Efficacy of clinical guideline implementation to improve the appropriateness of chest physiotherapy prescription among inpatients with community-acquired pneumonia

BACKGROUND: Although there is no strong evidence of benefit, chest physiotherapy (CP) seems to be commonly used in simple pneumonia. CP requires equipment and frequently involves the assistance of a respiratory therapist, engendering a significant medical workload and cost. AIM: To measure and compare the efficacy of two modalities of chest physiotherapy (CP) guideline implementation on the appropriateness of CP prescription among patients hospitalised for community-acquired pneumonia (CAP). PATIENTS AND METHODS: We measured the CP prescription rate and duration in all consecutive CAP inpatients admitted in a division of general internal medicine at an urban teaching community hospital during three consecutive one-year time periods: (1) before any guideline implementation; (2) after a passive implementation by medical grand rounds and guideline diffusion through mailing; (3) after adding a one-page reminder in the CAP patient's medical chart highlighting our recommendations. Death and recurrent hospitalisation rates within one year after hospitalisation were recorded to assess whether CP prescription reduction, if any, impaired patient outcomes. RESULTS: During the three successive phases, 127, 157, and 147 patients with similar characteristics were included. Among all CAP inpatients, the CP prescription rate decreased from 68% (86/127) to 51% (80/157), and to 48% (71/147), respectively (P for trend <0.01 for trend). A significant reduction in CP duration was observed after the active guideline implementation (12.0, 11.0, 7.0days, respectively) and persisted after adjustment for length of stay. Reductions in CP prescription rate and duration were also observed among CAP patients with COPD CP prescription rate: 97% (30/31), 67% (24/36), 75% (35/47), respectively (P<0.01 for trend). The mean cost of CP per patient was reduced by 56%, from $709 to $481, and to $309, respectively. Neither the in-hospital deaths, the one-year overall recurrent hospitalisation nor the one-year CAP-specific recurrent hospitalisation significantly differed between the three phases. CONCLUSION: Both passive and active implementation of guidelines appear to improve the appropriateness of CP prescription among inpatients with CAP without impairing their outcomes. Restricting CP use to patients who benefit from this treatment might be an opportunity to decrease CAP medical cost and workload.

Improving Transition Outcomes: Resource Mapping Workshop: Community Organizations Survey

Community organizations survey tool from the Improving Transition Outcomes Resource Mapping Workshops

Improving Transition Outcomes: Resource Mapping Workshop: Community Members Survey

Community members survey tool from the Improving Transition Outcomes Resource Mapping Workshops

Improving Transition Outcomes: Community Demonstration Prototypes

Information on the Council Bluffs Youth Connections, Henry County Transition Partners, and CASE (Career And Self Awareness) community demonstration prototypes.

Ants and their effects on an insect herbivore community associated with the inflorescences of Byrsonima crassifolia (Linnaeus) H.B.K. (Malpighiaceae)

The effects of ants on the insect community on inflorescences of Byrsonima crassifolia (Malpighiaceae) were tested in an ant exclusion experiment in a cerrado vegetation in southeastern Brazil. Forty-four species of insects (23 families) and nine species of ants (6 genera and 3 subfamilies) were found on the inflorescences of B. crassifolia. The exclusion of ants, primarily Camponotus sericeiventris and Camponotus spp., reduced the treehopper population to 20% of the original abundance. Ant exclusion and time influenced the abundance of chewing (Exclusion, P<0.001; Time, P<0.002), and sucking insects (Exclusion, P<0.02; Time, P<0.01). Twice as many chewing and sucking insects were found on ant-excluded inflorescences as compared to control inflorescences (P<0.001). One and half more sucking insects were found on ant-excluded than on control inflorescences. Only time significantly influenced the richness of chewing and sucking insects associated with B. crassifolia inflorescences. Inflorescences on control branches were significantly less attacked by herbivores than inflorescences on ant-excluded branches (P<0.001). Therefore, these results suggest that the presence of ants alters the structure of insect herbivore community associated with B. crassifolia.

Improving Transition Outcomes: Announcement of Community Demonstration Prototypes

Announcement of the Improving Transition Outcomes Community Demonstration Prototypes with general information for each.

Improving Transition Outcomes: Announcement of Community Demonstration Prototypes #2

Announcement of the Improving Transition Outcomes Community Demonstration Prototypes with general information for each.

Improving Transition Outcomes: CASE (Career And Self Awareness) Prototype: Community Team Award

Promotional article recognizing an award presented to the CASE (Career And Self Awareness) team.

Improving Transition Outcomes: CASE (Career And Self Awareness) Prototype: Iowa Association of Community Providers Award

Promotional article recognizing an award presented to the CASE (Career And Self Awareness) team.

Audit report on Clarke Community School District in Osceola, Iowa for the year ended June 30, 2007

Audit report on Clarke Community School District in Osceola, Iowa for the year ended June 30, 2007

The Effect of Teacher Expectations on Student Achievement: Does The Pygmalion Effect Hold True for Cape Verde?

The present study is about the relationship between teacher expectations and student achievement. Do teachers have the power to influence student achievement? This is the question at hand. Are students under the influence of their teachers in regards to how they perceive themselves as achievers and ultimately how well they perform? What are the other factors that come into play when assessing student’s academic achievement? In light of the literature written on this topic, the two most prevalent theories are (1) Pygmalion in the Class and (2) The Sustaining Effect. These theories show a direct and determinant relationship between teacher expectations and student achievement. The main objective of this study was to investigate if in Cape Verde, teachers follow the same trend. Responses to teacher and student surveys carried out at Domingos Ramos High School gave revealing insights into how Capeverdean teachers view their students and the role the teachers themselves play in supporting the studen’s academic performance. Is the teacher’s expectation of their students the last word? In general, teachers do have a powerful influence on their students for good or for bad, but the key questions are: (1) are they aware of this power and (2) how well do they manage it? This paper includes an in-depth discussion on the different factors that influence student achievement and research carried out at an urban secondary school which characterizes how teachers and students view their roles in the student’s academic success. Recommendations are also provided to assist teachers in managing their expectations to maximize their role as a positive contributor to the success of their students.

Aleo Vera living barriers - Cape Verde - Barreiras Vivas de Aleo vera (Portuguese)

Projecto DESIRE - Cabo Verde

ALOE VERA LIFE BARRIERS - CAPE VERDE

Projecto DESIRE - Cabo Verde