99901
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Integrated Employee Occupational Health and Organizational-Level Registered Nurse Outcomes. J Occup Environ Med 2018; 58:466-70. [PMID: 27158954 DOI: 10.1097/jom.0000000000000696] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The study examined organizational culture, structural supports, and employee health program integration influence on registered nurse (RN) outcomes. METHODS An organizational health survey, employee health clinical operations survey, employee attitudes survey, and administration data were collected. Multivariate regression models examined outcomes of sick leave, leave without pay, voluntary turnover, intention to leave, and organizational culture using 122 medical centers. RESULTS Lower staffing ratios were associated with greater sick leave, higher turnover, and intention to leave. Safety climate was favorably associated with each of the five outcomes. Both onsite employee occupational health services and a robust health promotion program were associated with more positive organizational culture perceptions. CONCLUSIONS Findings highlight the positive influence of integrating employee health and health promotion services on organizational health outcomes. Attention to promoting employee health may benefit organizations in multiple, synergistic ways.
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99902
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Bailey SR, Stevens VJ, Fortmann SP, Kurtz SE, McBurnie MA, Priest E, Puro J, Solberg LI, Schweitzer R, Masica AL, Hazlehurst B. Long-Term Outcomes From Repeated Smoking Cessation Assistance in Routine Primary Care. Am J Health Promot 2018. [PMID: 29534598 DOI: 10.1177/0890117118761886] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To test the association between repeated clinical smoking cessation support and long-term cessation. DESIGN Retrospective, observational cohort study using structured and free-text data from electronic health records. SETTING Six diverse health systems in the United States. PARTICIPANTS Patients aged ≥18 years who were smokers in 2007 and had ≥1 primary care visit in each of the following 4 years (N = 33 691). MEASURES Primary exposure was a composite categorical variable (comprised of documentation of smoking cessation medication, counseling, or referral) classifying the proportions of visits for which patients received any cessation assistance (<25% (reference), 25%-49%, 50%-74%, and ≥75% of visits). The dependent variable was long-term quit (LTQ; yes/no), defined as no indication of being a current smoker for ≥365 days following a visit where nonsmoker or former smoker was indicated. ANALYSIS Mixed effects logistic regression analysis adjusted for age, sex, race, and comorbidities, with robust standard error estimation to account for within site correlation. RESULTS Overall, 20% of the cohort achieved LTQ status. Patients with ≥75% of visits with any assistance had almost 3 times the odds of achieving LTQ status compared to those with <25% visits with assistance (odds ratio = 2.84; 95% confidence interval: 1.50-5.37). Results were similar for specific assistance types. CONCLUSIONS These findings provide support for the importance of repeated assistance at primary care visits to increase long-term smoking cessation.
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Affiliation(s)
- Steffani R Bailey
- 1 Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Victor J Stevens
- 2 Kaiser Permanente Center for Health Research, Portland, OR, USA
| | | | - Stephen E Kurtz
- 2 Kaiser Permanente Center for Health Research, Portland, OR, USA
| | | | | | | | | | - Rebecca Schweitzer
- 6 Department is Office of Public Health Studies, University of Hawai'i at Manoa, Honolulu, HI, USA
| | | | - Brian Hazlehurst
- 2 Kaiser Permanente Center for Health Research, Portland, OR, USA
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99903
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Mulango ID, Atashili J, Gaynes BN, Njim T. Knowledge, attitudes and practices regarding depression among primary health care providers in Fako division, Cameroon. BMC Psychiatry 2018; 18:66. [PMID: 29534695 PMCID: PMC5850974 DOI: 10.1186/s12888-018-1653-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Mental health and mental illness are often overlooked in the management of patients in our health services. Depression is a common mental disorder worldwide. Recognising and managing mental illnesses such as depression by primary health care providers (PHCPs) is crucial. This study describes the knowledge, attitudes and practices (KAP) of PHCPs regarding depression in Fako Division. METHODS A cross-sectional study was conducted among PHCPs (general practitioners, nurses, pharmacy attendants and social workers) in public-owned health facilities in the four health districts in Fako Division. Participants were selected by a consecutive convenience sampling. A structured questionnaire including the Depression Attitude Questionnaire (DAQ) was used to collect information about their socio-demographic characteristics, professional qualifications and KAP about depression. RESULTS The survey had a response rate of 56.7%. Most of the 226 participants (92.9%) were aware that depression needs medical intervention. Only 1.8% knew a standard tool used to diagnose depression. Two-thirds agreed that majority of the cases of depression encountered originate from recent misfortune. About 66% felt uncomfortable working with depressed patients. Also, 45.1% of PHCPs did not know if psychotropic drugs were available at pharmacies within their health area. Very few (15.2%) reported to have prescribed psychotropic drugs. Less than half (49.1%) of the participants had prior formal training in mental health. CONCLUSION PHCPs in Fako Division tend to have limited knowledge and poor attitudes regarding depression. Practices towards diagnosis and management of depression tend to be inadequate. There is an urgent need to train PHCPs in mental health in general and depression diagnosis and management in particular.
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Affiliation(s)
| | - Julius Atashili
- 0000 0001 2288 3199grid.29273.3dMedicine Programme, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Bradley N. Gaynes
- 0000000122483208grid.10698.36Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina USA
| | - Tsi Njim
- Health and Human Development Research Group, Douala, Littoral Region Cameroon ,0000 0004 1936 8948grid.4991.5Nuffield Department of Health, Centre for Global Health and Tropical Medicine, University of Oxford, Oxfordshire, UK
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99904
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Beckman JA, Duncan MS, Alcorn CW, So-Armah K, Butt AA, Goetz MB, Tindle HA, Sico JJ, Tracy RP, Justice AC, Freiberg MS. Association of Human Immunodeficiency Virus Infection and Risk of Peripheral Artery Disease. Circulation 2018. [PMID: 29535090 DOI: 10.1161/circulationaha.117.032647] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The effect of human immunodeficiency virus (HIV) on the development of peripheral artery disease (PAD) remains unclear. We investigated whether HIV infection is associated with an increased risk of PAD after adjustment for traditional atherosclerotic risk factors in a large cohort of HIV-infected (HIV+) and demographically similar HIV-uninfected veterans. METHODS We studied participants in the Veterans Aging Cohort Study from April 1, 2003 through December 31, 2014. We excluded participants with known prior PAD or prevalent cardiovascular disease (myocardial infarction, stroke, coronary heart disease, and congestive heart failure) and analyzed the effect of HIV status on the risk of incident PAD events after adjusting for demographics, PAD risk factors, substance use, CD4 cell count, HIV-1 ribonucleic acid, and antiretroviral therapy. The primary outcome is incident peripheral artery disease events. Secondary outcomes include mortality and amputation in subjects with incident PAD events by HIV infection status, viral load, and CD4 count. RESULTS Among 91 953 participants, over a median follow up of 9.0 years, there were 7708 incident PAD events. Rates of incident PAD events per 1000 person-years were higher among HIV+ (11.9; 95% confidence interval [CI], 11.5-12.4) than uninfected veterans (9.9; 95% CI, 9.6-10.1). After adjustment for demographics, PAD risk factors, and other covariates, HIV+ veterans had an increased risk of incident PAD events compared with uninfected veterans (hazard ratio [HR], 1.19; 95% CI, 1.13-1.25). This risk was highest among those with time-updated HIV viral load >500 copies/mL (HR, 1.51; 95% CI, 1.38-1.65) and CD4 cell counts <200 cells/mm3 (HR, 1.91; 95% CI, 1.71-2.13). In contrast, HIV+ veterans with time updated CD4 cell count ≥500 cells/mm3 had no increased risk of PAD (HR, 1.03; 95% CI, 0.96-1.11). Mortality rates after incident PAD events are high regardless of HIV status. HIV infection did not affect rates of amputation after incident PAD events. CONCLUSIONS Infection with HIV is associated with a 19% increased risk of PAD beyond that explained by traditional atherosclerotic risk factors. However, for those with sustained CD4 cell counts <200 cells/mm3, the risk of incident PAD events is nearly 2-fold higher whereas for those with sustained CD4 cell counts ≥500 cells/mm3 there is no excess risk of incident PAD events compared with uninfected people.
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Affiliation(s)
- Joshua A Beckman
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (J.A.B., M.S.D., M.S.F.).
| | - Meredith S Duncan
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (J.A.B., M.S.D., M.S.F.)
| | - Charles W Alcorn
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, PA (C.W.A.)
| | - Kaku So-Armah
- Section of General Internal Medicine, Boston University School of Medicine, MA (K.S.-A.)
| | - Adeel A Butt
- Department of Medicine, Weill Cornell Medical College, New York, NY (A.A.B.).,Veterans Association Pittsburgh Healthcare System, PA (A.A.B.)
| | - Matthew Bidwell Goetz
- Department of Medicine, VA Greater Los Angeles Healthcare System and David Geffen School of Medicine, University of California (M.B.G.)
| | - Hilary A Tindle
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN (H.A.T.).,Geriatric Research Education and Clinical Centers, Veterans Affairs Tennessee Valley Healthcare System, Nashville (H.A.T., M.S.F.)
| | - Jason J Sico
- Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center (J.J.S, A.C.J.)
| | - Russel P Tracy
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington (R.P.T.)
| | - Amy C Justice
- Veterans Affairs Connecticut Health Care System, West Haven Veterans Administration Medical Center (J.J.S, A.C.J.).,Yale University Schools of Medicine and Public Health, New Haven, CT (A.C.J.)
| | - Matthew S Freiberg
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (J.A.B., M.S.D., M.S.F.).,Geriatric Research Education and Clinical Centers, Veterans Affairs Tennessee Valley Healthcare System, Nashville (H.A.T., M.S.F.)
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99905
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Suwanabol PA, Reichstein AC, Suzer-Gurtekin ZT, Forman J, Silveira MJ, Mody L, Morris AM. Surgeons' Perceived Barriers to Palliative and End-of-Life Care: A Mixed Methods Study of a Surgical Society. J Palliat Med 2018; 21:780-788. [PMID: 29649396 DOI: 10.1089/jpm.2017.0470] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Nearly 20% of colorectal cancer (CRC) patients present with potentially incurable (Stage IV) disease, yet their physicians do not integrate cancer treatment with palliative care. Compared with patients treated by primary providers, surgical patients with terminal diseases are significantly less likely to receive palliative or end-of-life care. OBJECTIVE To describe surgeon perspectives on palliative and end-of-life care for patients with Stage IV CRCs. DESIGN This is a convergent mixed methods study using a validated survey instrument from the Critical Care Peer Workgroup of the Robert Wood Johnson Foundation's Promoting Excellence in End-of-Life Care Project with additional qualitative questions. SETTINGS Participants were all current, nonretired members of the American Society of Colon and Rectal Surgeons. MAIN OUTCOME MEASURES Surgeon-perceived barriers to palliative and end-of-life care for patients with Stage IV CRCs were identified. RESULTS Among 131 Internet survey respondents (response rate 16.5%), 76.1% reported no formal education in palliative care, and specifically noted inadequate training in techniques to forgo life-sustaining measures (37.9%) and communication (42.7%). Over half (61.8%) of surgeons cited unrealistic expectations among patients and families as a barrier to care, which also limited discussion of palliation. At the system level, absence of documentation, appropriate processes, and culture hindered the initiation of palliative care. Thematic analysis of open-ended questions confirmed and extended these findings through the following major barriers to palliative and end-of-life care: (1) surgeon knowledge and training; (2) communication challenges; (3) difficulty with prognostication; (4) patient and family factors encompassing unrealistic expectations and discordant preferences; and (5) systemic issues including culture and lack of documentation and appropriate resources. LIMITATIONS Generalizability is limited by the small sample size inherent to Internet surveys, which may contribute to selection bias. CONCLUSIONS Surgeons valued palliative and end-of-life care but reported multilevel barriers to its provision. These data will inform strategies to reduce these perceived barriers.
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Affiliation(s)
- Pasithorn A Suwanabol
- 1 Division of Colorectal Surgery, Department of Surgery, University of Michigan , Ann Arbor, Michigan
| | - Ari C Reichstein
- 2 Division of Colorectal Surgery, Department of Surgery, Allegheny Health Network , Pittsburgh, Pennsylvania
| | | | - Jane Forman
- 4 Center for Clinical Management Research , Veterans Affairs Health Services Research & Development, VA Ann Arbor Health Care System, Ann Arbor, Michigan
| | - Maria J Silveira
- 5 Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan , Ann Arbor, Michigan.,6 Geriatric Research, Education and Clinical Center (GRECC) , Veterans Affairs Health Affairs, VA Ann Arbor Health Care System, Ann Arbor, Michigan
| | - Lona Mody
- 5 Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan , Ann Arbor, Michigan.,6 Geriatric Research, Education and Clinical Center (GRECC) , Veterans Affairs Health Affairs, VA Ann Arbor Health Care System, Ann Arbor, Michigan
| | - Arden M Morris
- 7 Department of Surgery, S-SPIRE Center, Stanford University , Stanford, California
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99906
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DuMontier C, Clough-Gorr KM, Silliman RA, Stuck AE, Moser A. Health-Related Quality of Life in a Predictive Model for Mortality in Older Breast Cancer Survivors. J Am Geriatr Soc 2018. [PMID: 29533469 DOI: 10.1111/jgs.15340] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To develop a predictive model and risk score for 10-year mortality using health-related quality of life (HRQOL) in a cohort of older women with early-stage breast cancer. DESIGN Prospective cohort. SETTING Community. PARTICIPANTS U.S. women aged 65 and older diagnosed with Stage I to IIIA primary breast cancer (N=660). MEASUREMENTS We used medical variables (age, comorbidity), HRQOL measures (10-item Physical Function Index and 5-item Mental Health Index from the Medical Outcomes Study (MOS) 36-item Short-Form Survey; 8-item Modified MOS Social Support Survey), and breast cancer variables (stage, surgery, chemotherapy, endocrine therapy) to develop a 10-year mortality risk score using penalized logistic regression models. We assessed model discriminative performance using the area under the receiver operating characteristic curve (AUC), calibration performance using the Hosmer-Lemeshow test, and overall model performance using Nagelkerke R2 (NR). RESULTS Compared to a model including only age, comorbidity, and cancer stage and treatment variables, adding HRQOL variables improved discrimination (AUC 0.742 from 0.715) and overall performance (NR 0.221 from 0.190) with good calibration (p=0.96 from HL test). CONCLUSION In a cohort of older women with early-stage breast cancer, HRQOL measures predict 10-year mortality independently of traditional breast cancer prognostic variables. These findings suggest that interventions aimed at improving physical function, mental health, and social support might improve both HRQOL and survival.
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Affiliation(s)
- Clark DuMontier
- Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Kerri M Clough-Gorr
- National Cancer Registry Ireland, Cork, Ireland.,University College Cork, Cork, Ireland.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Rebecca A Silliman
- Section of Geriatrics, Boston Medical Center/Boston University School of Medicine, Boston, Massachusetts
| | - Andreas E Stuck
- Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - André Moser
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Department of Geriatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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99907
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Khang PS, Wang SE, Liu ILA, Watson HL, Koyama SY, Huynh DN, Lee JS, Nguyen HQ. Impact of Inpatient Palliative Care on Quality of End-of-Life Care and Downstream Acute and Postacute Care Utilization. J Palliat Med 2018; 21:913-923. [PMID: 29649400 DOI: 10.1089/jpm.2017.0275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Additional evidence is needed regarding the impact of inpatient palliative care (IPC) on the quality of end-of-life care and downstream utilization. AIM Examine the effects of IPC on quality of end-of-life care and acute and postacute care use in a large integrated system. DESIGN Retrospective cohort design. SETTING/PARTICIPANTS Adult decedents from January 1, 2012, to December 31, 2014, who had at least one hospitalization at 11 Kaiser Permanente Southern California medical centers in the 12 months before death and not hospitalized for a trauma-related condition or receiving home-based PC or hospice were included in the cohort. MATERIALS AND METHODS Inverse probability of treatment weighting of propensity scores was used to compare outcomes between patients exposed to IPC (n = 3742) and controls (n = 12,755) who never received IPC before death. RESULTS Patients who received IPC were more likely to enroll in home-based PC or hospice (69% vs. 43%) and were less likely to die in a hospital (15% vs. 29%) or intensive care (2% vs. 9%) compared with controls (all, p < 0.001). IPC exposure was associated with higher risk for rehospitalization (HR: 1.18, 95% CI 1.11-1.25) and more frequent emergency department visits (RR: 1.16, 95% CI 1.07-1.26) with no increase in postacute care use compared with controls. Stratified analyses showed that IPC effects on acute care utilization were dependent on code status. CONCLUSION IPC exposure was associated with higher enrollment in home-based PC/hospice and more deaths at home. The increased acute care utilization by the IPC group may reflect persistent confounding by indication.
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Affiliation(s)
- Peter S Khang
- 1 Geriatric Palliative Care, Kaiser Permanente Southern California, Los Angeles Medical Center , Los Angeles, California
| | - Susan E Wang
- 2 Geriatric Palliative Care, Kaiser Permanente Southern California, West Los Angeles Medical Center , Los Angeles, California
| | - In-Lu Amy Liu
- 3 Department of Research and Evaluation, Kaiser Permanente Southern California , Pasadena, California
| | - Heather L Watson
- 4 Complete Care Programs, Kaiser Permanente Southern California , Pasadena, California
| | - Sandra Y Koyama
- 5 Internal Medicine, Kaiser Permanente Southern California , Baldwin Park, California
| | - Dan N Huynh
- 6 Hospital Medicine, Home Care Services, Kaiser Permanente Southern California , Pasadena, California
| | - Janet S Lee
- 3 Department of Research and Evaluation, Kaiser Permanente Southern California , Pasadena, California
| | - Huong Q Nguyen
- 3 Department of Research and Evaluation, Kaiser Permanente Southern California , Pasadena, California
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99908
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Abstract
This article was originally published with errors that were introduced during the editing process. The corrected version of this article appears below.
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Affiliation(s)
- Daniel J Rubin
- Section of Endocrinology, Diabetes, and Metabolism, School of Medicine, Temple University, 3322 N. Broad ST., Ste 205, Philadelphia, PA, 19140, USA.
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99909
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Wilson LE, Pollack CE, Greiner MA, Dinan MA. Association between physician characteristics and the use of 21-gene recurrence score genomic testing among Medicare beneficiaries with early-stage breast cancer, 2008-2011. Breast Cancer Res Treat 2018. [PMID: 29536319 DOI: 10.1007/s10549-018-4746-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE We sought to determine whether physician-level characteristics were associated with 21-gene recurrence score (RS) genomic testing to evaluate recurrence risk and benefit of adjuvant chemotherapy in patients with estrogen receptor-positive, node-negative breast cancer. METHODS Retrospective cohort study of a nationally representative sample of Medicare beneficiaries using Surveillance, Epidemiology, and End Results program-Medicare data linked with the American Medical Association physician master file. The main outcome was receipt of genomic testing within 1 year of diagnosis as a function of physician-level factors. RESULTS A total of 24,463 patients met the study criteria; they received care from 3172 surgeons and 2475 medical oncologists. Of 4124 tests ordered, 70% were ordered by a medical oncologist and 16% by a surgeon. In multivariable regression models, multiple variables were associated with receipt of testing, including having a medical oncologist (odds ratio [OR] 2.77; 95% CI 2.00-3.82), a surgeon specializing in surgical oncology (OR 1.20; 95% CI 1.09-1.31), and a female medical oncologist (OR 1.10; 95% CI 1.02-1.20). Having a medical oncologist with 5 or more years in practice was associated with lower odds of testing (OR 0.83; 95% CI 0.76-0.92). Surgical procedures performed at academic centers were associated with higher odds of testing (OR 1.11; 95% CI 1.02-1.20). CONCLUSIONS Although most RS testing was ordered by medical oncologists, physicians in other specialties ordered roughly one-third of the tests. Physician characteristics, including gender and time in practice, were associated with receiving testing, creating opportunities for targeting interventions to help patients receive optimal care.
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Affiliation(s)
- Lauren E Wilson
- Department of Population Health Sciences, Duke University School of Medicine, Erwin Square Suite 720A, Box 104023, Durham, NC, 27705, USA.
| | - Craig Evan Pollack
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MA, USA
| | - Melissa A Greiner
- Department of Population Health Sciences, Duke University School of Medicine, Erwin Square Suite 720A, Box 104023, Durham, NC, 27705, USA
| | - Michaela A Dinan
- Department of Population Health Sciences, Duke University School of Medicine, Erwin Square Suite 720A, Box 104023, Durham, NC, 27705, USA
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99910
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Doumouras AG, Anvari S, Cadeddu M, Anvari M, Hong D. Geographic variation in the provider of screening colonoscopy in Canada: a population-based cohort study. CMAJ Open 2018. [PMID: 29535104 PMCID: PMC5878955 DOI: 10.9778/cmajo.20170131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Screening colonoscopy for the detection of colorectal carcinoma is provided by several specialties. Few studies have assessed geographic variation in the delivery of this care. Our objective was to investigate how geographic and socioeconomic factors affect who provides screening colonoscopy in Canada. METHODS This was a population-based cohort of all screening colonoscopy procedures performed at publicly funded Canadian health care facilities (excluding those in Quebec) between April 2008 and March 2015. The main outcome of interest was the proportion of colonoscopy procedures performed by surgeons versus gastroenterologists at the neighbourhood level. Predictors of interest included socioeconomic and geographic variables. We used spatial analysis to evaluate significant clustering of practitioner services and multinomial logistic regression to model predictors. RESULTS We identified 658 113 screening colonoscopy procedures performed by 1886 providers (1169 surgeons and 717 gastroenterologists) over the study period, of which 353 165 (53.7%) were performed by surgeons. A total of 24.2% of neighbourhoods were located within clusters predominantly served by gastroenterologists, and 19.5% were within surgeon clusters; the remainder were in mixed clusters. Rural neighbourhoods had a significantly increased relative risk of being within a surgeon cluster (relative risk [RR] 5.38, 95% confidence interval [CI] 3.48-8.01) compared to mixed clusters and nearly 100 times higher relative risk of being in a surgeon cluster compared to gastroenterologist clusters (RR 98.95, 95% CI 15.3-427.2). Neighbourhoods with the highest socioeconomic status were 1.74 (95% CI 1.14-2.56) times likelier to be in gastroenterologist clusters than in mixed clusters. INTERPRETATION Surgeons provide a large proportion of colonoscopy procedures in Canada and are essential for access to care, particularly in rural regions. Most Canadians are served relatively equally by surgeons and gastroenterologists. This emphasizes the importance of both specialties to the delivery of colonoscopy care across the country.
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Affiliation(s)
- Aristithes G Doumouras
- Affiliations: Department of Surgery (Doumouras, Cadeddu, M. Anvari, Hong), McMaster University; Division of General Surgery (Doumouras, M. Anvari, Cadeddu, S. Anvari, Hong), St. Joseph's Healthcare, Hamilton, Ont
| | - Sama Anvari
- Affiliations: Department of Surgery (Doumouras, Cadeddu, M. Anvari, Hong), McMaster University; Division of General Surgery (Doumouras, M. Anvari, Cadeddu, S. Anvari, Hong), St. Joseph's Healthcare, Hamilton, Ont
| | - Margherita Cadeddu
- Affiliations: Department of Surgery (Doumouras, Cadeddu, M. Anvari, Hong), McMaster University; Division of General Surgery (Doumouras, M. Anvari, Cadeddu, S. Anvari, Hong), St. Joseph's Healthcare, Hamilton, Ont
| | - Mehran Anvari
- Affiliations: Department of Surgery (Doumouras, Cadeddu, M. Anvari, Hong), McMaster University; Division of General Surgery (Doumouras, M. Anvari, Cadeddu, S. Anvari, Hong), St. Joseph's Healthcare, Hamilton, Ont
| | - Dennis Hong
- Affiliations: Department of Surgery (Doumouras, Cadeddu, M. Anvari, Hong), McMaster University; Division of General Surgery (Doumouras, M. Anvari, Cadeddu, S. Anvari, Hong), St. Joseph's Healthcare, Hamilton, Ont
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99911
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Khan Z, Darr U, Khan MA, Nawras M, Khalil B, Abdel-Aziz Y, Alastal Y, Barnett W, Sodeman T, Nawras A. Improving Internal Medicine Residents' Colorectal Cancer Screening Knowledge Using a Smartphone App: Pilot Study. JMIR MEDICAL EDUCATION 2018; 4:e10. [PMID: 29535080 PMCID: PMC5871737 DOI: 10.2196/mededu.9635] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/11/2018] [Accepted: 02/11/2018] [Indexed: 08/10/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is the third most common type of cancer and the second leading cause of cancer death in the United States. About one in three adults in the United States is not getting the CRC screening as recommended. Internal medicine residents are deficient in CRC screening knowledge. OBJECTIVE The objective of our study was to assess the improvement in internal medicine residents' CRC screening knowledge via a pilot approach using a smartphone app. METHODS We designed a questionnaire based on the CRC screening guidelines of the American Cancer Society, American College of Gastroenterology, and US Preventive Services Task Force. We emailed the questionnaire via a SurveyMonkey link to all the residents of an internal medicine department to assess their knowledge of CRC screening guidelines. Then we designed an educational intervention in the form of a smartphone app containing all the knowledge about the CRC screening guidelines. The residents were introduced to the app and asked to download it onto their smartphones. We repeated the survey to test for changes in the residents' knowledge after publication of the smartphone app and compared the responses with the previous survey. We applied the Pearson chi-square test and the Fisher exact test to look for statistical significance. RESULTS A total of 50 residents completed the first survey and 41 completed the second survey after publication of the app. Areas of CRC screening that showed statistically significant improvement (P<.05) were age at which CRC screening was started in African Americans, preventive tests being ordered first, identification of CRC screening tests, identification of preventive and detection methods, following up positive tests with colonoscopy, follow-up after colonoscopy findings, and CRC surveillance in diseases. CONCLUSIONS In this modern era of smartphones and gadgets, developing a smartphone-based app or educational tool is a novel idea and can help improve residents' knowledge about CRC screening.
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Affiliation(s)
- Zubair Khan
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, United States
| | - Umar Darr
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, United States
| | - Muhammad Ali Khan
- Department of Gastroenterology, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Mohamad Nawras
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, United States
| | - Basmah Khalil
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, United States
| | - Yousef Abdel-Aziz
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, United States
| | - Yaseen Alastal
- Department of Gastroenterology, University of Toledo Medical Center, Toledo, OH, United States
| | - William Barnett
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, United States
| | - Thomas Sodeman
- Department of Gastroenterology, University of Toledo Medical Center, Toledo, OH, United States
| | - Ali Nawras
- Department of Gastroenterology, University of Toledo Medical Center, Toledo, OH, United States
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99912
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Radix AE. Pharmacists' role in provision of transgender healthcare. Am J Health Syst Pharm 2018; 74:103-104. [PMID: 28122749 DOI: 10.2146/ajhp160939] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Asa E Radix
- Callen-Lorde Community Health CenterNew York,
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99913
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Dong YH, Chang CH, Wu LC, Hwang JS, Toh S. Comparative cardiovascular safety of nonsteroidal anti-inflammatory drugs in patients with hypertension: a population-based cohort study. Br J Clin Pharmacol 2018; 84:1045-1056. [PMID: 29468706 DOI: 10.1111/bcp.13537] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 01/04/2018] [Accepted: 01/10/2018] [Indexed: 12/24/2022] Open
Abstract
AIMS Previous studies have suggested that nonsteroidal anti-inflammatory drugs (NSAIDs) may be associated with higher cardiovascular risks. However, few have been active comparison studies that directly assessed the potential differential cardiovascular risk between NSAID classes or across individual NSAIDs. We compared the risk of major cardiovascular events between cyclooxygenase 2 (COX-2)-selective and nonselective NSAIDs in patients with hypertension. METHODS We conducted a cohort study of patients with hypertension who initiated COX-2-selective or nonselective NSAIDs in a population-based Taiwanese database. The outcomes included hospitalization for the following major cardiovascular events: ischaemic stroke, acute myocardial infarction, congestive heart failure, transient ischaemic attack, unstable angina or coronary revascularization. We followed patients for up to 4 weeks, based on the as-treated principle. We used inverse probability weighting to control for baseline and time-varying covariates, and estimated the on-treatment hazard ratios (HRs) and 95% conservative confidence interval (CIs). RESULTS We identified 2749 eligible COX-2-selective NSAID users and 52 880 eligible nonselective NSAID users. The HR of major cardiovascular events comparing COX-2-selective with nonselective NSAIDs after adjusting for baseline and time-varying covariates was 1.07 (95% CI 0.65, 1.74). We did not observe a differential risk when comparing celecoxib to diclofenac (HR 1.17; 95% CI 0.61, 2.25), ibuprofen (HR 1.36; 95% CI 0.58, 3.18) or naproxen (HR 0.75; 95% CI 0.23, 2.44). There was an increased risk with COX-2-selective NSAIDs, however, when comparing COX-2-selective NSAIDs with mefenamic acid (HR 2.11; 95% CI 1.09, 4.09). CONCLUSIONS Our results provide important information about the comparative cardiovascular safety of NSAIDs in patients with hypertension.
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Affiliation(s)
- Yaa-Hui Dong
- Faculty of Pharmacy, School of Pharmaceutical Science, National Yang-Ming University, Taipei, 112, Taiwan
| | - Chia-Hsuin Chang
- Department of Medicine, College of Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan.,Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, 100, Taiwan
| | - Li-Chiu Wu
- Department of Medicine, College of Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Jing-Shiang Hwang
- Institute of Statistical Science, Academia Sinica, Taipei, 115, Taiwan
| | - Sengwee Toh
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, 02215, USA
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99914
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Porsbjerg C, Sverrild A, Baines KJ, Searles A, Maltby S, Foster PS, Brightling C, Gibson PG. Advancing the management of obstructive airways diseases through translational research. Clin Exp Allergy 2018; 48:493-501. [PMID: 29412485 DOI: 10.1111/cea.13112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Obstructive airways diseases (OAD) represent a huge burden of illness world-wide, and in spite of the development of effective therapies, significant morbidity and mortality related to asthma and COPD still remains. Over the past decade, our understanding of OAD has improved vastly, and novel treatments have evolved. This evolution is the result of successful translational research, which has connected clinical presentations of OAD and underlying disease mechanisms, thereby enabling the development of targeted treatments. The next challenge of translational research will be to position these novel treatments for OAD for optimal clinical use. At the same time, there is great potential in these treatments providing even better insights into disease mechanisms in OAD by studying the effects of blocking individual immunological pathways. To optimize this potential, there is a need to ensure that translational aspects are added to randomized clinical trials, as well as real-world studies, but also to use other trial designs such as platform studies, which allow for simultaneous assessment of different interventions. Furthermore, demonstrating clinical impact, that is research translation, is an increasingly important component of successful translational research. This review outlines concepts of translational research, exemplifying how translational research has moved management of obstructive airways diseases into the next century, with the introduction of targeted, individualized therapy. Furthermore, the review describes how these therapies may be used as research tools to further our understanding of disease mechanisms in OAD, through translational, mechanistic studies. We underline the current need for implementing basic immunological concepts into clinical care in order to optimize the use of novel targeted treatments and to further the clinical understanding of disease mechanisms. Finally, potential barriers to adoption of novel targeted therapies into routine practice and how these may be overcome are described.
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Affiliation(s)
- C Porsbjerg
- Department of Respiratory Medicine, Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
| | - A Sverrild
- Department of Respiratory Medicine, Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
| | - K J Baines
- Centre for Asthma and Respiratory Disease Hunter Medical Research Institute, The University of Newcastle, Newcastle, Australia
| | - A Searles
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, Newcastle, Australia
| | - S Maltby
- Centre for Asthma and Respiratory Disease Hunter Medical Research Institute, The University of Newcastle, Newcastle, Australia
| | - P S Foster
- Centre for Asthma and Respiratory Diseases, and Hunter Medical Research Institute, The University of Newcastle/Royal Newcastle Hospital, Newcastle, Australia
| | - C Brightling
- Department of Infection, Immunity and Inflammation, Institute for Lung Health, NIHR BRU Respiratory Medicine, University of Leicester, Leicester, UK
| | - P G Gibson
- Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, The University of Newcastle, Newcastle, Australia
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99915
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Hutchinson M. The crisis of public trust in governance and institutions: Implications for nursing leadership. J Nurs Manag 2018. [DOI: 10.1111/jonm.12625] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Marie Hutchinson
- School of Health and Human Sciences; Coffs Harbour NSW Australia
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99916
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Dodd N, Mansfield E, Carey M, Oldmeadow C. Prevalence of appropriate colorectal cancer screening and preferences for receiving screening advice among people attending outpatient clinics. Aust N Z J Public Health 2018. [PMID: 29528551 DOI: 10.1111/1753-6405.12776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To examine among people attending outpatient clinics aged 50-74 at average risk of colorectal cancer (CRC): 1) The proportion who report: a) faecal occult blood test (FOBT) within the past two years; and b) colonoscopy within the past five years, including the reasons for undergoing colonoscopy; 2) characteristics associated with under-screening; 3) For those who are under-screened, the proportion who are: a) willing to receive help and the acceptability of different methods of receiving help, and; b) unwilling to receive help and reasons for this. METHODS Cross-sectional survey of 197 participants attending a major regional hospital in New South Wales, Australia. Multivariable logistic regression was used to determine correlates of under-screening. RESULTS A total of 59% reported either FOBT in the past two years or colonoscopy in the past five years. Of those reporting colonoscopy in the past five years, 21% were potentially over-screened. Males were more likely than females to be under-screened. Of those under-screened (41%), fewer than half were willing to receive screening advice. Conclusions and implications for public health: A significant proportion of people attending outpatient clinics are under-screened for CRC, with some people also over-screened. There is a need to explore strategies to overcome both under- and over-screening.
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Affiliation(s)
- Natalie Dodd
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, New South Wales.,Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales
| | - Elise Mansfield
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, New South Wales.,Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales
| | - Mariko Carey
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, New South Wales.,Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales
| | - Christopher Oldmeadow
- Hunter Medical Research Institute, New South Wales.,Clinical Research Design, IT and Statistical Support (CReDITSS), Hunter Medical Research Institute, New South Wales
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99917
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Alcañiz M, Solé-Auró A. Feeling good in old age: factors explaining health-related quality of life. Health Qual Life Outcomes 2018. [PMID: 29534708 PMCID: PMC5851254 DOI: 10.1186/s12955-018-0877-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Sustained growth in longevity raises questions as to why some individuals report a good quality of life in older ages, while others seem to suffer more markedly the effects of natural deterioration. Health-related quality of life (HRQL) is mediated by several easily measurable factors, including socio-demographics, morbidity, functional status and lifestyles. This study seeks to further our knowledge of these factors in order to outline a profile of the population at greater risk of poor ageing, and to identify those attributes that might be modified during younger stages of the life course. Methods We use nationally representative data for Catalonia (Spain) to explain the HRQL of the population aged 80-plus. Cross-sectional data from 2011 to 2016 were provided by an official face-to-face survey. HRQL was measured using EQ-VAS – the EuroQol-5D visual analogue scale – which summarizes current self-perceived health. Multivariate linear regression was used to identify variables influencing the EQ-VAS score. Results Sociodemographic factors, including being older, female, poorly educated and belonging to a low social class, were related with poor HRQL at advanced ages. The presence of severe mobility problems, pain/discomfort, and anxiety/depression were highly correlated to the HRQL of the elderly, while problems of self-care and with usual activities had a weaker association. Conclusions Encouraging the young to stay in education, as well as to adopt healthier lifestyles across the lifespan, might ensure better HRQL when individuals reach old age. More multidisciplinary research is required to understand the multifaceted nature of quality of life in the oldest-old population.
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Affiliation(s)
- Manuela Alcañiz
- Riskcenter, Department of Econometrics, Statistics and Applied Economy, Universitat de Barcelona, Av. Diagonal 690, 08034, Barcelona, Spain. .,Faculty of Economics and Business, Universitat Oberta de Catalunya, Av. Tibidabo 39-43, 08035, Barcelona, Spain.
| | - Aïda Solé-Auró
- DemoSoc Research Group, Department of Political and Social Sciences, Universitat Pompeu Fabra, C/ Ramon Trias Fargas, 25-27, 08005, Barcelona, Spain
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99918
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Britt TW, Black KJ, Cheung JH, Pury CLS, Zinzow HM. Unit training to increase support for military personnel with mental health problems. WORK AND STRESS 2018. [DOI: 10.1080/02678373.2018.1445671] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Thomas W. Britt
- Department of Psychology, Clemson University, Clemson, SC, USA
| | | | | | | | - Heidi M. Zinzow
- Department of Psychology, Clemson University, Clemson, SC, USA
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99919
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Clarkson P, Hays R, Tucker S, Paddock K, Challis D. Healthcare support to older residents of care homes: a systematic review of specialist services. QUALITY IN AGEING AND OLDER ADULTS 2018. [DOI: 10.1108/qaoa-08-2017-0029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
A growing ageing population with complex healthcare needs is a challenge to the organisation of healthcare support for older people residing in care homes. The lack of specialised healthcare support for care home residents has resulted in poorer outcomes, compared with community-dwelling older people. However, little is known about the forms, staff mix, organisation and delivery of such services for residents’ physical healthcare needs. The paper aims to discuss these issues.
Design/methodology/approach
This systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, aimed to provide an overview of the range of healthcare services delivered to care homes and to identify core features of variation in their organisation, activities and responsibilities. The eligibility criteria for studies were services designed to address the physical healthcare needs of older people, permanently residing in care homes, with or without nursing. To search the literature, terms relating to care homes, healthcare and older people, across ten electronic databases were used. The quality of service descriptions was appraised using a rating tool designed for the study. The evidence was synthesised, by means of a narrative summary, according to key areas of variation, into models of healthcare support with examples of their relative effectiveness.
Findings
In total, 84 studies, covering 74 interventions, identified a diverse range of specialist healthcare support services, suggesting a wide variety of ways of delivering healthcare support to care homes. These fell within five models: assessment – no consultant; assessment with consultant; assessment/management – no consultant; assessment/management with consultant; and training and support. The predominant model offered a combination of assessment and management. Overall, there was a lack of detail in the data, making judgements of relative effectiveness difficult. Recommendations for future research include the need for clearer descriptions of interventions and particularly of data on resident-level costs and effectiveness, as well as better explanations of how services are implemented (review registration: PROSPERO CRD42017081161).
Originality/value
There is considerable debate about the best means of providing healthcare to older people in care homes. A number of specialist initiatives have developed and this review seeks to bring these together in a comparative approach deriving models of care of value to policy makers and commissioners.
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99920
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Dalal AA, Guerin A, Mutebi A, Culver KW. Treatment patterns, clinical and economic outcomes of patients with anaplastic lymphoma kinase-positive non-small cell lung cancer receiving ceritinib: a retrospective observational claims analysis. J Drug Assess 2018; 7:21-27. [PMID: 29707414 PMCID: PMC5917332 DOI: 10.1080/21556660.2018.1445092] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/12/2018] [Indexed: 11/15/2022] Open
Abstract
Objective: To describe patient characteristics, treatment patterns, healthcare resource utilization (HRU), and costs among patients with anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC) receiving ceritinib in second or later line of therapy. Methods: Adult patients with NSCLC receiving ceritinib were identified from two large US claims databases (2006–2015). Patient characteristics, comorbidity profile, treatment patterns prior to ceritinib, and ceritinib dosing patterns were described. All-cause, HRU, and costs incurred during the observation period after ceritinib initiation were reported per patient per six months. Results: One hundred sixty-four patients were included (mean age 54.2 years, 57.3% female); the majority had metastatic disease (94.5%) and the average Charlson Comorbidity Index was 7.6. 150 (91.5%) patients received crizotinib prior to ceritinib – average crizotinib duration was 10.2 months and time between crizotinib discontinuation and ceritinib initiation was 2.1 months (median= 0; 25th–75th percentile= 0–0.8). Most patients (73.8%) initiated ceritinib on the recommended dose (750 mg) and maintained the dose until the end of the observation period (mean of 7.4 months) or ceritinib discontinuation; 61 (37.2%) patients discontinued ceritinib during the observation period. A total of 76 (46.3%) patients had at least one inpatient admission during the observation period after ceritinib initiation. Mean total healthcare cost per patient per six months was $111,468. Conclusions: Patients with ALK-positive NSCLC receiving ceritinib had a high comorbidity burden and generally started ceritinib on the recommended dose quickly after crizotinib discontinuation. Medical costs accounted for nearly a half of the total healthcare costs.
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Affiliation(s)
- Anand A Dalal
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Alex Mutebi
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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99921
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Foster NE, Bishop A, Bartlam B, Ogollah R, Barlas P, Holden M, Ismail K, Jowett S, Kettle C, Kigozi J, Lewis M, Lloyd A, Waterfield J, Young J. Evaluating Acupuncture and Standard carE for pregnant women with Back pain (EASE Back): a feasibility study and pilot randomised trial. Health Technol Assess 2018; 20:1-236. [PMID: 27133814 DOI: 10.3310/hta20330] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Many pregnant women experience low back pain. Acupuncture appears to be a safe, promising intervention but evidence is needed about its clinical effectiveness and cost-effectiveness. OBJECTIVES To assess the feasibility of a future large randomised controlled trial (RCT) testing the additional benefit of adding acupuncture to standard care (SC) for pregnancy-related back pain. DESIGN Phase 1: a questionnaire survey described current care for pregnancy-related back pain. Focus groups and interviews with midwives, physiotherapists and pregnant women explored acceptability and feasibility of acupuncture and the proposed RCT. Phase 2: a single-centre pilot RCT. Participants were identified using six methods and randomised to SC, SC plus true acupuncture or SC plus non-penetrating acupuncture. PARTICIPANTS Phase 1: 1093 physiotherapists were surveyed and 15 midwives, 21 physiotherapists and 17 pregnant women participated in five focus groups and 20 individual interviews. Phase 2: 125 women with pregnancy-related back pain participated. INTERVENTIONS SC: a self-management booklet and onward referral for one-to-one physiotherapy (two to four sessions) for those who needed it. SC plus true acupuncture: the self-management booklet and six to eight treatments with a physiotherapist comprising true (penetrating) acupuncture, advice and exercise. SC plus non-penetrating acupuncture: the self-management booklet and six to eight treatments with a physiotherapist comprising non-penetrating acupuncture, advice and exercise. MAIN OUTCOME MEASURES Pilot RCT outcomes included recruitment rates, treatment fidelity, follow-up rate, patient-reported pain and function, quality of life and health-care resource use. Birth and neonatal outcomes were also assessed. Staff overseeing outcome data collection were blind to treatment allocation. RESULTS Phase 1: 629 (57.5%) physiotherapists responded to the survey, 499 were experienced in treating pregnancy-related back pain and reported 16 advice and 18 treatment options. Typical treatment comprised two to four individual sessions of advice and exercise over 6 weeks. Acupuncture was reported by 24%. Interviews highlighted the impact of back pain and paucity of effective interventions. Women and midwives strongly supported a RCT and expressed few concerns. Physiotherapists' concerns about acupuncture in pregnancy informed a training programme prior to the pilot RCT. Phase 2: We recruited 125 of 280 potentially eligible women (45%) in 6 months and randomised 41 to SC and 42 each to the SC plus true acupuncture and SC plus non-penetrating acupuncture arms. Analysis was conducted with 124 participants (41, 42 and 41, respectively) as one participant was randomised in error. Three of six recruitment methods were the most successful. In total, 10% of women (n = 4) randomised to SC alone accessed one-to-one physiotherapy and received an average of two treatments. The average number of treatments was six for both SC plus true acupuncture and SC plus non-penetrating acupuncture. Treatments were in line with protocols. Eight-week follow-up was 74%. Patient-reported outcomes (pain, function and quality of life) favoured the addition of acupuncture. There was no evidence of serious adverse events on mothers or birth and neonatal outcomes. The Pelvic Girdle Questionnaire was found to be an appropriate outcome measure for a future trial. CONCLUSIONS A future main RCT is feasible and would be welcomed by women and clinicians. Longer-term follow-up and further follow-up efforts are recommended for a main trial. TRIAL REGISTRATION Current Controlled Trials ISRCTN49955124. FUNDING This project was funded by the National Institute of Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 33. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Nadine E Foster
- Research Institute of Primary Care and Health Sciences, Faculty of Health, Keele University, Keele, Staffordshire, UK
| | - Annette Bishop
- Research Institute of Primary Care and Health Sciences, Faculty of Health, Keele University, Keele, Staffordshire, UK
| | - Bernadette Bartlam
- Research Institute of Primary Care and Health Sciences, Faculty of Health, Keele University, Keele, Staffordshire, UK
| | - Reuben Ogollah
- Research Institute of Primary Care and Health Sciences, Faculty of Health, Keele University, Keele, Staffordshire, UK
| | - Panos Barlas
- Research Institute of Primary Care and Health Sciences, Faculty of Health, Keele University, Keele, Staffordshire, UK
| | - Melanie Holden
- Research Institute of Primary Care and Health Sciences, Faculty of Health, Keele University, Keele, Staffordshire, UK
| | - Khaled Ismail
- Reproduction, Genes and Development Department, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, West Midlands, UK
| | - Sue Jowett
- Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | - Christine Kettle
- Faculty of Health Sciences, Staffordshire University, Stoke-on-Trent, Staffordshire, UK
| | - Jesse Kigozi
- Health Economics Unit, School of Health and Population Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | - Martyn Lewis
- Research Institute of Primary Care and Health Sciences, Faculty of Health, Keele University, Keele, Staffordshire, UK
| | - Alison Lloyd
- Research Institute of Primary Care and Health Sciences, Faculty of Health, Keele University, Keele, Staffordshire, UK
| | - Jackie Waterfield
- Research Institute of Primary Care and Health Sciences, Faculty of Health, Keele University, Keele, Staffordshire, UK
| | - Julie Young
- Research Institute of Primary Care and Health Sciences, Faculty of Health, Keele University, Keele, Staffordshire, UK
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99922
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Touw HR, Parlevliet KL, Beerepoot M, Schober P, Vonk A, Twisk JW, Elbers PW, Boer C, Tuinman PR. Lung ultrasound compared with chest X-ray in diagnosing postoperative pulmonary complications following cardiothoracic surgery: a prospective observational study. Anaesthesia 2018. [PMID: 29529332 PMCID: PMC6099367 DOI: 10.1111/anae.14243] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Postoperative pulmonary complications are common after cardiothoracic surgery and are associated with adverse outcomes. The ability to detect postoperative pulmonary complications using chest X-rays is limited, and this technique requires radiation exposure. Little is known about the diagnostic accuracy of lung ultrasound for the detection of postoperative pulmonary complications after cardiothoracic surgery, and we therefore aimed to compare lung ultrasound with chest X-ray to detect postoperative pulmonary complications in this group of patients. We performed this prospective, observational, single-centre study in a tertiary intensive care unit treating adult patients who had undergone cardiothoracic surgery. We recorded chest X-ray findings upon admission and on postoperative days 2 and 3, as well as rates of postoperative pulmonary complications and clinically-relevant postoperative pulmonary complications that required therapy according to the treating physician as part of their standard clinical practice. Lung ultrasound was performed by an independent researcher at the time of chest X-ray. We compared lung ultrasound with chest X-ray for the detection of postoperative pulmonary complications and clinically-relevant postoperative pulmonary complications. We also assessed inter-observer agreement for lung ultrasound, and the time to perform both imaging techniques. Subgroup analyses were performed to compare the time to detection of clinically-relevant postoperative pulmonary complications by both modalities. We recruited a total of 177 patients in whom both lung ultrasound and chest X-ray imaging were performed. Lung ultrasound identified 159 (90%) postoperative pulmonary complications on the day of admission compared with 107 (61%) identified with chest X-ray (p < 0.001). Lung ultrasound identified 11 out of 17 patients (65%) and chest X-ray 7 out of 17 patients (41%) with clinically-relevant postoperative pulmonary complications (p < 0.001). The clinically-relevant postoperative pulmonary complications were detected earlier using lung ultrasound compared with chest X-ray (p = 0.024). Overall inter-observer agreement for lung ultrasound was excellent (κ = 0.907, p < 0.001). Following cardiothoracic surgery, lung ultrasound detected more postoperative pulmonary complications and clinically-relevant postoperative pulmonary complications than chest X-ray, and at an earlier time-point. Our results suggest lung ultrasound may be used as the primary imaging technique to search for postoperative pulmonary complications after cardiothoracic surgery, and will enhance bedside decision making.
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Affiliation(s)
- H R Touw
- Department of Intensive Care Medicine, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity Institute, VU University Medical Center Amsterdam, the Netherlands.,Department of Anaesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity Institute, VU University Medical Center Amsterdam, the Netherlands
| | - K L Parlevliet
- Department of Intensive Care Medicine, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity Institute, VU University Medical Center Amsterdam, the Netherlands
| | - M Beerepoot
- Department of Intensive Care Medicine, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity Institute, VU University Medical Center Amsterdam, the Netherlands
| | - P Schober
- Department of Anaesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity Institute, VU University Medical Center Amsterdam, the Netherlands
| | - A Vonk
- Department of Cardiothoracic Surgery, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity Institute, VU University Medical Center Amsterdam, the Netherlands
| | - J W Twisk
- Department of Epidemiology and Biostatistics, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity Institute, VU University Medical Center Amsterdam, the Netherlands
| | - P W Elbers
- Department of Intensive Care Medicine, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity Institute, VU University Medical Center Amsterdam, the Netherlands
| | - C Boer
- Department of Anaesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity Institute, VU University Medical Center Amsterdam, the Netherlands
| | - P R Tuinman
- Department of Intensive Care Medicine, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity Institute, VU University Medical Center Amsterdam, the Netherlands
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99923
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Haas AD, Hunter DA, Howard NL. Bringing a structural perspective to work: Framing occupational safety and health disparities for nursing assistants with work-related musculoskeletal disorders. Work 2018; 59:211-229. [DOI: 10.3233/wor-172676] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Alysa D. Haas
- Safety and Health Assessment and Research for Prevention (SHARP) Program, Washington State Department of Labor and Industries, Olympia, WA, USA
| | - Daniel A. Hunter
- Safety and Health Assessment and Research for Prevention (SHARP) Program, Washington State Department of Labor and Industries, Olympia, WA, USA
| | - Ninica L. Howard
- Safety and Health Assessment and Research for Prevention (SHARP) Program, Washington State Department of Labor and Industries, Olympia, WA, USA
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99924
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The Impact of the Implementation of the Enhanced Recovery After Surgery (ERAS®) Program in an Entire Health System: A Natural Experiment in Alberta, Canada. World J Surg 2018. [DOI: 10.1007/s00268-018-4559-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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99925
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Andrew E, Mercier E, Nehme Z, Bernard S, Smith K. Long-term functional recovery and health-related quality of life of elderly out-of-hospital cardiac arrest survivors. Resuscitation 2018; 126:118-124. [PMID: 29545136 DOI: 10.1016/j.resuscitation.2018.03.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/05/2018] [Accepted: 03/09/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Understanding the prognosis of elderly out-of-hospital cardiac arrest (OHCA) patients is vital to informing resuscitation and advanced care planning decisions. However, short-term outcomes such as survival to hospital discharge do not account for post-arrest quality of life. We describe the 12-month functional recovery and health-related quality of life (HR-QOL) of elderly OHCA survivors, including those arresting in aged care facilities. METHODS We conducted a retrospective analysis of Victorian Ambulance Cardiac Arrest Registry data for all OHCA survivors to hospital discharge aged ≥65 years between 1 January 2010 and 30 June 2016. The influence of age on functional recovery and independent living was assessed using multivariable logistic regression. RESULTS During the study period, 20,103 elderly OHCAs were attended, 9016 (44.9%) of whom received a resuscitation attempt. In total, 876 (9.7%) patients survived to hospital discharge and 777 were alive 12 months post-arrest. Of these, 651 participated in 12-month follow-up (response rate 83.8%). Most (60.6%) resided at home without additional care and 66.6% reported a good functional recovery, however both measures decreased with increasing age (p < 0.001). Mental HR-QOL increased with increasing age and was significantly better than the age- and sex-matched Australian population. Each 10-year increase in age was associated with a 40.8% (95%CI 25.6-53.0%) reduction in the odds of good functional recovery, and a 65.8% (95%CI 55.8-73.5%) reduction in the odds of living independently. Of the 2575 OHCAs in an aged care facility, 2.2% survived to hospital discharge, however no patient reported a good 12-month functional recovery. CONCLUSIONS Most elderly OHCA survivors resided independently with good functionality 12 months post-arrest. However, increasing age was associated with less favourable outcomes. New strategies are needed with regard to resuscitation in aged care facilities.
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Affiliation(s)
- Emily Andrew
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Eric Mercier
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Centre de recherche du CHU de Québec, Québec, Canada; The Alfred Hospital, Melbourne, Australia.
| | - Ziad Nehme
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Australia.
| | - Stephen Bernard
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia.
| | - Karen Smith
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Frankston, Australia.
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99926
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Gottlieb L, Tobey R, Cantor J, Hessler D, Adler NE. Integrating Social And Medical Data To Improve Population Health: Opportunities And Barriers. Health Aff (Millwood) 2018; 35:2116-2123. [PMID: 27834254 DOI: 10.1377/hlthaff.2016.0723] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Recent efforts in medical settings to identify social determinants of health have focused primarily on screening for the purpose of improving care for individual patients and getting standardized data into electronic health records (EHRs). Relatively little attention has been given to processes needed to extract data on social determinants of health out of medical records with adequate validity and efficiency to facilitate analysis across individual encounters to inform population health efforts relevant to the health care sector. In this article we describe the rationale for extracting data on social determinants of health from EHRs, including the potential influence of aggregated data on quality improvement activities and health care payment reform. We then discuss opportunities and challenges to pulling these data from EHRs to enable population-level applications, focusing on the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, as one potential data aggregation resource. Standardizing methods for extracting data on social determinants of health from EHRs will require understanding current challenges and refining existing translation tools.
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Affiliation(s)
- Laura Gottlieb
- Laura Gottlieb is an associate professor in the Department of Family and Community Medicine at the University of California, San Francisco
| | - Rachel Tobey
- Rachel Tobey is director of John Snow Inc. in San Francisco
| | - Jeremy Cantor
- Jeremy Cantor is a senior researcher at John Snow Inc. in San Francisco
| | - Danielle Hessler
- Danielle Hessler is an associate professor in the Department of Family and Community Medicine at the University of California, San Francisco
| | - Nancy E Adler
- Nancy E. Adler is a professor in the Department of Psychiatry and Pediatrics at the University of California, San Francisco
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99927
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Gimbel RW, Pirrallo RG, Lowe SC, Wright DW, Zhang L, Woo MJ, Fontelo P, Liu F, Connor Z. Effect of clinical decision rules, patient cost and malpractice information on clinician brain CT image ordering: a randomized controlled trial. BMC Med Inform Decis Mak 2018. [PMID: 29530029 PMCID: PMC5848437 DOI: 10.1186/s12911-018-0602-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The frequency of head computed tomography (CT) imaging for mild head trauma patients has raised safety and cost concerns. Validated clinical decision rules exist in the published literature and on-line sources to guide medical image ordering but are often not used by emergency department (ED) clinicians. Using simulation, we explored whether the presentation of a clinical decision rule (i.e. Canadian CT Head Rule - CCHR), findings from malpractice cases related to clinicians not ordering CT imaging in mild head trauma cases, and estimated patient out-of-pocket cost might influence clinician brain CT ordering. Understanding what type and how information may influence clinical decision making in the ordering advanced medical imaging is important in shaping the optimal design and implementation of related clinical decision support systems. Methods Multi-center, double-blinded simulation-based randomized controlled trial. Following standardized clinical vignette presentation, clinicians made an initial imaging decision for the patient. This was followed by additional information on decision support rules, malpractice outcome review, and patient cost; each with opportunity to modify their initial order. The malpractice and cost information differed by assigned group to test the any temporal relationship. The simulation closed with a second vignette and an imaging decision. Results One hundred sixteen of the 167 participants (66.9%) initially ordered a brain CT scan. After CCHR presentation, the number of clinicians ordering a CT dropped to 76 (45.8%), representing a 21.1% reduction in CT ordering (P = 0.002). This reduction in CT ordering was maintained, in comparison to initial imaging orders, when presented with malpractice review information (p = 0.002) and patient cost information (p = 0.002). About 57% of clinicians changed their order during study, while 43% never modified their imaging order. Conclusion This study suggests that ED clinician brain CT imaging decisions may be influenced by clinical decision support rules, patient out-of-pocket cost information and findings from malpractice case review. Trial registration NCT03449862, February 27, 2018, Retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12911-018-0602-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ronald W Gimbel
- Department of Public Health Sciences, Clemson University, 501 Edwards Hall, Clemson, SC, 29634-0745, USA.
| | - Ronald G Pirrallo
- Department of Emergency Medicine, Greenville Health System, Greenville, SC, USA
| | - Steven C Lowe
- Department of Radiology, Greenville Health System, Greenville, SC, USA
| | - David W Wright
- Department of Emergency Medicine, Emory University, Atlanta, GA, USA
| | - Lu Zhang
- Department of Public Health Sciences, Clemson University, 501 Edwards Hall, Clemson, SC, 29634-0745, USA
| | - Min-Jae Woo
- Department of Public Health Sciences, Clemson University, 501 Edwards Hall, Clemson, SC, 29634-0745, USA
| | - Paul Fontelo
- Lister Hill National Center for Biomedical Communication, National Library of Medicine, Bethesda, MD, USA
| | - Fang Liu
- Lister Hill National Center for Biomedical Communication, National Library of Medicine, Bethesda, MD, USA
| | - Zachary Connor
- Department of Public Health Sciences, Clemson University, 501 Edwards Hall, Clemson, SC, 29634-0745, USA.,Department of Radiology, Greenville Health System, Greenville, SC, USA
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99928
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Olfson M. Building The Mental Health Workforce Capacity Needed To Treat Adults With Serious Mental Illnesses. Health Aff (Millwood) 2018; 35:983-90. [PMID: 27269013 DOI: 10.1377/hlthaff.2015.1619] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
There are widespread shortages of mental health professionals in the United States, especially for the care of adults with serious mental illnesses. Such shortages are aggravated by maldistribution of mental health professionals and attractive practice opportunities treating adults with less severe conditions. The Affordable Care Act (ACA) and legislation extending mental health parity coverage are contributing to an increasing demand for mental health services. I consider four policy recommendations to reinvigorate the mental health workforce to meet the rising mental health care demand by adults with serious mental illnesses: expanding loan repayment programs for mental health professionals to practice in underserved areas; raising Medicaid reimbursement for treating serious mental illness; increasing training opportunities for social workers in relevant evidence-based psychosocial services; and disseminating service models that integrate mental health specialists as consultants in general medical care. Achieving progress in attracting mental health professionals to care for adults with serious mental illnesses will require vigorous policy interventions.
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Affiliation(s)
- Mark Olfson
- Mark Olfson is a professor in the Department of Psychiatry, New York State Psychiatric Institute, at Columbia University Medical Center, in New York City
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99929
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Eisold C, Heller AR. [Risk management in anesthesia and critical care medicine]. Med Klin Intensivmed Notfmed 2018; 112:163-176. [PMID: 28210760 DOI: 10.1007/s00063-017-0264-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Throughout its history, anesthesia and critical care medicine has experienced vast improvements to increase patient safety. Consequently, anesthesia has never been performed on such a high level as it is being performed today. As a result, we do not always fully perceive the risks involved in our daily activity. A survey performed in Swiss hospitals identified a total of 169 hot spots which endanger patient safety. It turned out that there is a complex variety of possible errors that can only be tackled through consistent implementation of a safety culture. The key elements to reduce complications are continuing staff education, algorithms and standard operating procedures (SOP), working according to the principles of crisis resource management (CRM) and last but not least the continuous work-up of mistakes identified by critical incident reporting systems.
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Affiliation(s)
- C Eisold
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus, 01307, Dresden, Deutschland.
| | - A R Heller
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus, 01307, Dresden, Deutschland
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99930
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Scanlan GM, Cleland J, Johnston P, Walker K, Krucien N, Skåtun D. What factors are critical to attracting NHS foundation doctors into specialty or core training? A discrete choice experiment. BMJ Open 2018; 8:e019911. [PMID: 29530910 PMCID: PMC5857684 DOI: 10.1136/bmjopen-2017-019911] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Multiple personal and work-related factors influence medical trainees' career decision-making. The relative value of these diverse factors is under-researched, yet this intelligence is crucially important for informing medical workforce planning and retention and recruitment policies. Our aim was to investigate the relative value of UK doctors' preferences for different training post characteristics during the time period when they either apply for specialty or core training or take time out. METHODS We developed a discrete choice experiment (DCE) specifically for this population. The DCE was distributed to all Foundation Programme Year 2 (F2) doctors across Scotland as part of the National Career Destination Survey in June 2016. The main outcome measure was the monetary value of training post characteristics, based on willingness to forgo additional potential income and willingness to accept extra income for a change in each job characteristic calculated from regression coefficients. RESULTS 677/798 F2 doctors provided usable DCE responses. Location was the most influential characteristic of a training position, followed closely by supportive culture and then working conditions. F2 doctors would need to be compensated by an additional 45.75% above potential earnings to move from a post in a desirable location to one in an undesirable location. Doctors who applied for a training post placed less value on supportive culture and excellent working conditions than those who did not apply. Male F2s valued location and a supportive culture less than female F2s. CONCLUSION This is the first study focusing on the career decision-making of UK doctors at a critical careers decision-making point. Both location and specific job-related attributes are highly valued by F2 doctors when deciding their future. This intelligence can inform workforce policy to focus their efforts in terms of making training posts attractive to this group of doctors to enhance recruitment and retention.
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Affiliation(s)
- Gillian Marion Scanlan
- Centre for Healthcare Education Research and Innovation (CHERI), Institute of Education for Medical and Dental Sciences, School of Medicine, Dentistry and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Jennifer Cleland
- Centre for Healthcare Education Research and Innovation (CHERI), Institute of Education for Medical and Dental Sciences, School of Medicine, Dentistry and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Peter Johnston
- NHS Education for Scotland, Scotland Deanery, Aberdeen, UK
| | - Kim Walker
- NHS Education for Scotland, Scotland Deanery, Aberdeen, UK
| | - Nicolas Krucien
- Health Economics Research Unit (HERU), School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | - Diane Skåtun
- Health Economics Research Unit (HERU), School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
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99931
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99932
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Yang TY, Chen M, Lin WR, Li CY, Tsai WK, Chiu AW, Ko MC. Preoperative treatment with 5α-reductase inhibitors and the risk of hemorrhagic events in patients undergoing transurethral resection of the prostate - A population-based cohort study. Clinics (Sao Paulo) 2018; 73:e264. [PMID: 29538495 PMCID: PMC5840823 DOI: 10.6061/clinics/2018/e264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To assess the associations between preoperative treatment with 5-alpha reductase inhibitors and the risks of blood transfusion during transurethral resection of the prostate and blood clot evacuation or emergency department visits for hematuria within 1 month after surgery. METHODS We used data from the Taiwan National Health Insurance Research Database in this population-based cohort study. A total of 3,126 patients who underwent first-time transurethral resection of the prostate from 2004 to 2013 were identified. Adjusted odds ratios estimated by multiple logistic regression models were used to assess the independent effects of the preoperative use of 5-alpha reductase inhibitors on the risks of perioperative hemorrhagic events after adjustment for potential confounders. RESULTS Two hundred and ninety-seven (9.4%) patients were treated with 5-alpha reductase inhibitors for <3 months, and 65 (2.1%) patients were treated for ≥3 months prior to undergoing transurethral resection of the prostate. The blood transfusion rates for patients who were not treated with 5-alpha reductase inhibitors (controls), patients who were treated with 5-alpha reductase inhibitors for <3 months, and patients who were treated with 5-alpha reductase inhibitors ≥3 months were 9.5%, 8.8%, and 3.1%, respectively. 5-alpha reductase inhibitors tended to decrease the risk of blood transfusion; however, this association was not statistically significant (adjusted odds ratio=0.14, 95% confidence interval: 0.02-1.01). Age ≥80 years, coagulopathy, and a resected prostate tissue weight >50 g were associated with significantly higher risks of blood transfusion than other parameters. CONCLUSIONS This nationwide study did not show that significant associations exist between 5-alpha reductase inhibitor use before transurethral resection of the prostate and the risks of blood transfusion and blood clot evacuation or emergency visits for hematuria.
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Affiliation(s)
- Ti-Yuan Yang
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, Taipei, Taiwan
| | - Marcelo Chen
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Cosmetic Applications and Management, Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Wun-Rong Lin
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, Taipei, Taiwan
| | - Chung-Yi Li
- Department of Public Health College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Wei-Kung Tsai
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, Taipei, Taiwan
| | - Allen W. Chiu
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ming-Chung Ko
- Department of Urology, Taipei City Hospital, Taipei, Taiwan
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- Corresponding author. E-mail:
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99933
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Soudy H, Maghfoor I, Elhassan TAM, Abdullah E, Rauf SM, Al Zahrani A, Akhtar S. Translation and validation of the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) version 4 quality of life instrument into Arabic language. Health Qual Life Outcomes 2018. [PMID: 29530033 PMCID: PMC5848601 DOI: 10.1186/s12955-018-0861-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) has been translated from English into several languages. Currently, there is no validated translation of FACT-BMT in Arabic. Here, we are reporting the first Arabic translation and validation of the FACT-BMT. Methods The study was approved by the Institutional Research Advisory Council. The Arabic translation followed the standard Functional Assessment of Chronic Illness Therapy (FACIT.org) translation methodology (with permission). Arabic FACT-BMT (50- items) was statistically validated. Cronbach’s alpha for internal consistency, Spearman’s rank correlation coefficients method for Inter-scale correlations and Principal Component Analysis for factorial construct validity was used. Results One hundred and eight consecutive relapsed /refractory lymphoma patients who underwent high dose chemotherapy and autologous stem cell transplant were enrolled. There were 68 males (63%) and 40 females (37%) with a median age of 29 years (range 14–62). After Arabic questionnaire pre-testing (Cronbach’s alpha 0.744), the study included 108 patients. Cronbach’s alpha for the entire FACT-BMT indicated an excellent internal consistency (0.90); range (0.67 to 0.91). Cronbach’s alpha for sub-groups of social (0.78), emotional (0.67) and functional wellbeing was (0.88). Cronbach’s alpha for bone marrow transplant (0.81), FACT-General (0.89), and FACT- Trial Outcome Index (TOI); (0.91) also revealed excellent internal consistency. Patients had high scores in all domains of quality of life, indicating that most patients were leading a normal life. This translation of FACT-BMT in Arabic was reviewed and approved for submission by the FACIT.org. Conclusions Our data reports the first translated, validated and approved Arabic version of FACT-BMT. This will help large numbers of Arabic speaking patients undergoing stem cell/bone marrow transplantation, across the globe. Electronic supplementary material The online version of this article (10.1186/s12955-018-0861-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hussein Soudy
- Oncology Center, King Faisal Specialist Hospital & Research Center, P.O. Box 3354, MBC# 64, Riyadh, 11211, Kingdom of Saudi Arabia
| | - Irfan Maghfoor
- Oncology Center, King Faisal Specialist Hospital & Research Center, P.O. Box 3354, MBC# 64, Riyadh, 11211, Kingdom of Saudi Arabia
| | - Tusneem Ahmed M Elhassan
- Oncology Center, King Faisal Specialist Hospital & Research Center, P.O. Box 3354, MBC# 64, Riyadh, 11211, Kingdom of Saudi Arabia
| | - Eman Abdullah
- Department of Nursing Affairs, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Shahzad M Rauf
- Oncology Center, King Faisal Specialist Hospital & Research Center, P.O. Box 3354, MBC# 64, Riyadh, 11211, Kingdom of Saudi Arabia
| | - Ahmed Al Zahrani
- Oncology Center, King Faisal Specialist Hospital & Research Center, P.O. Box 3354, MBC# 64, Riyadh, 11211, Kingdom of Saudi Arabia
| | - Saad Akhtar
- Oncology Center, King Faisal Specialist Hospital & Research Center, P.O. Box 3354, MBC# 64, Riyadh, 11211, Kingdom of Saudi Arabia.
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99934
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Boulos D, Fikretoglu D. Influence of military component and deployment-related experiences on mental disorders among Canadian military personnel who deployed to Afghanistan: a cross-sectional survey. BMJ Open 2018; 8:e018735. [PMID: 29530906 PMCID: PMC5857669 DOI: 10.1136/bmjopen-2017-018735] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 12/18/2017] [Accepted: 01/12/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The primary objective was to explore differences in mental health problems (MHP) between serving Canadian Armed Forces (CAF) components (Regular Force (RegF); Reserve Force (ResF)) with an Afghanistan deployment and to assess the contribution of both component and deployment experiences to MHP using covariate-adjusted prevalence difference estimates. Additionally, mental health services use (MHSU) was descriptively assessed among those with a mental disorder. DESIGN Data came from the 2013 CAF Mental Health Survey, a cross-sectional survey of serving personnel (n=72 629). Analyses were limited to those with an Afghanistan deployment (population n=35 311; sampled n=4854). Logistic regression compared MHP between RegF and ResF members. Covariate-adjusted prevalence differences were computed. PRIMARY OUTCOME MEASURE The primary outcomes were MHP, past-year mental disorders, identified using the WHO's Composite International Diagnostic Interview, and past-year suicide ideation. RESULTS ResF personnel were less likely to be identified with a past-year anxiety disorder (adjusted OR (AOR)=0.72 (95% CI 0.58 to 0.90)), specifically both generalised anxiety disorder and panic disorder, but more likely to be identified with a past-year alcohol abuse disorder (AOR=1.63 (95% CI 1.04 to 2.58)). The magnitude of the covariate-adjusted disorder prevalence differences for component was highest for the any anxiety disorder outcome, 2.8% (95% CI 1.0 to 4.6); lower for ResF. All but one deployment-related experience variable had some association with MHP. The 'ever felt responsible for the death of a Canadian or ally personnel' experience had the strongest association with MHP; its estimated covariate-adjusted disorder prevalence difference was highest for the any (of the six measured) mental disorder outcome (11.2% (95% CI 6.6 to 15.9)). Additionally, ResF reported less past-year MHSU and more past-year civilian MHSU. CONCLUSIONS Past-year MHP differences were identified between components. Our findings suggest that although deployment-related experiences were highly associated with MHP, these only partially accounted for MHP differences between components. Additional research is needed to further investigate MHSU differences between components.
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Affiliation(s)
- David Boulos
- Directorate of Mental Health, Canadian Forces Health Services Group, Ottawa, Ontario, Canada
| | - Deniz Fikretoglu
- Defence Research and Development Canada, Toronto, Ontario, Canada
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99935
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Chalmers N, Grover J, Compton R. After Medicaid Expansion In Kentucky, Use Of Hospital Emergency Departments For Dental Conditions Increased. Health Aff (Millwood) 2018; 35:2268-2276. [PMID: 27920315 DOI: 10.1377/hlthaff.2016.0976] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Access to oral health care is a critical need for the adult Medicaid population. Following the 2014 expansion of Medicaid eligibility in Kentucky, millions of adults became eligible to receive dental benefits. We examined the impact of the expansion on adult Medicaid enrollees' use of hospital emergency departments (EDs) for conditions related to dental or oral health in the period 2010-14. Based on our analysis of data for Kentucky from the State Emergency Department Databases, we found that the rate of discharges for these conditions from the ED increased significantly, from 1,833 per 100,000 population in 2013 to 5,635 in 2014. Adults covered by Medicaid who used the ED for treatment of oral health conditions in 2014 had high levels of chronic comorbidities and were more likely to be male and nonwhite than those in earlier years. To avoid costly and inappropriate use of the ED, states considering adding an adult Medicaid dental benefit should consider also making changes to assist beneficiaries in obtaining access to the dental health care delivery system.
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Affiliation(s)
- Natalia Chalmers
- Natalia Chalmers is director of analytics and publication at DentaQuest Institute, in Westborough, Massachusetts
| | - Jane Grover
- Jane Grover is director of the Council on Access, Prevention, and Interprofessional Relations at the American Dental Association, in Chicago, Illinois
| | - Rob Compton
- Rob Compton is president of DentaQuest Institute
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99936
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Cummings JR, Wen H, Ko M. Decline In Public Substance Use Disorder Treatment Centers Most Serious In Counties With High Shares Of Black Residents. Health Aff (Millwood) 2018; 35:1036-44. [PMID: 27269020 DOI: 10.1377/hlthaff.2015.1630] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Previous research has associated declines in health care resources such as hospitals and trauma centers with communities' racial composition. However, little is known about changes in the substance use disorder treatment infrastructure in recent years and the implications for black communities. We used data for the period 2002-10 from the National Survey of Substance Abuse Treatment Services to describe changes in the supply of public and private outpatient facilities for substance use disorder treatment, and to determine whether these trends had implications for the geographical availability of these facilities in counties with high percentages of black residents. During the study period the number of publicly owned facilities declined 17.2 percent, whereas the number of private for-profit facilities grew 19.1 percent. At baseline, counties with very high percentages of black residents (that is, more than one standard deviation above the mean) were more likely than counties with less than the mean percentage of black residents to be served by public facilities and were thus disproportionately affected by the overall decline in public facilities. Future research should examine the effect of expanding eligibility for Medicaid on the supply of substance use disorder treatment facilities across diverse communities.
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Affiliation(s)
- Janet R Cummings
- Janet R. Cummings is an associate professor in the Department of Health Policy and Management, Rollins School of Public Health, at Emory University, in Atlanta, Georgia
| | - Hefei Wen
- Hefei Wen is an assistant professor of health management and policy at the University of Kentucky, in Lexington
| | - Michelle Ko
- Michelle Ko is a research scientist at the Center for Health Policy Research, at the University of California, Los Angeles
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99937
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McAlister FA, Bakal JA, Green L, Bahler B, Lewanczuk R. The effect of provider affiliation with a primary care network on emergency department visits and hospital admissions. CMAJ 2018; 190:E276-E284. [PMID: 29530868 PMCID: PMC5849446 DOI: 10.1503/cmaj.170385] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Primary care networks are designed to facilitate access to inter-professional, team-based care. We compared health outcomes associated with primary care networks versus conventional primary care. METHODS We obtained data on all adult residents of Alberta who visited a primary care physician during fiscal years 2008 and 2009 and classified them as affiliated with a primary care network or not, based on the physician most involved in their care. The primary outcome was an emergency department visit or nonelective hospital admission for a Patient Medical Home indicator condition (asthma, chronic obstructive pulmonary disease, heart failure, coronary disease, hypertension and diabetes) within 12 months. RESULTS Adults receiving care within a primary care network (n = 1 502 916) were older and had higher comorbidity burdens than those receiving conventional primary care (n = 1 109 941). Patients in a primary care network were less likely to visit the emergency department for an indicator condition (1.4% v. 1.7%, mean 0.031 v. 0.035 per patient, adjusted risk ratio [RR] 0.98, 95% confidence interval [CI] 0.96-0.99) or for any cause (25.5% v. 30.5%, mean 0.55 v. 0.72 per patient, adjusted RR 0.93, 95% CI 0.93-0.94), but were more likely to be admitted to hospital for an indicator condition (0.6% v. 0.6%, mean 0.018 v. 0.017 per patient, adjusted RR 1.07, 95% CI 1.03-1.11) or all-cause (9.3% v. 9.1%, mean 0.25 v. 0.23 per patient, adjusted RR 1.08, 95% CI 1.07-1.09). Patients in a primary care network had 169 fewer all-cause emergency department visits and 86 fewer days in hospital (owing to shorter lengths of stay) per 1000 patient-years. INTERPRETATION Care within a primary care network was associated with fewer emergency department visits and fewer hospital days.
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Affiliation(s)
- Finlay A McAlister
- Division of General Internal Medicine (McAlister) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister, Bakal), Alberta SPOR Support Unit Data Platform; Department of Family Medicine (Green); Department of Medicine (Lewanczuk), University of Alberta and Primary Health Care, Alberta Health Services (Bahler), Edmonton, Alta.
| | - Jeffrey A Bakal
- Division of General Internal Medicine (McAlister) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister, Bakal), Alberta SPOR Support Unit Data Platform; Department of Family Medicine (Green); Department of Medicine (Lewanczuk), University of Alberta and Primary Health Care, Alberta Health Services (Bahler), Edmonton, Alta
| | - Lee Green
- Division of General Internal Medicine (McAlister) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister, Bakal), Alberta SPOR Support Unit Data Platform; Department of Family Medicine (Green); Department of Medicine (Lewanczuk), University of Alberta and Primary Health Care, Alberta Health Services (Bahler), Edmonton, Alta
| | - Brad Bahler
- Division of General Internal Medicine (McAlister) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister, Bakal), Alberta SPOR Support Unit Data Platform; Department of Family Medicine (Green); Department of Medicine (Lewanczuk), University of Alberta and Primary Health Care, Alberta Health Services (Bahler), Edmonton, Alta
| | - Richard Lewanczuk
- Division of General Internal Medicine (McAlister) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister, Bakal), Alberta SPOR Support Unit Data Platform; Department of Family Medicine (Green); Department of Medicine (Lewanczuk), University of Alberta and Primary Health Care, Alberta Health Services (Bahler), Edmonton, Alta
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99938
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Shepherd J, Cooper K, Harris P, Picot J, Rose M. The clinical effectiveness and cost-effectiveness of abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis: a systematic review and economic evaluation. Health Technol Assess 2018; 20:1-222. [PMID: 27135404 DOI: 10.3310/hta20340] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is characterised by joint pain, swelling and a limitation of movement caused by inflammation. Subsequent joint damage can lead to disability and growth restriction. Treatment commonly includes disease-modifying antirheumatic drugs (DMARDs), such as methotrexate. Clinical practice now favours newer drugs termed biologic DMARDs where indicated. OBJECTIVE To assess the clinical effectiveness and cost-effectiveness of four biologic DMARDs [etanercept (Enbrel(®), Pfizer), abatacept (Orencia(®), Bristol-Myers Squibb), adalimumab (Humira(®), AbbVie) and tocilizumab (RoActemra(®), Roche) - with or without methotrexate where indicated] for the treatment of JIA (systemic or oligoarticular JIA are excluded). DATA SOURCES Electronic bibliographic databases including MEDLINE, EMBASE, The Cochrane Library and the Database of Abstracts of Reviews of Effects were searched for published studies from inception to May 2015 for English-language articles. Bibliographies of related papers, systematic reviews and company submissions were screened and experts were contacted to identify additional evidence. REVIEW METHODS Systematic reviews of clinical effectiveness, health-related quality of life and cost-effectiveness were undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A cost-utility decision-analytic model was developed to compare the estimated cost-effectiveness of biologic DMARDs versus methotrexate. The base-case time horizon was 30 years and the model took a NHS perspective, with costs and benefits discounted at 3.5%. RESULTS Four placebo-controlled randomised controlled trials (RCTs) met the inclusion criteria for the clinical effectiveness review (one RCT evaluating each biologic DMARD). Only one RCT included UK participants. Participants had to achieve an American College of Rheumatology Pediatric (ACR Pedi)-30 response to open-label lead-in treatment in order to be randomised. An exploratory adjusted indirect comparison suggests that the four biologic DMARDs are similar, with fewer disease flares and greater proportions of ACR Pedi-50 and -70 responses among participants randomised to continued biologic DMARDs. However, confidence intervals were wide, the number of trials was low and there was clinical heterogeneity between trials. Open-label extensions of the trials showed that, generally, ACR responses remained constant or even increased after the double-blind phase. The proportions of adverse events and serious adverse events were generally similar between the treatment and placebo groups. Four economic evaluations of biologic DMARDs for patients with JIA were identified but all had limitations. Two quality-of-life studies were included, one of which informed the cost-utility model. The incremental cost-effectiveness ratios (ICERs) for adalimumab, etanercept and tocilizumab versus methotrexate were £38,127, £32,526 and £38,656 per quality-adjusted life year (QALY), respectively. The ICER for abatacept versus methotrexate as a second-line biologic was £39,536 per QALY. LIMITATIONS The model does not incorporate the natural history of JIA in terms of long-term disease progression, as the current evidence is limited. There are no head-to-head trials of biologic DMARDs, and clinical evidence for specific JIA subtypes is limited. CONCLUSIONS Biologic DMARDs are superior to placebo (with methotrexate where permitted) in children with (predominantly) polyarticular course JIA who have had an insufficient response to previous treatment. Randomised comparisons of biologic DMARDs with long-term efficacy and safety follow-up are needed to establish comparative effectiveness. RCTs for JIA subtypes for which evidence is lacking are also required. STUDY REGISTRATION This study is registered as PROSPERO CRD42015016459. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Jonathan Shepherd
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
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99939
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Stevenson M, Archer R, Tosh J, Simpson E, Everson-Hock E, Stevens J, Hernandez-Alava M, Paisley S, Dickinson K, Scott D, Young A, Wailoo A. Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for the treatment of rheumatoid arthritis not previously treated with disease-modifying antirheumatic drugs and after the failure of conventional disease-modifying antirheumatic drugs only: systematic review and economic evaluation. Health Technol Assess 2018; 20:1-610. [PMID: 27140438 DOI: 10.3310/hta20350] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with increasing disability, reduced quality of life and substantial costs (as a result of both intervention acquisition and hospitalisation). The objective was to assess the clinical effectiveness and cost-effectiveness of seven biologic disease-modifying antirheumatic drugs (bDMARDs) compared with each other and conventional disease-modifying antirheumatic drugs (cDMARDs). The decision problem was divided into those patients who were cDMARD naive and those who were cDMARD experienced; whether a patient had severe or moderate to severe disease; and whether or not an individual could tolerate methotrexate (MTX). DATA SOURCES The following databases were searched: MEDLINE from 1948 to July 2013; EMBASE from 1980 to July 2013; Cochrane Database of Systematic Reviews from 1996 to May 2013; Cochrane Central Register of Controlled Trials from 1898 to May 2013; Health Technology Assessment Database from 1995 to May 2013; Database of Abstracts of Reviews of Effects from 1995 to May 2013; Cumulative Index to Nursing and Allied Health Literature from 1982 to April 2013; and TOXLINE from 1840 to July 2013. Studies were eligible for inclusion if they evaluated the impact of a bDMARD used within licensed indications on an outcome of interest compared against an appropriate comparator in one of the stated population subgroups within a randomised controlled trial (RCT). Outcomes of interest included American College of Rheumatology (ACR) scores and European League Against Rheumatism (EULAR) response. Interrogation of Early Rheumatoid Arthritis Study (ERAS) data was undertaken to assess the Health Assessment Questionnaire (HAQ) progression while on cDMARDs. METHODS Network meta-analyses (NMAs) were undertaken for patients who were cDMARD naive and for those who were cDMARD experienced. These were undertaken separately for EULAR and ACR data. Sensitivity analyses were undertaken to explore the impact of including RCTs with a small proportion of bDMARD experienced patients and where MTX exposure was deemed insufficient. A mathematical model was constructed to simulate the experiences of hypothetical patients. The model was based on EULAR response as this is commonly used in clinical practice in England. Observational databases, published literature and NMA results were used to populate the model. The outcome measure was cost per quality-adjusted life-year (QALY) gained. RESULTS Sixty RCTs met the review inclusion criteria for clinical effectiveness, 38 of these trials provided ACR and/or EULAR response data for the NMA. Fourteen additional trials contributed data to sensitivity analyses. There was uncertainty in the relative effectiveness of the interventions. It was not clear whether or not formal ranking of interventions would result in clinically meaningful differences. Results from the analysis of ERAS data indicated that historical assumptions regarding HAQ progression had been pessimistic. The typical incremental cost per QALY of bDMARDs compared with cDMARDs alone for those with severe RA is > £40,000. This increases for those who cannot tolerate MTX (£50,000) and is > £60,000 per QALY when bDMARDs were used prior to cDMARDs. Values for individuals with moderate to severe RA were higher than those with severe RA. Results produced using EULAR and ACR data were similar. The key parameter that affected the results is the assumed HAQ progression while on cDMARDs. When historic assumptions were used typical incremental cost per QALY values fell to £38,000 for those with severe disease who could tolerate MTX. CONCLUSIONS bDMARDs appear to have cost per QALY values greater than the thresholds stated by the National Institute for Health and Care Excellence for interventions to be cost-effective. Future research priorities include: the evaluation of the long-term HAQ trajectory while on cDMARDs; the relationship between HAQ direct medical costs; and whether or not bDMARDs could be stopped once a patient has achieved a stated target (e.g. remission). STUDY REGISTRATION This study is registered as PROSPERO CRD42012003386. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Matt Stevenson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Rachel Archer
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jon Tosh
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Emma Simpson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Emma Everson-Hock
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - John Stevens
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Suzy Paisley
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Kath Dickinson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - David Scott
- Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, UK
| | - Adam Young
- Department of Rheumatology, West Hertfordshire Hospitals NHS Trust, Hertfordshire, UK
| | - Allan Wailoo
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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99940
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Myers J, Cosby R, Gzik D, Harle I, Harrold D, Incardona N, Walton T. Provider Tools for Advance Care Planning and Goals of Care Discussions: A Systematic Review. Am J Hosp Palliat Care 2018. [PMID: 29529884 DOI: 10.1177/1049909118760303] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Advance care planning and goals of care discussions involve the exploration of what is most important to a person, including their values and beliefs in preparation for health-care decision-making. Advance care planning conversations focus on planning for future health care, ensuring that an incapable person's wishes are known and can guide the person's substitute decision maker for future decision-making. Goals of care discussions focus on preparing for current decision-making by ensuring the person's goals guide this process. AIM To provide evidence regarding tools and/or practices available for use by health-care providers to effectively facilitate advance care planning conversations and/or goals of care discussions. DATA SOURCES A systematic review was conducted focusing on guidelines, randomized trials, comparative studies, and noncomparative studies. Databases searched included MEDLINE, EMBASE, and the proceedings of the International Advance Care Planning Conference and the American Society of Clinical Oncology Palliative Care Symposium. CONCLUSIONS Although several studies report positive findings, there is a lack of consistent patient outcome evidence to support any one clinical tool for use in advance care planning or goals of care discussions. Effective advance care planning conversations at both the population and the individual level require provider education and communication skill development, standardized and accessible documentation, quality improvement initiatives, and system-wide coordination to impact the population level. There is a need for research focused on goals of care discussions, to clarify the purpose and expected outcomes of these discussions, and to clearly differentiate goals of care from advance care planning.
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Affiliation(s)
- Jeff Myers
- 1 Sinai-Bridgepoint Palliative Care Unit, Toronto, Ontario, Canada
| | - Roxanne Cosby
- 2 Program in Evidence-Based Care, McMaster University, Hamilton, Canada
| | - Danusia Gzik
- 3 North Simcoe Muskoka Regional Cancer Program, Cancer Care Ontario, Barrie, Canada
| | - Ingrid Harle
- 4 Department of Medicine, Queen's University, Kingston, Canada.,5 Department of Oncology, Queen's University, Kingston, Canada
| | - Deb Harrold
- 3 North Simcoe Muskoka Regional Cancer Program, Cancer Care Ontario, Barrie, Canada
| | - Nadia Incardona
- 6 Michael Garron Hospital, Toronto East Health Network, Ontario, Canada.,7 Department of Family & Community Medicine, University of Toronto, Toronto, Canada
| | - Tara Walton
- 8 Ontario Palliative Care Network Secretariat, Toronto, Canada
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99941
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Newhouse R, Byon HD, Storkman Wolf E, Johantgen M. Multisite Studies Demonstrate Positive Relationship Between Practice Environments and Smoking Cessation Counseling Evidence‐Based Practices. Worldviews Evid Based Nurs 2018. [DOI: 10.1111/wvn.12277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Robin Newhouse
- Dean and Distinguished ProfessorIndiana University School of Nursing Indianapolis IN USA
| | - Ha Do Byon
- Assistant Professor, University of Virginia School of Nursing Charlottesville VA USA
| | - Emily Storkman Wolf
- Registered Nurse, Riley Hospital for ChildrenGraduate Student, Indiana University School of Nursing Indianapolis IN USA
| | - Meg Johantgen
- Associate Professor and Associate Dean, PhD ProgramUniversity of Maryland School of Nursing Baltimore MD USA
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99942
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Doshi R, Shah J, Jauhar V, Decter D, Jauhar R, Meraj P. Comparison of drug eluting stents (DESs) and bare metal stents (BMSs) with STEMI: who received BMS in the era of 2nd generation DES? Heart Lung 2018; 47:231-236. [PMID: 29544863 DOI: 10.1016/j.hrtlng.2018.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/09/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this study was to analyze the indications for using bare metal stents (BMSs) in hospitalizations with ST segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). METHODS The study cohorts were identified from the National Inpatient Sample database from 2010-2014 using appropriate, International Classification of Diseases, 9th Revision, Clinical Modification, diagnostic and procedural codes. RESULTS A total of 123,487 hospitalizations were identified for this study. Drug eluting stent (DES) use demonstrated lower in-hospital mortality (5.8% vs. 3.3%, P = < 0.01) and other in-hospital outcomes, thus resulting in lower hospitalization stay. Higher age, black race, greater comorbidity burden, inferior wall myocardial infarction, and the use of mechanical circulatory devices were all associated with BMS use. CONCLUSION DES was the preferred standard of care in the era of 2nd generation DES; however, BMSs were used in hospitalizations with high-risk procedures and multiple risk factors.
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Affiliation(s)
- Rajkumar Doshi
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York.
| | - Jay Shah
- Department of Internal Medicine, Mercy Saint Vincent Hospital, University of Toledo, Toledo, OH
| | - Varun Jauhar
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Dean Decter
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Rajiv Jauhar
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York
| | - Perwaiz Meraj
- Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, New York
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99943
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Dowell D, Zhang K, Noonan RK, Hockenberry JM. Mandatory Provider Review And Pain Clinic Laws Reduce The Amounts Of Opioids Prescribed And Overdose Death Rates. Health Aff (Millwood) 2018; 35:1876-1883. [PMID: 27702962 DOI: 10.1377/hlthaff.2016.0448] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
To address the opioid overdose epidemic in the United States, states have implemented policies to reduce inappropriate opioid prescribing. These policies could affect the coincident heroin overdose epidemic by either driving the substitution of heroin for opioids or reducing simultaneous use of both substances. We used IMS Health's National Prescription Audit and government mortality data to examine the effect of these policies on opioid prescribing and on prescription opioid and heroin overdose death rates in the United States during 2006-13. The analysis revealed that combined implementation of mandated provider review of state-run prescription drug monitoring program data and pain clinic laws reduced opioid amounts prescribed by 8 percent and prescription opioid overdose death rates by 12 percent. We also observed relatively large but statistically insignificant reductions in heroin overdose death rates after implementation of these policies. This combination of policies was effective, but broader approaches to address these coincident epidemics are needed.
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Affiliation(s)
- Deborah Dowell
- Deborah Dowell is a senior medical advisor at the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), in Atlanta, Georgia
| | - Kun Zhang
- Kun Zhang is a health economist and senior service fellow at the National Center for Injury Prevention and Control, CDC
| | - Rita K Noonan
- Rita K. Noonan is chief of the Health Systems and Trauma Systems Branch of the National Center for Injury Prevention and Control, CDC
| | - Jason M Hockenberry
- Jason M. Hockenberry is an associate professor in the Department of Health Policy and Management at Emory University, in Atlanta
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99944
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The fundamental association between mental health and life satisfaction: results from successive waves of a Canadian national survey. BMC Public Health 2018. [PMID: 29530010 PMCID: PMC5848433 DOI: 10.1186/s12889-018-5235-x] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background A self-reported life satisfaction question is routinely used as an indicator of societal well-being. Several studies support that mental illness is an important determinant for life satisfaction and improvement of mental healthcare access therefore could have beneficial effects on a population’s life satisfaction. However, only a few studies report the relationship between subjective mental health and life satisfaction. Subjective mental health is a broader concept than the presence or absence of psychopathology. In this study, we examine the strength of the association between a self-reported mental health question and self-reported life satisfaction, taking into account other relevant factors. Methods We conducted this analysis using successive waves of the Canadian Community Health Survey (CCHS) collected between 2003 and 2012. Respondents included more than 400,000 participants aged 12 and over. We extracted information on self-reported mental health, socio-demographic and other factors and examined correlation with self-reported life satisfaction using a proportional ordered logistic regression. Results Life satisfaction was strongly associated with self-reported mental health, even after simultaneously considering factors such as income, general health, and gender. The poor-self-reported mental health group had a particularly low life satisfaction. In the fair-self-reported mental health category, the odds of having a higher life satisfaction were 2.35 (95% CI 2.21 to 2.50) times higher than the odds in the poor category. In contrast, for the “between 60,000 CAD and 79,999 CAD” household income category, the odds of having a higher life satisfaction were only 1.96 (95% CI 1.90 to 2.01) times higher than the odds in the “less than 19,999 CAD” category. Conclusions Subjective mental health contributes highly to life satisfaction, being more strongly associated than other selected previously known factors. Future studies could be useful to deepen our understanding of the interplay between subjective mental health, mental illness and life satisfaction. This may be beneficial for developing public health policies that optimize mental health promotion, illness prevention and treatment of mental disorders to enhance life satisfaction in the general population. Electronic supplementary material The online version of this article (10.1186/s12889-018-5235-x) contains supplementary material, which is available to authorized users.
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99945
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Qu N, Shi RL, Lu ZW, Liao T, Wen D, Sun GH, Li DS, Ji QH. Metastatic lymph node ratio can further stratify risk for mortality in medullary thyroid cancer patients: A population-based analysis. Oncotarget 2018; 7:65937-65945. [PMID: 27588396 PMCID: PMC5323204 DOI: 10.18632/oncotarget.11725] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 08/09/2016] [Indexed: 12/13/2022] Open
Abstract
Medullary thyroid cancer (MTC) has a propensity to cervical lymph node metastases (LNM). Recent studies have shown that both the number of involved lymph nodes (LNs) and the metastatic lymph node ratio (MLNR) confer prognostic information. This study was to determine the predictive value of MLNR on cancer-specific survival (CSS) in SEER (Surveillance, Epidemiology and End Results)-registered MTC patients treated with thyroidectomy and lymphadenectomy between 1991 and 2012, investigate the cutoff points for MLNR in stratifying risk of mortality and provide evidence for selection of appropriate treatment strategies. X-tile program determined 0.5 as optimal cut-off value for MLNR in terms of CSS in 890 MTC patients. According to multivariate Cox regression analysis, MLNR (0.50–1.00) is a significant independent prognostic factor for CSS (hazard ratio 2.161, 95% confidence interval 1.327–3.519, p=0.002). MLNR (0.50–1.00) has a greater prognostic impact on CSS in female, non-Hispanic white, T3/4, N1b and M1 patients. The lymph node yield (LNY) influences the effect of MLNR on CSS; LNY ≥9 results in MLNR (0.50–1.00) having a higher HR for CSS than MLNR (0.00-0.49). In conclusion, higher MLNRs predict poorer survival in MTC patients. Eradication of involved nodes ensures accurate staging and maximizes the ability of MLNR to predict prognosis.
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Affiliation(s)
- Ning Qu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Rong-Liang Shi
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.,Department of General Surgery, Minhang Hospital, Fudan University, Shanghai 201199, China
| | - Zhong-Wu Lu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Tian Liao
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Duo Wen
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Guo-Hua Sun
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Duan-Shu Li
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Qing-Hai Ji
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
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99946
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Kramer BJ, Creekmur B, Mitchell MN, Saliba D. Expanding Home-Based Primary Care to American Indian Reservations and Other Rural Communities: An Observational Study. J Am Geriatr Soc 2018. [DOI: 10.1111/jgs.15193] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- B. Josea Kramer
- Geriatric Research Education and Clinical Center; Veterans Affairs Greater Los Angeles Healthcare System; Los Angeles California
- Division of Geriatric Medicine; David Geffen School of Medicine, University of California Los Angeles; Los Angeles California
| | | | - Michael N. Mitchell
- Geriatric Research Education and Clinical Center; Veterans Affairs Greater Los Angeles Healthcare System; Los Angeles California
| | - Debra Saliba
- Geriatric Research Education and Clinical Center; Veterans Affairs Greater Los Angeles Healthcare System; Los Angeles California
- Division of Geriatric Medicine; David Geffen School of Medicine, University of California Los Angeles; Los Angeles California
- University of California, Los Angeles/Jewish Home Borun Center for Gerontological Research; Los Angeles California
- RAND Corporation; Santa Monica California
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99947
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Roberts AW, Farley JF, Holmes GM, Oramasionwu CU, Ringwalt C, Sleath B, Skinner AC. Controlled Substance Lock-In Programs: Examining An Unintended Consequence Of A Prescription Drug Abuse Policy. Health Aff (Millwood) 2018; 35:1884-1892. [PMID: 27702963 DOI: 10.1377/hlthaff.2016.0355] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Controlled substance lock-in programs are garnering increased attention from payers and policy makers seeking to combat the epidemic of opioid misuse. These programs require high-risk patients to visit a single prescriber and pharmacy for coverage of controlled substance medication services. Despite high prevalence of the programs in Medicaid, we know little about their effects on patients' behavior and outcomes aside from reducing controlled substance-related claims. Our study was the first rigorous investigation of lock-in programs' effects on out-of-pocket controlled substance prescription fills, which circumvent the programs' restrictions and mitigate their potential public health benefits. We linked claims data and prescription drug monitoring program data for the period 2009-12 for 1,647 enrollees in North Carolina Medicaid's lock-in program and found that enrollment was associated with a roughly fourfold increase in the likelihood and frequency of out-of-pocket controlled substance prescription fills. This finding illuminates weaknesses of lock-in programs and highlights the need for further scrutiny of the appropriate role, optimal design, and potential unintended consequences of the programs as tools to prevent opioid abuse.
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Affiliation(s)
- Andrew W Roberts
- Andrew W. Roberts is an assistant professor in the Department of Pharmacy Sciences, School of Pharmacy and Health Professions, and a program faculty member in the Center for Health Services Research and Patient Safety, both at Creighton University, in Omaha, Nebraska
| | - Joel F Farley
- Joel F. Farley is a professor in the Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, at the University of North Carolina at Chapel Hill
| | - G Mark Holmes
- G. Mark Holmes is an associate professor in the Department of Health Policy and Management, Gillings School of Global Public Health, and director of the the Cecil G. Sheps Center for Health Services Research, both at UNC-Chapel Hill
| | - Christine U Oramasionwu
- Christine U. Oramasionwu is an assistant professor in the Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, at UNC-Chapel Hill
| | - Chris Ringwalt
- Chris Ringwalt is a senior research scientist at the Injury Prevention Research Center, UNC-Chapel Hill
| | - Betsy Sleath
- Betsy Sleath is the George H. Cocolas Distinguished Professor; chair of the Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy; and director of the Child and Adolescent Health Services Program at the Sheps Center, all at UNC-Chapel Hill
| | - Asheley C Skinner
- Asheley C. Skinner is an associate professor at the Duke Clinical Research Institute, Duke University, in Durham, North Carolina
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99948
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Darbari DS, Liljencrantz J, Ikechi A, Martin S, Roderick MC, Fitzhugh CD, Tisdale JF, Thein SL, Hsieh M. Pain and opioid use after reversal of sickle cell disease following HLA-matched sibling haematopoietic stem cell transplant. Br J Haematol 2018. [PMID: 29527656 DOI: 10.1111/bjh.15169] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Deepika S Darbari
- Division of Hematology and Oncology, Children's National Medical Center, Washington, DC, USA.,The George Washington University School of Medicine, Washington, DC, USA.,Sickle Cell Branch, National Heart, Lung and Blood Institute, Bethesda, MD, USA.,National Institutes of Health, Bethesda, MD, USA
| | - Jaquette Liljencrantz
- National Institutes of Health, Bethesda, MD, USA.,Pain and Integrative Neuroscience Laboratory, National Center for Complementary and Integrative Health, Bethesda, MD, USA
| | | | - Staci Martin
- National Institutes of Health, Bethesda, MD, USA.,National Cancer Institute, Rockville, MD, USA
| | - Marie Claire Roderick
- National Institutes of Health, Bethesda, MD, USA.,National Cancer Institute, Rockville, MD, USA
| | - Courtney D Fitzhugh
- Sickle Cell Branch, National Heart, Lung and Blood Institute, Bethesda, MD, USA.,National Institutes of Health, Bethesda, MD, USA
| | - John F Tisdale
- National Institutes of Health, Bethesda, MD, USA.,Molecular and Clinical Hematology Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Swee Lay Thein
- Sickle Cell Branch, National Heart, Lung and Blood Institute, Bethesda, MD, USA.,National Institutes of Health, Bethesda, MD, USA
| | - Matthew Hsieh
- National Institutes of Health, Bethesda, MD, USA.,Molecular and Clinical Hematology Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
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99949
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Friebel R, Hauck K, Aylin P, Steventon A. National trends in emergency readmission rates: a longitudinal analysis of administrative data for England between 2006 and 2016. BMJ Open 2018. [PMID: 29530912 PMCID: PMC5857687 DOI: 10.1136/bmjopen-2017-020325] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To assess trends in 30-day emergency readmission rates across England over one decade. DESIGN Retrospective study design. SETTING 150 non-specialist hospital trusts in England. PARTICIPANTS 23 069 134 patients above 18 years of age who were readmitted following an initial admission (n=62 584 297) between April 2006 and February 2016. PRIMARY AND SECONDARY OUTCOMES We examined emergency admissions that occurred within 30 days of discharge from hospital ('emergency readmissions') as a measure of healthcare quality. Presented are overall readmission rates, and disaggregated by the nature of the indexed admission, including whether it was elective or emergency, and by clinical health condition recorded. All rates were risk-adjusted for patient age, gender, ethnicity, socioeconomic status, comorbidities and length of stay. RESULTS The average risk-adjusted, 30-day readmission rate increased from 6.56% in 2006/2007 to 6.76% (P<0.01) in 2012/2013, followed by a small decrease to 6.64% (P<0.01) in 2015/2016. Emergency readmissions for patients discharged following elective procedures decreased by 0.13% (P<0.05), whereas those following emergency admission increased by 1.27% (P<0.001). Readmission rates for hip or knee replacements decreased (-1.29%; P<0.001); for acute myocardial infarction (-0.04%; P<0.49), stroke (+0.62%; P<0.05), chronic obstructive pulmonary disease (+0.41%; P<0.05) and heart failure (+0.15%; P<0.05) remained stable; and for pneumonia (+2.72%; P<0.001), diabetes (+7.09%; P<0.001), cholecystectomy (+1.86%; P<0.001) and hysterectomy (+2.54%; P<0.001) increased. CONCLUSIONS Overall, emergency readmission rates in England remained relatively stable across the observation period, with trends of slight increases contained post 2012/2013. However, there were large variations in trends across clinical areas, with some experiencing marked increases in readmission rates. This highlights the need to better understand variations in outcomes across clinical subgroups to allow for targeted interventions that will ensure highest standards of care provided for all patients.
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Affiliation(s)
- Rocco Friebel
- School of Public Health, Imperial College London, London, UK
- Data Analytics, The Health Foundation, London, UK
| | - Katharina Hauck
- School of Public Health, Imperial College London, London, UK
| | - Paul Aylin
- School of Public Health, Imperial College London, London, UK
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99950
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Morton M, Nagpal S, Sadanandan R, Bauhoff S. India's Largest Hospital Insurance Program Faces Challenges In Using Claims Data To Measure Quality. Health Aff (Millwood) 2018; 35:1792-1799. [PMID: 27702951 PMCID: PMC7473072 DOI: 10.1377/hlthaff.2016.0588] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
The routine data generated by India’s universal coverage programs offer an important opportunity to evaluate and track the quality of health care systematically and on a large scale. We examined the potential and challenges of measuring the quality of hospital care through claims data from India’s hospital insurance program for the poor, Rashtriya Swasthya Bima Yojana (RSBY). Using data from one district in India, we illustrate how these data already provide useful insights and show that simple efforts to enhance data quality and an effort to expand the data captured could facilitate RSBY’s ability to track quality of care. The data collected by RSBY has significant potential to characterize and uncover the provision of low-quality care and help inform much-needed efforts to raise the quality of hospital care.
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Affiliation(s)
- Matthew Morton
- Matthew Morton is a social protection specialist at the World Bank in New Delhi, India
| | - Somil Nagpal
- Somil Nagpal is a senior health specialist at the World Bank in Phnom Penh, Cambodia
| | - Rajeev Sadanandan
- Rajeev Sadanandan is an additional chief secretary (health) in the Government of Kerala, Thiruvananthapuram, India
| | - Sebastian Bauhoff
- Sebastian Bauhoff is a research fellow at the Center for Global Development, in Washington, D.C
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