Suchergebnisse

Context: As physiotherapy (PT) is a young profession in Nepal, there is a dearth of insight into the common practices of physiotherapists in critical care. Aims: To identify the availability of PT services in Intensive Care Units (ICUs) and articulate the common practices by physiotherapists in ICUs of Nepal. Settings and Design: All tertiary care hospitals across Nepal with ICU facility via an exploratory cross-sectional survey. Subjects and Methods: An existing questionnaire was distributed to all the physiotherapists currently working in ICUs of Nepal with 2 years of experience. The survey was sent via E-mail or given in person to 86 physiotherapists. Statistical Analysis Used: Descriptive and inferential statistics according to nature of data. Results: The response rate was 60% (n = 52). In the majority of hospitals (68%), PT service was provided only after a physician consultation, and few hospitals (13%) had established hospital criteria for PT in ICUs. Private hospitals (57.1%) were providing PT service in weekends compared to government hospitals (32.1%) (P = 0.17). The likelihood of routine PT involvement varied significantly with the clinical scenarios (highest 71.2% status cerebrovascular accident, lowest 3.8% myocardial infarction, P < 0.001). The most preferred PT treatment was chest PT (53.8%) and positioning (21.2%) while least preferred was therapeutic exercise (3.8%) irrespective of clinical scenarios. Conclusions: There is a lack of regular PT service during weekends in ICUs of Nepal. Most of the cases are treated by physiotherapists only after physician's referral. The preferred intervention seems to be limited only to chest PT and physiotherapists are not practicing therapeutic exercise and functional mobility training to a great extent.

A government-appointed task force in British Columbia investig­ated and made recommendations on the delivery of vision care services in that province. Alternative means ofdelivery were considered within role definitions of optometrists and ophthalmologists and their respec­tive workloads.

Various e-strategies have been developed since the late '90s in an attempt to describe the governmental vision for administrative and for societal change, the objectives and priorities with regard to the development of the Information and Communication Technologies (ICT) at national and at supranational levels. Terms such as the European "Information Society", the U.S. "Information Highways" and the Korean and Chinese "Informatization" try to describe social transformation that occurs due to the ICT, and to determine means with which governments will capitalize the ICT to improve social life and to support economic growth. This book focuses on the context of managing Government e-Strategies. In this order it combines strategic management issues with recent trends in forming, planning and developing Government ICT strategies. It aims to identify various e-strategic management approaches that are followed worldwide, addresses the gaps that appear between e-strategic updates, and presents alternative strategic management methods adopted or uses strategic management methods as a means to describe the e-strategic evolution in different geographic regions. In this order, this book illustrates experiences from various national and supranational cases and offers the opportunity to readers to identify and compare the association between policies and ICT. Empirical findings from the United Arab Emirates (UAE) introduce readers to the context of this book, while part A collects chapters that address general strategic management issues in the ICT domain, such as evaluation, social involvement's assessment, location information strategies, strategic documents' analysis, effectiveness enhancement and innovation strategic management. On the other hand, part B presents various supranational, national and regional e-strategic cases and respective ICT management issues, beginning from Canada, continuing in Europe and more specifically in U.K., Spain and southern Europe; then Asian cases follow, concerning Turkey, Bangladesh, Hong Kong and Malaysia; finally, two African e-strategic cases are presented regarding Morocco and Zambia. Readers will gain significant outcomes and they will explore various e-strategic management issues such as evaluation, transformation, forming and planning, accompanied by methods for e-strategic analysis. It is of significant interest to scholars and policy-makers in public administration, management and information technology doma ...

Variations in physician practice patterns have important implications for quality and cost. The purpose of this article is to explain variation in physicians' practice patterns in terms of physician personal characteristics, practice setting, patient population, and managed care involvement. Data on 2,455 primary care physicians were derived from the Community Tracking Study Physician Survey (1996-1997). Factor scores were determined based on responses to three clinical scenarios that represent discretionary medical decisions. These scenarios include a specialist referral for benign prostatic hyperplasia, prescription drugs for elevated cholesterol, and an office visit for vaginal discharge. Physician age, being a foreign medical school graduate, being a solo practitioner, and having a larger proportion of Medicaid patients were all associated with higher factor scores, a greater likelihood of ordering a service. Being board certified was associated with lower factor scores. Managed care involvement was not a significant predictor of factor scores.

BACKGROUND/PURPOSE: There were 70 oral pathology specialists (OPSs) in Taiwan till 2018. This study reported the current practice patterns and training project of OPSs in Taiwan. MATERIALS AND METHODS: This study exploited the secondary data analysis and interview to survey the current practice patterns and training project of OPSs in Taiwan. RESULTS: Of the 70 OPSs, 8 practiced both anatomical oral pathology (oral histopathological diagnosis) and clinical oral pathology (oral medicine), 8 practiced both general pathology (majorly) and anatomical oral pathology (minorly), 5 practiced oral medicine only, 30 practiced general dentistry or other dental divisions, 11 did teaching or researching, and 8 had retired. There were 9 OPS training hospitals (8 medical centers and one regional hospital) that had 23 OPSs and a training capacity of 11 dentists. Of the 9 OPS training hospitals in Taiwan in 2019, 5 were located in the northern, one in central, two in southern, and one in eastern region. Moreover, we found none of the dentists applying for the OPS training program and the number of OPSs did not increase along with the population and the number of the dentists in recent two years. CONCLUSION: Only 8 OPSs practice both anatomical oral pathology and oral medicine in Taiwan and the manpower of the OPSs in Taiwan faces a severe problem of shortage. We suggest that the government should build a long-term budget to subsidize young OPSs and those dentists who enter the OPS training program to resolve this OPS shortage problem.

INTRODUCTION: We examined antibiotic management of combat-related extremity wound infections (CEWI) among wounded US military personnel (2009–2012). METHODS: Patients were included if they sustained blast injuries, resulting in ≥1 open extremity wound, were admitted to participating US hospitals, developed a CEWI (osteomyelitis or deep soft-tissue infections) within 30 days post-injury, and received ≥3 days of relevant antibiotic(s) for treatment. RESULTS: Among 267 patients, 133 (50%) had only a CEWI, while 134 (50%) had a CEWI plus concomitant non-extremity infection. In the pre-diagnosis period (4–10 days prior to CEWI diagnosis), 95 (36%) patients started a new antibiotic with 28% of patients receiving ≥2 antibiotics. During CEWI diagnosis week (±3 days of diagnosis), 209 (78%) patients started a new antibiotic (71% with ≥2 antibiotics). In the week following diagnosis (4–10 days after CEWI diagnosis), 121 (45%) patients started a new antibiotic with 39% receiving ≥2 antibiotics. Restricting to ±7 days of CEWI diagnosis, patients commonly received two (35%) or three (27%) antibiotics with frequent combinations involving carbapenem, vancomycin, and fluoroquinolones. CONCLUSIONS: Substantial variation in antibiotic prescribing patterns related to CEWIs warrants development of combat-related clinical practice guidelines beyond infection prevention, to include strategies to reduce use of unnecessary antibiotics and improve stewardship.

Health care spending in the United States more than tripled between 1972 and 1982, increasing from $94 billion to $322 billion. This growth substantially outpaced overall growth in the economy. National health expenditures are projected to reach approximately $690 billion in 1990 and consume roughly 12 percent of the gross national product. Government spending for health care is projected to reach $294 billion by 1990, with the Federal Government paying 72 percent. The Medicare prospective payment system and increasing competition in the health services sector are providing incentives to integrate clinical practice patterns with improved management practices.

Abstract Background The purpose of our study was to determine characteristics that influence the utilization of non-conventional hemodialysis (NCHD) therapies and its subtypes (nocturnal (NHD), short daily (SDHD), long conventional (LCHD) and conventional hemodialysis (CHD) as well as provider attitudes regarding the evidence for NCHD use. Methods An international cohort of subscribers of a nephrology education website http://www.nephrologynow.com was invited to participate in an online survey. Non-conventional hemodialysis was defined as any forms of hemodialysis delivered > 3 treatments per week and/or > 4 hours per session. NHD and SDHD included both home and in-centre. Respondents were categorized as CHD if their centre only offered conventional thrice weekly hemodialysis. Variables associated with NCHD and its subtypes were determined using multivariate logistic regression analysis. The survey assessed multiple domains regarding NCHD including reasons for initiating and discontinuing, for not offering and attitudes regarding evidence. Results 544 surveys were completed leading to a 15.6% response rate. The final cohort was limited to 311 physicians. Dialysis modalities utilized among the respondents were as follows: NCHD194 (62.4%), NHD 83 (26.7%), SDHD 107 (34.4%), LCHD 81 (26%) and CHD 117 (37.6%). The geographic regions of participants were as follows: 11.9% Canada, 26.7% USA, 21.5% Europe, 6.1% Australia/New Zealand, 10% Africa/Middle East, 10.9% Asia and 12.9% South America. Variables associated with NCHD utilization included NCHD training (OR 2.47 CI 1.25-4.16), government physician reimbursement (OR 2.66, CI 1.11-6.40), practicing at an academic centre (OR 2.28 CI 1.25-4.16), higher national health care expenditure and number of ESRD patients per centre. Hemodialysis providers with patients on NCHD were significantly more likely to agree with the statements that NCHD improves quality of life, improves nutritional status, reduces EPO requirements and is cost effective. The most common reasons to initiate NCHD were driven by patient preference and the desire to improve volume control and global health outcomes. Conclusion Physician attitudes toward the evidence for NCHD differ significantly between NCHD providers and conventional HD providers. Interventions and health policy targeting these areas along with increased physician education and training in NCHD modalities may be effective in increasing its utilization.

The dental workforce is increasingly gender diverse. This study analyzed gender differences in dental practice using the American Dental Association's 2010-2016 Masterfile and the 2017 Survey of Dental Practice. Between 2010 and 2016, the proportion of women working in dentistry increased from 24.5% to 29.8%. Overall, female dentists were more racially/ethnically diverse, more likely to be foreign-trained, and more likely to work in pediatric dentistry than male dentists. The likelihood of female dentists working as employees, part-time, and/or in metropolitan areas was 1.2 to 4.2 times greater compared with male dentists. Female solo practitioners were 1.2 to 1.8 times more likely to provide services to children and patients covered by public insurance than male solo practitioners. Gender diversification in dentistry and other factors, including generational differences and changes in the dental service delivery system and public policy, will continue to reshape the delivery of oral health services.

The article of record as published may be found at http://dx.doi.org/10.1007/s00404-013-2904-y ; Purpose Episiotomy is one of the most commonly performed procedures among women of childbearing age in the United States. In 2005, a major systematic review conducted by Hartmann and colleagues recommended against routine use of episiotomy and was widely covered in the media. We assessed the impact of the Hartman et al. study on episiotomy trend. Methods Based on 100 % hospital discharge data from eight states in 2003–2008, we used interrupted time series regression models to estimate the impact of the Hartman et al. review on episiotomy rates. We used mixed-effects regression models to assess whether interhospital variation was reduced over time. Results After controlling for underlying trend, episiotomy rates dropped by 1.4 percentage points after Hartman et al. publication (p\0.01 for spontaneous delivery; p\0.1 for operative delivery). The publication has smaller effect on government hospitals as compared to private hospitals. Mixed effects models estimated negative correlation between cross-time and cross-hospital variations in episiotomy rates, indicating reduced cross-hospital variation over time. Conclusions Our results suggested that there has been a gradual decline in episiotomy rates over the period 2003–2008, and that synthesis of evidence showing harms from routine episiotomy had limited impact on practice patterns in the case of episiotomy. The experience of episiotomy illustrates the challenge of using comparative effectiveness and evidenced-based medicine to reduce use of unnecessary procedures.