involved working with the multidisciplinary team to create a 'Baby Friendly' neonatal hypoglycaemia pathway with implementation of dextrose gel as a first-line treatment. As a result of the project, formula supplementation rates and admissions for transitional hypoglycaemia were reduced and breastfeeding rates at 3 months improved. This initiative demonstrates that evidence-based guidelines with multidisciplinary team input can improve standards of care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Cooperative studyware development of organic chemistry module by experts, teachers, and students

NASA Astrophysics Data System (ADS)

Dori, Yehudit J.

1995-06-01

Experts, teachers, and students took active part in a process of organic chemistry studyware development. A unique characteristic of this process was the active involvement of three different groups of people in the authoring process: science educators, chemistry teachers, and chemistry students studying towards an education certificate. The science educators—the experts—advised the team on new methods of presenting the subject matter in an appealing way, using 3D computerized molecular modeling. The in-service chemistry teachers contributed from their rich field experience to constructing the studyware. This mutual development helped maintain the balance between expert requirements and expectations from students on one hand, and the actual student capabilities, as perceived by teachers through constant contact with the students, on the other. Finally, the preservice teachers—the undergraduate chemistry students—were often zealous, enthusiastic, and willing to put in the extra time and effort needed to produce quality studyware, while following the guidelines of the experts and teachers. Feedback on the qualities and shortcomings of the studyware was obtained in two cycles. The first one was done while the studyware was still under development by peers, and the second by individual target students, serving as a beta-site. This double feedback helped improve the studyware, mainly by elaborating on portions that require more detail and explanation. The paper describes the process as well as representative parts of the studyware. The combination of experts, teachers, and students in the development team seems to have the potential to yield studyware that is appropriate for effective science education in general and chemistry teaching in particular.

[Physical activity guidelines for Canadians: strategies for dissemination of the message, expectations for change and evaluation].

PubMed

Brawley, Lawrence R; Latimer, Amy E

2007-01-01

Physical activity guidelines offer evidence-based behavioural benchmarks that relate to reduced risk of morbidity and mortality if people adhere to them. Essentially, the guidelines tell people what to do, but not why and how they should do it. Thus, to motivate adherence, messages that translate guidelines should convey not only how much physical activity one should attempt and why it is recommended, but also how to achieve such a recommendation. Canada's physical activity guides exemplify how guidelines can be translated. This paper (i) provides a brief overview of the challenges encountered in creating the existing guides and (ii) highlights important practical issues and empirical evidence that should be considered in the future when translating guidelines into messages and disseminating these messages. We draw on the successes of past efforts to translate the goals of physical activity guidelines and on recent literature on messages and media campaigns to make recommendations. Information to motivate people to move toward the goals in physical activity guidelines should be translated into a set of messages that are informative, thought provoking, and persuasive. These messages should be disseminated to the public via a multi-phase social-marketing campaign that is carefully planned and thoroughly evaluated.

Psychologists' views of inter-disciplinary psychosocial communication within the cancer care team.

PubMed

Thewes, B; Butow, P; Davis, E; Turner, J; Mason, C

2014-12-01

Little is known about how psychologists working in cancer care centres communicate clinical information to other members of the multidisciplinary team or what information is communicated. This study surveyed Australian cancer care psychologists regarding their communication practices and their views on barriers to and facilitators of effective inter-disciplinary communication. Psychologists were invited to complete an online survey containing purpose-designed items that addressed study aims. Forty-four psychologists completed the survey. Psychologists' most common method of recording initial consultations was in patient medical records, with 69 % of respondents recording notes in either most of the time or all of the time. Twenty-two percent of psychologists said they did not regularly feedback the results of an initial assessment to a referrer and more than 40 % used verbal and e-mail communication to do so. This study provides data that will assist in the development of guidelines for inter-professional communication between psychologists and other members of the cancer care team.

Effects of team-building on communication and teamwork among nursing students.

PubMed

Yi, Y J

2016-03-01

The aim of this study was to assess the effects of team-building on communication and teamwork (i.e. teamwork skills and team effectiveness) among nursing students. Team-building is effective for improving communication and teamwork among the nursing organization. However, the effects of team-building are not well known especially in Korea. This study used a quasi-experimental design. The sample was composed of 195 junior-year nursing students in Korea. The experimental group (100 subjects) participated in team-building activities over a 100-day period, whereas no intervention was applied to the control group (95 subjects). Pretest was conducted in both groups, and post-test was conducted after the 100-day intervention. The pre-post change in mean communication competence score did not differ between the two groups. However, the mean scores for teamwork skills and team effectiveness differed significantly between the two groups after team-building activity. This study was not a double-blind test, and randomized sampling was not implemented. Caution should thus be used when interpreting the findings. Team-building activities were effective for improving the teamwork skills and team effectiveness among Korean nursing students. It is recommended that team-building activities should be included regularly as an integral educational approach in nursing education. The findings suggest that suggests that team-building for improving communication and teamwork should be designated as one of the required criteria for nursing college programme accreditation in many countries, including Korea. However team-building requires further testing to verify this across cultures. Nurses need to receive formal team-building training for improving communication and teamwork, and formal education should be included in their job training schedule. It is recommended that communication competence and teamwork be used as one of job performance evaluations in their workplace. © 2015 International Council of Nurses.

Collaborating to reduce costs in invasive cardiology: the Partners Healthcare experience. Partners Healthcare Invasive Cardiology Team.

PubMed

Lee, T H

1995-11-01

As part of the closely watched marriage between Brigham and Women's Hospital and Massachusetts General Hospital, the invasive cardiology team--cardiologists and other staff from the two organizations--began with monthly meetings; its mission is to reduce costs of cardiology services while maintaining or improving patient satisfaction and outcomes. Joint purchasing efforts have led to substantial price reductions for some supplies, such as pacemakers and balloon angioplasty. However, concern over quality drove cardiologists to choose newer, more expensive models of other supplies, such as implantible cardioverter-defibrillators. Also, the team is studying the actual costs savings that can be achieved by shifting patients undergoing cardiac catheterization to the outpatient setting. In addition, cardiologists recognized an opportunity to decrease length of stay and increase quality by removing the arterial sheath for uncomplicated percutaneous transluminal coronary angioplasty patients on the same day the procedure is performed. Each hospital is developing strategies for this change in procedure. In addition to these improvement efforts, the team is encouraging optimal use of contrast agents and increasing overall efficiency of laboratories. Team members are also sharing guidelines and critical pathways and developing strategies for evaluating new technologies. The team has had little difficulty in achieving a collegial atmosphere and consensus around clinical issues and products once clinicians are face-to-face. Announcing bimonthly meetings may overcome meeting scheduling difficulties. The other major stumbling block has been the lack of detailed cost information.