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Cordier LF, Kalaris K, Rakotonanahary RJL, Rakotonirina L, Haruna J, Mayfield A, Marovavy L, McCarty MG, Tsirinomen'ny Aina A, Ratsimbazafy B, Razafinjato B, Loyd T, Ihantamalala F, Garchitorena A, Bonds MH, Finnegan KE. Networks of Care in Rural Madagascar for Achieving Universal Health Coverage in Ifanadiana District. Health Syst Reform 2020; 6:e1841437. [PMID: 33314984 DOI: 10.1080/23288604.2020.1841437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/03/2023] Open
Abstract
Health care is most effective when a patient's basic primary care needs are met as close to home as possible, with advanced care accessible when needed. In Ifanadiana District, Madagascar, a collaboration between the Ministry of Public Health (MoPH) and PIVOT, a non-governmental organization (NGO), fosters Networks of Care (NOC) to support high-quality, patient-centered care. The district's health system has three levels of care: community, health center, district hospital; a regional hospital is available for tertiary care services. We explore the MoPH/PIVOT collaboration through a case study which focuses on noteworthy elements of the collaboration across the four NOC domains: (I) agreement and enabling environment, (II) operational standards, (III) quality, efficiency, and responsibility, (IV) learning and adaptation. Under Domain I, we describe formal agreements between the MoPH and PIVOT and the process for engaging communities in creating effective NOC. Domain II discusses patient referral across levels of the health system and improvements to facility readiness and service availability. Under Domain III the collaboration prioritizes communication and supervision to support clinical quality, and social support for patients. Domain IV focuses on evaluation, research, and the use of data to modify programs to better meet community needs. The case study, organized by the domains of the NOC framework, demonstrates that a collaboration between the MoPH and an NGO can create effective NOC in a remote district with limited accessibility and advance the country's agenda to achieve universal health coverage.
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Affiliation(s)
| | - Katherine Kalaris
- Maternal Newborn and Reproductive Health, Clinton Health Access Initiative , Boston, Massachusetts, USA
| | | | | | | | - Alishya Mayfield
- NGO PIVOT , Ranomafana, Madagascar.,Department of Global Health Equity, Brigham and Women's Hospital , Boston, Massachusetts, USA.,Department of Global Health and Social Medicine, Harvard Medical School , Boston, Massachusetts, USA
| | | | | | | | | | | | | | | | - Andres Garchitorena
- NGO PIVOT , Ranomafana, Madagascar.,MIVEGEC Laboratory, University of Montpellier, Centre National de la Recherche Scientifique, Institut de Recherche pour le Développement , Antananarivo, Madagascar
| | - Matthew H Bonds
- NGO PIVOT , Ranomafana, Madagascar.,Department of Global Health and Social Medicine, Harvard Medical School , Boston, Massachusetts, USA
| | - Karen E Finnegan
- NGO PIVOT , Ranomafana, Madagascar.,Department of Global Health and Social Medicine, Harvard Medical School , Boston, Massachusetts, USA
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2
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Armstrong MJ, Alliance S, Corsentino P, Maixner SM, Paulson HL, Taylor A. Caregiver-Reported Barriers to Quality End-of-Life Care in Dementia With Lewy Bodies: A Qualitative Analysis. Am J Hosp Palliat Care 2020; 37:728-737. [PMID: 31902223 PMCID: PMC7335680 DOI: 10.1177/1049909119897241] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE This study investigated barriers to quality end-of-life (EOL) care in the context of dementia with Lewy bodies (DLB), one of the most common degenerative dementias in the United States. METHODS The study consisted of telephone interviews with caregivers and family members of individuals who died with DLB in the last 5 years. Interviews used a semi-structured questionnaire. Investigators employed a qualitative descriptive approach to analyze interview transcripts and identify common barriers to quality EOL care. RESULTS Thirty participants completed interviews. Reported barriers to quality EOL experiences in DLB pertained to the DLB diagnosis itself and factors relating to the US health-care system, facilities, hospice, and health-care providers (physicians and staff). Commonly reported barriers included lack of recognition and knowledge of DLB, lack of education regarding what to expect, poor coordination of care and communication across health-care teams and circumstances, and difficulty accessing health-care resources including skilled nursing facility placement and hospice. CONCLUSION Many identified themes were consistent with published barriers to quality EOL care in dementia. However, DLB-specific EOL considerations included diagnostic challenges, lack of knowledge regarding DLB and resultant prescribing errors, difficulty accessing resources due to behavioral changes in DLB, and waiting to meet Medicare dementia hospice guidelines. Improving EOL experiences in DLB will require a multifaceted approach, starting with improving DLB recognition and provider knowledge. More research is needed to improve recognition of EOL in DLB and factors that drive quality EOL experiences.
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Affiliation(s)
- Melissa J. Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL
- McKnight Brain Institute, University of Florida, Gainesville, FL
| | - Slande Alliance
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL
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3
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Waterman AD, Lipsey AF, Ranasinghe ON, Wood EH, Anderson C, Bozzolo C, Henry SL, Dub B, Mittman B. Recommendations for Systematizing Transplant Education Within a Care Delivery System for Patients With Chronic Kidney Disease Stages 3 to 5. Prog Transplant 2020; 30:76-87. [PMID: 32238045 DOI: 10.1177/1526924820913520] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
CONTEXT Early tailored transplant education could help patients make informed transplant choices. OBJECTIVE We interviewed 40 patients with chronic kidney disease (CKD) stages 3 to 5, 13 support persons, and 10 providers at Kaiser Permanente Southern California to understand: (1) barriers to transplant education and (2) transplant educational preferences and recommendations based on CKD stage and primary language spoken. DESIGN A grounded theory analysis identified central themes related to transplant education barriers, preferences, and recommendations. RESULTS Barriers included confusion about diagnosis and when transplant may be necessary, concerns about transplant risks, families' lack of transplant knowledge, financial burdens, transportation and scheduling, and the emotional overload of chronic illness. Hispanic and Spanish-speaking participants reported difficulty in understanding transplant education and medical mistrust. Recommendations included providing general education, earlier introduction to transplant, wait-listing information, transplant education for support persons, living donation education for patients and potential donors, opportunities to meet living donors and kidney recipients, information on the benefits of transplant, recovery, and available financial resources, flexible class scheduling, online and print resources, and more provider follow-up. Spanish-speaking and Hispanic participants recommended using bilingual educators, print, video, and online resources in Spanish, and culturally responsive education. Patients with CKD stages 3 to 4 wanted information on slowing disease progression and avoiding transplant. CONCLUSION Increasing access to culturally responsive transplant education in multiple languages, pairing appropriate content to the disease stage, and increasing system-wide follow-up as the disease progresses might help patients make more informed choices about transplant.
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Affiliation(s)
- Amy D Waterman
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, CA, USA.,Terasaki Research Institute, Los Angeles, CA, USA
| | | | - Omesh N Ranasinghe
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, CA, USA
| | - Emily H Wood
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, CA, USA
| | - Crystal Anderson
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, CA, USA
| | | | - Shayna L Henry
- Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Bhanuja Dub
- Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Brian Mittman
- Kaiser Permanente Southern California, Pasadena, CA, USA
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4
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Harrison R, Walton M, Chitkara U, Manias E, Chauhan A, Latanik M, Leone D. Beyond translation: Engaging with culturally and linguistically diverse consumers. Health Expect 2019; 23:159-168. [PMID: 31625264 PMCID: PMC6978859 DOI: 10.1111/hex.12984] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [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: 02/22/2019] [Revised: 07/28/2019] [Accepted: 09/20/2019] [Indexed: 12/02/2022] Open
Abstract
Background In the context of an effective consumer engagement framework, there is potential for health‐care delivery to be safer. Consumers from culturally and linguistically diverse (CALD) backgrounds may experience several barriers when trying to engage about their health care, and they are not acknowledged sufficiently in contemporary strategies to facilitate patient engagement. Methods Four focus group discussions were facilitated by bilingual fieldworkers in Arabic, Mandarin, Turkish and Dari in a district of Sydney, Australia that has a high proportion of CALD consumers. Each group included 5‐7 health‐care consumers who, using a topic guide, discussed their experiences of barriers and facilitators when engaging with health‐care services in Australia. Thematic analysis was undertaken to identify, analyse and report patterns in the data. Results In all, 24 consumers participated. Six inter‐related themes emerged: navigating the health system; seeking meaningful interpretation; understanding and managing expectations; respectful professional care; accessing services; and feeling unsafe. Conclusions The incorporation of strategies such as professional interpreters and migrant health workers may go some way to addressing the needs of culturally or linguistically diverse consumers and facilitate communication, but do not sufficiently address the range of barriers to consumer engagement identified in this work. Understanding consumer experience in the context of the complex factors that may be associated with poor engagement and poor outcomes such as health literacy, cultural, educational and linguistic background, and health‐care setting or condition, may contribute to better understanding about how to deliver quality health care to these patients.
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Affiliation(s)
- Reema Harrison
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Merrilyn Walton
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Upma Chitkara
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Deakin University, Burwood, Vic., Australia.,Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Ashfaq Chauhan
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Monika Latanik
- Multicultural Health, Western Sydney Local Health District, Penrith, NSW, Australia
| | - Desiree Leone
- Multicultural Health, Western Sydney Local Health District, Penrith, NSW, Australia
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5
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Ladin K, Marotta SA, Butt Z, Gordon EJ, Daniels N, Lavelle TA, Hanto DW. A Mixed-Methods Approach to Understanding Variation in Social Support Requirements and Implications for Access to Transplantation in the United States. Prog Transplant 2019; 29:344-353. [PMID: 31581889 DOI: 10.1177/1526924819874387] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 01/08/2023]
Abstract
Social support is a key component of transplantation evaluation in the United States. Social support definitions and evaluation procedures require examination to achieve clear, consistent implementation. We surveyed psychosocial clinicians from the Society for Transplant Social Workers and American Society of Transplant Surgeons about their definitions and evaluation procedures for using social support to determine transplant eligibility. Bivariate statistical analysis was used for quantitative data and content analysis for qualitative data. Among 276 psychosocial clinicians (50.2% response rate), 92% had ruled out patients from transplantation due to inadequate support. Social support definitions varied significantly: 10% of respondents indicated their center lacked a definition. Key domains of social support included informational, emotional, instrumental, motivational, paid support, and the patient's importance to others. Almost half of clinicians (47%) rarely or never requested second opinions when excluding patients due to social support. Confidence and perceived clarity and consistency in center guidelines were significantly associated with informing patients when support contributed to negative wait-listing decisions (P = .001). Clinicians who excluded fewer patients because of social support offered significantly more supportive health care (P = .02). Clearer definitions and more supportive care may reduce the number of patients excluded from transplant candidacy due to inadequate social support.
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Affiliation(s)
- Keren Ladin
- Department of Occupational Therapy and Community Health, Tufts University, Medford, MA, USA.,Research on Ethics, Aging, and Community Health (REACH Lab), Tufts University, Medford, MA, USA
| | - Satia A Marotta
- Research on Ethics, Aging, and Community Health (REACH Lab), Tufts University, Medford, MA, USA
| | - Zeeshan Butt
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elisa J Gordon
- Division of Transplantation, Department of Surgery, Center for Healthcare Studies and Center for Bioethics and Medical Humanities, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Norman Daniels
- Department of Global Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tara A Lavelle
- Center for the Evaluation of Value and Risk, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Douglas W Hanto
- VA St Louis Health Care System, St Louis, MO, USA.,Vanderbilt Transplant Center and Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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6
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Soroush A, Poneros JM, Lightdale CJ, Abrams JA. Shorter time to achieve endoscopic eradication is not associated with improved long-term outcomes in Barrett's esophagus. Dis Esophagus 2019; 32:5475051. [PMID: 30997483 DOI: 10.1093/dote/doz026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 12/11/2022]
Abstract
Quality indicators have been proposed for endoscopic eradication therapy of Barrett's esophagus (BE). One such measure suggests that complete eradication of intestinal metaplasia (CE-IM) should be achieved within 18 months of starting treatment. The aim of this study was to assess whether achievement of CE-IM within 18 months is associated with improved long-term clinical outcomes. This was a retrospective cohort study of BE patients who underwent endoscopic eradication. Time to CE-IM was recorded and categorized as ≤ or > 18 months. The main outcome measures were recurrence of IM and of dysplasia after CE-IM, defined as a single endoscopy without endoscopic evidence of BE or histologic evidence of intestinal metaplasia. Recurrence was analyzed using the Kaplan-Meier method and multivariable Cox proportional hazards modeling. A total of 290 patients were included in the analyses. The baseline histology was high-grade dysplasia or intramucosal carcinoma in 74.2% of patients. CE-IM was achieved in 85.5% of patients, and 54.1% of the cohort achieved CE-IM within 18 months. Achieving CE-IM within 18 months was not associated with reduced risk of recurrence of IM or dysplasia in both unadjusted and adjusted analyses. In this cohort, older age and increased BE length were associated with IM recurrence, and increased hiatal hernia size was associated with dysplasia recurrence. Compared to longer times, achieving CE-IM within 18 months was not associated with a reduced risk of recurrence of IM or dysplasia. Alternative evidence-based quality metrics for endoscopic eradication therapy should be identified.
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Affiliation(s)
- Ali Soroush
- Department of Medicine, Columbia University Medical Center, New York, USA
| | - John M Poneros
- Department of Medicine, Columbia University Medical Center, New York, USA
| | | | - Julian A Abrams
- Department of Medicine, Columbia University Medical Center, New York, USA
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7
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DeMitchell-Rodriguez EM, Irving H, Friedman AL, Alfonso AR, Ramly EP, Diaz-Siso JR, Gelb BE, Kantar RS, Rodriguez ED. Toward Increased Organ Procurement Organization Involvement in Vascularized Composite Allograft Donation. Prog Transplant 2019; 29:294-295. [PMID: 31232160 DOI: 10.1177/1526924819856613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | - Allyson R Alfonso
- 1 Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - Elie P Ramly
- 1 Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - J Rodrigo Diaz-Siso
- 1 Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - Bruce E Gelb
- 3 Transplant Institute, New York University Langone Health, New York, NY, USA
| | - Rami S Kantar
- 1 Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| | - Eduardo D Rodriguez
- 1 Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
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8
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Matulis JC, Schilling JJ, North F. Primary Care Provider Continuity Is Associated With Improved Preventive Service Ordering During Brief Visits for Acute Symptoms. Health Serv Res Manag Epidemiol 2019; 6:2333392819826262. [PMID: 30793012 PMCID: PMC6376498 DOI: 10.1177/2333392819826262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 01/05/2019] [Accepted: 01/05/2019] [Indexed: 11/25/2022] Open
Abstract
Background: If a patient presents for an acute care visit and sees their assigned primary care provider (PCP), they may be more likely to receive preventive and other services than a patient not seeing their assigned PCP. Methods: After exclusion of 2 visits with insufficient information, we reviewed 98 consecutive, outpatient internal medicine 15-minute acute care visits comparing patients seeing their assigned PCP with those seeing a non-PCP provider. The primary outcome, preventive service ordering, was measured in 2 ways: percentage of patient visits with any preventive service ordered and the total number of preventive services ordered as a proportion of all preventive service items due for each entire cohort. The secondary outcome of other work completed was assessed by comparing tests and consults ordered, and by counting the number of physical examination elements and discrete medical diagnoses documented. Results: The PCPs were significantly more likely than non-PCPs to order any preventive service 45% versus 17% (P = .005; odds ratio [OR]: 4.16, 95% confidence interval [CI]: 1.45-12.0). The PCP cohort ordered a higher proportion of the total number of preventive services due compared with the non-PCP cohort (30% vs 11%; P = .002; OR: 3.4, CI: 1.5-7.7). The PCPs also addressed more medical diagnoses (2.3 vs 1.4; P = .008) and more frequently ordered tests outside the reason for that visit (40% vs 13%; P = .003; OR: 4.27, CI: 1.5-11.8). Conclusion: Patients seeing their assigned PCP in brief, acute visits have higher rates of preventive and other service ordering compared to those not seeing their assigned PCP.
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Affiliation(s)
- John C Matulis
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Frederick North
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
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9
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Kawashima Vasconcelos MY, Lopes ARF, Mente ÊD, Castro-E-Silva O, Galvão CM, Dal Sasso-Mendes K. Chronic Liver Disease Questionnaire as a Tool to Evaluate the Quality of Life in Liver Transplant Candidates. Prog Transplant 2018; 29:1526924818817053. [PMID: 30585113 DOI: 10.1177/1526924818817053] [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] [Indexed: 11/15/2022]
Abstract
INTRODUCTION: The advanced stage of liver disease causes impairments in the quality of life due to the physiological symptoms, besides the social and emotional stress. The aim of this study was to evaluate the quality of life of candidates for liver transplantation in specialized center in the interior of the state of São Paulo, Brazil. METHODS: An observational study was carried out, with a quantitative approach. The sample was of convenience with the participation of 50 candidates for liver transplantation. Demographic characterization data, clinical data, and the Chronic Liver Disease Questionnaire were used to evaluate the quality of life. RESULTS: The majority of the participants were male (68%), married (76%), with an average age of 55.7 years and average income of 2 to 3 minimum wages (42%). The main cause of liver disease was alcoholism (34%), mean time on the waiting list was 247.8 days, and mean model for end-stage liver disease was 20.5 points. The mean quality of life score was 2.9 points (standard deviation = 1.0) and the analysis of the 6 domains showed greater impairment of fatigue (2.2), activity (2.7), and concern (2.9) and better evaluation of systemic symptoms (3.4) and emotion (3.3). CONCLUSION: Quality of life is impaired in most of the participants, indicating the need for greater attention and evaluation in the physical, mental, and social scope of this clientele.
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Affiliation(s)
- Marianna Yumi Kawashima Vasconcelos
- 1 General and Specialized Nursing Department, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Ana Rafaela Felippini Lopes
- 2 Special Liver Transplantation Unit, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ênio David Mente
- 2 Special Liver Transplantation Unit, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Orlando Castro-E-Silva
- 2 Special Liver Transplantation Unit, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Cristina Maria Galvão
- 1 General and Specialized Nursing Department, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Karina Dal Sasso-Mendes
- 1 General and Specialized Nursing Department, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
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10
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Snipelisky D, Shipman J, Olson N, Pellikka P, Aqel B, McCully R, Watt K. Low to Intermediate Dose Atropine Administration During Dobutamine Stress Echocardiography in the Pre-Liver Transplant Population. Prog Transplant 2018; 28:361-367. [PMID: 30222085 DOI: 10.1177/1526924818800048] [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] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Dobutamine stress echocardiography (DSE) is frequently used to screen for obstructive coronary artery disease in the pre-liver transplant evaluation. Although atropine is a commonly used adjunctive medication, no study has evaluated its side effect profile in patients with end-stage liver disease (ESLD). RESEARCH QUESTION What is the safety of atropine in candidates undergoing pre-liver transplant evaluation when atropine is used in stress testing? DESIGN This multicenter, prospective study enrolled patients over a 6-month period undergoing pre-liver transplant evaluation. Each patient completed a questionnaire assessing anticholinergic-related symptoms within 24 hours of testing and 48 hours following. Comparisons were made among patients receiving any atropine dose versus those who did not and among patients receiving at least 1 mg atropine and those receiving less/none. RESULTS Forty patients were evaluated, and 32 (80%) had adjunctive atropine administered. No differences in clinical characteristics were noted. In comparisons among patients receiving any dose of atropine with those who did not, questionnaire results indicated a higher rate of nausea prior to testing and higher overall symptom severity following testing in patients not receiving atropine. In comparisons among patients receiving less than 1 mg atropine with those receiving at least 1 mg atropine, no difference in pre- or posttesting questionnaire responses was present. No patient in the study required reversal agents or hospitalization within 7 days of testing. CONCLUSIONS Atropine, a hepatically metabolized medication, did not predispose patients with ESLD to an increased symptom burden, and clinical outcomes related to DSE were unaffected.
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Affiliation(s)
- David Snipelisky
- 1 Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Justin Shipman
- 2 Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, USA
| | - Nicole Olson
- 3 Department of Pharmacy, Mayo Clinic, Rochester, MN, USA
| | - Patricia Pellikka
- 1 Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Bashar Aqel
- 4 Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Robert McCully
- 1 Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Kymberly Watt
- 5 Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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11
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Sarti AJ, Sutherland S, Healey A, Dhanani S, Landriault A, Fothergill-Bourbonnais F, Hartwick M, Beitel J, Oczkowski S, Cardinal P. A Multicenter Qualitative Investigation of the Experiences and Perspectives of Substitute Decision Makers Who Underwent Organ Donation Decisions. Prog Transplant 2018; 28:343-348. [PMID: 30222045 DOI: 10.1177/1526924818800046] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Organ donation research has centered on improving donation rates rather than focusing on the experience and impact on substitute decision makers. The purpose of this study was to document donor and nondonor family experiences, as well as lasting impacts of donation. METHODS We used a qualitative exploratory design. Semistructured interviews of 27 next-of-kin decision makers were conducted, transcribed verbatim, and entered into qualitative software. We analyzed the process-based reflections using inductive coding and thematic analysis techniques. RESULTS Four broad and interrelated themes emerged from the data: empathetic care, information needs, donation decision, and impact and follow-up. The donation experience left lasting impacts on family members due to lingering, unanswered questions. Suggested solutions to improve the donor experience for families included providers employing multimodal communication, ensuring a proper setting for family meetings, and the presence of a support person. DISCUSSION We now have improved our understanding of the donation process from the perspective of and final impression from the next of kin. To our knowledge, this is the largest cohort interviewed in Canada. We have explored families' experiences, which included but did not end with donation. We learned that despite being appreciative of nurses, physicians, and organ and tissue donation coordinators, family members were often troubled by unanswered questions. CONCLUSION This study described donor and nondonor family experiences with donation as well as lasting impacts. Addressing unanswered questions should be done in a place sufficiently remote from the donation event to enhance the family members' understanding and well-being.
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Affiliation(s)
- Aimee J Sarti
- 1 Department of Critical Care, The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Andrew Healey
- 2 Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sonny Dhanani
- 3 Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Angele Landriault
- 1 Department of Critical Care, The Ottawa Hospital, Ottawa, Ontario, Canada.,4 Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
| | | | - Michael Hartwick
- 1 Department of Critical Care, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Janice Beitel
- 6 Trillium Gift of Life Network (TGLN), Toronto, Ontario, Canada
| | - Simon Oczkowski
- 7 Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Pierre Cardinal
- 1 Department of Critical Care, The Ottawa Hospital, Ottawa, Ontario, Canada.,4 Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
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12
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Torabi J, Rocca JP, Choinski K, Lorenzen KA, Ajaimy M, Graham JA. Renal Allograft Torsion Following Simultaneous Pancreas Kidney Transplant Should Be Suspected With Sustained Kidney Injury With Normal Pancreas Function. Prog Transplant 2018; 28:396-397. [PMID: 30213234 DOI: 10.1177/1526924818800041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Julia Torabi
- 1 Albert Einstein College of Medicine, Bronx, NY, USA
| | - Juan P Rocca
- 1 Albert Einstein College of Medicine, Bronx, NY, USA.,2 Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | | | - Katherine A Lorenzen
- 2 Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Maria Ajaimy
- 1 Albert Einstein College of Medicine, Bronx, NY, USA.,2 Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
| | - Jay A Graham
- 1 Albert Einstein College of Medicine, Bronx, NY, USA.,2 Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA
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13
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Beal EW, Tumin D, Sobotka L, Tobias JD, Hayes D, Pawlik TM, Washburn K, Mumtaz K, Conteh L, Black SM. Patients From Appalachia Have Reduced Access to Liver Transplantation After Wait-Listing. Prog Transplant 2018; 28:305-313. [PMID: 30205758 DOI: 10.1177/1526924818800037] [Citation(s) in RCA: 2] [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] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Appalachian region is medically underserved and characterized by high morbidity and mortality. We investigated disparities among patients listed for liver transplantation (LT) in wait-list outcomes, according to residence in the Appalachian region. METHODS Data on adult patients listed for LT were obtained from the United Network for Organ Sharing for July 2013 to December 2015. Wait-list outcomes were compared using cause-specific hazard models by region of residence (Appalachian vs non-Appalachian) among patients listed at centers serving Appalachia. Posttransplant patient and graft survival were also compared. The study included 1835 LT candidates from Appalachia and 5200 from non-Appalachian regions, of whom 1016 patients experienced wait-list mortality or were delisted; 3505 received liver transplants. RESULTS In multivariable analyses, patients from Appalachia were less likely to receive LT (hazard ratio [HR] = 0.86; 95% confidence interval [CI]: 0.79-0.93; P < .001), but Appalachian residence was not associated with wait-list mortality or delisting (HR = 1.03; 95% CI: 0.89-1.18; P = .696). Among liver transplant recipients, patient and graft survival did not differ by Appalachian versus non-Appalachian residence. CONCLUSION Appalachian residence was associated with lower access to transplantation after listing for LT. This geographic disparity should be addressed in the current debate over reforming donor liver allocation and patient priority for LT.
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Affiliation(s)
- Eliza W Beal
- 1 Division of Transplantation, Department of General Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Dmitry Tumin
- 2 Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Lindsay Sobotka
- 3 Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Joseph D Tobias
- 2 Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Don Hayes
- 4 Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Timothy M Pawlik
- 5 Division of Surgical Oncology, Department of General Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kenneth Washburn
- 1 Division of Transplantation, Department of General Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Khalid Mumtaz
- 3 Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Lanla Conteh
- 3 Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sylvester M Black
- 1 Division of Transplantation, Department of General Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Abstract
INTRODUCTION Understanding medical information and self-management ability is vital for good quality of life among transplant recipients. However, health literacy (HL) has never been investigated among lung transplant recipients. OBJECTIVE This study investigated HL among Swedish lung transplant recipients 1 to 5 years after lung transplantation in relation to recovery, fatigue, adherence, cognitive function (CF), and relevant demographic variables. METHOD This study was part of a cross-sectional, Swedish multicenter study 1 to 5 years post lung transplantation called Self-Management after Thoracic Transplantation. In total, 117 (57%) of 204 eligible lung recipients due for their yearly follow-up were included; 1 year (n = 35), 2 years (n = 28), 3 years (n = 23), 4 years (n = 20) or 5 years (n = 11) after transplantation. The newest vital sign (NVS) instrument was used to measure the level of HL and contained 6 interview questions. The total scores ranged from 0 to 6 with 0 to 1= inadequate/low, 2 to 3 = marginal, 4 to 6 = adequate/good HL. RESULTS Twenty-one percent reported an NVS score of 0 to 3 indicating low or marginal HL and 79% scored 4 to 6 indicating adequate HL. Recipients scoring low or marginal were represented in all 5 years posttransplant, and the majority were not able to work. Health literacy was not related to age, sex, fatigue, adherence, recovery, marital status, or self-reported CF. DISCUSSION Health literacy was good among Swedish lung recipients. Providers should be aware that patients with low HL might present at any time posttransplant, and screening will help identify patients who need extra support.
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Affiliation(s)
- Annette Lennerling
- 1 Institute of Health and Care Sciences, Sahlgrenska Univerity Hospital, Gothenburg, Sweden.,2 The Transplant Centre, Sahlgrenska University Hospital Gothenburg, Sweden
| | - Annika M Kisch
- 3 Department of Hematology at Skåne University Hospital, Lund, Sweden.,4 Institute of Health Sciences at Lund University, Lund, Sweden
| | - Anna Forsberg
- 4 Institute of Health Sciences at Lund University, Lund, Sweden.,5 Department of Thoracic Transplantation and Cardiology, Skåne University Hospital, Lund, Sweden
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Evans DK, Welander Tärneberg A. Health-care quality and information failure: Evidence from Nigeria. Health Econ 2018; 27:e90-e93. [PMID: 29063634 DOI: 10.1002/hec.3611] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 06/23/2016] [Revised: 07/26/2017] [Accepted: 09/18/2017] [Indexed: 06/07/2023]
Abstract
Low-quality health services are a problem across low- and middle-income countries. Information failure may contribute, as patients may have insufficient knowledge to discern the quality of health services. That decreases the likelihood that patients will sort into higher quality facilities, increasing demand for better health services. This paper presents results from a health survey in Nigeria to investigate whether patients can evaluate health service quality effectively. Specifically, this paper demonstrates that although more than 90% of patients agree with any positive statement about the quality of their local health services, satisfaction is significantly associated with the diagnostic ability of health workers at the facility. Satisfaction is not associated with more superficial characteristics such as infrastructure quality or prescriptions of medicines. This suggests that patients may have sufficient information to discern some of the most important elements of quality, but that alternative measures are crucial for gauging the overall quality of care.
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Abstract
Hospitalists, known as physicians, are an emerging group in the medical field that is focused on the general medical care of hospitalized patients. Specializing in hospital medicine, they often attract a mix of appreciation and criticism. In the present manuscript, we review the pros and cons of a hospitalist in the health-care system. Although experts agree that hospitalists add value to the health-care system by reducing costs, streamlining administrative processes, and contributing to improved health-care outcomes, there is a large degree of disagreement regarding the extent of hospitalist contribution to overall improvements on health-care outcomes. In this paper, new strategies to overcome reported shortcomings and to further improve the quality of health care are discussed. Abbreviations: SHM: Society of Hospital Medicine; BOOST: Better Outcomes by Optimizing Safe Transitions; RED: Re-Engineered Discharge; CHF: chronic heart failure; MI: myocardial infarction; ICU: intensive care unit; PACT: post-acute care transitions; MRSA: methicillin-resistant Staphylococcus aureus; CINAHL: The Cumulative Index to Nursing and Allied Health Literature; PCP: primary care physician.
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Affiliation(s)
- Venkataraman Palabindala
- Division of Hospital Medicine, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Sohail Abdul Salim
- School of Medicine, Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
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17
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Richards CA, Starks H, O'Connor MR, Bourget E, Lindhorst T, Hays R, Doorenbos AZ. When and Why Do Neonatal and Pediatric Critical Care Physicians Consult Palliative Care? Am J Hosp Palliat Care 2017; 35:840-846. [PMID: 29179572 DOI: 10.1177/1049909117739853] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 01/03/2023] Open
Abstract
BACKGROUND Parents of children admitted to neonatal and pediatric intensive care units (ICUs) are at increased risk of experiencing acute and post-traumatic stress disorder. The integration of palliative care may improve child and family outcomes, yet there remains a lack of information about indicators for specialty-level palliative care involvement in this setting. OBJECTIVE To describe neonatal and pediatric critical care physician perspectives on indicators for when and why to involve palliative care consultants. METHODS Semistructured interviews were conducted with 22 attending physicians from neonatal, pediatric, and cardiothoracic ICUs in a single quaternary care pediatric hospital. Transcribed interviews were analyzed using content and thematic analyses. RESULTS We identified 2 themes related to the indicators for involving palliative care consultants: (1) palliative care expertise including support and bridging communication and (2) organizational factors influencing communication including competing priorities and fragmentation of care. CONCLUSIONS Palliative care was most beneficial for families at risk of experiencing communication problems that resulted from organizational factors, including those with long lengths of stay and medical complexity. The ability of palliative care consultants to bridge communication was limited by some of these same organizational factors. Physicians valued the involvement of palliative care consultants when they improved efficiency and promoted harmony. Given the increasing number of children with complex chronic conditions, it is important to support the capacity of ICU clinical teams to provide primary palliative care. We suggest comprehensive system changes and critical care physician training to include topics related to chronic illness and disability.
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Affiliation(s)
- Claire A Richards
- 1 Health Services Research & Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.,2 Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Helene Starks
- 1 Health Services Research & Development, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.,3 Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
| | - M Rebecca O'Connor
- 6 Department of Family and Child Nursing, School of Nursing, University of Washington, Seattle, WA
| | - Erica Bourget
- 7 Department of Immunology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Taryn Lindhorst
- 8 School of Social Work, University of Washington, Seattle, WA, USA
| | - Ross Hays
- 3 Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA.,4 Department of Bioethics and Humanities, School of Medicine, University of Washington, Seattle, WA, USA.,10 Palliative Care Program, Seattle Children's Hospital, Seattle, WA, USA.,11 The Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA.,12 Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Ardith Z Doorenbos
- 4 Department of Bioethics and Humanities, School of Medicine, University of Washington, Seattle, WA, USA.,5 Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA.,12 Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA.,13 Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, WA, USA
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Walker IF, Lord PA, Farragher TM. Variations in dementia diagnosis in England and association with general practice characteristics. Prim Health Care Res Dev 2017; 18:235-41. [PMID: 28262084 DOI: 10.1017/S146342361700007X] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Improving dementia diagnosis rates in England has been a key strategic aim of the UK Government but the variation and low diagnosis rates are poorly understood. The aim of this study was to explore the variation in actual versus expected diagnosis of dementia across England, and how these variations were associated with general practice characteristics. METHOD A cross-sectional, ecological study design using secondary data sources and median regression modelling was used. Data from the year 2011 for 7711 of the GP practices in England (92.7%). Associations of dementia diagnosis rates (%) per practice, calculated using National Health Service England's 'Dementia Prevalence Calculator' and various practice characteristics were explored using a regression model. RESULTS The median dementia diagnosis rate was 41.6% and the interquartile range was 31.2-53.9%. Multivariable regression analysis demonstrated positive associations between dementia diagnosis rates and deprivation of the population, overall Quality and Outcomes Framework performance, type of primary care contract and size of practice list. Negative associations were found between dementia diagnosis rates and average experience of GPs in the practice and the proportion of the practice caseload over 65 years old. CONCLUSION Dementia diagnosis rates vary greatly across GP practices in England. This study has found independent associations between dementia diagnosis rates and a number of patient and practice characteristics. Consideration of these factors locally may provide targets for case-finding interventions and so facilitate timely diagnosis.
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Walsh BK, Smallwood C, Rettig J, Kacmarek RM, Thompson J, Arnold JH. Daily Goals Formulation and Enhanced Visualization of Mechanical Ventilation Variance Improves Mechanical Ventilation Score. Respir Care 2017; 62:268-278. [PMID: 28073993 DOI: 10.4187/respcare.04873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/05/2022]
Abstract
BACKGROUND The systematic implementation of evidence-based practice through the use of guidelines, checklists, and protocols mitigates the risks associated with mechanical ventilation, yet variation in practice remains prevalent. Recent advances in software and hardware have allowed for the development and deployment of an enhanced visualization tool that identifies mechanical ventilation goal variance. Our aim was to assess the utility of daily goal establishment and a computer-aided visualization of variance. METHODS This study was composed of 3 phases: a retrospective observational phase (baseline) followed by 2 prospective sequential interventions. Phase I intervention comprised daily goal establishment of mechanical ventilation. Phase II intervention was the setting and monitoring of daily goals of mechanical ventilation with a web-based data visualization system (T3). A single score of mechanical ventilation was developed to evaluate the outcome. RESULTS The baseline phase evaluated 130 subjects, phase I enrolled 31 subjects, and phase II enrolled 36 subjects. There were no differences in demographic characteristics between cohorts. A total of 171 verbalizations of goals of mechanical ventilation were completed in phase I. The use of T3 increased by 87% from phase I. Mechanical ventilation score improved by 8.4% in phase I and 11.3% in phase II from baseline (P = .032). The largest effect was in the low risk VT category, with a 40.3% improvement from baseline in phase I, which was maintained at 39% improvement from baseline in phase II (P = .01). mechanical ventilation score was 9% higher on average in those who survived. CONCLUSIONS Daily goal formation and computer-enhanced visualization of mechanical ventilation variance were associated with an improvement in goal attainment by evidence of an improved mechanical ventilation score. Further research is needed to determine whether improvements in mechanical ventilation score through a targeted, process-oriented intervention will lead to improved patient outcomes. (ClinicalTrials.gov registration NCT02184208.).
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Affiliation(s)
- Brian K Walsh
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Craig Smallwood
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Jordan Rettig
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Robert M Kacmarek
- Department of Anesthesia, Critical Care and Pain Medicine, and Respiratory Care Services, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - John Thompson
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - John H Arnold
- Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care Medicine, Boston Children's Hospital, Boston, Massachusetts
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20
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Raios C, Keating JL, Stitt N, Opdam HI, Skinner EH. Challenges in Providing Timely Physiotherapy and Opportunities to Influence Outcomes for Potential Lung Donors. Prog Transplant 2016; 27:112-124. [PMID: 28617166 DOI: 10.1177/1526924816680098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/31/2023]
Abstract
CONTEXT There is a critical shortage of donor lungs however, considerable ethical considerations are associated with the conduct of research to optimize care of the potential organ donor. OBJECTIVE To investigate pathways of consent, respiratory care by physiotherapists and donation rates to contextualize future research on physiotherapy effects on donor lung suitability for procurement. DESIGN Retrospective audit. SETTING Australian tertiary hospital. PATIENTS Potential organ donors (defined as patients who may have been eligible to donate organs for transplantation via either brain death or circulatory death) 75 years or younger presenting to the emergency department or the intensive care unit (ICU) between September 2011 and December 2012. MAIN OUTCOME MEASURES Donation rates, timing of organ procurement from initial hospital presentation, number of persons designated to make health-care decisions approached for and consenting to donation and clinical research, and number of patients assessed and/or treated by physiotherapists. RESULTS Records of 65 potentially eligible donors were analyzed. Eighteen (28%) of the 65 became donors. Organ procurement occurred at a median of 48 hours (interquartile range: 34-72 hours) after ICU admission. All decision-makers approached regarding participation in clinical research (4 [6%] of the 65) consented. Physiotherapists assessed 48 (74%) of the 65 patients at least once and provided 28 respiratory treatments to 18 (28%) of the 65 patients, including lung hyperinflation and positioning. Limitations were the retrospective, single-center design and the "potential organ donor" definition. CONCLUSION Organ procurement occurs early. There is potential for early intervention to improve lung donor rates. Randomized controlled trials investigating protocolized respiratory packages of care may increase the potential donor pool and transplantation rates.
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Affiliation(s)
- Cassandra Raios
- 1 Faculty of Medicine, Nursing, and Health Science, Department of Physiotherapy, School of Primary Health Care, Monash University, Frankston, Victoria, Australia.,2 Department of Physiotherapy, Western Health, Footscray, Victoria, Australia
| | - Jenny L Keating
- 1 Faculty of Medicine, Nursing, and Health Science, Department of Physiotherapy, School of Primary Health Care, Monash University, Frankston, Victoria, Australia
| | - Nicola Stitt
- 3 Department of Intensive Care, Monash Health, Clayton, Victoria, Australia
| | - Helen I Opdam
- 4 Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
| | - Elizabeth H Skinner
- 1 Faculty of Medicine, Nursing, and Health Science, Department of Physiotherapy, School of Primary Health Care, Monash University, Frankston, Victoria, Australia.,2 Department of Physiotherapy, Western Health, Footscray, Victoria, Australia.,3 Department of Intensive Care, Monash Health, Clayton, Victoria, Australia.,5 Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
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Abstract
CONTEXT Transplant recipients require long-term immunosuppressive therapy, so continued medical follow-up is necessary for long-term survival. OBJECTIVE To investigate the current role of recipient transplant coordinators (RTCs) in the outpatient care of organ transplant recipients in Japan. METHODS We sent a questionnaire survey to doctors in transplant facilities affiliated with the Japan Society for Transplantation probing attitudes on the role of RTCs in outpatient clinics. The questionnaire assessed responses using an ordinal scale of 5 ranks. RESULTS In total, 139 responses were obtained from 233 transplant facilities. Respondents were divided into 2 groups, doctors currently working with RTCs (group A) and doctors not currently working with RTCs (group B). Differences in response rates between groups were analyzed using the Mann-Whitney U test. The overall attendance rate of RTCs in outpatient clinics was only 45%. Of all items on transplant outpatient clinics, group A exhibited a significantly higher response rate of "strongly agree" for "The involvement of an RTC in outpatient work can be expected to help prevent complications in transplant patients" ( P < .01) and "The involvement of an RTC in outpatient work can be expected to help prevent or reduce drug-related side effects in transplant patients" ( P < .01). Those with the highest rate of "strongly agree" were "It is necessary for RTCs to provide outpatient follow-up for transplant patients alongside doctors" (82.1% vs 67.3%, P < .07). CONCLUSION We suggest that Japanese RTCs must participate more frequently in posttransplant outpatient care.
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Affiliation(s)
- Kuniko Hagiwara
- 1 Division of Nursing, Department of Transplantation Medicine, Osaka University Hospital, Suita, Osaka, Japan.,2 School of Nursing, Kansai Medical University, Hirakata, Osaka, Japan
| | - Natsuko Seto
- 2 School of Nursing, Kansai Medical University, Hirakata, Osaka, Japan
| | - Yasuko Shimizu
- 3 Division of Health Sciences, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Shiro Takahara
- 4 Department of Advanced Technology for Transplantation, Osaka University, Suita, Osaka, Japan
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Bani-Issa W, Al Yateem N, Al Makhzoomy IK, Ibrahim A. Satisfaction of health-care providers with electronic health records and perceived barriers to its implementation in the United Arab Emirates. Int J Nurs Pract 2016; 22:408-16. [PMID: 27481126 DOI: 10.1111/ijn.12450] [Citation(s) in RCA: 8] [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] [Received: 08/04/2015] [Revised: 02/29/2016] [Accepted: 04/10/2016] [Indexed: 11/29/2022]
Abstract
The integration of electronic health records (EHRs) has shown promise in improving health-care quality. In the United Arab Emirates, EHRs have been recently adopted to improve the quality and safety of patient care. A cross-sectional survey of 680 health-care providers (HCPs) was conducted to assess the satisfaction of HCPs in the United Arab Emirates with EHRs' impact on access/viewing, documentation and medication administration and to explore the barriers encountered in their use. Data were collected over 6 months from April to September 2014. High overall satisfaction with EHRs was reported by HCPs, suggesting their acceptance. Physicians reported the greatest overall satisfaction with EHRs, although nurses showed significantly higher satisfaction with the impact on medication administration compared with other HCPs. The most significant barriers reported by nurses were lack of belief in the value of EHRs for patients and lack of adequate computer skills. Given the large investment in technology, additional research is necessary to promote the full utilization of EHRs. Nurses need to be aware of the value of EHRs for patient care and be involved in all stages of EHR implementations to maximize its meaningful use for better clinical outcomes.
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Affiliation(s)
- Wegdan Bani-Issa
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Nabeel Al Yateem
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Ibtihal Khalaf Al Makhzoomy
- Nursing Program, Fatima College of Health Sciences, Abu Dhabi, United Arab Emirates.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Ali Ibrahim
- College of Business Administration/Marketing Department, Griffith University, Brisbane, Queensland, Australia
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Tuffrey-Wijne I, McLaughlin D, Curfs L, Dusart A, Hoenger C, McEnhill L, Read S, Ryan K, Satgé D, Straßer B, Westergård BE, Oliver D. Defining consensus norms for palliative care of people with intellectual disabilities in Europe, using Delphi methods: A White Paper from the European Association of Palliative Care. Palliat Med 2016; 30:446-55. [PMID: 26346181 PMCID: PMC4838171 DOI: 10.1177/0269216315600993] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND People with intellectual disabilities often present with unique challenges that make it more difficult to meet their palliative care needs. AIM To define consensus norms for palliative care of people with intellectual disabilities in Europe. DESIGN Delphi study in four rounds: (1) a taskforce of 12 experts from seven European countries drafted the norms, based on available empirical knowledge and regional/national guidelines; (2) using an online survey, 34 experts from 18 European countries evaluated the draft norms, provided feedback and distributed the survey within their professional networks. Criteria for consensus were clearly defined; (3) modifications and recommendations were made by the taskforce; and (4) the European Association for Palliative Care reviewed and approved the final version. SETTING AND PARTICIPANTS Taskforce members: identified through international networking strategies. Expert panel: a purposive sample identified through taskforce members' networks. RESULTS A total of 80 experts from 15 European countries evaluated 52 items within the following 13 norms: equity of access, communication, recognising the need for palliative care, assessment of total needs, symptom management, end-of-life decision making, involving those who matter, collaboration, support for family/carers, preparing for death, bereavement support, education/training and developing/managing services. None of the items scored less than 86% agreement, making a further round unnecessary. In light of respondents' comments, several items were modified and one item was deleted. CONCLUSION This White Paper presents the first guidance for clinical practice, policy and research related to palliative care for people with intellectual disabilities based on evidence and European consensus, setting a benchmark for changes in policy and practice.
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Affiliation(s)
- Irene Tuffrey-Wijne
- Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London, UK
| | | | - Leopold Curfs
- Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | | | | | - Karen Ryan
- Mater Misericordiae University Hospital, Dublin, Republic of Ireland
| | | | | | | | - David Oliver
- Tizard Centre, University of Kent, Canterbury, UK
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Abstract
This article describes the evolution of mandated nurse staffing committees in Texas from 2002 to 2009 and presents a study that analyzed nurse staffing trends in Texas using a secondary analysis of hospital staffing data (N = 313 hospitals) from 2000 to 2012 obtained from the American Hospital Association Annual Survey. Nurse staffing patterns based on three staffing variables for registered nurses (RNs), licensed vocational nurses (LVNs), and total licensed nurses were identified: full-time equivalents per 1,000 adjusted patient days, productive hours per adjusted patient day, and RN skill mix. Similar to national trends between 2000 and 2012, most Texas hospitals experienced an increase in RN and total nurse staffing, decrease in LVN staffing, and an increase in RN skill mix. The magnitude of total nurse staffing changes in Texas (5% increase) was smaller than national trends (13.6% increase). Texas's small, rural, government hospitals and those with the highest preregulation staffing levels experienced the least change in staffing between 2000 and 2012: median change of 0 to .13 full-time equivalents per 1,000 adjusted patient days and median change in productive hours per patient day of 0 to .23. The varying effects of staffing committees in different organizational contexts should be considered in future staffing legislative proposals and other policy initiatives.
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Bouwman R, Bomhoff M, Robben P, Friele R. Patients' perspectives on the role of their complaints in the regulatory process. Health Expect 2015; 19:483-96. [PMID: 25950924 DOI: 10.1111/hex.12373] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Governments in several countries are facing problems concerning the accountability of regulators in health care. Questions have been raised about how patients' complaints should be valued in the regulatory process. However, it is not known what patients who made complaints expect to achieve in the process of health-care quality regulation. OBJECTIVE To assess expectations and experiences of patients who complained to the regulator. DESIGN Interviews were conducted with 11 people, and a questionnaire was submitted to 343 people who complained to the Dutch Health-care Inspectorate. The Inspectorate handled 92 of those complaints. This decision was based on the idea that the Inspectorate should only deal with complaints that relate to 'structural and severe' problems. RESULTS The response rate was 54%. Self-reported severity of physical injury of complaints that were not handled was significantly lower than of complaints that were. Most respondents felt that their complaint indicated a structural and severe problem that the Inspectorate should act upon. The desire for penalties or personal satisfaction played a lesser role. Only a minority felt that their complaint had led to improvements in health-care quality. CONCLUSIONS Patients and the regulator share a common goal: improving health-care quality. However, patients' perceptions of the complaints' relevance differ from the regulator's perceptions. Regulators should favour more responsive approaches, going beyond assessing against exclusively clinical standards to identify the range of social problems associated with complaints about health care. Long-term learning commitment through public participation mechanisms can enhance accountability and improve the detection of problems in health care.
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Affiliation(s)
- Renée Bouwman
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Manja Bomhoff
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Paul Robben
- Dutch Health-care Inspectorate, Utrecht, The Netherlands.,Institute of Health Policy and Management (iBMG), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Roland Friele
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,TRANZO (Scientific Centre for Care and Welfare), Faculty of Social and Behavioural Sciences, Tilburg University, Tilburg, The Netherlands
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Maurer J, Ramos A. One-year routine opportunistic screening for hypertension in formal medical settings and potential improvements in hypertension awareness among older persons in developing countries: evidence from the Study on Global Ageing and Adult Health (SAGE). Am J Epidemiol 2015; 181:180-4. [PMID: 25550358 DOI: 10.1093/aje/kwu339] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Hypertension is a leading risk factor in the global disease burden. Limited hypertension awareness is a major determinant of widespread gaps in hypertension treatment and control, especially in developing countries. We analyzed data on persons aged 50 years or older from 6 low- and middle-income countries participating in the first wave (2007-2010) of the World Health Organization's Survey of Global Ageing and Adult Health (SAGE). Our estimates suggest that just 1 year of routine opportunistic hypertension screening during formal visits to medical-care providers could yield significant increases in hypertension awareness among seniors in the developing world. We also show that eliminating missed opportunities for hypertension screening in medical settings would not necessarily exacerbate existing socioeconomic differences in hypertension awareness, despite requiring at least occasional contact with a formal health-care provider for obtaining a hypertension diagnosis. Thus, routine opportunistic screening for hypertension in formal medical settings may provide a simple but reliable way to increase hypertension awareness. Moreover, the proposed approach has the added advantage of leveraging existing resources and infrastructures, as well as facilitating a direct transition from the point of diagnosis to subsequent expert counseling and clinical care for newly identified hypertension patients.
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Rorat M, Jurek T. Sepsis in Poland: why do we die? Med Princ Pract 2014; 24:159-64. [PMID: 25501966 PMCID: PMC5588220 DOI: 10.1159/000369463] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 10/30/2014] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate the adverse events and potential risk factors in patients who develop sepsis. SUBJECTS AND METHODS Fifty-five medico-legal opinion forms relating to sepsis cases issued by the Department of Forensic Medicine, Wroclaw, Poland, between 2004 and 2013 were analyzed for medical errors and risk factors for adverse events. RESULTS The most common causes of medical errors were a lack of knowledge in recognition, diagnosis and therapy as well as ignorance of risk. The common risk factors for adverse events were deferral of a diagnostic or therapeutic decision, high-level anxiety of patients or their families about the patient's health and actively seeking for help. The most significant risk factors were communication errors, not enough medical staff, stereotype-based thinking about diseases and providing easy explanations for serious symptoms. CONCLUSION The most common cause of adverse events related to sepsis in the Polish health-care system was a lack of knowledge about the symptoms, diagnosis and treatment as well as the ignoring of danger. A possible means of improving safety might be through spreading knowledge and creating medical management algorithms for all health-care workers, especially physicians.
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Affiliation(s)
- Marta Rorat
- Department of Forensic Medicine, Wroclaw Medical University, Wroclaw, Poland
- Department of Infectious Diseases, Regional Specialist Hospital, Wroclaw, Poland
| | - Tomasz Jurek
- Department of Forensic Medicine, Wroclaw Medical University, Wroclaw, Poland
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