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Shin CH, Kim KH, Jeeva S, Kang SM. Towards Goals to Refine Prophylactic and Therapeutic Strategies Against COVID-19 Linked to Aging and Metabolic Syndrome. Cells 2021; 10:1412. [PMID: 34204163 PMCID: PMC8227274 DOI: 10.3390/cells10061412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 02/06/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) gave rise to the coronavirus disease 2019 (COVID-19) pandemic. A strong correlation has been demonstrated between worse COVID-19 outcomes, aging, and metabolic syndrome (MetS), which is primarily derived from obesity-induced systemic chronic low-grade inflammation with numerous complications, including type 2 diabetes mellitus (T2DM). The majority of COVID-19 deaths occurs in people over the age of 65. Individuals with MetS are inclined to manifest adverse disease consequences and mortality from COVID-19. In this review, we examine the prevalence and molecular mechanisms underlying enhanced risk of COVID-19 in elderly people and individuals with MetS. Subsequently, we discuss current progresses in treating COVID-19, including the development of new COVID-19 vaccines and antivirals, towards goals to elaborate prophylactic and therapeutic treatment options in this vulnerable population.
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Affiliation(s)
- Chong-Hyun Shin
- Center for Inflammation, Immunity & Infection, Institute for Biomedical Sciences, Georgia State University, Atlanta, GA 30303, USA; (K.-H.K.); (S.J.)
| | | | | | - Sang-Moo Kang
- Center for Inflammation, Immunity & Infection, Institute for Biomedical Sciences, Georgia State University, Atlanta, GA 30303, USA; (K.-H.K.); (S.J.)
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2
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Joosten A, Coeckelenbergh S, Alexander B, Delaporte A, Cannesson M, Duranteau J, Saugel B, Vincent JL, Van der Linden P. Hydroxyethyl starch for perioperative goal-directed fluid therapy in 2020: a narrative review. BMC Anesthesiol 2020; 20:209. [PMID: 32819296 PMCID: PMC7441629 DOI: 10.1186/s12871-020-01128-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 05/14/2020] [Accepted: 08/12/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Perioperative fluid management - including the type, dose, and timing of administration -directly affects patient outcome after major surgery. The objective of fluid administration is to optimize intravascular fluid status to maintain adequate tissue perfusion. There is continuing controversy around the perioperative use of crystalloid versus colloid fluids. Unfortunately, the importance of fluid volume, which significantly influences the benefit-to-risk ratio of each chosen solution, has often been overlooked in this debate. MAIN TEXT The volume of fluid administered during the perioperative period can influence the incidence and severity of postoperative complications. Regrettably, there is still huge variability in fluid administration practices, both intra-and inter-individual, among clinicians. Goal-directed fluid therapy (GDFT), aimed at optimizing flow-related variables, has been demonstrated to have some clinical benefit and has been recommended by multiple professional societies. However, this approach has failed to achieve widespread adoption. A closed-loop fluid administration system designed to assist anesthesia providers in consistently applying GDFT strategies has recently been developed and tested. Such an approach may change the crystalloid versus colloid debate. Because colloid solutions have a more profound effect on intravascular volume and longer plasma persistence, their use in this more "controlled" context could be associated with a lower fluid balance, and potentially improved patient outcome. Additionally, most studies that have assessed the impact of a GDFT strategy on the outcome of high-risk surgical patients have used hydroxyethyl starch (HES) solutions in their protocols. Some of these studies have demonstrated beneficial effects, while none of them has reported severe complications. CONCLUSIONS The type and volume of fluid used for perioperative management need to be individualized according to the patient's hemodynamic status and clinical condition. The amount of fluid given should be guided by well-defined physiologic targets. Compliance with a predefined hemodynamic protocol may be optimized by using a computerized system. The type of fluid should also be individualized, as should any drug therapy, with careful consideration of timing and dose. It is our perspective that HES solutions remain a valid option for fluid therapy in the perioperative context because of their effects on blood volume and their reasonable benefit/risk profile.
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Affiliation(s)
- Alexandre Joosten
- Department of Anesthesiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
- Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Hôpital De Bicêtre, Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
- Department of Anesthesiology & Perioperative Medicine, Bicêtre Hospital, 78, Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Sean Coeckelenbergh
- Department of Anesthesiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Brenton Alexander
- Department of Anesthesiology & Perioperative Care, University of California San Diego, San Diego, USA
| | - Amélie Delaporte
- Department of Anesthesiology & Intensive Care, Marie Lannelongue Hospital, Paris, France
| | - Maxime Cannesson
- Department of Anesthesiology & Perioperative Medicine, University of California Los Angeles, Los Angeles, USA
| | - Jacques Duranteau
- Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Hôpital De Bicêtre, Assistance Publique Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | - Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Outcomes Research Consortium, Cleveland, OH USA
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Philippe Van der Linden
- Department of Anesthesiology, Brugmann Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Sillo H, Ambali A, Azatyan S, Chamdimba C, Kaale E, Kabatende J, Lumpkin M, Mashingia JH, Mukanga D, Nyabenda B, Sematiko G, Sigonda M, Simai B, Siyoi F, Sonoiya S, Ward M, Ahonkhai V. Coming together to improve access to medicines: The genesis of the East African Community's Medicines Regulatory Harmonization initiative. PLoS Med 2020; 17:e1003133. [PMID: 32785273 PMCID: PMC7423075 DOI: 10.1371/journal.pmed.1003133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Hiiti Sillo and colleagues reveal how the East African Community's Medicines Regulatory Harmonization initiative improves access to important medicines in Africa.
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Affiliation(s)
- Hiiti Sillo
- World Health Organization, Geneva, Switzerland
| | - Aggrey Ambali
- African Union Development Agency–New Partnership for Africa’s Development, Midrand, South Africa
| | | | - Chimwemwe Chamdimba
- African Union Development Agency–New Partnership for Africa’s Development, Midrand, South Africa
| | - Eliangiringa Kaale
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Murray Lumpkin
- Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | | | - David Mukanga
- Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | | | | | - Margareth Sigonda
- African Union Development Agency–New Partnership for Africa’s Development, Midrand, South Africa
| | - Burhani Simai
- Zanzibar Food and Drug Agency, Zanzibar City, Zanzibar
| | - Fred Siyoi
- Pharmacy & Poisons Board, Nairobi, Kenya
| | | | - Mike Ward
- World Health Organization, Geneva, Switzerland
| | - Vincent Ahonkhai
- Gwynedd Consultancy, LLC, Philadelphia, Pennsylvania, United States of America
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4
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Reyes Valdivia A, Gandarias Zúñiga C, Riambau V. Vascular Life During the COVID-19 Pandemic Reminds Us to Prepare for the Unexpected. Eur J Vasc Endovasc Surg 2020; 60:154-155. [PMID: 32446539 PMCID: PMC7214295 DOI: 10.1016/j.ejvs.2020.04.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/17/2020] [Accepted: 04/29/2020] [Indexed: 11/22/2022]
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Abstract
Medical emergencies at the end of life require recognition of patients at risk, so that a comprehensive assessment and plan of care can be put in place. Frequently, the interventions depend on the patient's underlying prognosis, location of care, and goals of care. The mere presence of a medical emergency often rapidly changes an estimated prognosis. Education of the patient and family may help empower them to adequately handle many situations when clinicians are not available.
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Affiliation(s)
- Benjamin M Skoch
- Division of Palliative Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Christian T Sinclair
- Division of Palliative Medicine, University of Kansas Medical Center, Kansas City, KS, USA. https://twitter.com/ctsinclair
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Kaufmann T, Saugel B, Scheeren TWL. Perioperative goal-directed therapy - What is the evidence? Best Pract Res Clin Anaesthesiol 2019; 33:179-187. [PMID: 31582097 DOI: 10.1016/j.bpa.2019.05.005] [Citation(s) in RCA: 15] [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: 05/02/2019] [Accepted: 05/08/2019] [Indexed: 01/27/2023]
Abstract
Perioperative goal-directed therapy aims at optimizing global hemodynamics during the perioperative period by titrating fluids, vasopressors, and/or inotropes to predefined hemodynamic goals. There is evidence on the benefit of perioperative goal-directed therapy, but its adoption into clinical practice is slow and incomprehensive. Current evidence indicates that treating patients according to perioperative goal-directed therapy protocols reduces morbidity and mortality, particularly in patients having high-risk surgery. Perioperative goal-directed therapy protocols need to be started early, should include vasoactive agents in addition to fluids, and should target blood flow related variables. Future promising developments in the field of perioperative goal-directed therapy include personalized hemodynamic management and closed-loop system management.
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Affiliation(s)
- Thomas Kaufmann
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands.
| | - Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Thomas W L Scheeren
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, the Netherlands.
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7
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Greally M, Keane F, Power DG, Leonard GD. A Survey of Colorectal Cancer Surveillance Practices In Ireland, And Implementation of A Survivorship Care Plan Pilot Programme. Ir Med J 2019; 112:870. [PMID: 30892003] [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: 06/09/2023]
Abstract
Aims The number of colorectal cancer (CRC) survivors in Ireland is rising. We aimed to survey current surveillance practices and pilot the use of survivorship care plans (SCPs) in the clinic. Methods An online survey was issued to medical oncologists (MOs) in designated cancer centres (DCC) and satellite centres. The SCP was piloted in CRC patients and a follow-up questionnaire assessing their views was issued. Results Responses from 8 DCC and satellite centres were obtained (n=13). Routine surveillance is practiced by 77% (n=10) and 69% (n=9) believe that the MO clinic is inappropriate for follow-up. Most think that the SCP is useful and that ANP-led surveillance clinics should be introduced. Of 16 patients who replied to the survey, most felt that the SCP was benecial. Sixty-two percent (n=10) were agreeable to GP follow-up using the SCP. Conclusion Surveillance practices in Ireland are heterogeneous. The SCP may be useful for streamlining follow-up practices nationally.
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Affiliation(s)
- M Greally
- Medical Oncology Department, University Hospital Galway, Galway
- Gastrointestinal Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, United States
| | - F Keane
- Medical Oncology Department, University Hospital Galway, Galway
| | - D G Power
- Medical Oncology Department, Cork and Mercy University Department, Cork
| | - G D Leonard
- Medical Oncology Department, University Hospital Galway, Galway
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8
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Rush B, Tremblay J, Brown D. Development of a Needs-Based Planning Model to Estimate Required Capacity of a Substance Use Treatment System. J Stud Alcohol Drugs Suppl 2019; Sup 18:51-63. [PMID: 30681949 PMCID: PMC6377026] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 07/10/2018] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE Substance use services and supports have traditionally been funded without the benefit of a comprehensive, quantitative planning model closely aligned with population needs. This article describes the methodology used to develop and refine key features of such a model, gives an overview of the resulting Canadian prototype, and offers examples and lessons learned in pilot work. METHOD The need for treatment was defined according to five categories of problem severity derived from national survey data and anticipated levels of help-seeking estimated from a narrative synthesis of international literature. A pan-Canadian Delphi procedure was used to allocate this help-seeking population across an agreed-upon set of treatment service categories, which included three levels each of withdrawal management, community, and residential treatment services. Projections of need and required service capacity for Canadian health planning regions were derived using synthetic estimation by age and gender. The model and gap analyses were piloted in nine regions. RESULTS National distribution of need was estimated as Tier 1: 80.7%; Tier 2: 10.4%; Tier 3: 6.1%; Tier 4: 2.6%; and Tier 5: 0.2%. Pilot work of the full estimation protocol, including gap analysis, showed the results triangulated with other indicators of need and were useful for local planning. CONCLUSIONS Lessons learned from pilot testing were identified, including challenges with the model itself and those associated with its implementation. The process of estimation developed in this Canadian prototype, and the specifics of the model itself, can be adapted to other jurisdictions and contexts.
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Affiliation(s)
- Brian Rush
- Institute for Mental Health Policy
Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario,
Canada
| | - Joël Tremblay
- Université du Québec à
Trois-Rivières, Trois-Rivières, Québec, Canada
| | - David Brown
- Pathways Research, Winnipeg, Manitoba,
Canada
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9
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Ritter A, Mellor R, Chalmers J, Sunderland M, Lancaster K. Key Considerations in Planning for Substance Use Treatment: Estimating Treatment Need and Demand. J Stud Alcohol Drugs Suppl 2019; Sup 18:22-30. [PMID: 30681945 PMCID: PMC6377022] [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] [Received: 04/18/2017] [Accepted: 02/07/2018] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE Estimates of the extent of treatment need (defined by the presence of a diagnosis for which there is an effective treatment available) and treatment demand (defined as treatment seeking) are essential parts of effective treatment planning, service provision, and treatment funding. This article reviews the existing literature on approaches to estimating need and demand and the use of models to inform such estimation, and then considers the implications for health planners. METHOD A thematic review of the literature was undertaken, with a focus on covering the key concepts and research methods that have been used to date. RESULTS Both need and demand are important estimates in planning for services but contain many difficulties in moving from the theory of measurement to the practicalities of establishing these figures. Furthermore, the simple quantum of need or demand is limited in its usefulness unless it is matched with consideration of different treatment types and their relative intensity, and/or explored as a function of geography and subpopulation. Modeling can assist with establishing more fine-tuned planning estimates, and is able to take into account both client severity and the various treatment types that might be available. CONCLUSIONS Moving from relatively simplistic estimates of need and demand for treatment, this review has shown that although such estimation can inform national or subnational treatment planning, more sophisticated models are required for alcohol and other drug treatment planning. These can help health planners to determine the appropriate amount and mix of treatments for substance use disorders.
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Affiliation(s)
- Alison Ritter
- Drug Policy Modelling Program, National
Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW,
Australia
| | - Richard Mellor
- Drug Policy Modelling Program, National
Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW,
Australia
| | - Jenny Chalmers
- Drug Policy Modelling Program, National
Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW,
Australia
| | - Matthew Sunderland
- Drug Policy Modelling Program, National
Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW,
Australia
| | - Kari Lancaster
- Drug Policy Modelling Program, National
Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW,
Australia
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10
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Beaupin LK, DiGrande S. Survivorship care in AYA patients: battling the loss to follow-up. Am J Manag Care 2018; 24:SP419-SP420. [PMID: 30260619] [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: 06/08/2023]
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11
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Tabesh M, Shaw JE, Zimmet PZ, Soderberg S, Kowlessur S, Timol M, Joonas N, Alberti GMM, Tuomilehto J, Shaw BJ, Magliano DJ. Meeting American Diabetes Association diabetes management targets: trends in Mauritius. Diabet Med 2017; 34:1719-1727. [PMID: 28792634 DOI: 10.1111/dme.13447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2017] [Indexed: 12/19/2022]
Abstract
AIMS To examine the proportion of people with diabetes in the multi-ethnic country of Mauritius meeting American Diabetes Association targets in 2009 and 2015. METHODS Data from independent population-based samples of 858 and 656 adults with diagnosed diabetes in 2009 and 2015, respectively, were analysed with regard to recommended American Diabetes Association targets for HbA1c , blood pressure and LDL cholesterol. RESULTS In 2015 compared with 2009, the proportion of people achieving American Diabetes Association targets for glycaemic control in Mauritius was higher in women (P≤0.01) and in those with only a primary education level (P=0.07), but not in men or people with a higher level of education. Achievement of blood pressure <140/90 mmHg was higher in 2015 compared with 2009 (60% vs 42%) in people of South Asian ethnicity (P<0.001), but not in those of African ethnicity (P=0.16). The percentages of people with LDL cholesterol <2.59 mmol/l were 42.1% and 50.4%, in 2009 and 2015, respectively (P=0.27). Better control of HbA1c and blood pressure was observed in groups in which that control was poorest in 2009. The use of glucose-, blood pressure- and LDL cholesterol-lowering medication was higher in 2015 than in 2009. CONCLUSIONS In certain subgroups, namely women, those with poorer education and those of South Asian ethnicity, whose target achievement was the poorest in 2009, control of glycaemia and blood pressure was better in 2015 as compared with 2009. While these findings are encouraging, further work is required to improve outcomes.
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Affiliation(s)
- M Tabesh
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - J E Shaw
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - P Z Zimmet
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - S Soderberg
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Public Health and Clinical Medicine, Umeå University and Heart Center, Umeå, Sweden
| | - S Kowlessur
- Ministry of Health and Quality of Life, Republic of Mauritius
| | - M Timol
- Ministry of Health and Quality of Life, Republic of Mauritius
| | - N Joonas
- Ministry of Health and Quality of Life, Republic of Mauritius
| | - G M M Alberti
- Department of Endocrinology and Metabolism, St Mary's Hospital and Imperial College, London, UK
| | - J Tuomilehto
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
- Dasman Diabetes Institute, Dasman, Kuwait
- Department of Neurosciences and Preventive Medicine, Danube-University Krems, Austria
- Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - B J Shaw
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - D J Magliano
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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12
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West J. New Trends in Endodontics and Treatment Planning. Dent Today 2017; 36:64-69. [PMID: 29235310] [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: 06/07/2023]
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13
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Kutschke A. [In process]. Pflege Z 2017; 70:25-27. [PMID: 29425432] [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: 06/08/2023]
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14
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Schaller SJ, Anstey M, Blobner M, Edrich T, Grabitz SD, Gradwohl-Matis I, Heim M, Houle T, Kurth T, Latronico N, Lee J, Meyer MJ, Peponis T, Talmor D, Velmahos GC, Waak K, Walz JM, Zafonte R, Eikermann M. Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. Lancet 2016; 388:1377-1388. [PMID: 27707496 DOI: 10.1016/s0140-6736(16)31637-3] [Citation(s) in RCA: 405] [Impact Index Per Article: 50.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/13/2016] [Accepted: 07/19/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Immobilisation predicts adverse outcomes in patients in the surgical intensive care unit (SICU). Attempts to mobilise critically ill patients early after surgery are frequently restricted, but we tested whether early mobilisation leads to improved mobility, decreased SICU length of stay, and increased functional independence of patients at hospital discharge. METHODS We did a multicentre, international, parallel-group, assessor-blinded, randomised controlled trial in SICUs of five university hospitals in Austria (n=1), Germany (n=1), and the USA (n=3). Eligible patients (aged 18 years or older, who had been mechanically ventilated for <48 h, and were expected to require mechanical ventilation for ≥24 h) were randomly assigned (1:1) by use of a stratified block randomisation via restricted web platform to standard of care (control) or early, goal-directed mobilisation using an inter-professional approach of closed-loop communication and the SICU optimal mobilisation score (SOMS) algorithm (intervention), which describes patients' mobilisation capacity on a numerical rating scale ranging from 0 (no mobilisation) to 4 (ambulation). We had three main outcomes hierarchically tested in a prespecified order: the mean SOMS level patients achieved during their SICU stay (primary outcome), and patient's length of stay on SICU and the mini-modified functional independence measure score (mmFIM) at hospital discharge (both secondary outcomes). This trial is registered with ClinicalTrials.gov (NCT01363102). FINDINGS Between July 1, 2011, and Nov 4, 2015, we randomly assigned 200 patients to receive standard treatment (control; n=96) or intervention (n=104). Intention-to-treat analysis showed that the intervention improved the mobilisation level (mean achieved SOMS 2·2 [SD 1·0] in intervention group vs 1·5 [0·8] in control group, p<0·0001), decreased SICU length of stay (mean 7 days [SD 5-12] in intervention group vs 10 days [6-15] in control group, p=0·0054), and improved functional mobility at hospital discharge (mmFIM score 8 [4-8] in intervention group vs 5 [2-8] in control group, p=0·0002). More adverse events were reported in the intervention group (25 cases [2·8%]) than in the control group (ten cases [0·8%]); no serious adverse events were observed. Before hospital discharge 25 patients died (17 [16%] in the intervention group, eight [8%] in the control group). 3 months after hospital discharge 36 patients died (21 [22%] in the intervention group, 15 [17%] in the control group). INTERPRETATION Early, goal-directed mobilisation improved patient mobilisation throughout SICU admission, shortened patient length of stay in the SICU, and improved patients' functional mobility at hospital discharge. FUNDING Jeffrey and Judy Buzen.
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Affiliation(s)
- Stefan J Schaller
- Klinik für Anaesthesiologie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Matthew Anstey
- Department of Intensive Care, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Manfred Blobner
- Klinik für Anaesthesiologie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Thomas Edrich
- Department of Anesthesiology and Critical Care, Klinikum Landkreis Erding, Erding, Germany; Universitätsklinik für Anästhesiologie, perioperative Medizin und allgemeine Intensivmedizin, Universitätsklinikum Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Stephanie D Grabitz
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ilse Gradwohl-Matis
- Universitätsklinik für Anästhesiologie, perioperative Medizin und allgemeine Intensivmedizin, Universitätsklinikum Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Markus Heim
- Klinik für Anaesthesiologie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Timothy Houle
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Tobias Kurth
- Institute of Public Health, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Nicola Latronico
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, University of Brescia, Brescia, Italy
| | - Jarone Lee
- Department of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Matthew J Meyer
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Thomas Peponis
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Daniel Talmor
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - George C Velmahos
- Department of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Karen Waak
- Department of Physical Therapy, Massachusetts General Hospital, Boston, MA, USA
| | - J Matthias Walz
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham, MA, USA; Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Matthias Eikermann
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Universität Duisburg-Essen, Klinik für Anaesthesiologie und Intensivmedizin, Essen, Germany.
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15
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[Chronic pain: national health insurance promotes national health goal]. Pflege Z 2016; 69:196. [PMID: 27218128] [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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Cillo JE, Basi D, Peacock Z, Aghaloo T, Bouloux G, Dodson T, Edwards SP, Kademani D. Proceedings of the American Association of Oral and Maxillofacial Surgeons 2015 Research Summit. J Oral Maxillofac Surg 2015; 74:429-37. [PMID: 26707430 DOI: 10.1016/j.joms.2015.11.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 11/18/2015] [Accepted: 11/18/2015] [Indexed: 11/15/2022]
Abstract
The Fifth Biennial Research Summit of the American Association of Oral and Maxillofacial Surgeons and its Committee on Research Planning and Technology Assessment was held in Rosemont, Illinois on May 6 and 7, 2015. The goal of the symposium is to provide a forum for the most recent clinical and scientific advances to be brought to the specialty. The proceedings of the events of that summit are presented in this report.
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Affiliation(s)
- Joseph E Cillo
- Assistant Professor and Program Director, Division of Oral and Maxillofacial Surgery, Allegheny General Hospital, Pittsburgh, PA.
| | | | - Zachary Peacock
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA
| | - Tara Aghaloo
- Assistant Dean, Clinical Research; Professor, Section of Oral and Maxillofacial Surgery, Division of Diagnostic and Surgical Sciences, UCLA School of Dentistry, Los Angeles, CA
| | - Gary Bouloux
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Emory University, Atlanta, GA
| | - Thomas Dodson
- Professor and Chair, Department of Oral and Maxillofacial Surgery, University of Washington, Seattle, WA
| | - Sean P Edwards
- Clinical Associate Professor; Director, Residency Program; Chief, Pediatric Oral and Maxillofacial Surgery, University of Michigan School of Dentistry, Ann Arbor, MI
| | - Deepak Kademani
- Medical Director, Department of Oral and Maxillofacial Surgery; Fellowship Director, Oral-Head and Neck Oncologic and Reconstructive Surgery, North Memorial and Hubert Humphrey Cancer Center, Minneapolis, MN
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Hahn-Goldberg S, Okrainec K, Huynh T, Zahr N, Abrams H. Co-creating patient-oriented discharge instructions with patients, caregivers, and healthcare providers. J Hosp Med 2015; 10:804-7. [PMID: 26406116 DOI: 10.1002/jhm.2444] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 07/20/2015] [Accepted: 07/24/2015] [Indexed: 12/30/2022]
Abstract
For hospitalized patients, the transition from hospital to home is frequently accompanied by a significant amount of information to absorb. The objective of this work was to engage patients, caregivers, and healthcare providers in codeveloping patient-oriented discharge instructions, (ie, a brief transition plan with information that patients want). Overseen by a multidisciplinary advisory team, a participatory action approach using mixed methods was employed. Although formal inclusion and exclusion criteria were not used, deliberate efforts were made to engage groups with language barriers and limited health literacy. Symbols were designed and validated with the patient groups to represent each section of information to make the form more understandable for these patients. A prototype was codesigned using an iterative process. The form has been adapted for use in multiple health settings and is currently undergoing a multisite pilot to evaluate its effect on patient and provider experience.
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Affiliation(s)
| | - Karen Okrainec
- OpenLab, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Tai Huynh
- OpenLab, University Health Network, Toronto, Ontario, Canada
| | - Najla Zahr
- OpenLab, University Health Network, Toronto, Ontario, Canada
| | - Howard Abrams
- OpenLab, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
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Koontz BF, Benda R, De Los Santos J, Hoffman KE, Huq MS, Morrell R, Sims A, Stevens S, Yu JB, Chen RC. US radiation oncology practice patterns for posttreatment survivor care. Pract Radiat Oncol 2015; 6:50-6. [PMID: 26603597 DOI: 10.1016/j.prro.2015.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE Increasing numbers of cancer survivors have driven a greater focus on care of cancer patients after treatment. Radiation oncologists have long considered follow-up of patients an integral part of practice. We sought to document current survivor-focused care patterns and identify barriers to meeting new regulatory commission guidelines for survivorship care plans (SCPs) and provide guidance for survivorship care. METHODS AND MATERIALS A 23-question electronic survey was e-mailed to all practicing US physician American Society of Radiation Oncology members. Responses were collected for 25 days in March 2014. Survey data were descriptively analyzed. RESULTS A total of 574 eligible providers responded, for a response percentage of 14.7%. Almost all providers follow their patients after treatment (97%). Length of follow-up was frequently extensive: 17% followed up to 2 years, 40% for 3-5 years, 12% for 6-10 years, and 31% indefinitely. Ancillary services, particularly social work and nutrition services, are commonly available onsite to patients in follow-up. Fewer than half of respondents (40%) indicated that they currently use SCPs for curative intent patients and those who do generally use internally developed templates. SCPs typically go to patients (91%), but infrequently to primary care providers (22%). The top 3 barriers to implementation of SCPs were cost (57%), duplicative survivorship care plans provided by other physicians (43%), and lack of consensus or professional guidelines (40%). Eighty-seven percent indicated that SCPs built into an electronic medical record system would be useful. CONCLUSIONS A significant part of radiation oncology practice includes the care of those in the surveillance of follow-up phase of care. SCPs may be beneficial in improving communication with the patient and other care but are not widely used within our field. This survey identified key barriers to use of SCPs and provides specialty guidance for important information to be included in a radiation oncology oriented SCP.
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Affiliation(s)
- Bridget F Koontz
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
| | - Rashmi Benda
- Department of Radiation Oncology Lynn Cancer Institute at Boca Raton Regional Hospital, Boca Raton, Florida
| | - Jennifer De Los Santos
- University of Alabama at Birmingham, The Kirklin Clinic at Acton Road and Comprehensive Cancer Center, Birmingham, Alabama
| | - Karen E Hoffman
- The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - M Saiful Huq
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, and UPMC Cancer Center, Pittsburgh, Pennsylvania
| | - Rosalyn Morrell
- Advanced Radiation Center of Beverly Hills, Beverly Hills, California
| | - Amber Sims
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia
| | | | | | - Ronald C Chen
- Department of Radiation Oncology, University of North Carolina - Chapel Hill, Chapel Hill, North Carolina
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Home PD, Dain MP, Freemantle N, Kawamori R, Pfohl M, Brette S, Pilorget V, Scherbaum WA, Vespasiani G, Vincent M, Balkau B. Four-year evolution of insulin regimens, glycaemic control, hypoglycaemia and body weight after starting insulin therapy in type 2 diabetes across three continents. Diabetes Res Clin Pract 2015; 108:350-9. [PMID: 25825361 DOI: 10.1016/j.diabres.2015.01.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 07/29/2014] [Revised: 10/24/2014] [Accepted: 01/18/2015] [Indexed: 10/24/2022]
Abstract
AIMS It is of interest to understand how insulin therapy currently evolves in clinical practice, in the years after starting insulin in people with type 2 diabetes. We aimed to describe this evolution prospectively over 4 years, to assist health care planning. METHODS People who had started any insulin were identified from 12 countries on three continents. Baseline, then yearly follow-up, data were extracted from clinical records over 4 years. RESULTS Of the 2999 eligible people, 2272 were followed over 4 years. When starting insulin, mean (SD) duration of diabetes was 10.6 (7.8) years, HbA1c 9.5 (2.0)% (80 [22]mmol/mol) and BMI 29.3 (6.3)kg/m(2). Initial insulin therapy was basal 52%, premix 23%, mealtime+basal 14%, mealtime 8% and other 3%; at 4 years, 30%, 25%, 33%, 2% and 5%, respectively, with 5% not on insulin. Insulin dose was 20.2U/day at the start and 45.8U/day at year 4. There were 1258 people (55%) on their original regimen at 4 years, and this percentage differed according to baseline insulin regimen. HbA1c change was -2.0 (2.2)% (-22 [24]mmol/mol) and was similar by final insulin regimen. Hypoglycaemia prevalence was <20% in years 1-4. Body weight change was mostly in year 1, and was very variable, mean +2.7 (7.5)kg at year 4. CONCLUSION Different insulin regimens were started in people with differing characteristics, and they evolved differently; insulin dose, hypoglycaemia and body weight change were diverse and largely independent of regimen.
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Affiliation(s)
- Philip D Home
- Newcastle University, Newcastle upon Tyne, United Kingdom.
| | | | - Nick Freemantle
- Department of Primary Care and Population Health, University College London, United Kingdom
| | - Ryuzo Kawamori
- Department of Medicine, Juntendo University, Tokyo, Japan
| | - Martin Pfohl
- Evangelisches Bethesda-Krankenhaus zu Duisburg GmbH, Duisburg, Germany
| | | | | | - Werner A Scherbaum
- Heinrich-Heine-University, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Giacomo Vespasiani
- Diabetology and Metabolic Disorders Centre, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy
| | | | - Beverley Balkau
- INSERM, U1018, University Paris Sud 11, UMRS 1018, F-94807 Villejuif, France
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21
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Girault D. [Management of mentally handicapped patients: room for improvement!]. Rev Infirm 2015; 64:1. [PMID: 26144819 DOI: 10.1016/j.revinf.2014.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Damien Girault
- Association régionale de sauvegarde de l'enfant, de l'adolescent et de l'adulte, pôle guidance infantile, 7 chemin de Colasson, 31000 Toulouse, France.
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Affiliation(s)
- H K Kroemer
- Vorstand Forschung und Lehre/Dekan der Universitätsmedizin Göttingen, Robert-Koch-Str. 42, 37075, Göttingen, Deutschland,
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Abstract
Cancer programs are increasingly required to use survivorship care plans (SCPs). Compliance with SCP use requirements will be evaluated at the cancer program level. Cancer program-level determinants of SCP use may suggest strategies for compliance. The objective of this study was to describe SCP use and identify its cancer program-level determinants. We surveyed employees knowledgeable about survivorship practices in cancer programs throughout the USA with a wide range of annual incident cancers, program types, and cancer care quality improvement organization memberships (81/100 response rate). We used descriptive statistics to describe SCP use and bivariate statistics to identify its cancer program-level determinants. Most respondents (56 %) reported that SCPs were not used. In programs reporting use, SCP use is restricted primarily to breast (82 %) and colorectal (55 %) cancer survivors, and few providers use SCPs. When developed, SCPs seldom reach survivors and their primary care providers. Most respondents (78 %) reported beginning to use SCPs because of requirements. Frequently cited barriers included insufficient resources (76 %), perceived difficulty using SCPs (29 %), and lack of advocacy for SCP use from influential people (24 %). SCP use was positively associated with academic program type (p = .009) and membership in the National Cancer Institute's Community Cancer Centers Program (p = .009) and negatively associated with freestanding program type (p = .02). SCP use in the US cancer programs is highly inconsistent. Many cancer programs plan to implement SCPs to comply with SCP use requirements. Support specifically intended to facilitate SCP use may be more effective than non-specific resources.
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Affiliation(s)
- Sarah A Birken
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7411, USA,
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Abstract
The Institute of Medicine suggests that consistent survivorship care plan (SCP) use involves developing and delivering SCPs to all cancer survivors and their primary care providers (PCPs). We describe the consistency of SCP use in US cancer programs and assess its relationship with cancer-program-level determinants. We surveyed employees knowledgeable about survivorship practices in cancer programs reporting current SCP use (n = 36, 81 % response rate). We operationalized consistent SCP use as whether SCPs were (1) developed for ≥75 % survivors, (2) delivered to ≥75 % survivors, (3) delivered to ≥75 % PCPs, and (4) all of the above. We use descriptive statistics to report SCP use consistency and evaluate associations using Fisher's exact and Wilcoxon rank sum tests. SCPs were developed for ≥75 % survivors in five programs (15 %), eight (25 %) delivered ≥75 % SCPs to survivors, seven (23 %) delivered ≥75 % SCPs to PCPs, and only one program (4 %) met all three criteria. We found relationships between SCP use consistency and geographic region (p = .05), initiating SCP use in response to survivors' requests (p = .03), and membership in the National Cancer Institute's National Community Cancer Centers Program (p = .01). SCP use is highly inconsistent. Survivors and cancer care quality improvement organizations may play a key role in improving the consistency of SCP use in US cancer programs. Survivors can initiate SCP use. Cancer care quality improvement organizations can specify how cancer programs' compliance with SCP guidelines will be assessed. Future research should identify mechanisms underlying the relationships that we found.
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Affiliation(s)
- Sarah A Birken
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 1107A McGavran-Greenberg Hall, Chapel Hill, NC, 27599, USA,
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Abstract
Stem cells are attributed with having a great potential in regenerative medicine. Pluripotent stem cells are particularly interesting because they can be multiplied indefinitely and also differentiated under defined conditions. Currently, cardiomyocytes can be differentiated very effectively from pluripotent stem cells, making the former an attractive starting material for cardiac disease modeling in a culture dish (patient in a dish) and cell based-therapy in heart failure. The rapid biotechnological advances made in recent years now enable these concepts to be translated into clinical applications.
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Affiliation(s)
- W-H Zimmermann
- Institute for Pharmacology, University Medical Center, Georg-August-University, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland,
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Janssens R, van Delden JJM, Widdershoven GAM. Palliative sedation: not just normal medical practice. Ethical reflections on the Royal Dutch Medical Association's guideline on palliative sedation. J Med Ethics 2012; 38:664-668. [PMID: 22811556 DOI: 10.1136/medethics-2011-100353] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The main premise of the Royal Dutch Medical Association's (RDMA) guideline on palliative sedation is that palliative sedation, contrary to euthanasia, is normal medical practice. Although we do not deny the ethical distinctions between euthanasia and palliative sedation, we will critically analyse the guideline's argumentation strategy with which euthanasia is demarcated from palliative sedation. First, we will analyse the guideline's main premise, which entails that palliative sedation is normal medical treatment. After this, we will critically discuss three crucial propositions of the guideline that are used to support this premise: (1) the patient's life expectancy should not exceed 2 weeks; (2) the aim of the physician should be to relieve suffering and (3) expert consultation is optional. We will conclude that, if inherent problematic aspects of palliative sedation are taken seriously, palliative sedation is less normal than it is now depicted in the guideline.
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Affiliation(s)
- Rien Janssens
- Department of Medical Humanities, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands.
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27
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Abstract
Contrary to the widespread concern about over-treatment at the end of life, today, patient preferences for palliative care at the end of life are frequently respected. However, ethically challenging situations in the current healthcare climate are, instead, situations in which a competent patient requests active treatment with the goal of life-prolongation while the physician suggests best supportive care only. The argument of futility has often been used to justify unilateral decisions made by physicians to withhold or withdraw life-sustaining treatment. However, we argue that neither the concept of futility nor that of patient autonomy alone is apt for resolving situations in which physicians are confronted with patients' requests for active treatment. Instead, we integrate the relevant arguments that have been put forward in the academic discussion about 'futile' treatment into an ethical algorithm with five guiding questions: (1) Is there a chance that medical intervention will be effective in achieving the patient's treatment goal? (2) How does the physician evaluate the expected benefit and the potential harm of the treatment? (3) Does the patient understand his or her medical situation? (4) Does the patient prefer receiving treatment after evaluating the benefit-harm ratio and the costs? (5) Does the treatment require many resources? This algorithm shall facilitate approaching patients' requests for treatments deemed futile by the physician in a systematic way, and responding to these requests in an ethically appropriate manner. It thereby adds substantive considerations to the current procedural approaches of conflict resolution in order to improve decision making among physicians, patients and families.
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Affiliation(s)
- Eva C Winkler
- National Center for Tumour Diseases, University of Heidelberg, Heidelberg, Germany.
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28
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Müller V, Tamási L, Gálffy G, Losonczy G. [Supportive care during chemotherapy for lung cancer in daily practice]. Magy Onkol 2012; 56:159-165. [PMID: 23008823] [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] [Received: 07/03/2012] [Accepted: 08/07/2012] [Indexed: 06/01/2023]
Abstract
Active oncotherapy, combination chemotherapy of lung cancer is accompanied with many side effects which may impair patients' quality of life and compromise the effectiveness of chemotherapy. Most side effects of chemotherapy are preventable or treatable with optimal supportive care which enhances success in patient care and treatment. The aim of this review is to summarize the most important conditions that may be associated with combined chemotherapy of lung cancer from the practical point of view.
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Affiliation(s)
- Veronika Müller
- Pulmonológiai Klinika, Semmelweis Egyetem, Budapest, Hungary.
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Affiliation(s)
- Agnes H Chen
- Division of Pediatric Neurology, Los Angeles County-Harbor-UCLA Medical Center, David Geffen School of Medicine at University of California Los Angeles, Box 468, 1000 West Carson Street, Torrance, CA 90502-2004, USA.
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Abstract
Type 2 diabetes mellitus is increasing in prevalence at alarming rates. Concurrent with its expanding prevalence is the increase in the related risk of morbidity and mortality. Because diabetic patients are prone to cardiovascular disease, treatment strategies should address the cardiovascular risk factors, including blood pressure, lipids, and body weight, in addition to the glycemic aspects of the disease. Newer agents, such as glucagon-like peptide-1 (GLP-1) analogs and dipeptidyl peptidase-4 (DPP-4) inhibitors, have varying degrees of evidence to support their effects on body weight, blood pressure, and lipid levels, beyond glycated hemoglobin reduction. While GLP-1 agonists produce a weight loss, the DPP-4 inhibitors, conversely, appear to have a weight-neutral effect. Substantial evidence demonstrates that both medications produce modest reductions in systolic blood pressure and, in some cases, diastolic blood pressure, and reduce several markers of cardiovascular risk, including C-reactive protein. Moreover, GLP-1 influences endothelial function. The effect of the incretin hormones on serum lipids are either neutral or beneficial, with small, non-significant decreases in LDL cholesterol, increases in HDL cholesterol, and occasionally significant decreases in fasting triglyceride levels. Also, they have positive effects on hepatic steatosis. Although GLP-1 agonists and DPP-4 inhibitors are at present not appropriate for primary treatment of cardiovascular risks factors, the reduction of these parameters is evidently beneficial.
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Affiliation(s)
- F Giorgino
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Piazza Giulio Cesare, 11, I- 70124 Bari, Italy.
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Dinan MA, Simmons LA, Snyderman R. Commentary: Personalized health planning and the Patient Protection and Affordable Care Act: an opportunity for academic medicine to lead health care reform. Acad Med 2010; 85:1665-1668. [PMID: 20844424 DOI: 10.1097/acm.0b013e3181f4ab3c] [Citation(s) in RCA: 13] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The Patient Protection and Affordable Care Act of 2010 (PPACA) mandates the exploration of new approaches to coordinated health care delivery--such as patient-centered medical homes, accountable care organizations, and disease management programs--in which reimbursement is aligned with desired outcomes. PPACA does not, however, delineate a standardized approach to improve the delivery process or a specific means to quantify performance for value-based reimbursement; these details are left to administrative agencies to develop and implement. The authors propose that coordinated care can be implemented more effectively and performance quantified more accurately by using personalized health planning, which employs individualized strategic health planning and care relevant to the patient's specific needs. Personalized health plans, developed by providers in collaboration with their patients, quantify patients' health and health risks over time, identify strategies to mitigate risks and/or treat disease, deliver personalized care, engage patients in their care, and measure outcomes. Personalized health planning is a core clinical process that can standardize coordinated care approaches while providing the data needed for performance-based reimbursement. The authors argue that academic health centers have a significant opportunity to lead true health care reform by adopting personalized health planning to coordinate care delivery while conducting the research and education necessary to enable its broad clinical application.
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Affiliation(s)
- Michaela A Dinan
- Center for Research on Prospective Health Care, Duke University Medical Center, Durham, North Carolina 27710, USA
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33
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Affiliation(s)
- Ralph Snyderman
- Center for Research on Prospective Health Care, Duke University, DUMC 3059, Durham, NC 27710, USA.
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34
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Affiliation(s)
- Robert D Truog
- Harvard Medical School, Division of Medical Ethics, 641 Huntington Avenue, Boston, MA 02115, USA.
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35
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Pope TM. Restricting CPR to patients who provide informed consent will not permit physicians to unilaterally refuse requested CPR. Am J Bioeth 2010; 10:82-83. [PMID: 20077353 DOI: 10.1080/15265160903460996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Affiliation(s)
- Carolyn Ells
- McGill University, Biomedical Ethics Unit, 3647 Peel St., #305, Montreal, Quebec, H3A 1X1, Canada.
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37
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Affiliation(s)
- Eli Feen
- Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
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38
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Sillo H, Ambali A, Azatyan S, Chamdimba C, Kaale E, Kabatende J, Lumpkin M, Mashingia JH, Mukanga D, Nyabenda B, Sematiko G, Sigonda M, Simai B, Siyoi F, Sonoiya S, Ward M, Ahonkhai V. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009. [PMID: 32785273 DOI: 10.1371/journal.pmed] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Hiiti Sillo
- World Health Organization, Geneva, Switzerland
| | - Aggrey Ambali
- African Union Development Agency-New Partnership for Africa's Development, Midrand, South Africa
| | | | - Chimwemwe Chamdimba
- African Union Development Agency-New Partnership for Africa's Development, Midrand, South Africa
| | - Eliangiringa Kaale
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Murray Lumpkin
- Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | | | - David Mukanga
- Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | | | | | - Margareth Sigonda
- African Union Development Agency-New Partnership for Africa's Development, Midrand, South Africa
| | - Burhani Simai
- Zanzibar Food and Drug Agency, Zanzibar City, Zanzibar
| | - Fred Siyoi
- Pharmacy & Poisons Board, Nairobi, Kenya
| | | | - Mike Ward
- World Health Organization, Geneva, Switzerland
| | - Vincent Ahonkhai
- Gwynedd Consultancy, LLC, Philadelphia, Pennsylvania, United States of America
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Hobson K. A radical rethinking of treatment. The aim is to make cancer curable or a manageable chronic disease. US News World Rep 2008; 145:48-53. [PMID: 18998442] [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: 05/27/2023]
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40
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Healy B. Unlocking the secrets of cancer. US News World Rep 2008; 145:46-47. [PMID: 18998441] [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: 05/27/2023]
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Auerbach AD, Katz R, Pantilat SZ, Bernacki R, Schnipper J, Kaboli P, Wetterneck T, Gonzales D, Arora V, Zhang J, Meltzer D. Factors associated with discussion of care plans and code status at the time of hospital admission: results from the Multicenter Hospitalist Study. J Hosp Med 2008; 3:437-45. [PMID: 19084893 PMCID: PMC3049295 DOI: 10.1002/jhm.369] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Hospital admission is a time when patients are sickest and also often encountering an entirely new set of caregivers. As a result, understanding and documenting a patient's care preferences at hospital admission is critically important. OBJECTIVE To understand factors associated with documentation of care planning discussions in patients admitted to general medical services at 6 academic medical centers. DESIGN Observational cohort study using data collected during the Multicenter Hospitalist Study, conducted between July 1, 2002 and June 30, 2004. SETTING Prospective trial enrolling patients admitted to general medicine services at 6 university-based teaching hospitals. PATIENTS Patients were eligible for this study if they were 18 years of age or older, admitted to a hospitalist or nonhospitalist physician, and able to give informed consent. MEASUREMENTS Presence of chart documentation that the admitting team had discussed care plans with the patient within the first 24 hours of hospitalization. Notations such as "full code" were not counted as a discussion, whereas notations such as "discussed care wishes and plan with patient" were counted. RESULTS A total of 17,097 patients over the age of 18 gave informed consent and completed an interview and chart abstraction; of these, 1776 (10.3%) had a code status discussion (CD) documented in the first 24 hours of their admission. Patients with a CD were older (69 years vs. 56 years, P < 0.0001), more often white (52.8% vs. 43.3%, P < 0.0001), and more likely to have cancer (19.8% vs. 11.4%, P < 0.0001), or depression (35.1% vs. 30.9%, P < 0.0001). There was marked variability in CD documentation across sites of enrollment (2.8%-24.9%, P < 0.0001). Despite strong associations seen in unadjusted comparisons, in multivariable models many socioeconomic factors, functional status, comorbid illness, and documentation of a surrogate decision maker were only moderately associated with a CD (adjusted odds ratios all less than 2.0). However, patients' site of enrollment (odds ratios 1.74-5.14) and informal notations describing prehospital care wishes (eg, orders for "do not resuscitate"/"do not intubate;" odds ratios 3.22-11.32 compared with no preexisting documentation) were powerfully associated with CD documentation. Site remained a powerful influence even in patients with no documented prehospital wishes. LIMITATIONS Our results are derived from a relatively small number of academic sites, and we cannot connect documentation differences to differences in patient outcomes. CONCLUSIONS Documentation of a CD at admission was more strongly associated with informal documentation of prehospital care wishes and where the patient was hospitalized than legal care planning documents (such as durable power of attorney), or comorbid illnesses. Efforts to improve communication between hospitalists and their patients might target local documentation practices and culture.
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Affiliation(s)
- Andrew D Auerbach
- University of California San Francisco, UCSF Department of Hospital Medicine, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
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Liu S, Liston RM, Joseph KS, Heaman M, Sauve R, Kramer MS. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ 2007; 176:455-60. [PMID: 17296957 PMCID: PMC1800583 DOI: 10.1503/cmaj.060870] [Citation(s) in RCA: 531] [Impact Index Per Article: 31.2] [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: 11/01/2022] Open
Abstract
BACKGROUND The rate of elective primary cesarean delivery continues to rise, owing in part to the widespread perception that the procedure is of little or no risk to healthy women. METHODS Using the Canadian Institute for Health Information's Discharge Abstract Database, we carried out a retrospective population-based cohort study of all women in Canada (excluding Quebec and Manitoba) who delivered from April 1991 through March 2005. Healthy women who underwent a primary cesarean delivery for breech presentation constituted a surrogate "planned cesarean group" considered to have undergone low-risk elective cesarean delivery, for comparison with an otherwise similar group of women who had planned to deliver vaginally. RESULTS The planned cesarean group comprised 46,766 women v. 2,292,420 in the planned vaginal delivery group; overall rates of severe morbidity for the entire 14-year period were 27.3 and 9.0, respectively, per 1000 deliveries. The planned cesarean group had increased postpartum risks of cardiac arrest (adjusted odds ratio [OR] 5.1, 95% confidence interval [CI] 4.1-6.3), wound hematoma (OR 5.1, 95% CI 4.6-5.5), hysterectomy (OR 3.2, 95% CI 2.2-4.8), major puerperal infection (OR 3.0, 95% CI 2.7-3.4), anesthetic complications (OR 2.3, 95% CI 2.0-2.6), venous thromboembolism (OR 2.2, 95% CI 1.5-3.2) and hemorrhage requiring hysterectomy (OR 2.1, 95% CI 1.2-3.8), and stayed in hospital longer (adjusted mean difference 1.47 d, 95% CI 1.46-1.49 d) than those in the planned vaginal delivery group, but a lower risk of hemorrhage requiring blood transfusion (OR 0.4, 95% CI 0.2-0.8). Absolute risk increases in severe maternal morbidity rates were low (e.g., for postpartum cardiac arrest, the increase with planned cesarean delivery was 1.6 per 1000 deliveries, 95% CI 1.2-2.1). The difference in the rate of in-hospital maternal death between the 2 groups was nonsignificant (p = 0.87). INTERPRETATION Although the absolute difference is small, the risks of severe maternal morbidity associated with planned cesarean delivery are higher than those associated with planned vaginal delivery. These risks should be considered by women contemplating an elective cesarean delivery and by their physicians.
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Affiliation(s)
- Shiliang Liu
- Health Surveillance and Epidemiology Division, Centre for Health Promotion, Public Health Agency of Canada, Ottawa, Ont.
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Affiliation(s)
- B Anthony Armson
- Department of Obstetrics and Gynaecology, University of Toronto, and the Maternal, Infant and Reproductive Health Research Unit, Women's College Research Institute, Toronto, Ont.
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Hughes G. Urgent care: is this the future? Probably. Emerg Med J 2007; 24:2. [PMID: 17183031 PMCID: PMC2658143 DOI: 10.1136/emj.2006.043869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Früh-Buck V. [Fortunate nursing planning--in motion]. Krankenpfl Soins Infirm 2007; 100:28-9. [PMID: 17511396] [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: 05/15/2023]
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AbuRuz SM, Bulatova NR, Yousef AM. Validation of a comprehensive classification tool for treatment-related problems. Pharm World Sci 2006; 28:222-32. [PMID: 17066238 DOI: 10.1007/s11096-006-9048-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2005] [Accepted: 07/19/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Several drug-related problem classification systems can be found in the literature. However, it is generally agreed that a comprehensive, well constructed and validated instrument is currently lacking. The aim of this study is the development and validation of a comprehensive treatment-related problems assessment and classification tool for use in teaching, practicing and researching pharmaceutical care and to improve identification, resolving and preventing of treatment-related problems. METHOD The development and validation involved five steps starting with literature search to define a treatment related problem and also to form a database of treatment-related problems identified in the literature. In the next step, all problems that were identified in the first step and passed the evaluation of the three authors were pooled together and then divided into groups according to their common or shared construct, in the third step a suitable assessment method was developed according to the construct of the different problems, in the next step the developed instrument was validated for content, internal and external validity. Finally the tool was finalized and tested for reproducibility and inter-rater agreement. RESULTS The final validated version included six main categories for treatment-related problems (Indication, Effectiveness, Safety, Knowledge, Adherence and Miscellaneous). These categories include a total of nine subcategories and a total of 29 treatment related problems. CONCLUSION The treatment-related problems assessment and classification tool introduced in this paper was applied to actual patient cases and proved to be valid. This tool also has several features that are new.
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Affiliation(s)
- Salah M AbuRuz
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman, Jordan.
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Abstract
A peer support intervention was developed to support aging caregivers and adults with developmental disabilities in planning for the future. The intervention consisted of a legal/financial training session followed by five additional small-group workshops. Pretest and 1-year follow-up surveys were conducted with 29 families participating in the intervention and 19 control families. Outcome measures included future planning activities, caregiving appraisals, discussion of plans with individuals who have developmental disabilities, and choice-making of individuals with developmental disabilities. The intervention significantly contributed to families completing a letter of intent, taking action on residential planning, and developing a special needs trust. Caregiving burden significantly decreased for families in the intervention and daily choice-making of individuals with disabilities increased.
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Affiliation(s)
- Tamar Heller
- Rehabilitation Research and Training Center on Aging With Developmental Disabilities, Department of Disability and Human Development, University of Illinois at Chicago, 1640 W. Roosevelt Rd., Chicago, IL 60608-6904, USA.
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Miaskowski C. Symptom clusters: establishing the link between clinical practice and symptom management research. Support Care Cancer 2006; 14:792-4. [PMID: 16565822 DOI: 10.1007/s00520-006-0038-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2006] [Accepted: 02/07/2006] [Indexed: 11/12/2022]
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Abstract
The U.S. health care system is transforming. It must. Patient-centered care (PCC) is a core quality that the system should include. This article presents the highlights of a project on the future of PCC created for the Picker Institute. As an example of futures work, this project developed four images or stories of what might happen, as well as a vision and audacious goals for what should happen to PCC. The first and most likely scenario is an increase in patient-centeredness as a function of current trends. However, in the second scenario, health care could become even more stressed and leave PCC behind as it seeks to lower cost without focusing on quality. The third scenario envisions more excellent systems that integrate PCC seamlessly into their work. The fourth scenario sees collaboration and shared responsibility, in association with advanced information tools, thereby enabling PCC to contribute to preventing illness and lowering health care costs. The scenarios indicate that the patient-centeredness of health care could improve slightly, stall, or advance significantly. The PCC Vision calls for each of us to be in charge of our health, and to get the care we need (not less and not more) in timely, effective, and personal ways consistent with our values. The audacious goals set an agenda with priorities from the PCC community. These include shared decision making by consumers, ensuring health care professionals are trained in supporting active patients, anticipating health and long-term care needs for individuals, adopting the Institute of Medicine's (IOM) simple rules for health care, and making the patient perspective a priority in policy and planning. Each of us and our organizations are confronted with the challenge of this vision and audacious goals. Health care professionals and provider systems, whether conventional or alternative in nature, face these issues. While complementary and alternative medicine (CAM) providers often get higher marks from consumers for their attention, many CAM modalities are largely provider-determined. Patient-centered care will require more empowerment and activation of patients and consumers.
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Affiliation(s)
- Clement Bezold
- Institute for Alternative Futures, Alexandria, VA 22314, USA.
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