236,143 research outputs found

    Limited availability of cardiac rehabilitation for heart failure patients in the United Kingdom: findings from a national survey

    Get PDF
    Background: Participation of patients with heart failure in cardiac rehabilitation in the UK is low. This study investigated the availability of cardiac rehabilitation services for patients with heart failure in the UK and the views of service coordinators on ideal service models. Design: Our study was a cross-sectional national postal survey that was mailed to 342 service coordinators in the UK between April and June 2009. Methods: We developed a 38-item questionnaire to survey all cardiac rehabilitation service coordinators on theNational Audit of Cardiac Rehabilitation register in the UK in 2009. Results: The survey response rate was 71% (244/342). Forty three per cent (105/244) of coordinators did not accept patients with heart failure to their cardiac rehabilitation services. Most coordinators who did accept patients with heart failure offered their services to patients with a variety of cardiac conditions, though referral criteria and models of care varied widely. Services inconsistently used New York Heart Association classes and left ventricular ejection fraction measures to select patients. Few offered separate dedicated heart failure programmes (14%; 33/244) but where these existed they ran for longer than programmes which included patients with heart failure alongside other cardiac patients (10.9 vs 8.5 weeks; F=4.04; p=0.019). Few offered home-based options for patients with heart failure (11%; 27/244). Coordinators accepting patients with heart failure to their cardiac rehabilitation services tended to agree that patients with heart failure should be included in services alongside other cardiac patients (X2=6.2; p=0.013). Conclusions: There is limited access for patients with heart failure to cardiac rehabilitation in the UK. Local policies on referral and selection criteria differ and reflect coordinators views rather than clinical guidance. © The European Society of Cardiology 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav

    The safe insertion of peripheral intravenous catheters : a mixed methods descriptive study of the availability of the equipment needed

    Get PDF
    Background: Intravenous cannulation is undertaken in a high proportion of hospitalised patients. Much international attention has been given to the use of care bundles to reduce the incidence of infection in these patients. However, less attention has been given to the systems required to ensure availability of the equipment needed to support these care bundles. Our objectives were to assess how reliably the equipment recommended for a peripheral intravenous care bundle was available for use, and to explore factors which contributed to its non-availability. Methods: We studied 350 peripheral cannula insertions in three NHS hospital organisations across the UK. Staff inserting cannulae were asked to report details of all equipment problems. Key staff were then interviewed to identify the causes of problems with equipment availability, using semi-structured qualitative interviews and a standard coding frame. Results: 47 equipment problems were recorded during 46 of 350 cannulations, corresponding to a reliability of 87%, or 94% if problems with sharps disposal were excluded. Overall reliability was similar in all three organisations, but the types of problem varied. Interviews revealed a variety of causes including issues associated with purchasing policies, storage facilities, and lack of teamwork and communication in relation to reordering. The many human factors related to the supply chain were highlighted. Often staff had adopted work-arounds to deal with these problems. Conclusions: Overall, 87% of cannulations had the correct and functional equipment available. Different problems were identified in different organisations, suggesting that each had resolved some issues. Supply chain management principles may be useful to support best practice in care bundle delivery. Keywords: Cannulation, Patient safety, Equipment, Care bundles, Hospital acquired bacteraemia, Systems reliabilit

    Development and implementation of preventive-maintenance practices in Nigerian industries.

    No full text
    A methodology for the development of PM using the modern approaches of FMEA, root-cause analysis, and fault-tree analysis is presented. Applying PM leads to a cost reduction in maintenance and less overall energy expenditure. Implementation of PM is preferable to the present reactive maintenance procedures (still prevalent in Nigeria

    Why are IPTp Coverage Targets so Elusive in Sub-Saharan Africa? A Systematic Review of Health System Barriers.

    Get PDF
    Use of intermittent preventive treatment (IPTp) is a proven cost-effective intervention for preventing malaria in pregnancy. However, despite the roll-out of IPTp policies across Africa more than ten years ago, utilization levels remain low. This review sought to consolidate scattered evidence as to the health system barriers for IPTp coverage in the continent.Methods and findings: Relevant literature from Africa was systematically searched, reviewed and synthesized. Only studies containing primary data were considered. Studies reveal that: (i) poor leadership and governance contribute to slow decentralization of programme management, lack of harmonized guidelines, poor accountability mechanisms, such as robust monitoring and evaluation systems; (ii) low budgetary allocation towards policy implementation slows scale-up, while out-of-pocket expenditure deters women from seeking antenatal services that include IPTp; (iii) there are rampant human resource challenges including low staff motivation levels attributed to such factors as incorrect knowledge of IPTp recommendations and inadequate staffing; (iv) implementation of IPTp policies is hampered by prevailing service delivery barriers, such as long waiting time, long distances to health facilities and poor service provider/client relations; and (v) drug stock-outs and poor management of information and supply chains impair sustained availability of drugs for IPTp. For successful IPTp policy implementation, it is imperative that malaria control programmes target health system barriers that result in low coverage and hence programme ineffectiveness

    Customer-oriented risk assessment in Network Utilities

    Get PDF
    For companies that distribute services such as telecommunications, water, energy, gas, etc., quality perceived by the customers has a strong impact on the fulfillment of financial goals, positively increasing the demand and negatively increasing the risk of customer churn (loss of customers). Failures by these companies may cause customer affection in a massive way, augmenting the intention to leave the company. Therefore, maintenance performance and specifically service reliability has a strong influence on financial goals. This paper proposes a methodology to evaluate the contribution of the maintenance department in economic terms, based on service unreliability by network failures. The developed methodology aims to provide an analysis of failures to facilitate decision making about maintenance (preventive/predictive and corrective) costs versus negative impacts in end-customer invoicing based on the probability of losing customers. Survival analysis of recurrent failures with the General Renewal Process distribution is used for this novel purpose with the intention to be applied as a standard procedure to calculate the expected maintenance financial impact, for a given period of time. Also, geographical areas of coverage are distinguished, enabling the comparison of different technical or management alternatives. Two case studies in a telecommunications services company are presented in order to illustrate the applicability of the methodology

    Model to Predict Duty of Community Nurses in Promotive and Preventive Care

    Get PDF
    Community nurses had important role in promotive and preventive care in community. Aim of the study was to make model to predict community nurses role in promotive and preventive care based on Health Promotion Model (HPM). Design of the study was used explanatory with cross sectional approach. Sum of participant was 161. This study was conducted in 11 Public Health Center in Banyuwangi at 1 January to 30 January 2018. Methods of data collection was cluster sampling. The data was analysed using smartPLS software.. Inner model: personal factors (t=1.981), interpersonal influences (t=4.036), situational influences (5.720), commitment (t=5.138) had affected to community nurses duty in promotive and preventive care. This model could predict community nurses duty in promotive and preventive care in high level (Q=0.998). That was important to enhance of community nurses duty through modifying commitment of nurses, interpersonal influence factors, personal factors and situational influence factors

    Systematizing Decentralization and Privacy: Lessons from 15 Years of Research and Deployments

    Get PDF
    Decentralized systems are a subset of distributed systems where multiple authorities control different components and no authority is fully trusted by all. This implies that any component in a decentralized system is potentially adversarial. We revise fifteen years of research on decentralization and privacy, and provide an overview of key systems, as well as key insights for designers of future systems. We show that decentralized designs can enhance privacy, integrity, and availability but also require careful trade-offs in terms of system complexity, properties provided, and degree of decentralization. These trade-offs need to be understood and navigated by designers. We argue that a combination of insights from cryptography, distributed systems, and mechanism design, aligned with the development of adequate incentives, are necessary to build scalable and successful privacy-preserving decentralized systems
    • …
    corecore