PURPOSE:  The purpose of this study was to examine usual long-term care (LTC) practices related to 3 aspects of morning care and determine if there were resident characteristics related to the lack of care. DESIGN AND METHODS:  Participants were 169 long-stay residents in 4 community LTC facilities who required staff ...

OBJECTIVE:: Determine if procalcitonin at the time of initial rapid response team activation identifies patients who are likely to need subsequent intensive care unit transfer. DESIGN:: Prospective observational cohort study. SETTING:: Urban, tertiary care hospital with rapid response team activation through an electronic modified early warning score. PATIENTS:: One hundred ...

Unexpected adverse fetal and neonatal outcomes (e.g., stillbirth, birth trauma, congenital anomalies) present a crisis for the family and the medical care team. In cases of stillbirth, the family physician should be flexible in supporting the parents' choices, validate the loss, and work as a team with the nursing staff. ...

STUDY OBJECTIVE: To conduct a systematic review on the effectiveness of emergency department (ED)-based care coordination interventions. METHODS: We reviewed any randomized controlled trial or quasi-experimental study indexed in MEDLINE, CINAHL, Web of Science, Cochrane, or Scopus that evaluated the effectiveness of ED-based care coordination interventions. To be included, interventions ...

Objectives.To identify informal primary caregiver characteristics associated with care transitions of community-dwelling older persons with impairments in daily living activities.Method.Data for this study were pooled to observe transitions from Wave 1-Wave 2 and Wave 2-Wave 3 of the Second Longitudinal Survey on Aging (LSOA II). The sample includes respondents with ...

OVERVIEW: This narrative is related in the alternating voices of the two authors. One author, a 55-year-old man, quadriplegic from primary progressive multiple sclerosis, describes the 10 weeks he spent in four facilities for treatment of a stage IV ischial pressure ulcer. The other author, his friend and health care ...

Handoffs in the perioperative setting--the period during which the patient leaves the operating room (OR) and arrives at the postanesthesia care unit (PACU) or intensive care unit (ICU)--have received little attention. A perioperative handoff tool consisting of an OR-to-ICU/PACU protocol and checklists incorporates a defined process, a specified team structure, ...

The objective of this study was to test the efficacy of a standardized form used during transfers between long-term care facilities (LTCFs) and the acute care setting. The intervention consisted of development and implementation of the transfer form and education about its use. Charts from 26 LTCFs and 1 acute ...

Abstract Linkage services are an increasingly important component of the continuum of care for people living with HIV, particularly for individuals diagnosed in nonprimary care settings who are less likely than those identified in primary care settings to have a usual source of care. This study examines successful models used ...

BACKGROUND: There is a lack of data on the effect(s) of suboptimal human immunodeficiency virus (HIV) care on subsequent health care utilization among emergency department (ED) patients with HIV. Findings on their ED and inpatient care utilization patterns will provide information on service provision for those who have suboptimal access ...

This interim final rule with comment period implements parts of section 1104 of the Affordable Care Act which requires the adoption of a standard for electronic funds transfers (EFT). It defines EFT and explains how the adopted standards support and facilitate health care EFT transmissions.

OBJECTIVE: To assess the impact of reorganisation of neonatal specialist care services in England after a UK Department of Health report in 2003. DESIGN: A population-wide observational comparison of outcomes over two epochs, before and after the establishment of managed clinical neonatal networks. SETTING: Epoch one: 294 maternity and neonatal ...

There is growing evidence of sub-optimal care coordination in the US. Care coordination includes the specialty referral process, which involves referral decision-making and information transfer between primary and specialty care. This article summarizes the evidence of sub-optimal care coordination in this process, as well as potential strategies to improve it.

We evaluated A/H1N1 influenza in healthcare workers (HCWs) and in a flu room during the 2009 pandemic. The flu room aided HCW care and management by facilitating rapid diagnosis and treatment. Absence of fever was common, and symptoms were nonspecific. A higher rate of H1N1 occurred in HCWs deployed in ...

The prevention of mother-to-child HIV transmission (PMTCT) is a complex challenge in heavily affected and resource-limited settings such as South Africa. Management of PMTCT requires a cascade of interventions that need to be addressed to effectively decrease the risk of HIV transmission to infants. This PMTCT cascade includes incremental components ...

BACKGROUND: Nosocomial infections have rarely been characterized in pediatric residential care facilities. The purpose of this study is to assess the frequency of and risk factors for infectious diseases in pediatric residential care facilities over a 1-year period and to contrast them with other pediatric extended care facilities. METHODS: A ...

The aim of this study was to explore the perspectives of healthcare providers on the advantages and disadvantages of integrating HIV care services, including highly active antiretroviral therapy (HAART), into antenatal care (ANC) clinics in rural Kenya. We conducted a qualitative study using in-depth interviews and thematic analysis; 36 healthcare ...

In March 2009, UN member states met at the 53rd Commission on the Status of Women (CSW) to discuss the priority theme of "the equal sharing of responsibilities between women and men, including caregiving in the context of HIV/AIDS". This meeting focused the international community's attention on care issues and ...

The linkage and barriers of linkage to facility-based HIV care from a mobile HIV testing unit have not previously been described. A stratified random sample (N = 192) was drawn of all eligible, newly diagnosed, HIV-infected individuals with a laboratory CD4 count result on a mobile unit between August 2008 ...

The incidence of anal cancer is increasing among HIV-infected men and women. The process of screening for anal dysplasia and the management of abnormal findings are currently and most often based on a medical model. The needs of these patients, however, go well beyond medical care. A more comprehensive and ...

Abstract The aim of this study was to determine factors associated with complete satisfaction with the care provided (satisfaction with physicians and satisfaction with services and organization) among HIV-infected patients followed up in the French ANRS CO8 APROCO-COPILOTE cohort. Analyses focused on cross-sectional data collected during the ninth year of ...

To combat morbidity and mortality from the worldwide epidemic of the human immunodeficiency virus (HIV), the United States Congress implemented a President's Emergency Plan for AIDS Relief (PEPFAR) in 30 resource-limited countries to integrate combination antiretroviral therapy (ART) for both prevention and cure. Over 35% of eligible persons have been ...

Abstract Adults infected with HIV live longer when they receive regular medical care, yet many adults are not retained in care. Providers measure retention in order to evaluate interventions to improve retention and quality of HIV care. However, multiple measures for retention exist. This study compares two methods of operationalizing ...

The long-term acute care liaison at Pennsylvania State University Milton S. Hershey Medical Center identifies patients eligible for a long-term acute care hospital (LTACH) stay and coordinates their transition. The LTACH liaison works with the case management and social work staffto identify patients early in the stay and give families ...

ABSTRACT: The past decade has seen remarkable progress in increasing access to antiretroviral therapy in resource-limited settings. Early concerns about the cost and complexity of treatment were overcome thanks to the efforts of a global coalition of health providers, activists, academics, and people living with HIV/AIDS, who argued that every ...

Teleradiology involves much more than merely transmitting images and information between two points: teleradiology consists of sharing knowledge and working together in a network. It facilitates rapid access to radiological reports and second opinions, remote consulting among physicians, improved patient care, access to complex tools for postprocessing and computer-aided diagnosis, ...

BACKGROUND: Loss to follow-up of HIV-positive patients before initiation of antiretroviral therapy can exceed 50% in low-income settings and is a challenge to the scale-up of treatment. We implemented point-of-care counting of CD4 cells in Mozambique and assessed the effect on loss to follow-up before immunological staging and treatment initiation. ...

BACKGROUND:: Episodic acyclovir therapy has been added to genital ulcer disease (GUD) syndromic management guidelines in several sub-Saharan African countries with human immunodeficiency virus (HIV) epidemics. We examined the correlates of health care seeking in men with GUD and its relationship to HIV-1 and herpes simplex virus type 2 outcomes. ...

Effective communication between patients, their families, their carers and health care professionals is paramount to the delivery of high quality care. Addressing the ideas, concerns and expectations of these groups may improve their healthcare experience. We propose that opening a new channel of communication between patients, families, carers and healthcare ...

Previously considered unavoidable complications of hospital care (reflecting an "entitlement" mental model), health care-associated infections are now considered as medical errors and cause significant preventable morbidity and mortality in neonates. Prevention of such infections, particularly central line-associated bloodstream infections (CLABSI), should be an important patient safety priority for all neonatal ...

ABSTRACT: BACKGROUND: : In South Africa, limited human resources are a major constraint to achieving universal antiretroviral therapy (ART) coverage. Many of the public-sector HIV clinics operating within tertiary facilities, that were the first to provide ART in the country, have reached maximum patient capacity. Decentralization or "down-referral" (wherein ART ...

Twenty-two persons in Northern Thailand who knew of their HIV positivity but were not in care were identified. They had significant medical, economic, behavioral, and family problems. A nurse researcher carried out a 6-month intervention with them to (1) assess whether they would remain in contact with the researcher for ...

A retrospective record review was conducted for patients down referred to primary health care facilities between 2007 and 2009 to assess the rate and reported reasons for loss to follow-up among stable antiretroviral patients in a down referral model of care in Johannesburg, South Africa. Missing patients were traced telephonically. ...

BACKGROUND:: In South Africa, CD4 count results are typically available within a week of testing. However, 35-55% of newly diagnosed HIV positive patients do not return for their CD4 results and therefore do not access further care. We evaluated the impact of a CD4 count result and patient written information ...

A key aspect of maintaining health for HIV-infected adolescents is the transition from pediatric care to adult medical care. Because young people who were infected with HIV as children were initially not expected to survive until adulthood, relatively little attention has been given to issues associated with this transition to ...

ABSTRACT: BACKGROUND: Task shifting and the integration of human immunodeficiency virus (HIV) care into primary care services have been identified as possible strategies for improving access to antiretroviral treatment (ART). This paper describes the development and content of an intervention involving these two strategies, as part of the Streamlining Tasks ...

An urban primary health care facility in Khayelitsha, South Africa. To determine the difference in total tuberculosis (TB) treatment delay in patients who initially seek care at National TB Control Programme (NTP) facilities after the onset of TB-related symptoms, compared to patients who initially seek care from non-NTP health care ...

A CD4 T-lymphocyte count determines eligibility for antiretroviral therapy (ART) in patients recently diagnosed with HIV and also monitors the efficacy of ART treatment thereafter. ART slows the progression of HIV to AIDS. In the developing world, CD4 tests are often performed in centralized laboratories, typically in urban areas. The ...

ABSTRACT: BACKGROUND: Only about one-third of eligible HIV/AIDS patients receive anti-retroviral treatment (ART). Decentralizing treatment is crucial to wider and more equitable access, but key obstacles are a shortage of trained healthcare workers (HCW) and challenges integrating HIV/AIDS care with other primary care. This report describes the development of a ...

A frequent objection to the unrestricted visiting policy in intensive care units (ICUs) is the risk of acquired infections. In a mixed 8-bed ICU, an adopted shift from a restricted to a partially unrestricted visiting policy did not result in an increase in ICU-acquired infections.

Objective  To assess the quality of pre-antiretroviral therapy (ART) care in Cape Town and its continuity with HIV counselling and testing (HCT) and ART. Methods  The scale-up of the HCT, pre-ART and ART service platform and programmatic support in Cape was described. Data from the August 2010 routine annual HIV/TB/STI ...

Adolescents in foster care are at risk for unplanned pregnancy and sexually transmitted infections, including HIV infection. A study using a qualitative method was conducted to describe how and where foster youth receive reproductive health and risk reduction information to prevent pregnancy and sexually transmitted infections. Participants also were asked ...

ABSTRACT: BACKGROUND: The World Health Organisation recognises the importance of palliative care in an African setting. Despite this services are often patchy and inconsistent and many operate at health centre and / or community level. Few reports from hospital based palliative care services in sub-Saharan Africa exist in the current ...

PURPOSE: To determine the proportion of soft contact lens (CL) wearers who are able to recall their habitual products (lenses and care system) correctly from memory, and to evaluate the value of using photographic aids (PAs) to improve recall. METHODS: 103 soft lens wearers attended 2 visits to investigate their ...

With more than 250,000 cases and 4,000 deaths in the first 6 months, the cholera epidemic in Haiti has been one of the most explosive and deadly in recent history. It is also one of the best documented, with detailed surveillance information available from the beginning of the epidemic, which ...

Measurement of health-care quality in the UK is no longer restricted to evaluating the effectiveness of treatments or the cost efficiency of services. There is a drive towards a patient-based agenda which enables them to make a clear contribution to the way services are shaped by expressing their values and ...

: In antiretroviral therapy (ART) programs, decreasing loss to follow up (LTFU) is a major priority. : We conducted a prospective study in Abidjan. Adults who started ART between June 2005 and May 2008 and were still in care 6 months later had monthly visits, biannual CD4 counts, computerized data ...

Nathan Ford and Edward Mills discuss broader issues in HIV care delivery raised by research carried out by Lawrence Long and colleagues into down-shifting HIV care to primary health facilities.

To address human resource and infrastructure shortages, resource-constrained countries are being encouraged to shift HIV care to lesser trained care providers and lower level health care facilities. This study evaluated the cost-effectiveness of down-referring stable antiretroviral therapy (ART) patients from a doctor-managed, hospital-based ART clinic to a nurse-managed primary health ...

Positive social support has been associated with medication adherence and slowed disease progression among people living with HIV. The nature of support within the medical context itself has not been adequately investigated, however. The purpose of our study was to describe HIV health care providers' perspectives on informal supporter-oriented health ...