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Knutzen KE, Sacks OA, Brody-Bizar OC, Murray GF, Jain RH, Holdcroft LA, Alam SS, Liu MA, Pollak KI, Tulsky JA, Barnato AE. Actual and Missed Opportunities for End-of-Life Care Discussions With Oncology Patients: A Qualitative Study. JAMA Netw Open 2021; 4:e2113193. [PMID: 34110395 PMCID: PMC8193430 DOI: 10.1001/jamanetworkopen.2021.13193] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/13/2021] [Indexed: 11/14/2022] Open
Abstract
Importance Early discussion of end-of-life (EOL) care preferences improves clinical outcomes and goal-concordant care. However, most EOL discussions occur approximately 1 month before death, despite most patients desiring information earlier. Objective To describe successful navigation and missed opportunities for EOL discussions (eg, advance care planning, palliative care, discontinuation of disease-directed treatment, hospice care, and after-death wishes) between oncologists and outpatients with advanced cancer. Design, Setting, and Participants This study is a secondary qualitative analysis of outpatient visits audio-recorded between November 2010 and September 2014 for the Studying Communication in Oncologist-Patient Encounters randomized clinical trial. The study was conducted at 2 US academic medical centers. Participants included medical, gynecological, and radiation oncologists and patients with stage IV malignant neoplasm, whom oncologists characterized as being ones whom they "…would not be surprised if they were admitted to an intensive care unit or died within one year." Data were analyzed between January 2018 and August 2020. Exposures The parent study randomized participants to oncologist- and patient-directed interventions to facilitate discussion of emotions. Encounters were sampled across preintervention and postintervention periods and all 4 treatment conditions. Main Outcomes and Measures Secondary qualitative analysis was done of patient-oncologist dyads with 3 consecutive visits for EOL discussions, and a random sample of 7 to 8 dyads from 4 trial groups was analyzed for missed opportunities. Results The full sample included 141 patients (54 women [38.3%]) and 39 oncologists (8 women [19.5%]) (mean [SD] age for both patients and oncologists, 56.3 [10.0] years). Of 423 encounters, only 21 (5%) included EOL discussions. Oncologists reevaluated treatment options in response to patients' concerns, honored patients as experts on their goals, or used anticipatory guidance to frame treatment reevaluation. In the random sample of 31 dyads and 93 encounters, 35 (38%) included at least 1 missed opportunity. Oncologists responded inadequately to patient concerns over disease progression or dying, used optimistic future talk to address patient concerns, or expressed concern over treatment discontinuation. Only 4 of 23 oncologists (17.4%) had both an EOL discussion and a missed opportunity. Conclusions and Relevance Opportunities for EOL discussions were rarely realized, whereas missed opportunities were more common, a trend that mirrored oncologists' treatment style. There remains a need to address oncologists' sensitivity to EOL discussions, to avoid unnecessary EOL treatment.
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Affiliation(s)
- Kristin E. Knutzen
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Olivia A. Sacks
- Department of Surgery, Boston Medical Center, Boston, Massachusetts
| | | | - Genevra F. Murray
- Department of General Medicine, Boston Medical Center, Boston, Massachusetts
| | - Raina H. Jain
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | | | - Shama S. Alam
- Pharmaceutical Product Development, Evidera, Bethesda, Maryland
| | - Matthew A. Liu
- School of Medicine, University of California, San Diego, La Jolla
| | | | - James A. Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
- Division of Palliative Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Amber E. Barnato
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Ye P, Fry L, Champion JD. Changes in Advance Care Planning for Nursing Home Residents During the COVID-19 Pandemic. J Am Med Dir Assoc 2021; 22:209-214. [PMID: 33290730 PMCID: PMC7674113 DOI: 10.1016/j.jamda.2020.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/06/2020] [Accepted: 11/10/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Describe the care preference changes among nursing home residents receiving proactive Advance Care Planning (ACP) conversations from health care practitioners during the COVID-19 pandemic. DESIGN Retrospective chart review. SETTING AND PARTICIPANTS Nursing home residents (n = 963) or their surrogate decision makers had at least 1 ACP conversation with a primary health care practitioner between April 1, 2020, and May 30, 2020, and made decisions of any changes in code status and hospitalization preferences. METHODS Health care practitioners conducted ACP conversations proactively with residents or their surrogate decision makers at 15 nursing homes in a metropolitan area of the southwestern United States between April 1, 2020, and May 30, 2020. ACP conversations reviewed code status and goals of care including Do Not Hospitalize (DNH) care preference. Resident age, gender, code status, and DNH choice before and after the ACP conversations were documented. Descriptive data analyses identified significant changes in resident care preferences before and after ACP conversations. RESULTS Before the most recent ACP discussion, 361 residents were full code status and the rest were Out of Hospital Do Not Resuscitate (DNR). Of the individuals with Out of Hospital DNR, 188 residents also chose DNH. After the ACP conversation, 88 residents opted to change from full code status to Out of Hospital DNR, thereby increasing the percentage of residents with Out of Hospital DNR from 63% to 72%. Almost half of the residents decided to keep or change to the DNH care option after the ACP conversation. CONCLUSION AND IMPLICATIONS Proactive ACP conversations during COVID-19 increased DNH from less than a quarter to almost half among the nursing home residents. Out of Hospital DNR increased by 9%. It is important for all health care practitioners to proactively review ACP with nursing home residents and their surrogate decision makers during a pandemic, thereby ensuring care consistent with personal goals of care and avoiding unnecessary hospitalizations.
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Affiliation(s)
- Ping Ye
- The School of Nursing, the University of Texas at Austin, Austin, TX, USA; Austin Geriatric Specialists, Austin, TX, USA.
| | - Liam Fry
- Austin Geriatric Specialists, Austin, TX, USA; Dell Medical School, the University of Texas at Austin, Austin, TX, USA
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Feeley C, Thomson G, Downe S. Understanding how midwives employed by the National Health Service facilitate women's alternative birthing choices: Findings from a feminist pragmatist study. PLoS One 2020; 15:e0242508. [PMID: 33216777 PMCID: PMC7678977 DOI: 10.1371/journal.pone.0242508] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 10/12/2020] [Indexed: 12/30/2022] Open
Abstract
UK legislation and government policy favour women's rights to bodily autonomy and active involvement in childbirth decision-making including the right to decline recommendations of care/treatment. However, evidence suggests that both women and maternity professionals can face challenges enacting decisions outside of sociocultural norms. This study explored how NHS midwives facilitated women's alternative physiological birthing choices-defined in this study as 'birth choices that go outside of local/national maternity guidelines or when women decline recommended treatment of care, in the pursuit of a physiological birth'. The study was underpinned by a feminist pragmatist theoretical framework and narrative methodology was used to collect professional stories of practice via self-written narratives and interviews. Through purposive and snowball sampling, a diverse sample in terms of age, years of experience, workplace settings and model of care they operated within, 45 NHS midwives from across the UK were recruited. Data were analysed using narrative thematic that generated four themes that described midwives' processes of facilitating women's alternative physiological births: 1. Relationship building, 2. Processes of support and facilitation, 3. Behind the scenes, 4. Birth facilitation. Collectively, the midwives were involved in a wide range of alternative birth choices across all birth settings. Fundamental to their practice was the development of mutually trusting relationships with the women which were strongly asserted a key component of safe care. The participants highlighted a wide range of personal and advanced clinical skills which was framed within an inherent desire to meet the women's needs. Capturing what has been successfully achieved within institutionalised settings, specifically how, maternity providers may benefit from the findings of this study.
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Affiliation(s)
- Claire Feeley
- THRIVE Centre, ReaCH Group, University of Central Lancashire, Preston, United Kingdom
| | - Gill Thomson
- THRIVE Centre, ReaCH Group, University of Central Lancashire, Preston, United Kingdom
- MAINN Group, University of Central Lancashire, Preston, United Kingdom
| | - Soo Downe
- THRIVE Centre, ReaCH Group, University of Central Lancashire, Preston, United Kingdom
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Ferranti M, Pinnarelli L, Rosa A, Pastorino R, D’Ovidio M, Fusco D, Davoli M. Evaluation of the breast cancer care network within the Lazio Region (Central Italy). PLoS One 2020; 15:e0238562. [PMID: 32881971 PMCID: PMC7470269 DOI: 10.1371/journal.pone.0238562] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/14/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A summary indicator for evaluating the breast cancer network has never been measured at the regional level. The aim is to design treemaps providing a summary description of hospitals (including breast units) and Local Health Units (LHUs) in terms of their levels of performance within the breast cancer network of the Lazio region (central Italy). The treemap structure has an intuitive design and displays information from both general and specific analyses. METHODS Patients admitted to the regional hospitals for malignant breast cancer (MBC) surgery in 2010-2017 were selected in a population-based cohort study. These quality indicators were calculated based on the international guidelines (EUSOMA, ESMO) to assess the performance in terms of volume of activity, surgery procedure, post-surgery assistance and timeliness of medical therapy or radiotherapy beginning. The quality indicators were calculated using administrative health data systematically collected at the regional level and were included in the treemap to represent the surgery or the post-surgery areas of the breast cancer clinical pathway. In order to allow aggregation of scores for different indicators belonging to the same clinical area, up to five evaluation classes were defined using the "Jenks Natural Breaks" algorithm. A score and a colour were assigned to each clinical area based on the ranking of the indicators involved. The analyses were performed on an annual basis, by the LHU of residence and by the hospital which performed the surgical intervention. RESULTS In 2017, 6218 surgical interventions for MBC were performed in the hospitals of Lazio. The results showed a continuous increase of the level of performance over the years. Hospitals showed higher variability in the levels of performance than the LHUs. 36% of the evaluated hospitals reached a high level of performance. An audit of the S. Filippo Neri breast unit revealed incorrect coding of the input data. For this reason, the score for the indicator for the volume of wards was re-calculated and re-evaluated, with a subsequent improvement of the level of performance. Most LHUs achieved at least an average overall level of performance, with 20% of the LHUs reaching a high level of performance. CONCLUSIONS This is the first attempt to apply the treemap logic to a single clinical network, in order to obtain a summary indicator for the evaluation of the breast cancer care network. Our results supply decision makers with a transparent instrument of governance for heterogeneous users, directing efforts improving and promoting equity of care. The treemaps could be reproduced and adapted for other local contexts, in order to limit inappropriateness and ensure uniform levels of breast cancer care within local areas. The next step is the evaluation of audit and feedback interventions to improve the quality of care and to guarantee homogeneous levels of care throughout the region.
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Affiliation(s)
- Margherita Ferranti
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
- Department of Woman and Child Health and Public Health—Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- * E-mail:
| | - Luigi Pinnarelli
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
| | - Alessandro Rosa
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
| | - Roberta Pastorino
- Department of Woman and Child Health and Public Health—Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | - Danilo Fusco
- Lazio Regional Health Service, Department of Health Information Systems, Rome, Italy
| | - Marina Davoli
- Department of Epidemiology of Lazio Regional Health Service, Rome, Italy
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Crowley C, Guitron S, Son J, Pianykh OS. Modeling workflows: Identifying the most predictive features in healthcare operational processes. PLoS One 2020; 15:e0233810. [PMID: 32525888 PMCID: PMC7289434 DOI: 10.1371/journal.pone.0233810] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/12/2020] [Indexed: 11/18/2022] Open
Abstract
Limited resources and increased patient flow highlight the importance of optimizing healthcare operational systems to improve patient care. Accurate prediction of exam volumes, workflow surges and, most notably, patient delay and wait times are known to have significant impact on quality of care and patient satisfaction. The main objective of this work was to investigate the choice of different operational features to achieve (1) more accurate and concise process models and (2) more effective interventions. To exclude process modelling bias, data from four different workflows was considered, including a mix of walk-in, scheduled, and hybrid facilities. A total of 84 features were computed, based on previous literature and our independent work, all derivable from a typical Hospital Information System. The features were categorized by five subgroups: congestion, customer, resource, task and time features. Two models were used in the feature selection process: linear regression and random forest. Independent of workflow and the model used for selection, it was determined that congestion feature sets lead to models most predictive for operational processes, with a smaller number of predictors.
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Affiliation(s)
- Colm Crowley
- Massachusetts General Hospital, Boston, MA, United States of America
- Department of Statistics, University College Cork, Cork, Ireland
| | - Steven Guitron
- Massachusetts General Hospital, Boston, MA, United States of America
| | - Joseph Son
- Department of Statistics, Stanford University, Stanford, CA, United States of America
| | - Oleg S. Pianykh
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States of America
- * E-mail:
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Friebert S, Grossoehme DH, Baker JN, Needle J, Thompkins JD, Cheng YI, Wang J, Lyon ME. Congruence Gaps Between Adolescents With Cancer and Their Families Regarding Values, Goals, and Beliefs About End-of-Life Care. JAMA Netw Open 2020; 3:e205424. [PMID: 32427325 PMCID: PMC7237980 DOI: 10.1001/jamanetworkopen.2020.5424] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/13/2020] [Indexed: 11/14/2022] Open
Abstract
Importance Lack of pediatric advance care planning has been associated with poor communication, increased hospitalization, poor quality of life, and legal actions. Clinicians presume that families understand adolescents' treatment preferences for end-of-life care. Objective To examine patient-reported end-of-life values and needs of adolescents with cancer and congruence with their families' understanding of these needs. Design, Setting, and Participants This cross-sectional survey was conducted among adolescent-family dyads from July 16, 2016, to April 30, 2019, at 4 tertiary care pediatric US hospitals. Participants included 80 adolescent-family dyads (160 participants) within a larger study facilitating pediatric advance care planning. Adolescent eligibility criteria included being aged 14 to 21 years, English speaking, being diagnosed with cancer at any stage, and knowing their diagnosis. Family included legal guardians for minors or chosen surrogate decision-makers for those aged 18 years or older. Data analysis was performed from April 2019 to November 2019. Exposure Session 1 of the 3-session Family Centered Pediatric Advance Care Planning for Teens With Cancer intervention. Main Outcomes and Measures The main outcome was congruence between adolescents with cancer and their families regarding adolescents' values, goals, and beliefs about end-of-life care. Prevalence-adjusted and bias-adjusted κ (PABAK) values were used to measure congruence on the Lyon Advance Care Planning Survey-Revised (Patient and Surrogate versions). Results A total of 80 adolescent-family dyads (160 participants) were randomized to the intervention group in the original trial. Among the adolescents, 44 (55.0%) were female and 60 (75.0%) were white, with a mean (SD) age of 16.9 (1.8) years. Among family members, 66 (82.5%) were female and 65 (81.3%) were white, with a mean (SD) age of 45.3 (8.3) years. Family members' understanding of their adolescent's beliefs about the best time bring up end-of-life decisions was poor: 86% of adolescents wanted early timing (before getting sick, while healthy, when first diagnosed, when first sick from a life-threatening illness, or all of the above), but only 39% of families knew this (PABAK, 0.18). Families' understanding of what was important to their adolescents when dealing with their own dying was excellent for wanting honest answers from their physician (PABAK, 0.95) and understanding treatment choices (PABAK, 0.95) but poor for dying a natural death (PABAK, 0.18) and being off machines that extend life, if dying (PABAK, 0). Conclusions and Relevance Many families had a poor understanding of their adolescent's values regarding their own end-of-life care, such as when to initiate end-of-life conversations and preference for being off machines that extend life. Pediatric advance care planning could minimize these misunderstandings with the potential for a substantial impact on quality of care.
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Affiliation(s)
- Sarah Friebert
- Haslinger Family Pediatric Palliative Care Center, Akron Children’s Hospital, Akron, Ohio
- Rebecca D. Considine Research Institute, Akron Children’s Hospital, Akron, Ohio
| | - Daniel H. Grossoehme
- Haslinger Family Pediatric Palliative Care Center, Akron Children’s Hospital, Akron, Ohio
- Rebecca D. Considine Research Institute, Akron Children’s Hospital, Akron, Ohio
| | - Justin N. Baker
- Division of Quality of Life and Palliative Care, St Jude Research Hospital, Memphis, Tennessee
| | - Jennifer Needle
- Center for Bioethics, Department of Pediatrics, University of Minnesota, Minneapolis
| | - Jessica D. Thompkins
- Center for Translational Research, Children’s Research Institute, Children’s National Hospital, Washington, DC
| | - Yao I. Cheng
- Division of Biostatistics and Study Methodology, Center for Translational Research, Children’s Research Institute, Children’s National Hospital, Washington, DC
| | - Jichuan Wang
- Division of Biostatistics and Study Methodology, Center for Translational Research, Children’s Research Institute, Children’s National Hospital, Washington, DC
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Maureen E. Lyon
- George Washington University School of Medicine and Health Sciences, Washington, DC
- Division of Adolescent and Young Adult Medicine, Center for Translational Research, Children’s Research Institute, Children’s National Hospital, Washington, DC
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Galbete A, Cambra K, Forga L, Baquedano FJ, Aizpuru F, Lecea O, Librero J, Ibáñez B. Achievement of cardiovascular risk factor targets according to sex and previous history of cardiovascular disease in type 2 diabetes: A population-based study. J Diabetes Complications 2019; 33:107445. [PMID: 31668588 DOI: 10.1016/j.jdiacomp.2019.107445] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 05/13/2019] [Revised: 08/01/2019] [Accepted: 09/07/2019] [Indexed: 12/22/2022]
Abstract
AIMS The main objective was to assess, using real-practice primary care records, the degree of control of cardiovascular risk factor targets. Records were stratified by the presence of previous history or cardiovascular disease (CVD), and sex differences in the fulfillment profile were analyzed. METHODS This is a cross-sectional population-based study conducted in Spain. Type 2 diabetes patients over 20 years old (n = 32,638) were identified from primary care electronic health records, and the following information was extracted: glycated hemoglobin (HbA1c), systolic and diastolic blood pressure (SBP and DBP), LDL and HDL cholesterol levels, triglycerides, BMI and smoking history. RESULTS Patients with CVD had worse control of HbA1c than patients without it, (HbA1c < 7% 56.9% vs. 61.2%) but better control of BP (<130/80: 43.5% vs 38.2%) and lipids. In the group without prior CVD history, women had worse control of HbA1c, LDL, HDL, BMI and triglycerides and better control of blood pressure and smoking. These differences were maintained or accentuated in the group with previous CVD. CONCLUSIONS Women had poorer control of CV risk factors in both groups, and the sex-gap is accentuated in patients with previous CVD.
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Affiliation(s)
- Arkaitz Galbete
- Navarrabiomed-Complejo Hospitalario de Navarra-UPNA, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain.
| | - Koldo Cambra
- Instituto de Salud Pública y Laboral de Navarra, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain; IdiSNA, Pamplona, Spain.
| | - Luis Forga
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Navarra, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain; IdiSNA, Pamplona, Spain.
| | - Francisco Javier Baquedano
- Gerencia de Atención Primaria, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain.
| | - Felipe Aizpuru
- Hospital de Txagorritxu, Servicio Vasco de Salud-Osakidetza, Vitoria Gasteiz, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain.
| | - Oscar Lecea
- Gerencia de Atención Primaria, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain.
| | - Julián Librero
- Navarrabiomed-Complejo Hospitalario de Navarra-UPNA, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain.
| | - Berta Ibáñez
- Navarrabiomed-Complejo Hospitalario de Navarra-UPNA, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain; IdiSNA, Pamplona, Spain.
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Rai A, Chawla N, Han X, Rim SH, Smith T, de Moor J, Yabroff KR. Has the Quality of Patient-Provider Communication About Survivorship Care Improved? J Oncol Pract 2019; 15:e916-e924. [PMID: 31265350 PMCID: PMC6851794 DOI: 10.1200/jop.19.00157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2019] [Indexed: 01/19/2023] Open
Abstract
PURPOSE The aim of the current study was to assess whether the quality of patient-provider communication on key elements of cancer survivorship care changed between 2011 and 2016. METHODS Participating survivors completed the 2011 or 2016 Medical Expenditure Panel Survey Experiences with Cancer Surveys (N = 2,266). Participants reported whether any clinician ever discussed different aspects of survivorship care. Responses ranged from "Did not discuss at all" to "Discussed it with me in detail". Distributions of responses were compared among all respondents and only among those who had received cancer-directed treatment within 3 years of the survey. RESULTS In 2011, the percentage of survivors who did not receive detailed instructions on follow-up care, late or long-term adverse effects, lifestyle recommendations, and emotional or social needs were 35.1% (95% CI, 31.9% to 38.4%), 54.2% (95% CI, 50.7% to 57.6%), 58.9% (95% CI, 55.3% to 62.5%), and 69.2% (95% CI, 65.9% to 72.3%), respectively, and the corresponding proportions for 2016 were 35.4% (95% CI, 31.9% to 37.8%), 55.5% (95% CI, 51.7% to 59.3%), 57.8% (95% CI, 54.2% to 61.2%), and 68.2% (95% CI, 64.3% to 71.8%), respectively. Findings were similar among recently treated respondents. Only 24% in 2011 and 22% in 2016 reported having detailed discussions about all four topics. In 2016, 47.6% of patients (95% CI, 43.8% to 51.4%) reported not having detailed discussions with their providers about a summary of their cancer treatments. CONCLUSION Clear gaps in the quality of communication between survivors of cancer and providers persist. Our results highlight the need for continued efforts to improve communication between survivors of cancer and providers, including targeted interventions in key survivorship care areas.
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Affiliation(s)
| | | | | | - Sun Hee Rim
- Centers for Disease Prevention and Control, Atlanta, GA
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van Overveld LFJ, Takes RP, Braspenning JCC, Baatenburg de Jong RJ, de Boer JP, Brouns JJA, Bun RJ, Dik EA, van Dijk BAC, van Es RJJ, Hoebers FJP, Kolenaar B, Kropveld A, Langeveld TPM, Verschuur HP, de Visscher JGAM, van Weert S, Witjes MJH, Smeele LE, Merkx MAW, Hermens RPMG. Variation in Integrated Head and Neck Cancer Care: Impact of Patient and Hospital Characteristics. J Natl Compr Canc Netw 2019; 16:1491-1498. [PMID: 30545996 DOI: 10.6004/jnccn.2018.7061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 07/17/2018] [Indexed: 11/17/2022]
Abstract
Background: Monitoring and effectively improving oncologic integrated care requires dashboard information based on quality registrations. The dashboard includes evidence-based quality indicators (QIs) that measure quality of care. This study aimed to assess the quality of current integrated head and neck cancer care with QIs, the variation between Dutch hospitals, and the influence of patient and hospital characteristics. Methods: Previously, 39 QIs were developed with input from medical specialists, allied health professionals, and patients' perspectives. QI scores were calculated with data from 1,667 curatively treated patients in 8 hospitals. QIs with a sample size of >400 patients were included to calculate reliable QI scores. We used multilevel analysis to explain the variation. Results: Current care varied from 29% for the QI about a case manager being present to discuss the treatment plan to 100% for the QI about the availability of a treatment plan. Variation between hospitals was small for the QI about patients discussed in multidisciplinary team meetings (adherence: 95%, range 88%-98%), but large for the QI about malnutrition screening (adherence: 50%, range 2%-100%). Higher QI scores were associated with lower performance status, advanced tumor stage, and tumor in the oral cavity or oropharynx at the patient level, and with more curatively treated patients (volume) at hospital level. Conclusions: Although the quality registration was only recently launched, it already visualizes hospital variation in current care. Four determinants were found to be influential: tumor stage, performance status, tumor site, and volume. More data are needed to assure stable results for use in quality improvement.
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Fan W, Song Y, Inzucchi SE, Sperling L, Cannon CP, Arnold SV, Kosiborod M, Wong ND. Composite cardiovascular risk factor target achievement and its predictors in US adults with diabetes: The Diabetes Collaborative Registry. Diabetes Obes Metab 2019; 21:1121-1127. [PMID: 30609214 DOI: 10.1111/dom.13625] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 11/09/2018] [Revised: 12/27/2018] [Accepted: 01/02/2019] [Indexed: 12/20/2022]
Abstract
AIM To investigate multiple risk factor target attainment in adults with diabetes mellitus (DM) for atherosclerotic cardiovascular disease (ASCVD) prevention and the predictors of such attainment in a contemporary DM registry. METHODS In the US Diabetes Collaborative Registry we identified patients who were at target for glycated haemoglobin (HbA1c; < 53 mmol/mol (7%) or < 64 mmol/mol (8%) if with ASCVD), LDL cholesterol (< 2.6 mmol/L (100 mg/dL) or < 1.8 mmol/L (70 mg/dL) 1.8 if with ASCVD) and blood pressure (BP; <140/90 mmHg and < 130/80 mmHg as an alternate), and who had non-smoking status, by sex, race and history of ASCVD. Multiple logistic regression was used to examine predictors of target attainment. RESULTS In 74 393 patients with DM who had available data (mean age 69.0 years, 41.0% women), overall target attainment for HbA1c, BP, LDL cholesterol and non-smoking status was 73.6%, 69.0% (40.3% for BP <130/80 mmHg), 48.6% and 85.2%, respectively. Only 21.6% (13.0% with BP <130/80 mmHg) were at target for all four measures, and the proportions were higher in men (23.6%) versus women (18.6%) and in white people (22.5%) versus African-American people (14.7%) and people of other races (20.8%; P < 0.01). A total of 62.4% were on a moderate-/high-intensity statin. Age (≥65 years: odds ratio [OR] 1.9, 95% confidence interval [CI] 1.7-2.0; and 55-64 years: OR 1.3, 95% CI 1.2-1.4 vs. <55 years), male sex (OR 1.3, 95% CI 1.3-1.4), white race (OR 1.4, 95% CI 1.3-1.5), middle or high income (ORs 1.1, 95% CI 1.1-1.2 or 1.4, 95% CI 1.4-1.5, respectively) were associated, and depression (OR 0.9, 95% CI 0.8-1.0) was inversely associated with meeting all four targets (all P = 0.01 to P < 0.001). CONCLUSIONS In our US registry of patients with DM, only one in five patients were achieving comprehensive risk factor control. Multifactorial interventions will be necessary to optimize ASCVD risk factor control.
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Affiliation(s)
- Wenjun Fan
- University of California, Irvine School of Medicine, Irvine, California
| | - Yang Song
- Baim Institute, Boston, Massachusetts
| | | | | | - Christopher P Cannon
- Baim Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | | | - Nathan D Wong
- University of California, Irvine School of Medicine, Irvine, California
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Sandoval Y, Tajti P, Karatasakis A, Burke MN, Danek BA, Karmpaliotis D, Alaswad K, Jaffer FA, Yeh RW, Patel M, Mahmud E, Krestyaninov O, Khelimskii D, Choi JW, Doing AH, Toma C, Wyman RM, Uretsky B, Garcia S, Koutouzis M, Tsiafoutis I, Holper E, Moses JW, Lembo NJ, Parikh M, Kirtane AJ, Ali ZA, Doshi D, Kandzari DE, Karacsonyi J, Rangan BV, Thompson C, Banerjee S, Brilakis ES. Frequency and Outcomes of Ad Hoc Versus Planned Chronic Total Occlusion Percutaneous Coronary Intervention: Multicenter Experience. J Invasive Cardiol 2019; 31:133-139. [PMID: 30643040] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND For patients needing coronary chronic total occlusion (CTO) percutaneous coronary intervention (PCI), a planned, staged intervention has been recommended by experts. Ad hoc CTO-PCI, however, occurs in practice. METHODS Observational, contemporary, multicenter, international registry. Our goals were to determine the frequency, characteristics, procedural techniques, and outcomes of patients who underwent ad hoc vs planned CTO-PCI. RESULTS Among 2282 patients who underwent CTO-PCI between 2012 and 2017, 318 (14%) were ad hoc. Patients undergoing ad hoc CTO-PCI had lower J-CTO, PROGRESS CTO, and PROGRESS Complications scores. Antegrade-wire escalation was used more often in ad hoc PCI (96% vs 81%; P<.001), whereas antegrade-dissection re-entry (22% vs 32%) and retrograde approaches (14% vs 38%) were more common in planned PCI (P<.001). There was no difference in ad hoc vs planned PCI in technical (85% vs 86%) and procedural success (84% vs 84%). In-hospital major adverse cardiac events (MACE) were more common in patients who underwent planned procedures (0.6% vs 2.9%; P=.02). Multivariable analyses showed that ad hoc CTO-PCI was not associated with technical success or MACE. CONCLUSIONS Ad hoc CTO-PCI occurs more commonly in less complex lesions and is associated with similarly high success rates as planned CTO-PCI in lower J-CTO score lesions, suggesting that ad hoc CTO-PCI may be an acceptable option for experienced hybrid operators in carefully selected cases. Complex cases, as quantified by the J-CTO score, have a higher in-hospital MACE rate and should preferably be performed following proper planning and preparation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Emmanouil S Brilakis
- Minneapolis Heart Institute, 920 E. 28th Street #300, Minneapolis, MN 55407 USA.
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Levin SK, Nilsen P, Bendtsen P, Bülow P. Adherence to planned risk management interventions in Swedish forensic care: What is said and done according to patient records. Int J Law Psychiatry 2019; 64:71-82. [PMID: 31122642 DOI: 10.1016/j.ijlp.2019.02.003] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 01/26/2019] [Accepted: 02/16/2019] [Indexed: 06/09/2023]
Abstract
Both structured and unstructured clinical risk assessments within forensic care aim to prevent violence by informing risk management, but research about their preventive role is inconclusive. The aim of this study was to investigate risk management interventions that were planned and realized during forensic care by analysing patient records. Records from a forensic clinic in Sweden, covering 14 patients and 526 months, were reviewed. Eight main types of risk management interventions were evaluated by content analysis: monitoring, supervision, assessment, treatment, victim protection, acute coercion, security level and police interventions. Most planned risk management interventions were realized, both in structured and clinical risk assessments. However, most realized interventions were not planned, making them more open to subjective decisions. Analysing risk management interventions actually planned and realized in clinical settings can reveal the preventive role of structured risk assessments and how different interventions mediate violence risk.
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Affiliation(s)
- Sara K Levin
- Regional Forensic Psychiatric Hospital, Vadstena, Sweden; Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
| | - Per Nilsen
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Preben Bendtsen
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden; Department of Medical Specialist, Department of Medicine and Health Sciences, Linköping University, Motala, Sweden
| | - Per Bülow
- Regional Forensic Psychiatric Hospital, Vadstena, Sweden; Department of Psychiatry, Ryhov County Hospital, Jönköping, Sweden; Department of Behavioural Science and Social Work, School of Health Sciences, Jönköping University, Jönköping, Sweden
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McLean K, Glasbey J, Borakati A, Brooks T, Chang H, Choi S, Goodson R, Nielsen M, Pronin S, Salloum N, Sewart E, Vanniasegaram D, Drake T, Gillies M, Harrison E, Chapman S, Khatri C, Kong C, Claireaux H, Bath M, Mohan M, McNamee L, Kelly M, Mitchell H, Fitzgerald J, Bhangu A, Nepogodiev D, Antoniou I, Dean R, Davies N, Trecarten S, Henderson I, Holmes C, Wylie J, Shuttleworth R, Jindal A, Hughes F, Gouda P, Fleck R, Hanrahan M, Karunakaran P, Chen J, Sykes M, Sethi R, Suresh S, Patel P, Patel M, Varma R, Mushtaq J, Gundogan B, Bolton W, Khan T, Burke J, Morley R, Favero N, Adams R, Thirumal V, Kennedy E, Ong K, Tan Y, Gabriel J, Bakhsh A, Low J, Yener A, Paraoan V, Preece R, Tilston T, Cumber E, Dean S, Ross T, McCance E, Amin H, Satterthwaite L, Clement K, Gratton R, Mills E, Chiu S, Hung G, Rafiq N, Hayes J, Robertson K, Dynes K, Huang H, Assadullah S, Duncumb J, Moon R, Poo S, Mehta J, Joshi K, Callan R, Norris J, Chilvers N, Keevil H, Jull P, Mallick S, Elf D, Carr L, Player C, Barton E, Martin A, Ratu S, Roberts E, Phan P, Dyal A, Rogers J, Henson A, Reid N, Burke D, Culleton G, Lynne S, Mansoor S, Brennan C, Blessed R, Holloway C, Hill A, Goldsmith T, Mackin S, Kim S, Woin E, Brent G, Coffin J, Ziff O, Momoh Z, Debenham R, Ahmed M, Yong C, Wan J, Copley H, Raut P, Chaudhry F, Nixon G, Dorman C, Tan R, Kanabar S, Canning N, Dolaghan M, Bell N, McMenamin M, Chhabra A, Duke K, Turner L, Patel T, Chew L, Mirza M, Lunawat S, Oremule B, Ward N, Khan M, Tan E, Maclennan D, McGregor R, Chisholm E, Griffin E, Bell L, Hughes B, Davies J, Haq H, Ahmed H, Ungcharoen N, Whacha C, Thethi R, Markham R, Lee A, Batt E, Bullock N, Francescon C, Davies J, Shafiq N, Zhao J, Vivekanantham S, Barai I, Allen J, Marshall D, McIntyre C, Wilson H, Ashton A, Lek C, Behar N, Davis-Hall M, Seneviratne N, Esteve L, Sirakaya M, Ali S, Pope S, Ahn J, Craig-McQuaide A, Gatfield W, Leong S, Demetri A, Kerr A, Rees C, Loveday J, Liu S, Wijesekera M, Maru D, Attalla M, Smith N, Brown D, Sritharan P, Shah A, Charavanamuttu V, Heppenstall-Harris G, Ng K, Raghvani T, Rajan N, Hulley K, Moody N, Williams M, Cotton A, Sharifpour M, Lwin K, Bright M, Chitnis A, Abdelhadi M, Semana A, Morgan F, Reid R, Dickson J, Anderson L, McMullan R, Ahern N, Asmadi A, Anderson L, Boon Xuan JL, Crozier L, McAleer S, Lees D, Adebayo A, Das M, Amphlett A, Al-Robeye A, Valli A, Khangura J, Winarski A, Ali A, Woodward H, Gouldthrope C, Turner M, Sasapu K, Tonkins M, Wild J, Robinson M, Hardie J, Heminway R, Narramore R, Ramjeeawon N, Hibberd A, Winslow F, Ho W, Chong B, Lim K, Ho S, Crewdson J, Singagireson S, Kalra N, Koumpa F, Jhala H, Soon W, Karia M, Rasiah M, Xylas D, Gilbert H, Sundar-Singh M, Wills J, Akhtar S, Patel S, Hu L, Brathwaite-Shirley C, Nayee H, Amin O, Rangan T, Turner E, McCrann C, Shepherd R, Patel N, Prest-Smith J, Auyoung E, Murtaza A, Coates A, Prys-Jones O, King M, Gaffney S, Dewdney C, Nehikhare I, Lavery J, Bassett J, Davies K, Ahmad K, Collins A, Acres M, Egerton C, Cheng K, Chen X, Chan N, Sheldon A, Khan S, Empey J, Ingram E, Malik A, Johnstone M, Goodier R, Shah J, Giles J, Sanders J, McLure S, Pal S, Rangedara A, Baker A, Asbjoernsen C, Girling C, Gray L, Gauntlett L, Joyner C, Qureshi S, Mogan Y, Ng J, Kumar A, Park J, Tan D, Choo K, Raman K, Buakuma P, Xiao C, Govinden S, Thompson O, Charalambos M, Brown E, Karsan R, Dogra T, Bullman L, Dawson P, Frank A, Abid H, Tung L, Qureshi U, Tahmina A, Matthews B, Harris R, O'Connor A, Mazan K, Iqbal S, Stanger S, Thompson J, Sullivan J, Uppal E, MacAskill A, Bamgbose F, Neophytou C, Carroll A, Rookes C, Datta U, Dhutia A, Rashid S, Ahmed N, Lo T, Bhanderi S, Blore C, Ahmed S, Shaheen H, Abburu S, Majid S, Abbas Z, Talukdar S, Burney L, Patel J, Al-Obaedi O, Roberts A, Mahboob S, Singh B, Sheth S, Karia P, Prabhudesai A, Kow K, Koysombat K, Wang S, Morrison P, Maheswaran Y, Keane P, Copley P, Brewster O, Xu G, Harries P, Wall C, Al-Mousawi A, Bonsu S, Cunha P, Ward T, Paul J, Nadanakumaran K, Tayeh S, Holyoak H, Remedios J, Theodoropoulou K, Luhishi A, Jacob L, Long F, Atayi A, Sarwar S, Parker O, Harvey J, Ross H, Rampal R, Thomas G, Vanmali P, McGowan C, Stein J, Robertson V, Carthew L, Teng V, Fong J, Street A, Thakker C, O'Reilly D, Bravo M, Pizzolato A, Khokhar H, Ryan M, Cheskes L, Carr R, Salih A, Bassiony S, Yuen R, Chrastek D, Rosen O'Sullivan H, Amajuoyi A, Wang A, Sitta O, Wye J, Qamar M, Major C, Kaushal A, Morgan C, Petrarca M, Allot R, Verma K, Dutt S, Chilima C, Peroos S, Kosasih S, Chin H, Ashken L, Pearse R, O'Loughlin R, Menon A, Singh K, Norton J, Sagar R, Jathanna N, Rothwell L, Watson N, Harding F, Dube P, Khalid H, Punjabi N, Sagmeister M, Gill P, Shahid S, Hudson-Phillips S, George D, Ashwood J, Lewis T, Dhar M, Sangal P, Rhema I, Kotecha D, Afzal Z, Syeed J, Prakash E, Jalota P, Herron J, Kimani L, Delport A, Shukla A, Agarwal V, Parthiban S, Thakur H, Cymes W, Rinkoff S, Turnbull J, Hayat M, Darr S, Khan U, Lim J, Higgins A, Lakshmipathy G, Forte B, Canning E, Jaitley A, Lamont J, Toner E, Ghaffar A, McDowell M, Salmon D, O'Carroll O, Khan A, Kelly M, Clesham K, Palmer C, Lyons R, Bell A, Chin R, Waldron R, Trimble A, Cox S, Ashfaq U, Campbell J, Holliday R, McCabe G, Morris F, Priestland R, Vernon O, Ledsam A, Vaughan R, Lim D, Bakewell Z, Hughes R, Koshy R, Jackson H, Narayan P, Cardwell A, Jubainville C, Arif T, Elliott L, Gupta V, Bhaskaran G, Odeleye A, Ahmed F, Shah R, Pickard J, Suleman Y, North A, McClymont L, Hussain N, Ibrahim I, Ng G, Wong V, Lim A, Harris L, Tharmachandirar T, Mittapalli D, Patel V, Lakhani M, Bazeer H, Narwani V, Sandhu K, Wingfield L, Gentry S, Adjei H, Bhatti M, Braganza L, Barnes J, Mistry S, Chillarge G, Stokes S, Cleere J, Wadanamby S, Bucko A, Meek J, Boxall N, Heywood E, Wiltshire J, Toh C, Ward A, Shurovi B, Horth D, Patel B, Ali B, Spencer T, Axelson T, Kretzmer L, Chhina C, Anandarajah C, Fautz T, Horst C, Thevathasan A, Ng J, Hirst F, Brewer C, Logan A, Lockey J, Forrest P, Keelty N, Wood A, Springford L, Avery P, Schulz T, Bemand T, Howells L, Collier H, Khajuria A, Tharakan R, Parsons S, Buchan A, McGalliard R, Mason J, Cundy O, Li N, Redgrave N, Watson R, Pezas T, Dennis Y, Segall E, Hameed M, Lynch A, Chamberlain M, Peck F, Neo Y, Russell G, Elseedawy M, Lee S, Foster N, Soo Y, Puan L, Dennis R, Goradia H, Qureshi A, Osman S, Reeves T, Dinsmore L, Marsden M, Lu Q, Pitts-Tucker T, Dunn C, Walford R, Heathcote E, Martin R, Pericleous A, Brzyska K, Reid K, Williams M, Wetherall N, McAleer E, Thomas D, Kiff R, Milne S, Holmes M, Bartlett J, Lucas de Carvalho J, Bloomfield T, Tongo F, Bremner R, Yong N, Atraszkiewicz B, Mehdi A, Tahir M, Sherliker G, Tear A, Pandey A, Broyd A, Omer H, Raphael M, Chaudhry W, Shahidi S, Jawad A, Gill C, Fisher IH, Adeleja I, Clark I, Aidoo-Micah G, Stather P, Salam G, Glover T, Deas G, Sim N, Obute R, Wynell-Mayow W, Sait M, Mitha N, de Bernier G, Siddiqui M, Shaunak R, Wali A, Cuthbert G, Bhudia R, Webb E, Shah S, Ansari N, Perera M, Kelly N, McAllister R, Stanley G, Keane C, Shatkar V, Maxwell-Armstrong C, Henderson L, Maple N, Manson R, Adams R, Semple E, Mills M, Daoub A, Marsh A, Ramnarine A, Hartley J, Malaj M, Jewell P, Whatling E, Hitchen N, Chen M, Goh B, Fern J, Rogers S, Derbyshire L, Robertson D, Abuhussein N, Deekonda P, Abid A, Harrison P, Aildasani L, Turley H, Sherif M, Pandey G, Filby J, Johnston A, Burke E, Mohamud M, Gohil K, Tsui A, Singh R, Lim S, O'Sullivan K, McKelvey L, O'Neill S, Roberts H, Brown F, Cao Y, Buckle R, Liew Y, Sii S, Ventre C, Graham C, Filipescu T, Yousif A, Dawar R, Wright A, Peters M, Varley R, Owczarek S, Hartley S, Khattak M, Iqbal A, Ali M, Durrani B, Narang Y, Bethell G, Horne L, Pinto R, Nicholls K, Kisyov I, Torrance H, English W, Lakhani S, Ashraf S, Venn M, Elangovan V, Kazmi Z, Brecher J, Sukumar S, Mastan A, Mortimer A, Parker J, Boyle J, Elkawafi M, Beckett J, Mohite A, Narain A, Mazumdar E, Sreh A, Hague A, Weinberg D, Fletcher L, Steel M, Shufflebotham H, Masood M, Sinha Y, Jenvey C, Kitt H, Slade R, Craig A, Deall C, Reakes T, Chervenkoff J, Strange E, O'Bryan M, Murkin C, Joshi D, Bergara T, Naqib S, Wylam D, Scotcher S, Hewitt C, Stoddart M, Kerai A, Trist A, Cole S, Knight C, Stevens S, Cooper G, Ingham R, Dobson J, O'Kane A, Moradzadeh J, Duffy A, Henderson C, Ashraf S, McLaughin C, Hoskins T, Reehal R, Bookless L, McLean R, Stone E, Wright E, Abdikadir H, Roberts C, Spence O, Srikantharajah M, Ruiz E, Matthews J, Gardner E, Hester E, Naran P, Simpson R, Minhas M, Cornish E, Semnani S, Rojoa D, Radotra A, Eraifej J, Eparh K, Smith D, Mistry B, Hickling S, Din W, Liu C, Mithrakumar P, Mirdavoudi V, Rashid M, Mcgenity C, Hussain O, Kadicheeni M, Gardner H, Anim-Addo N, Pearce J, Aslanyan A, Ntala C, Sorah T, Parkin J, Alizadeh M, White A, Edozie F, Johnston J, Kahar A, Navayogaarajah V, Patel B, Carter D, Khonsari P, Burgess A, Kong C, Ponweera A, Cody A, Tan Y, Ng A, Croall A, Allan C, Ng S, Raghuvir V, Telfer R, Greenhalgh A, McKerr C, Edison M, Patel B, Dear K, Hardy M, Williams P, Hassan S, Sajjad U, O'Neill E, Lopes S, Healy L, Jamal N, Tan S, Lazenby D, Husnoo S, Beecroft S, Sarvanandan T, Weston C, Bassam N, Rabinthiran S, Hayat U, Ng L, Varma D, Sukkari M, Mian A, Omar A, Kim J, Sellathurai J, Mahmood J, O'Connell C, Bose R, Heneghan H, Lalor P, Matheson J, Doherty C, Cullen C, Cooper D, Angelov S, Drislane C, Smith A, Kreibich A, Palkhi E, Durr A, Lotfallah A, Gold D, Mckean E, Dhanji A, Anilkumar A, Thacoor A, Siddiqui Z, Lim S, Piquet A, Anderson S, McCormack D, Gulati J, Ibrahim A, Murray S, Walsh S, McGrath A, Ziprin P, Chua E, Lou C, Bloomer J, Paine H, Osei-Kuffour D, White C, Szczap A, Gokani S, Patel K, Malys M, Reed A, Torlot G, Cumber E, Charania A, Ahmad S, Varma N, Cheema H, Austreng L, Petra H, Chaudhary M, Zegeye M, Cheung F, Coffey D, Heer R, Singh S, Seager E, Cumming S, Suresh R, Verma S, Ptacek I, Gwozdz A, Yang T, Khetarpal A, Shumon S, Fung T, Leung W, Kwang P, Chew L, Loke W, Curran A, Chan C, McGarrigle C, Mohan K, Cullen S, Wong E, Toale C, Collins D, Keane N, Traynor B, Shanahan D, Yan A, Jafree D, Topham C, Mitrasinovic S, Omara S, Bingham G, Lykoudis P, Miranda B, Whitehurst K, Kumaran G, Devabalan Y, Aziz H, Shoa M, Dindyal S, Yates J, Bernstein I, Rattan G, Coulson R, Stezaker S, Isaac A, Salem M, McBride A, McFarlane H, Yow L, MacDonald J, Bartlett R, Turaga S, White U, Liew W, Yim N, Ang A, Simpson A, McAuley D, Craig E, Murphy L, Shepherd P, Kee J, Abdulmajid A, Chung A, Warwick H, Livesey A, Holton P, Theodoreson M, Jenkin S, Turner J, Entwisle J, Marchal S, O'Connor S, Blege H, Aithie J, Sabine L, Stewart G, Jackson S, Kishore A, Lankage C, Acquaah F, Joyce H, McKevitt K, Coffey C, Fawaz A, Dolbec K, O'Sullivan D, Geraghty J, Lim E, Bolton L, FitzPatrick D, Robinson C, Ramtoola T, Collinson S, Grundy L, McEnhill P, Harbhajan Singh G, Loughran D, Golding D, Keeling R, Williams R, Whitham R, Yoganathan S, Nachiappan R, Egan R, Owasil R, Kwan M, He A, Goh R, Bhome R, Wilson H, Teoh P, Raji K, Jayakody N, Matthams J, Chong J, Luk C, Greig R, Trail M, Charalambous G, Rocke A, Gardiner N, Bulley F, Warren N, Brennan E, Fergurson P, Wilson R, Whittingham H, Brown E, Khanijau R, Gandhi K, Morris S, Boulton A, Chandan N, Barthorpe A, Maamari R, Sandhu S, McCann M, Higgs L, Balian V, Reeder C, Diaper C, Sale T, Ali H, Archer C, Clarke A, Heskin J, Hurst P, Farmer J, O'Flynn L, Doan L, Shuker B, Stott G, Vithanage N, Hoban K, Nesargikar P, Kennedy H, Grossart C, Tan E, Roy C, Sim P, Leslie K, Sim D, Abul M, Cody N, Tay A, Woon E, Sng S, Mah J, Robson J, Shakweh E, Wing V, Mills H, Li M, Barrow T, Balaji S, Jordan H, Phillips C, Naveed H, Hirani S, Tai A, Ratnakumaran R, Sahathevan A, Shafi A, Seedat M, Weaver R, Batho A, Punj R, Selvachandran H, Bhatt N, Botchey S, Khonat Z, Brennan K, Morrison C, Devlin E, Linton A, Galloway E, McGarvie S, Ramsay N, McRobbie H, Whewell H, Dean W, Nelaj S, Eragat M, Mishra A, Kane T, Zuhair M, Wells M, Wilkinson D, Woodcock N, Sun E, Aziz N, Ghaffar MKA. Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study. Br J Anaesth 2019; 122:42-50. [PMID: 30579405 DOI: 10.1016/j.bja.2018.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Received: 03/15/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. METHODS This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy. RESULTS Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI. CONCLUSIONS After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.
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Leeman M, Dramaix M, Van Nieuwenhuyse B, Thomas JR. Cross-sectional survey evaluating blood pressure control ACHIEVEment in hypertensive patients treated with multiple anti-hypertensive agents in Belgium and Luxembourg. PLoS One 2018; 13:e0206510. [PMID: 30383839 PMCID: PMC6211697 DOI: 10.1371/journal.pone.0206510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/15/2018] [Indexed: 11/18/2022] Open
Abstract
Objective This study evaluates the actual blood pressure control rate and its estimation by general practitioners, the use of single-pill or free combinations, and the attitude towards single-pill combinations in primary care. Methods Cross-sectional observational survey in primary care between January 2015 and September 2016 in Belgium and Luxembourg. The participating general practitioners enrolled hypertensive patients taking at least 2 antihypertensive molecules (as fixed or free associations). Results 742 general practitioners included a total of 8,006 patients, with a mean age of 66 ± 12 years. Systolic blood pressure and diastolic blood pressure were respectively 141 ± 17 mmHg and 82 ± 10 mmHg (means ± SD). These patients had a blood pressure control rate of 45%, whereas it was estimated by general practitioners to be 60%. General practitioners with 11–25 years’ experience performed better than general practitioners with 36–51 years’ experience in the evaluation of blood pressure control. Combinations used were free in 39%, single-pill in 34% and mixed in 27% of the patients. Patients receiving single-pill combinations were younger than those treated with free combinations (63 ± 12 vs. 68 ± 12 years, p < 0.001), with fewer comorbidities (39 vs. 55%, p < 0.001). In patients treated solely with free pill associations, 66% of patient cases, general practitioners were willing to switch to a single-pill combination. The main reasons were improved adherence (76%) and better blood pressure control (64%). Conclusion In patients requiring at least two antihypertensive drugs, blood pressure control rate remains low and is overestimated by general practitioners. Free combinations remain largely used although many general practitioners seem willing to shift to single-pill combinations. Treatment simplification could improve adherence and blood pressure control rate, which has been shown to lead to reduced morbidity and mortality.
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Affiliation(s)
- Marc Leeman
- Department of Internal Medicine and Hypertension Clinic, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium
- * E-mail:
| | - Michèle Dramaix
- Research Centre of Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université libre de Bruxelles, Brussels, Belgium
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Davies-Tuck ML, Wallace EM, Davey MA, Veitch V, Oats J. Planned private homebirth in Victoria 2000-2015: a retrospective cohort study of Victorian perinatal data. BMC Pregnancy Childbirth 2018; 18:357. [PMID: 30176816 PMCID: PMC6122533 DOI: 10.1186/s12884-018-1996-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 08/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The outcomes for planned homebirth in Victoria are unknown. We aimed to compare the rates of outcomes for high risk and low risk women who planned to birth at home compared to those who planned to birth in hospital. METHODS We undertook a population based cohort study of all births in Victoria, Australia 2000-2015. Women were defined as being of low or high risk of adverse pregnancy outcomes according to the eligibility criteria for homebirth and either planning to birth at home or in a hospital setting at the at the onset of labour. Rates of perinatal and maternal mortality and morbidity as well as obstetric interventions were compared. RESULTS Three thousand nine hundred forty-five women planned to give birth at home with a privately practising midwife and 829,286 women planned to give birth in a hospital setting. Regardless of risk status, planned homebirth was associated with significantly lower rates of all obstetric interventions and higher rates of spontaneous vaginal birth (p ≤ 0.0001 for all). For low risk women the rates of perinatal mortality were similar (1.6 per 1000 v's 1.7 per 1000; p = 0.90) and overall composite perinatal (3.6% v's 13.4%; p ≤ 0.001) and maternal morbidities (10.7% v's 17.3%; p ≤ 0.001) were significantly lower for those planning a homebirth. Planned homebirth among high risk women was associated with significantly higher rates of perinatal mortality (9.3 per 1000 v's 3.5 per 1000; p = 0.009) but an overall significant decrease in composite perinatal (7.8% v's 16.9%; p ≤ 0.001) and maternal morbidities (16.7% v's 24.6%; p ≤ 0.001). CONCLUSION Regardless of risk status, planned homebirth was associated with significantly lower rates of obstetric interventions and combined overall maternal and perinatal morbidities. For low risk women, planned homebirth was also associated with similar risks of perinatal mortality, however for women with recognized risk factors, planned homebirth was associated with significantly higher rates of perinatal mortality.
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Affiliation(s)
- Miranda L. Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Vic, 3168 Australia
- Safer Care Victoria, 50 Lonsdale Street, Melbourne, 3000 Australia
| | - Euan M. Wallace
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Vic, 3168 Australia
- Safer Care Victoria, 50 Lonsdale Street, Melbourne, 3000 Australia
| | - Mary-Ann Davey
- Safer Care Victoria, 50 Lonsdale Street, Melbourne, 3000 Australia
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, 246 Clayton Rd, Clayton, Vic, 3168 Australia
| | - Vickie Veitch
- Safer Care Victoria, 50 Lonsdale Street, Melbourne, 3000 Australia
| | - Jeremy Oats
- Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM) Department of Health and Human Services, 50 Lonsdale Street, Melbourne, 3000 Australia
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Weissman GE, Hubbard RA, Ungar LH, Harhay MO, Greene CS, Himes BE, Halpern SD. Inclusion of Unstructured Clinical Text Improves Early Prediction of Death or Prolonged ICU Stay. Crit Care Med 2018; 46:1125-1132. [PMID: 29629986 PMCID: PMC6005735 DOI: 10.1097/ccm.0000000000003148] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [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: 02/02/2023]
Abstract
OBJECTIVES Early prediction of undesired outcomes among newly hospitalized patients could improve patient triage and prompt conversations about patients' goals of care. We evaluated the performance of logistic regression, gradient boosting machine, random forest, and elastic net regression models, with and without unstructured clinical text data, to predict a binary composite outcome of in-hospital death or ICU length of stay greater than or equal to 7 days using data from the first 48 hours of hospitalization. DESIGN Retrospective cohort study with split sampling for model training and testing. SETTING A single urban academic hospital. PATIENTS All hospitalized patients who required ICU care at the Beth Israel Deaconess Medical Center in Boston, MA, from 2001 to 2012. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Among eligible 25,947 hospital admissions, we observed 5,504 (21.2%) in which patients died or had ICU length of stay greater than or equal to 7 days. The gradient boosting machine model had the highest discrimination without (area under the receiver operating characteristic curve, 0.83; 95% CI, 0.81-0.84) and with (area under the receiver operating characteristic curve, 0.89; 95% CI, 0.88-0.90) text-derived variables. Both gradient boosting machines and random forests outperformed logistic regression without text data (p < 0.001), whereas all models outperformed logistic regression with text data (p < 0.02). The inclusion of text data increased the discrimination of all four model types (p < 0.001). Among those models using text data, the increasing presence of terms "intubated" and "poor prognosis" were positively associated with mortality and ICU length of stay, whereas the term "extubated" was inversely associated with them. CONCLUSIONS Variables extracted from unstructured clinical text from the first 48 hours of hospital admission using natural language processing techniques significantly improved the abilities of logistic regression and other machine learning models to predict which patients died or had long ICU stays. Learning health systems may adapt such models using open-source approaches to capture local variation in care patterns.
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Affiliation(s)
- Gary E. Weissman
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, PA
- Palliative and Advanced Illness Research Center, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Rebecca A. Hubbard
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lyle H. Ungar
- Department of Computer and Information Science, University of Pennsylvania, Philadelphia, PA
| | - Michael O. Harhay
- Palliative and Advanced Illness Research Center, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Casey S. Greene
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, PA
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania, Philadelphia, PA
- Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA
| | - Blanca E. Himes
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA
| | - Scott D. Halpern
- Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, University of Pennsylvania, PA
- Palliative and Advanced Illness Research Center, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Pettit KE, Turner JS, Pollard KA, Buente BB, Humbert AJ, Perkins AJ, Hobgood CD, Kline JA. Effect of an Educational Intervention on Medical Student Scripting and Patient Satisfaction: A Randomized Trial. West J Emerg Med 2018; 19:585-592. [PMID: 29760860 PMCID: PMC5942029 DOI: 10.5811/westjem.2018.1.35992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 01/11/2018] [Accepted: 01/17/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Effective communication between clinicians and patients has been shown to improve patient outcomes, reduce malpractice liability, and is now being tied to reimbursement. Use of a communication strategy known as "scripting" has been suggested to improve patient satisfaction in multiple hospital settings, but the frequency with which medical students use this strategy and whether this affects patient perception of medical student care is unknown. Our objective was to measure the use of targeted communication skills after an educational intervention as well as to further clarify the relationship between communication element usage and patient satisfaction. METHODS Medical students were block randomized into the control or intervention group. Those in the intervention group received refresher training in scripted communication. Those in the control group received no instruction or other intervention related to communication. Use of six explicit communication behaviors were recorded by trained study observers: 1) acknowledging the patient by name, 2) introducing themselves as medical students, 3) explaining their role in the patient's care, 4) explaining the care plan, 5) providing an estimated duration of time to be spent in the emergency department (ED), and 6) notifying the patient that another provider would also be seeing them. Patients then completed a survey regarding their satisfaction with the medical student encounter. RESULTS We observed 474 medical student-patient encounters in the ED (231 in the control group and 243 in the intervention group). We were unable to detect a statistically significant difference in communication element use between the intervention and control groups. One of the communication elements, explaining steps in the care plan, was positively associated with patient perception of the medical student's overall communication skills. Otherwise, there was no statistically significant association between element use and patient satisfaction. CONCLUSION We were unable to demonstrate any improvement in student use of communication elements or in patient satisfaction after refresher training in scripted communication. Furthermore, there was little variation in patient satisfaction based on the use of scripted communication elements. Effective communication with patients in the ED is complicated and requires further investigation on how to provide this skill set.
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Affiliation(s)
- Katie E Pettit
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - Joseph S Turner
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - Katherine A Pollard
- Washington University School of Medicine, Department of Medicine, St. Louis, Missouri
| | - Bryce B Buente
- Marion University College of Osteopathic Medicine, Indianapolis, Indiana
| | - Aloysius J Humbert
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - Anthony J Perkins
- Indiana University Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Sciences Institute, Indianapolis, Indiana
| | - Cherri D Hobgood
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - Jeffrey A Kline
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
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18
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Gardiner FW, Nwose EU, Bwititi PT, Crockett J, Wang L. Blood glucose and pressure controls in diabetic kidney disease: Narrative review of adherence, barriers and evidence of achievement. J Diabetes Complications 2018; 32:104-112. [PMID: 29102249 DOI: 10.1016/j.jdiacomp.2017.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 07/26/2017] [Revised: 09/07/2017] [Accepted: 09/10/2017] [Indexed: 11/17/2022]
Abstract
AIMS To review the epidemiology and the clinical evidence regarding achieving blood pressure (BP) and blood glucose control in patients with chronic kidney disease (CKD) and diabetes mellitus (DM), with emphasis on adherence and barriers within the context of Australian clinical guidelines. This article then considers Australian services aimed at BP, DM, and CKD, guideline adherence and control. METHODS Evidence from PubMed-listed articles published between 1994 and 2016 is considered, including original research, focusing on randomised controlled trials and prospective studies, review articles, meta- analyses, expert and professional bodies' guidelines as well as our experience. RESULTS There have been no Australian studies that consider adherence to BP control in DM and CKD patients. This is a major limitation in preventing DM and renal disease progression. It is possible that Australian clinicians are not adhering to DM, hypertension (HT), and glucose recommendations, thus resulting in reduced patient outcomes. CONCLUSIONS It is hoped that future studies ascertain the extent to which the required BP and glucose control in patients is achieved, and the potential barriers to adherence. The significance of this is immense since the impact of failure to control blood glucose levels and BP leads to renal damage.
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Affiliation(s)
- Fergus William Gardiner
- School of Community Health, Charles Sturt University, Australia; Calvary Hospital, ACT, Australia; School of Biomedical Sciences, Charles Sturt University, Australia.
| | | | | | - Judith Crockett
- School of Community Health, Charles Sturt University, Australia
| | - Lexin Wang
- School of Biomedical Sciences, Charles Sturt University, Australia
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19
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Nickel F, Schmidt L, Sander J, Tapking C, Bruckner T, Müller-Stich BP, Fischer L. Patient Perspective in Obesity Surgery: Goals for Weight Loss and Improvement of Body Shape in a Prospective Cohort Study. Obes Facts 2018; 11:466-474. [PMID: 30537759 PMCID: PMC6341368 DOI: 10.1159/000493372] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 01/29/2018] [Accepted: 08/26/2018] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Obesity surgery provides sustainable weight loss, improvement of comorbidities, and improved quality of life (QOL). There is few evidence on the patient perspective and goals. This study compared expected and achieved weight loss, body shape, and QOL. METHODS Patients completed the Moorehead-Ardelt QOL questionnaire (MAQOL) and questionnaires on actual and expected weight loss and body shape, comorbidities, and goals of obesity surgery preoperatively and within 24 months postoperatively. RESULTS 44 patients completed questionnaires pre- and postoperatively. BMI, MAQOL and comorbidities significantly improved postoperatively. Patients' expected weight loss goal corresponded to a postoperative BMI of 32.6 ± 5.6 kg/m2 and was not different from their achieved BMI within 24 months after surgery (33.9 ± 6.3 kg/m2, p = 0.276). Self-reported body shape improved but did not reach preoperatively expected goals. During the weight loss period, patients adapted their weight loss and body shape goals to higher levels. Patients attributed a higher part of their success in weight loss to surgery postoperatively (79.5 ± 22.0 vs. 89.1 ± 18.4%, p = 0.028). CONCLUSION Patients lost as much weight as they had expected and later modified the goals to even greater weight loss. Body shape improved but did not reach expected levels. QOL improved independently from weight loss and body shape. Patients attributed successful weight loss predominantly to surgery.
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Affiliation(s)
- Felix Nickel
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany,
| | - Lukas Schmidt
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Johannes Sander
- Obesity Clinic, Schoen Klinik Hamburg Eilbek, Hamburg, Germany
| | - Christian Tapking
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Thomas Bruckner
- Institute for Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Beat-Peter Müller-Stich
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
| | - Lars Fischer
- Department of General and Visceral Surgery, Hospital Mittelbaden, Baden-Baden, Germany
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Vedam S, Rossiter C, Homer CSE, Stoll K, Scarf VL. The ResQu Index: A new instrument to appraise the quality of research on birth place. PLoS One 2017; 12:e0182991. [PMID: 28797127 PMCID: PMC5552354 DOI: 10.1371/journal.pone.0182991] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 07/27/2017] [Indexed: 12/13/2022] Open
Abstract
Objective Place of birth is a known determinant of health care outcomes, interventions and costs. Many studies have examined the maternal and perinatal outcomes when women plan to give birth in hospitals compared with births in birth centres or at home. However, these studies vary substantially in rigour; assessing their quality is challenging. Existing research appraisal tools do not always capture important elements of study design that are critical when comparing outcomes by planned place of birth. To address this deficiency, we aimed to develop a reliable instrument to rate the quality of primary research on maternal and newborn outcomes by place of birth. Study design The instrument development process involved five phases: 1) generation of items and a weighted scoring system; 2) content validation via a quantitative survey and a modified Delphi process with an international, multi-disciplinary panel of experts; 3) inter-rater consistency; 4) alignment with established research appraisal tools; and 5) pilot-testing of instrument usability. Results A Birth Place Research Quality Index (ResQu Index) was developed comprising 27 scored items that are summed to generate a weighted composite score out of 100 for studies comparing planned place of birth. Scale content validation indices were .89 for clarity, .94 for relevance and .90 for importance. The Index demonstrated substantial inter-rater consistency; pilot-testing confirmed feasibility and user-friendliness. Conclusion The ResQu Index is a reliable instrument to evaluate the quality of design, methods and interpretation of reported outcomes from research about place of birth. Higher-scoring studies have greater potential to inform evidence-based selection of birth place by clinicians, policy makers, and women and their families. The Index can also guide the design of future research on place of birth.
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Affiliation(s)
- Saraswathi Vedam
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
- UBC Midwifery Faculty of Medicine, University of British Columbia, University Boulevard, Vancouver, BC, Canada
| | - Chris Rossiter
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| | - Caroline S. E. Homer
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| | - Kathrin Stoll
- UBC Midwifery Faculty of Medicine, University of British Columbia, University Boulevard, Vancouver, BC, Canada
| | - Vanessa L. Scarf
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
- * E-mail:
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Chang TI, Reboussin DM, Chertow GM, Cheung AK, Cushman WC, Kostis WJ, Parati G, Raj D, Riessen E, Shapiro B, Stergiou GS, Townsend RR, Tsioufis K, Whelton PK, Whittle J, Wright JT, Papademetriou V. Visit-to-Visit Office Blood Pressure Variability and Cardiovascular Outcomes in SPRINT (Systolic Blood Pressure Intervention Trial). Hypertension 2017; 70:751-758. [PMID: 28760939 DOI: 10.1161/hypertensionaha.117.09788] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 06/10/2017] [Accepted: 07/11/2017] [Indexed: 12/13/2022]
Abstract
Studies of visit-to-visit office blood pressure (BP) variability (OBPV) as a predictor of cardiovascular events and death in high-risk patients treated to lower BP targets are lacking. We conducted a post hoc analysis of SPRINT (Systolic Blood Pressure Intervention Trial), a well-characterized cohort of participants randomized to intensive (<120 mm Hg) or standard (<140 mm Hg) systolic BP targets. We defined OBPV as the coefficient of variation of the systolic BP using measurements taken during the 3-,6-, 9-, and 12-month study visits. In our cohort of 7879 participants, older age, female sex, black race, current smoking, chronic kidney disease, and coronary disease were independent determinants of higher OBPV. Use of thiazide-type diuretics or dihydropyridine calcium channel blockers was associated with lower OBPV whereas angiotensin-converting enzyme inhibitors or angiotensin receptor blocker use was associated with higher OBPV. There was no difference in OBPV in participants randomized to standard or intensive treatment groups. We found that OBPV had no significant associations with the composite end point of fatal and nonfatal cardiovascular events (n=324 primary end points; adjusted hazard ratio, 1.20; 95% confidence interval, 0.85-1.69, highest versus lowest quintile) nor with heart failure or stroke. The highest quintile of OBPV (versus lowest) was associated with all-cause mortality (adjusted hazard ratio, 1.92; confidence interval, 1.22-3.03) although the association of OBPV overall with all-cause mortality was marginal (P=0.07). Our results suggest that clinicians should continue to focus on office BP control rather than on OBPV unless definitive benefits of reducing OBPV are shown in prospective trials. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01206062.
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Affiliation(s)
- Tara I Chang
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - David M Reboussin
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - Glenn M Chertow
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - Alfred K Cheung
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - William C Cushman
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - William J Kostis
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - Gianfranco Parati
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - Dominic Raj
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - Erik Riessen
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - Brian Shapiro
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - George S Stergiou
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - Raymond R Townsend
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - Konstantinos Tsioufis
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - Paul K Whelton
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - Jeffrey Whittle
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - Jackson T Wright
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.)
| | - Vasilios Papademetriou
- From the Division of Nephrology, Stanford University School of Medicine, CA (T.I.C., G.M.C.); Wake Forest School of Medicine, Winston-Salem, NC (D.M.R.); Division of Nephrology and Hypertension, University of Utah and Renal Section, Veterans Affairs Salt Lake City Health Care System (A.K.C.); Memphis Veterans Affairs Medical Center, TN (W.C.C.); Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (W.J.K.); Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.); St. Luke Hospital, Italian Auxology Institute, Milan, Italy (G.P.); Division of Renal Diseases and Hypertension, George Washington University, Washington, DC (D.R.); Intermountain Medical Center, Murray, UT (E.R.); Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL (B.S.); School of Medicine, National and Kapodistrian University of Athens, Greece (G.S.S., K.T.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (P.K.W.); Primary Care Division, Clement J. Zablocki VA Medical Center, Milwaukee, WI (J.W.); Division of Nephrology and Hypertension, Case Western Reserve University, University Hospitals Cleveland Medical Center, OH (J.T.W.); and Department of Veterans Affairs and Georgetown University, Washington, DC (V.P.).
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Tuinman A, de Greef MHG, Krijnen WP, Paans W, Roodbol PF. Accuracy of documentation in the nursing care plan in long-term institutional care. Geriatr Nurs 2017; 38:578-583. [PMID: 28552204 DOI: 10.1016/j.gerinurse.2017.04.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 12/17/2016] [Revised: 04/20/2017] [Accepted: 04/24/2017] [Indexed: 11/19/2022]
Abstract
Nursing staff working in long-term institutional care attend to residents with an increasing number of severe physical and cognitive limitations. To exchange information about the health status of these residents, accurate nursing documentation is important to ensure the safety of residents. This study examined the accuracy of nursing documentation in 197 care plans of five long-term institutional care facilities. Based on the phases of the nursing process, the D-Catch instrument measures the accuracy of the content and coherence of documentation. Inadequacies were especially found in the description of residents' care needs and stated nursing diagnoses as well as in progress and outcome reports. In somatic and psycho-geriatric units, higher accuracy scores were determined compared with residential care units. Investments in resources (e.g., time), reasoning skills of nursing staff, and implementation of professional standards in accordance with legal requirements may be needed to enhance the quality of nursing documentation.
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Affiliation(s)
- Astrid Tuinman
- Hanze University of Applied Sciences Groningen, School of Nursing, Groningen, The Netherlands.
| | - Mathieu H G de Greef
- University of Groningen and University Medical Center Groningen, Department Human Movement Sciences, Groningen, The Netherlands
| | - Wim P Krijnen
- Hanze University of Applied Sciences Groningen, Research Group Healthy Ageing, Allied Health Care and Nursing, Groningen, The Netherlands
| | - Wolter Paans
- Hanze University of Applied Sciences Groningen, Research Group Nursing Diagnostics, Groningen, The Netherlands
| | - Petrie F Roodbol
- University of Groningen and University Medical Center Groningen, Department of Health Psychology, Groningen, The Netherlands
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Haley EM, Meisel D, Gitelman Y, Dingfield L, Casarett DJ, O'Connor NR. Electronic Goals of Care Alerts: An Innovative Strategy to Promote Primary Palliative Care. J Pain Symptom Manage 2017; 53:932-937. [PMID: 28062333 DOI: 10.1016/j.jpainsymman.2016.12.329] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 05/13/2016] [Revised: 11/20/2016] [Accepted: 12/23/2016] [Indexed: 01/13/2023]
Abstract
CONTEXT Given the shortage of palliative care specialists, strategies are needed to promote primary palliative care by nonpalliative care providers. Electronic reminders are frequently used in medicine to standardize practice, but their effectiveness in encouraging goals of care discussions is not well understood. OBJECTIVES To determine whether brief education and electronic alerts increase the frequency of goals of care discussions. METHODS All general medicine services at a large academic medical center were included. Each medicine team received brief education on rounds about goals of care communication tool. When a newly admitted patient met predefined criteria, an electronic alert that included the tool was sent to the patient's resident and attending physicians within 48 hours. RESULTS Of 352 admissions screened over a four-week period, 18% met one or more criteria. The combination of alerts and education increased documentation of goals of care in the medical record from 20.5% (15/73) to 44.6% (25/56) of patients (risk ratio 2.17, 95% CI 1.23-3.72). There were no significant changes in code status, noncode status limitations in care, or palliative care consultation. CONCLUSION The combination of brief education and electronic goals of care alerts significantly increased documented goals of care discussions. This intervention is simple and feasible in many settings, but larger studies are needed to determine impact on patient outcomes.
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Affiliation(s)
- Erin M Haley
- Department of Medicine at the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Deborah Meisel
- Department of Medicine at the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Yevgeniy Gitelman
- Department of Medicine at the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Laura Dingfield
- Department of Medicine at the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - David J Casarett
- Department of Medicine at Duke University School of Medicine, Durham, North Carolina, USA
| | - Nina R O'Connor
- Department of Medicine at the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA. nina.o'
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Granich R, Gupta S, Hall I, Aberle-Grasse J, Hader S, Mermin J. Status and methodology of publicly available national HIV care continua and 90-90-90 targets: A systematic review. PLoS Med 2017; 14:e1002253. [PMID: 28376085 PMCID: PMC5380306 DOI: 10.1371/journal.pmed.1002253] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 02/03/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In 2014, the Joint United Nations Program on HIV/AIDS (UNAIDS) issued treatment goals for human immunodeficiency virus (HIV). The 90-90-90 target specifies that by 2020, 90% of individuals living with HIV will know their HIV status, 90% of people with diagnosed HIV infection will receive antiretroviral treatment (ART), and 90% of those taking ART will be virally suppressed. Consistent methods and routine reporting in the public domain will be necessary for tracking progress towards the 90-90-90 target. METHODS AND FINDINGS For the period 2010-2016, we searched PubMed, UNAIDS country progress reports, World Health Organization (WHO), UNAIDS reports, national surveillance and program reports, United States President's Emergency Plan for AIDS Relief (PEPFAR) Country Operational Plans, and conference presentations and/or abstracts for the latest available national HIV care continuum in the public domain. Continua of care included the number and proportion of people living with HIV (PLHIV) who are diagnosed, on ART, and virally suppressed out of the estimated number of PLHIV. We ranked the described methods for indicators to derive high-, medium-, and low-quality continuum. For 2010-2016, we identified 53 national care continua with viral suppression estimates representing 19.7 million (54%) of the 2015 global estimate of PLHIV. Of the 53, 6 (with 2% of global burden) were high quality, using standard surveillance methods to derive an overall denominator and program data from national cohorts for estimating steps in the continuum. Only nine countries in sub-Saharan Africa had care continua with viral suppression estimates. Of the 53 countries, the average proportion of the aggregate of PLHIV from all countries on ART was 48%, and the proportion of PLHIV who were virally suppressed was 40%. Seven countries (Sweden, Cambodia, United Kingdom, Switzerland, Denmark, Rwanda, and Namibia) were within 12% and 10% of achieving the 90-90-90 target for "on ART" and for "viral suppression," respectively. The limitations to consider when interpreting the results include significant variation in methods used to determine national continua and the possibility that complete continua were not available through our comprehensive search of the public domain. CONCLUSIONS Relatively few complete national continua of care are available in the public domain, and there is considerable variation in the methods for determining progress towards the 90-90-90 target. Despite bearing the highest HIV burden, national care continua from sub-Saharan Africa were less likely to be in the public domain. A standardized monitoring and evaluation approach could improve the use of scarce resources to achieve 90-90-90 through improved transparency, accountability, and efficiency.
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Affiliation(s)
- Reuben Granich
- International Association of Providers of AIDS Care, Washington, D.C., United States of America
| | - Somya Gupta
- International Association of Providers of AIDS Care, Washington, D.C., United States of America
| | - Irene Hall
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - John Aberle-Grasse
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Shannon Hader
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jonathan Mermin
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Li H, Zhang Q, Chen L, Min L, Wang X, Liu F, Sun Y. [Role of diagnostic laparoscopy in the treatment plan of gastric cancer]. Zhonghua Wei Chang Wai Ke Za Zhi 2017; 20:195-199. [PMID: 28226355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To assess the clinical value of the diagnostic laparoscopy in choosing treatment strategies for patients with gastric cancer. METHODS Retrospective analysis was performed on clinical and pathological data collected from 2 023 patients undergoing gastric cancer surgery in the Zhongshan Hospital of Fudan University from 2009 to 2014. All the patients were diagnosed as gastric cancer by endoscopic biopsy and staged by imaging examination before surgery. During the diagnostic laparoscopy procedure, a small periumbilical incision was made and a pneumoperitoneum with CO2 under 10-15 mmHg was established through a port. A 10 mm trocar was put in, and the camera was inserted. Two 5 mm trocars were put in two ports which located in midclavicular line two fingers under the left and right costal margin and then the instruments were inserted. A thorough inspection included ascites, the abdominal cavity, liver, diaphragm, spleen, greater omentum, colon, small intestine, mesentery, adnexa (female) and pelvic floor. If the tumor located at the posterior part of the stomach, the gastrocolic ligament was opened in order to look for carcinomatosis in the omental bursa. The accuracy rate of diagnostic laparoscopy in diagnosing adjacent organ invasion and intra-abdominal metastasis was calculated, and the rate of adjusting treatment plans after diagnostic laparoscopy was also calculated. RESULTS There were 52.7%(1 067/2 023) of patients underwent diagnostic laparoscopy. The accuracy rate of diagnostic laparoscopy in evaluating adjacent organ invasion and intra-abdominal metastasis were 98.3%(1 049/1 067) and 98.1%(1 047/1 067) respectively. Besides, 14 patients with stage T4b and 32 with intra-abdominal metastasis, which were missed by imaging examination, were diagnosed by diagnostic laparoscopy. The treatment plans of 9.3% (99/1 067) of patients were changed after diagnostic laparoscopy, and 65 (6.1%) cases of non-therapeutic laparotomy were avoided. However, 18 cases of adjacent organ invasion and 20 cases of intra-abdominal metastasis were still missed by diagnostic laparoscopy, and 12 cases received non-therapeutic laparotomy. CONCLUSION Diagnostic laparoscopy has considerable value in assessing adjacent organ invasion and intra-abdominal metastasis and has great clinical significance in making precise treatment plans.
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Affiliation(s)
- Haojie Li
- Deparatment of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Qi Zhang
- Fudan University School of Medicine, Shanghai 200032, China
| | - Ling Chen
- Deparatment of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Lingqiang Min
- Deparatment of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xuefei Wang
- Deparatment of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Fenglin Liu
- Deparatment of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
| | - Yihong Sun
- Deparatment of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Getahun B, Nkosi ZZ. Satisfaction of patients with directly observed treatment strategy in Addis Ababa, Ethiopia: A mixed-methods study. PLoS One 2017; 12:e0171209. [PMID: 28182754 PMCID: PMC5300143 DOI: 10.1371/journal.pone.0171209] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/18/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Directly observed treatment, short course (DOTS) strategy has been a cornerstone for Tuberculosis (TB) control programs in developing countries. However, in Ethiopia satisfaction level of patients' with TB with the this strategy is not well understood. Therefore, the study aimed to assess the satisfaction level of patients with TB with the DOTS. METHOD Explanatory sequential mixed method design was carried out in Addis Ababa, Ethiopia. Interviewer-administered questionnaire with 601 patients with TB who were on follow-up was employed in the quantitative approach. In the qualitative approach telephonic-interview with 25 persons lost to follow-up and focus group discussions with 23 TB experts were conducted. RESULT Sixty seven percent of respondent was satisfied with the DOTS. Rural residency (AOR = 3.4, 95% CI 1.6, 7.6), having TB symptoms (AOR = 0.6, 95% CI 0.4, 0.94) and treatment supporter (AOR = 4.3, 95%CI 2.7, 6.8) were associated with satisfaction with DOTS. In qualitative finding, all persons lost to follow-up were dissatisfied while TB experts enlightened lack of evidence to affirm the satisfaction level of patients with DOTS. Explored factors contributing to satisfaction include: on time availability of health care providers, DOTS service delivery process, general condition of health care facilities, nutritional support and transportation. CONCLUSION DOTS is limited to satisfy patients with TB and lacks a consistent system that determines the satisfaction level of patients with TB. Therefore, DOTS strategy needs to have a system to captures patients' satisfaction level to respond on areas that need progress to improve DOTS service quality.
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Affiliation(s)
- Belete Getahun
- University of South Africa, College of Human Science, Department of Health studies, Pretoria, South Africa
- Addis Ababa University, College of Health Sciences, School of Public Health, Addis Ababa, Ethiopia
- * E-mail:
| | - Zethu Zerish Nkosi
- University of South Africa, College of Human Science, Department of Health studies, Pretoria, South Africa
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Abstract
The development of the Client Problem Profile and Index are described, and initial concurrent and predictive validity data are presented for a sample of 547 patients in outpatient methadone treatment. Derived from the TCU Brief Intake for drug treatment admissions, the profile covers 14 problem areas related to drug use (particularly cocaine, heroin/opiate, marijuana, other illegal drugs, and multiple drug use), HIV risks, psychosocial functioning, health, employment, and criminality. Analyses of predictive validity show the profile and its index (number of problem areas) were significantly related to therapeutic engagement, during-treatment performance, and posttreatment follow-up outcomes. Low moderate to high moderate effect sizes were observed in analyses of the index's discrimination.
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Affiliation(s)
- George W Joe
- Institute of Behavioral Research, Texas Christian University, Fort Worth 76129, USA.
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Wolff C, Mücke T, Wagenpfeil S, Kanatas A, Bissinger O, Deppe H. Do CBCT scans alter surgical treatment plans? Comparison of preoperative surgical diagnosis using panoramic versus cone-beam CT images. J Craniomaxillofac Surg 2016; 44:1700-1705. [PMID: 27567358 DOI: 10.1016/j.jcms.2016.07.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 05/15/2016] [Revised: 06/16/2016] [Accepted: 07/27/2016] [Indexed: 02/07/2023] Open
Abstract
Cone beam CT and/or panoramic images are often required for a successful diagnosis in oral and maxillofacial surgery. The aim of this study was to evaluate if 3D diagnostic imaging information had a significant impact on the decision process in six different classes of surgical indications. MATERIAL AND METHODS Records of all patients who had undergone both panoramic X-ray and CBCT imaging due to surgical indications between January 2008 and December 2012 were examined retrospectively. In February 2013, all surgically relevant diagnoses of both conventional panoramic radiographs and CBCT scans were retrieved from the patient's charts. It was recorded whether (1) 3D imaging presented additional surgically relevant information and (2) if the final decision of surgical therapy had been based on 2D or 3D imaging. RESULTS A total of 253 consecutive patients with both panoramic radiographs and CBCT analysis were eligible for the study. 3D imaging provided significantly more surgically relevant information in cases of implant dentistry, maxillary sinus diagnosis and in oral and maxillofacial traumatology. However, surgical strategies had not been influenced to any significant extent by 3D imaging. CONCLUSION Within the limitations of this study it may be concluded that CBCT imaging results in significantly more surgically relevant information in implant dentistry, maxillary sinus diagnosis and in cases of oral and maxillofacial trauma. However, 3D imaging information did not alter significantly the surgical plan that was based on 2D panoramic radiography. Further studies are necessary to define indications for CBCT in detail.
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Affiliation(s)
- Carolina Wolff
- Department of Oral and Craniomaxillofacial Surgery, Technical University of Munich, Klinikum rechts der Isar, Germany.
| | - Thomas Mücke
- Department of Oral and Craniomaxillofacial Surgery, Technical University of Munich, Klinikum rechts der Isar, Germany.
| | - Stefan Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, University of Saarland, Homburg/Saar, Germany.
| | - Anastasios Kanatas
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds General Infirmary, LS1 3EX, UK.
| | - Oliver Bissinger
- Department of Oral and Craniomaxillofacial Surgery, Technical University of Munich, Klinikum rechts der Isar, Germany.
| | - Herbert Deppe
- Department of Oral and Craniomaxillofacial Surgery, Technical University of Munich, Klinikum rechts der Isar, Germany.
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Ullah R, Turner PJ, Khambay BS. Accuracy of three-dimensional soft tissue predictions in orthognathic surgery after Le Fort I advancement osteotomies. Br J Oral Maxillofac Surg 2016; 53:153-7. [PMID: 25432431 DOI: 10.1016/j.bjoms.2014.11.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 11/01/2014] [Indexed: 11/17/2022]
Abstract
Prediction of postoperative facial appearance after orthognathic surgery can be used for communication, managing patients' expectations,avoiding postoperative dissatisfaction and exploring different treatment options. We have assessed the accuracy of 3dMD Vultus in predicting the final 3-dimensional soft tissue facial morphology after Le Fort I advancement osteotomy. We retrospectively studied 13 patients who were treated with a Le Fort I advancement osteotomy alone. We used routine cone-beam computed tomographic (CT) images taken immediately before and a minimum of 6 months after operation, and 3dMD Vultus to virtually reposition the preoperative maxilla and mandible in their post operative positions to generate a prediction of what the soft tissue would look like. Segmented anatomical areas of the predicted mesh were then compared with the actual soft tissue. The means of the absolute distance between the 90th percentile of the mesh points for each region were calculated, and a one-sample Student's t test was used to calculate if the difference differed significantly from 3 mm.The differences in the mean absolute distances between the actual soft tissue and the prediction were significantly below 3 mm for all segmented anatomical areas (p < 0.001), and ranged from 0.65 mm (chin) to 1.17 mm (upper lip). 3dMD Vultus produces clinically satisfactory 3-dimensional facial soft tissue predictions after Le Fort I advancement osteotomy. The mass-spring model for prediction seems to be able to predict the position of the lip and chin, but its ability to predict nasal and paranasal areas could be improved.
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Elgart JF, González L, Prestes M, Rucci E, Gagliardino JJ. Frequency of self-monitoring blood glucose and attainment of HbA1c target values. Acta Diabetol 2016; 53:57-62. [PMID: 25841589 DOI: 10.1007/s00592-015-0745-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [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: 12/15/2014] [Accepted: 03/18/2015] [Indexed: 11/30/2022]
Abstract
AIMS Test strips for self-monitoring of blood glucose (SMBG) represent in Argentina, around 50 % of diabetes treatment cost; the frequency of their use is closely associated with hyperglycemia treatment. However, the favorable impact of SMBG on attainment of HbA1c goal in different treatment conditions remains controversial. We therefore attempted to estimate the relationship between use of SMBG test strips and degree of attainment of metabolic control in an institution of our social security subsector (SSS) in which provision is fully covered and submitted to a regular audit system. METHODS Observational retrospective study using information of 657 patients with T2DM (period 2009-2010) from the database of the Diabetes and Other Cardiovascular Risk Factors Program (DICARO) of one institution of our SSS. DICARO provides-with an audit system-100 % coverage for all drugs and keeps records of clinical, metabolic and treatment data from every patient. RESULTS The average monthly test strips/patient used for SMBG increased as a function of treatment intensification: Monotherapy with oral antidiabetic drugs (OAD) < combined OAD therapy < insulin treatment. In every condition, the number was larger in people with target HbA1c levels. Test strips represented the larger percentage of total prescription cost. CONCLUSIONS In our population, the type of hyperglycemia treatment was the main driver of test strip use for SMBG; in every condition tested, targeted HbA1c values were associated with greater strip use. Patient education and prescription audit may optimize its use and treatment outcomes.
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Affiliation(s)
- Jorge F Elgart
- CENEXA. Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET LA PLATA, Centro Colaborador de la OPS/OMS en Diabetes), Facultad de Ciencias Médicas UNLP, 60 y 120, 1900, La Plata, Argentina.
| | - Lorena González
- CENEXA. Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET LA PLATA, Centro Colaborador de la OPS/OMS en Diabetes), Facultad de Ciencias Médicas UNLP, 60 y 120, 1900, La Plata, Argentina.
- Escuela de Economía de la Salud y Administración de Organizaciones de Salud, Facultad de Ciencias Económicas, Universidad Nacional de La Plata (UNLP), La Plata, Argentina.
| | - Mariana Prestes
- CENEXA. Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET LA PLATA, Centro Colaborador de la OPS/OMS en Diabetes), Facultad de Ciencias Médicas UNLP, 60 y 120, 1900, La Plata, Argentina.
| | - Enzo Rucci
- CENEXA. Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET LA PLATA, Centro Colaborador de la OPS/OMS en Diabetes), Facultad de Ciencias Médicas UNLP, 60 y 120, 1900, La Plata, Argentina.
- III-LIDI, Facultad de Informática, Universidad Nacional de La Plata (UNLP), La Plata, Argentina.
| | - Juan J Gagliardino
- CENEXA. Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET LA PLATA, Centro Colaborador de la OPS/OMS en Diabetes), Facultad de Ciencias Médicas UNLP, 60 y 120, 1900, La Plata, Argentina.
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Law M. What Nurses Need to Know About Private Patient Advocates. ONS Connect 2016; 31:23. [PMID: 26930997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Sockolow P, Bass EJ, Eberle CL, Bowles KH. Homecare Nurses' Decision-Making During Admission Care Planning. Stud Health Technol Inform 2016; 225:28-32. [PMID: 27332156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The re-hospitalization rate of homecare patients within 60 days of hospital discharge is 30%. Enhanced care planning based on better information may reduce this rate. However, very little is known about the homecare admission and care planning processes. The research team collected data during observations of three nursing visits to admit homecare patients in Camden NJ, and conducted thematic content analysis on these data. Human factors methods helped to identify nurse decision-making related to selection of the plan of care problems, non-nursing resources, and the nursing visit pattern. They identified how the electronic health record (EHR) assisted the nurse in visit pattern frequency decisions. Major themes that emerged included reduced efficiency due to use of redundant intra-team communication methods to augment EHR documentation, redundant documentation, and workarounds and reorganization of clinical workflow.
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Affiliation(s)
- Paulina Sockolow
- Drexel University College of Nursing and Health Professions, Philadelphia, PA, USA
| | - Ellen J Bass
- Drexel University College of Nursing and Health Professions, Philadelphia, PA, USA
| | - Carl L Eberle
- Drexel University School of Biomedical Engineering, Science and Health Systems, Philadelphia, PA, USA
| | - Kathryn H Bowles
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Huang HL, Chen CJ. Decision Support System in the Nursing Instruction Information System. Stud Health Technol Inform 2016; 225:909-910. [PMID: 27332404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The purpose of this study is to explore the usage frequency of the decision support instruction in the nursing information system, and to survey the technology acceptance among nurses in one hospital. The results indicated that the usage frequency of the care instruction was increased from 191.3 to 1308.5 per month. Nurses also rated the "perceived usefulness" the highest score, followed by "perceived ease of use" in the survey.
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Affiliation(s)
- Hui Ling Huang
- Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC
| | - Chun Jen Chen
- Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC
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Doolan-Noble F, Gauld R, Waters DL. Are nurses more likely to report providing care plans for chronic disease patients than doctors? Findings from a New Zealand study. Chronic Illn 2015; 11:210-7. [PMID: 25566996 DOI: 10.1177/1742395314567479] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 12/16/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The main aim of this study was to compare the perceptions of general practitioners (GPs) and primary care nurses (PCNs) in the Southern Region of New Zealand regarding their provision of chronic illness care. Whether PCNs rated their frequency of providing aspects of chronic illness care higher than GPs was a key question. METHODS The modified version of the Patient Assessment of Chronic Illness Care (PACIC) was used to compare the perceptions of GPs and PCNs. RESULTS Surveys were received from 77% of practices in the Southern region. Responding PCNs were more likely than their GP counterparts to document they provided aspects of chronic illness care 'most of the time' or 'always' in 18 activities from the six M-PACIC domains. Their level of providing patients with formal care plans was surprisingly low. CONCLUSION This level of engagement of PCNs with chronic illness care was no surprise. The low number reporting they provided patients with a care plan, most of the time or always, was unexpected. Aspects of care planning, however, were reported as taking place more frequently. This discrepancy between the process of care planning and the outcome, a care plan, is not unique to this region of New Zealand and warrants further research.
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Affiliation(s)
- Fiona Doolan-Noble
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Robin Gauld
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Debra L Waters
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
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Cho HD, Kim NY, Gil HW, Jeong DS, Hong SY. Comparison of Families with and without a Suicide Prevention Plan Following a Suicidal Attempt by a Family Member. J Korean Med Sci 2015; 30:974-8. [PMID: 26130963 PMCID: PMC4479954 DOI: 10.3346/jkms.2015.30.7.974] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 04/01/2015] [Indexed: 11/23/2022] Open
Abstract
The frequency and extent of the existence of a familial suicide prevention plan may differ across cultures. The aim of this work was, therefore, to determine how common it was for families to develop a suicide prevention plan and to compare the main measures used by families with and without such a plan, after an attempt to commit suicide was made by a member of a family living in a rural area of Korea. On the basis of the presence or absence of a familial suicide prevention plan, we compared 50 recruited families that were divided into 2 groups, with Group A (31 families) employing a familial suicide prevention plan after a suicide attempt by a family member, and Group B (19 families) not doing so. The strategy that was employed most frequently to prevent a reoccurrence among both populations was promoting communication among family members, followed by seeking psychological counseling and/or psychiatric treatment. Contrary to our expectation, the economic burden from medical treatment after a suicide attempt did not influence the establishment of a familial suicide prevention plan. It is a pressing social issue that 38% (19 of 50) of families in this study did not employ a familial suicide prevention plan, even after a family member had attempted suicide. Regional suicide prevention centers and/or health authorities should pay particular attention to these patients and their families.
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Affiliation(s)
- Heung-Don Cho
- Department of Nursing, Soonchunhyang University Hospital, Cheonan, Korea
| | - Nam-Young Kim
- Department of Nursing, Soonchunhyang University Hospital, Cheonan, Korea
| | - Hyo-wook Gil
- Department of Internal Medicine, Soonchunhyang University Hospital, Cheonan, Korea
| | - Du-shin Jeong
- Department of Neurology, Soonchunhyang University Hospital, Cheonan, Korea
| | - Sae-yong Hong
- Department of Internal Medicine, Soonchunhyang University Hospital, Cheonan, Korea
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Schmieder RE, Gitt AK, Koch C, Bramlage P, Ouarrak T, Tschöpe D. Achievement of individualized treatment targets in patients with comorbid type-2 diabetes and hypertension: 6 months results of the DIALOGUE registry. BMC Endocr Disord 2015; 15:23. [PMID: 25934177 PMCID: PMC4426603 DOI: 10.1186/s12902-015-0020-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 04/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with type-2 diabetes mellitus (T2DM) and hypertension have increased risk of cardiovascular disease (CVD). We studied individualized treatment targets and their achievement in clinical practice. METHODS DIALOGUE is a prospective, multi-center registry in patients with both T2DM and hypertension. RESULTS Patients (n = 6,586) had a baseline fasting glucose (8.5 ± 2.8 mmol/l), postprandial glucose (10.9 ± 3.4 mmol/l), and HbA1c (7.8 ± 2.1%) levels indicated poor glycemic control. Baseline systolic and diastolic BP were 140.3 ± 15.7 and 82.6 ± 9.5, respectively. Patients were categorized by HbA1c treatment goals: ≤6.5% (strict), >6.5 to ≤7.0% (medium), and >7.0 to ≤7.5% (loose). When considering systolic BP (SBP) targets (≤130 mmHg [strict], >130 to ≤135 mmHg [medium], and >135 to ≤140 mmHg [loose]), patients with strict SBP treatment goals displayed similar characteristics to those with strict HbA1c targets. Although approximately 70% of patients received both strict HbA1c and SBP targeting, overall treatment goals remained unmet in all HbA1c target groups at the 6-month follow-up. SBP targets were not reached in the strict and medium groups, but were achieved in the loose treatment group. Specific predictors for choosing loose SBP or HbA1c treatment goals were identified, including SBP/HbA1c levels and various comorbidities. CONCLUSIONS Individualized glucose and BP targets were selected by treating physicians based on patient characteristics and overall comorbidity. While treatment goals were not consistently met using various antidiabetic and antihypertensive therapies, our analyses indicated that the strictly targeted patient populations maintained lower overall HbA1c and SBP levels at 6 months.
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Affiliation(s)
- Roland E Schmieder
- Medizinische Klinik 4, Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
| | - Anselm K Gitt
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany.
- Medizinische Klinik B, Herzzentrum Ludwigshafen, Ludwigshafen, Germany.
| | | | - Peter Bramlage
- Institut für Pharmakologie und Präventive Medizin, Mahlow, Germany.
| | - Taoufik Ouarrak
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany.
| | - Diethelm Tschöpe
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany.
- Stiftung "Der herzkranke Diabetiker" in der Deutschen Diabetes-Stiftung, Georgstrasse 11, 32545, Bad Oeynhausen, Germany.
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Ozkan A. Hospital birth: are we giving women the facts? Pract Midwife 2015; 18:26-28. [PMID: 26328463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
An article published last year in the Journal of Medical Ethics compares giving birth at home to being as reckless as driving without putting a seatbelt on your child (de Crespigny and Savulescu 2014). Planning to give birth at home is often thought of as quite an 'alternative' decision, with just 2.4 per cent of women in England and Wales opting for this in 2011 (Office for National Statistics (ONS) 2013). The politics surrounding place of birth in contemporary maternity care are highly contentious and not at all as clear cut as one may initially presume. As a midwife working in a busy UK unit, I would liken the assumption that a low risk birth is inherently safer in a high risk unit to investing in ill-fitting metaphorical seat belts, which may give the whole family whiplash.
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Durão AR, Alqerban A, Ferreira AP, Jacobs R. Influence of lateral cephalometric radiography in orthodontic diagnosis and treatment planning. Angle Orthod 2015; 85:206-210. [PMID: 25191839 PMCID: PMC8631877 DOI: 10.2319/011214-41.1] [Citation(s) in RCA: 27] [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] [Received: 01/01/2014] [Accepted: 04/01/2014] [Indexed: 01/15/2024] Open
Abstract
OBJECTIVE To evaluate the impact of additional lateral cephalometric radiography in orthodontic diagnosis and treatment planning. MATERIALS AND METHODS Forty-three patients seeking orthodontic treatment, and for whom pretreatment diagnostic records were available, were randomly selected. Ten qualified orthodontists were involved in this study. The patients' records included three photographs of the angle trimmed dental casts, digital lateral cephalometric and panoramic radiographs, and standard clinical photographs comprising seven intra- and four extraoral pictures. Records were evaluated in two sessions. At the first session, orthodontists evaluated records without lateral cephalometric radiography (LCR). In the second session, the same information was presented, but with LCR. Between the two sessions the order in which the cases were presented was altered to avoid bias. RESULTS The percentage of agreement between sessions was lower for diagnosis than for treatment planning. Concerning skeletal classification, the least experienced orthodontist was the least consistent (28%), while the more experienced orthodontist was the more reliable (67%). In terms of treatment modalities, in general there was an agreement of 64%. The most frequent modifications in treatment modalities were seen in Class II malocclusion patients. CONCLUSIONS The results of our study suggest that the majority of Portuguese orthodontists judge that LCR is important to producing a treatment plan. Despite that, it does not seem to have an influence on orthodontic treatment planning.
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Affiliation(s)
- Ana Reis Durão
- Invited Assistant, Department of Dental Radiology, Faculty of Dental Medicine, University of Porto, Portugal
| | - Ali Alqerban
- Doctorandus, Department of Oral Health Sciences, Faculty of Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Afonso Pinhão Ferreira
- Full Professor, Department of Orthodontics, Faculty of Dental Medicine, University of Porto, Portugal
| | - Reinhilde Jacobs
- Full Professor, OIC, OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
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Abstract
Healthcare assistants must always act in a patient's best interests.
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40
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de Britto FA, Martins TB, Landsberg GAP. Impact of a mobile health aplication in the nursing care plan compliance of a home care service in Belo Horizonte, Minas Gerais, Brazil. Stud Health Technol Inform 2015; 216:895. [PMID: 26262197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To assess impact of a mobile health solution in the nursing care plan compliance of a home care service. METHODS A retrospective cohort study was performed with 3,036 patients. Compliance rates before and after the implementation were compared. RESULTS After the implementation of a mobile health aplication, compliance with the nursing care plan increased from 53% to 94%. The system reduced IT spending, increased the nursing team efficiency and prevented planned hiring. CONCLUSION The use of a mobile health solution with geolocating feature by a nursing home care team increased compliance to the care plan.
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Affiliation(s)
- Felipe A de Britto
- Health Information Technology Management of Unimed BH, Belo Horizonte, Brazil
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Janiszewska-Olszowska J, Grocholewicz K, Czerniawska-Kliman L. Interdisciplinary index of prosthodontic/substitution orthodontic treatment need for patients with missing teeth. ACTA ACUST UNITED AC 2015; 61:64-7. [PMID: 27116858 DOI: 10.21164/pomjlifesci.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The need for treatment in cases of missing teeth may result from aesthetic demands or functional impairment, although tooth loss itself does not necessarily constitute a need for prosthetic replacement. In selected cases, restorative treatment can be replaced by tooth autotransplantation or substitution orthodontic treatment. The authors have tried to make an index based not on missing particular teeth, but on the presence of spacing requiring restoration. An attempt has been made to categorize the restorative treatment need. Orthodontic treatment was considered, when it could completely eliminate the need for prosthetic treatment. The proposed classification could be used for assessing eligibility for public refund of restorative or substitution orthodontic treatment, as well as to motivate the patients to have restorations. It should be an individual approach-based decision, which treatment: orthodontic substitution tooth movement or prosthodontic is more cost-effective for the rest of the patient's life.
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Wong CM, Wu SY, Ting WH, Ho KH, Tong LH, Cheung NT. An Electronic Nursing Patient Care Plan Helps in Clinical Decision Support. Stud Health Technol Inform 2015; 216:945. [PMID: 26262247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Information technology can help to improve health care delivery. The utilisation of informatics principle enhances the quality of nursing practices through improved communication, documentation and efficiency. The Nursing Profession constitutes 34% of the total workforce in the Hong Kong Hospital Authority (HA) and includes 21,000 nurses in 2012. To enhance the quality of care and patient safety in both hospitals and community care setting, it is essential that an integrated electronic decision support system for nurses is designed to track documentation and support care or service including observations, decisions, actions and outcomes throughout the care process at each point-of-care. The Patient Care Plan project was set up to achieve these objectives. The Project adheres to strict documentation information architecture to ensure data sharing is freely available. Preliminary results showed very promising improvement in clinical care.
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Affiliation(s)
- C M Wong
- Health Informatics Section, Hospital Authority, Hong Kong SAR
| | - S Y Wu
- Health Informatics Section, Hospital Authority, Hong Kong SAR
| | - W H Ting
- Information Technology Division, Hospital Authority, Hong Kong SAR
| | - K H Ho
- Information Technology Division, Hospital Authority, Hong Kong SAR
| | - L H Tong
- Health Informatics Section, Hospital Authority, Hong Kong SAR
| | - N T Cheung
- Health Informatics Section, Hospital Authority, Hong Kong SAR
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Harkey J. Safety first for a homebound patient with dementia. Home Healthc Nurse 2014; 32:601-602. [PMID: 25370976 DOI: 10.1097/nhh.0000000000000157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This article is a short case study that describes how a certified geriatric case manager coordinated care and provided safe alternatives to institutional care for an elderly, community dwelling patient with dementia.
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Affiliation(s)
- Jane Harkey
- Jane Harkey, RN, MSW, CCM, is a Commissioner, Commission for Case Manager Certification, Mount Laurel, New Jersey
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Janson G, Maria FRT, Bombonatti R. Frequency evaluation of different extraction protocols in orthodontic treatment during 35 years. Prog Orthod 2014; 15:51. [PMID: 25139394 PMCID: PMC4138554 DOI: 10.1186/s40510-014-0051-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [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] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 07/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies that show frequencies of different orthodontic treatment protocols can be used as valuable parameters in the interpretation of treatment tendency with time. The purpose of this retrospective study was to evaluate all orthodontic treatment planning conducted at the Orthodontic Department at Bauru Dental School, University of São Paulo, Brazil, since 1973, in order to investigate extraction and non-extraction protocol frequencies selected at each considered period. METHODS The sample comprised 3,413 records of treated patients and was evaluated according to the protocol choice, divided into 10 groups: Protocol 0 (non-extraction); Protocol 1 (four first premolar extractions); Protocol 2 (two first maxillary and two second mandibular premolars); Protocol 3 (two maxillary premolar extractions); Protocol 4 (four second premolars); Protocol 5 (asymmetric premolar extractions); Protocol 6 (incisor or canine extractions); Protocol 7 (first or second molar extractions); Protocol 8 (atypical extractions) and Protocol 9 (agenesis and previously missing permanent teeth). These protocols were evaluated in seven 5-year intervals: Interval 1 (1973 to 1977); Interval 2 (1978 to 1982); Interval 3 (1983 to 1987); Interval 4 (1988 to 1992); Interval 5 (1993 to 1997); Interval 6 (1998 to 2002); Interval 7 (2003 to 2007). The frequency of each protocol was compared between the seven intervals, using the proportion test (P < 0.05). RESULTS The results showed that 10 protocol frequencies were significantly different among the 7 time intervals. CONCLUSIONS The non-extraction protocol frequency increased gradually with consequent reduction of extraction treatments. The four premolar extraction protocol frequency decreased gradually while the two maxillary premolar extraction protocol has maintained the same frequency of indications throughout time.
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Affiliation(s)
- Guilherme Janson
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, SP, 17012-901, Brazil.
| | - Fábio Rogério Torres Maria
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, SP, 17012-901, Brazil.
| | - Roberto Bombonatti
- Department of Orthodontics, Bauru Dental School, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, SP, 17012-901, Brazil.
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Perlman C, Martin L, Hirdes J. Using routinely collected clinical assessments in mental health services: the resident assessment instrument-mental health. Can J Psychiatry 2014; 59:399. [PMID: 25004497 PMCID: PMC4086312 DOI: 10.1177/070674371405900708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
PURPOSE The purpose of this preliminary study was to describe the extent to which providers used collaborative goal setting and individualized assessment with patients who were newly prescribed glaucoma medications. METHODS English-speaking glaucoma suspect patients from six ophthalmology clinics who were newly prescribed glaucoma medications had their medical visits videotaped and were interviewed after the visits. The videotapes were transcribed and coded to examine provider use of collaborative goal setting and individualized assessment. RESULTS Fifty-one patients seeing 12 ophthalmologists participated. Providers gave patients glaucoma treatment options during 37% of the visits; only five providers gave patients treatment options Providers asked for patient treatment preferences in less than 20% of the visits; only two providers asked for patient treatment preferences. Providers were significantly more likely to ask African American patients for their preferences or ideas concerning treatment than non-African American patients (Pearson χ² = 4.1, p = 0.04). Providers were also significantly more likely to ask African American patients about their confidence in using glaucoma medication regularly than non-African American patients (Pearson χ² = 8.2, p = 0.004). Providers asked about patient views about glaucoma in less than 20% of the visits; five providers asked patients their views on glaucoma and its treatment. Providers were significantly more likely to ask African American patients about their views on glaucoma than non-African American patients (Pearson χ² = 5.62, p = 0.02). CONCLUSIONS Eye care providers often did not use collaborative goal setting or conduct individualized assessments of patient views on glaucoma when prescribing treatment for the first time.
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Affiliation(s)
- Betsy Sleath
- *PhD †PhD candidate ‡PharmD §PhD, MSPH ∥MD University of North Carolina Eshelman School of Pharmacy (BS, CS, SJB, RS, DMC), Cecil G. Sheps Center for Health Services Research (BS), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Ophthalmology, School of Medicine, Duke University, Durham, North Carolina (KWM); Durham VA Medical Center, Health Services Research and Development, Durham, North Carolina (KWM); Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah (MEH); and Department of International Health, Bloomberg School of Public Health, and Department of Ophthalmology, School of Medicine, Johns Hopkins University, Baltimore, Maryland (ALR)
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Kuriyama S, Saitoh M, Furuuchi T, Muramatsu K, Sakai H, Kubo T, Matsuda S. [Analysis of cancer treatment in Iwate Prefecture - an analysis of health care regions based on MHLW DPC data]. J UOEH 2014; 36:49-60. [PMID: 24633185 DOI: 10.7888/juoeh.36.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Iwate Prefecture has the second largest area and the second lowest population density in Japan, therefore needing a system that can supply medical service efficiently. Although there are nine Secondary Medical Districts (SMD) and fourteen hospitals subject to the Diagnosis Procedure Combination (DPC hospitals) in Iwate, four of the DPC hospitals are concentrated in Morioka SMD, the biggest area and administrative center in Iwate, and the other areas have only a few DPC hospitals. To consider the whole concept of cancer care in Iwate, we analyzed lung, stomach, liver, colon, and breast cancer from DPC data published by the Ministry of Health, Labor and Welfare (MHLW). We analyzed the monthly number of patients and estimated the number of patients that each SMD and DPC hospital was capable of receiving, finding that the trend of consultation is different depending on the type of cancer. We consider that the DPC hospitals should think strategically about their functional compartmentalization, and that the local government should revise the regional health care planning.
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Foli-Andersen NJ. Treatment and follow-up in the psychiatric emergency room can be improved. Dan Med J 2014; 61:A4779. [PMID: 24495886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION The first and perhaps only contact many patients have with the psychiatric hospital system is at the psychiatric emergency room (PER). A growing load on the wards has raised the threshold for admission. Thus, it is important to make plans for patients who are seen in the PER, but are not hospitalised. The objective of this study was to investigate what treatment, plans and follow-up patients receive in the PER when they are not admitted. MATERIAL AND METHODS This is a review of 100 consecutive PER patient reports from 2012 on patients who were seen by a doctor and not admitted at the Psychiatric Centre Frederiksberg, Denmark. The following issues were investigated: diagnosis, which medical and/or psychotherapeutic treatment was given or recommended, social interventions, objective findings, plans for treatment and referrals, and whether relevant referral was neglected. RESULTS A total of 29 patients started psychopharmacological treatment, but only four received a plan for further treatment. Eleven received psychotherapy. Nine received social intervention. A total of 97 were discharged with follow-up. In 14 cases, relevant referral may have been neglected. Eleven reports lacked a description of psychiatrically objective findings, 20 lacked evaluation of suicidality. CONCLUSION Doctors in the PER are vigilant to ensure plans for follow-up. However, these plans may sometimes be deficient. Doctors in the PER often use medical approaches to relieve patients' symptoms, but there is a need for a plan for how these treatments should be followed up. Furthermore, there seems to be a need for a stronger focus on psychotherapy and social intervention. FUNDING not relevant. TRIAL REGISTRATION not relevant.
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Affiliation(s)
- Nina J Foli-Andersen
- Psykiatrisk Center Frederiksberg, Nordre Fasanvej 57-59, 2000 Frederiksberg, Denmark.
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in der Schmitten J, Lex K, Mellert C, Rothärmel S, Wegscheider K, Marckmann G. Implementing an advance care planning program in German nursing homes: results of an inter-regionally controlled intervention trial. Dtsch Arztebl Int 2014; 111:50-7. [PMID: 24612497 PMCID: PMC3950824 DOI: 10.3238/arztebl.2014.0050] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 10/07/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Advance Care Planning (ACP) is a systematic approach to ensure that effective advance directives (ADs) are developed and respected. We studied the effects of implementing a regional ACP program in Germany. METHODS In a prospective, inter-regionally controlled trial focusing on nursing homes (n/hs), we compared the number, relevance and validity of new ADs completed in the intervention region versus the control region. Intervention n/h residents and their families were offered professional facilitation including standardized documentation. RESULTS Data from 136 residents of three intervention n/hs were compared with data from 439 residents of 10 control n/hs over a study period of 16.5 months. In the intervention region, 49 (36.0%) participating residents completed a new AD over the period of the study, compared to 18 (4.1%) in the control region; these ADs included 30 ADs by proxy in the intervention region versus 10 in the control region. Proxies were designated in 94.7% versus 50.0% of cases, the AD was signed by a physician in 93.9% versus 16.7%, and an emergency order was included in 98.0% versus 44.4%. Resuscitation status was addressed in 95.9% versus 38.9% of cases (p<0.01 for all of the differences mentioned above). In the intervention region, new ADs were preceded by an average of 2.5 facilitated conversations (range, 2–5) with a mean total duration of 100 minutes (range, 60–240 minutes). CONCLUSION The implementation of an ACP program in German nursing homes led, much more frequently than previously reported, to the creation of advance directives with potential relevance to medical decision-making. Future research should assess the effect of such programs on clinical and structural outcomes.
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Affiliation(s)
| | - Katharina Lex
- Institute for Patient Safety, Rheinische Friedrich-Wilhelms-Universität Bonn
| | - Christine Mellert
- Department of General Practice, Düsseldorf University, University Hospital
| | - Sonja Rothärmel
- Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf
| | - Georg Marckmann
- Institute of Ethics, History and Theory of Medicine at the Ludwig Maximilians University Munich
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Abstract
Survivorship care plans (SCPs) are intended to educate survivors and providers about survivors' transition from cancer treatment to follow-up care. Using a survey of 23 cancer programs in the South Atlantic United States, we (1) describe the prevalence and barriers to SCP use and (2) assess relationships between SCP use and (a) barriers and (b) cancer program characteristics. Most cancer programs (86 %) reported some SCP use; however, less than a quarter of cancer programs' providers had ever used an SCP. The majority (61 %) began using SCPs because of professional societies' recommendations. Key barriers to SCP use were insufficient organizational resources (75 %) and systems for SCP use. We found patterns in SCP use across location, program type, and professional society membership. Most cancer programs have adopted SCPs, but use remains inconsistent. Efforts to promote SCP use should address barriers, particularly in cancer programs that are susceptible to barriers to SCP use.
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Affiliation(s)
- Sarah A Birken
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, 1107A McGavran-Greenberg Hall, #7411, Chapel Hill, NC, 27599-7411, USA.
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