Patient Satisfaction in a Statewide Cervical Cancer Screening Program

A cross-sectional study of patients participating in the Nevada State Health Division’s Women Health Connection Program (WHC) was conducted to assess patient satisfaction for cervical cancer screening. In this study, 528 WHC program patients provided information regarding their satisfaction with the treatment services they received, accessibility issues, breast and cervical cancer health education and information, and overall program satisfaction. A large majority of patients reported high levels of satisfaction with the program services and clinic personnel. Significant positive correlations were found when comparing satisfaction with services received at the clinic to treatment received by physicians, nurses, and admissions personnel, how well information provided to patients eased their concerns, and when results were discussed with patients. Wait time for admission and to see a physician were negatively correlated to satisfaction. Those who reported that they would not use services again indicated lower levels of satisfaction with the information received and treatment from caregivers and admissions personnel when compared to those who would use the program again

Do healthcare services behave as complex systems? Analysis of patterns of attendance and implications for service delivery

Background: The science of complex systems has been proposed as a way of understanding health services and the demand for them, but there is little quantitative evidence to support this. We analysed patterns of healthcare use in different urgent care settings to see if they showed two characteristic statistical features of complex systems: heavy-tailed distributions (including the inverse power law) and generative burst patterns. Methods: We conducted three linked studies. In study 1 we analysed the distribution of number of contacts per patient with an urgent care service in two settings: emergency department (ED) and primary care out-of-hours (PCOOH) services. We hypothesised that these distributions should be heavy-tailed (inverse power law or log-normal) in keeping with typical complex systems. In study 2 we analysed the distribution of bursts of contact with urgent care services by individuals: correlated bursts of activity occur in complex systems and represent a mechanism by which overall heavy-tailed distributions arise. In study 3 we replicated the approach of study 1 using data systematically identified from published sources. Results: Study 1 involved data from a PCOOH service in Scotland (725,000) adults, 1.1 million contacts) and an ED in New Zealand (60,000 adults, 98,000 contacts). The total number of contacts per individual in each dataset was statistically indistinguishable from an inverse power law (p &gt; 0.05) above 4 contacts for the PCOOH data and 3 contacts for the ED data. Study 2 found the distribution of contact bursts closely followed a heavy-tailed distribution (p &lt; 0.008), indicating the presence of correlated bursts. Study 3 identified data from 17 studies across 8 countries and found distributions similar to study 1 in all of them. Conclusions: Urgent healthcare use displays characteristic statistical features of large complex systems. These studies provide strong quantitative evidence that healthcare services behave as complex systems and have important implications for urgent care. Interventions to manage demand must address drivers for consultation across the whole system: focusing on only the highest users (in the tail of the distribution) will have limited impact on efficiency. Bursts of attendance - and ways to shorten them - represent promising targets for managing demand.</p

Timeliness of electronic laboratory reporting vs. traditional laboratory reporting in Southern Nevada from 1999-2012

This project aims to compare timeliness between traditional laboratory reporting, ELR, and reporting after the implementation of TriSano, a modern electronic surveillance system, for common GI illnesses in Southern Nevada, with a prediction that ELR will be faster than traditional reports, and TriSano will be faster than the other two methods

Improving survival in out of hospital cardiac arrest a prospective synthesis of best practice

Cardiac arrest is the leading cause of death in the United States. By reviewing and analyzing the successes and failures of resuscitation efforts, it has been possible to identify critical components which have come to be known as the “Chain of Survival:” Early Recognition, Early CPR, Early Defibrillation, Early ALS, and Early Post Resuscitative Care. A failure in any one of the five links will result in a failed resuscitation. Early Recognition is the beginning of the resuscitation effort and includes a number of related components. Witnessed cardiac arrests, those that are seen or heard to occur, have a significantly higher chance of survival than those which are unwitnessed. Properly identifying agonal gasps: irregular, forceful, reflexive breaths which can occur during cardiac arrest, is key to recognition of arrest and activation of the emergency response system. Emergency dispatchers trained to recognize cardiac arrest, as well as to initiate Early CPR via telephonic instruction, have been identified as key personnel in the resuscitation effort. Once professional rescuers have been dispatched, response delays due to distance and traffic can be costly. The use of new technologies like GPS and traffic signal preemption (as well as the use of Police, Fire and EMS in conjunction) has been shown to make it possible to get qualified persons to the scene of a cardiac arrest more safely and more quickly. Once on scene, early, high quality CPR has been shown to dramatically improve survival. After just 8 minutes without assistance, a victim of cardiac arrest has a near zero percent chance of survival. CPR of high quality has been shown to help maintain survivability until more definitive care can be obtained. Early Defibrillation is another key component to survival in many cardiac arrests. While CPR can sustain organ function briefly, cardiac arrest is rarely reversed without defibrillation. Increasingly widespread prevalence of public automated external defibrillators (AEDs) has made Early Defibrillation easier. Furthermore, increased use of AEDs by lay and professional rescuers has called into question the value of more traditional, higher risk interventions like intubation and medication administration. Early ALS interventions have been a staple of resuscitation for decades, but there is little data to support the use of these interventions during cardiac arrest. Early Post-Resuscitative Care, however, has been shown to be an area where invasive ALS interventions can and do make a difference in improved survival. By looking at the body of research for links in the Chain of Survival, opportunities for improvement of resuscitation were identified. Persons who spend significant time around an individual at high risk for heart disease should be educated on possible precipitating symptoms of a myocardial infarct or other early signs of potential cardiac arrest. Persons likely to encounter a cardiac arrest should likewise be trained not only in how to recognize cardiac arrest (through the combination of unresponsiveness and abnormal breathing) but also to initiate basic care via compressions-only CPR. Emergency dispatchers should be increasingly trained to recognize cardiac arrest, as well how to effectively provide dispatcher assisted CPR. The focus of these efforts should be high quality CPR and the early deployment of defibrillation. The use of AEDs by bystanders should be encouraged whenever possible. The emphasis on CPR and use of an AED should be paramount, with invasive ALS interventions eschewed for the simpler and more effective therapies. Once ROSC has been obtained, the use of ALS interventions in unstable patients has been shown not only to prevent death due to transient hemodynamic instability, but also to improve the likelihood of survival with little to no neurological deficit. By embracing the chain of survival, and identifying the critical areas in need of research and improvement, it is possible to provide recommendations that may lead to improved survival from cardiac arrest

Quantum Interpretations for Building Science/Religion Bridges

This paper attempts a systematic comparison of the multiple interpretations of quantum mechanics (QM). The article ends with a summary table that has 13 rows and 10 columns. The columns are metaphysical principles such as determinism and reality. The rows are the main interpretations from 1925 to the present. Each row has entries such as Yes/No/Agnostic. We have contacted most of the living authors and based on their comments we have modified the entry for their interpretation. However, there is reasonable space for disagreement when it comes to determining the correct value of each box (Yes/No/Agnostic). We hope to improve the table in the future. We have also eliminated one of the columns and replaced it with two new columns. We believe that this topic is especially relevant to bridge building in dialogues on science, religion and spirituality because of the unique way that QM brings out metaphysical questions from within science. While any science may lend itself to metaphysical speculation, few sciences beyond QM have such a wide range of metaphysical speculation that all correspond to the same empirical results. This fact may humble scientists and have interesting consequences for how to build bridges between conflicting worldviews

Evaluation of the impact of a Health Care Administration Student Practicum

As the health care industry becomes increasingly complex, many leaders and practitioners in the field are worried about the quality and preparation of health care administration graduates (Robbins, Bradley, & Spicer, 2001). Academic health care administration programs prepare students for a professional career in the health care field. One of the biggest challenges for university health care administration programs is to meet industry needs by effectively incorporating practical skills and knowledge into the academic curricula. For students, coursework provides some insight into the demands of the industry, but they also require hands-on experience to be relevant in a highly competitive job market. Many academic institutions have incorporated student internships or practicums as a way to meet the needs of both the health care industry and graduates