Appropriate and inappropriate influences on outpatient discharge decision making in dermatology : a prospective qualitative study

© 2015 British Association of Dermatologists.BACKGROUND: Outpatient discharge decision making in dermatology is poorly understood. OBJECTIVE: To identify the influences on clinicians' thought processes when making discharge decisions in dermatology outpatient clinics. METHODS: Forty clinicians from 11 National Health Service Trusts in England were interviewed. The interviews were audiorecorded, transcribed, coded and thematically analysed. RESULTS: The mean age of the clinicians was 48.8 years (range 33.0-67.0), 17 (43%) were men and 19 (48%) had > 20 years of clinical experience. One hundred and forty-eight influences were reported, with five main themes: (i) disease-based influences included type of diagnosis (100% of clinicians), guidelines (100%) and treatment needed (100%); (ii) clinician-based influences included the clinician's level of experience (100%), seniority (37%), emotional attitude (95%), 'gut feeling' (25%), personal attitude towards discharge (45%) and level of perception (100%); (iii) patient-based influences included patients' ability to cope with their disease (100%), wishes (70%), quality of life (32%), command of English (40%) and cultural background (25%); (iv) practice-based influences included good primary care (100%), secondary support structure (100%) and clinic capacity pressure (67%); (v) policy-based influences included pressure from hospital managers (57%) and an active discharge policy (7%). Fourteen (9%) influences were potentially inappropriate. CONCLUSION: This study has identified multiple factors influencing outpatient discharge decision making. This provides the basis for developing evidence-based training to improve discharge decision appropriateness.Peer reviewe

Renormalization of the N=1 Abelian Super-Chern-Simons Theory Coupled to Parity-Preserving Matter

We analyse the renormalizability of an Abelian N=1 super-Chern-Simons model coupled to parity-preserving matter on the light of the regularization independent algebraic method. The model shows to be stable under radiative corrections and to be gauge anomaly free.Comment: Latex, 7 pages, no figure

Dermatology life quality index (DLQI) as a psoriasis referral triage tool

Most primary care psoriasis referrals in the UK are triaged as ‘routine’, in part because of the prioritisation of skin cancer. As a result, patients with severe psoriasis may wait several months to be seen, enduring quality of life (QoL) impairment that could have been reduced. Furthermore some patients may spontaneously improve by the time they are seen by a specialist, making the appointment unnecessary at that time. Therefore, following approval from the local ethics committee, we conducted a prospective study to evaluate the usefulness of Dermatology Life Quality Index (DLQI) scores in triaging patients with psoriasis referred to our dermatology secondary health care services

Octopus - An Autonomous Wheeled Climbing Robot

This paper presents an innovative off-road wheeled mobile robot, named Octopus, able to deal autonomously with obstacles in rough terrain without getting stuck. To achieve such a performance, the robot is equipped with tilt sensors and tactile wheels. The sophisticated locomotion mechanism of Octopus has 8 motorized wheels and a total of 15 degrees of freedom (14 of them are motorized). A two-dimensional static model and a controller are proposed. The inputs of the controller are the contact points with ground, the geometric angles of the articulations, and the direction of the gravity field. The outputs of the controller are the torques for the wheels, the torques for the forearms, and the position set point for the body

"Hands-On Mechatronics": Problem-Based Learning for Mechatronics

The project "Hands-On Mechatronics" aims to develop a problem-based learning environment for mechatronics. This environment is based on four specific aspects: a mobile robot competition as motivation factor, a WEB environment as framework for all student, the SmartEASE robot as experimental platform and a good software environment for design and fast prototyping. The actual status of this concept is applied at the Swiss Federal Institute of Technology in Lausanne (EPFL) with participants coming from several schools of different levels. We present the actual implementation of the concept "Hands-On Mechatronics", the hardware and software tools used and some problems found in our approach

Renormalizability of Nonrenormalizable Field Theories

We give a simple and elegant proof of the Equivalence Theorem, stating that two field theories related by nonlinear field transformations have the same S matrix. We are thus able to identify a subclass of nonrenormalizable field theories which are actually physically equivalent to renormalizable ones. Our strategy is to show by means of the BRS formalism that the "nonrenormalizable" part of such fake nonrenormalizable theories, is a kind of gauge fixing, being confined in the cohomologically trivial sector of the theory.Comment: 3 pages, revtex, no figure

Physical renormalization condition for the quark-mixing matrix

We investigate the renormalization of the quark-mixing matrix in the Electroweak Standard Model. We show that the corresponding counterterms must be gauge independent as a consequence of extended BRS invariance. Using rigid SU(2)_L symmetry, we proof that the ultraviolet-divergent parts of the invariant counterterms are related to the field renormalization constants of the quark fields. We point out that for a general class of renormalization schemes rigid SU(2)_L symmetry cannot be preserved in its classical form, but is renormalized by finite counterterms. Finally, we discuss a genuine physical renormalization condition for the quark-mixing matrix that is gauge independent and does not destroy the symmetry between quark generations.Comment: 20 pages, LaTeX, minor changes, references adde

Analisis Kebutuhan Parkir Pada Rumah Sakit Umum Kelas B Di Kota Semarang

Parking is one of the important elements of urban transportation, such, it has various long and short-term impacts on individuals, societies, and transportation systems. It affects to the transportation mode selection. People tend to drive private car when the representative parking area is available. This research is focused at the determination of the parameters that affect the use of parking area. The parameters are expected to be useful in estimating the parking area demand of the hospital class B in Semarang. There are six major parameters describing the parking slot, i.e.: accumulation, parking volume, total spaces available (capacity), parking turnover, peak time, duration of occupancy and occupancy. Three hospitals are selected as object of the study; there are RS Telogorejo, RS Elisabeth and RS dr Kariadi. The survey is carried out by direct investigation and questionnaire. Statistical analysis by using linear regression, logarithmic, quadratic, and exponential, indicated that the amount of bed used has a very high correlation with the parking demand. The next highest correlation is observed between medical specialist and parking demand. The average duration in RS Telogorejo is 15 – 30 minutes, RS Elisabeth is 30 minutes – 2 hours, and RS dr Kariadi is 15 – 30 minutes for car. For motorcycle, the average duration in RS Telogorejo is 30 minutes – 1 hour, RS Elisabeth is 30 minutes – 2 hours, and RS dr Kariadi is above 4 hours. From the study, it was found that the ratio between parking demand for vehicle and the number of bed being used is 0.89, meanwhile the ratio between parking demand for motorcycle and the number of bed being used is 1.29. Other alternative of parking facility like special parking building area is recommended to be considered for the hospital with limited area