Performance Indicators

Measures of overall institutional performance were explored from a decision support perspective with twenty similar Carnegie Classification Baccalaureate II institutions. The study examined the usefulness of performance indicators in campus decision making following both a hypothesis testing and case study approach. Two conclusions were reached: first, that the performance measures most commonly cited in the literature as measures of institutional financial viability are of limited use for institution specific policy development; and second, that performance indicators are most effectively used within an institution specific, whole system framework

Performance Indicators: Information in Search of a Valid and Reliable Use

Measures of overall institutional performance were explored from a decision support perspective with twenty similar Carnegie Classification Baccalaureate II institutions. The study examined the usefulness of performance indicators in campus decision making following both a hypothesis testing and case study approach. Two conclusions were reached: first, that the performance measures most commonly cited in the literature as measures of institutional financial viability are of limited use for institution specific policy development; and second, that performance indicators are most effectively used within an institution specific, whole system framework.https://digitalcommons.usf.edu/usf_EPAA/1020/thumbnail.jp

Performance Indicators

Measures of overall institutional performance were explored from a decision support perspective with twenty similar Carnegie Classification Baccalaureate II institutions. The study examined the usefulness of performance indicators in campus decision making following both a hypothesis testing and case study approach. Two conclusions were reached: first, that the performance measures most commonly cited in the literature as measures of institutional financial viability are of limited use for institution specific policy development; and second, that performance indicators are most effectively used within an institution specific, whole system framework

HIV medical providers\u27 perceptions of the use of antiretroviral therapy as nonoccupational postexposure prophylaxis in 2 major metropolitan area

INTRO: In 2005, the Centers for Disease Control and Prevention expanded its recommendation of post exposure prophylaxis (PEP) use in the workplace to include non-occupational exposures (nPEP). The availability and extensive use of nPEP has not achieved widespread acceptance among health care providers of high-risk populations, and public health and primary care agencies have been sparse in their implementation of nPEP promotion, protocols, and practices. METHODS: We conducted a survey of HIV providers (n=142, response rate = 61%) in Miami-Dade County (Florida) and the District of Columbia (DC) that focused on their knowledge, attitudes, beliefs and practices related to the delivery of nPEP. We then analyzed differences in survey responses by site and by history of prescribing nPEP using bivariate and multivariate logistic regression. RESULTS: More DC providers (59.7%) reported ever prescribing nPEP than in Miami (39.5%%, p < 0.048). The majority of practices in both cities did not have a written nPEP protocol and rarely or never had patients request nPEP. Multivariable analysis for history of prescribing nPEP was dominated by having patients request nPEP (OR = 21.53) and the belief that nPEP would lead to antiretroviral resistance (OR = 0.14), as well as having an nPEP written protocol (OR = 7.49). DISCUSSION: Our findings are consistent with earlier studies showing the underuse of nPEP as a prevention strategy. The significance of having an nPEP written protocol and of patient requests for nPEP speaks to the importance of using targeted strategies to promote widespread awareness of the use of HIV antiretroviral medications as a prevention intervention

'My wife ordered me to come!' A discursive analysis of doctors' and nurses' accounts of men's use of General Practitioners

This study used a discursive approach to analysing doctors’ and nurses’ accounts of men’s health in the context of general practice. The analysis worked intensively with interview material from a small sample of general practitioners and their nursing colleagues. We examine the contradictory discursive framework through which this sample made sense of their male patients. The ‘interpretative repertoires’ through which doctors and nurses constructed their representations of male patients and the ‘subject positions’ these afforded men are outlined in detail. We describe how hegemonic masculinity is both critiqued for its detrimental consequences for health and paradoxically also indulged and protected. These constructions reflect a series of ideological dilemmas for men and health professionals between the maintenance of hegemonic masculine identities and negotiating adequate health care. Men who step outside ‘typical’ gender constructions tended to be marked as deviant or rendered invisible as a consequence

Anesthesia interventions that alter perioperative mortality: a scoping review

Abstract Background With over 230 million surgical procedures performed annually worldwide, better application of evidence in anesthesia and perioperative medicine may reduce widespread variation in clinical practice and improve patient care. However, a comprehensive summary of the complete available evidence has yet to be conducted. This scoping review aims to map the existing literature investigating perioperative anesthesia interventions and their potential impact on patient mortality, to inform future knowledge translation and ultimately improve perioperative clinical practice. Methods Searches were conducted in MEDLINE, EMBASE, CINAHL, and the Cochrane Library databases from inception to March 2015. Study inclusion criteria were adult patients, surgical procedures requiring anesthesia, perioperative intervention conducted/organized by a professional with training in anesthesia, randomized controlled trials (RCTs), and patient mortality as an outcome. Studies were screened for inclusion, and data was extracted in duplicate by pairs of independent reviewers. Data were extracted, tabulated, and reported thematically. Results Among the 10,505 publications identified, 369 RCTs (n = 147,326 patients) met the eligibility criteria. While 15 intervention themes were identified, only 7 themes (39 studies) had a significant impact on mortality: pharmacotherapy (n = 23), nutritional (n = 3), transfusion (n = 4), ventilation (n = 5), glucose control (n = 1), medical device (n = 2), and dialysis (n = 1). Conclusions By mapping intervention themes, this scoping review has identified areas requiring further systematic investigation given their potential value for reducing patient mortality as well as areas where continued investment may not be cost-effective given limited evidence for improving survival. This is a key starting point for future knowledge translation to optimize anesthesia practice

Permo-Carboniferous granitoids with Jurassic high temperature metamorphism in Central Pontides, Northern Turkey

In the northern part of the Central Pontides (N Turkey) there are different metamorphic rocks exposed, notably the Devrekani metamorphic rocks. Here, upper amphibolite-lower granulite facies metamorphic rocks contain predominantly paragneiss, orthogneiss and metacarbonate, and to a lesser extent, amphibolite and quartzite, with cross-cutting aplite, pegmatite and granite veins. This is the first report of these rocks and includes new data on the petrochemistry, geochronology and metamorphic evolution of the Devrekani orthogneisses from the Central Pontides. The orthogneisses show five different mineral parageneses with the characteristic mineral assemblage quartz + K-feldspar + plagioclase + biotite ± hornblende ± opaque (± ilmenite and ± magnetite), and accessory minerals (zircon, sphene and apatite). These metamorphic rocks exhibit generally granoblastic, lepidogranoblastic and nematolepidogranoblastic with locally migmatitic and relic micrographic textures. They have well-developed centimeter-spaced gneissic banding and display gneissose structure with symmetric, asymmetric and irregular folds. The petrographic features, mineralogical assemblages and weak migmatization reflect high temperature conditions. Thermometric calculations in the orthogneisses indicate metamorphic temperatures reached 744 ± 33 °C. Field relations, petrography and petrochemistry suggest that the orthogneisses have predominantly granodioritic and some granitic protoliths, that show features of I-type, medium to high-potassic calc-alkaline volcanic arc granitoids. The orthogneisses have high contents of LILEs and low contents of HFSEs with negative Nb and Ti anomalies, which are typical of subduction-related magmas. The orthogneisses also show significant LREE enrichment relative to HREE with negative Eu anomalies (EuN/Eu* = 0.33–1.07) with LaN/LuN = 6.98–20.47 values. Based on U-Pb zircon dating data, the protoliths are related to Permo-Carboniferous (316–252 Ma) magmatism. It is likely that peak metamorphism took place during the Jurassic as reflected by the U-Pb zircon ages (199–158 Ma) and also 40Ar/39Ar from hornblende/biotite (163–152 Ma). The four biotite 40Ar/39Ar average ages from the rock samples are ca. 156 Ma, suggesting that the metamorphic rocks cooled to 350–400 °C at ca. 156 Ma. Conclusively, the Devrekani metamorphic rocks can be ascribed as products of Permo-Carboniferous continental arc magmatism overprinted by Jurassic metamorphism in the northern Central Pontides

Innovative models of healthcare delivery: an umbrella review of reviews

Objective To undertake a synthesis of evidence-based research for seven innovative models of care to inform the development of new hospitals.Design Umbrella review.Setting Interventions delivered inside and outside of acute care settings.Participants Children and adults with one or more identified acute or chronic health conditions.Data sources PsycINFO, Ovid MEDLINE and CINAHL.Primary and secondary outcome measures Clinical indicators and mortality, healthcare utilisation, quality of life, self-management and self-care and patient knowledge.Results A total of 66 reviews were included, synthesising evidence from 1272 primary studies across the 7 models of care. Virtual care was the most common model studied, addressed by 47 (73%) of the reviews. Common outcomes evaluated across reviews were clinical indicators and mortality, healthcare utilisation, self-care and self-management, patient knowledge, quality of life and cost-effectiveness. The findings indicate that the innovative models of healthcare we identified in this review may be effective in managing patients with a range of acute and chronic conditions. Most of the included reviews reported evidence of comparable or improved care.Conclusions A consideration of local infrastructure and individual patient characteristics, such as health literacy, may be critical in determining the suitability of models of care for patients and their implementation in local health systems.Trial registration number 10.17605/OSF.IO/PS6ZU