Deficiencies in Leg Ulcer Care: A National Survey in Scotland

1998 ◽  
Vol 13 (2) ◽  
pp. 40-44 ◽  
Author(s):  
S. H. Armstrong ◽  
C. V. Ruckley ◽  
R. J. Prescott ◽  
J. J. Dale ◽  
E. A. Nelson
Keyword(s):  
Community Care ◽  
Great Majority ◽  
Cost Effective ◽  
Leg Ulcer ◽  
Health Board ◽  
Community Nurse ◽  
Perceived Need ◽  
Level Of Satisfaction ◽  
Choice Of Treatment ◽  
And Training

Objective: To identify what specialist expertise and services are currently available, in Scotland, to support general practitioners (GPs) and community nurses in the management of leg ulcer patients and the perceived need for the improvement of the service. Design: Postal questionnaires to randomly selected samples of GPs and community nurses. Setting: All 15 Scottish Health Board areas. Subjects: Six hundred and seventy-three GPs and 441 community nurses were questioned. Results: Five hundred and twelve (76%) GPs replied. Barely half, 285 (56%), expressed satisfaction with the service and only 155 (30%) had access to a recognized leg ulcer specialist. GPs who had access to a specialist expressed a greater level of satisfaction with the leg ulcer service than those without a local specialist. Community nurse questionnaire: Three hundred and sixty (82%) nurses replied. Two hundred and forty six (68%) indicated that the diagnosis of the cause of ulceration was usually made by both the GP and the nurse but the choice of treatment was most often made by the nurse alone. The great majority (69%) did not have access to a local leg ulcer clinic and only 34 (9%) indicated that they had access to management protocols, almost 90% of nurses expressing a need for protocols. Both questionnaires revealed a lack of specialist support, dedicated leg ulcer clinics, better education and training, and leg ulcer management protocols. Conclusion: Serious deficiencies in the support available for community care of leg ulcer patients have been identified. The situation requires to be remedied if more cost-effective outcomes for leg ulcer patients are to be achieved.

scholarly journals 781. C.difficile PCR+/ Toxin EIA- treat or not treat? A clinician survey

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S435-S436
Author(s):  
Sarath G Nath ◽  
Francesca Lee ◽  
Anjali Bararia ◽  
Ank E Nijhawan
Keyword(s):  
Clinical Judgment ◽  
Clinical Care ◽  
Cost Effective ◽  
False Positive Diagnosis ◽  
Missed Diagnosis ◽  
Stool Samples ◽  
Polymerase Chain ◽  
Low Sensitivity ◽  
Survey Responses ◽  
And Training

Abstract Background C.difficile Toxin Polymerase Chain Reaction (C.diff PCR) and C.difficile Toxin Enzyme Immunoassays (toxin EIA) are commonly used tests to diagnose Clostridoides difficile infection (CDI). C.diff PCR cannot differentiate between colonization and infection, leading to a higher false-positive diagnosis of CDI. Toxin EIA has low sensitivity leading to a missed diagnosis of CDI. In patients with C.diff PCR positive(+) and Toxin EIA negative(-), clinical judgment is often needed regarding the decision to treat or not to treat. C.diff cytotoxic assay (CCA), is a more sensitive method to detect the toxin but is time-consuming and not readily available. Methods Between 6/2019 and 12/2019, 83 patients who were admitted to the hospital, met our inclusion criteria (C.diff PCR+/EIA-). Clinicians who cared for these patients were contacted and surveyed with a predesigned questionnaire evaluating the rationale of treatment. Also, a simultaneous medical records review was done to ensure consistency. Along with this C.diff PCR+/EIA- stool samples were sent to ARUP laboratories for CCA. The CCA results were not available for clinicians and did not impact clinical care. Average cost for a CCA assay was $29 Results Demographics of the clinicians were variable (Table 1). Several parameters were considered when making decisions regarding treatment and GI/ID were frequently involved (figure 1). Among the 83 patients, 41(49%) were CCA (+) and 42(51%) were CCA (-). 48 of 83 (58%) patients received treatment for CDI. 25 of 48 (52%) patients who were treated were CCA positive while 23 of 48 (48%) patients were CCA negative. Among the untreated patients, 16/35 (46%) were CCA+ while 19/35(54%) were CCA-. There was no statistically significant correlation between clinical judgment and CCA assay results (p: 0.56 on the Chi test). Demographics of the clinicians Clinician survey responses CDI Treatment and by CCA positivity Conclusion Clinicians regardless of their background and training face challenges with the treatment of C.diff PCR+/EIA- patients. Patient outcomes based on the incorporation of CCA assay into an algorithm for C.diff PCR+/EIA- patients, need to be evaluated. But it has a potential role in stopping unnecessary CDI treatment as well as avoidance of missed treatment opportunities while possibly also being cost-effective. Disclosures Ank E. Nijhawan, MD, MPH, Gilead (Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support)

scholarly journals Modeling the Costs of Hospital-Acquired Infections in New Zealand

2003 ◽  
Vol 24 (3) ◽  
pp. 214-223 ◽  
Author(s):  
Nicholas Graves ◽  
Tanya M. Nicholls ◽  
Arthur J. Morris
Keyword(s):  
New Zealand ◽  
Economic Cost ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Primary Data ◽  
Health Board ◽  
District Health ◽  
Hospital Acquired Infections ◽  
Input Variables ◽  
Hospital Acquired

AbstractObjective:To model the economic costs of hospital-acquired infections (HAIs) in New Zealand, by type of HAI.Design:Monte Carlo simulation model.Setting:Auckland District Health Board Hospitals (DHBH), the largest publicly funded hospital group in New Zealand supplying secondary and tertiary services. Costs are also estimated for predicted HAIs in admissions to all hospitals in New Zealand.Patients:All adults admitted to general medical and general surgical services.Method:Data on the number of cases of HAI were combined with data on the estimated prolongation of hospital stay due to HAI to produce an estimate of the number of bed days attributable to HAI. A cost per bed day value was applied to provide an estimate of the economic cost. Costs were estimated for predicted infections of the urinary tract, surgical wounds, the lower and upper respiratory tracts, the bloodstream, and other sites, and for cases of multiple sites of infection. Sensitivity analyses were undertaken for input variables.Results:The estimated costs of predicted HAIs in medical and surgical admissions to Auckland DHBH were $10.12 (US $4.56) million and $8.64 (US $3.90) million, respectively. They were $51.35 (US $23.16) million and $85.26 (US $38.47) million, respectively, for medical and surgical admissions to all hospitals in New Zealand.Conclusions:The method used produces results that are less precise than those of a specifically designed study using primary data collection, but has been applied at a lower cost. The estimated cost of HAIs is substantial, but only a proportion of infections can be avoided. Further work is required to identify the most cost-effective strategies for the prevention of HAI.

Using Mobile Technologies in Education

2017 ◽  
Vol 13 (4) ◽  
pp. 77-90 ◽  
Author(s):  
Célio Gonçalo Cardoso Marques ◽  
António Manso ◽  
Ana Paula Ferreira ◽  
Felisbela Morgado
Keyword(s):  
Teaching And Learning ◽  
Reading Skills ◽  
Mobile Technologies ◽  
Ministry Of Education ◽  
Digital Repository ◽  
Learning To Read ◽  
Level Of Satisfaction ◽  
Complex Process ◽  
High Level ◽  
And Training

The acquisition of reading skills is decisive for the academic achievement of students. However, learning to read is a complex process. With this in mind, several attempts have been made to find new educational approaches to enhance students' reading motivation. Considering the enormous potential of ICT for education and training, we have developed a digital repository of teaching and learning materials and a multiplatform application that runs on mobile devices: Letrinhas. This information system was designed to promote the development of reading and to provide tools for monitoring and assessing reading skills against the curricular targets set by the Ministry of Education. Letrinhas was evaluated by specialists and users and a high level of satisfaction was observed among students and teachers as time and effort spent to consolidate reading is considerably reduced with this application. This evaluation also enabled to identify features that will be available in the future.

Costs and Benefits of Hospital and Day Treatment with Community Care of Affective and Schizophrenic Disorders

1995 ◽  
Vol 166 (S27) ◽  
pp. 52-59 ◽  
Author(s):  
D. Wiersma ◽  
H. Kluiter ◽  
F. J. Nienhuis ◽  
M. Rüphan ◽  
R. Giel
Keyword(s):  
Community Care ◽  
Psychiatric Treatment ◽  
Day Treatment ◽  
Controlled Trial ◽  
Clinical Care ◽  
Cost Effective ◽  
Patient Treatment ◽  
Schizophrenic Disorder ◽  
Course Of Illness ◽  
Schizophrenic Patients

Background. A randomised controlled trial of day treatment with community care for patients with schizophrenic and affective disorders, referred for in-patient psychiatric treatment, was conducted to evaluate patterns of treatment and the course of illness with its psychosocial consequences over a period of two years.Method. Seventy patients, of whom 34 had affective and 36 had schizophrenic disorder, were assigned to the experimental condition (day treatment with ambulatory and domiciliary care), and 33 patients, of whom 16 had affective and 17 had schizophrenic disorder, were assigned to the control condition of standard clinical care.Results. Day treatment with community care was feasible for 40.6% of the affective patients and 33.3% of the schizophrenic patients. The direct treatment costs of both disorders, based on numbers of in- and day-patient days and out-patient contacts over two years, appeared more or less the same. Patients benefited equally from day treatment as from in-patient treatment, although there were some gains in self-care and in functioning in the household among experimentals. Although schizophrenics were socioeconomically worse off, and also suffered from more (severe) symptoms and social disabilities than the affective patients at entry into the study, they were similar at two years. This finding is unexpected, compared with other follow-up studies. Extra cost for patients and families were not observed. Patients and their families in the experimental condition were significantly more satisfied with the treatment. Experimental patients spent much more time at home during admission, remained much less time in secluded wards, and were more compliant with treatment.Conclusions. Day treatment could be considered a cost-effective alternative to in-patient treatment.

scholarly journals EVALUASI PROGRAM PEMBERDAYAAN PEREMPUAN MELALUI PELATIHAN MENJAHIT DI SANGGAR KEGIATAN BELAJAR (SKB) UJUNG PANDANG

GANEC SWARA ◽  
2021 ◽  
Vol 15 (1) ◽  
pp. 935
Author(s):  
NINI PRATIWI ◽  
ILHAM SUPIANA
Keyword(s):  
Research Result ◽  
Evaluation Research ◽  
Training Material ◽  
Level Of Satisfaction ◽  
Level Model ◽  
Level Of Understanding ◽  
Evaluation Of Learning ◽  
Research Type ◽  
And Training ◽  
Reaction Level

      This study was aimed to describe evaluation results of: (1) participants’ level of satisfaction, (2) participants’ level of understanding of the material, (3) participants’ post-training level of implementation, (4) improved success of participants due to the training.      The research type was evaluation research using Kirkpatrick’s Four Level model, which consisted of: Reaction, learning, behavioral, and result levels. The research samples were 20 former training participants. Data was collected by questionnaire, observation, and unstructured interview. Quantitative data was processed with the help of SPSS 21.0 for Windows. Validity of instrument at reaction, learning, behavioral, and result levels used Corrected Item-Total Correlation. Reliability calculation used Alpha formula.      The research result showed that: 1) evaluation of reaction level: the satisfaction to sewing making training in terms of material, tutor, facility, and training method by PAP and PAP was “satisfying” 2) evaluation of learning level: understanding of material of the participants of making training sewing in terms of understanding of training material by PAP and PAN was “Mastering” 3) evaluation of behavioral level: participants’ implementation after training sewing of making in terms of post-training behavioral aspect by PAP and PAN was “implementing” 4) evaluation of result level: improved resulting competence due to training sewing of making by PAP and PAN was “poorly improved”.

scholarly journals Changing the Game - Can A Sport-Based Youth Development Programme Generate a Positive Social Return on Investment?

2018 ◽  
Vol 15 (1) ◽  
Author(s):  
Ben Sanders ◽  
Emanuel Raptis
Keyword(s):  
Young People ◽  
Youth Development ◽  
Return On Investment ◽  
Cost Effective ◽  
Management Approach ◽  
Social Return On Investment ◽  
Sport For Development ◽  
External Stakeholders ◽  
Employment Education ◽  
And Training

This study examines a sport for development and peace intervention initiated by Grassroot Soccer South Africa that promotes youth employability and leadership. A results-based management approach and a social return on investment methodology were used to track the young people during and after the intervention. Preliminary results offer encouraging evidence of progress into employment, education and training with positive social returns for the youth and external stakeholders, suggesting that this investment is cost-effective and impactful. The results indicate that structured sport-based programmes can put young people to work and study in a constructive manner, thereby stimulating economic growth and development. It is concluded that initiatives using sport to promote youth work merit greater investment, recognition and research.

The changing context of advanced practice nursing within the UK community care setting

2021 ◽  
Vol 26 (12) ◽  
pp. 581-586
Author(s):  
Barry Hill ◽  
Sadie Diamond-Fox ◽  
Aby Mitchell
Keyword(s):  
Community Care ◽  
Advanced Practice Nursing ◽  
Advanced Practice ◽  
Advanced Level ◽  
The Public ◽  
Independent Prescribing ◽  
Consultation Skills ◽  
The Uk ◽  
Additional Education ◽  
And Training

Advanced practice nursing (APN) roles have developed partly to address demand and workforce issues. In community care settings and general practice, an advanced nursing practitioner is generally understood to mean a nurse who has undertaken additional education and training in clinical assessment, including history-taking and physical examination, clinical reasoning and independent prescribing, so they can safely manage patients presenting with undifferentiated and undiagnosed conditions. Capabilities in the Skills for Health framework cover everything from communication and consultation skills, practising holistically and personalised care, to working with colleagues and in teams. The framework is intended to ensure advanced nursing practitioners work to an advanced level. It is also designed to support them to demonstrate and evidence their capabilities to service commissioners, employers, people accessing healthcare and the public.

Prevalence and Incidence of Schizophrenia Spectrum Disorders: Implications for Prevention

2000 ◽  
Vol 34 (1_suppl) ◽  
pp. A26-A34 ◽  
Author(s):  
Assen Jablensky
Keyword(s):  
At Risk ◽  
High Risk ◽  
Screening Program ◽  
Great Majority ◽  
Cost Effective ◽  
Schizophrenia Spectrum Disorders ◽  
Continuous Performance Task ◽  
Intention To Treat ◽  
Risk Criteria ◽  
Conceptual Background

Objective This paper reviews the historical and conceptual background to proposals about prevention of schizophrenia through intervention targeting asymptomatic, high-risk individuals. It also examines the outcomes of a hypothetical model of prevention based on a two-stage risk segmenting approach. Method The assumptions and parameters used in the model are derived from actual epidemiological and clinical research. The two risk criteria selected are: (i) genetic risk (having a parent with schizophrenia); and (ii) neurocognitive deficit (abnormal performance on the Continuous Performance Task, CPT). The parameters and risk factors are applied to a hypothetical screening program covering a population of 100 000. Results At the end of the second stage of screening the program using the risk criteria to search for preventable cases will have correctly identified only three out of 20 ‘true’ cases and will have incorrectly assigned to treatment two non-cases. The great majority of people at risk who will eventually develop schizophrenia are likely to remain undetected by current screening or preclinical diagnostic programs, while a certain number of people actually not at risk would be falsely identified as high-risk and offered treatment. Conclusions Reliably identifying, with intention to treat, asymptomatic people in the community who are presumed to be at high risk of developing schizophrenia is at present epidemiologically non-viable. This caveat should not apply to strategies for early diagnosis and treatment of incipient episodes of schizophrenia where strategies to reduce the duration of untreated psychosis are likely to be both feasible and cost-effective.

scholarly journals Evaluating human versus machine learning performance in classifying research abstracts

2020 ◽  
Vol 125 (2) ◽  
pp. 1197-1212
Author(s):  
Yeow Chong Goh ◽  
Xin Qing Cai ◽  
Walter Theseira ◽  
Giovanni Ko ◽  
Khiam Aik Khor
Keyword(s):  
Machine Learning ◽  
Research Council ◽  
Cost Effective ◽  
Accurate Method ◽  
Learning Performance ◽  
Classification Models ◽  
Funding Agencies ◽  
Actual Evaluation ◽  
Fixed Set ◽  
And Training

AbstractWe study whether humans or machine learning (ML) classification models are better at classifying scientific research abstracts according to a fixed set of discipline groups. We recruit both undergraduate and postgraduate assistants for this task in separate stages, and compare their performance against the support vectors machine ML algorithm at classifying European Research Council Starting Grant project abstracts to their actual evaluation panels, which are organised by discipline groups. On average, ML is more accurate than human classifiers, across a variety of training and test datasets, and across evaluation panels. ML classifiers trained on different training sets are also more reliable than human classifiers, meaning that different ML classifiers are more consistent in assigning the same classifications to any given abstract, compared to different human classifiers. While the top five percentile of human classifiers can outperform ML in limited cases, selection and training of such classifiers is likely costly and difficult compared to training ML models. Our results suggest ML models are a cost effective and highly accurate method for addressing problems in comparative bibliometric analysis, such as harmonising the discipline classifications of research from different funding agencies or countries.

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