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Ogunyemi AO, Balogun MR, Ojo AE, Welch SB, Onasanya OO, Yesufu VO, Omotayo AT, Hirschhorn LR. Barriers and facilitators to the delivery of age-friendly health services in Primary Health Care centres in southwest, Nigeria: A qualitative study. PLoS One 2024; 19:e0288574. [PMID: 38502650 PMCID: PMC10950227 DOI: 10.1371/journal.pone.0288574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 02/07/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND With the rapid growth of Nigeria's older population, it has become important to establish age-friendly healthcare systems that support care for older people. This study aimed to explore the barriers and facilitators to the delivery of age-friendly health services from the perspectives of primary healthcare managers in Lagos State, Nigeria. METHOD We conducted 13 key informant interviews including medical officers of health, principal officers of the (Primary Health Care) PHC Board and board members at the state level. Using a grounded theory approach, qualitative data analysis was initially done by rapid thematic analysis followed by constant comparative analysis using Dedoose software to create a codebook. Three teams of two coders each blind-coded the interviews, resolved coding discrepancies, and reviewed excerpts by code to extract themes. RESULTS The main barriers to the delivery of age-friendly services included the lack of recognition of older adults as a priority population group; absence of PHC policies targeted to serve older adults specifically; limited training in care of older adults; lack of dedicated funding for care services for older adults and data disaggregated by age to drive decision-making. Key facilitators included an acknowledged mission of the PHCs to provide services for all ages; opportunities for the enhancement of older adult care; availability of a new building template that supports facility design which is more age-friendly; access to basic health care funds; and a positive attitude towards capacity building for existing workforce. CONCLUSION While we identified a number of challenges, these offer opportunities to strengthen and prioritize services for older adults in PHCs and build on existing facilitators. Work is needed to identify and test interventions to overcome these challenges and improve the responsiveness of the PHC system to older adults through the delivery of age-friendly health services in PHCs in Lagos, Nigeria.
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Affiliation(s)
- Adedoyin O. Ogunyemi
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Mobolanle R. Balogun
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Adedayo E. Ojo
- Department of Internal Medicine, University of Abuja Teaching Hospital, Abuja, Nigeria
- Department of Epidemiology and Global Health, University Medical Centre, Utrecht University, Utrecht, The Netherlands
| | - Sarah B. Welch
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- Robert J Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | | | - Victoria O. Yesufu
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | - Lisa R. Hirschhorn
- Robert J Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
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Tavares J, Santinha G, Rocha NP. Unlocking the WHO's Age-Friendly Healthcare Principles: Portugal's Quest and Recommendations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7039. [PMID: 37998270 PMCID: PMC10670962 DOI: 10.3390/ijerph20227039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/27/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023]
Abstract
Countries worldwide are grappling with a pressing demographic challenge characterized by a growing older population. This poses a significant healthcare dilemma, presenting challenges for healthcare systems and providers. To address these challenges, the World Health Organization (WHO) has devised a set of Age-Friendly Principles, aimed at optimizing healthcare provision for older people. This article delves into the current state of healthcare adaptation for older adults in Portugal and assesses the implementation of the WHO Principles. Case studies were conducted in three distinct regions of Portugal, involving semistructured interviews with key decision makers from both the healthcare sector and organizations wielding direct influence over health policies (n = 11). A comprehensive content analysis was conducted employing the webQDA software. The findings unveiled a noteworthy trend in which most interviewees displayed limited familiarity with the WHO Principles. Nevertheless, all interviewees acknowledged the need to adapt the healthcare system accordingly. Strengths were identified, primarily within the healthcare management system, but noteworthy gaps were also revealed, particularly in terms of facility preparedness and professional training. Interviewees proposed various interventions to enhance age-friendly healthcare provision; however, they concurrently pinpointed challenges related to human resources, infrastructure, and financial management. In their concluding recommendations, interviewees underscored the development of tools to facilitate the application and evaluation of the WHO Principles, as well as the development by the WHO of an accreditation system to encourage the application of the principles in healthcare providers across the world.
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Affiliation(s)
- Jéssica Tavares
- GOVCOPP, Department of Social, Political and Territorial Sciences, University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Gonçalo Santinha
- GOVCOPP, Department of Social, Political and Territorial Sciences, University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Nelson Pacheco Rocha
- IEETA, Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
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Ogunyemi AO, Balogun MR, Ojo AE, Welch SB, Onasanya OO, Yesufu VO, Omotayo AO, Hirschhorn LR. Provider and facility readiness for age-friendly health services for older adults in primary health care centres in southwest, Nigeria. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001411. [PMID: 37552675 PMCID: PMC10409274 DOI: 10.1371/journal.pgph.0001411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 07/12/2023] [Indexed: 08/10/2023]
Abstract
There is a growing focus on interventions at the health system level to promote healthy aging and provide age-friendly health services (AFHS) in low- and middle-income countries where populations are aging. This study aimed to determine the provider and facility readiness for AFHS. We developed and implemented surveys to collect PHC facility capacity and readiness to deliver AFHS and a KAP survey for facility healthcare workers based on guidelines from the WHO age-friendly tool kit and questionnaires from other studies. Direct observation and structured interviews of facility heads were conducted in a stratified random sample of 15 out of the 57 comprehensive PHC facilities in Lagos, Nigeria. One hundred and twenty providers were conveniently sampled for the KAP survey. Statistical analysis was conducted using STATA version 15 (StataCorp, College Station, Texas, USA). For facility readiness, only 13.3% of PHCs sometimes offered hearing assessment and none of the PHCs offered colorectal cancer assessment. Few (20.0%) facilities offered home services and only 1 (0.7%) had dedicated funding for care of older people. Ramps were at the entrance in 60.0% of facilities and almost half (43.3%) of the PHCs had wheelchair accessible entrances to the public toilets. The majority of HCWs (81.7%) had heard about healthy aging but only 5.0% about AFHS, only 10.8% reported formal training. Around a third knew about specific conditions which affect people as they age, including; depression (37.5%), urinary incontinence (35.0%), and falls/immobility (33.3%). Over half of the providers (54.2%) screened for malnutrition in older patients, 25.8% screened for suspected elder abuse and much less (19.2%) for delirium. This study found some areas of strength but also gaps in facility readiness as well as knowledge and training needed to support AFHS care. We recommend identifying interventions to improve the availability and delivery of care for older adults.
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Affiliation(s)
- Adedoyin O. Ogunyemi
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Mobolanle R. Balogun
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Adedayo E. Ojo
- Department of Internal Medicine, University of Abuja Teaching Hospital, Abuja, Nigeria
- Department of Epidemiology and Global Health, University Medical Centre, Utrecht University, Utrecht, The Netherlands
| | - Sarah B. Welch
- Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- Robert J Havey Institute of Global Health, Feinberg School of Medicine, Northwestern University, Chicago IL, United States of America
| | | | - Victoria O. Yesufu
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | - Lisa R. Hirschhorn
- Robert J Havey Institute of Global Health, Feinberg School of Medicine, Northwestern University, Chicago IL, United States of America
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago IL, United States of America
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Liebzeit D, Krupp A, Bunch J, Tonelli S, Griffin E, McVeigh S, Chi N, Jaboob S, Nakad L, Arbaje AI, Buck H. Rural age-friendly ecosystems for older adults: An international scoping review with recommendations to support age-friendly communities. Health Sci Rep 2023; 6:e1241. [PMID: 37152222 PMCID: PMC10162383 DOI: 10.1002/hsr2.1241] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 03/22/2023] [Accepted: 04/10/2023] [Indexed: 05/09/2023] Open
Abstract
Background and Aims The population of older adults in rural areas is rising, and they experience higher rates of poverty and chronic illness, have poorer health behaviors, and experience different challenges than those in urban areas. This scoping review seeks to (1) map the state of the science of age-friendly systems in rural areas regarding structural characteristics, processes for delivering age-friendly practices, and outcomes of age-friendly systems, (2) analyze strengths, weakness, opportunities, and threats of age-friendly system implementation, and (3) make person, practice, and policy-level recommendations to support active aging and development of age-friendly communities. Methods An international scoping review was conducted of articles that used age-friendly framing, had a sample age of 45 years of age or older, self-identified as rural, and reported empiric data. Searches were conducted in PubMed, CINAHL, AgeLine, PsychINFO, EMBASE, Scopus, and Academic Search Elite on October 26, 2021, and rerun March 10, 2023. Data were charted across three analytic layers: socioecological model, Donabedian's framework, and SWOT analysis. Results Results reveal limited data on outcomes relevant to organizations, such as return on investment or healthcare utilization. While the SWOT analysis revealed many strengths of age-friendly systems, including their impact on persons' outcomes, it also revealed several weaknesses, threats, and gaps. Namely, age-friendly systems have weaknesses due to reliance on trained volunteers and staff, communication, and teamwork. System-level threats include community and health system barriers, and challenges in poor/developing areas. Conclusions While age-friendly systems in this review were heterogeneous, there is an opportunity to focus on unifying elements including the World Health Organization age-friendly cities framework or 4Ms framework for age-friendly care. Despite the many benefits of age-friendly systems, we must acknowledge limitations of the evidence base, pursue opportunities to examine organizational metrics to support implementation and sustainability of age-friendly systems, and leverage improvements in age-friendliness at a community level.
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Affiliation(s)
| | - Anna Krupp
- The University of Iowa College of NursingIowa CityIowaUSA
| | - Jacinda Bunch
- The University of Iowa College of NursingIowa CityIowaUSA
| | | | - Emily Griffin
- The University of Iowa College of NursingIowa CityIowaUSA
| | - Sarah McVeigh
- The University of Iowa College of NursingIowa CityIowaUSA
| | - Nai‐Ching Chi
- The University of Iowa College of NursingIowa CityIowaUSA
| | - Saida Jaboob
- The University of Iowa College of NursingIowa CityIowaUSA
| | - Lynn Nakad
- The University of Iowa College of NursingIowa CityIowaUSA
| | - Alicia I. Arbaje
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Center for Transformative Geriatric ResearchJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Health Policy and ManagementJohns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUSA
- Armstrong Institute Center for Health Care Human FactorsJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Harleah Buck
- The University of Iowa College of NursingIowa CityIowaUSA
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Valenzano TJ, Smaoui S, Peladeau-Pigeon M, Barbon CEA, Craven BC, Steele CM. Using Reference Values to Identify Profiles of Swallowing Impairment in a Case Series of Individuals With Traumatic Spinal Cord Injury. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:688-700. [PMID: 36812476 PMCID: PMC10171848 DOI: 10.1044/2022_ajslp-22-00298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/28/2022] [Accepted: 12/09/2022] [Indexed: 05/12/2023]
Abstract
PURPOSE In this article, we illustrate use of a systematic approach to rating videofluoroscopic swallowing studies (VFSS), the Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT) method. The method is applied to a clinical case series of individuals with a history of traumatic spinal cord injury (tSCI) requiring surgical intervention using a posterior approach. Previous studies suggest that swallowing is highly variable in this population given heterogeneity in mechanisms, location and extent of injury, and in surgical management approaches. METHOD The case series involved 6 individuals who were at least 1 month postsurgery for management of tSCI. Participants completed a VFSS using a standardized bolus protocol. Each VFSS was blindly rated in duplicate using the ASPEKT method and compared with published reference values. RESULTS The analysis revealed considerable heterogeneity across this clinical sample. Penetration-aspiration scale scores of 3 or higher were not observed in this cohort. Of note, patterns of impairment did emerge, suggesting there are some commonalities across profiles in this population, including the presence of residue associated with poor pharyngeal constriction, reduced upper esophageal opening diameter, and short upper esophageal sphincter opening duration. CONCLUSIONS Although the participants in this clinical sample shared a history of tSCI requiring surgical intervention using a posterior approach, there was great heterogeneity in swallowing profile. Using a systematic method to identify atypical swallowing parameters can guide clinical decision making for determining rehabilitative targets and measuring swallowing outcomes.
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Affiliation(s)
- Teresa J. Valenzano
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Sana Smaoui
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada
| | - Melanie Peladeau-Pigeon
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
| | - Carly E. A. Barbon
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - B. Cathy Craven
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
- Division of Physiatry, Department of Medicine, University of Toronto, Ontario, Canada
| | - Catriona M. Steele
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Ontario, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Canada
- Canada Research Chair (Tier 1) in Swallowing and Food Oral Processing
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Dolan S, Nowell L, Moules NJ. Interpretive description in applied mixed methods research: Exploring issues of fit, purpose, process, context, and design. Nurs Inq 2022:e12542. [DOI: 10.1111/nin.12542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Sara Dolan
- Faculty of Nursing University of Calgary Calgary Alberta Canada
| | - Lorelli Nowell
- Faculty of Nursing University of Calgary Calgary Alberta Canada
| | - Nancy J. Moules
- Faculty of Nursing University of Calgary Calgary Alberta Canada
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Aghamohammadi N, Ramakreshnan L, Fong CS, Noor RM, Hanif NR, Sulaiman NM. Perceived impacts of Urban Heat Island phenomenon in a tropical metropolitan city: Perspectives from stakeholder dialogue sessions. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 806:150331. [PMID: 34571225 DOI: 10.1016/j.scitotenv.2021.150331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 09/05/2021] [Accepted: 09/10/2021] [Indexed: 06/13/2023]
Abstract
The stakeholders' perceptions on the impacts of Urban Heat Island (UHI) are critical for reducing exposure and influencing their response to interventions that are aimed at encouraging a behaviour change. A proper understanding of the UHI impacts on the society, economy and environment is deemed an essential motivating factor for the stakeholders to work towards UHI mitigations in the local context. This study adopted an inductive qualitative approach using Stakeholder Dialogue Sessions (SDSs) to assess the perceived impacts of UHI among various stakeholders, comprising policy makers, academicians, developers and Non-Governmental Organizations (NGO), in a tropical metropolitan city. The results revealed five themes such as deterioration of public health, acceleration of urban migration patterns and spending time in cooler areas, reduction of workers' productivity, increased energy consumption by the households and deterioration of environmental quality and natural resources that were categorized into social, economic and environmental impacts. Although most of the stakeholders were quite unfamiliar with the term UHI, they still display a good understanding of the potential impacts of UHI due to their posteriori knowledge and ability to rationalize the physical condition of the environment in which they live. The findings provide useful insights and valuable information to the local authorities to tailor necessary actions and educational campaigns to increase UHI awareness among the stakeholders. Being among the earlier studies to use a qualitative approach to attain the aforementioned objective, the findings are crucial to determine the level of understanding of the stakeholders on the impact of UHI. Through this study, the authors have highlighted the gaps and needs for knowledge improvements aimed at behaviour change among the stakeholders.
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Affiliation(s)
- Nasrin Aghamohammadi
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; Centre for Energy Sciences, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Logaraj Ramakreshnan
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; Institute for Advanced Studies, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Chng Saun Fong
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia; Institute for Advanced Studies, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Rafidah Md Noor
- Department of Computer System and Technology, Faculty of Computer Science & Information Technology, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Noor Rosly Hanif
- Department of Estate Management, Faculty of Built Environment, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nik Meriam Sulaiman
- Department of Chemical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
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A Rapid Realist Review of Quality Care Process Metrics Implementation in Nursing and Midwifery Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211932. [PMID: 34831694 PMCID: PMC8621300 DOI: 10.3390/ijerph182211932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 12/02/2022]
Abstract
Quality measurement initiatives promote quality improvement in healthcare but can be challenging to implement effectively. This paper presents a Rapid Realist Review (RRR) of published literature on Quality Care-Process Metrics (QCP-M) implementation in nursing and midwifery practice. An RRR informed by RAMESES II standards was conducted as an efficient means to synthesize evidence using an expert panel. The review involved research question development, quality appraisal, data extraction, and evidence synthesis. Six program theories summarised below identify the key characteristics that promote positive outcomes in QCP-M implementation. Program Theory 1: Focuses on the evidence base and accessibility of the QCP-M and their ease of use by nurses and midwives working in busy and complex care environments. Program Theory 2: Examines the influence of external factors on QCP-M implementation. Program Theory 3: Relates to existing cultures and systems within clinical sites. Program Theory 4: Relates to nurses’ and midwives’ knowledge and beliefs. Program Theory 5: Builds on the staff theme of Programme Theory four, extending the culture of organizational learning, and highlights the meaningful engagement of nurses and midwives in the implementation process as a key characteristic of success. Program Theory 6: Relates to patient needs. The results provide nursing and midwifery policymakers and professionals with evidence-based program theory that can be translated into action-orientated strategies to help guide successful QCP-M implementation.
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Rezaei-Shahsavarloo Z, Atashzadeh-Shoorideh F, Ebadi A, Gobbens RJJ. Factors affecting missed nursing care in hospitalized frail older adults in the medical wards: a qualitative study. BMC Geriatr 2021; 21:555. [PMID: 34649518 PMCID: PMC8515677 DOI: 10.1186/s12877-021-02524-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Frail older adults who are hospitalized, are more likely to experience missed nursing care (MNC) due to high care needs, communication problems, and complexity of nursing care. We conducted a qualitative study to examine the factors affecting MNC among hospitalized frail older adults in the medical units. METHODS This qualitative study was carried using the conventional content analysis approach in three teaching hospitals. Semi-structured interviews were conducted with 17 nurses through purposive and snowball sampling. The inclusion criteria for the nurses were: at least two years of clinical work experience on a medical ward, caring for frail older people in hospital and willingness to participate. Data were analyzed in accordance with the process described by Graneheim and Lundman. In addition, trustworthiness of the study was assessed using the criteria proposed by Lincoln and Guba. RESULTS In general, 20 interviews were conducted with nurses. A total of 1320 primary codes were extracted, which were classified into two main categories: MNC aggravating and moderating factors. Factors such as "age-unfriendly structure," "inefficient care," and "frailty of older adults" could increase the risk of MNC. In addition, factors such as "support capabilities" and "ethical and legal requirements" will moderate MNC. CONCLUSIONS Hospitalized frail older adults are more at risk of MNC due to high care needs, communication problems, and nursing care complexity. Nursing managers can take practical steps to improve the quality of care by addressing the aggravating and moderating factors of MNC. In addition, nurses with a humanistic perspective who understand the multidimensional problems of frail older adults and pay attention to their weakness in expressing needs, can create a better experience for them in the hospital and improve patient safety.
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Affiliation(s)
- Zahra Rezaei-Shahsavarloo
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Foroozan Atashzadeh-Shoorideh
- Department of Psychiatric Nursing & Management, School of Nursing and Midwifery, Shahid Labbafinezhad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, IR, Iran
- Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, IR, Iran
| | - Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands
- Zonnehuisgroep Amstelland, Amstelveen, The Netherlands
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Conchon MF, Fonseca LF, Galvão CM. Use of Mentholated Popsicle in the Management of the Elderly Patient's Thirst in the Immediate Postoperative Period: A Randomized Controlled Trial. J Perianesth Nurs 2021; 36:262-267. [PMID: 33640289 DOI: 10.1016/j.jopan.2020.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/02/2020] [Accepted: 09/13/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE This study aimed to compare a mentholated popsicle with usual care (absolute fasting) in the change in thirst intensity and discomfort in elderly patients in the immediate postoperative period (IPP). DESIGN A randomized controlled trial. METHODS The sample consisted of 50 elderly patients (60 years or older) in the IPP who were randomly assigned to two groups: experimental group (20 mL mentholated popsicle) and control group (usual care). The outcomes, thirst intensity and discomfort, were assessed at baseline and 20 minutes after the intervention. FINDINGS The mentholated popsicle presented a statistically significant (P < .001) decrease in thirst intensity and discomfort by 5.0 in the median and a Cohen's r large effect size for both outcomes. There were no adverse events or side effects. CONCLUSIONS The use of a mentholated popsicle decreased the intensity and discomfort of the elderly patient's thirst in the IPP.
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Affiliation(s)
| | | | - Cristina M Galvão
- Ribeirão Preto College of Nursing, University of São Paulo, São Paulo, Brazil
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11
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Tavares J, Santinha G, Rocha NP. Age-Friendly Health Care: A Systematic Review. Healthcare (Basel) 2021; 9:healthcare9010083. [PMID: 33561084 PMCID: PMC7830866 DOI: 10.3390/healthcare9010083] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/08/2021] [Accepted: 01/12/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Health care provided to older adults must take into account the characteristics of chronic diseases and the comorbidities resulting from ageing. However, health services are still too oriented towards acute situations. To overcome this problem, the World Health Organization (WHO) proposed a set of Age-Friendly Principles that seek to optimize the provision of health care for this population. This article aims to understand how such Principles are considered in the implementation of age-friendly health care worldwide. Methods: A systematic review was conducted to synthesize the literature on age-friendly health care in accordance with the PRISMA recommendations in the PubMed, Web of Science, and Scopus databases. Results: The research identified 34 articles, with only seven recognizing the WHO Principles and only four using the implementation toolkit. In addition, in the context of primary care, three studies recognize the WHO Principles, but only two use the toolkit. Conclusions: The WHO Principles are being implemented in health care, but in a smaller scale than desired, which reveals possible flaws in their dissemination and standardization. Thus, a greater scientific investment in age-friendly health care should be considered, which represents a greater operationalization of the Principles and an evaluation of their effectiveness and impacts.
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Affiliation(s)
- Jéssica Tavares
- GOVCOPP, Department of Social, Political and Territorial Sciences, University of Aveiro, 3810-193 Aveiro, Portugal;
- Correspondence:
| | - Gonçalo Santinha
- GOVCOPP, Department of Social, Political and Territorial Sciences, University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Nelson P. Rocha
- IEETA, Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal;
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Kannisto K, Hirvonen E, Koivuniemi M, Teeri S, Asikainen P, Koivunen M. Daily functioning support - a qualitative exploration of rehabilitative approach in acute hospitalised care. Scand J Caring Sci 2021; 35:1342-1351. [PMID: 33394504 DOI: 10.1111/scs.12954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 12/13/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Hospitalised patients are at risk of temporary or permanent loss of functioning which impacts their future independence. Implementation of a rehabilitative approach in everyday nursing in the acute care setting may produce good therapeutic results and promote independent daily living of patients. Thus, the aim of the study was to explore and understand the patterns of a rehabilitative approach in acute hospital wards from the perspective of interdisciplinary team members. Specifically, our aim was to identify the factors promoting and preventing a rehabilitative approach. METHOD We conducted four focus group interviews with 21 participants, including multidisciplinary team members from acute hospital wards. Data were analysed with conventional inductive content analysis. RESULTS The findings highlighted that the rehabilitative approach, as a personal way of working and personal working attitude, was a part of comprehensive nursing. The main goals of the rehabilitative approach were to support the physical functioning of the patients and their independent initiative and individuality during clinical care in hospital ward. The promoting and preventing factors that influenced the development of the rehabilitative approach consisted of personal factors, organisational factors and the physical settings of the hospital wards. CONCLUSION The findings of this study indicate that the rehabilitative approach in nursing focused on supporting the physical functioning, independence and self-confidence of the patient. The staff highlighted that interdisciplinary teamwork was one feature of the rehabilitative approach. The rehabilitative approach in nursing should be established as a part of everyday activity in clinical practice.
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Affiliation(s)
- Kati Kannisto
- Satakunta Hospital District, Pori, Finland.,SataDiag, Hospital District of Satakunta Public Utility of Diagnostic and Related Services, Pori, Finland
| | | | - Minna Koivuniemi
- Satakunta Hospital District, Pori, Finland.,Turku School of Economics, Pori, Finland
| | - Sari Teeri
- Satakunta University of Applied Sciences, Pori, Finland
| | - Paula Asikainen
- Satakunta Hospital District, Pori, Finland.,Nursing Science, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Marita Koivunen
- Satakunta Hospital District, Pori, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
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Abraham J, Meng A, Siraco S, Kannampallil T, Politi MC, Baumann AA, Lenze EJ, Avidan MS. A Qualitative Study of Perioperative Depression and Anxiety in Older Adults. Am J Geriatr Psychiatry 2020; 28:1107-1118. [PMID: 32234274 DOI: 10.1016/j.jagp.2020.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We had three aims 1) understand barriers to perioperative management of anxiety and depression in older surgical patients; 2) identify preferences and requirements for interventions to manage their anxiety and depression; and 3) explore the feasibility of implementing such interventions in perioperative care. DESIGN A qualitative study using semistructured interviews was conducted. SETTING Participants were recruited at a large academic medical center. PARTICIPANTS We interviewed older surgical patients and clinicians to characterize their perspectives on management of anxiety and depression symptoms, with emphasis on patient needs, barriers, and potential interventions to address these needs. MEASUREMENTS We used the Consolidated Framework for Intervention Research to guide the development of interview questions related to intervention implementation feasibility. Thematic analysis was used to analyze interview responses. RESULTS Forty semistructured interviews were conducted. Key barriers for perioperative management of depression and anxiety included fear of surgery, acute pain, postoperative neurocognitive disorders, limited understanding of what to expect regarding surgery and recovery, and overwhelmingly complex medication management. Patients and clinicians suggested that a bundled mental health management intervention targeted for older surgical patient population comprised of behavioral and pharmacologic strategies can help mitigate anxiety and depression symptoms during the perioperative period. Clinicians emphasized the need for a collaborative engagement strategy that includes multiple stakeholders in the design, planning, and implementation of such an intevention. CONCLUSION New care models need to be developed to integrate mental health care into the current perioperative care practice.
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Affiliation(s)
- Joanna Abraham
- Department Anesthesiology of (JA, AM, TK, MSA), School of Medicine, Washington University, St. Louis, MO; Institute for Informatics, School of Medicine, Washington University (JA, TK), St. Louis, MO.
| | - Alicia Meng
- Department Anesthesiology of (JA, AM, TK, MSA), School of Medicine, Washington University, St. Louis, MO
| | - Susan Siraco
- School of Medicine, St. Louis University (SS), St. Louis, MO
| | - Thomas Kannampallil
- Department Anesthesiology of (JA, AM, TK, MSA), School of Medicine, Washington University, St. Louis, MO; Institute for Informatics, School of Medicine, Washington University (JA, TK), St. Louis, MO
| | - Mary C Politi
- Division of Public Health Sciences, Department of Surgery (MCP), School of Medicine, Washington University, St. Louis, MO
| | - Ana A Baumann
- George Warren Brown School of Social Work, Washington University (AAB), St. Louis, MO
| | - Eric J Lenze
- Department of Psychiatry (EJL), School of Medicine, Washington University, St. Louis, MO
| | - Michael S Avidan
- Department Anesthesiology of (JA, AM, TK, MSA), School of Medicine, Washington University, St. Louis, MO
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Abstract
Keeping patients safe while they receive medical care is essential. Yet current systems designed to ensure patient safety are not enough, because medical error is the third leading cause of preventable deaths in the United States. Clinicians can partner with the patient to enhance patient safety. Pulse Center for Patient Safety proposes patient- and family-driven processes designed to improve a patient's chances of avoiding harm. This article discusses highlights of the role of patient safety through a grassroots lens, summarizes the factors that influence the patient's role in patient safety and reviews recommendations on how clinicians can partner with patients.
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Affiliation(s)
- Ilene Corina
- Pulse Center for Patient Safety Education & Advocacy, P.O. Box 353, Wantagh, NY 11793-0353, USA.
| | - Marissa Abram
- Pulse Center for Patient Safety Education & Advocacy, Wantagh, NY, USA
| | - David Halperin
- Pulse Center for Patient Safety Education & Advocacy, Wantagh, NY, USA
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Storkholm MH, Savage C, Tessma MK, Salvig JD, Mazzocato P. Ready for the Triple Aim? Perspectives on organizational readiness for implementing change from a Danish obstetrics and gynecology department. BMC Health Serv Res 2019; 19:517. [PMID: 31340843 PMCID: PMC6657111 DOI: 10.1186/s12913-019-4319-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/02/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND As health care strives towards the Triple Aim of improved population health, patient experience, and reduced costs, an organization's readiness for change may be a key factor. The concept refers to the collective commitment of organizational members to a change and belief in their shared ability to make that change happen (efficacy). This study aims to assess the organizational readiness for implementing large-scale change at a clinical department in pursuit of the Triple Aim and to determine key associated factors. METHODS A cross-sectional study at a Danish Obstetrics and Gynecology department faced with external pressure to become more efficient without compromising patient outcomes and experience. The Organisational Readiness for Implementing Change (ORIC) questionnaire was distributed to all employees (n = 403). Descriptive statistics was used to assess overall organizational readiness and single items. The between-group differences in subject characteristics were assessed with independent t-test and non-parametric test. Multiple linear regression was employed to control for potential confounders. RESULTS Response rate was 72%. The level of agreement with the commitment statements was high, and low with the efficacy statements. We did not observe statistically significant differences in the overall score between organizational sections or in relation to gender, age, or profession. Managerial status (B = 3.2, 95% CI = .52, 5.9, P = .02) or interim employment(B = 2.7, 95% CI = .47, 4.9, P = .02) were significant predictors of a high change efficacy score after controlling for potential confounders. CONCLUSIONS Changes related to pursuit of the Triple Aim were seen as something that "has to" be done, but left managers, and even more so staff, wondering what "to do" and "how to" do it. Change strategies should therefore address these uncertainties by translating political "have to's" proposals that resonate with staff, spark engagement, and clarify "how to" deal with the complexity of large-scale change.
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Affiliation(s)
- Marie Höjriis Storkholm
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18A, 171 77 Stockholm, Sweden
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Carl Savage
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18A, 171 77 Stockholm, Sweden
| | - Mesfin Kassaye Tessma
- Medical Statistics Unit, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Jannie Dalby Salvig
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Pamela Mazzocato
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18A, 171 77 Stockholm, Sweden
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16
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Hower KI, Pfaff H, Kowalski C, Wensing M, Ansmann L. Measuring change attitudes in health care organizations. J Health Organ Manag 2019; 33:266-285. [PMID: 31122117 DOI: 10.1108/jhom-06-2018-0177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Measuring attitudes of healthcare providers and managers toward change in health care organizations (HCOs) has been of widespread interest. The purpose of this paper is to evaluate the psychometric characteristics and usability of an abbreviated German version of the Change Attitude Scale. DESIGN/METHODOLOGY/APPROACH The Change Attitude Scale was used in a survey of healthcare providers and managers in German hospitals after the implementation of a breast cancer center concept. Reliability analysis, confirmatory factor analysis, structural equation modeling and bivariate analysis were conducted. FINDINGS Data from 191 key persons in 82 hospitals were analyzed. The item-scale structure produced an acceptable model fit. Convergent validity was shown by significant correlations with measures of individuals' general opinions of the breast center concept. A non-significant correlation with a scale measuring the hospital's hierarchical structure of leadership verified discriminant validity. The interaction of key persons' change attitude and hospitals' change performance through change culture as a mediator supported the predictive validity. RESEARCH LIMITATIONS/IMPLICATIONS The study found general support for the validity and usability of a short version of the German Change Attitude Scale. PRACTICAL IMPLICATIONS Since attitudes toward change influence successful implementation, the survey may be used to tailor the design of implementation programs and to create a sustainable culture of high readiness for change. ORIGINALITY/VALUE This is the first study finding that a short instrument can be used to measure attitudes toward change among healthcare providers and managers in HCOs.
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Affiliation(s)
- Kira Isabel Hower
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne , Cologne, Germany
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne , Cologne, Germany
| | - Christoph Kowalski
- Certification Program Cancer Centers, German Cancer Society (DKG), Berlin, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University , Heidelberg, Germany
| | - Lena Ansmann
- Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky Oldenburg University , Oldenburg, Germany
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17
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Smith TL, Kim B, Benzer JK, Yusuf Z, Fletcher TL, Walder AM. FLOW: Early results from a clinical demonstration project to improve the transition of patients with mental health disorders back to primary care. Psychol Serv 2019; 18:23-32. [PMID: 30869978 DOI: 10.1037/ser0000336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Access to mental health (MH) care is of paramount concern to U.S. health care delivery systems, including the Veterans Health Administration. To improve access, there is a need to better focus existing MH resources toward care for those most in need of specialty-level MH treatment. This article provides early results of Project FLOW's (not an acronym) approach to developing and evaluating electronic medical record (EMR)-based criteria to identify clinically stable patients and promote their effective transition from specialty MH back to primary care (PC). Implementation utilized a blended facilitation approach consistent with Integrated Promoting Action on Research Implementation in Health Services (iPARIHS). The Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework guided measurement of implementation outcomes. During FLOW, 424 unique MH patients transitioned from MH to PC; of those, only 9 (2.1%) returned to MH after that transition. Most of those patients (n = 335; 79.0%) were first identified on the MH FLOW report, but 89 (21.0%) were other MH patients. The total number of patients discharged due to recovery or stabilization was 411. The 335 patients represent 21.3% of all unique patients (n = 1,566) who met the EMR criteria during the project. The 411 recovered/stabilized patients are 16.4% of all unique MH patients (n = 2,504) treated at the site. These early results suggest that this EMR-based system, combined with sound clinical practices, can be used to identify MH patients who are candidates for transition and foster their effective transition to care management in PC. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Bo Kim
- Veterans Affairs Health Services Research and Development Service Center for Healthcare Organization and Implementation Research
| | - Justin K Benzer
- Veterans Integrated Service Network 17 Center of Excellence for Research on Returning War Veterans
| | - Zenab Yusuf
- South Central Mental Illness Research Education and Clinical Care, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine
| | - Terri L Fletcher
- South Central Mental Illness Research Education and Clinical Care, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine
| | - Annette M Walder
- South Central Mental Illness Research Education and Clinical Care, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine
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18
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Abstract
Elderly patients are at increased risk for morbidity and mortality after injury or surgery in both the inpatient and postdischarge settings. The importance of discharge destination after the index hospitalization is increasingly recognized as a determinant of long-term survival, with discharge to a post-acute care facility portending a worse prognosis. Efforts to minimize discharge to post-acute care facilities should include early discharge planning. Communication among a multidisciplinary care team sets the groundwork for effective discharge planning and transitions of care. The elderly face several systematic, psychosocial, functional, and financial barriers that pose significant challenges to successful transitions of care.
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Affiliation(s)
- Shailvi Gupta
- Shock Trauma Center, University of Maryland School of Medicine, T1R51, 22 South Greene Street, Baltimore, MD 21201, USA
| | - Justin A Perry
- Department of Care Management, University of Maryland Medical Center, 22 South Greene Street, N1E10A, Baltimore, MD 21201, USA
| | - Rosemary Kozar
- Shock Trauma Center, University of Maryland School of Medicine, T1R40, 22 South Green Street, Baltimore, MD 21201, USA.
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