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Oleksich, Zhanna, Jan Polcyn i Oleg Shtogrin. "Adaptation of the best European practices in administering local health care institutions". Health Economics and Management Review 2, nr 2 (2021): 15–22. http://dx.doi.org/10.21272/hem.2021.2-02.
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This study aimed to justify the mechanisms for improving the administration system of local health care facilities based on the best European experience. This study determined the state of health care facilities in Ukraine based on assessing the quality of medical services, rational resources usage, personnel management, and technical and technological improvement. Systematization of scientific sources and approaches to solving investigated issues showed methodological underdevelopment and methodological lack of administration systems of Ukrainian health care facilities at the local level, considering the specifics of medical services. Thus, healthcare institutions need to adapt, develop, and implement the best international practices in administrative technologies. For gaining the research goal, the study was carried out in the following logical sequence: 1) analyzing the current models of health care development processes in the world; 2) determining the features of administration system od the health care institutions; 3) developing recommendations for improving the administration system of local health care facilities in Ukraine. The methodological tool of this research is the systematization of information based on the content analysis of official websites. The research object is the administration system of health care facilities in Ukraine. In the study, the authors present several approaches to organize state administration of health care at the national and regional levels. The authors determined the effective tools for administering health care institutions. The study substantiated the strategic format of developing health care facilities in modern conditions by providing high-quality services, rational resources usage, personnel management, and technical and technological improvement.
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Shyu, Guey-Shin, Shinn-Jou Lin, Wei-Ta Fang i Bai-You Cheng. "How to Screen Suitable Service Improve Community Health Care Services by University Students in Taiwan". International Journal of Environmental Research and Public Health 17, nr 15 (27.07.2020): 5402. http://dx.doi.org/10.3390/ijerph17155402.
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Engaging in social contributions to enhance social participation and attending community experiential service learning or internship courses have become an essential learning experience for university students. On the basis of postmodern education theories, this study adopted images and oral accounts involving personal experiences to construct a postmodern education research scheme by using the method of collaborative ethnography. This study selected and performed the following services: filming a community documentary, administering community health dance classes, and archiving community cultural artifacts in databases. Interviews were also administered to facilitate implementation of the actual services. Community health services commonly seen in Taiwan and abroad were compiled, and the resources required for each service were examined. Subsequently, factor analysis was performed to explore the characteristic of these services in order to recommend feasible services for university students to undertake. The results indicated that the eight resources required for the 59 common community health services were (1) a designated space or venue, (2) materials, (3) monetary resources, (4) human resources, (5) expertise, (6) professional equipment, (7) patience, and (8) empathy. The results revealed three principal components, namely labor services, high-resource services, and professional services, for a total explanatory power of 67.99%; the individual explanatory power of these components accounted for 25.04%, 21.81%, and 21.15%, respectively. Next, community health care services suitable for university students to perform were selected and implemented, and these services were well received. The study results indicated that community and environmental justice can be realized by identifying with the value of community health services and promoting postmodern education theories and social norms. The research results are suitable for implementation after the COVID-19 pandemic.
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Asadi-Lari, Mohsen, i David Gray. "Health needs assessment tools: Progress and potential". International Journal of Technology Assessment in Health Care 21, nr 3 (lipiec 2005): 288–97. http://dx.doi.org/10.1017/s0266462305050385.
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Objectives:Health needs has attracted the interest of policy-makers, health economists, and health professionals as modern health services try to satisfy individual and population health needs to optimize resource utilization. Health needs can be assessed by administering various types of survey or interview-based instruments. If health needs are to be satisfied in changing health agendas in developed and developing countries, it is essential to employ valid and reliable tools. Despite the importance of needs assessment, no comprehensive review of tools is currently available. We carried out a literature search to define and categorize existing health needs assessment tools.Methods:We reviewed medical and social search engines for items containing specific health needs–related words to identify needs tools across a range of specialties. Papers were reviewed in terms of design, subject matter, psychometric features, and method of administration method.Results:Thirty-one employed in 52 studies including cancer, mental health, palliative care, multiple sclerosis, and cardiovascular disease tools were identified.Conclusions:This report summarizes available health needs instruments in a range of diseases to assist researchers in accessing health needs resources more easily and to encourage further research in this field.
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Jonas, Stephan Michael, Thomas Martin Deserno, Catalin Sorin Buhimschi, Jennifer Makin, Michael Andrew Choma i Irina Alexandra Buhimschi. "Smartphone-based diagnostic for preeclampsia: an mHealth solution for administering the Congo Red Dot (CRD) test in settings with limited resources". Journal of the American Medical Informatics Association 23, nr 1 (29.05.2015): 166–73. http://dx.doi.org/10.1093/jamia/ocv015.
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Abstract Objective Morbidity and mortality due to preeclampsia in settings with limited resources often results from delayed diagnosis. The Congo Red Dot (CRD) test, a simple modality to assess the presence of misfolded proteins in urine, shows promise as a diagnostic and prognostic tool for preeclampsia. We propose an innovative mobile health (mHealth) solution that enables the quantification of the CRD test as a batch laboratory test, with minimal cost and equipment. Methods A smartphone application that guides the user through seven easy steps, and that can be used successfully by non-specialized personnel, was developed. After image acquisition, a robust analysis runs on a smartphone, quantifying the CRD test response without the need for an internet connection or additional hardware. In the first stage, the basic image processing algorithms and supporting test standardizations were developed using urine samples from 218 patients. In the second stage, the standardized procedure was evaluated on 328 urine specimens from 273 women. In the third stage, the application was tested for robustness using four different operators and 94 altered samples. Results In the first stage, the image processing chain was set up with high correlation to manual analysis (z-test P < 0.001). In the second stage, a high agreement between manual and automated processing was calculated (Lin’s concordance coefficient ρ c = 0.968). In the last stage, sources of error were identified and remedies were developed accordingly. Altered samples resulted in an acceptable concordance with the manual gold-standard (Lin’s ρc = 0.914). Conclusion Combining smartphone-based image analysis with molecular-specific disease features represents a cost-effective application of mHealth that has the potential to fill gaps in access to health care solutions that are critical to reducing adverse events in resource-poor settings.
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Law, Elaine, Marie C. Scott, Yong S. K. Moon, Audrey J. Lee, Veronica T. Bandy, Andrew Haydon, Allen Shek i S. Lena Kang-Birken. "Adapting pharmacy experiential education during COVID-19: Innovating remote preceptor resources, tools, and patient care delivery beyond virtual meetings". American Journal of Health-System Pharmacy 78, nr 18 (5.05.2021): 1732–38. http://dx.doi.org/10.1093/ajhp/zxab192.
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Abstract Purpose To describe the innovative teaching practices, tools, and resources for remote learning developed by a school of pharmacy with a decentralized experiential program to empower and support preceptors in response to the coronavirus disease 2019 (COVID-19) pandemic. Summary As the pandemic has continued, there have been significant shifts in pharmacy workflow, staffing, and patient care delivery. Pharmacy students are slowly being reintegrated into these learning environments. Although preceptors are willing and eager to teach, many lack the resources, tools, and support to create remote learning experiences at their facilities. The University of the Pacific Thomas J. Long School of Pharmacy has a decentralized experiential education model in which faculty regional coordinators with clinical practices and diverse expertise are disseminated throughout California. This model allowed us to collaborate and understand preceptor needs from a local level. We created a preceptor COVID-19 guidance document, introduced innovative virtual playbooks to pivot up to 100% remote rotations, and promoted the layered learning model to integrate pharmacy residents into the remote teaching space. Communication and flexibility are key to ensure student and preceptor safety while maintaining high-quality advanced pharmacy practice experiences and preserving patient-student relationships in telehealth. Conclusion Overall, we successfully created innovative solutions and leveraged our decentralized experiential model to meet the teaching and learning demands during an unanticipated crisis. We continue to adapt and plan to assess the effectiveness of the tools by administering surveys of preceptors and pharmacy students.
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Coller, Barry S. "Expand the scorecard for health-care reform to achieve a better result and enhance clinical and translational science". Journal of Clinical and Translational Science 2, nr 5 (październik 2018): 276–79. http://dx.doi.org/10.1017/cts.2018.333.
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Clinical and translational science is vitally dependent on the nation’s underlying health-care policies and programs. In a reciprocal fashion, data generated by clinical and translational research can inform both health policy and health-care delivery. It is important, therefore, to rate health reform proposals comprehensively on a set of criteria that reflect the broad goals of reform, including the potential impact on clinical and translational science and medical education. I propose that the criteria include achieving universal coverage, reducing administrative costs, retaining one’s chosen primary care physician, encouraging care coordination, empowering physicians, freeing industry from choosing and administering health plans, providing choice of specialists and hospitals, providing patient education, preventing patient overuse of services, rationalizing resource allocation, encouraging competition, limiting government’s role, supporting medical education, training, and research, and freeing industry to make personnel decisions based on business criteria rather than the impact on health-care costs to the company. I discuss the rationale for each element and offer a rating of current proposals relative to a proposal previously made.
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Mick, Stephen S. Farnsworth, i Patrick D. Shay. "Accountable Care Organizations and Transaction Cost Economics". Medical Care Research and Review 73, nr 6 (3.08.2016): 649–59. http://dx.doi.org/10.1177/1077558716640411.
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Using a Transaction Cost Economics (TCE) approach, this paper explores which organizational forms Accountable Care Organizations (ACOs) may take. A critical question about form is the amount of vertical integration that an ACO may have, a topic central to TCE. We posit that contextual factors outside and inside an ACO will produce variable transaction costs (the non-production costs of care) such that the decision to integrate vertically will derive from a comparison of these external versus internal costs, assuming reasonably rational management abilities. External costs include those arising from environmental uncertainty and complexity, small numbers bargaining, asset specificity, frequency of exchanges, and information “impactedness.” Internal costs include those arising from human resource activities including hiring and staffing, training, evaluating (i.e., disciplining, appraising, or promoting), and otherwise administering programs. At the extreme, these different costs may produce either total vertical integration or little to no vertical integration with most ACOs falling in between. This essay demonstrates how TCE can be applied to the ACO organization form issue, explains TCE, considers ACO activity from the TCE perspective, and reflects on research directions that may inform TCE and facilitate ACO development.
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Foster, Lynelle, i Anne McMurray. "Community Parenteral Therapy Project: A pilot study". Australian Health Review 21, nr 1 (1998): 98. http://dx.doi.org/10.1071/ah980098.
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The pilot study reported in this paper was devised to develop and compare servicedelivery models that would achieve the provision of high quality parenteral therapycare to patients in the Gold Coast District Health Service community. All data werecollected on 113 patients for a 12-month period, January to December 1996. Thestudy compared the provision of outreach nursing services and contracted nursingservices on measures of satisfaction and cost.The study showed that patient and carers indicated a preference for community care,medical officers advocated the benefits of administering parenteral therapies in thecommunity, general practitioners were interested in managing future communityparenteral therapies, and contracted (nurse) service providers endorsed the developmentof a parenteral therapy resource centre. The findings also revealed considerablepotential cost savings in community-based care.
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Patel, K., C. Crowley i R. H. M. Lim. "A service evaluation of subcutaneous insulin administration at a large hospital". International Journal of Pharmacy Practice 29, Supplement_1 (26.03.2021): i29—i30. http://dx.doi.org/10.1093/ijpp/riab015.035.
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Abstract Introduction One in six adult patients in hospitals have diabetes1. According to the National Diabetes Inpatient Audit (NaDIA)1, around 40% of these patients are treated with insulin, a high-risk drug used to regulate blood glucose levels. Worryingly, 40% of patients treated with insulin experience an insulin error whilst in hospital1. Although the annual NaDIA shows consistent improvement in patient care since 2011, insulin error rates have not reduced significantly. Local data from a large NHS Trust mirrors the national picture2 and this study was part of the Trust’s 2018 NaDIA Quality Improvement Collaborative work to improve patient care specific to subcutaneous (SC) insulin administration. Preliminary work involved the development of a process map of the use of SC insulin with multidisciplinary teams from two wards at the Trust, reflecting how teams think SC insulin is used (work-as-imagined, WAI). Aims 1) To observe and describe the task of administering SC insulin (work-as-done, WAD), 2) To compare WAI and WAD relating to the task of administering SC insulin. Methods Non-participant observation of SC insulin administration took place over a 2-week period (Nov-Dec 2018), during lunch and dinner times, in the same two wards at the Trust where preliminary work took place. A ward pharmacist identified up to 16 opportunities for observations. Data were collected using a piloted observation template. Data from each observation was coded to identify tasks performed, using MS Word. Tasks were further analysed to develop a Hierarchical Task Analysis (HTA). This HTA was compared with the previously developed process map to identify similarities and differences in tasks. Results A total of 13 observations were made. The HTA top-level goal was to administer SC insulin, from which there were four sub-goals: 1) time to give insulin, 2) collect equipment, 3) enter ward and 4) administer insulin. More than 50 sub-tasks were represented in the HTA, highlighting the complexity of the overall task of administering SC insulin. There were variations in the way nurses prepared and gave insulin such as the use of workarounds and omissions of tasks. The comparison of the HTA (WAD) and process map (WAI) identified broadly similar tasks in sub-goal “administer insulin”. Differences in the boundaries of analysis in the process map and HTA made further comparisons of tasks difficult. For example, when describing the task of administering SC insulin, teams focused primarily on the final stage of insulin administration and not tasks that took place prior to it. Conclusion The administration of SC insulin was a complex process. The observations of SC insulin administration (WAD) largely matched those described by healthcare staff (WAI). Nurses were observed to adapt their work to provide essential patient centred care, The study was limited by the number of observations and differences in the boundary of analysis in the HTA and process map. Future work could investigate and understand the nature and implications of adaptations in SC insulin administration, as a key potential to develop a resilient work system. References 1. NHS Digital (2018) National Diabetes Inpatient Audit England and Wales, 2017. https://files.digital.nhs.uk/pdf/s/7/nadia-17-rep.pdf Accessed 17/10/2020 2. NHS Digital (2018) National Diabetes Inpatient Audit (NaDIA) – 2017. https://digital.nhs.uk/data-and-information/publications/statistical/national-diabetes-inpatient-audit/national-diabetes-inpatient-audit-nadia-2017#resources Accessed 18/10/2020
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Bintang, Sanusi, Mujibussalim Mujibussalim i Fikri Fikri. "Decentralization of Indonesia social health insurance". International Journal of Law and Management 61, nr 2 (4.04.2019): 310–27. http://dx.doi.org/10.1108/ijlma-07-2018-0143.
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Purpose The purpose of this study is to explain the need for the implementation of decentralization of Indonesia social health insurance (INA-Medicare), with particular emphasis for Aceh Province. First, it discusses the inconsistency of Act on National Social Security System (ANSSS) to the 1945 Constitution, because certain rules in ANSSS are contrary to the 1945 Constitution. This weakens the practice of broader regional autonomy, lessens the importance of public service quality in health care and ignores specific cultural and religious values of the regional people. Then, it explains provisions on central and regional government authority in the 1945 Constitution, Act on Regional Autonomy and Act on Governing of Aceh. Later, it explores current law and practice of INA-Medicare under the national social security system and the centralized administering body. Finally, it provides reasons for decentralization of INA-Medicare, as the solution. Design/methodology/approach This study uses doctrinal legal research. It relies on both primary and secondary legal authorities. In additions, it also uses sociolegal research by relying on non-legal materials, including empirical data from books, journals and newspapers. Analysis of legal authorities is by legal reasoning process, whereas analysis of non-legal materials is by qualitative approach. Findings This study argues that the decentralization of INA-Medicare is more suitable for Aceh Province because of several reasons, including implementing broader regional autonomy, improving public service quality in health care and implementing the principle of sharia social health insurance. Originality/value The study is original because it focuses on a specific regional area of Aceh Province, Indonesia. It concentrates on specific legal issues and provides unique reasons for argumentation. Therefore, it provides important specific information for journal readers.
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Taylor, Douglas C. A., Michelle Skornecki, Gregory Hill, Richard Barron, Chris Anstead, Barry Fortner i Seval Ozer-Deniz. "Clinic Staff Time and Labor Costs Associated with Administering Pegfilgrastim as Compared with Filgrastim to Patients Receiving Myelosuppressive Chemotherapy: Results of a Health Economic Model". Blood 116, nr 21 (19.11.2010): 1515. http://dx.doi.org/10.1182/blood.v116.21.1515.1515.
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Abstract Abstract 1515 Objective: Patients receiving myelosuppressive chemotherapy are at risk for developing febrile neutropenia, a major dose-limiting toxicity of systemic chemotherapy. Prophylactic use of recombinant human granulocyte colony-stimulating factors (G-CSF), such as filgrastim used daily for up to two weeks and pegfilgrastim used once per cycle, decreases the incidence of febrile neutropenia. Cancer delivery models are under pressure to become more efficient in an increasingly cost-restrictive environment. The use of growth factors to help prevent febrile neutropenia is well established, but little is known regarding the use of practice resources necessary to deliver therapy. The objective of this study was to construct an empirical model to calculate the human resource time and cost associated with delivery of filgrastim and pegfilgrastim. Methods: A practice-level model was constructed detailing staff tasks required for the administration of G-CSF on a monthly basis. Key model inputs include specific clinic characteristics, such as the number of patients treated with G-CSF, the number of filgrastim injections administered per cycle, and hourly pay rates for nurses and clerks. As described by Fortner et al (Community Oncology 2004, 1:23-28), interviews were conducted with 400 medical professionals at 20 US community oncology practices to provide data for the time required for the tasks involved in G-CSF delivery (scheduling, front desk, phlebotomy, laboratory, triage, injection, and billing). Model outputs were time expended for each staff type for administration of filgrastim or pegfilgrastim and corresponding labor costs. Costs for drug (filgrastim or pegfilgrastim), laboratory tests, and other materials were excluded from this model. The base-case scenarios contrasted 1 patient vs. 30 patients per month. Also examined were results for patients who received 11 injections of filgrastim per chemotherapy cycle, reflecting the mean number of injections received per cycle in the pegfilgrastim registrational clinical trials, and patients receiving 6 injections per cycle, as observed in current clinical practice. Using Bureau of Labor Statistics data, hourly pay rates were assumed to be $31.28 for nurses and $12.35 for clerks. Results: Table 1 displays monthly opportunity costs in hours and dollars of using once-per-cycle pegfilgrastim injection as compared with filgrastim given as either 6 or 11 injections per cycle. Alternate cost and time assumptions, with 95% confidence intervals for salary and time inputs, are shown in parentheses. Conclusions: The 30-patient model predicts monthly opportunity costs with pegfilgrastim as compared with filgrastim of 378 to 756 staff hours and between $9,000 and $18,000. On a per-patient basis, the monthly opportunity cost would be 13 to 25 staff hours and $300 to $600. Use of pegfilgrastim as compared with filgrastim is associated with substantial savings in time and labor costs. Future medical care delivery models should consider practice resource requirements as a means of increasing efficiency and cost effectiveness. Disclosures: Taylor: i3 Innovus: Employment; Amgen Inc.: Consultancy, Research Funding. Skornecki:i3 Innovus: Employment; Amgen Inc.: Consultancy, Research Funding. Hill:i3 Innovus: Employment; Amgen Inc.: Consultancy, Research Funding. Barron:Amgen Inc.: Employment, Equity Ownership, Research Funding. Anstead:Amgen Inc.: Employment, Equity Ownership. Fortner:P4 Healthcare: Employment. Ozer-Deniz:i3 Innovus: Employment; Amgen Inc.: Consultancy, Research Funding.
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Gerbarg, Patricia, Gretchen Wallace i Richard Brown. "Mass Disasters and Mind-Body Solutions: Evidence and Field Insights". International Journal of Yoga Therapy 21, nr 1 (1.09.2011): 97–107. http://dx.doi.org/10.17761/ijyt.21.1.gn36102834522n07.
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Treatment for the psychological consequences of mass disasters is essential to the recovery of individuals and communities. Little is known about how to provide effective mental health interventions when there are thousands of victims and little, if any, access to care. Post-disaster research and program evaluations suggest that mind-body practices can provide significant relief of anxiety, depression, posttraumatic stress, and physical ailments. Mind-body programs are inexpensive, adaptable to different cultures and conditions, and can be taught rapidly to large numbers of people, including community leaders, to create a sustainable resource for local mental health needs. The challenges of doing research in disaster areas are illustrated using examples from field studies. Potential risks of administering programs to vulnerable populations are discussed, with program design recommendations. The development of safe, effective, trauma-sensitive, culturally appropriate, sustainable programs requires research and collaboration among healthcare professionals, mind-body trainers, researchers, academic institutions, government agencies, and non-governmental humanitarian organizations.
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Aston, Jeff, Keith Wilson i David Terry. "STARTING A NEW MEDICINE STUDY". Archives of Disease in Childhood 101, nr 9 (17.08.2016): e2.54-e2. http://dx.doi.org/10.1136/archdischild-2016-311535.58.
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AimTo identify the experiences of patients, parents or carers when a child/young person is prescribed a new long-term medicine.MethodPatients' prescribed a new long-term (>6 weeks) medicine were recruited from a single UK paediatric hospital out-patient pharmacy.A semi-structured questionnaire was administered to participants, via telephone, 6 weeks after the dispensing of their medicine. The questionnaire included the following themes: information requirements, resources used to seek further information, medicine administration issues, new concerns or questions that have arisen, adverse effects, arranging repeat supplies and an assessment of adherence.The results were analysed using Microsoft Excel 2013 and NVivo Version 10.ResultsFifty patients consented and were included in the study. Eighteen (36%) participants had undertaken further research prior to taking/administering their new medicine. 13 (72%) of these used the internet for further information. Participants had further concerns/questions in 18 (36%) cases with 7 (38.9%) contacting the hospital team for further advice. Thirteen (26%) participants experienced difficulty administering/taking the medicine. Sixteen (36%) believed that they had experienced an adverse effect. Eight (16%) participants experienced difficulties when obtaining further supplies. With regard to adherence, 17 (34%) participants had forgotten a dose on at least one occasion and 4 (8%) found it difficult to keep to the medication regimen.ConclusionThis research has demonstrated that paediatric patients, parents and carers experience a wide range of issues during the first few weeks after starting a new medicine. This is in accordance with a recent review of non-adherence in paediatric long-term medical conditions.1 The New Medicines Service (NMS) offered through community pharmacists is designed to support patients' who have recently been prescribed a medicine to manage a long-term condition.2 However, this is not readily available to children/young people or their carers. The main barriers being the targeted conditions included in the service, consent and exclusion of undertaking an NMS consultation with a carer. Further research is required to establish and evaluate a paediatric specific medication review service for children/young people and their parents/carers when a new long-term medicine has been prescribed. This research will support the recent research recommendation of the National Institute of Health and Care Excellence.3
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Pollock, Kristian, Eleanor Wilson, Glenys Caswell, Asam Latif, Alan Caswell, Anthony Avery, Claire Anderson, Vincent Crosby i Christina Faull. "Family and health-care professionals managing medicines for patients with serious and terminal illness at home: a qualitative study". Health Services and Delivery Research 9, nr 14 (sierpień 2021): 1–162. http://dx.doi.org/10.3310/hsdr09140.
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Background More effective ways of managing symptoms of chronic and terminal illness enable patients to be cared for, and to die, at home. This requires patients and family caregivers to manage complex medicines regimens, including powerful painkillers that can have serious side effects. Little is known about how patients and family caregivers manage the physical and emotional work of managing medicines in the home or the support that they receive from health-care professionals and services. Objective To investigate how patients with serious and terminal illness, their family caregivers and the health-care professionals manage complex medication regimens and routines of care in the domestic setting. Design A qualitative study involving (1) semistructured interviews and group discussions with 40 health-care professionals and 21 bereaved family caregivers, (2) 20 patient case studies with up to 4 months’ follow-up and (3) two end-of-project stakeholder workshops. Setting This took place in Nottinghamshire and Leicestershire, UK. Results As patients’ health deteriorated, family caregivers assumed the role of a care co-ordinator, undertaking the everyday work of organising and collecting prescriptions and storing and administering medicines around other care tasks and daily routines. Participants described the difficulties of navigating a complex and fragmented system and the need to remain vigilant about medicines prescribed, especially when changes were made by different professionals. Access to support, resilience and coping capacity are mediated through the resources available to patients, through the relationships that they have with people in their personal and professional networks, and, beyond that, through the wider connections – or disconnections – that these links have with others. Health-care professionals often lacked understanding of the practical and emotional challenges involved. All participants experienced difficulties in communication and organisation within a health-care system that they felt was complicated and poorly co-ordinated. Having a key health professional to support and guide patients and family caregivers through the system was important to a good experience of care. Limitations The study achieved diversity in the recruitment of patients, with different characteristics relating to the type of illness and socioeconomic circumstances. However, recruitment of participants from ethnically diverse and disadvantaged or hard-to-reach populations was particularly challenging, and we were unable to include as many participants from these groups as had been originally planned. Conclusions The study identified two key and inter-related areas in which patient and family caregiver experience of managing medicines at home in end-of-life care could be improved: (1) reducing work and responsibility for medicines management and (2) improving co-ordination and communication in health care. It is important to be mindful of the need for transparency and open discussion about the extent to which patients and family caregivers can and should be co-opted as proto-professionals in the technically and emotionally demanding tasks of managing medicines at the end of life. Future work Priorities for future research include investigating how allocated key professionals could integrate and co-ordinate care and optimise medicines management; the role of domiciliary home care workers in supporting medicines management in end-of-life care; patient and family perspectives and understanding of anticipatory prescribing and their preferences for involvement in decision-making; the experience of medicines management in terminal illness among minority, disadvantaged and hard-to-reach patient groups; and barriers to and facilitators of increased involvement of community pharmacists in palliative and end-of-life care. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 14. See the NIHR Journals Library website for further project information.
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Miyagawa, Shoko, Shigeichiro Yamasaki, Eiko Uchiyama i Donald L. Amoroso. "Framework for Information Sharing with Privacy and Priority Control in Long-Term Care in Japan". International Journal of E-Health and Medical Communications 5, nr 1 (styczeń 2014): 46–62. http://dx.doi.org/10.4018/ijehmc.2014010103.
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In this paper, the authors present a framework for information sharing with privacy and priority control in long-term care designed to promote appropriate information sharing among the people who are involved in long-term care for provision of better care service. The authors' framework includes four agents (user agent, local information system access agent, authentication/access control agent and priority control agent) and two databases (user database and care record index database). The LIS (local information system) access agent creates and updates the care record index database, which act as an index when user agents try to access to care recipient's record, based on the Open Authentication protocol. It also acts as a query interface from each user agent. The authentication/access control agent allows sensitive information to be shared in accordance with the policy defined by care recipient. The priority control agent judges the urgency of the information for either periodic or immediate notification. The authors also propose an implementation of this framework using the Resource Description Framework Site Summary, and demonstrate how our framework works with the scenario of care recipient's unexpected injury. In summary, this framework is designed to help people who require long-term care and provides an effective system for each staff that is in charge of administering long-term care services. The authors' information sharing system incorporates a multi-agent architecture to facilitate information sharing and privacy/priority control. The authors believe that this research provides an important first step for researchers who intend to build a prototype to automate the processes of information sharing for long-term health care.
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Ertel, Lyudmila A. "Optimization of the quality of life of patients who need palliative care introduction". Sociology of Medicine 19, nr 1 (23.11.2020): 43–52. http://dx.doi.org/10.17816/1728-2810-2020-19-1-43-52.
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People suffering from chronic progressive diseases of non-infectious and infectious nature need palliative care. When a condition with an unfavorable prognosis occurs, an integrated approach is required, which involves patient care in the medical, psychological, social, and spiritual aspects. This assistance is aimed at improving the quality of life of such patients and implemented in Russia as part of the provision of palliative care, which aims to improve the quality of life of not only the patient himself but also his family members. This study aims to examine the impact of legal regulation of palliative care as well as the medical, psychological, social, and spiritual aspects of palliative care on the quality of life and needs of the patients and their families. Using content analysis and documentary observation, the results regarding the impact of legal, medical, psychological, social, and spiritual aspects combined in the provision of palliative care on the quality of life of patients in need were examined. The study revealed gaps in the legal regulation of the provision of palliative care for patients, particularly HIV-infected patients and those with chronic tuberculosis. As part of optimizing the provision of palliative care, creating a vertically integrated information system for palliative care (VIMIS Palliative) is necessary. To improve the professional stability of medical staff groups providing palliative care and preventing suicidal behavior among patients, health care organizers should improve the mechanisms of psychological interaction among all the participants in the palliative care system. Organizational and methodological approaches in administering anesthesia must be improved, and the knowledge of medical workers on the theoretical foundations of the formation of pain syndromes and the modern methodology for analgesic treatment is required. The organization of the state system of the artificial ventilation of the lungs at home is required with the aim of long-term respiratory support for patients in need. Additionally, further research is needed to determine the impact of nutritional support as a supportive therapy on the course of treatment and the results of palliative care, allowing to optimize the quality of life of patients in need. Optimization of the quality of life of incurable patients depends on the level of palliative care to achieve and maintain the maximum of their physical, psychological, social, and spiritual potential. Furthermore, palliative care should meet the following requirements: early-onset, continuity, succession, comprehensive, phased, and individual approach. Despite certain existing common problems in the implementation of palliative care and the difficulties caused by the restructuring of the health care system in the fight against coronavirus infection, the system is functioning and has the necessary resources to ensure the quality of life and alleviate persistent painful symptoms of patients.
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Downey-Wall, Kathryn, Keneth Hilary, Deo Katabalo, Nestory Masalu i Kristin Schroeder. "Impact of Pharmacist Participation on Chemotherapy Administration Outcomes in a Low-Resource Setting". Journal of Global Oncology 4, Supplement 1 (marzec 2018): 20s. http://dx.doi.org/10.1200/jgo.18.13000.
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Abstract 50 Purpose Implementation of specialty oncology pharmacy services is associated with improved patient care and reduced medical errors. Pharmacy capacity is limited in many low-resource countries, with chemotherapy preparation and administration often being performed by other allied health care providers. At Bugando Medical Center in Tanzania, both nurses and pharmacists are responsible for mixing and administering chemotherapy; however, most nurses do not have specialized oncology training, which increases the risk for medication errors. The purpose of the current study was to assess the effects of pharmacist participation on therapeutic outcomes, including verified dosage calculations, chemotherapy administration adherence, and dose documentation. Methods Chemotherapy encounters were observed over a 1-month period. Recorded observations included adherence to prescribed chemotherapy administration times; errors, including spills and extravasation; and administrative adherence, including dose verification and documentation. Results There were 53 observed encounters—32 with a pharmacist and 21 without; 15 were for pediatric patients. Pharmacist participation increased adherence to prescribed administration time (54% v 19%; P = .009) and decreased errors (zero v two extravasations; zero v one spill). Pharmacist participation improved chemotherapy administration documentation (96.8% v 76.2%; P = .049); however, patient safety measures, including intravenous catheter placement verification, secondary dose check, and toxicity monitoring during administration, were not done with or without pharmacist participation. Conclusion Pharmacist participation increased adherence to prescribed chemotherapy administration and documentation, and reduced extravasation; however, additional patient safety training is needed. A larger study can further evaluate the impact of the participation of a specialty pharmacist on patient-related outcomes. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.
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Collins, Sarah A., Dana Alexander i Jacqueline Moss. "Nursing domain of CI governance: recommendations for health IT adoption and optimization". Journal of the American Medical Informatics Association 22, nr 3 (9.02.2015): 697–706. http://dx.doi.org/10.1093/jamia/ocu001.
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Abstract Context There is a lack of recommended models for clinical informatics (CI) governance that can facilitate successful health information technology implementation. Objectives To understand existing CI governance structures and provide a model with recommended roles, partnerships, and councils based on perspectives of nursing informatics leaders. Design, Setting, Participants We conducted a cross-sectional study through administering a survey via telephone to facilitate semistructured interviews from June 2012 through November 2012. We interviewed 12 nursing informatics leaders, across the United States, currently serving in executive- or director-level CI roles at integrated health care systems that have pioneered electronic health records implementation projects. Results We found the following 4 themes emerge: (1) Interprofessional partnerships are essential. (2) Critical role-based levels of practice and competencies need to be defined. (3) Integration into existing clinical infrastructure facilitates success. (4) CI governance is an evolving process. We described specific lessons learned and a model of CI governance with recommended roles, partnerships, and councils from the perspective of nursing informatics leaders. Conclusion Applied CI work is highly interprofessional with patient safety implications that heighten the need for best practice models for governance structures, adequate resource allocation, and role-based competencies. Overall, there is a notable lack of a centralized CI group comprised of formally trained informaticians to provide expertise and promote adherence to informatics principles within EHR implementation governance structures. Our model of the nursing domain of CI governance with recommended roles, partnerships, and councils provides a starting point that should be further explored and validated. Not only can the model be used to understand, shape, and standardize roles, competencies, and structures within CI practice for nursing, it can be used within other clinical domains and by other informaticians.
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Afriyie, Daniel Kwame, George Awuku Asare, Seth Kwabena Amponsah i Brian Godman. "COVID-19 pandemic in resource-poor countries: challenges, experiences and opportunities in Ghana". Journal of Infection in Developing Countries 14, nr 08 (31.08.2020): 838–43. http://dx.doi.org/10.3855/jidc.12909.
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The novel coronavirus, SARS-CoV-2, which causes COVID-19, is seen world-wide. In developing countries, adequate health facilities and staff numbers are a concern. Ghana recorded its first 2 cases of COVID-19 on 12 March 2020. On 30 March 2020, a partial lockdown for 14 days was imposed and later extended along with other measures. By the end of the initial lockdown, 19 April 2020, an estimated 86,000 people had been traced and 68,591 tests performed. Of the 68,591 tests, there were 1,042 (1.5%) positive cases, 9 deaths, and 99 recoveries, with Ghana ranked number one among African countries in administering tests per million people. Ghana’s effective track and trace system, as well as lockdown and other measures, have helped limit mortality with only 85 recorded deaths by 23 June 2020. Scientists from three facilities of the University of Ghana have also successfully sequenced the genomes of COVID-19 from 15 confirmed cases, and the Food and Drugs Authority in Ghana have also helped address shortages by fast-tracking certification of hand sanitizers and local production of 3.6 million standardized personal protective equipment. There has also been the development of prototypes of locally-manufactured mechanical ventilators to meet local need at intensive care units. Most people have also resorted to changing diets and the use of supplements to boost their immune system. Although initial results are encouraging, further research is needed to understand the dynamics of COVID-19 in Ghana and provide additional guidance.
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Siddins, Mark T., John Boland, Brian Mathews i Perry Swanborough. "Achieving waiting list reform: a pilot program integrating waiting time, category and patient factors". Australian Health Review 36, nr 3 (2012): 248. http://dx.doi.org/10.1071/ah11997.
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Equity in resource allocation is central to the tenet of social justice in health care. The management of surgical waiting lists is of critical importance to clinicians, patients and regulators. In most hospital environments, the basic process has remained unchanged for decades. Patients are assigned to one of three urgency-related categories. Clinicians consequently administer three competing patient pools. The basis by which patients are selected for treatment may be difficult to define. The specific clinical circumstances of each patient are often unreported and may be unknown to those administering the list. Waiting list bias is also recognised. This may reflect clinician advocacy, pressure to meet category timeframe restrictions or perceived training requirements. In this environment, it is difficult to demonstrate propriety in care. We report the implementation of a pilot program to redesign waiting list management within a South Australian public hospital unit. This allows assemblage of patients into a single list. Overall priority is determined by balancing clinical acuity and waiting time. The determination of acuity takes into account both the primary category and the specific characteristics of each patient that are relevant to their intended procedure. Uniquely, the process is applicable to lists containing patients with dissimilar conditions. This paper reviews the limitations of current approaches in meeting reasonable community expectations. The principles and social justification underpinning this reform are introduced. Finally, the benefits offered by the program are discussed and interim results are reported. What is known about this topic? Current models for the management of hospital waiting lists have remained largely unchanged for several decades. Typically patients are allocated to urgent, semi-urgent and non-urgent categories of care. No methodology exists to systematically integrate these groups, or to account for specific patient factors. In this void, propriety in management is difficult to establish or defend. What does this paper add? A program is reported that unifies all categories of patients into a single prioritised waiting list. The order of patients is dynamic, and transparently reflects waiting time, category assignment and relevant individual patient factors. Uniquely, the program is applicable to lists containing patients with diverse clinical conditions. What are the implications for clinicians? Adoption of new technology is essential if reasonable community expectations in waiting list management are to be met. The current program provides unambiguous, defensible prioritisation of all patients awaiting care. The present reliance on individual managers is reduced, and the unique circumstances of each patient are recognised. We believe this approach affords significant benefit to patients, practitioners and regulators.
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Lim, M. S. "1162 Financial Savings and Improved Outcomes from an Innovative, Integrated Sleep Apnea Management Program for a Safety Net Population: 5-Year Results". Sleep 43, Supplement_1 (kwiecień 2020): A444. http://dx.doi.org/10.1093/sleep/zsaa056.1156.
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Abstract Introduction Sleep disorders are extremely common in the general population and are associated with an increased risk for fatal accidents, heart disease, stroke, neurocognitive decline, and diabetes. Sleep problems disproportionately affect socioeconomically disadvantaged and under resourced communities. We present here a 5-year analysis of a private-public partnership between a private sleep medicine practice (Redwood Pulmonary Medical Associates, RPMA) and county medical system (the Health Plan of San Mateo) to provide a coordinated, value-based sleep apnea program to adult residents of San Mateo County, CA. Methods Referring providers send referrals to a single location (RPMA), and sleep consultations, testing, follow-up care, and CPAP management occur out of the same location by a dedicated staff. Limited channel cardiopulmonary (CP) sleep testing initiated in the office and completed at home was done for most patients. Patients with AHI>5 plus daytime sleepiness were offered nasal CPAP, unlimited mask fittings, and compliance checks. Results 2101 CP tests were successfully completed (93.5%). There were 49.6% females and 50.4% males, with an average age of 51.6 years. 31% had severe obstructive sleep apnea (OSA) and 59% were moderate or severe. 1471 (65%) of patients were given prescriptions for CPAP and 471 (32%) were still using CPAP at 5 years, 68.7% of whom were initiated within 3 years of the analysis. Of the patients returning satisfaction surveys, 97% would recommend the program to a relative or friend, and all respondents (99 to date) who were using CPAP felt it had benefitted their health overall. Comparing actual costs of the program to projected fee-for-service costs for the same services, the program saved the Health Plan of San Mateo $1,132,510, or 51.4%. Conclusion This program demonstrates the potential clinical and financial benefit of private-public partnerships in administering clinical programs to high risk populations, as private businesses can quickly adapt to new technologies, financial metrics, and standards of care. Support No outside financial support was provided
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Yanamandra, Uday, Pankaj Malhotra, K. K. Sahu, Yanamandra Sushma, Neha Saini, Pooja Chauhan, Jasmeen Gill i in. "Variation in Adherence Measures to Imatinib Therapy". Journal of Global Oncology, nr 4 (grudzień 2018): 1–10. http://dx.doi.org/10.1200/jgo.2016.007906.
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Purpose The introduction of tyrosine kinase inhibitors has transformed the care of patients with chronic myeloid leukemia, with survival approaching that of healthy individuals. Current-day challenges in chronic myeloid leukemia care include adherence to tyrosine kinase inhibitor therapy. We studied adherence from resource-constrained settings and tried to analyze the factors responsible for nonadherence in these individuals. We also correlated adherence to current molecular status. Patients and Methods This was a single-center, cross-sectional, observational study from north India. It consisted of a questionnaire-based survey in which a one-to-one interview technique was used by trained nursing staff administering the Modified Morisky Adherence Scale (MMAS-9) questionnaire. Adherence was also measured on the basis of physician’s assessment. JMP 13.0.0 was used for statistical analysis. Results A total of 333 patients with a median age of 42 years were included in the study. The median BCR-ABL/ABL ratio (IS) was 0.175 (0.0 to 98.0). The mean MMAS-9 score was 11 ± 2. Adherence was seen in 54.95% on the basis of MMAS-9, whereas physician’s assessment reported adherence in 90.39% of patients. Using the χ2 test, no relationship was found between the two assessment techniques. There was a significant relationship between major molecular response status and adherence by physician’s assessment and MMAS-9 ( P < .001). Bivariate analysis by logistic fit showed a good relation between the MMAS-9 score and the BCR-ABL/ABL ratio (IS), χ2 (1,220) = 135.45 ( P < .001). On multivariate analysis, enrolment in the Novartis Oncology Access program (a patient assistance program) was significantly associated with adherence ( P = .012). Conclusion This study highlights the lack of adherence in real-world settings and the various factors responsible. Such studies are important from a public health services perspective in various settings around the world because they may lead to corrective action being taken at the institutional level.
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Steuerle, C. Eugene. "Financing and administering health care". Society 32, nr 1 (listopad 1994): 69–70. http://dx.doi.org/10.1007/bf02693359.
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Noy-Sharav, Dorit. "The Rorschach and the TAT as Relational Instruments". Rorschachiana 27, nr 1 (styczeń 2005): 139–63. http://dx.doi.org/10.1027/1192-5604.27.1.139.
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The paper presents a procedure for evaluating couples for clinical as well as for screening purposes such as assessing couples for therapy or for adoptive parenting. The procedure combines individual evaluation (a clinical interview, two subtests of the WAIS-R, the Rorschach, and TAT), with couple evaluation (Consensus Rorschach and Consensus TAT). The author describes her method for administering and scoring the Consensus Rorschach and of administering and analyzing the Consensus TAT as follows: Having completed an individual Rorschach and TAT, in the couple stage the partners discuss each card and try to reach agreements on one or more responses, and to create together stories about several TAT cards. The examiner tape-records the process, and notes patterns of interaction, such as who presses for agreements; who dominates the decisions; are they flexible or rigid and defensive; do they negotiate with a sense of respect for self and other or do they fight about autonomy, control, or power. Each Rorschach response is scored according to the Exner system, and a structural summary for the couple’s record is constructed. Then each response gets an Interaction score developed by the author (see Table 2 ). (Readers are referred to other publications by the author, describing this procedure and several relational styles of couples. See references.) This method offers a representation of the couple dynamics and makes possible an appraisal of the process as well as the final product of the couple’s interaction. While in the individual tests each spouse creates for the examiner his unique interpretation of reality, in the relational part we watch the couple’s effort to integrate each spouse’s individual “script” – i.e., his/her interpretation of reality and of the relationship – and to create a “couple script.” Spouses often experience surprise and even dismay at the dissimilarity of their perception, while others feel intrigued and excited at the opportunity of seeing things in a different, new way. In some cases relief or joy is experienced at seeing things the same way. A number of vignettes illustrate how the unique style of the couple emerges in their test interaction, revealing their positive resources as well as their problematic areas. An extended case is presented, of a couple in the stage of courtship, hesitating on the verge of getting married. Each spouse’s background material and test material are presented and analyzed (see Tables 3 and 4 ), and some hypotheses are made as to their inner needs from a partner and their inhibitions about commitment to an intimate relationship. The interaction reveals their struggle in the first stages of creating a “couple script,” as each of them presents his personae, but also reveals his hidden needs and fears, and his projected image of the other. Focusing on issues of dependence and of aggression, the reader can see what these two young people need from each other. The man, Ami, impresses and attracts the woman, Irit, with his strong, coping, and ambitious personae. But he needs her to contain his insecurity and dependency needs, as well as to support his needs to develop and become what he strives for. Irit needs Ami to accept and even admire her hidden fiery, imaginative qualities, but also to respect her individuality and not try to dominate her. She also unconsciously yearns for his help in restoring parts of her repressed, lost self. On the basis of this material the author suggests ways of using the feedback session and the written report for counseling and for planning psychotherapy.
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Fletcher, Ruth. "Peripheral governance: administering transnational health-care flows". International Journal of Law in Context 9, nr 2 (czerwiec 2013): 160–91. http://dx.doi.org/10.1017/s1744552313000074.
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AbstractThis paper develops the concept of peripheral governance as a kind of legal transnationalism that is being generated by responses to outward travel for health care. I argue for a recuperation of the ‘peripheral’ in order to think through the ways in which marginal actors and marginal objects contribute to transnationalism. The paper draws on the idea of networked governance, nodal governance in particular, to capture governance mechanisms that have emerged in response to outward flows for health care. Peripheral governance comes into being through the cultivation of dependency on core provision of health care in other jurisdictions and by focusing domestic provision on those services (information, counselling, check-ups), which lie on the margins of health care. Peripheral governance has four key technologies: non-development, exit, use and return. These technologies illustrate how state agencies may actively mobilise the peripheral as they claim to address local needs through participation in the regulation of cross-border health care. In so doing they configure a conception of the peripheral that does not want to become core, participates in transnational networks on its own terms, and focuses on marginal objects of health care. I develop this account of peripheral governance through a critical reading of the strategies that the Irish Crisis Pregnancy Agency has adopted in response to women's practices of travelling for abortion care.
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Alawi, Faizan. "Oral health care providers should be administering vaccines". Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology 131, nr 3 (marzec 2021): 267–68. http://dx.doi.org/10.1016/j.oooo.2020.12.007.
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Haskell, Andrew, i Todd Kim. "Implementation of Patient-Reported Outcomes Measurement Information System (PROMIS) Data Collection in a Private Orthopedic Surgery Practice". Foot & Ankle Orthopaedics 2, nr 2 (1.06.2017): 2473011416S0001. http://dx.doi.org/10.1177/2473011417s000013.
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Category: Other Introduction/Purpose: The use of computerized adaptive testing (CAT) allows measurement of patient reported outcomes (PROs) through the fewest number of questions while achieving a higher precision, diminished floor and ceiling effects, and minimal administration burden compared with traditional methods. The National Institute of Health (NIH) created the Patient-Reported Outcomes Measurement Information System (PROMIS), a series of validated item banks that measure key clinical domains. Each item bank has as few as 4 questions or up to 12 questions depending on the subject’s answers. This study describes a method of administering the PROMIS CAT in a high volume Orthopedic Surgery practice, reports the administration burden and rate of patient capture, compares this population to previously reported national standards, and compares preoperative to postoperative pain item banks. Methods: The PROMIS CAT was intended to be collected prospectively for all patients as part of a standard intake. Patients used a tablet-based program that accesses the NIH PROMIS server generating a CAT in English or Spanish. Clinical domains include physical function, pain intensity, pain interference, global physical health, and global mental health. Scores for each domain and the time required were recorded in the patient’s electronic medical record (EMR) as part of their clinic visit, preserving confidentiality of the data and preventing the need for a separate database. De-identified data was retrospectively extracted from the EMR of every patient from March to December 2015. Results for each domain were compared to validated national norms using single variable t-test. Linear regression was used to assess the effect of age on outcome variables. Paired t-test was used to compare preoperative and postoperative pain intensity and pain interference when these scores were available. Results: 1688 PROMIS CATs were administered during 5345 visits (32%), reaching 70% as logistical issues were resolved. Patient age was 53±16. Completing the CAT required 157±164 seconds, with older patients taking 10.5 more seconds per decade (p < 0.05). The PROMIS item banks are normalized to mean 50±10 for the US population. Our results were: pain intensity 47.8±8.6*, pain interference 57.9±8.8*, physical function 40.1±9.0*, global physical health 43.3±9.6*, and global mental health 48.4±8.9 (*p < 0.05). Age has a small effect on all domains (p < 0.05). Approximately 20 patients are required to demonstrate a 15% change for a two-tailed, paired study with α=0.05 and 80% power. 109 patients had pre and postoperative PROMIS data. Pain intensity improved from 51.8±7.8 to 44.6±8.6 (p < 0.001) and pain interference improved from 60.1±8.8 to 55.5±9.0 (p < 0.001). Conclusion: Using tablets to access PROMIS CATs and entering the data in the patient’s chart for later retrieval is an effective technique to collect PROs in a busy Orthopedic Surgery practice with limited resources and no research coordinator. The process adds 2.5 minutes to a patient’s intake and does not require a complicated database or expensive equipment or licensing. Adequate number of tablets and “buy in” from staff are needed for acceptable completion rates. Demonstrating improvement in PROs after surgery holds promise for comparative studies of surgical indications and techniques and highlights the value these interventions add to patient care.
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Wonnacott, D., S. Scott, R. Flynn, S. Ali i N. Poonai. "P102: Perspectives surrounding paediatric procedural sedation using intranasal ketamine administration: a qualitative study of emergency nurses". CJEM 21, S1 (maj 2019): S100—S101. http://dx.doi.org/10.1017/cem.2019.293.
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Introduction: Intranasal ketamine (INK) has an emerging role for procedural sedation (PSA) in children in the emergency department (ED). While INK is less invasive and requires fewer personnel than IV ketamine, widespread adoption in the paediatric ED would require strong nursing acceptance. To inform INK implementation strategies, we explored nursing perspectives surrounding INK, including perceived barriers to its adoption. Methods: Nurses in the paediatric ED of London Health Sciences Centre, London, Ontario were recruited by email. Two, one-hour, in-person focus groups were conducted on January 26 and February 2, 2018 using a semi-structured interview format. Transcription was performed by a professional medical transcription service and analyzed using an inductive qualitative approach involving code words corresponding to recurring topics. Thematic analysis was used to group similar codes into themes. The analytic process was managed using the NVivo 11 software package. Results: Results: Eight nurses participated. All nurses were female and had a mean of 8.9 (range: 2.5 - 26) years of pediatric emergency nursing experience. Seven nurses had experience monitoring and administering INK to children for PSA. Five themes emerged: 1) attributes of INK, 2) INK effects on patients and families, 3) INK effects on health care providers, 4) INK effects on the ED environment, and 5) uncertainty regarding INK's effectiveness, predictability, and fit into institutional sedation protocols. Subthemes included 1) perceptions that INK produced a relatively shallower, slower-onset, and/or less titratable sedation, 2) the importance of patient cooperation (i.e. INK may be preferred by providers for older patients undergoing relatively painful or long procedures), 3) belief that INK was an effective anxiolytic and sedative with the potential to improve nursing resource utilization, and 4) belief that physician resistance to change and lack of personal familiarity were barriers to adoption. Conclusion: Conclusions: We identified clinical advantages to using INK in children, the importance of selecting appropriate patients, and barriers to widespread INK adoption. Importantly, our findings highlighted uncertainty about INK's effectiveness and incorporation into sedation protocols. Our findings will inform future knowledge translation strategies when implementing INK in the clinical setting.
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Oostenbrink, J. B., M. J. D. Tangelder i J. W. Gorter. "Costs of Outpatient Anticoagulant Treatment in Patients with Cerebral and Peripheral Arterial Occlusive Disease". Thrombosis and Haemostasis 85, nr 01 (2001): 52–56. http://dx.doi.org/10.1055/s-0037-1612903.
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Summary Background and objective: Knowledge of the costs of oral anticoagulant (AC) treatment may be relevant for resource allocation. Also, the incremental costs may be compared with other treatments for health care policy decisions. In this report, we have assessed actual costs of anticoagulant therapy in anticoagulation clinics (AC-clinic) in three different settings in the Netherlands. Methods: Costs of anticoagulant drug supply and costs as a result of INR-adjustment procedures were estimated. We compared the total costs of treatment in patients treated after minor cerebral ischaemia in the Stroke Prevention in Reversible Ischemia Trial (SPIRIT) and in patients treated because of peripheral arterial occlusive disease in the Dutch Bypass Oral anticoagulants or Aspirin Trial (BOA). Results: Costs of monitoring ranged between Euro 6.44 and Euro 9.87 per visit for monitoring at the AC-clinic and at home, respectively. The annual costs of administering anticoagulant drugs ranged between Euro 83 (phenprocoumon) and 107 (acenocoumarol). Variation in the overall actual annual costs of AC treatment was caused by the number of monitoring visits, the distribution of home and clinic visits and, to a lesser extent, the medication used. Annual costs of AC therapy for patients in SPIRIT was Euro 239 and for patients in BOA Euro 312. Overall costs of anticoagulant therapy were about 3 to 4-fold higher than standard treatment with aspirin. Conclusions: Although the actual costs of anticoagulant therapy may be substantially higher than that of other antithrombotic therapies, its cost-effectiveness depends highly on efficacy.Writing Committee: A. Algra MD, E. Buskens MD, J. W. Gorter MD, J. B. Oostenbrink MSc, M. J. D. Tangelder MD.Extended writing committee: All above authors plus: B. C. Eikelboom MD, B. A. van Hout PhD, J. van Gijn MD, L. J. Kappelle MD, P. J. Koudstaal MD, J. A. Lawson MD, J. de Vries-Goldschmeding, MD (on behalf of the Federatie van Nederlandse Trombosediensten), and the SPIRIT and Dutch BOA Study Groups.
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Smith, Eldon R. "Health care human resources". Canadian Journal of Cardiology 23, nr 3 (marzec 2007): 235–36. http://dx.doi.org/10.1016/s0828-282x(07)70752-3.
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MAYO, THOMAS W. "Allocating health care resources". Pediatric Infectious Disease Journal 10, nr 3 (marzec 1991): 175–78. http://dx.doi.org/10.1097/00006454-199103000-00001.
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Callahan, Daniel. "ALLOCATING HEALTH CARE RESOURCES". American Journal of Physical Medicine & Rehabilitation 72, nr 2 (kwiecień 1993): 101–5. http://dx.doi.org/10.1097/00002060-199304000-00009.
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Ferenz, Leonard. "Allocating health care resources". Social Science & Medicine 42, nr 4 (luty 1996): 633–34. http://dx.doi.org/10.1016/s0277-9536(96)90383-4.
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Baltikauskas, Ida L. "Allocating Health Care Resources". Teaching Philosophy 18, nr 4 (1995): 379–81. http://dx.doi.org/10.5840/teachphil199518459.
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Carrera, Percivil M. "Investing Health Care Resources". Health Affairs 27, nr 1 (styczeń 2008): 301–2. http://dx.doi.org/10.1377/hlthaff.27.1.301-a.
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Knoetze, Adriaan, i Shaun De Freitas. "The Protection of Conscientious Objection against Euthanasia in Health Care". Potchefstroom Electronic Law Journal 22 (20.09.2019): 1–32. http://dx.doi.org/10.17159/1727-3781/2019/v22i0a5590.
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In 2015 the South African judiciary was confronted with the issue of the so-called "right to die", when Robin Stransham-Ford applied to the High Court of South Africa (the North Gauteng Division) for an order to have his life terminated. Although the Supreme Court of Appeal set aside the order (on procedural grounds), the High Court's judgment paved the way towards renewed attention regarding the possible legalisation of euthanasia. A pertinent question arising from this is whether a medical practitioner may be compelled to participate in the administering of euthanasia. Bearing this in mind, this article argues for the protection of the rights of medical practitioners who conscientiously object to participating in the administering of euthanasia, especially where such an objection is based on religious beliefs. From this arises the necessity to investigate the rights applicable both to the medical practitioner and the patient (which focusses on the right to freedom of religion and personal autonomy), the weighing up against one another of the different meanings ascribed to such rights, as well as the postulation of a substantively competitive rationale against the background of the importance and sacredness of human life. This also overlaps with the importance of the endeavour towards higher levels of religious freedoms and consequently of plurality in democratic societies. Applying the proportionality test in the analysis whether a medical practitioner's rights may be reasonably and justifiably limited against the background of administering euthanasia also strengthens the argument for the protection of the medical practitioner's right to object conscientiously to the administering of euthanasia. This, together with the vacuum there is in substantive human rights jurisprudence related to this topic, suggests the importance of this article both for the South African context and beyond.
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Nokes, Kathleen M. "Experiences of Health Care Providers in Administering Aerosolized Pentamidine Treatments". AIDS Patient Care 6, nr 3 (czerwiec 1992): 126–29. http://dx.doi.org/10.1089/apc.1992.6.126.
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Jennings, John C. "Optimizing Womenʼs Health Care Resources". Obstetrics & Gynecology 124, nr 1 (lipiec 2014): 1–4. http://dx.doi.org/10.1097/aog.0000000000000323.
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Levin, Paul E. "Utilizing Health-Care Resources Wisely". Journal of Bone and Joint Surgery 98, nr 11 (czerwiec 2016): e47. http://dx.doi.org/10.2106/jbjs.16.00020.
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Gandjour, A., i K. W. Lauterbach. "Allocating resources in health care". HEPAC Health Economics in Prevention and Care 1, nr 2 (1.11.2000): 116–21. http://dx.doi.org/10.1007/s101980070005.
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Henderson, Angela. "The Hidden Health Care System: Social Resources in Health Care". Nursing Philosophy 12, nr 4 (9.09.2011): 299–300. http://dx.doi.org/10.1111/j.1466-769x.2010.00477.x.
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PALMER, H. "Editorial: Quality of Care and Health Care Resources". International Journal for Quality in Health Care 7, nr 2 (1.06.1995): 79. http://dx.doi.org/10.1093/intqhc/7.2.79.
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Rao, Gautham. "Administering Entitlement: Governance, Public Health Care, and the Early American State". Law & Social Inquiry 37, nr 03 (2012): 627–56. http://dx.doi.org/10.1111/j.1747-4469.2011.01274.x.
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This article explores the federal marine hospitals of the early republic, the first public health care system in US history. Beginning in 1798, the federal government collected twenty cents per month from mariners' wages and used this revenue to subsidize medical care for sick and disabled merchant mariners. Previous studies have traced links between marine hospitals and modern public policy. By studying governance from the bottom up, this article takes a different approach. I argue that jurists, physicians, and officials' regulation of sailors' entitlement to public health care facilitated and reflected a transformation of national authority. Between 1798 and 1816, sailors' entitlement was a local matter, based on the traditional paternalist understandings of maritime laborers as social dependents. By 1836, though, the federal Treasury redefined entitlement around a newly calculus of productivity: only the productive were entitled to care at the marine hospitals. This story about governance, federal law, and political economy in the early United States suggests that the early American state was a more vibrant participant in the market and society than has been previously understood.
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Tekian, Ara, i Gerald Stapleton. "Online resources for health care simulation". Clinical Teacher 9, nr 6 (20.11.2012): 417–19. http://dx.doi.org/10.1111/tct.12020.
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Whittam, Judith. "Information for Managing Health Care Resources". Physiotherapy 89, nr 8 (sierpień 2003): 508. http://dx.doi.org/10.1016/s0031-9406(05)60012-0.
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Davis, Anne J. "The Allocation of Health Care Resources". Western Journal of Nursing Research 13, nr 1 (luty 1991): 136–37. http://dx.doi.org/10.1177/019394599101300110.
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Harter, Lynn M., i Heather M. Zoller. "Organizing Healing and Health Care Resources". Management Communication Quarterly 24, nr 3 (10.06.2010): 446–48. http://dx.doi.org/10.1177/0893318910370268.
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Haywood, Stuart, i Wendy Ranadé. "Resources and Innovation in Health Care". Policy & Politics 14, nr 4 (1.10.1986): 461–74. http://dx.doi.org/10.1332/030557386782595674.
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Hoekstra, Ann, i Brittany Payeur. "Vaccination resources for health care providers". Journal of the American Pharmacists Association 56, nr 2 (marzec 2016): 161–65. http://dx.doi.org/10.1016/j.japh.2015.12.009.
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Iserson, Kenneth V. "The limits of health care resources". American Journal of Emergency Medicine 10, nr 6 (listopad 1992): 588–92. http://dx.doi.org/10.1016/0735-6757(92)90191-y.
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