History and examination

Author(s):  
Manoj Sivan ◽  
Margaret Phillips ◽  
Ian Baguley ◽  
Melissa Nott

This chapter describes the principles of taking a history, an essential part of a comprehensive assessment of an individual by a rehabilitation physician, including presenting complaints; assessment of body function, activities, and participation; past medical and functional history; review of symptoms; personal and environmental history; and the individual’s perception of their condition. The approach taken in eliciting a history in rehabilitation settings is unique in that there is equal emphasis on understanding the impact of any illness on body function, activities, and participation in the context of that particular individual in the unique environment they live in. Describing examination of the neurological system and musculoskeletal system, the chapter provides details of how to design a rehabilitation plan, and methods for successful implementation.

2020 ◽  
Vol 41 (S1) ◽  
pp. s482-s483
Author(s):  
Paul Gentile ◽  
Jesse Jacob ◽  
Shanza Ashraf

Background: Using alternatives to indwelling urinary catheters plays a vital role in reducing catheter-associated urinary tract infections (CAUTIs). We assessed the impact of introducing female external catheters on urinary catheter utilization and CAUTIs. Methods: In a 500-bed academic medical center, female external catheters were implemented on October 1, 2017, with use encouraged for eligible females with urinary incontinence but not meeting other standard indications for urinary catheters. Nurses were educated and trained on female external catheter application and maintenance, and infection prevention staff performed surveillance case reviews with nursing and medical staff. We determined the number of catheter days for both devices based on nursing documentation of device insertion or application, maintenance, and removal. We used the CAUTI and DUR (device utilization ratio) definitions from the CDC NHSN. Our primary outcomes were changes in DUR for both devices 21 months before and 24 months after the intervention in both intensive care units (ICUs) and non-ICU wards. We used a generalized least-squares model to account for temporal autocorrelation and compare the trends before and after the intervention. Our secondary outcome was a reduction in CAUTIs, comparing females to males. Results: In total, there were 346,213 patient days in 35 months. The mean rate of patient days per month increased from 7,436.4 to 7,601.9 after the implementation of female external catheters, with higher catheter days for both urinary catheters (18,040 vs 19,625) and female external catheters (22 vs 12,675). After the intervention, the DUR for female external catheters increased (0 vs 0.07; P < .001) and for urinary catheters the DUR decreased (0.12 vs 0.10; P < .001) (Fig. 1). A reduction in urinary catheter DUR was observed in ICUs (0.29 vs 0.27; P < .001) but not wards (0.08 vs 0.08; P = NS) (Fig. 2). Of the 39 CAUTIs, there was no significant overall change in the rate per 1,000 catheter days (1.22 vs 0.87; P = .27). In females (n = 20 CAUTI), there was a 61% reduction in the CAUTI rate per 1,000 catheter days (0.78 vs 0.31; P = .02), but no significant change in the rate in males (0.44 vs 0.56; P = .64). The CAUTI rate per 1,000 catheter days among females decreased in the ICUs (1.14 vs 0.31; P = .04) but not in wards (0.6 vs 0.33; P = .96). Conclusions: In a setting with a baseline low UC DUR, successful implementation of female external catheters further modestly reduced UC DUR and was associated with a 61% decrease in CAUTI among females in the ICU but not in wards. Further interventions to better identify appropriate patients for female external catheters may improve patient safety and prevent patient harm.Funding: NoneDisclosures: None


2015 ◽  
Vol 21 (5) ◽  
pp. 1117-1139 ◽  
Author(s):  
Dimitrios Chatzoudes ◽  
Prodromos Chatzoglou ◽  
Eftichia Vraimaki

Purpose – Knowledge Management (KM) is a contemporary research field of high interest for both academics and practitioners. For more than 15 years, successful companies have used KM as their most valuable source of competitive advantage. The purpose of this paper is attempt to extend the existing empirical approaches (research models), by focusing on the process of KM and its diffusion throughout the organisation. Design/methodology/approach – The present study proposes a newly developed conceptual framework that adopts a four-step approach, highlighting four areas of interest that have never been simultaneously examined before: knowledge antecedents, KM process, KM outcomes (satisfaction from the KM process) and individual (employee) outcomes. The proposed conceptual framework is tested, using a structured questionnaire, in a sample of 211 bank employees. The reliability and the validity of the questionnaire were thoroughly examined, while research hypotheses were tested using the “Structural Equation Modelling” technique. Findings – The results revealed that companies with enhanced innovative culture and an organisational climate that facilitates cooperation between employees tend to promote and ultimately maximise knowledge diffusion. Moreover, a contribution of the present study is the empirical confirmation of the relationship between the proposed factor “satisfaction from the knowledge management process” and both organisational commitment and job satisfaction. Research limitations/implications – A limitation stemming from the adopted methodology is the use of self-report scales to measure the factors (constructs) of the proposed model. Moreover, the present paper lacks a longitudinal approach, since it provides a static picture (snapshot) of the application of KM within enterprises. Practical implications – The paper highlights-specific areas (factors) that companies should enhance in order to harvest the potential benefits of KM. According to the empirical findings, organisations should focus on their human capital when managing their knowledge processes. After all, employee satisfaction from the KM process is found to be crucial for enhancing their job satisfaction and job performance. Originality/value – The paper proposes an enhanced conceptual framework that incorporates critical issues concerning the successful implementation of KM, thus, providing valuable tools for decision makers and academics. Its originality lies in the nature of its approach. More specifically, the present study examines the impact of KM on individual-level (employee), something that rarely appears in the relevant literature. Additionally, it incorporates “satisfaction from the knowledge management process” as a significant outcome of the KM process, thus, enriching the literature of the field. Finally, it investigates the impact of three contextual factors (innovative culture, organisational climate, inter-functional coordination) on KM process (externalisation, internalisation, socialisation, combination), adopting an approach that acknowledges KM as a function (factor) that transmits contextual influence onto individual effectiveness. The results of the study may be generalised in other sectors with similar characteristics (knowledge-intensive and learning organisations, service sector companies, etc) and in other developed countries whose financial institutions face similar challenges as the ones in Greece.


2010 ◽  
Vol 37 (3) ◽  
pp. 250-260 ◽  
Author(s):  
LORIEN R. BELTON ◽  
DOUGLAS JACKSON-SMITH

SUMMARYConsiderable efforts have been put into collaborative conservation efforts across the globe. In the western USA, concern about declines of two sage-grouse species (Centrocercus urophasianus and C. minimus) has led to the creation of over 60 collaborative wildlife management partnership groups to develop and implement local sage-grouse management plans. These sage-grouse local working groups (LWGs) share a common goal, information, and policy environment, but were implemented in diverse ways. As a result, they provide a rare opportunity to study systematically the impact of contextual, organizational, institutional and process factors on local collaborative group success. Data from document reviews and an extensive survey of over 700 group participants from 53 sage-grouse LWGs were used to assess the success of this collaborative conservation effort and identify those group attributes that were related to successful implementation and funding of projects. Specifically, external, internal and emergent group characteristics were considered as likely predictors of LWG implementation success. The LWGs varied broadly in their achievements. The presence of a neutral facilitator, participants' feelings of ownership, groups whose local plans had more authority and early-stage group successes were significantly related to implementation success at the group level.


2009 ◽  
Vol 145-146 ◽  
pp. 177-180 ◽  
Author(s):  
Roger Loo ◽  
Andriy Hikavyy ◽  
Frederik E. Leys ◽  
Masayuki Wada ◽  
Kenichi Sano ◽  
...  

Several device concepts have been further evaluated after the successful implementation of epitaxial Si, SiGe and/or Si:C layers. Most of the next device generations will put limitations on the thermal budget of the deposition processes without making concessions on the epitaxial layer quality. In this work we address the impact of ex-situ wet chemical cleans and in-situ pre-epi bake steps, which are required to obtain oxide free Si surfaces for epitaxial growth. The combination of defect measurements, Secondary Ion Mass Spectroscopy, photoluminescence, lifetime measurements, and electrical diode characterization gives a very complete overview of the performance of low-temperature pre-epi cleaning methods. Contamination at the epi/substrate interface cannot be avoided if the pre-epi bake temperature is too low. This interface contamination is traceable by the photoluminescence and lifetime measurements. It may affect device characteristics by enhanced leakage currents and eventually by yield issues due to SiGe layer relaxation or other defect generation. A comparison of state of the art 200 mm and 300 mm process equipment indicates that for the same thermal budgets the lowest contamination levels are obtained for the 300 mm equipments.


Author(s):  
James St. Louis ◽  
Arinze Nkemdirim Okere

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To provide an overview of the impact of pharmacist interventions on antibiotic prescribing and the resultant clinical outcomes in an outpatient antibiotic stewardship program (ASP) in the United States. Methods Reports on studies of pharmacist-led ASP interventions implemented in US outpatient settings published from January 2000 to November 2020 and indexed in PubMed or Google Scholar were included. Additionally, studies documented at the ClinicalTrials.gov website were evaluated. Study selection was based on predetermined inclusion criteria; only randomized controlled trials, observational studies, nonrandomized controlled trials, and case-control studies conducted in outpatient settings in the United States were included. The primary outcome was the observed differences in antibiotic prescribing or clinical benefits between pharmacist-led ASP interventions and usual care. Results Of the 196 studies retrieved for full-text review, a cumulative total of 15 studies were included for final evaluation. Upon analysis, we observed that there was no consistent methodology in the implementation of ASPs and, in most cases, the outcome of interest varied. Nonetheless, there was a trend toward improvement in antibiotic prescribing with pharmacist interventions in ASPs compared with that under usual care (P &lt; 0.05). However, the results of these studies are not easily generalizable. Conclusion Our findings suggest a need for a consistent approach for the practical application of outpatient pharmacist-led ASPs. Managed care organizations could play a significant role in ensuring the successful implementation of pharmacist-led ASPs in outpatient settings.


2014 ◽  
Vol 22 (02) ◽  
pp. 249-270 ◽  
Author(s):  
ANUPAMA SHARMA ◽  
A. K. MISRA

Vaccines are a core component of any preventive strategy designed to ensure the global public health. A major factor influencing the successful implementation of any immunization program is awareness and public acceptance of the vaccine. The present study focuses on potential impacts of awareness created by media campaigns on vaccination coverage of hepatitis B. In this paper, a SIR model with vital dynamics in a population of varying size is investigated, which couples hepatitis B vaccination and awareness created by media within a single framework. It is assumed that media campaigns propagate awareness about measures requisite for escaping the chances of contracting hepatitis B. The awareness created by media motivates people to get vaccinated and attain full immunization against hepatitis B virus. For analyzing the model, stability theory of differential equations is employed. First, equilibria of the system comprising fractions of the population are obtained and their stability behavior is discussed. Then the asymptotic behavior of total population is discussed in detail. Three threshold parameters R0, R1and R2governing the dynamics of infection and total population are also affirmed. The findings of numerical simulations are also in line with analytically obtained results.


2011 ◽  
Vol 71-78 ◽  
pp. 2895-2898
Author(s):  
Jian Min Xie ◽  
Qin Qin

In the process of developing e-commerce system, enterprises are able to accurately understand and grasp the needs of the user enterprise that is the key to the successful implementation of e-commerce. Based on this, the article proposed a new method which was based on the process of developing consumer demand for e-business decision-making though a rough set theory. This new approach is built using rough set decision model to calculate the different needs of the impact on consumer satisfaction, come to an important degree of each demand and the demand reduction order. This method overcomes the traditional rough set method cumbersome bottlenecks, and helps operating; cases studies show that the proposed method is simple and effective.


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