598 resultados para Doctor-patient relationship


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Is there a threshold above which hand-rub solution consumption is efficient for decreasing MRSA incidence? [J Hosp Infect. 2009] Association between an index of consumption of hand-rub solution and the incidence of acquired meticillin-resistant Staphylococcus aureus in an intensive care unit.

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A comprehensive literature review has been undertaken exploring the stressors placed on the personal relationships of Australian Army personnel, through service life and also overseas deployments. This work is the first step in a program of research aimed at developing a screening tool, aimed at acting as an early warning system to enable the right assistance to be given to affected personnel at the earliest possible time. It is envisioned that this tool will be utilised by the day-to-day managers of Australian Army personnel, of whom the vast majority are not health practitioners. This review has identified the commonalities of relationships that last through service life and/or deployments, and those that fail. These factors are those which will aid the development of the screening tool, and enable the early identification of Australian Army personnel who are at risk of having their personal relationship break down. Several of the known relationship stressors are relevant to other ‘high intensity’ professions, such as paramedics. Personal experience as an Army Officer has helped to highlight the importance of this research, and the benefits of developing a tool tailored to the unique social microclimate that is the Australian Army are clear. This research is, to the author’s knowledge, unique in the Australian context.

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The preservation technique of drying offers a significant increase in the shelf life of food materials, along with the modification of quality attributes due to simultaneous heat and mass transfer. Variations in porosity are just one of the microstructural changes that take place during the drying of most food materials. Some studies found that there may be a relationship between porosity and the properties of dried foods. However, no conclusive relationship has yet been established in the literature. This paper presents an overview of the factors that influence porosity, as well as the effects of porosity on dried food quality attributes. The effect of heat and mass transfer on porosity is also discussed along with porosity development in various drying methods. After an extensive review of the literature concerning the study of porosity, it emerges that a relationship between process parameters, food qualities, and sample properties can be established. Therefore, we propose a hypothesis of relationships between process parameters, product quality attributes, and porosity.

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Parental controlling feeding practices have been directly associated with maladaptive child eating behaviours, such as Eating in the Absence of Hunger (EAH). The aim of this study was to examine EAH in very young children (3-4 years old) and to investigate the association between maternal controlling feeding practices and energy intake from a standardised selection of snacks consumed ‘in the absence of hunger’. Thirty-seven mother-child dyads enrolled in the NOURISH RCT participated in a modified EAH protocol conducted in the child’s home. All children displayed EAH, despite 80% reporting to be full or very full following completion of lunch 15 minutes earlier. The relationship between maternal and child covariates and controlling feeding practices and EAH were examined using non-parametric tests, and were stratified by child gender. For boys only, pressure to eat was positively associated with EAH. Neither restriction nor monitoring practices were associated with EAH in either boys or girls. Overall, the present findings suggest gender differences in the relationship between maternal feeding practices and children’s eating behaviours emerge early and should be considered in future research and intervention design.

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Objective: To estimate the relative inpatient costs of hospital-acquired conditions. Methods: Patient level costs were estimated using computerized costing systems that log individual utilization of inpatient services and apply sophisticated cost estimates from the hospital's general ledger. Occurrence of hospital-acquired conditions was identified using an Australian ‘condition-onset' flag for diagnoses not present on admission. These were grouped to yield a comprehensive set of 144 categories of hospital-acquired conditions to summarize data coded with ICD-10. Standard linear regression techniques were used to identify the independent contribution of hospital-acquired conditions to costs, taking into account the case-mix of a sample of acute inpatients (n = 1,699,997) treated in Australian public hospitals in Victoria (2005/06) and Queensland (2006/07). Results: The most costly types of complications were post-procedure endocrine/metabolic disorders, adding AU$21,827 to the cost of an episode, followed by MRSA (AU$19,881) and enterocolitis due to Clostridium difficile (AU$19,743). Aggregate costs to the system, however, were highest for septicaemia (AU$41.4 million), complications of cardiac and vascular implants other than septicaemia (AU$28.7 million), acute lower respiratory infections, including influenza and pneumonia (AU$27.8 million) and UTI (AU$24.7 million). Hospital-acquired complications are estimated to add 17.3% to treatment costs in this sample. Conclusions: Patient safety efforts frequently focus on dramatic but rare complications with very serious patient harm. Previous studies of the costs of adverse events have provided information on ‘indicators’ of safety problems rather than the full range of hospital-acquired conditions. Adding a cost dimension to priority-setting could result in changes to the focus of patient safety programmes and research. Financial information should be combined with information on patient outcomes to allow for cost-utility evaluation of future interventions.

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Vehicle speed is an important attribute for analysing the utility of a transport mode. The speed relationship between multiple modes of transport is of interest to traffic planners and operators. This paper quantifies the relationship between bus speed and average car speed by integrating Bluetooth data and Transit Signal Priority data from the urban network in Brisbane, Australia. The method proposed in this paper is the first of its kind to relate bus speed and average car speed by integrating multi-source traffic data in a corridor-based method. Three transferable regression models relating not-in-service bus, in-service bus during peak periods, and in-service bus during off-peak periods with average car speed are proposed. The models are cross-validated and the interrelationships are significant.

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The National Curriculum is a current innovation in Australian schooling history which is likely to have a widespread and long-term impact on schools, teachers and students. This paper has investigated educational change during the early phase of curriculum implementation in a large secondary school, north of Brisbane, Australia. Specifically, this study explored teachers’ perceptions of the principal’s transformational leadership skills during an early stage of the curriculum’s implementation along with teachers’ perceptions of implementing a National Curriculum in their classroom. For this research, sixty-nine teachers were surveyed about their perceptions of their principal’s leadership and their perceptions of the difficulty of implementation of the new curriculum. Findings indicated that teachers with positive perceptions of their principal's leadership also had positive perceptions of their capacity to implement the new National Curriculum. Specifically, teachers who perceived the principal as holding high expectations and providing intellectual stimulation believed they had the capacity to successfully implement curriculum change.

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This study sought to examine how measures of player experience used in videogame research relate to Metacritic Professional and User scores. In total, 573 participants completed an online survey, where they responded the Player Experience of Need Satisfaction (PENS) and the Game Experience Questionnaire (GEQ) in relation to their current favourite videogame. Correlations among the data indicate an overlap between the player experience constructs and the factors informing Metacritic scores. Additionally, differences emerged in the ways professionals and users appear to allocate game ratings. However, the data also provide clear evidence that Metacritic scores do not reflect the full complexity of player experience and may be misleading in some cases.

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Anatomically pre-contoured fracture fixation plates are a treatment option for bone fractures. A well-fitting plate can be used as a tool for anatomical reduction of the fractured bone. However, recent studies showed that some plates fit poorly for many patients due to considerable shape variations between bones of the same anatomical site. Therefore, the plates have to be manually fitted and deformed by surgeons to fit each patient optimally. The process is time-intensive and labor-intensive, and could lead to adverse clinical implications such as wound infection or plate failure. This paper proposes a new iterative method to simulate the patient-specific deformation of an optimally fitting plate for pre-operative planning purposes. We further demonstrate the validation of the method through a case study. The proposed method involves the integration of four commercially available software tools, Matlab, Rapidform2006, SolidWorks, and ANSYS, each performing specific tasks to obtain a plate shape that fits optimally for an individual tibia and is mechanically safe. A typical challenge when crossing multiple platforms is to ensure correct data transfer. We present an example of the implementation of the proposed method to demonstrate successful data transfer between the four platforms and the feasibility of the method.

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In a recent issue of the Journal of Lymphoedema, Nickolaidis and Karlsson (2013) indicated that most of the standard treatments for lymphoedema patients were explored and developed early last century, and suggested that holistic assessment of the individual is critical for good outcomes, but that perhaps “less emphasis should be placed on manual lymphatic drainage (MLD) and more on compression, exercise and weight reduction.”

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New product innovation has been identified as the key to firms' marketplace success, profit and survival. Yet, the failure rate for new products is high. Because of the high costs associated with new product development, there is considerable theoretical and managerial interest in how to minimize the high failure rates of new products and what separates new product winners from losers. This study focuses on individual level ambidexterity – namely head of the R&D departments' capacity to engage in creativity and attention-to-detail simultaneously, a skill involving different centers of attention, and relying on somewhat incompatible behaviors and processes. The ability to engage in these behaviors simultaneously is seen as being ambidextrous. Drawing from the data of 150 advanced manufacturing firms in India (gathered from one CEO and one head of the R&D department for each firm), the results show that when an individual head of R&D engages heavily only in creativity, too many new, risky ideas may come and when he/she engages heavily only in attention-to-detail, he/she may suffer through a lack of novel ideas. Both approaches limit individual's contribution to enhancing product innovation – financial performance relationship. The results also show that an individual head of R&D needs to engage in high levels creativity and attention-to-detail in the pursuit of enhancing product innovation to achieve superior financial performance.

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The O-specific polysaccharide (OPS) is a variable constituent of the lipopolysaccharide of Gram-negative bacteria. The polymorphic nature of OPSs within a species is usually first defined serologically, and the current serotyping scheme for Yersinia pseudotuberculosis consists of 21 O serotypes of which 15 have been characterized genetically and structurally. Here, we present the structure and DNA sequence of Y. pseudotuberculosis O:10 OPS. The O unit consists of one residue each of d-galactopyranose, N-acetyl-d-galactosamine (2-amino-2-deoxy-d-galactopyranose) and d-glucopyranose in the backbone, with two colitose (3,6-dideoxy-l-xylo-hexopyranose) side-branch residues. This structure is very similar to that shared by Escherichia coli O111 and Salmonella enterica O35. The gene cluster sequences of these serotypes, however, have only low levels of similarity to that of Y. pseudotuberculosis O:10, although there is significant conservation of gene order. Within Y. pseudotuberculosis, the O10 structure is most closely related to the O:6 and O:7 structures.