Differences in performance for quality of care indicators for acute myocardial infarction (AMI) across various hospital categories in Texas

The study analyzed Hospital Compare data for Medicare Fee-for-service patients at least 65 years of age to determine whether hospital performance for AMI outcome and processes of care measures differ amongst Texas hospitals with respect to ownership status (for profit vs. not-for-profit), academic status (teaching vs. non-teaching) and geographical setting (rural vs. urban). ^ The study found a statistically significant difference between for-profit and not-for-profit hospitals in four process-of-care measures (aspirin at discharge, P=0.028; ACE or ARB inhibitor for LSVD, P=0.048; Smoking cessation advice: P=0.034; outpatients who got aspirin with 24 hours of arrival in the ED, P=0.044). No significant difference in performance was found between COTH-member teaching and non-teaching hospitals for any of the eight process-of-care measures or the two outcome measures for AMI. The study was unable to compare performance based on geographic setting of hospitals due to lack of sufficient data for rural hospitals. ^ The results of the study suggest that for-profit Texas hospitals might be slightly better than not-for –profit hospitals at providing possible heart attack patients with certain processes of care.^

The role of a nursing home administrator's education in influencing quality of care in US nursing homes

Nursing home literature links poor management practices to poor quality of care and resident outcomes. Since Nursing Home Administrators (NHAs) require an array of skills to perform their role, it is important to explore what makes a NHA effective. This research fills a gap in the literature and provides a possible option to improve the quality of care in nursing homes. Purpose of the study. The study examines whether NHAs with advanced education (defined as a Masters degree or more) are associated with better quality of care in licensed nursing homes (NHs). Design and Methods. Data was derived from the CDC’s 2004 National Nursing Home Survey, which is a representative sample of NHs across the US. A Donabedian- inspired structure-process-outcomes study model was created to explain how education relates to quality of care. Quality of care was defined as onsite oral care, employee influenza vaccination rates and staff recognition programs. Statistical analyses included multivariate logistic regression; covariates included facility-level variables used in similar peer-reviewed research but also included select measures from the Area Resource File to control for county-level factors. Results. Descriptive and analytical analyses confirm that NHAs with a Bachelor’s degree, Associate degree or high school diploma perform less well than NHAs with a Masters degree or more. NHAs with advanced education are more likely to have onsite dental care and recognition programs for staff than NHAs with a Bachelor’s degree (or less). Also NHAs with less than graduate education are more likely to provide off-site dental care. Employee vaccination rates are not impacted by education. Adding certification, tenure or years of experience to a NHA with advanced education gives them an advantage. In fact, certification and experience alone do not have a positive relationship to care indicators; however adding these to advanced education produces a significant result. Implications. This research provides preliminary evidence that advanced education for the NHA is associated with better quality of care. If future research can confirm these findings, there is merit in revisiting the qualifications. Education can be a legitimate option to support quality improvement efforts in US nursing homes. ^

Black/white disparities in infant mortality rates in the U.S.: A quality of care perspective

The infant mortality rate for non-Hispanic Black infants in the U.S. is 13.63 deaths per 1,000 live births while the IMR for non-Hispanic White persons in the U.S. is 5.76 deaths per 1,000 live births. Black women are 2 times as likely as White women to deliver preterm infants and Black women are 2 times as likely as White women to deliver low birth weight infants (weighing less than 2,500 grams at birth). Differential underlying risk factors among mothers of different racial/ethnic groups for delivering pre-term and low birth weight infants have been historically accepted as the cause of racial disparities in IMRs. However, differential underlying risk status may not be the only major causative factor. Differential or unequal access to and provision of care is widely speculated to be a leading contributing factor to the wide racial disparity in infant mortality.2 This paper conducts a systematic review of existing literature investigating racial disparities in obstetrical care provided by healthcare practitioners to evaluate whether inequities in healthcare services provided to pregnant mothers and their neonates exist. The search terms "racial disparities obstetrical care," "racial differences quality of prenatal care," and "infant mortality racial disparities" were entered into the EBSCO Medline, Ovid Medline, PubMed, and Academic Search Complete databases, and articles between years 1990–2011 were selected for abstract review. The only articles included were those that used statistical methods to assess whether racial inequalities were present in the obstetrical services provided to pregnant women. My literature search returned 5 articles. Four of the five studies yielded significant racial differences in obstetrical care. However, the one study that used a large, nationally representative valid sample did not represent significant differences. Thus, this review provides initial evidence for racial disparities in obstetrical care, but concludes that more studies are needed in this area. Not all of the studies reviewed were consistent in the use and measurement of services, and not all studies were significant. The policy and public health implications of possible racial disparities in obstetrical care include the need to develop standard of care protocols for ALL obstetrical patients across the United States to minimize and/or eliminate the inequities and differences in obstetrical services provided.^

The cost effective management of Central Line-Associated Bloodstream Infections (CLABSIs) comparing the central line bundle to antimicrobialcoated central venous catheters: A systematic review

Central Line-Associated Bloodstream Infections (CLABSIs) are one of the most costly and preventable cases of morbidity and mortality among intensive care units (ICUs) in health care today. In 2008, the Centers for Medicare and Medicaid Services Medicare Program, under the Deficit Reduction Act, announced it will no longer reimburse hospitals for such adverse events among those related to CLABSIs. This reveals the financial burden shift onto the hospital rather than the health care payer who can now withhold reimbursements. With this weighing more heavily on hospital management, decision makers will need to find a way to completely prevent cases of CLABSI or simply pay for the financial consequences. ^ To reduce the risk of CLABSIs, several clinical, preventive interventions have been studied and even instituted including the Central Line (CL) Bundle and Antimicrobial Coated Central Venous Catheters (AM-CVCs). I carried out a formal systematic review on the topic to compare the cost-effectiveness of the Central Line (CL) Bundle to the commercially available antimicrobial coated central venous catheters (AM-CVCs) in preventing CLABSIs among critically and chronically ill patients in the U.S. Evidence was assessed for inclusion against predefined criteria. I, myself, conducted the data extraction. Ten studies were included in the review. Efficacy in reducing the mean incidence rate of CLABSI by the CL Bundle and AM-CVC interventions were compared with one another including costs. ^ The AM-CVC impregnated with antibiotics, rifampin-minocycline (AI-RM) is more clinically effective than the CL Bundle in reducing the mean rate of CLABSI per 1,000 catheter days. The lowest mean incidence rate of CLABSI per 1,000 catheter days among the AM-CVC studies was as low as zero in favor of the AI-RM. Moreover, the review revealed that the AI-RM appears to be more cost-effective than the CL Bundle. Results showed the adjusted incremental cost of the CL Bundle per ICU patient requiring a CVC to be approximately $196 while the AI-RM at only an additional cost of $48 per ICU patient requiring a CVC. ^ Limited data regarding the cost of the CL Bundle made it difficult to make a true comparison to the direct cost of the AM-CVCs. However, using the result I did have from this review, I concluded that the AM-CVCs do appear to be more cost-effective in decreasing the mean rate of CLABSI while also minimizing incremental costs per CVC than the CL Bundle. This review calls for further research addressing the cost of the CL Bundle and compliance and more effective study designs such as randomized control trials comparing the efficacy and cost of the CL Bundle to the AM-CVCs. Barriers that may face health care managers when implementing the CL Bundle or AM-CVCs include additional costs associated with the intervention, educational training and ongoing reinforcement as well as creating a new culture of understanding.^

Efficient management of available technologies. Aplication to mining operations for industry supplies

Nowadays, processing Industry Sector is going through a series of changes, including right management and reduction of environmental affections. Any productive process which looks for sustainable management is incomplete if Cycle of Life of mineral resources sustainability is not taken into account. Raw materials for manufacturing are provided by mineral resources extraction processes, such as copper, aluminum, iron, gold, silver, silicon, titanium? Those elements are necessary for Mankind development and are obtained from the Earth through mineral extractive processes. Mineral extraction processes are operations which must take care about the environmental consequences. Extraction of huge volumes of rock for their transformation into raw materials for industry must be optimized to reduce ecological cost of the final product as l was possible. Reducing the ecological balance on a global scale has no sense to design an efficient manufacturing in secondary industry (transformation), if in first steps of the supply chain (extraction) impact exceeds the savings of resources in successive phases. Mining operations size suggests that it is an environmental aggressive activity, but precisely because of its great impact must be the first element to be considered. That idea implies that a new concept born: Reduce economical and environmental cost This work aims to make a reflection on the parameters that can be modified to reduce the energy cost of the process without an increasing in operational costs and always ensuring the same production capacity. That means minimize economic and environmental cost at same time. An efficient design of mining operation which has taken into account that idea does not implies an increasing of the operating cost. To get this objective is necessary to think in global operation view to make that all departments involved have common guidelines which make you think in the optimization of global energy costs. Sometimes a single operational cost must be increased to reduce global cost. This work makes a review through different design parameters of surface mining setting some key performance indicators (KPIs) which are estimated from an efficient point of view. Those KPIs can be included by HQE Policies as global indicators. The new concept developed is that a new criteria has to be applied in company policies: improve management, improving OPERATIONAL efficiency. That means, that is better to use current resources properly (machinery, equipment,?) than to replace them with new things but not used correctly. As a conclusion, through an efficient management of current technologies in each extractive operation an important reduction of the energy can be achieved looking at downstream in the process. That implies a lower energetic cost in the whole cycle of life in manufactured product.

Management of intestinal obstruction in advanced malignancy

Peer reviewed

The multidisciplinary management of hip fractures in older patients

Acknowledgements The authors would like to thank our colleagues for valuable discussion and feedback on the article. These include Jane Thompson (Physiotherapy), Janet Christie (Occupational Therapy), Denise Donald (Discharge Coordinator) and James Duff (Orthogeriatric Specialist Nurse). Miss Riemen is supported by Wellcome Trust through the Scottish Translational Medicine and Therapeutics Initiative (Grant no. WT 085664) and through Clinical Research Fellowship Number 105424/Z/14/Z.

Point of care testing: randomised controlled trial of clinical outcome

Objectives: To describe the proportion of patients attending an accident and emergency department for whom blood analysis at the point of care brought about a change in management; to measure the extent to which point of care testing resulted in differences in clinical outcome for these patients when compared with patients whose samples were tested by the hospital laboratory.

Management of Trihalomethanes in Finished Drinking Water Through Source Water Precursor Monitoring

Trihalomethanes are organic compounds formed in drinking water distribution systems as a result of disinfection. This capstone project researched and evaluated the statistical correlation of trihalomethanes in finished drinking water and total organic carbon in source water using data generated by Denver area utilities. Results of the study conclude that some drinking water supply systems show a slight correlation between source water total organic carbon levels and trihalomethane levels in finished water. Results of the study also verify the assertion that changes to treatment for the reduction of trihalomethanes, for the protection of human health under the Safe Drinking Water Act should be determined by each utility, using information from gathered data, seasonal trends, and small scale batch testing.

Reviewing the EU’s Crisis Management Procedures. IES Policy Brief Issue 2012/04/November 2012

Summary. The ongoing review of the EU’s Crisis Management Procedures warrants attention. What passes as an update of an arcane and technical document masks a profoundly political debate concerning what the Common Security and Defence Policy (CSDP) should be about. This policy brief summarises the main proposals and formulates a set of critical reflections. It calls for replacing the bureaucratic scheming with a more forthright political debate, and warns against sacrificing incompatible organisational cultures on the altar of the comprehensive approach. At a time when European security and prosperity trends are increasingly pointing downwards, the EEAS and the member states must look to the future and embrace, rather than resist, change.

Selected statements of labor policy ...

Part II has subtitle: Quotations arranged under selected topics.

Advice to a mother on the management of her children : and on the treatment on the moment of some of [sic] their more pressing illnesses and accidents /

Includes index.

Oversight of U.S. progress under the Great Lakes Water Quality Agreement : hearing before the Subcommittee on Oversight of Government Management of the Committee on Governmental Affairs, United States Senate, One Hundred First Congress, second session, June 13, 1990.

Shipping list no.: 90-646-P.