Evaluating health services with point of service feedback: perspectives and experiences of patients, staff and community volunteers in an inpatient rehabilitation facility

PURPOSE: To determine patient, staff and community volunteer opinions and experiences of point of service feedback (POSF) in an inpatient rehabilitation facility. METHOD: Participants were recruited by purposeful sampling. Two researchers conducted in-depth semi-scripted interviews with patients, staff or volunteers until no new issues emerged. Manually transcribed interview data underwent thematic analysis that grouped information into categories of related information. RESULTS: Twenty patients, 26 staff from 10 different professional groups, and 2 community volunteers were interviewed. Patient and volunteer data were grouped into five main categories: patients wanted their voice heard and acted on; patients could be positively and negatively affected by POSF; patients could be reluctant to evaluate staff; patients preferred POSF to post-discharge mailed questionnaires; and patients' feedback was influenced by the data collector. Staff wanted: feedback to help them improve the patient experience; and feedback that was trustworthy, usable and used. Staff believed that the feedback-collector influenced patients' feedback and affected how feedback could be used. CONCLUSIONS: Patients, staff and community volunteers identified issues that determine the appropriateness and usefulness of POSF. Policy and practise should address the preferences, needs and experiences of health service users and providers so that POSF produces maximum benefits for both patients and health services. Implications for Rehabilitation POSF can enhance patients' experiences of inpatient rehabilitation by providing a mechanism to be heard and communicating that patients are valued; care must be exercised with patients who find giving feedback stressful. Collecting POSF is most beneficial when coupled with methods to efficiently and effectively respond to feedback. POSF requires interpretation in light of its limitations including patients' ability to accurately and unreservedly communicate their experiences. Who collects POSF requires careful consideration; community volunteers have both advantages and disadvantages.

Suzhi development: Indigenous approaches to enhancing the quality of human resources

Purpose- This paper aims to examine the Chinese indigenous concept of suzhi ((ProQuest: Non US-ASCII text omitted)) by analyzing its historical evolution and its contemporary implications for human resource management (HRM) research and practice at the national and organizational levels.Design/methodology/approach- An integrated review of literatures in sinology, political science, anthropology and sociology concerned with suzhi-related research, combined with recent incidents associated with suzhi.Findings-Suzhi is an indigenous concept embedded in the centuries-long historical context of China.Suzhi development has been focused on three key dimensions, moral, physical and mental, as a way of building quality employees and citizens. Yet developing and quantifying the moral aspects ofsuzhi is more challenging than measuring its physical and mental dimensions. Linkingsuzhi development to human capital theory enriches the understanding of this indigenous concept at both organizational and national levels.Research limitations/implications- By analyzing a three-dimensionalsuzhi composite, the article offers an example of howsuzhi may be linked to human capital theory and identifies directions for future research.Originality/value- By analyzingsuzhi at organizational and national levels for HRM purposes, this article broadens thesuzhi literature from its place in the political sciences and social anthropology to encompass a theoretical analysis in HRM and development for the benefit of organizations and the society.

Interventions to improve cultural competency in healthcare: a systematic review of reviews

Cultural competency is a recognized and popular approach to improving the provision of health care to racial/ethnic minority groups in the community with the aim of reducing racial/ethnic health disparities. The aim of this systematic review of reviews is to gather and synthesize existing reviews of studies in the field to form a comprehensive understanding of the current evidence base that can guide future interventions and research in the area.

Modeling companion diagnostics in economic evaluations of targeted oncology therapies: systematic review and methodological checklist

The successful use of a targeted therapy is intrinsically linked to the ability of a companion diagnostic to correctly identify patients most likely to benefit from treatment. The aim of this study was to review the characteristics of companion diagnostics that are of importance for inclusion in an economic evaluation. Approaches for including these characteristics in model-based economic evaluations are compared with the intent to describe best practice methods. Five databases and government agency websites were searched to identify model-based economic evaluations comparing a companion diagnostic and subsequent treatment strategy to another alternative treatment strategy with model parameters for the sensitivity and specificity of the companion diagnostic (primary synthesis). Economic evaluations that limited model parameters for the companion diagnostic to only its cost were also identified (secondary synthesis). Quality was assessed using the Quality of Health Economic Studies instrument. 30 studies were included in the review (primary synthesis n = 12; secondary synthesis n = 18). Incremental cost-effectiveness ratios may be lower when the only parameter for the companion diagnostic included in a model is the cost of testing. Incorporating the test's accuracy in addition to its cost may be a more appropriate methodological approach. Altering the prevalence of the genetic biomarker, specific population tested, type of test, test accuracy and timing/sequence of multiple tests can all impact overall model results. The impact of altering a test's threshold for positivity is unknown as it was not addressed in any of the included studies. Additional quality criteria as outlined in our methodological checklist should be considered due to the shortcomings of standard quality assessment tools in differentiating studies that incorporate important test-related characteristics and those that do not. There is a need to refine methods for incorporating the characteristics of companion diagnostics into model-based economic evaluations to ensure consistent and transparent reimbursement decisions are made.

Factors associated with service use for young adolescents with mental health problems: findings from an Australian longitudinal study

The objective of the study wasto identify factors associated with use of services for adolescent mental health problems in an Australian community-based sample. Logistic regression analysis was conducted on data collected from 636 parents and their adolescent child to identify individual and family variables predicting parent report of service use for mental health problems in the adolescent 12 months later. The services most reported by parents to have been accessed were schoolbased ones. Multivariate analysis found that the following were associated with service use 12 months later: the adolescent being female, parent report of peer problems and hyperactivity, single-parent household, the parent being Australian born, and prior service use by the adolescent. Parental overcontrol was associated with reducedlikelihood of service use at followup. No association was found between service use at follow-up and parent gender, socioeconomic status, number of siblings, parent psychopathology, family social connectedness, and prior service use by the parent. No association was also found for family environment factors, parental attachment, or for the adolescent’s emotional competence or use of social support. The results indicate that families provide a potential target for interventions aimed at increasing use of professional services for adolescent mental health problems.

Food security: one of a number of ‘securities’ we need for a full life: an Australian perspective

Although agriculture in Australia is very productive, the current food supply systems in Australia fail to deliver healthy diets to all Australians and fail to protect the natural resources on which they depend. The operation of the food systems creates ‘collateral damage’ to the natural environment including biodiversity loss. In coming decades, Australia’s food supply systems will be increasingly challenged by resource price inflation and climate change. Australia exports more than half of its current agricultural production. Government and business are aiming to substantially increase production to bolster exports. This will increase pressure on agricultural resources and exacerbate ‘collateral’ damage to the environment. The Australian public have a deep and ongoing interest in a very wide range of issues associated with the food systems including the environment, health and sustainability. Food is something we require in order to live and a good diet is something we have to have to be healthy. For health over a life-time we need food security. However, we also require a range of other material goods and social arrangements in order to develop and flourish as human beings. And we need these other things to be secure over a life-time. Food is therefore one security among a range of other securities we need in order to flourish. The paper outlines a number of approaches, as examples, that help to identify what these other goods and arrangements might be. The approaches mentioned in this paper include human rights, national securities, human needs, authentic happiness, capabilities, sustainability and environmental ethics. The different approaches provide a way of evaluating the current situation and indicating a direction for change within the food systems that will address the problems. However, changing large systems such as those involved in food supply is difficult because inertias and vested interests make the current food supply systems resilient to change. The paper suggests that one of the first and ongoing tasks is to develop an understanding of the situation from a comprehensive social–ecological systems perspective. The paper also suggests that a practical leverage point for system change is restructuring the flow of information on the health, natural resources and biodiversity loss issues related to the food supply systems.

Cost effectiveness of an elementary school active physical education policy

INTRODUCTION: Many American children do not meet recommendations for moderate to vigorous physical activity (MVPA). Although school-based physical education (PE) provides children with opportunities for MVPA, less than half of PE minutes are typically active. The purpose of this study is to estimate the cost effectiveness of a state "active PE" policy implemented nationally requiring that at least 50% of elementary school PE time is spent in MVPA. METHODS: A cohort model was used to simulate the impact of an active PE policy on physical activity, BMI, and healthcare costs over 10 years for a simulated cohort of the 2015 U.S. population aged 6-11 years. Data were analyzed in 2014. RESULTS: An elementary school active PE policy would increase MVPA per 30-minute PE class by 1.87 minutes (95% uncertainty interval [UI]=1.23, 2.51) and cost $70.7 million (95% UI=$51.1, $95.9 million) in the first year to implement nationally. Physical activity gains would cost $0.34 per MET-hour/day (95% UI=$0.15, $2.15), and BMI could be reduced after 2 years at a cost of $401 per BMI unit (95% UI=$148, $3,100). From 2015 to 2025, the policy would cost $235 million (95% UI=$170 million, $319 million) and reduce healthcare costs by $60.5 million (95% UI=$7.93 million, $153 million). CONCLUSIONS: Implementing an active PE policy at the elementary school level could have a small impact on physical activity levels in the population and potentially lead to reductions in BMI and obesity-related healthcare expenditures over 10 years.

Modeling the cost effectiveness of child care policy changes in the U.S.

INTRODUCTION: Child care facilities influence diet and physical activity, making them ideal obesity prevention settings. The purpose of this study is to quantify the health and economic impacts of a multi-component regulatory obesity policy intervention in licensed U.S. child care facilities. METHODS: Two-year costs and BMI changes resulting from changes in beverage, physical activity, and screen time regulations affecting a cohort of up to 6.5 million preschool-aged children attending child care facilities were estimated in 2014 using published data. A Markov cohort model simulated the intervention's impact on changes in the U.S. population from 2015 to 2025, including short-term BMI effects and 10-year healthcare expenditures. Future outcomes were discounted at 3% annually. Probabilistic sensitivity analyses simulated 95% uncertainty intervals (UIs) around outcomes. RESULTS: Regulatory changes would lead children to watch less TV, get more minutes of moderate and vigorous physical activity, and consume fewer sugar-sweetened beverages. Within the 6.5 million eligible population, national implementation could reach 3.69 million children, cost $4.82 million in the first year, and result in 0.0186 fewer BMI units (95% UI=0.00592 kg/m(2), 0.0434 kg/m(2)) per eligible child at a cost of $57.80 per BMI unit avoided. Over 10 years, these effects would result in net healthcare cost savings of $51.6 (95% UI=$14.2, $134) million. The intervention is 94.7% likely to be cost saving by 2025. CONCLUSIONS: Changing child care regulations could have a small but meaningful impact on short-term BMI at low cost. If effects are maintained for 10 years, obesity-related healthcare cost savings are likely.

Development of a measure of health literacy for caregivers of people with cancer

Caregivers play a key role in supporting people with cancer. Little is known about challenges that caregivers might have when finding and understanding health information, making health-related decisions, and navigating the healthcare system. Using an innovative mixed-methods approach, the study developed and evaluated a tool to measure cancer caregiver health literacy.

Motor competence and its effect on positive developmental trajectories of health

In 2008, Stodden and colleagues took a unique developmental approach toward addressing the potential role of motor competence in promoting positive or negative trajectories of physical activity, health-related fitness, and weight status. The conceptual model proposed synergistic relationships among physical activity, motor competence, perceived motor competence, health-related physical fitness, and obesity with associations hypothesized to strengthen over time. At the time the model was proposed, limited evidence was available to support or refute the model hypotheses. Over the past 6 years, the number of investigations exploring these relationships has increased significantly. Thus, it is an appropriate time to examine published data that directly or indirectly relate to specific pathways noted in the conceptual model. Evidence indicates that motor competence is positively associated with perceived competence and multiple aspects of health (i.e., physical activity, cardiorespiratory fitness, muscular strength, muscular endurance, and a healthy weight status). However, questions related to the increased strength of associations across time and antecedent/consequent mechanisms remain. An individual’s physical and psychological development is a complex and multifaceted process that synergistically evolves across time. Understanding the most salient factors that influence health and well-being and how relationships among these factors change across time is a critical need for future research in this area. This knowledge could aid in addressing the declining levels of physical activity and fitness along with the increasing rates of obesity across childhood and adolescence.

Cleaning, resistant bacteria, and antibiotic prescribing in residential aged care facilities

Residents of residential aged care facilities (RACFs) are at risk of colonization and infection with multidrug-resistant bacteria, and antibiotic prescribing is often inappropriate and not based on culture-proven infection. We describe low levels of resident colonization and environmental contamination with resistant gram-negative bacteria in RACFs, but high levels of empirical antibiotic use not guided by microbiologic culture. This research highlights the importance of antimicrobial stewardship and environmental cleaning in aged care facilities.

Fatores associados ao controle metabólico em pacientes com diabetes melito tipo 2 não usuários de insulina

Introdução: a obtenção de um bom controle metabólico é essencial para a prevenção das complicações crônicas do Diabetes Melito (DM). O tratamento é complexo e depende da implementação efetiva das diferentes estratégias terapêuticas disponíveis. Para que isso seja possível, é necessário que o paciente entenda os princípios terapêuticos e consiga executá-los. A precária educação em diabetes é percebida como um dos obstáculos para o alcance das metas terapêuticas. Objetivo: analisar, os fatores associados ao controle metabólico, em pacientes com DM tipo 2 (DM2) não usuários de insulina. Métodos: foi realizado um estudo transversal em pacientes com DM2 não usuários de insulina, selecionados ao acaso entre aqueles que consultavam nos ambulatórios de Medicina Interna, Endocrinologia e Enfermagem do Hospital de Clínicas de Porto Alegre. Os pacientes foram submetidos à avaliação clínica, laboratorial e responderam um questionário que incluía o tipo de tratamento realizado para DM, outros medicamentos e co-morbidades, pesquisa de complicações em ano prévio e avaliação do conhecimento sobre DM. Os pacientes foram classificados em dois grupos, com bom ou mau controle glicêmico, de acordo com o valor da glico-hemoglobina de 1 ponto % acima do limite superior do método utilizado. As comparações entre variáveis contínuas, com distribuição normal, foram analisadas pelo teste t de Student para amostras não-pareadas e para as variáveis de distribuição assimétrica ou com variância heterogênea o teste U de Mann-Whitney. A comparação entre percentagem foi feita pelo teste de qui-quadrado ou exato de Fisher. Foi realizada uma análise logística múltipla para identificar os fatores mais relevantes associados ao controle metabólico (variável dependente). As variáveis independentes com um nível de significância de P < 0,1 na análise bivariada, foram incluídas no modelo. Resultados: foram avaliados 143 pacientes com DM2, idade de 59,3 ± 10,1 anos, duração conhecida do DM 7,5 ± 6,3 anos, índice de massa corporal (IMC) de 29,7 ± 5,2 kg/m².Destes, 94 pacientes (65,73%) apresentavam bom controle glicêmico. Os pacientes com mau controle glicêmico usavam mais anti-hiperglicemiantes orais como monoterapia (OR = 9,37; IC = 2,60-33,81; P=0,004) ou associados (OR = 31,08; IC = 7,42-130,15; P < 0,001). Da mesma maneira, não fizeram dieta em dias de festa (OR = 3,29; IC = 1,51-7,16; P = 0,012). A inclusão do conhecimento sobre diabetes não foi diferente entre os pacientes com bom ou mau controle glicêmico (OR = 1,08; IC = 0,97 - 1,21; P = 0,219). A análise multivariada demonstrou que a consulta com a enfermeira educadora (OR = 0,24; IC = 0,108-0,534; P = 0,003), com o endocrinologista (OR = 0,15 ; IC = 0,063-0,373; P = 0,001) e o uso de hipolipemiantes (OR = 0,10; IC = 0,016 - 0,72; P = 0,054) foram associados ao bom controle glicêmico, ajustados para a não realização de dieta em festas, uso de anti-hiperglicemiantes orais e conhecimento sobre diabetes. Conclusão: o controle metabólico em pacientes DM2 é influenciado pelas atividades de educação com enfermeira e endocrinologista. O tratamento do DM2 deve incluir atividades de educação de forma sistemática.

Growing research where economies grow: essays on strategy and international expansion of companies from emerging countries

In recent years, emerging countries have assumed an increasingly prominent position in the world economy, as growth has picked up in these countries and slowed in developed economies. Two related phenomena, among others, can be associated with this growth: emerging countries were less affected by the 2008-2009 global economic recession; and they increased their participation in foreign direct investment, both inflows and outflows. This doctoral dissertation contributes to research on firms from emerging countries through four independent papers. The first group of two papers examines firm strategy in recessionary moments and uses Brazil, one of the largest emerging countries, as setting for the investigation. Data were collected through a survey on Brazilian firms referring to the 2008-2009 global recession, and 17 hypotheses were tested using structural equation modeling based on partial least squares. Paper 1 offered an integrative model linking RBV to literatures on entrepreneurship, improvisation, and flexibility to indicate the characteristics and capabilities that allow a firm to have superior performance in recessions. We found that firms that pre-recession have a propensity to recognize opportunities and improvisation capabilities for fast and creative actions have superior performance in recessions. We also found that entrepreneurial orientation and flexibility have indirect effects. Paper 2 built on business cycle literature to study which strategies - pro-cyclical or counter-cyclical – enable superior performance in recessions. We found that while most firms pro-cyclically reduce costs and investments during recessions, a counter-cyclical strategy of investing in opportunities created by changes in the environment enables superior performance. Most successful are firms with a propensity to recognize opportunities, entrepreneurial orientation to invest, and flexibility to efficiently implement these investments. The second group of two papers investigated international expansion of multinational enterprises, particularly the use of distance for their location decisions. Paper 3 proposed a conceptual framework to examine circumstances under which distance is less important for international location decisions, taking the new perspective of economic institutional distance as theoretical foundation. The framework indicated that the general preference for low-distance countries is lower: (1) when the company is state owned, rather than private owned; (2) when its internationalization motives are asset, resource, or efficiency seeking, as opposed to market seeking; and (3) when internationalization occurred after globalization and the advent of new technologies. Paper 4 compared five concurrent perspectives of distance and indicated their suitability to the study of various issues based on industry, ownership, and type, motive, and timing of internationalization. The paper also proposed that distance represents the disadvantages of host countries for international location decisions; as such, it should be used in conjunction with factors that represent host country attractiveness, or advantages as international locations. In conjunction, papers 3 and 4 provided additional, alternative explanations for the mixed empirical results of current research on distance. Moreover, the studies shed light into the discussion of differences between multinational enterprises from emerging countries versus those from advanced countries.

Eficácia do florfenicol e da oxitetraciclina no controle de Aeromonas hydrophila em pacu (Piaractus mesopotamicus)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Spatial variability of soil CO2 emission in a sugarcane area characterized by secondary information

Soil CO2 emission (FCO2) is governed by the inherent properties of the soil, such as bulk density (BD). Mapping of FCO2 allows the evaluation and identification of areas with different accumulation potential of carbon. However, FCO2 mapping over larger areas is not feasible due to the period required for evaluation. This study aimed to assess the quality of FCO2 spatial estimates using values of BD as secondary information. FCO2 and BD were evaluated on a regular sampling grid of 60 m × 60 m comprising 141 points, which was established on a sugarcane area. Four scenarios were defined according to the proportion of the number of sampling points of FCO2 to those of BD. For these scenarios, 67 (F67), 87 (F87), 107 (F107) and 127 (F127) FCO2 sampling points were used in addition to 127 BD sampling points used as supplementary information. The use of additional information from the BD provided an increase in the accuracy of the estimates only in the F107, F67 and F87 scenarios, respectively. The F87 scenario, with the approximate ratio between the FCO2 and BD of 1.00:1.50, presented the best relative improvement in the quality of estimates, thereby indicating that the BD should be sampled at a density 1.5 time greater than that applied for the FCO2. This procedure avoided problems related to the high temporal variability associated with FCO2, which enabled the mapping of this variable to be elaborated in large areas.