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Urionagüena A, Piquer-Martinez C, Benrimoj SI, Calvo B, Garcia-Cardenas V, Gastelurrutia MA, Martinez-Martinez F, Fernandez-Llimos F. Mapping the concept of health care integration: A lexicographic analysis of scientific literature. Res Social Adm Pharm 2024; 20:506-511. [PMID: 38336512 DOI: 10.1016/j.sapharm.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 12/29/2023] [Accepted: 01/25/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Systems fragmentation is a major challenge for an efficient organization, integration being a potential solution also proposed in health care field, including pharmacy as a player. However, the use of different terms and definitions in the literature hinders the comparison of different integration initiatives. OBJECTIVE To identify and map the terms used in scientific literature regarding integration in health care and to characterize each emerging topic. METHODS A lexicographic analysis of the integration of healthcare systems literature indexed in PubMed was conducted. Ten different systematic searches, four using only Medical Subject Headings (MeSH) and six using text words, were conducted in March 2023. Journal scattering was analyzed following Bradford's distribution using the Leimkuhler model. An overall text corpus was created with titles and abstracts of all the records retrieved. The corpus was lemmatized, and the most used bigrams were tokenized as single strings. To perform a topic modeling, the lemmatized corpus text was analyzed using IRaMuTeQ, producing descending hierarchic classification and a correspondence analysis. The 50 words with higher chi-square statistics in each class were considered as representative of the class. RESULTS A total of 42,479 articles published from 1943 to 2023 in 4469 different journals were retrieved. The MeSH "Delivery of Health Care, Integrated", created in the 1996 MeSH update, was the most productive retrieving 33.7 % of the total articles but also retrieving 22.6 % of articles not retrieved in any other search. The text word "Integration" appeared in 15,357 (36.2 %) records. The lexicographic analysis resulted in 7 classes, named as: Evidence and implementation, Quantitative research, Professional education, Qualitative research, Governance and leadership, Clinical research, and Financial resources. Association between the classes and the searches or the text-words used ranged from moderate to weak demonstrating the lack of a standard pattern of use of terms in literature regarding healthcare integration. CONCLUSIONS The term "integration" and the MeSH "Delivery of Health Care, Integrated" are the most used to represent the concept of integration in healthcare and should be the preferred terms in the literature.
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Affiliation(s)
- Amaia Urionagüena
- Pharmacy Practice Research Group, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain.
| | | | | | - Begoña Calvo
- Pharmacy Practice Research Group, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain.
| | - Victoria Garcia-Cardenas
- Pharmacy and Pharmaceutical Technology Department, Social and Legal Pharmacy Section, Faculty of Pharmacy, University of Granada, Granada, Spain.
| | - Miguel Angel Gastelurrutia
- Pharmacy Practice Research Group, Faculty of Pharmacy, University of the Basque Country, UPV/EHU, Vitoria-Gasteiz, Spain; Pharmaceutical Care Research Group, University of Granada, Granada, Spain.
| | | | - Fernando Fernandez-Llimos
- Applied Molecular Biosciences Unit (UCIBIO), Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal.
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Sharpe M, Toynbee M, van Niekerk M, Solomons L, Owens C, Price A, Yousif M, Palmer A, Clay F, Berk G, Burns J, Hill L, Harris J, Bajorek T, Sirois-Giguere G, Magill N, Aitken P, Dickens C, Walker J. Proactive and integrated consultation-liaison psychiatry for older medical inpatients: A mixed methods description of training, care provided and clinician experience in the HOME study. Gen Hosp Psychiatry 2024; 86:108-117. [PMID: 38185070 DOI: 10.1016/j.genhosppsych.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVES To describe the practical experience of delivering a proactive and integrated consultation-liaison (C-L) psychiatry service model (PICLP). PICLP is designed for older medical inpatients and is explicitly biopsychosocial and discharge-focused. In this paper we report: (a) observations on the training of 15 clinicians (seven senior C-L psychiatrists and eight assisting clinicians) to deliver PICLP; (b) the care they provided to 1359 patients; (c) their experiences of working in this new way. METHOD A mixed methods observational study using quantitative and qualitative data, collected prospectively over two years as part of The HOME Study (a randomized trial comparing PICLP with usual care). RESULTS The clinicians were successfully trained to deliver PICLP according to the service manual. They proactively assessed all patients and found that most had multiple biopsychosocial problems impeding their timely discharge from hospital. They integrated with ward teams to provide a range of interventions aimed at addressing these problems. Delivering PICLP took a modest amount of clinical time, and the clinicians experienced it as both clinically valuable and professionally rewarding. CONCLUSION The experience of delivering PICLP highlights the special role that C-L psychiatry clinicians, working in a proactive and integrated way, can play in medical care.
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Affiliation(s)
- Michael Sharpe
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK.
| | - Mark Toynbee
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Maike van Niekerk
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Luke Solomons
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Colm Owens
- NHS Devon Mental Health, Learning Disability and Neurodiversity Provider Collaborative, Devon, UK
| | - Annabel Price
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | | | - Aelfrida Palmer
- NHS Devon Mental Health, Learning Disability and Neurodiversity Provider Collaborative, Devon, UK
| | - Felix Clay
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Gunes Berk
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Jonathan Burns
- NHS Devon Mental Health, Learning Disability and Neurodiversity Provider Collaborative, Devon, UK
| | - Laura Hill
- NHS Devon Mental Health, Learning Disability and Neurodiversity Provider Collaborative, Devon, UK
| | - Jessica Harris
- Gloucestershire Health and Care NHS Foundation Trust, Gloucester, UK
| | - Tomasz Bajorek
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Nicholas Magill
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Aitken
- Sussex Partnership Foundation Trust, Worthing, UK
| | | | - Jane Walker
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK
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Alege JB, Oyore JP, Nanyonga RC, Musoke P, Orago ASS. Barriers and facilitators of integrated hepatitis B, C, and HIV screening among pregnant mothers and their newborns attending maternal and newborn clinics in Koboko District, Uganda: A qualitative inquiry of providers' perspective. Res Sq 2023:rs.3.rs-3739602. [PMID: 38196577 PMCID: PMC10775386 DOI: 10.21203/rs.3.rs-3739602/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Background HIV and HBV remain significant public health challenges characterized by high prevalence, morbidity, and mortality, especially among women of reproductive age in Uganda. However, both HIV and HBV patients are managed in separate clinics with separate staff even though they all receive ART. Patients with HBV do not receive routine counselling and education, and there are limited resources for laboratory investigation coupled with a high loss to follow-up. This study set out to "assess barriers and facilitators of integrated viral hepatitis B C and HIV care model to optimize screening uptake among mothers and newborns at health facilities in Koboko District, west Nile sub-region, Uganda". Methods A cross-sectional grounded theory qualitative approach was employed in an institutional setting (HC IIIs). Data was audio recorded using a recording device during the key informant interviews and was transcribed after all interviews were conducted. Data was then analyzed using framework analysis. Results The following facilitated integration: High prevalence, and therefore burden of hepatitis B infection in West Nile region, team spirit by the health workers, reduced long waiting time, availability of medical products such as HBV and HCV test kits, integration of HBV and HIV into HMIS2 form and availability of support from implementing partners such as Infectious Dease Institute which offered mentorship and training on integration and support supervision. Conclusion Barriers to integration included; knowledge gap among health care workers, lack of transport for patients, language barriers during health education, inadequate human resources for health, stock-out of testing kits for HBV and HCV, lack of HMIS 2 column to capture HCV data, lack of funds to facilitate follow up of patients after referral for further investigation upon suspected cases of HBV and HCV. The study participants recommended; Promoting the integration of HBV, HCV, and HIV into routine health services; ensuring a constant supply of HBV, and HCV test kits to avoid stock-out; Engaging VHTs/Community health volunteers to support follow-up of patients and conducting health care workers performance reviews; addressing the issue of inadequate human resource; and finally dealing with misconceptions at community level about HBV and HCV diseases which hinder access to services.
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Chan VF, Yard E, Mashayo E, Mulewa D, Drake L, Omar F. Contextual factors affecting integration of eye health into school health programme in Zanzibar: a qualitative health system research. BMC Health Serv Res 2023; 23:1414. [PMID: 38098051 PMCID: PMC10722834 DOI: 10.1186/s12913-023-10469-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 12/12/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Short-term school eye health programmes supported by external funders have sustainability issues. This study aimed to understand the contextual factors affecting integrating eye health into the school health programme. METHODS We elicited responses from 83 respondents, purposefully selected from the Ministry of Health (n = 7), Ministry of Education and Vocational Training (n = 7), hospitals/eye centres (n = 5), master trainers (4) and schools (n = 60) who participated in in-depth interviews. Their responses were analysed and grouped into contextual factors according to the WHO Consolidated Framework for Implementation Research: stakeholders/political, institutional, physical, cultural, delivery system and others. Themes were then generated, and quotations were presented to illustrate the findings. RESULTS The six contextual factors affecting the integration of eye health into the school eye health programme were i) Stakeholders/political (Good ministry coordination, defined departmental roles and resource mobilisation from multiple stakeholders; Good stakeholder synergies and address current gaps); ii) Institutional (Institutional coordination and adequate clinic space; Securing human and financial resources; Strategic advocacy for institutional resources); iii) Physical (Long travel distance to service points); vi) Cultural (low eye health awareness among parents, teachers and children); iv) Delivery system (Practical approach to increase screening coverage using teachers as screeners; Balance teachers' workload, increase screening sensitivity and follow up and; v) Others (Comprehensive training material and effective training delivery; Improved curriculum, teacher selection and supervision and incentives). CONCLUSION Integrated school eye health delivery is generally well-received by stakeholders in Zanzibar, with the caveat that investment is required to address the six contextual factors identified in the study.
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Affiliation(s)
- Ving Fai Chan
- Centre of Public Health, School of Medicine, Dentistry and Biomedical Medicine, Royal Victoria Hospital, Institute of Clinical Sciences, Queen's University of Belfast, Block B, Belfast, BT12 6BA, UK.
- Brien Holden Vision Institute Foundation Africa Trust, Durban, South Africa.
- University of KwaZulu Natal, Durban, South Africa.
| | - Elodie Yard
- Partnership for Child Development, Imperial College London, London, UK
- Oriole Global Health, Nairobi, Kenya
| | - Eden Mashayo
- Brien Holden Vision Institute Foundation Africa Trust, Durban, South Africa
| | - Damaris Mulewa
- Partnership for Child Development, Imperial College London, London, UK
| | - Lesley Drake
- Partnership for Child Development, Imperial College London, London, UK
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Gichuki PM, Kibe L, Mwatele C, Mwangangi J, Mbogo CM. Towards an integrated vector management approach for sustainable control of schistosomiasis and malaria in Mwea, Kirinyaga County, Kenya: Baseline epidemiological and vector results. Heliyon 2023; 9:e20966. [PMID: 37876477 PMCID: PMC10590948 DOI: 10.1016/j.heliyon.2023.e20966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 10/12/2023] [Accepted: 10/12/2023] [Indexed: 10/26/2023] Open
Abstract
Background Vector control is an important approach in the control of most parasitic and vector-borne diseases including malaria, and schistosomiasis. Distribution of these two infections often overlaps and in such areas it's more economically viable to employ an integrated approach in the control of their vectors which largely shares the same breeding ecosystem. We carried out a baseline epidemiological and vector surveys for malaria and schistosomiasis in Mwea, Kirinyaga County, in preparation for the upscaling of integrated vector management (IVM) for the two diseases. Methods This was a repeated cross sectional survey, where mosquito and snails were sampled during dry and wet seasons in three different ecological zones, Kiamaciri, Thiba and Murinduko to identify possible breeding sites. Mosquito larvae were collected using standard dippers, adults using CDC miniature light traps while snail vectors were sampled using standard snail scoops in different breeding habitats. A total of 1200 pupils from 12 primary schools were tested for malaria using rapid diagnostic tests (Malaria Pf/PAN Ag combo). Stool samples were processed using the Kato Katz technique for intestinal schistosomiasis. Results The overall prevalence of intestinal schistosomiasis was 9.08 % (95 % CI: 07.00-11.00), with Kiamaciri zone recording the highest prevalence at 19 % (95%CI: 15.00-23.00) and Murinduko zone the least at 0.17 % (95%CI: 0.00-0.01). Majority of the infections were of light intensity 78.9 % (95%CI: 70.04-86.13). There was no positive malaria case detected in this study. Of the 3208 adult mosquitoes sampled during the dry season, 20.6 % (95 % CI: 19.25-22.08) were Anopheles gambiae s.l while 79.4 % (95 % CI: 77.92-80.75) were culicines. During the wet season, 3378 adult mosquitoes were collected, of which 14.7 % (95 % CI: 13.56-15.98) were Anopheles gambiae s.l and 85.3 % (95 % CI: 84.02-86.44) culicines. Overall, 4085 mosquito larvae were collected during the two seasons, of which, 57.3 % and 42.7 % were anopheles and culicine respectively. Majority of the larvae (85.1 % (95%CI: 84.01-86.10) were collected during the wet season, with only 14.9 % (95%CI: 14.10-16.00) being collected during the dry season. A total of 2292 fresh water vector snails were collected with a majority (69.6 % (95%CI: 68.00-71.10) being Biomphalaria pffeiferi responsible for transmission of intestinal schistosomiasis. Conclusion This study demonstrates that intestinal schistosomiasis is prevalent in Kiamaciri and Thiba zones, and points to the possibility of active transmission of schistosomiasis in Murinduko zone. Malaria vectors were predominantly observed in all sites despite there being no malaria positive case. Culex quinquefaciatus responsible for the spread of several arboviruses was also observed. The presence of these vectors may lead to future disease outbreaks in the area if concerted control initiatives are not undertaken. The disease vectors shared the same breeding sites and thus its economical and feasible to adopt an integrated vector management approach in control efforts for these disease in the study area.
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Affiliation(s)
- Paul M. Gichuki
- Kenya Medical Research Institute (KEMRI), Eastern & Southern Africa Centre of International Parasite Control (ESACIPAC), Nairobi, P.O BOX 54840-00200 Nairobi, Kenya
- School of Health Sciences, Meru University of Science and Technology, P.O BOX 972-60200 Meru, Kenya
| | - Lydia Kibe
- Kenya Medical Research Institute (KEMRI), Eastern & Southern Africa Centre of International Parasite Control (ESACIPAC), Nairobi, P.O BOX 54840-00200 Nairobi, Kenya
| | - Cassian Mwatele
- Kenya Medical Research Institute (KEMRI), Eastern & Southern Africa Centre of International Parasite Control (ESACIPAC), Nairobi, P.O BOX 54840-00200 Nairobi, Kenya
| | - Joseph Mwangangi
- KEMRI-Wellcome Trust Research Programme, Public Health Unit, PO Box 43640 - 00100, Nairobi, Kenya
- Kenya Medical Research Institute (KEMRI), Centre for Geographical Medicine Research-Coast (CGMR-C). P.O Box 230- 80108 Kilifi, Kenya
| | - Charles M. Mbogo
- Kenya Medical Research Institute (KEMRI), Eastern & Southern Africa Centre of International Parasite Control (ESACIPAC), Nairobi, P.O BOX 54840-00200 Nairobi, Kenya
- KEMRI-Wellcome Trust Research Programme, Public Health Unit, PO Box 43640 - 00100, Nairobi, Kenya
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Xu L, Fu Z. Multi-field coupled dynamics for a movable tooth drive system integrated with shape memory alloys. Heliyon 2023; 9:e17531. [PMID: 37456050 PMCID: PMC10338312 DOI: 10.1016/j.heliyon.2023.e17531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 05/26/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
The harmonic movable tooth drive system integrated with shape memory alloys has a small size and a large output torque. Its dynamics performance is the key factor for evaluating the drive system. Here, for the drive system, based on its structure and working principle, the coupled dynamics equations are deduced. Using the equations, changes of the natural frequencies of the drive system during the operation are investigated. Effects of the system parameters and SMA wires phase change process on the natural frequencies are analyzed. The nonlinear resonant frequencies of the drive system and its amplitude-frequency relationship are studied. Results show that natural frequencies of the drive system change periodically which is caused by SMA phase transformation during operation. The eccentricity, movable tooth radius, the wave generator radius and SMA wire length have also important effects on the natural frequencies of the drive system. The nonlinear resonant frequencies are smaller than linear resonant frequencies. In the design of the drive system, the coupled nonlinear effects of the temperature, phase change, stress and strain of the SMA wires, and the system parameters of the movable tooth drive system should be considered. In this paper, the coupled nonlinear dynamics model of the harmonic movable tooth drive system integrated with shape memory alloys is proposed in which the coupled effects of the temperature, phase change, stress and strain of the SMA, and the system parameters of the movable tooth drive system are considered.
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Borba Martins J, T D Viseu M, Barbosa Pinto M. [Psychossocial Rehabilitation in Continued Integrated Care in Mental Health: The Portuguese Reality]. ACTA MEDICA PORT 2023. [PMID: 37068466 DOI: 10.20344/amp.19351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/22/2023] [Indexed: 04/19/2023]
Affiliation(s)
- João Borba Martins
- Serviço de Psiquiatria 1. Departamento de Psiquiatria e Saúde Mental. Centro Hospitalar Universitário do Algarve. Faro. Portugal
| | - Maria T D Viseu
- Serviço de Psiquiatria 1. Departamento de Psiquiatria e Saúde Mental. Centro Hospitalar Universitário do Algarve. Faro. Portugal
| | - Mónica Barbosa Pinto
- Serviço de Psiquiatria 1. Departamento de Psiquiatria e Saúde Mental. Centro Hospitalar Universitário do Algarve. Faro. Portugal
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Hesse DW, Ramsey LM, Bruner LP, Vega-Castillo CS, Teshager D, Hill JR, Bond MT, Sperr EV, Baldwin A, Medlock AE. Exploring Academic Performance of Medical Students in an Integrated Hybrid Curriculum by Gender. Med Sci Educ 2023; 33:353-357. [PMID: 37261018 PMCID: PMC10226948 DOI: 10.1007/s40670-023-01743-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 06/02/2023]
Abstract
Gender gaps in academic performance have been reported at a variety of educational levels including several national standardized exams for medical education, with men scoring higher than women. These gaps potentially impact medical school acceptance and residency matching and may be influenced by curricular design. Performance data for our 4-year integrated hybrid curriculum, which features a large proportion of active learning, revealed a gender gap with men performing better early in the curriculum and on the first national standardized exam. This gap in performance almost entirely disappeared for years 2-4 of the curriculum and the second national standardized exam.
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Affiliation(s)
- DeLoris Wenzel Hesse
- Augusta University/University of Georgia Medical Partnership, Athens, GA USA
- Department of Cellular Biology, University of Georgia, Athens, GA USA
| | - Lynn M. Ramsey
- Augusta University/University of Georgia Medical Partnership, Athens, GA USA
| | - Lia Pierson Bruner
- Augusta University/University of Georgia Medical Partnership, Athens, GA USA
- Department of Family and Community Medicine, Medical College of Georgia, Augusta University, Augusta, GA USA
| | | | - Dina Teshager
- Augusta University/University of Georgia Medical Partnership, Athens, GA USA
| | - Janette R. Hill
- College of Education, Learning, Design, & Technology, University of Georgia, Athens, GA USA
| | - Mary T. Bond
- Augusta University/University of Georgia Medical Partnership, Athens, GA USA
- Department of Medicine: General Internal Medicine, Medical College of Georgia, Augusta University, Augusta, GA USA
| | - Edwin V. Sperr
- Augusta University/University of Georgia Medical Partnership, Athens, GA USA
| | - Amy Baldwin
- Augusta University/University of Georgia Medical Partnership, Athens, GA USA
- Department of Biochemistry and Molecular Biology, Medical College of Georgia, Augusta University, Augusta, GA USA
| | - Amy E. Medlock
- Augusta University/University of Georgia Medical Partnership, Athens, GA USA
- Department of Biochemistry and Molecular Biology, University of Georgia, Athens, GA USA
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Snowdon N, Allan J, Shakeshaft A, Courtney RJ. "I didn't even know headspace had the drug thing until today": A socio-ecological analysis of access to drug and alcohol interventions in integrated youth health care services. J Subst Use Addict Treat 2023; 146:208959. [PMID: 36880903 DOI: 10.1016/j.josat.2023.208959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 10/11/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND With 150 centers Australia-wide, the headspace National Youth Mental Health Foundation is an exemplary integrated youth health service. Headspace centers provide medical care, mental health interventions, alcohol and other drug (AOD) services, and vocational support to Australian young people (YP) aged 12 to 25 years. Co-located headspace salaried youth workers, private health care practitioners (e.g. psychologists, psychiatrists, and medical practitioners) and in-kind community service providers (e.g. AOD clinicians) form coordinated multidisciplinary teams. This article aims to identify the factors influencing the access to AOD interventions for YP, in the Australian rural headspace setting; as perceived by YP, their family and friends, and headspace staff. METHODS The study purposively recruited YP (n = 16), their family and friends (n = 9), and headspace staff (n = 23) and management (n = 7) in four headspace centers in rural New South Wales, Australia. Recruited individuals participated in semistructured focus groups about the access to YP AOD interventions in the headspace setting. The study team thematically analyzed the data through the lens of the socio-ecological model. RESULTS The study identified convergent themes across groups and found several barriers to the access of AOD interventions; 1) YP's personal factors, 2) YP's family and peer attitudes, 3) practitioner skills, 4) organizational processes and 5) societal attitudes were all identified as negatively impacting access to YP AOD interventions. Practitioners' client-centered stance, and the youth-centric headspace model were factors that were considered as enablers of engagement of YP with an AOD concern. INTERPRETATION While this Australian example of an integrated youth health care model is well placed to provide YP AOD interventions, a mismatch existed between practitioner capability and YP needs. The sampled practitioners described limited AOD knowledge, and low confidence in providing AOD interventions. At the organizational level, multiple AOD intervention supply and utilization issues occurred. Taken together, these problems likely underlie previous findings of poor service utilization and low user satisfaction. CONCLUSION Clear enablers exist for AOD interventions to be better integrated into headspace services. Future work should determine how this integration can be achieved and what early intervention means in relation to AOD interventions.
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Affiliation(s)
- Nicole Snowdon
- National Drug and Alcohol Research Centre, 22 - 32 King Street, The University of New South Wales, Randwick, Sydney, NSW 2031, Australia.
| | - Julaine Allan
- National Drug and Alcohol Research Centre, 22 - 32 King Street, The University of New South Wales, Randwick, Sydney, NSW 2031, Australia; School of Health and Society, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, 22 - 32 King Street, The University of New South Wales, Randwick, Sydney, NSW 2031, Australia; Poche Centre for Indigenous Health, University of Queensland, 74 High St, Toowong, Queensland, 4066, Australia
| | - Ryan J Courtney
- National Drug and Alcohol Research Centre, 22 - 32 King Street, The University of New South Wales, Randwick, Sydney, NSW 2031, Australia
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Dovel K, Kalande P, Udedi E, Bruns L, Desmond C, Mbalanga C, Gupta S, Phiri S, Chivwala M, Richter L, Coates TJ. Triple Benefit: Impact of an Integrated Early Childhood Development and PMTCT Intervention on ART Outcomes Among Mothers Living with HIV and Infants in Malawi-An Endline Evaluation. AIDS Behav 2023:10.1007/s10461-022-03975-0. [PMID: 36746875 DOI: 10.1007/s10461-022-03975-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 02/08/2023]
Abstract
We conducted a programmatic, observational cohort study with mother-infant pairs (MIPs) enrolled in prevention-of-mother-to-child-transmission (PMTCT) programs in Malawi to assess the feasibility and potential HIV-related benefits of integrating Early Childhood Development (ECD) services into PMTCT programs. Six health facilities were included in the intervention. We offered ECD counseling from the WHO/UNICEF Care for Child Development package in PMTCT waiting spaces while MIPs waited for PMTCT and broader treatment consultations. Primary outcomes were mothers' retention in HIV care at 12 months and infant HIV testing at 6 weeks and 12 months after birth. Routine facility-level data from six comparison health facilities were collected as an adhoc standard of care comparison and used to calculate the cost of delivering the intervention. A total of 607 MIPs were enrolled in the integrated ECD-PMTCT intervention between June 2018 and December 2019. The average age of MIPs was 30 years and 7 weeks respectively. We found that 86% of mothers attended ≥ 5 of the 8 ECD sessions over the course of 12 months; 88% of intervention mothers were retained in PMTCT versus 59% of mothers in comparison health facilities, and 96% of intervention infants were tested for HIV by six weeks compared to 66% of infants in comparison health facilities. Costing data demonstrated the financial feasibility of integrating ECD and PMTCT programs in government health facilities in Malawi. Integrating ECD into PMTCT programs was feasible, acceptable, resulted in better programmatic outcomes for both mothers and infants. Further investigation is required to determine optimal delivery design for scale-up.
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Affiliation(s)
- Kathryn Dovel
- Partners in Hope, Implementation Science, Lilongwe, Malawi.
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | | | - Evelyn Udedi
- University of California Global Health Institute, San Francisco, CA, USA
| | - Laurie Bruns
- University of California Global Health Institute, San Francisco, CA, USA
| | | | | | - Sundeep Gupta
- Partners in Hope, Implementation Science, Lilongwe, Malawi
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Sam Phiri
- Partners in Hope, Implementation Science, Lilongwe, Malawi
| | | | - Linda Richter
- University of the Witwatersrand, Johannesburg, South Africa
| | - Thomas J Coates
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
- University of California Global Health Institute, San Francisco, CA, USA
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Kwok KM, Tay SS. Outcomes of a Multi-Modal Hospital-Associated Home-Based Cancer Prehabilitation Program. Ann Rehabil Med 2023; 47:52-67. [PMID: 36710586 PMCID: PMC10020046 DOI: 10.5535/arm.22126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/21/2022] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To assess the impact of a "one-stop", multi-modal, hospital-associated-home-based prehabilitation model, helmed by a small core team, on newly diagnosed gastrointestinal and urological cancer patients planned for surgery. METHODS This is a retrospective study in a tertiary public hospital, involving all newly diagnosed gastrointestinal and urological cancer patients planned for surgery. The primary outcome measure was the 6-minute walk test (6MWT). Other outcomes included physical, psychological and quality-of-life measures, and patient satisfaction surveys, taken at baseline, pre-operatively (post-prehabilitation), and at 3 months post-operatively. RESULTS When comparing the baseline to pre-operatively (post-prehabilitation), there was a statistically significant improvement in the 6MWT (21.52 m, p<0.001), 30-Second Sit to Stand test (STS) (1.08 repetitions, p<0.001), Timed Up and Go test (TUG) (0.83 seconds, p=0.014) and Hospital Anxiety and Depression Scale (HADS) (total score 1.77, p<0.001). These were sustained (6MWT: 0.22, p=0.964; STS: 0.08 repetitions, p=0.863; TUG: 0.04 seconds, p=0.939) or further improved (HADS total score 2.06, p=0.003) at 3 months post-operatively. There was also a statistically significant improvement in the EuroQol-5 dimension health score (health-related quality-of-life measure) from baseline to 3 months post-operatively (7.04 points, p=0.001), with more than 90% overall patient satisfaction reported. CONCLUSION Prehabilitation applied via our model resulted in significant improvements in functional capacity, psychological and quality-of-life outcomes, sustained at 3 months post-operatively, and is a feasible and effective approach that is well-received by our patients.
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Affiliation(s)
- Kah Meng Kwok
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore
| | - San San Tay
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore
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12
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Ding WY, Proietti M, Romiti GF, Vitolo M, Fawzy AM, Boriani G, Marin F, Blomström-Lundqvist C, Potpara TS, Fauchier L, H Lip GY. Impact of ABC (Atrial Fibrillation Better Care) pathway adherence in high-risk subgroups with atrial fibrillation: A report from the ESC-EHRA EORP-AF long-term general registry. Eur J Intern Med 2023; 107:60-65. [PMID: 36372692 DOI: 10.1016/j.ejim.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Effects of Atrial Fibrillation Better Care (ABC) adherence among high-risk atrial fibrillation (AF) subgroups remains unknown. We aimed to evaluate the impact of ABC adherence on clinical outcomes in these high-risk patients. METHODS EORP-AF General Long-Term Registry is a prospective, observational registry from 250 centres across 27 European countries. High-risk patients were defined as those with either CKD (eGFR <60 mL/min/1.73m2), elderly patients (≥75 years) or prior thromboembolism. Primary outcome was a composite event of all-cause death, thromboembolism and acute coronary syndrome. RESULTS 6646 patients with AF were screened (median age was 70 [IQR 61 - 77] years; 40.2% females). There were 3304 (54.2%) patients with either CKD (n = 1750), older age (n = 2236) or prior thromboembolism (n = 728). Among these, 924 (28.0%) were managed as adherent to ABC. At 2-year follow-up, 966 (14.5%) patients reported the primary outcome. The incidence of the primary outcome was significantly lower in high-risk patients managed as adherent to ABC pathway (IRR 0.53 [95%CI, 0.43 - 0.64]). Consistent results were obtained in the individual subgroups. Using multivariable Cox proportional hazards analysis, ABC adherence in the high-risk cohort was independently associated with a lower risk of the primary outcome (aHR 0.64 [95%CI, 0.51 - 0.80]), as well as in the CKD (aHR 0.51 [95%CI, 0.37 - 0.70]) and elderly subgroups (aHR 0.69 [95%CI, 0.53 - 0.90]). Overall, there was greater reduction in the risk of primary outcome as more ABC criteria were fulfilled, both in the overall high-risk patients (aHR 0.39 [95%CI, 0.25 - 0.61]), as well as in the individual subgroups. CONCLUSION In a large, contemporary cohort of patients with AF, we demonstrate that adherence to the ABC pathway was associated with a significant benefit among high-risk patients with either CKD, advanced age (≥75 years old) or prior thromboembolism.
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Affiliation(s)
- Wern Yew Ding
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Marco Proietti
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Translational and Precision Medicine, Sapienza - University of Rome, Italy
| | - Marco Vitolo
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Ameenathul Mazaya Fawzy
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Francisco Marin
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBERCV, Murcia, Spain
| | - Carina Blomström-Lundqvist
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Medical Science, Uppsala University, Uppsala, Sweden
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, Belgrade, Serbia; Intensive Arrhythmia Care, Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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Feeney M, Chur-Hansen A, Mikocka-Walus A. People Living with Inflammatory Bowel Disease Want Multidisciplinary Healthcare: A Qualitative Content Analysis. J Clin Psychol Med Settings 2022; 29:570-577. [PMID: 34185254 DOI: 10.1007/s10880-021-09801-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 12/20/2022]
Abstract
This study reports on the preferences of people with inflammatory bowel disease (IBD) for their healthcare. Overall, 477 people with IBD responded to an open-ended survey question within a larger study. We qualitatively content-analysed these responses with open coding using NVivo. Respondents expressed a desire for (1) better communication, (2) multidisciplinary care, (3) better treatment, services and specialist care, (4) whole person care, (5) health promotion, (6) proactive healthcare, (7) fewer administrative issues and (8) improved hospital experience. Patients with IBD want patient-centred, multidisciplinary care. Healthcare professionals should facilitate patients' access to proactive care.
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Affiliation(s)
- Meg Feeney
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, North Tce, SA, 5005, Australia
| | - Anna Chur-Hansen
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Antonina Mikocka-Walus
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, North Tce, SA, 5005, Australia.
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
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14
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Nana SD, Caffin JH, Duboz R, Antoine-Moussiaux N, Binot A, Diagbouga PS, Hendrikx P, Bordier M. Towards an integrated surveillance of zoonotic diseases in Burkina Faso: the case of anthrax. BMC Public Health 2022; 22:1535. [PMID: 35962327 PMCID: PMC9372945 DOI: 10.1186/s12889-022-13878-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background Anthrax is a zoonotic disease that causes frequent outbreaks in livestock and fatal human cases in Burkina Faso. Effective surveillance of this disease calls for the establishment of an integrated surveillance system, in line with the One Health concept. However, despite a strong technical and financial support from international partners, surveillance is still poorly conducted within an integrated approach. Based on stakeholder perspectives, the study has for objective to deepen our understanding of the anthrax surveillance system and to identify the obstacles and levers towards a more integrated approach to anthrax surveillance in Burkina Faso. Methods The data was collected from a literature review and interviews with surveillance stakeholders. We first conducted a qualitative descriptive analysis of the data to characterize the surveillance system (programmes, actors, collaboration). In a second step, we conducted a thematic analysis of the informants' discourse in order to identify what represents an obstacle or, conversely, a lever for a more integrated approach to anthrax surveillance. Results The surveillance system of anthrax in Burkina Faso includes three programmes (in the livestock, wildlife and human sectors), which involves 30 actors. These sectoral programmes operate almost independently from one another, although some collaborations are existing for the governance and implementation of surveillance activities. Analysis of the discourse of key stakeholders led to the identification of four categories of factors that may influence the implementation of an integrated surveillance system in the country: knowledge; technical, organizational and social capacities; motivation; intersectoral governance. Conclusions This study highlights the difficulty of translating One Health governance to the national level and the need to better articulate the visions of all categories of stakeholders. This study also reveals the need to develop specific evaluation systems for integrated policies in order to provide credible evidence of their added value for a better management of zoonotic diseases. Finally, our study underlines the need to act upstream the emergence of zoonoses and allocate more resources to the prevention of zoonoses than to their control. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13878-3.
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Affiliation(s)
- Sougrenoma Désiré Nana
- ASTRE, University of Montpellier, CIRAD, INRAE, Montpellier, France.,CIRAD, UMR ASTRE, Montpellier, France
| | | | - Raphaël Duboz
- ASTRE, University of Montpellier, CIRAD, INRAE, Montpellier, France.,CIRAD, UMR ASTRE, Dakar, Senegal.,IRD, Sorbonne University, UMMISCO, Bondy, France.,National Laboratory for Livestock and Veterinary Research, Senegalese Institute of Research in Agriculture, Dakar, Senegal
| | - Nicolas Antoine-Moussiaux
- Fundamental and Applied Research for Animals and Health Research Unit, Faculty of Veterinary Medicine, University of Liege, Liege, Belgium
| | - Aurélie Binot
- ASTRE, University of Montpellier, CIRAD, INRAE, Montpellier, France.,CIRAD, UMR ASTRE, Montpellier, France
| | - Potiandi Serge Diagbouga
- Research Institute of Health Sciences, Ouagadougou, Burkina Faso.,Etudes Formation Et Recherches Développement en Santé, Ouagadougou, Burkina Faso
| | - Pascal Hendrikx
- High Council for Food, Agriculture and Rural Areas, Paris, France
| | - Marion Bordier
- ASTRE, University of Montpellier, CIRAD, INRAE, Montpellier, France. .,CIRAD, UMR ASTRE, Dakar, Senegal. .,National Laboratory for Livestock and Veterinary Research, Senegalese Institute of Research in Agriculture, Dakar, Senegal.
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15
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Gracen L, Hayward KL, Aikebuse M, Russell A, O'Beirne J, McPhail S, Irvine KM, Williams S, Valery PC, Powell EE. Implementing the right care in the right place at the right time for non-alcoholic fatty liver disease (NAFLD-RRR study): a study protocol for a community care pathway for people with type 2 diabetes. BMC Health Serv Res 2022; 22:487. [PMID: 35413987 PMCID: PMC9004198 DOI: 10.1186/s12913-022-07808-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 02/06/2023] Open
Abstract
Background Non-alcoholic fatty liver disease (NAFLD) is an emerging epidemic that affects approximately half of all people with type 2 diabetes. Those with type 2 diabetes are a high-risk NAFLD subgroup because of their increased risk of clinically significant liver-related outcomes from NAFLD which include hepatocellular carcinoma, cirrhosis-related complications and liver disease mortality. They may benefit from early detection of disease as this would allow at risk patients to access hepatocellular carcinoma surveillance, emerging drug trials for NAFLD and specialist hepatology care prior to emergence of liver-related complications. Methods This is a prospective cohort study aimed at incorporating and assessing a community care pathway for liver fibrosis screening into routine care for type 2 diabetes. Patients undergo a point of care assessment of hepatic steatosis and stiffness using FibroScan at the time of the routine diabetes appointment or when attending the clinic for blood tests in preparation for this appointment. Discussion We propose that implementation of a community-based NAFLD diagnosis, risk-stratification, and referral pathway for people with type 2 diabetes is feasible, will provide earlier, targeted detection of advanced fibrosis, and reduce unnecessary referrals to hepatology outpatients for fibrosis risk assessment. Our study will provide important information about the feasibility of establishing a NAFLD pathway for people with type 2 diabetes in primary care. Ultimately, our findings will help direct spending and resource allocation for NAFLD in a high-risk population. Regular evaluation by stakeholders during implementation will help to create a reliable and sustainable community care pathway and establish a perpetual cycle of learning in primary care. Trial registration ANZCTR, ACTRN12621000330842. Registered 23 March 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07808-7.
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Affiliation(s)
- Lucy Gracen
- Centre for Liver Disease Research, Faculty of Medicine, Translational Research Institute, The University of Queensland, Level 5, West Wing, 37 Kent Street, Woolloongabba, Brisbane, QLD, 4102, Australia.,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Kelly L Hayward
- Centre for Liver Disease Research, Faculty of Medicine, Translational Research Institute, The University of Queensland, Level 5, West Wing, 37 Kent Street, Woolloongabba, Brisbane, QLD, 4102, Australia.,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Melanie Aikebuse
- Centre for Liver Disease Research, Faculty of Medicine, Translational Research Institute, The University of Queensland, Level 5, West Wing, 37 Kent Street, Woolloongabba, Brisbane, QLD, 4102, Australia.,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Anthony Russell
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia.,Department of Endocrinology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - James O'Beirne
- Department of Gastroenterology and Hepatology, Sunshine Coast University Hospital, Birtinya, QLD, Australia
| | - Steven McPhail
- Australian Centre for Health Services Innovation School of Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, QLD, Australia.,Digital Health and Informatics, Metro South Health, Brisbane, QLD, Australia
| | - Katharine M Irvine
- Mater Research, Translational Research Institute, Brisbane, QLD, Australia
| | | | - Patricia C Valery
- Centre for Liver Disease Research, Faculty of Medicine, Translational Research Institute, The University of Queensland, Level 5, West Wing, 37 Kent Street, Woolloongabba, Brisbane, QLD, 4102, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Elizabeth E Powell
- Centre for Liver Disease Research, Faculty of Medicine, Translational Research Institute, The University of Queensland, Level 5, West Wing, 37 Kent Street, Woolloongabba, Brisbane, QLD, 4102, Australia. .,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia.
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16
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Keane CA, Akhter MF, Sarac BA, Janis JE. Characteristics of Successful Integrated Plastic Surgery Applicants from US Allopathic Medical Schools without a Home Integrated Program. J Surg Educ 2022; 79:551-557. [PMID: 34840121 DOI: 10.1016/j.jsurg.2021.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/26/2021] [Accepted: 11/05/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Integrated plastic surgery (PS) is one of the most competitive residency programs, but current literature lacks data specific to matched applicants from medical schools without home integrated PS residency programs (NHP). Therefore, there is a need to examine this specific demographic of applicants to identify key factors that led to a successful match. DESIGN An anonymous survey was sent to PS residents who graduated from US allopathic medical schools with NHP. Survey questions focused on applicants' objective statistics (USMLE scores, research experiences, etc.), as well as various other factors, including access to resources and letters of recommendation. SETTING All US-based integrated plastic surgery residency programs. PARTICIPANTS PGY-1 through PGY-6 integrated PS residents who graduated from US allopathic medical schools with NHP. RESULTS The survey was distributed to 178 NHP residents from May to June of 2021, achieving a 55.1% response rate. Thirty-seven percent attended an institution with an independent, but not integrated, residency program. Average USMLE Step 1 and 2 scores were 248 ± 10.1 and 256 ± 9.7, respectively. Respondents reported having 9.8 ± 9.5 abstracts, presentations, and publications listed on their residency applications. NHP applicants had an average of 1.5 letters of recommendation written by away rotation faculty. Forty-five percent reported accessing resources at institutions with home integrated residency programs (HP), 55.6% of whom "strongly agreed" or "agreed" that this significantly helped in matching. CONCLUSION The USMLE Step scores and research experiences of NHP residents are similar to those which are reported among all matched applicants nationally. NHP respondents optimized their success by utilizing plastic surgery-related resources at their own institutions, while often seeking resources at other institutions.
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Affiliation(s)
- Charles A Keane
- Central Michigan University College of Medicine, Mount Pleasant, Michigan
| | - Maheen F Akhter
- Central Michigan University College of Medicine, Mount Pleasant, Michigan
| | - Benjamin A Sarac
- The Ohio State University, Department of Plastic and Reconstructive Surgery, Wexner Medical Center, Columbus, Ohio
| | - Jeffrey E Janis
- The Ohio State University, Department of Plastic and Reconstructive Surgery, Wexner Medical Center, Columbus, Ohio.
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17
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Dwivedi D, Santos ALD, Barnard MA, Crimmins TM, Malhotra A, Rod KA, Aho KS, Bell SM, Bomfim B, Brearley FQ, Cadillo‐Quiroz H, Chen J, Gough CM, Graham EB, Hakkenberg CR, Haygood L, Koren G, Lilleskov EA, Meredith LK, Naeher S, Nickerson ZL, Pourret O, Song H, Stahl M, Taş N, Vargas R, Weintraub‐Leff S. Biogeosciences Perspectives on Integrated, Coordinated, Open, Networked (ICON) Science. Earth Space Sci 2022; 9:e2021EA002119. [PMID: 35865637 PMCID: PMC9286804 DOI: 10.1029/2021ea002119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 06/15/2023]
Abstract
This article is composed of three independent commentaries about the state of Integrated, Coordinated, Open, Networked (ICON) principles in the American Geophysical Union Biogeosciences section, and discussion on the opportunities and challenges of adopting them. Each commentary focuses on a different topic: (a) Global collaboration, technology transfer, and application (Section 2), (b) Community engagement, community science, education, and stakeholder involvement (Section 3), and (c) Field, experimental, remote sensing, and real-time data research and application (Section 4). We discuss needs and strategies for implementing ICON and outline short- and long-term goals. The inclusion of global data and international community engagement are key to tackling grand challenges in biogeosciences. Although recent technological advances and growing open-access information across the world have enabled global collaborations to some extent, several barriers, ranging from technical to organizational to cultural, have remained in advancing interoperability and tangible scientific progress in biogeosciences. Overcoming these hurdles is necessary to address pressing large-scale research questions and applications in the biogeosciences, where ICON principles are essential. Here, we list several opportunities for ICON, including coordinated experimentation and field observations across global sites, that are ripe for implementation in biogeosciences as a means to scientific advancements and social progress.
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Affiliation(s)
- D. Dwivedi
- Earth and Environmental Sciences AreaLawrence Berkeley National LaboratoryBerkeleyCAUSA
| | - A. L. D. Santos
- Department of Environmental EngineeringFederal University of ParanáPolytechnic Center CampusCuritibaBrazil
| | - M. A. Barnard
- Institute of Marine SciencesUniversity of North Carolina at Chapel HillMorehead CityNCUSA
| | - T. M. Crimmins
- School of Natural Resources and the EnvironmentUSA National Phenology NetworkUniversity of ArizonaTucsonAZUSA
| | - A. Malhotra
- Department of Earth System ScienceStanford UniversityStanfordCAUSA
| | - K. A. Rod
- Earth and Biological Sciences DirectoratePacific Northwest National LaboratoryRichlandWAUSA
| | - K. S. Aho
- National Ecological Observatory NetworkBattelleBoulderCOUSA
| | - S. M. Bell
- Institute of Environmental Science and Technology (ICTA)Universitat Autònoma de Barcelona (UAB)BellaterraSpain
| | - B. Bomfim
- Climate and Ecosystems Sciences DivisionLawrence Berkeley National LaboratoryBerkeleyCAUSA
| | - F. Q. Brearley
- Department of Natural SciencesManchester Metropolitan UniversityManchesterUK
| | | | - J. Chen
- Department of Geography, Environment, and Spatial SciencesMichigan State UniversityEast LansingMIUSA
| | - C. M. Gough
- Department of BiologyVirginia Commonwealth UniversityRichmondVAUSA
| | - E. B. Graham
- Earth and Biological Sciences DirectoratePacific Northwest National LaboratoryRichlandWAUSA
- School of Biological SciencesWashington State UniversityRichlandWAUSA
| | - C. R. Hakkenberg
- School of Informatics, Computing & Cyber SystemsNorthern Arizona UniversityFlagstaffAZUSA
| | - L. Haygood
- Department of GeosciencesThe University of TulsaTulsaOKUSA
- Boone Pickens School of GeologyOklahoma State UniversityStillwaterOKUSA
| | - G. Koren
- Copernicus Institute of Sustainable DevelopmentUtrecht UniversityUtrechtThe Netherlands
| | | | - L. K. Meredith
- School of Natural Resources and the EnvironmentUniversity of ArizonaTucsonAZUSA
| | - S. Naeher
- Department of Surface GeosciencesGNS ScienceLower HuttNew Zealand
| | | | | | - H.‐S. Song
- Department of Biological Systems EngineeringUniversity of Nebraska–LincolnLincolnNEUSA
- Department of Food Science and TechnologyUniversity of Nebraska–LincolnLincolnNEUSA
| | - M. Stahl
- Department of GeosciencesUnion CollegeSchenectadyNYUSA
| | - N. Taş
- Earth and Environmental Sciences AreaLawrence Berkeley National LaboratoryBerkeleyCAUSA
| | - R. Vargas
- Department of Plant and Soil SciencesUniversity of DelawareNewarkDEUSA
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Sengupta S, Jacobson S, Williamson E. Straight on Through: the Current State of Child Tracks in Psychiatry Residency. Acad Psychiatry 2022; 46:65-69. [PMID: 31823305 DOI: 10.1007/s40596-019-01151-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 11/24/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The authors explore the advantages and disadvantages of 5-year integrated child and adolescent psychiatry tracks from the perspective of program directors. METHODS The authors surveyed via email the program directors of the 134 child and adolescent psychiatry training programs accredited by the Accreditation Council for Graduate Medical Education in the USA on their experiences with and perceptions of a formal child track. RESULTS The authors received 79 responses (60% response rate), including 13 (16%) with a child track, an increase from 7 programs in a survey completed 13 years ago. Of programs with a child track, a majority were created within the last 5 years. Out of an average postgraduate year 1 class size of nine, the most common child track size was two positions per year. Benefits cited for child tracks included improved recruitment, longitudinal retention, potential flexibility, scholarly productivity, and clinical benefits such as the foundation of a developmental perspective and improved integration of pediatrics and mental health. Of programs that do not have a track, more than half were strongly or very strongly considering one. CONCLUSIONS Child tracks have potential benefits for individual trainees, general psychiatry residency programs, and child and adolescent psychiatry fellowships. Additionally, long-term benefits to child mental health workforce recruitment and expansion are likely. The number of programs offering a child track has risen significantly over the last decade since the field was last surveyed, and this trend is likely to continue over the next decade.
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Affiliation(s)
- Sourav Sengupta
- University at Buffalo Jacobs School of Medicine, Buffalo, NY, USA.
| | - Sansea Jacobson
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Tay RY, Choo RWK, Ong WY, Hum AYM. Predictors of the final place of care of patients with advanced cancer receiving integrated home-based palliative care: a retrospective cohort study. BMC Palliat Care 2021; 20:164. [PMID: 34663303 DOI: 10.1186/s12904-021-00865-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/05/2021] [Indexed: 11/24/2022] Open
Abstract
Background Meeting patients’ preferences for place of care at the end-of-life is an indicator of quality palliative care. Understanding the key elements required for terminal care within an integrated model may inform policy and practice, and consequently increase the likelihood of meeting patients’ preferences. Hence, this study aimed to identify factors associated with the final place of care in patients with advanced cancer receiving integrated, home-based palliative care. Methods This retrospective cohort study included deceased adult patients with advanced cancer who were enrolled in the home-based palliative care service between January 2016 and December 2018. Patients with < 2 weeks’ enrollment in the home-based service, or ≤ 1-week duration at the final place of care, were excluded. The following information were retrieved from patients’ electronic medical records: patients’ and their families’ characteristics, care preferences, healthcare utilization, functional status (measured by the Palliative Performance Scale (PPSv2)), and symptom severity (measured by the Edmonton Symptom Assessment System). Multivariate logistic regression was employed to identify independent predictors of the final place of care. Kappa value was calculated to estimate the concordance between actual and preferred place of death. Results A total of 359 patients were included in the study. Home was the most common (58.2%) final place of care, followed by inpatient hospice (23.7%), and hospital (16.7%). Patients who were single or divorced (OR: 5.5; 95% CI: 1.1–27.8), or had older family caregivers (OR: 3.1; 95% CI: 1.1–8.8), PPSv2 score ≥ 40% (OR: 9.1; 95% CI: 3.3–24.8), pain score ≥ 2 (OR: 3.6; 95% CI: 1.3–9.8), and non-home death preference (OR: 23.8; 95% CI: 5.4–105.1), were more likely to receive terminal care in the inpatient hospice. Patients who were male (OR: 3.2; 95% CI: 1.0–9.9), or had PPSv2 score ≥ 40% (OR: 8.6; 95% CI: 2.9–26.0), pain score ≥ 2 (OR: 3.5; 95% CI: 1.2–10.3), and non-home death preference (OR: 9.8; 95% CI: 2.1–46.3), were more likely to be hospitalized. Goal-concordance was fair (72.6%, kappa = 0.39). Conclusions Higher functional status, greater pain intensity, and non-home death preference predicted institutionalization as the final place of care. Additionally, single or divorced patients with older family caregivers were more likely to receive terminal care in the inpatient hospice, while males were more likely to be hospitalized. Despite being part of an integrated care model, goal-concordance was sub-optimal. More comprehensive community networks and resources, enhanced pain control, and personalized care planning discussions, are recommended to better meet patients’ preferences for their final place of care. Future research could similarly examine factors associated with the final place of care in patients with advanced non-cancer conditions. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00865-5.
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Sengupta S. Engaging Pediatric Primary Care Clinicians in Collaborative and Integrated Care. Child Adolesc Psychiatr Clin N Am 2021; 30:767-776. [PMID: 34538447 DOI: 10.1016/j.chc.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Pediatric primary care clinicians (PPCCs) are managing increasing mental health challenges in the children and adolescents they treat. Child and adolescent psychiatrists (CAPs) are increasingly involved in collaborative and integrated care (CIC) work that builds the knowledge and skills of PPCCs to manage mild to moderate mental health challenges for children and adolescents in primary care. CAPs who can establish good working relationships, communicate clearly and efficiently, and facilitate the care of this population will be successful in engaging our PPCC partners in CIC.
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Affiliation(s)
- Sourav Sengupta
- Departments of Psychiatry & Pediatrics, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA; Children's Psychiatry Clinic of Oishei Children's Hospital, 1028 Main Street, Buffalo, NY 14202, USA.
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21
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Fu L, Wu C, Zuo J, Zhou Y, Yang J. Residual ozone in microorganisms enhanced organics removal and shaped microbial community. Chemosphere 2021; 278:130322. [PMID: 33831684 DOI: 10.1016/j.chemosphere.2021.130322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/06/2021] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
The residual ozone played an important role in enhancing the organics removal by stimulate subsequent biological processes. However, how the residual ozone affects the biological process is not well studied. In this work, a pilot scale integrated O3-BAF, ordinary BAF and separated O3-BAF were compared in advanced treatment of real bio-treated petrochemical wastewater. Results showed that residual ozone with 0.05-0.10 mg L-1 in the BAF demonstrated relatively high chemical oxygen demand (COD) removal efficiency of 48.4%, which was 1.5-fold higher than that obtained by separated O3-BAF and 3-fold higher than that obtained by ordinary BAF. The stimulative effect of low dosage of O3 on biological treatment additionally donated 33.9% of the COD removal in the BAF. The COD removal amount per dosage of ozone reached 5.30 mg-COD/mg-O3. The biofilm thickness in the integrated O3-BAF was reduced by 30-50% while the dehydrogenase activity (DHA) was improved by 500%, indicating the stimulate effect on the bioactivity. Additionally, Illumina HiSeq sequencing of 16S rRNA gene amplicons demonstrated significant microbial diversity decreasing. Specially, Gemmatimonadetes and Bacteroidetes are the dominate microorganism in the integrated O3-BAF, having a positive correlation with the proper residual ozone, and increased by 5.4% and 4.2% in comparison with the separated O3-BAF, respectively. The residual ozone higher than 0.22 mg L-1 showed inhibition effect on the bioactivity. In summary, the control of residual ozone introduced to BAF was crucial for stimulative effects and manager the microbial community in the integrated O3-BAF, which still need further detail research.
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Affiliation(s)
- Liya Fu
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing, 100012, China; Research Center of Environmental Pollution Control Engineering Technology, Chinese Research Academy of Environmental Sciences, Beijing, 100012, China; School of Environment, Tsinghua University, Beijing, 100084, China
| | - Changyong Wu
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing, 100012, China; Research Center of Environmental Pollution Control Engineering Technology, Chinese Research Academy of Environmental Sciences, Beijing, 100012, China.
| | - Jian'e Zuo
- Research Center of Environmental Pollution Control Engineering Technology, Chinese Research Academy of Environmental Sciences, Beijing, 100012, China
| | - Yuexi Zhou
- State Key Laboratory of Environmental Criteria and Risk Assessment, Chinese Research Academy of Environmental Sciences, Beijing, 100012, China; Research Center of Environmental Pollution Control Engineering Technology, Chinese Research Academy of Environmental Sciences, Beijing, 100012, China; School of Environment, Tsinghua University, Beijing, 100084, China.
| | - Jin Yang
- School of Chemical and Environmental Engineering, China University of Mining and Technology, Beijing, 100083, China
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22
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Lee RE, Parker NH, Hallett AM, Kao D, Modelska MJ, Rifai HS, Soltero EG, O'Connor DP. Stakeholder perspectives and sustainability of an integrated care model for the prevention and management of obesity: the Childhood Obesity Research Demonstration (CORD) project. Transl Behav Med 2021; 11:393-407. [PMID: 32667038 DOI: 10.1093/tbm/ibaa058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although reliable strategies exist to promote healthy habits that reduce childhood obesity, the sustainability of these strategies remains an ongoing public health challenge. This study aimed to identify factors experienced in a large, multisite project aimed at reducing childhood obesity that might contribute to project sustainability. Hypothesized constructs underpinning sustainability included replicability, continuation of benefits, institutionalization, and community capacity. Key informants (n = 27) completed 60 min, in-depth interviews, which were audio recorded and transcribed. Transcripts were first coded using a combined deductive and inductive approach. Four major themes emerged (with numerous subthemes): developing partnerships, challenges to the sustainability of implemented programming, the importance of intervening in multiple settings, and ongoing implementation and evaluation strategies. Replicability of complex childhood obesity interventions is possible when there are strong partnerships. Benefits can continue to be conferred from programming, particularly when evidence-based strategies are used that employ best practices. Implementation is facilitated by institutionalization and policies that buffer challenges, such as staffing or leadership changes. Community capacity both enhances the sustainability of interventions and develops as a result of strengthening partnerships and policies that support childhood obesity programming.
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Affiliation(s)
- Rebecca E Lee
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Nathan H Parker
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Allen M Hallett
- Department of Epidemiology, Human Genetics and Environmental Sciences, Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health in Austin, Austin, TX, USA
| | - Dennis Kao
- School of Social Work, Carleton University, Ottawa, Ontario, Canada
| | - Maria J Modelska
- Department of Civil and Environmental Engineering, Cullen College of Engineering, University of Houston, Houston, TX, USA
| | - Hanadi S Rifai
- Department of Civil and Environmental Engineering, Cullen College of Engineering, University of Houston, Houston, TX, USA
| | - Erica G Soltero
- Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Houston, TX, USA
| | - Daniel P O'Connor
- Department of Health and Human Performance, HEALTH Research Institute, University of Houston, Houston, TX, USA
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Yazdani AT, Muhammad A, Nisar MI, Khan U, Shafiq Y. Unveiling and addressing implementation barriers to routine immunization in the peri-urban slums of Karachi, Pakistan: a mixed-methods study. Health Res Policy Syst 2021; 19:55. [PMID: 34380526 PMCID: PMC8356369 DOI: 10.1186/s12961-021-00691-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Great disparities in immunization coverage exist in Pakistan between urban and rural areas. However, coverage estimates for large peri-urban slums in Sindh are largely unknown and implementation challenges remain unexplored. This study explores key supply- and demand-side immunization barriers in peri-urban slums, as well as strategies to address them. It also assesses immunization coverage in the target slums. METHODS Conducted in four peri-urban slums in Karachi, this mixed-methods study consists of a baseline cross-sectional coverage survey of a representative sample of 840 caregivers of children aged 12-23 months, and 155 in-depth interviews (IDIs) through purposive sampling of respondents (caregivers, community influencers and immunization staff). After identifying the barriers, a further six IDIs were then conducted with immunization policy-makers and policy influencers to determine strategies to address these barriers, resulting in the development of an original validated implementation framework for immunization in peri-urban slums. A thematic analysis approach was applied to qualitative data. RESULTS The survey revealed 49% of children were fully vaccinated, 43% were partially vaccinated and 8% were unvaccinated. Demand-side immunization barriers included household barriers, lack of knowledge and awareness, misconceptions and fears regarding vaccines and social and religious barriers. Supply-side barriers included underperformance of staff, inefficient utilization of funds, unreliable immunization and household data and interference of polio campaigns with immunization. The implementation framework's policy recommendations to address these barriers include: (1) improved human resource management; (2) staff training on counselling; (3) re-allocation of funds towards incentives, outreach, salaries and infrastructure; (4) a digital platform integrating birth registry and vaccination tracking systems for monitoring and reporting by frontline staff; (5) use of digital platform for immunization targets and generating dose reminders; and (6) mutual sharing of resources and data between the immunization, Lady Health Worker and polio programmes for improved coverage. CONCLUSIONS The implementation framework is underpinned by the study of uncharted immunization barriers in complex peri-urban slums, and can be used by implementers in Pakistan and other developing countries to improve immunization programmes in limited-resource settings, with possible application at a larger scale. In particular, a digital platform integrating vaccination tracking and birth registry data can be expanded for nationwide use.
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Affiliation(s)
- Amna Tanweer Yazdani
- VITAL Pakistan Trust, Karachi, Pakistan. .,Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
| | | | - Muhammad Imran Nisar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Uzma Khan
- VITAL Pakistan Trust, Karachi, Pakistan
| | - Yasir Shafiq
- VITAL Pakistan Trust, Karachi, Pakistan.,Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
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Abstract
It is essential that medical education should be equally representative of our society and subsequently the population that we will be serving as practicing physicians. As doctors, we have a duty of care to all members of our community. To align with these values, medical teaching should prepare future physicians to be able to treat patients from all backgrounds and ethnicities. After reflecting on medical education in the current global climate it is evident that there is unfortunately still a lack of ethnically diverse examples of clinical case presentations in medical education resources. This leads to students being ill-prepared in diagnosing certain illnesses in BAME patients which could result in a delay of treatment. It also causes BAME medical students to feel less included and acknowledged in the medical curriculum and can manifest in feelings of isolation and reduced self-worth.
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Affiliation(s)
- Simran Bedi
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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25
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Reyes Alcázar V, Carrillo Murcia I, Mira Solves JJ; Grupo de expertos. Definición de indicadores para una atención centrada en el paciente diabético tipo II. Estudio de consenso. J Healthc Qual Res 2021:S2603-6479(21)00053-1. [PMID: 34253506 DOI: 10.1016/j.jhqr.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/17/2021] [Accepted: 05/23/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Define a minimum set of indicators for person-focused-care applying for type 2 diabetes mellitus (DM2), as a complementary metric to current clinical-healthcare indicators. METHODS Qualitative consensus-building study (involving professionals and patients) structured in three stages: Metaplan to capture information, Delphi to agree on criteria and indicators, and consensus conference to ensure feasibility and relevance of the proposal. RESULTS Consensus was reached on a total of nine indicators upon: shared decision-making, self-care, adherence, renal function screening, activities of daily living, individualized therapeutic plan, vascular risk assessment, working life and human treatment. These indicators were grouped into three dimensions: the person with oneself, the person with one's family, and the person with the health system. CONCLUSIONS These indicators make it possible to establish alternative metrics to determine the degree of progress in a person-centered attention in case of DM2.
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26
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Yu R, Zhu X, Bai X, Tian Z, Jiang Y, Yang G. Inversion reflectance by apple tree canopy ground and unmanned aerial vehicle integrated remote sensing data. J Plant Res 2021; 134:729-736. [PMID: 33590370 DOI: 10.1007/s10265-020-01249-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 12/24/2020] [Indexed: 06/12/2023]
Abstract
To obtain accurate spatially continuous reflectance from Unmanned Aerial Vehicle (UAV) remote sensing, UAV data needs to be integrated with the data on the ground. Here, we tested accuracy of two methods to inverse reflectance, Ground-UAV-Linear Spectral Mixture Model (G-UAV-LSMM) and Minimum Noise Fraction-Pixel Purity Index-Linear Spectral Mixture Model (MNF-PPI-LSMM). At wavelengths of 550, 660, 735 and 790 nm, which were obtained by UAV multispectral observations, we calculated the canopy abundance based on the two methods to acquire the inversion reflectance. The correlation of the inversion and measured reflectance values was stronger in G-UAV-LSMM than MNF-PPI-LSMM. We conclude that G-UAV-LSMM is the better model to obtain the canopy inversion reflectance.
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Affiliation(s)
- Ruiyang Yu
- College of Resources and Environment, Shandong Agricultural University, Tai'an, 271018, China
| | - Xicun Zhu
- College of Resources and Environment, Shandong Agricultural University, Tai'an, 271018, China.
- National Engineering Laboratory for Efficient Utilization of Soil and Fertilizer Resources, College of Resources and Environment, Shandong Agricultural University, Tai'an, 271018, China.
| | - Xueyuan Bai
- College of Resources and Environment, Shandong Agricultural University, Tai'an, 271018, China
| | - Zhongyu Tian
- College of Resources and Environment, Shandong Agricultural University, Tai'an, 271018, China
| | - Yuanmao Jiang
- College of Horticulture Science and Engineering, National Apple Engineering and Technology Research Center, Shandong Agricultural University, Tai'an, 271018, China
| | - Guijun Yang
- National Engineering Research Center for Information Technology in Agriculture, Beijing, 100097, China
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Siqeca F, Obas K, Yip O, Stenz S, Vounatsou P, Briel M, Schwenkglenks M, Quinto C, Blozik E, Zeller A, Zullig LL, De Geest S, Deschodt M. The INSPIRE Population Survey: development, dissemination and respondent characteristics. BMC Med Res Methodol 2021; 21:131. [PMID: 34162324 PMCID: PMC8223353 DOI: 10.1186/s12874-021-01329-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/20/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Most older adults prefer to continue living at home despite increasing care needs and demand for services. To aid in maintaining independence, integrated care models for community-dwelling older people are promoted as the most cost-effective approach. The implementation of such care models is challenging and often the end-users are not involved or their needs are not considered. We conducted a population survey in order to understand the needs and preferences of home-dwelling older adults living in Canton Basel-Landschaft, Switzerland. The aims of this paper are to chronicle the development of the INSPIRE Population Survey, outline its variables and measurements, describe the marketing strategy utilized for survey dissemination and report on the response rate and respondent characteristics. METHODS The INSPIRE Population Survey, conducted between March and August 2019, is a cross-sectional survey of older adults aged 75 and older living at home in Canton Basel-Landschaft. The questionnaire was developed by expert input and stakeholder involvement. Its readability and acceptability were pilot-tested with older people. To ensure the likelihood of a high and representative response rate, a meticulous step-by-step marketing strategy was developed prior to the dissemination of the questionnaire. RESULTS The overall response rate was 30.7% (n = 8,846), with variations between 20.6 and 34.5% across the different care regions in the canton. A generally higher response rate was found in the care regions with a higher density and which bordered the urban city of Basel. We received support from local stakeholders, policy makers and media through using a broad combination of marketing channels and targeting our community partners who have a strong relationship with our target audience. CONCLUSIONS Although recruiting older adults in research is challenging, our study shows that a high response rate can be achieved by developing the survey through expert input and by involving all important stakeholders, including older adults, throughout the entire process.
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Affiliation(s)
- Flaka Siqeca
- Department Public Health, Institute of Nursing Science, University of Basel, 4051, Basel, Switzerland
| | - Katrina Obas
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, 4051, Basel, Switzerland
| | - Olivia Yip
- Department Public Health, Institute of Nursing Science, University of Basel, 4051, Basel, Switzerland
| | - Samuel Stenz
- Department Public Health, Institute of Nursing Science, University of Basel, 4051, Basel, Switzerland
| | - Penelope Vounatsou
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, 4051, Basel, Switzerland
| | - Matthias Briel
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, 4051, Basel, Switzerland
| | - Matthias Schwenkglenks
- Department Public Health, Institute of Pharmaceutical Medicine (ECPM), University of Basel, 4051, Basel, Switzerland
| | - Carlos Quinto
- Aerztegesellschaft Baselland, 4132, Muttenz, Switzerland
| | - Eva Blozik
- Helsana-Gruppe, 8001, Zürich, Switzerland
| | - Andreas Zeller
- Department Clinical Research, Center for Primary Health Care, University of Basel, 4051, Basel, Switzerland
| | - Leah L Zullig
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, 27701, USA
| | - Sabina De Geest
- Department Public Health, Institute of Nursing Science, University of Basel, 4051, Basel, Switzerland.
| | - Mieke Deschodt
- Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, 3000, Leuven, Belgium
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Masetti V, Hadj-Henni L, Rouger G, Ben Bacha M, Kechid L. Establishment of a multimodal protocol combining a motivational interview, subcutaneous injection of NicoSan® and hyper-hydration for the "stopsmoking therapy": A multicentre real-life study'. Encephale 2021; 47:518-532. [PMID: 34148643 DOI: 10.1016/j.encep.2021.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/03/2021] [Accepted: 02/24/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The StopSmoking Therapy, combins a motivational interview, a subcutaneous injection of NicoSan® and a hyperhydration protocol. The objectives were to evaluate the number of patients declaring cessation and factors related to relapse. METHODS In the 18 months following protocol, 554 subjects who consented, responded to the study's questionnaire. Categorical variables are presented as the frequency and percentage, continuous variables are presented as the mean and standard deviation, responses of abstinent subjects and of those who had started smoking again are compared via the chi-square test for categorical variables, and the Student's t-test for continuous variables. RESULTS In our sample 92.8% of the subjects reported smoking for 10 years or more. A total of 475 subjects (85.7%) reported a complete cessation (31.2% for more than 6 months and 33.1% for more than a year). Among relapsing subjects, were significantly over-represented: youngest ages, lower motivation, more frequent close friends or family using tobacco, lower dependency scores. No subject reported any significant adverse effects. CONCLUSION The multimodal protocol explored seems to have a favorable impact on smoking cessation, which could be enhanced by additional interventions dedicated to the youngest age groups, to people having smoking close friends and family, and should possibly add interventions based on cognitive behavioral therapy. A dedicated support by specialist tobacco addiction in the first weeks after treatment and/or the use of mobile support applications could also be useful. In order to asses efficacy, a prospective randomized double blind controlled versus placebo protocol could be considered.
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Affiliation(s)
- V Masetti
- Clinea Psychiatrie, 2, Rue Jean Jaurès, 92800 Puteaux, France.
| | - L Hadj-Henni
- Clinique Pole de Santé du Plateau, 5-7, 9, Rue des Carnets, 92140 Clamart, France
| | - G Rouger
- Clinique Castelviel-Pays d'Oc, Chemin des Affieux, Lieudit Castelviel, 31180 Castelmaurou, France
| | - M Ben Bacha
- Clinique de l'Alliance, 3, Voie de l'Orchidée Sauvage, 93420 Villepinte, France
| | - L Kechid
- Clinique de l'Alliance, 3, Voie de l'Orchidée Sauvage, 93420 Villepinte, France
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Yousef M, Goy G, Mitra R, Eischen CM, Jabeer A, Bakir-Gungor B. miRcorrNet: machine learning-based integration of miRNA and mRNA expression profiles, combined with feature grouping and ranking. PeerJ 2021; 9:e11458. [PMID: 34055490 PMCID: PMC8140596 DOI: 10.7717/peerj.11458] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 04/25/2021] [Indexed: 11/20/2022] Open
Abstract
A better understanding of disease development and progression mechanisms at the molecular level is critical both for the diagnosis of a disease and for the development of therapeutic approaches. The advancements in high throughput technologies allowed to generate mRNA and microRNA (miRNA) expression profiles; and the integrative analysis of these profiles allowed to uncover the functional effects of RNA expression in complex diseases, such as cancer. Several researches attempt to integrate miRNA and mRNA expression profiles using statistical methods such as Pearson correlation, and then combine it with enrichment analysis. In this study, we developed a novel tool called miRcorrNet, which performs machine learning-based integration to analyze miRNA and mRNA gene expression profiles. miRcorrNet groups mRNAs based on their correlation to miRNA expression levels and hence it generates groups of target genes associated with each miRNA. Then, these groups are subject to a rank function for classification. We have evaluated our tool using miRNA and mRNA expression profiling data downloaded from The Cancer Genome Atlas (TCGA), and performed comparative evaluation with existing tools. In our experiments we show that miRcorrNet performs as good as other tools in terms of accuracy (reaching more than 95% AUC value). Additionally, miRcorrNet includes ranking steps to separate two classes, namely case and control, which is not available in other tools. We have also evaluated the performance of miRcorrNet using a completely independent dataset. Moreover, we conducted a comprehensive literature search to explore the biological functions of the identified miRNAs. We have validated our significantly identified miRNA groups against known databases, which yielded about 90% accuracy. Our results suggest that miRcorrNet is able to accurately prioritize pan-cancer regulating high-confidence miRNAs. miRcorrNet tool and all other supplementary files are available at https://github.com/malikyousef/miRcorrNet.
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Affiliation(s)
- Malik Yousef
- Galilee Digital Health Research Center (GDH), Zefat Academic College, Zefat, Israel.,Department of Information Systems, Zefat Academic College, Zefat, Israel
| | - Gokhan Goy
- Department of Computer Engineering, Abdullah Gül University, Kayseri, Turkey
| | - Ramkrishna Mitra
- Department of Cancer Biology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christine M Eischen
- Department of Cancer Biology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Amhar Jabeer
- Department of Computer Engineering, Abdullah Gül University, Kayseri, Turkey
| | - Burcu Bakir-Gungor
- Department of Computer Engineering, Abdullah Gül University, Kayseri, Turkey
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30
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Caudeville J, Regrain C, Tognet F, Bonnard R, Guedda M, Brochot C, Beauchamp M, Letinois L, Malherbe L, Marliere F, Lestremau F, Chardon K, Bach V, Zeman FA. Characterizing environmental geographic inequalities using an integrated exposure assessment. Environ Health 2021; 20:58. [PMID: 33980260 PMCID: PMC8117491 DOI: 10.1186/s12940-021-00736-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/25/2021] [Indexed: 05/16/2023]
Abstract
BACKGROUND At a regional or continental scale, the characterization of environmental health inequities (EHI) expresses the idea that populations are not equal in the face of pollution. It implies an analysis be conducted in order to identify and manage the areas at risk of overexposure where an increasing risk to human health is suspected. The development of methods is a prerequisite for implementing public health activities aimed at protecting populations. METHODS This paper presents the methodological framework developed by INERIS (French National Institute for Industrial Environment and Risks) to identify a common framework for a structured and operationalized assessment of human exposure. An integrated exposure assessment approach has been developed to integrate the multiplicity of exposure pathways from various sources, through a series of models enabling the final exposure of a population to be defined. RESULTS Measured data from environmental networks reflecting the actual contamination of the environment are used to gauge the population's exposure. Sophisticated methods of spatial analysis are applied to include additional information and take benefit of spatial and inter-variable correlation to improve data representativeness and characterize the associated uncertainty. Integrated approaches bring together all the information available for assessing the source-to-human-dose continuum using a Geographic Information System, multimedia exposure and toxicokinetic model. DISCUSSION One of the objectives of the integrated approach was to demonstrate the feasibility of building complex realistic exposure scenarios satisfying the needs of stakeholders and the accuracy of the modelling predictions at a fine spatial-temporal resolution. A case study is presented to provide a specific application of the proposed framework and how the results could be used to identify an overexposed population. CONCLUSION This framework could be used for many purposes, such as mapping EHI, identifying vulnerable populations and providing determinants of exposure to manage and plan remedial actions and to assess the spatial relationships between health and the environment to identify factors that influence the variability of disease patterns.
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Affiliation(s)
- Julien Caudeville
- Institut National de l'Environnement Industriel et des Risques (INERIS), Parc ALATA BP2, 60550, Verneuil en Halatte, France.
- PériTox, UMR_I 01, CURS, Université de Picardie Jules Verne, Chemin du Thil, 80025, Amiens, France.
| | - Corentin Regrain
- Institut National de l'Environnement Industriel et des Risques (INERIS), Parc ALATA BP2, 60550, Verneuil en Halatte, France
- PériTox, UMR_I 01, CURS, Université de Picardie Jules Verne, Chemin du Thil, 80025, Amiens, France
- LAMFA, UMR CNRS 7352, Université de Picardie Jules Verne, 33 rue Saint-Leu, 80039, Amiens, France
| | - Frederic Tognet
- Institut National de l'Environnement Industriel et des Risques (INERIS), Parc ALATA BP2, 60550, Verneuil en Halatte, France
| | - Roseline Bonnard
- Institut National de l'Environnement Industriel et des Risques (INERIS), Parc ALATA BP2, 60550, Verneuil en Halatte, France
| | - Mohammed Guedda
- LAMFA, UMR CNRS 7352, Université de Picardie Jules Verne, 33 rue Saint-Leu, 80039, Amiens, France
| | - Celine Brochot
- Institut National de l'Environnement Industriel et des Risques (INERIS), Parc ALATA BP2, 60550, Verneuil en Halatte, France
| | - Maxime Beauchamp
- Institut National de l'Environnement Industriel et des Risques (INERIS), Parc ALATA BP2, 60550, Verneuil en Halatte, France
| | - Laurent Letinois
- Institut National de l'Environnement Industriel et des Risques (INERIS), Parc ALATA BP2, 60550, Verneuil en Halatte, France
| | - Laure Malherbe
- Institut National de l'Environnement Industriel et des Risques (INERIS), Parc ALATA BP2, 60550, Verneuil en Halatte, France
| | - Fabrice Marliere
- Institut National de l'Environnement Industriel et des Risques (INERIS), Parc ALATA BP2, 60550, Verneuil en Halatte, France
| | - Francois Lestremau
- Institut National de l'Environnement Industriel et des Risques (INERIS), Parc ALATA BP2, 60550, Verneuil en Halatte, France
| | - Karen Chardon
- PériTox, UMR_I 01, CURS, Université de Picardie Jules Verne, Chemin du Thil, 80025, Amiens, France
| | - Veronique Bach
- PériTox, UMR_I 01, CURS, Université de Picardie Jules Verne, Chemin du Thil, 80025, Amiens, France
| | - Florence Anna Zeman
- Institut National de l'Environnement Industriel et des Risques (INERIS), Parc ALATA BP2, 60550, Verneuil en Halatte, France
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Kline AC, Panza KE, Harlé KM, Angkaw AC, Trim RS, Back SE, Norman SB. Within-treatment clinical markers of dropout risk in integrated treatments for comorbid PTSD and alcohol use disorder. Drug Alcohol Depend 2021; 221:108592. [PMID: 33618193 DOI: 10.1016/j.drugalcdep.2021.108592] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Integrated interventions for comorbid posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) are effective, but many patients prematurely drop out from treatment. Little is known about within-treatment risk factors for dropout, limiting the ability during therapy to identify patients at risk for attrition. METHODS We examined measures assessing PTSD (PTSD Checklist for DSM-5; PCL-5), alcohol use (Substance Use Inventory; SUI), and patient satisfaction (Client Satisfaction Questionnaire; CSQ-8) as potential within-treatment markers of dropout risk, administered to 110 veterans in a randomized clinical trial of integrated exposure therapy versus integrated coping skills therapy for comorbid PTSD + AUD. Hierarchical Cox proportional hazard models with dropout status as the endpoint assessed effects of PCL-5, SUI, and CSQ-8 on dropout risk, and whether effects differed by treatment modality. RESULTS A significant interaction between treatment and changes in alcohol use was observed (HR = 2.86, p = .007), where between-session alcohol use was positively associated with dropout hazard rate for those receiving integrated exposure therapy (HR = 2.34, p = .004), but not coping skills therapy (HR = 0.73, p = .19). Specifically, an increase of one drink consumed per day in the interval since last assessment (typically 2-3 weeks) was associated with a 5-fold increase in dropout hazard rate. CONCLUSIONS The findings provide preliminary evidence of detectable within-treatment markers of dropout during integrated treatment for PTSD + AUD. Study of within-treatment indicators proximal to dropout may help identify at-risk patients and inform timely strategies to boost retention.
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Affiliation(s)
- Alexander C Kline
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
| | - Kaitlyn E Panza
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Katia M Harlé
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Abigail C Angkaw
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA; National Center for Posttraumatic Stress Disorder, 163 Veterans Dr, White River Junction, VT, 05009, USA
| | - Ryan S Trim
- VA San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Sudie E Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 171 Ashley Ave, Charleston, SC, 29425, USA; Ralph H. Johnson Veteran Affairs Medical Center, 109 Bee St, Charleston, SC, 29401, USA
| | - Sonya B Norman
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA; National Center for Posttraumatic Stress Disorder, 163 Veterans Dr, White River Junction, VT, 05009, USA
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Paulus DJ, Gallagher MW, Neighbors C, Zvolensky MJ. Computer-delivered personalized feedback intervention for hazardous drinkers with elevated anxiety sensitivity: A pilot randomized controlled trial. Behav Res Ther 2021; 141:103847. [PMID: 33813352 DOI: 10.1016/j.brat.2021.103847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/05/2020] [Accepted: 03/15/2021] [Indexed: 12/29/2022]
Abstract
Hazardous drinkers with emotional vulnerabilities (e.g., elevated anxiety sensitivity) remain an underserved group. This study aimed to evaluate the feasibility, acceptability, and initial efficacy of a single session remotely-delivered personalized feedback intervention (PFI) targeting alcohol (mis)use and anxiety sensitivity among college students. Hazardous drinkers with elevated anxiety sensitivity (N = 125; 76.8% female; Mage = 22.14; 66.4% racial/ethnic minorities) were randomized to receive the integrated PFI (n = 63) or attention control (n = 62). Follow-up assessments were conducted one-week, one-month and three-months post-intervention. Latent growth curve modeling was used to test pilot outcomes. It was feasible to recruit and retain hazardous drinking students with elevated anxiety sensitivity through follow-up with no group differences in retention. The integrated PFI was rated as more acceptable than the control with medium/large differences (p's < 0.004; d's = 0.54-0.80). The integrated PFI group had statistically significantly greater change in primary outcomes: motivation, hazardous alcohol use, and anxiety sensitivity (p's < 0.05; d's = 0.08-0.37) with larger within-group effect sizes (d's = 0.48-0.61) than in control (d's = 0.26-0.54). Despite a small sample size, this one-session intervention offers promise among a high-risk group of drinkers with emotional vulnerabilities. The computer-based format may allow for mass distribution of a low-cost intervention in the future; however, follow-up testing in larger samples is needed.
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Affiliation(s)
- Daniel J Paulus
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, PA, 15213, USA.
| | - Matthew W Gallagher
- University of Houston, Department of Psychology, Houston, TX, 77204, USA; University of Houston, Texas Institute for Measurement, Evaluation, and Statistics, Houston, TX, 77204, USA
| | - Clayton Neighbors
- University of Houston, Department of Psychology, Houston, TX, 77204, USA
| | - Michael J Zvolensky
- University of Houston, Department of Psychology, Houston, TX, 77204, USA; The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, TX, 77030, USA; Health Institute, University of Houston, Houston, TX, 77204, USA
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Ajwani S, Ferguson C, Kong AC, Villarosa AR, George A. Patient perceptions of oral health care following stroke: a qualitative study. BMC Oral Health 2021; 21:127. [PMID: 33731086 PMCID: PMC7968245 DOI: 10.1186/s12903-021-01501-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stroke is a serious cerebrovascular disease and is one of the world's leading causes of disability. Maintaining good oral health is a challenge among those hospitalised after stroke. A multidisciplinary approach to oral care involving non-dental professionals can be beneficial in improving oral health outcomes for patients. The aim of this study was to understand the perceptions of stroke survivors regarding oral healthcare across acute and rehabilitation settings. METHODS A descriptive qualitative approach was used. Face-to-face semi-structured interviews were conducted. A framework analysis was employed to analyse the data. Patients who had recently experienced a stroke were purposively recruited across both acute and rehabilitation settings, at two metropolitan hospitals in Sydney, Australia. In total, 11 patients were interviewed. RESULTS Although participants recognised the importance of oral health, few understood the link between oral and general health. Regular oral hygiene practices varied since having stroke, with a few receiving oral care assistance from nurses. Time, cost and lack of information were some barriers to accessing dental services, while supportive measures such as coordination of oral care, financial subsidy and nurse assistance were strategies proposed to support oral care practices amongst stroke survivors. CONCLUSIONS There is scope to improve current models of oral care in stroke. While stroke survivors understand the importance of oral care, an integrated oral health model with a multidisciplinary approach could improve health outcomes.
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Affiliation(s)
- Shilpi Ajwani
- Oral Health Promotion and Oral Health Research, Sydney Local Health District Oral Health Services/Sydney Dental Hospital/University of Sydney, Sydney, 2010, Australia
| | - Caleb Ferguson
- Heart Foundation Postdoctoral Fellow, Western Sydney Nursing and Midwifery Research Centre, Western Sydney University/Western Sydney Local Health District/Centre for Oral Health Outcomes and Research Translation (COHORT)/Ingham Institute for Applied Medical Research/Translational Health Research Institute (THRI) Blacktown Clinical and Research School Blacktown Hospital, Marcel Crescent, Blacktown, NSW, 2148, Australia
| | - Ariana C Kong
- Centre for Oral Health Outcomes and Research Translation (COHORT), South Western Sydney Local Health District/Ingham Institute for Applied Medical Research, Western Sydney University, Liverpool, NSW, 2170, Australia
| | - Amy R Villarosa
- Centre for Oral Health Outcomes and Research Translation (COHORT), South Western Sydney Local Health District/Ingham Institute for Applied Medical Research, Western Sydney University, Liverpool, NSW, 2170, Australia
| | - Ajesh George
- Centre for Oral Health Outcomes and Research Translation (COHORT), South Western Sydney Local Health District/Ingham Institute for Applied Medical Research/Translational Health Research Institute/University of Sydney, Western Sydney University, Liverpool, NSW, 2170, Australia.
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Hansen RN, Nørgaard LS, Hedegaard U, Søndergaard L, Servilieri K, Bendixen S, Rossing C. Integration of and visions for community pharmacy in primary health care in Denmark. Pharm Pract (Granada) 2021; 19:2212. [PMID: 33520039 PMCID: PMC7844971 DOI: 10.18549/pharmpract.2021.1.2212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In 2014, the Danish government launched a plan for health entitled: "Healthier lives for everyone - national goals for the health of Danes within the next 10 years". The overall objective is to prolong healthy years of life and to reduce inequality in health. In Denmark, the responsibility for health and social care is shared between the central government, the regions and the municipalities. National and local strategies seek to enhance public health through national and local initiatives initiated by different stakeholders. The Danish community pharmacies also contribute to promoting public health through distribution of and counselling on medication in the entire country and through offering several pharmacy services, six of which are fully or partly remunerated on a national level. Because of greater demands from patients, health care professionals and society and a lack of general practitioners, the Danish community pharmacies now have the opportunity to suggest several new functions and services or to extend existing services. The Danish pharmacy law changed in 2015 with the objective to maintain and develop community pharmacies and to achieve increased patient accessibility. The change in the law made it possible for every community pharmacy owner to open a maximum of seven pharmacy branches (apart from the main pharmacy) in a range of 75 km. This change also increased the competition between community pharmacies and consequently the pharmacies are now under financial pressure. On the other hand, each pharmacy may have been given an incentive to develop their specific pharmacy and become the best pharmacy for the patients. Community pharmacies are working to be seen as partners in the health care system. This role is in Denmark increasingly being supported by the government through the remunerated pharmacy services and through contract with municipalities. Concurrent with the extended tasks for the Danish community pharmacies and utilisation of their excellent competencies in medication the community pharmacies need to focus on their main tasks of supplying medicines and implementing services. This requires efficient management, an increased use of technology for distribution and communication and continuing education and training.
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Affiliation(s)
- Rikke N Hansen
- MSc (Pharmacy). Head of Department of Research and Development, Danish College of Pharmacy Practice. Hillerød (Denmark).
| | - Lotte S Nørgaard
- PhD (Pharmacy). Associate Professor. University of Copenhagen. Copenhagen (Denmark).
| | - Ulla Hedegaard
- PhD (Pharmacy). Associate Professor. University of Southern Denmark. Odense (Denmark).
| | - Lone Søndergaard
- MSc (Pharmacy). Deputy manager, Aarhus Viby Pharmacy. Aarhus (Denmark).
| | - Kerly Servilieri
- MSc (Pharmacy). Pharmacy owner Kløver Pharmacy. Brædstrup (Denmark).
| | - Susanne Bendixen
- MSc (Pharmacy). Pharmacy owner, Copenhagen Sønderbro Pharmacy, Sydhavns Pharmacy, Sluseholmen Pharmacy. Copenhagen (Denmark).
| | - Charlotte Rossing
- PhD (Pharmacy), Director of Department of Research and Development, Danish College of Pharmacy Practice. Hillerød (Denmark).
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Abstract
Germany is the highest populated country in Europe with a population of 82.3 million in 2019. As in many other developed countries, it has an aging population. Approximately 10% of the gross domestic product is spent on healthcare. The healthcare system is characterized by its accessibility. Patients are generally free to choose their primary care physicians, both family doctors and specialists, pharmacy, dentist, or emergency service. Up to a certain income, health insurance is mandatory with the statutory health insurance (SHI) system, covering 88% of the population. Major challenges are the lack of cooperation and integration between the different sectors and healthcare providers. This is expected to change with the introduction of a telematic infrastructure that is currently being implemented. It will not only connect all providers in primary and secondary care in a secure network but will also enable access to patients' electronic record/medical data and at the same time switch from paper to electronic prescriptions. Approximately 52,000 of the 67,000 pharmacists are working in approximately 19,000 community pharmacies. These pharmacies are owner-operated by a pharmacist. Pharmacists may own up to three subsidiaries nearby to their main pharmacy. Community pharmacy practice mainly consists of dispensing drugs, counselling patients on drug therapy and safety, and giving advice on lifestyle and healthy living. Many cognitive pharmaceutical services have been developed and evaluated in the past 20 years. Discussions within the profession and with stakeholders on the national level on the roles and responsibilities of pharmacists have resulted in nationally agreed guidelines, curricula, and services. However, cognitive services remunerated by the SHI funds on the national level remain to be negotiated and sustainably implemented. A law passed in November 2020 by parliament will regulate the remuneration of pharmaceutical services by the SHI funds with an annual budget of EUR 150 million. The type of services and their remuneration remain to be negotiated in 2021. The profession has to continue on all levels to advocate for a change in pharmacy practice by introducing pharmacy services into routine care.
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Affiliation(s)
- Christiane Eickhoff
- RPh, PhD. Division Scientific Development, Department of Medicine, Federal Union of German Associations of Pharmacists (ABDA). Berlin (Germany).
| | - Nina Griese-Mammen
- RPh, PhD. Head, Division Scientific Evaluation, Department of Medicine, Federal Union of German Associations of Pharmacists (ABDA). Berlin (Germany).
| | - Uta Müeller
- RPh, PhD. Head, Division Scientific Development. Department of Medicine, Federal Union of German Associations of Pharmacists (ABDA). Berlin (Germany).
| | - André Said
- RPh, PhD. Head, Office of the Drug Commission of German Pharmacists, Department of Medicine, Federal Union of German Associations of Pharmacists (ABDA). Berlin (Germany).
| | - Martin Schulz
- RPh, PhD, FFIP, FESCP. Adjunct Professor. Director, Department of Medicine, Federal Union of German Associations of Pharmacists (ABDA). Berlin (Germany).
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Airaksinen M, Toivo T, Jokinen L, Savela E, Parkkamäki S, Sandler C, Kalliomäki H, Dimitrow M. Policy and vision for community pharmacies in Finland: A roadmap towards enhanced integration and reduced costs. Pharm Pract (Granada) 2021; 19:2288. [PMID: 33628348 PMCID: PMC7886313 DOI: 10.18549/pharmpract.2021.1.2288] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Finland's community pharmacy system provides an example of a privately-owned regulated system being proactively developed by the profession and its stakeholders. Community pharmacists have a legal duty to promote safe and rational medicine use in outpatient care. The development of professionally oriented practice has been nationally coordinated since the 1990s with the support of a national steering group consisting of professional bodies, authorities, pharmacy schools and continuing education centers. The primary focus has been in patient counseling services and public health programs. The services have extended towards prospective medication risk management applying evidence-based tools, databases and digitalization. Research has been essential in informing progress by indicating high-risk patients, medications, practices and processes needing improvement. Despite the commitment of the profession and pharmacy owners, large-scale implementation of services has been challenging because of lack of remuneration, the pharmacy income still consisting primarily of sale of prescription and nonprescription medicines. Policy documents by the Ministry of Social Affairs and Health have supported the extension of the community pharmacists' role beyond traditional dispensing to promote rational pharmacotherapy. The current roadmap by the Ministry of Social Affairs and Health emphasizes ensuring adequate regional availability and accessibility of medicines, regardless of the future pharmacy system. It also emphasizes the importance of strong regulation on pharmacy business operations and sale of medicines to ensure medication safety. At the same time, the roadmap requires that the regulation must enable implementation of new patient-oriented services and procedures, and further promote digitalization in service provision. Competition and balance of funding should be enhanced, e.g., through price competition, but the risk of pharmaceutical market concentration should be managed. The regulation should also consider influence of the new social and health care system on drug delivery. Year 2021 will be crucial for making long-term political decisions on the future direction of tasks and finances of Finnish community pharmacies in this framework. Government-funded studies are underway to guide decision making. Ongoing Covid-19 crisis has demonstrated the readiness of Finnish community pharmacies to adapt fast to meet the changing societal needs.
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Affiliation(s)
- Marja Airaksinen
- MSc(Pharm), PhD. Professor, Head of Clinical Pharmacy Group. Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki. Helsinki (Finland).
| | - Terhi Toivo
- MSc(Pharm), PhD. Medication Safety Officer. Tampere University Hospital. Tampere (Finland).
| | - Lenita Jokinen
- MSc(Pharm), PhD. Proprietary pharmacist. Runosmäki Pharmacy. Turku (Finland).
| | - Eeva Savela
- MSc(Pharm), MSc(SocSci), PhD. Proprietary pharmacist. Lohja 1st Pharmacy. Lohja (Finland).
| | - Stina Parkkamäki
- MSc(Pharm), PhD. Proprietary pharmacist. Willan Kehrä Pharmacy. Hyvinkää (Finland).
| | - Charlotta Sandler
- MSc(Pharm), PhD. Director of Pharmaceutical Affairs. The Association of Finnish Pharmacies. Helsinki (Finland).
| | - Hanna Kalliomäki
- MSc(Pharm). Specialist Pharmacist. Helsinki University Hospital Pharmacy. Helsinki (Finland).
| | - Maarit Dimitrow
- MSc(Pharm), PhD. Visiting Scientist. Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki. Helsinki (Finland).
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Mellia JA, Jou C, Rathi S, Perzia BM, Morel A, Azoury SC, Fischer JP. An In-Depth Analysis of Research Output in Successful Integrated Plastic Surgery Match Applicants and Factors Associated With Matching at Top-Ranked Programs. J Surg Educ 2021; 78:282-291. [PMID: 32651120 DOI: 10.1016/j.jsurg.2020.06.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/23/2020] [Accepted: 06/23/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE With USMLE Step I score reports becoming pass/fail, research output may become a more important factor for applicants in the integrated plastic surgery match. The authors aim to assess the research output of successful applicants and bibliometric variables associated with matching at higher tier programs. DESIGN A search of peer-reviewed publications up to or during September before the matriculant's match year was performed using PubMed, Google Scholar, and Scopus for each resident. Bibliometric variables were analyzed including those associated with matching at higher tier Doximity reputation/research programs. SETTING University of Pennsylvania (Philadelphia, Pennsylvania). PARTICIPANTS Integrated plastic surgery interns for the 2019 to 2020 and 2020 to 2021 academic years (n = 301). RESULTS Three hundred one matriculants at 73 programs produced a total of 731 manuscripts. The mean number of publications and H-index per applicant was 2.43 ± 3.84 and 1.01 ± 1.30, respectively. The average and maximum journal impact factor was 2.8 ± 1.81 and 4.66 ± 5.59, respectively. H-index, total publications, plastic surgery-related and unrelated publications, and first-author studies were all associated with matching into both a higher ranked reputation and research tier program, respectively (p < 0.05). Highest impact factor publications were associated with matching at top tier research programs only (p < 0.05). Among students from US News Top 40 and non-Top 40 medical schools, total publications and first-author publications remained associated with matching at a higher tier reputation and research program (p < 0.05). However, plastic surgery-related publications were significantly linked to matching into a higher tier program for matriculants from non-Top 40 medical schools only (p < 0.05). CONCLUSIONS Research productivity, particularly total publications and first-author publications, is associated with an increased likelihood of matching at a higher tier integrated plastic surgery residency. Regardless of their medical school's US News rank, students may gain a competitive edge in the match with increased research output.
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Affiliation(s)
- Joseph A Mellia
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania; Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
| | - Christopher Jou
- Renaissance School of Medicine, Stony Brook University, Stony Brook, New York; Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Sourish Rathi
- College of Engineering and Applied Sciences, Stony Brook University, Stony Brook, New York
| | - Brittany M Perzia
- Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
| | - Andrew Morel
- Department of Surgery, NYU Winthrop Hospital, Mineola, New York
| | - Saïd C Azoury
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - John P Fischer
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Abstract
PURPOSE Training of compassionate and empathetic physicians requires commitment by educators to make it a priority. Chaplains typically have time and training to effectively demonstrate compassionate care in the clinical setting. This qualitative study aims to explore perceived benefits among medical students from pastoral care shadowing in integrating compassion and spirituality into education curricula. METHODS Sixty-four written reflections from first- and second-year medical students were collected from December 2018 to January 2020 after shadowing with hospital chaplains. Unprompted reflections were analyzed using coding networks. RESULTS Four major themes identified included (1) learned values within pastoral care, (2) learned roles of pastoral care in the healthcare setting, (3) practiced spiritual assessment tools and resource identification, and (4) reflected personal impact on future career. Within each major theme, three to four sub-themes were further identified. CONCLUSIONS Reflections support chaplain shadowing as a model for emphasizing spiritual and compassionate care through role-modeling, hands-on learning and reflective practices.
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Affiliation(s)
- Mikalyn T DeFoor
- School of Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA
- Center for Bioethics and Health Policy, Augusta University Health Systems, Augusta, GA, USA
| | - Mary M Moses
- School of Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA
- Center for Bioethics and Health Policy, Augusta University Health Systems, Augusta, GA, USA
| | - W Jeffery Flowers
- Center for Bioethics and Health Policy, Augusta University Health Systems, Augusta, GA, USA
- Department of Pastoral Care, Augusta University Health System, Augusta, GA, USA
| | - Richard W Sams
- Center for Bioethics and Health Policy, Augusta University Health Systems, Augusta, GA, USA
- Department of Family Medicine, Augusta University Health Systems, Augusta, GA, USA
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Abstract
Colombia is a decentralized republic with a population of 50 million, constituted by 32 departments (territorial units) and 1,204 municipalities. The health system provides universal coverage and equal access to health care services to 95% of the population. Primary health care is seen as a practical approach that guarantees the health and well-being of whole-of-society. The National Pharmaceutical Policy (NPP, 2012) goal is “to develop strategies that enable the Colombian population equitable access to effective medicines, through quality pharmaceutical services (PS)”. There are 4,351 providers certified to deliver PS: 3,699 (85%) ambulatory and 652 (15%) hospital care. The goals for PS are: a) promoting healthy lifestyles; b) preventing risk factors arising from medication errors; c) promoting rational use of medicines; and d) implementing Pharmaceutical Care. There are a number of ways that ambulatory patients access medications: through intermediary private companies, public and private hospitals pharmacies, and retail establishments (drugstores and pharmacies). Intermediary private companies are similar to Pharmaceutical Benefits Management in the U.S. health system, and act as intermediaries between health insurers, pharmaceutical laboratories, and patients. Pharmacists are being employed by these companies and in health insurance companies managing, auditing and delivering rational use of medicines programs. In 2014 there were approximately 20,000 pharmacies and drugstores, (private establishments) where a significant number of prescription-only medicines are sold without medical prescription. Colombian laws allow personal without pharmacy education to be a “director” in these establishments, so the training and education of persons working in drugstores and pharmacies is an important challenge. There about 8,000 registered pharmaceutical chemists with 25% to 30% working in patient care. Since the 90´s, there are more favorable conditions for pharmacist’s participation and contribution to health system and patient’s health outcome. These environmental facilitators include: a) laws and regulations regarding pharmaceutical services (2005-2007), b) establishment of a NPP (2012), and c) opportunities associated with the consolidation of private health management companies providing health services with an interest in pharmaceutical services (since 1995). Finally, telepharmacy, comprehensive care routes for pharmaceutical services, and further strengthen of postgraduate training in pharmacy practice are future strategies to improve the pharmacy profession in Colombia. They provide an opportunity to influence the recognition and value of the pharmacist as the health care professional.
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Affiliation(s)
- Pedro Amariles
- PhD, MPharm, BPharm. Professor. University of Antioquia. Medellín (Colombia).
| | - Mauricio Ceballos
- MSc, BPharm. Professor. University of Antioquia. Medellín (Colombia).
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Kontaxakis E, Fysarakis I, Lydakis D, Magan N. Farming System Effect on the Incidence of Aspergillus carbonarius on Kotsifali Grapes and Ochratoxin A Occurrence in Wines of Crete. J Food Prot 2020; 83:1796-1800. [PMID: 32502241 DOI: 10.4315/jfp-20-133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/02/2020] [Indexed: 11/11/2022]
Abstract
ABSTRACT During grape cultivation and wine production, the most effective way to prevent ochratoxin A (OTA) contamination of grapes and wine is to control ochratoxigenic fungal species, especially Aspergillus carbonarius, using appropriate cultivation techniques. In this study, the influence of an organic farming system (OFS) and an integrated farming system (IFS) on the incidence of A. carbonarius on grapes, and OTA contamination of wine, were examined. Mycological analysis of grapes collected from Kotsifali cultivar (Vitis vinifera L.) vineyards and grown under two farming systems (OFS and IFS) was performed over two growing seasons. For the same two growing seasons, OTA levels of representative wine samples from wineries located in the same area, made from the same cultivar (single varietal or covinificated with Mandilari), and grown under the two farming systems were determined. The results showed that the farming system had a significant influence on the incidence of A. carbonarius, with IFS being the most effective in the control of the fungus and the prevention of OTA occurrence in wine. This knowledge could offer viticulturists a useful tool to produce safer grapes, giving winemakers an incentive to make low-OTA wine. HIGHLIGHTS
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Affiliation(s)
- Emmanouil Kontaxakis
- Department of Agriculture, School of Agriculture Science, Hellenic Mediterranean University, Estavromenos, 71410 Heraklion, Greece.,(ORCID: https://orcid.org/0000-0001-6829-6264 [E.K.])
| | - Ioannis Fysarakis
- Department of Agriculture, School of Agriculture Science, Hellenic Mediterranean University, Estavromenos, 71410 Heraklion, Greece
| | - Dimitris Lydakis
- Department of Agriculture, School of Agriculture Science, Hellenic Mediterranean University, Estavromenos, 71410 Heraklion, Greece
| | - Naresh Magan
- Applied Mycology Group, Environment and AgriFood Theme, Cranfield University, Cranfield, Bedford MK43 0AL, UK (ORCID: https://orcid.org/0000-0002-5002-3564 [N.M.])
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41
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Salgado TM, Rosenthal MM, Coe AB, Kaefer TN, Dixon DL, Farris KB. Primary healthcare policy and vision for community pharmacy and pharmacists in the United States. Pharm Pract (Granada) 2020; 18:2160. [PMID: 33029264 PMCID: PMC7523559 DOI: 10.18549/pharmpract.2020.3.2160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The United States (US) has a complex healthcare system with a mix of public, private, nonprofit, and for-profit insurers, healthcare institutions and organizations, and providers. Unlike other developed countries, there is not a single payer healthcare system or a national pharmaceutical benefits scheme/plan. Despite spending over USD 10,000 per capita in healthcare, the US is among the worst performers compared to other developed countries in outcomes including life expectancy at birth, infant mortality, safety during childbirth, and unmanaged chronic conditions (e.g., asthma, diabetes). Primary care is delivered by physicians and advanced practice providers (i.e., nurse practitioners and physician assistants) in a variety of settings including large health systems, federally qualified health centers or free clinics that provide care to the underserved, or specific facilities for veterans or American Indian and Alaska native peoples. Since 2010, primary care delivery has shifted toward providing patient-centered, coordinated, comprehensive care focused on providing proactive, rather than reactive, population health management, and on the quality, versus volume, of care. Community pharmacy comprises a mix of independently owned, chain, supermarket and mass merchant pharmacies. Community pharmacies provide services such as immunizations, medication therapy management, medication packaging, medication synchronization, point-of-care testing and, in specific states where legislation has been passed, hormonal contraception, opioid reversal agents, and smoking cessation services. There has been criticism regarding the lack of standard terminology for services such as medication synchronization and medication therapy management, their components and how they should be provided, which hampers comparability across studies. One of the main challenges for pharmacists in the US is the lack of provider status at the federal level. This means that pharmacists are not allowed to use existing fee-for-service health insurance billing codes to receive reimbursement for non-dispensing services. In addition, despite there being regulatory infrastructure in multiple states, the extent of service implementation is either low or unknown. Research found that pharmacists face numerous barriers when providing some of these services. State fragmentation and the lack of a single pharmacy organization and vision for the profession are additional challenges.
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Affiliation(s)
- Teresa M Salgado
- MPharm, PhD. Center for Pharmacy Practice Innovation, School of Pharmacy, Virginia Commonwealth University. Richmond, VA (United States).
| | - Meagen M Rosenthal
- PhD. Department of Pharmacy Administration, School of Pharmacy, University of Mississippi. Oxford, MS (United States).
| | - Antoinette B Coe
- PharmD, PhD. Department of Clinical Pharmacy, College of Pharmacy, University of Michigan. Ann Arbor, MI (United States).
| | - Tana N Kaefer
- PharmD. Director of Clinical Services, Bremo Pharmacy. Richmond, VA (United States).
| | - Dave L Dixon
- PharmD. Center for Pharmacy Practice Innovation, School of Pharmacy, Virginia Commonwealth University. Richmond, VA (United States).
| | - Karen B Farris
- PhD. Department of Clinical Pharmacy, College of Pharmacy, University of Michigan. Ann Arbor, MI (United States).
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Sun C, Romero L, Joseph-Duran B, Meseguer J, Muñoz E, Guasch R, Martinez M, Puig V, Cembrano G. Integrated pollution-based real-time control of sanitation systems. J Environ Manage 2020; 269:110798. [PMID: 32561007 DOI: 10.1016/j.jenvman.2020.110798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/20/2020] [Accepted: 05/16/2020] [Indexed: 06/11/2023]
Abstract
An integrated pollution-based real-time control (RTC) approach is proposed for a sewer network (SN) integrated with wastewater treatment plants (WWTPs) in a sanitation system (SS) to mitigate the impacts of pollution from combined sewer overflows (CSOs) on ecosystems. To obtain the optimal solution for the SS while considering both quantity and quality dynamics for multiple objectives, model predictive control (MPC) is selected as the optimal control method. To integrate SN and WWTP management, a feedback coordination algorithm is developed. A closed-loop virtual-reality simulator is used to assess the results of the optimal management approach achieved by applying MPC. The Badalona SS (Spain) provides a pilot case study to assess the efficacy and applicability of the proposed approach. A comparison with local rule-based and volume-based control strategies currently in use indicates that the proposed integrated pollution-based RTC approach can reduce the pollutant loads released to the receiving environment.
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Affiliation(s)
- Congcong Sun
- Advanced Control Systems Group at the Institut de Robòtica i Informàtica Industrial (CSIC-UPC), Llorens i Artigas, 4-6, 08028, Barcelona, Spain.
| | - Luis Romero
- Advanced Control Systems Group at the Institut de Robòtica i Informàtica Industrial (CSIC-UPC), Llorens i Artigas, 4-6, 08028, Barcelona, Spain
| | - Bernat Joseph-Duran
- CETaqua, Water Technology Centre (SUEZ Spain Group), Barcelona, 08904, Spain
| | - Jordi Meseguer
- CETaqua, Water Technology Centre (SUEZ Spain Group), Barcelona, 08904, Spain
| | - Eduard Muñoz
- Aquambiente Servicios Para El Sector Del Agua, SAU (SUEZ Spain Group), Barcelona, 08038, Spain
| | - Ramon Guasch
- Aquatec, Proyectos para el Sector del Agua (SUEZ Spain Group), Barcelona, 08038, Spain
| | - Montse Martinez
- Aquatec, Proyectos para el Sector del Agua (SUEZ Spain Group), Barcelona, 08038, Spain
| | - Vicenç Puig
- Advanced Control Systems Group at the Institut de Robòtica i Informàtica Industrial (CSIC-UPC), Llorens i Artigas, 4-6, 08028, Barcelona, Spain
| | - Gabriela Cembrano
- Advanced Control Systems Group at the Institut de Robòtica i Informàtica Industrial (CSIC-UPC), Llorens i Artigas, 4-6, 08028, Barcelona, Spain; CETaqua, Water Technology Centre (SUEZ Spain Group), Barcelona, 08904, Spain
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43
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Stubbs CJ, McMahan C, Seegmiller W, Cook DD, Robertson DJ. Integrated Puncture Score: force-displacement weighted rind penetration tests improve stalk lodging resistance estimations in maize. Plant Methods 2020; 16:113. [PMID: 32821268 PMCID: PMC7429900 DOI: 10.1186/s13007-020-00654-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/07/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Stalk lodging (breaking of agricultural plant stalks prior to harvest) is a multi-billion dollar a year problem. Rind penetration resistance tests have been used by plant scientists and breeders to estimate the stalk lodging resistance of maize for nearly a hundred years. However, the rind puncture method has two key limitations: (1) the predictive power of the test decreases significantly when measuring elite or pre-commercial hybrids, and (2) using rind penetration measurements as a breeding metric does not necessarily create stronger stalks. In this study, we present a new rind penetration method called the Integrated Puncture Score, which uses a modified rind penetration testing protocol and a physics-based model to provide a robust measure of stalk lodging resistance. RESULTS Two datasets, one with a diverse array of maize hybrids and one with only elite hybrids, were evaluated by comparing traditional rind penetration testing and the Integrated Puncture Score method to measurements of stalk bending strength. When evaluating the diverse set of hybrids, both methods were good predictors of stalk bending strength (R2 values of 0.67). However, when evaluating elite hybrids, the Integrated Puncture Score had an R2 value of 0.74 whereas the traditional method had an R2 value of 0.48. Additionally, the Integrated Puncture Score was able to differentiate between the strongest and weakest hybrids in the elite hybrid data set whereas the traditional rind penetration method was not. Additional experiments revealed strong evidence in favor of the data aggregation steps utilized to compute the Integrated Puncture Score. CONCLUSIONS This study presents a new method for evaluating rind penetration resistance that highly correlates with stalk bending strength and can possibly be used as a breeding index for assessing stalk lodging resistance. This research lays the foundation required to develop a field-based high-throughput phenotyping device for stalk lodging resistance.
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Affiliation(s)
| | - Christopher McMahan
- School of Mathematical and Statistical Sciences, Clemson University, Clemson, SC 29634 USA
| | - Will Seegmiller
- Department of Mechanical Engineering, University of Idaho, Moscow, ID 83844 USA
| | - Douglas D. Cook
- Department of Mechanical Engineering, Brigham Young University, Provo, UT 84602 USA
| | - Daniel J. Robertson
- Department of Mechanical Engineering, University of Idaho, Moscow, ID 83844 USA
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44
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Edelman EJ, Maisto SA, Hansen NB, Cutter CJ, Dziura J, Deng Y, Fiellin LE, O'Connor PG, Bedimo R, Gibert CL, Marconi VC, Rimland D, Rodriguez-Barradas MC, Simberkoff MS, Tate JP, Justice AC, Bryant KJ, Fiellin DA. Integrated stepped alcohol treatment for patients with HIV and at-risk alcohol use: a randomized trial. Addict Sci Clin Pract 2020; 15:28. [PMID: 32727618 PMCID: PMC7388231 DOI: 10.1186/s13722-020-00200-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 07/09/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND At-risk levels of alcohol use threaten the health of patients with HIV (PWH), yet evidence-based strategies to decrease alcohol use and improve HIV-related outcomes in this population are lacking. We examined the effectiveness of integrated stepped alcohol treatment (ISAT) on alcohol use and HIV outcomes among PWH and at-risk alcohol use. METHODS In this multi-site, randomized trial conducted between January 28, 2013 through July 14, 2017, we enrolled PWH and at-risk alcohol use [defined as alcohol consumption of ≥ 14 drinks per week or ≥ 4 drinks per occasion in men ≤ 65 years old or ≥ 7 drinks per week or ≥ 3 drinks per occasion in women or men > 65 years old]. ISAT (n = 46) involved: Step 1- Brief Negotiated Interview with telephone booster, Step 2- Motivational Enhancement Therapy, and Step 3- Addiction Physician Management. Treatment as usual (TAU) (n = 47) involved receipt of a health handout plus routine care. Analyses were conducted based on intention to treat principles. RESULTS Despite a multi-pronged approach, we only recruited 37% of the target population (n = 93/254). Among ISAT participants, 50% advanced to Step 2, among whom 57% advanced to Step 3. Participants randomized to ISAT and TAU had no observed difference in drinks per week over the past 30 days at week 24 (primary outcome) [least square means (Ls mean) (95% CI) = 8.8 vs. 10.6; adjusted mean difference (AMD) (95% CI) = - 0.4 (- 3.9, 3.0)]. CONCLUSION An insufficient number of patients were interested in participating in the trial. Efforts to enhance motivation of PWH with at-risk alcohol use to engage in alcohol-related research and build upon ISAT are needed. Trial registration Clinicaltrials.gov: NCT01410123, First posted August 4, 2011.
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Affiliation(s)
- E Jennifer Edelman
- Yale School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA. .,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, 06510, USA.
| | | | - Nathan B Hansen
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, 06510, USA.,College of Public Health, University of Georgia, Athens, GA, 30602, USA
| | | | - James Dziura
- Yale Center for Analytic Sciences, Yale University School of Public Health, New Haven, CT, 06511, USA
| | - Yanhong Deng
- Yale Center for Analytic Sciences, Yale University School of Public Health, New Haven, CT, 06511, USA
| | - Lynn E Fiellin
- Yale School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA.,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, 06510, USA
| | - Patrick G O'Connor
- Yale School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA
| | - Roger Bedimo
- Veterans Affairs North Texas Health Care System and UT Southwestern, Dallas, TX, 75216, USA
| | - Cynthia L Gibert
- D.C. VAMC and George, Washington University School of Medicine and Health Sciences, Washington, D.C, 20422, USA
| | - Vincent C Marconi
- Atlanta VAMC and Emory University School of Medicine, Atlanta, GA, 30033, USA
| | - David Rimland
- Atlanta VAMC and Emory University School of Medicine, Atlanta, GA, 30033, USA
| | | | - Michael S Simberkoff
- VA NY Harbor Healthcare System and New York University School of Medicine, New York, NY, 10010, USA
| | - Janet P Tate
- Yale School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA.,VA Connecticut Healthcare System, Veterans Aging Cohort Study, West Haven, CT, 06516, USA
| | - Amy C Justice
- Yale School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA.,VA Connecticut Healthcare System, Veterans Aging Cohort Study, West Haven, CT, 06516, USA
| | - Kendall J Bryant
- National Institute On Alcohol Abuse and Alcoholism HIV/AIDS Program, Bethesda, MD, 20892-7003, USA
| | - David A Fiellin
- Yale School of Medicine, 367 Cedar Street, ESH A, New Haven, CT, 06510, USA.,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, 06510, USA
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Diaz-Lara A, Mosier NJ, Stevens K, Keller KE, Martin RR. Evidence of Rubus Yellow Net Virus Integration into the Red Raspberry Genome. Cytogenet Genome Res 2020; 160:329-334. [PMID: 32683370 DOI: 10.1159/000509845] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/22/2020] [Indexed: 11/19/2022] Open
Abstract
Rubus yellow net virus (RYNV) infects Rubus spp., causing a severe decline when present in mixed infections with other viruses. RYNV belongs to the family Caulimoviridae, also known as plant pararetroviruses, which can exist as episomal or integrated elements (endogenous). Most of integrated pararetroviruses are noninfectious; however, a few cases have been reported where they excised from the plant genome and formed infectious particles. Graft transmission onto indicator plants R. occidentalis "Munger" has been the standard test method for RYNV detection in certification programs. Previously, it was noticed that some RYNV PCR-positive plants did not induce symptoms on "Munger", suggesting an integration event. In this study, bio-indexing and different molecular techniques were employed to differentiate between integrated and episomal RYNV sequences. Reverse transcription-PCR using RYNV-specific oligonucleotides after DNase treatment generated positive results for the virus in graft transmissible isolates (episomal) only. To confirm these results, rolling circle amplification on DNA preparations from the same samples resulted in amplicons identified as RYNV only from plants with graft transmissible RYNV. High-throughput sequencing was used to identify the RYNV-like sequences present in the host DNA. These results indicate the integration of RYNV into the red raspberry genome and highlight the necessity to recognize this phenomenon (integration) in future Rubus quarantine and certification programs.
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Abstract
Within a crippling economic context and a rapidly evolving healthcare system, pharmacists in Lebanon are striving to promote their role in primary care. Community pharmacists, although held in high esteem by the population, are not recognised as primary health care providers by concerned authorities. They are perceived as medication sellers. The role of the pharmacist in primary health care networks, established by the Ministry of Public Health (MOPH) to serve most vulnerable populations, is limited to medication delivery. The practice of the pharmacy profession in Lebanon has been regulated in 1950 by the Lebanese Pharmacists Association [Order of Pharmacists of Lebanon] (OPL). In 2016, the OPL published its mission, vision, and objectives, aiming to protect the pharmacists' rights by enforcing rules and procedures, raise the profession's level through continuous education, and ensure patients' appropriate access to medications and pharmacist's counseling for safe medication use. Since then, based on the identified challenges, the OPL has suggested several programs, inspired by the World Health Organization and the International Pharmaceutical Federation guidelines, as part of a strategic plan to develop the pharmacy profession and support patient safety. These programs included the application of principles of good governance, the provision of paid services, developing pharmacists' core and advanced competencies, generation of accreditation standards for both community pharmacy and pharmacy education, suggesting new laws and decrees, continuing education consolidation and professional development. There was an emphasis on all decisions to be evidence assessment-based. However, OPL faces a major internal political challenge: its governing body, which is reelected every three years, holds absolute powers in changing strategies for the three-year mandate, without program continuation beyond each mandate. Within this context, we recommend the implementation of a strategic plan to integrate pharmacy in primary health centers, promoting the public health aspect of the profession and taking into account of critical health issues and the changing demographics and epidemiological transition of the Lebanese population. Unless the proposed blueprint in this paper is adopted, the profession is unfortunately condemned to disappear in the current political, economic and health-related Lebanese context.
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Affiliation(s)
- Souheil Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK). Jounieh (Lebanon).
| | | | - Pascale Salameh
- National Institute of Public Health, Clinical Epidemiology & Toxicology (INSPECT-LB). Beirut (Lebanon).
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Abstract
From a political and governance perspective Spain is a decentralized country with 17 states [comunidades autónomas] resulting in a governmental structure similar to a federal state. The various state regional health services organizational and management structures are focused on caring for acute illnesses and are dominated by hospitals and technology. In a review by the Interstate Council, a body for intercommunication and cooperation between the state health care services and national government, there is a move to improve health care through an integrative approach between specialized care and primary care at the state level. Community pharmacy does not appear to have a major role in this review. Primary health care is becoming more important and leading the change to improve the roles of the health care teams. Primary care pharmacists as the rest of public health professionals are employed by the respective states and are considered public servants. Total health care expenditure is 9.0% of its GDP with the public health sector accounting for the 71% and the private sector 29% of this expenditure. Community pharmacy contracts with each state health administration for the supply and dispensing of medicines and a very limited number of services. There are approximately 22,000 community pharmacies and 52,000 community pharmacists for a population of 47 million people. All community pharmacies are privately owned with only pharmacists owning a single pharmacy. Pharmacy chain stores are not legally permitted. Community pharmacy practice is based on dispensing of medications and dealing with consumer minor symptoms and requests for nonprescription medications although extensive philosophical deep debates on the conceptual and practical development of new clinical services have resulted in national consensually agreed classifications, definitions and protocolized services. There are a few remunerated services in Spain and these are funded at state, provincial or municipal level. There are no health services approved or funded at a national level. Although the profession promulgates a patient orientated community pharmacy it appears to be reluctant to advocate for a change in the remuneration model. The profession as a whole should reflect on the role of community pharmacy and advocate for a change to practice that is patient orientated alongside the maintenance of its stance on being a medication supplier. The future strategic position of community pharmacy in Spain as a primary health care partner with government would then be enhanced.
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Affiliation(s)
- Miguel A Gastelurrutia
- Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, University of Granada. Granada (Spain).
| | - María J Faus
- Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, University of Granada. Granada (Spain).
| | - Fernando Martínez-Martínez
- Pharmaceutical Research Group of the University of Granada, Faculty of Pharmacy, University of Granada. Granada (Spain).
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Abstract
There is evidence that the Australian Government is embracing a more integrated approach to health, with implementation of initiatives like primary health networks (PHNs) and the Government’s Health Care Homes program. However, integration of community pharmacy into primary health care faces challenges, including the lack of realistic integration in PHNs, and in service and remuneration models from government. Ideally, coordinated multidisciplinary teams working collaboratively in the community setting are needed, where expanding skills are embraced rather than resisted. It appears that community pharmacy is not sufficiently represented at a local level. Current service remuneration models encourage a volume approach. While more complex services and clinical roles, with associated remuneration structures (such as, accredited pharmacists, pharmacists embedded in general practice and residential aged care facilities) promote follow up, collaboration and integration into primary health care, they potentially marginalize community pharmacies. Community pharmacists’ roles have evolved and are being recognized as the medication management experts of the health care team at a less complex level with the delivery of MedChecks, clinical interventions and medication adherence services. More recently, vaccination services have greatly expanded through community pharmacy. Policy documents from professional bodies highlight the need to extend pharmacy services and enhance integration within primary care. The Pharmaceutical Society of Australia’s Pharmacists in 2023 report envisages pharmacists practising to full scope, driving greater efficiencies in the health system. The Pharmacy Guild of Australia’s future vision identifies community pharmacy as health hubs facilitating the provision of cost-effective and integrated health care services to patients. In 2019, the Australian Government announced the development of a Primary Health Care 10-Year Plan which will guide resource allocation for primary health care in Australia. At the same time, the Government has committed to conclude negotiations on the 7th Community Pharmacy Agreement (7CPA) with a focus on allowing pharmacists to practice to full scope and pledges to strengthen the role of primary care by better supporting pharmacists as primary health care providers. The 7CPA and the Government’s 10-year plan will largely shape the practice and viability of community pharmacy. It is essential that both provide a philosophical direction and prioritize integration, remuneration and resources which recognize the professional contribution and competencies of community pharmacy and community pharmacists, the financial implications of service roles and the retention of medicines-supply roles.
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Affiliation(s)
- Sarah Dineen-Griffin
- PhD, GradCertPharmPrac, MPharm, BBSci. University of Technology Sydney. Sydney, NSW (Australia).
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Abstract
The overall goal of Swedish health care is good health and equitable care for the whole population. The responsibility for health is shared by the central government, the regions, and the municipalities. Primary care accounts for approximately 20 percent of all expenditures on health care. About 16% of all physicians work in primary health. The regions have also employed a large number of clinical pharmacists, usually hospital-based, but many perform a variety of different primary care services, the most common of which is patient medication reviews. Swedish primary health care is at a crossroads facing extensive challenges, due to changes in demography and demanding financial conditions. These changes necessitate large transformations in health services and delivery. Current Government inquiries have primarily focused on two ways to meet the challenges; a shift towards more local care requiring a transfer of resources from hospital care, and a further development of structured digi-physical care, that is both digital ("online doctors") and physical accessibility of care. While primary care at present is undergoing processes of change, community pharmacy has done so during the past decade since the re-regulation of the Swedish pharmacy market. A monopoly was replaced by a competitive system, where five pharmacy chains now share most of the market, a competition that has made community pharmacy very commercialized. A number of different, promising primary care services are being offered, but they are usually delivered on a small scale due to a lack of remuneration and philosophy of providers. Priority is given to sales and fast dispensing of prescriptions, often with a minimum of counseling. Reflecting primary health care, community pharmacy in Sweden is at a crossroads but currently has a golden opportunity to choose a route of collaboration with primary health care in its current transformation into more local and digi-physical care. A major challenge is that primary health care inquires, strategic plans, and national policy documents usually do not include community pharmacy as a partner. Hence, community pharmacy have to be proactive and seize this chance of changes in primary health policy and organization in order to become an important link in the chain of health care delivery, or there is a significant risk that it will predominantly remain a retail business.
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Affiliation(s)
- Tommy Westerlund
- MS(Pharm), MS, PhD. Associate Professor. Department of Biomedical Science, Faculty of Health & Society, Malmö University. Malmö (Sweden).
| | - Bertil Marklund
- MD, PhD. Associate Professor. Institute of Medicine, Sahlgrenska Academy, University of Gothenburg. Gothenburg (Sweden).
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Abstract
Objectives: Teaching programmes within medicine focus primarily on pathways of a shorter length with little regard to teaching lasting longer than a month. This study is different from other studies as it examines the benefits of a nine month-long medical education degree programme and its impact beyond graduation. This study set out to explore the impact of a medical education intercalated degree programme for its graduates and their careers.Methods: A small scale, exploratory qualitative case study was conducted with 10 graduates of an intercalated degree programme.Results: The findings highlight the longer term value of an intercalated degree programme with particular emphasis on academic and personal skills; research and teaching skills; independence and confidence; its impact on future practice and the notion that 'student as teacher' programmes are a valuable asset to medical education as a whole. Participants advocated more teaching opportunities as a core longitudinal teaching component in preparation for the teaching responsibilities in their working lives.Conclusions: The programme enables the development of a range of academic and personal skills, with particular emphasis on research and teaching skills, independence and confidence.
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Affiliation(s)
- Fiona Muir
- Centre for Medical Education, University of Dundee, Dundee, Scotland, UK
| | - Jack Bruce
- Centre for Medical Education, University of Dundee, Dundee, Scotland, UK
| | - Kevin McConville
- Centre for Medical Education, University of Dundee, Dundee, Scotland, UK
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