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Morau E, Lejeune-Saada V, Chiesa-Dubruille C, Deneux-Tharaux C. [Maternal mortality and health care organization in France 2016-2018]. Gynecol Obstet Fertil Senol 2024; 52:280-287. [PMID: 38373490 DOI: 10.1016/j.gofs.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/13/2024] [Indexed: 02/21/2024]
Abstract
Organization of care is one of the elements examined when assessing cases. Organization of care is a factor, which is considered in addition to the content of care when assessing mortality cases. The factors related to the organization of care concern the suitability of the place of care, the completion of a necessary transfer, the adequacy of human and material resources, and the communication between caregivers. For the 2016-2018 triennium these preventability factors are the subject of a dedicated chapter. Overall, one or more preventability factors linked to the organization of care were reported in 51 cases, i.e. 24% of all assessed cases. The field of communication was the most frequently reported (32/51), followed by inappropriate place of care (20/51), insufficient human resources (13/51), transfers not performed or performed late (11/51) and insufficient material resources (9/51). An overall analysis can be made along two dimensions: organization within the maternity unit, and coordination with other sectors or outpatient medicine. Areas for improvement within the maternity unit relate to the ability to deal with life-threatening emergencies, to organize the call for specialized and/or trained human reinforcements, to organize intensive monitoring of patients in the event of organ failure, and to facilitate good communication between caregivers. Regarding coordination with other units, it is proposed to improve collaboration between the maternity unit's emergency department and the general emergency department, and to improve the transfer of information required by all those involved, including primary care physicians, in the pre-, per- and postpartum period. Finally, the place of care for patients presenting with a psychiatric and somatic pathology is a situation that requires careful consultation.
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Affiliation(s)
- Estelle Morau
- Service d'anesthésie-réanimation, CHU de Nîmes, Nîmes, France.
| | | | - Coralie Chiesa-Dubruille
- Département de Maïeutique UFR Simone-Veil - Santé, université de Versailles Saint-Quentin-en-Yvelines - Paris Saclay, Montigny-le-Bretonneux, France; Service de gynécologie-obstétrique, centre hospitalier de Rambouillet, Rambouillet, France
| | - Catherine Deneux-Tharaux
- Équipe épidémiologie obstétricale périnatale et pédiatrique (EPOPé), CRESS U1153, Inserm, université Paris Cité, Paris, France
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Garcia SF, O'Connor M, Kinahan K, Duffy M, Klein M, McCrum A, Didwania A, Kircher SM. Advancing survivorship at a comprehensive cancer center: integrating clinical care, education and research initiatives at Northwestern Medicine and the Robert H. Lurie Comprehensive Cancer Center. J Cancer Surviv 2024; 18:17-22. [PMID: 38294597 DOI: 10.1007/s11764-023-01518-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024]
Abstract
The unprecedented and growing number of cancer survivors requires comprehensive quality care that includes cancer surveillance, symptom management, and health promotion to reduce morbidity and mortality and improve quality of life. However, coordinated and sustainable survivorship care has been challenged by barriers at multiple levels. We outline the survivorship programs at Northwestern Medicine and the Robert H. Lurie Comprehensive Cancer Center that have evolved over two decades. Our current survivorship clinics comprise STAR (Survivors Taking Action and Responsibility) for adult survivors of childhood cancers; Adult Specialty Survivorship for survivors of breast, colorectal and testicular cancers, lymphomas, and leukemias; and Gynecologic Oncology Survivorship. Care provision models align with general, disease/treatment-specific, and integrated survivorship models, respectively. Reimbursement for survivorship services has been bolstered by institutional budget allocations. We have standardized survivor education, counseling, and referrals through electronic health record (EHR)-integrated survivorship care plan (SCP) templates that incorporate partial auto-population. We developed EHR-integrated data collection tools (e.g., dashboards; SmartForm, and registry) to facilitate data analytics, personalized patient referrals, and reports to the Commission on Cancer (CoC). We report to the CoC on SCP delivery, dietitian encounters, and DEXA scans. For the last decade, our Cancer Survivorship Institute has aligned the efforts of clinicians, researchers, and educators. The institute promotes evidence-based care, high-impact research, and state-of-the-science educational programs for professionals, survivors, and the community. Future plans include expansion of clinical services and funding for applied research centered on the unique needs of post-treatment cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: The survivorship programs at Northwestern Medicine and the Robert H. Lurie Comprehensive Cancer Center underscore the imperative for comprehensive, coordinated, and sustainable survivorship care to address the needs of increasing numbers of cancer survivors, with a focus on evidence-based clinical practices, associated research, and educational initiatives.
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Affiliation(s)
- Sofia F Garcia
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Cancer Survivorship Institute, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 625 N. Michigan Ave., Suite 2100, Chicago, IL, 60611, USA.
- Northwestern Medicine, Chicago, IL, USA.
| | - Mary O'Connor
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | | | - Aarati Didwania
- Cancer Survivorship Institute, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 625 N. Michigan Ave., Suite 2100, Chicago, IL, 60611, USA
- Northwestern Medicine, Chicago, IL, USA
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sheetal M Kircher
- Cancer Survivorship Institute, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 625 N. Michigan Ave., Suite 2100, Chicago, IL, 60611, USA
- Northwestern Medicine, Chicago, IL, USA
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Denninger NE, Brefka S, Skudlik S, Leinert C, Mross T, Meyer G, Sulmann D, Dallmeier D, Denkinger M, Müller M. Development of a complex intervention to prevent delirium in older hospitalized patients by optimizing discharge and transfer processes and involving caregivers: A multi-method study. Int J Nurs Stud 2024; 150:104645. [PMID: 38091654 DOI: 10.1016/j.ijnurstu.2023.104645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 10/09/2023] [Accepted: 11/09/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Delirium is a common yet challenging condition in older hospitalized patients, associated with various adverse outcomes. Environmental factors, such as room changes, may contribute to the development or severity of delirium. Most previous research has focused on preventing and reducing this condition by addressing risk factors and facilitating reorientation during hospital stay. OBJECTIVE We aimed to systematically develop a complex intervention to prevent delirium in older hospitalized patients by optimizing discharge and transfer processes and involving caregivers during and after these procedures. The intervention combines stakeholder and expert opinions, evidence, and theory. This article provides guidance and inspiration to research groups in developing complex interventions according to the recommendations in the Medical Research Council framework for complex interventions. DESIGN AND METHODS A stepwise multi-method study was conducted. The preparation phase included analysis of the context and current practice via focus groups. Based on these results, an expert workshop was organized, followed by a Delphi survey. Finally, the intervention was modeled and a program theory was developed, including a logic model. RESULTS A complex intervention was developed in an iterative process, involving healthcare professionals, delirium experts, researchers, as well as caregiver and patient representatives. The key intervention component is an 8-point-program, which provides caregivers with recommendations for preventing delirium during the transition phase and in the post-discharge period. Information materials (flyers, handbook, videos, posters, defined "Dos and Don'ts", discharge checklist), training for healthcare professionals, and status analyses are used as implementation strategies. In addition, roles were established for gatekeepers to act as leaders, and champions to serve as knowledge multipliers and trainers for the multi-professional team in the hospitals. CONCLUSIONS This study serves as an example of how to develop a complex intervention. In an additional step, the intervention and implementation strategies will be investigated for feasibility and acceptability in a pilot study with an accompanying process evaluation. TWEETABLE ABSTRACT Delirium prevention can benefit from optimizing discharge and transfer processes and involving caregivers of older patients in these procedures. STUDY REGISTRATION DRKS00017828, German Register of Clinical Studies, date of registration 17.09.2019.
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Affiliation(s)
- Natascha-Elisabeth Denninger
- Rosenheim Technical University of Applied Sciences, Centre for Research, Development and Technology Transfer, Rosenheim, Germany; Martin Luther University Halle-Wittenberg, International Graduate Academy, Institute for Health and Nursing Science, Medical Faculty, Halle (Saale), Germany; Heidelberg University, Medical Faculty Heidelberg, Department of Primary Care and Health Services Research, Nursing Science and Interprofessional Care, Heidelberg, Germany; University Hospital Heidelberg, Department of Primary Care and Health Services Research, Nursing Science and Interprofessional Care, Heidelberg, Germany.
| | - Simone Brefka
- Agaplesion Bethesda Hospital Ulm, Research Unit on Ageing, Ulm, Germany; Geriatric Centre Ulm at the Ulm University, Ulm, Germany; Ulm University Hospital, Institute for Geriatric Research at Agaplesion Bethesda Hospital Ulm, Ulm, Germany
| | - Stefanie Skudlik
- Rosenheim Technical University of Applied Sciences, Centre for Research, Development and Technology Transfer, Rosenheim, Germany
| | - Christoph Leinert
- Agaplesion Bethesda Hospital Ulm, Research Unit on Ageing, Ulm, Germany; Geriatric Centre Ulm at the Ulm University, Ulm, Germany; Ulm University Hospital, Institute for Geriatric Research at Agaplesion Bethesda Hospital Ulm, Ulm, Germany
| | - Thomas Mross
- Agaplesion Bethanien Hospital Heidelberg, Centre for Geriatric Medicine, University of Heidelberg, Heidelberg, Germany
| | - Gabriele Meyer
- Martin Luther University Halle-Wittenberg, International Graduate Academy, Institute for Health and Nursing Science, Medical Faculty, Halle (Saale), Germany
| | | | - Dhayana Dallmeier
- Agaplesion Bethesda Hospital Ulm, Research Unit on Ageing, Ulm, Germany; Geriatric Centre Ulm at the Ulm University, Ulm, Germany; Boston University School of Public Health, Department of Epidemiology, Boston, USA
| | - Michael Denkinger
- Agaplesion Bethesda Hospital Ulm, Research Unit on Ageing, Ulm, Germany; Geriatric Centre Ulm at the Ulm University, Ulm, Germany; Ulm University Hospital, Institute for Geriatric Research at Agaplesion Bethesda Hospital Ulm, Ulm, Germany
| | - Martin Müller
- Rosenheim Technical University of Applied Sciences, Centre for Research, Development and Technology Transfer, Rosenheim, Germany; Heidelberg University, Medical Faculty Heidelberg, Department of Primary Care and Health Services Research, Nursing Science and Interprofessional Care, Heidelberg, Germany; University Hospital Heidelberg, Department of Primary Care and Health Services Research, Nursing Science and Interprofessional Care, Heidelberg, Germany
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Shafer PR, Davis A, Clark JA. Finding social need-les in a haystack: ascertaining social needs of Medicare patients recorded in the notes of care managers. BMC Health Serv Res 2023; 23:1400. [PMID: 38087286 PMCID: PMC10717654 DOI: 10.1186/s12913-023-10446-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Unmet social needs may impair health and access to health care, and intervening on these holds particular promise in high-risk patient populations, such as those with multiple chronic conditions. Our objective was to identify social needs in a patient population at significant risk-Medicare enrollees with multiple chronic illnesses enrolled in care management services-and measure their prevalence prior to any systematic screening. METHODS We partnered with Renova Health, an independent Medicare Chronic Care Management (CCM) provider with patients in 10 states during our study period (January 2017 through August 2020). Our data included over 3,000 Medicare CCM patients, representing nearly 20,000 encounters. We used a dictionary-based natural language processing approach to ascertain the prevalence of six domains of barriers to care (food insecurity, housing instability, utility hardship) and unmet social needs (health care affordability, need for supportive services, transportation) in notes taken during telephonic Medicare CCM patient encounters. RESULTS Barriers to care, specifically need for supportive services (2.4%) and health care affordability (0.8%), were the most prevalent domains identified. Transportation as a barrier to care came up relatively less frequently in CCM encounters (0.1%). Unmet social needs were identified at a comparatively lower rate, with potential housing instability (0.3%) flagged most followed by potential utility hardship (0.2%) and food insecurity (0.1%). CONCLUSIONS There is substantial untapped opportunity to systematically screen for social determinants of health and unmet social needs in care management.
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Affiliation(s)
- Paul R Shafer
- Department of Health Law, Policy, and Management, School of Public Health, Boston University, 715 Albany Street, Boston, MA, 02118, United States of America.
| | - Amanda Davis
- Department of Health Law, Policy, and Management, School of Public Health, Boston University, 715 Albany Street, Boston, MA, 02118, United States of America
| | - Jack A Clark
- Department of Health Law, Policy, and Management, School of Public Health, Boston University, 715 Albany Street, Boston, MA, 02118, United States of America
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Valencia SA, Barrientos Gómez JG, Gómez Ramirez MC, Luna IF, Caicedo HA, Torres-Silva EA, Díaz ES. Evaluation of a telehealth program for high-risk pregnancy in a health service provider institution. Int J Med Inform 2023; 179:105234. [PMID: 37776668 DOI: 10.1016/j.ijmedinf.2023.105234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/14/2023] [Accepted: 09/23/2023] [Indexed: 10/02/2023]
Abstract
INTRODUCTION eHealth offers a solution to current challenges in maternal health. Telemonitoring can rethink antenatal care, achieving more personalized medicine, especially in high-obstetric risk conditions. A home care model mediated by the development of a mobile and web application that seeks support in clinical decision-making was created in our institution. The software architecture consists of an information system (HCIS, Health Care Information System), a database, an authentication server, and an interoperability bus. METHODS The usability of the software by patients was assessed using the Information Systems Usability Questionnaire (CSUQ) version 3, as well as the satisfaction of the care model designed through a survey in a prospective observational study in 62 patients with a high-risk pregnancy. Participants were monitored in real-time through blood glucose, blood pressure, and weight measurements, and attended telemedicine appointments with an obstetrician from admission to six weeks postpartum. RESULTS The CSUQ results show a good acceptance of the use of the application by patients both in the global score and the different domains, Global, System utility (SYSUSE), Information Quality (INFOQUAL), and Interface quality (INTERQUAL). The satisfaction survey also shows good results in general and by domains. CONCLUSION The findings of this study provide some suggestions for the implementation of a technological development and a care model from the patient's perspective.
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Affiliation(s)
- Sara Arango Valencia
- School of Health Sciences, Pontifical Bolivarian University, 050005 Medellin, Colombia; Scientific Direction, Bolivarian University Clinic, 050005 Medellín, Colombia.
| | - Juan Guillermo Barrientos Gómez
- School of Health Sciences, Pontifical Bolivarian University, 050005 Medellin, Colombia; Scientific Direction, Bolivarian University Clinic, 050005 Medellín, Colombia
| | | | - Iván Felipe Luna
- School of Health Sciences, Pontifical Bolivarian University, 050005 Medellin, Colombia; Scientific Direction, Bolivarian University Clinic, 050005 Medellín, Colombia
| | | | - E A Torres-Silva
- School of Health Sciences, Pontifical Bolivarian University, 050005 Medellin, Colombia; Metropolitan Technological University, 050005 Medellín, Colombia
| | - Emmanuel Sanchez Díaz
- School of Health Sciences, Pontifical Bolivarian University, 050005 Medellin, Colombia
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Capdevila Aguilera C, Vela Vallespín E, Clèries Escayola M, Yun Viladomat S, Fernández Solana C, Alcober Morte L, Monterde Prat D, Hidalgo Quirós E, Calero Molina E, José Bazán N, Moliner Borja P, Piera Jiménez J, Ruiz Muñoz M, Corbella Virós X, Jiménez-Marrero S, Garay Melero A, Ramos Polo R, Alcoberro Torres L, Pons Riverola A, Enjuanes Grau C, Comín-Colet J. Population-based evaluation of the impact of socioeconomic status on clinical outcomes in patients with heart failure in integrated care settings. Rev Esp Cardiol (Engl Ed) 2023; 76:803-812. [PMID: 36963612 DOI: 10.1016/j.rec.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/07/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION AND OBJECTIVES Low socioeconomic status (SES) is associated with poor outcomes in patients with heart failure (HF). We aimed to examine the influence of SES on health outcomes after a quality of care improvement intervention for the management of HF integrating hospital and primary care resources in a health care area of 209 255 inhabitants. METHODS We conducted a population-based pragmatic evaluation of the implementation of an integrated HF program by conducting a natural experiment using health care data. We included all individuals consecutively admitted to hospital with at least one ICD-9-CM code for HF as the primary diagnosis and discharged alive in Catalonia between January 1, 2015 and December 31, 2019. We compared outcomes between patients exposed to the new HF program and those in the remaining health care areas, globally and stratified by SES. RESULTS A total of 77 554 patients were included in the study. Death occurred in 37 469 (48.3%), clinically-related hospitalization in 41 709 (53.8%) and HF readmission in 29 755 (38.4%). On multivariate analysis, low or very low SES was associated with an increased risk of all-cause death and clinically-related hospitalization (all Ps <.05). The multivariate models showed a significant reduction in the risk of all-cause death (HR, 0.812; 95%CI, 0.723-0.912), clinically-related hospitalization (HR, 0.886; 95%CI, 0.805-0.976) and HF hospitalization (HR, 0.838; 95%CI, 0.745-0.944) in patients exposed to the new HF program compared with patients exposed to the remaining health care areas and this effect was independent of SES. CONCLUSIONS An intensive transitional HF management program improved clinical outcomes, both overall and across SES strata.
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Affiliation(s)
- Cristina Capdevila Aguilera
- Departamento de Gerencia, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Departamento de Ciencias Clínicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Barcelona, Barcelona, Spain
| | - Emili Vela Vallespín
- Unidad de Información y Conocimiento, Servicio Catalán de la Salud (CatSalut), Barcelona, Spain; Digitalización para la Sostenibilidad del Sistema Sanitario DS3-IDIBELL, Servicio Catalán de la Salud (CatSalut), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Montse Clèries Escayola
- Unidad de Información y Conocimiento, Servicio Catalán de la Salud (CatSalut), Barcelona, Spain; Digitalización para la Sostenibilidad del Sistema Sanitario DS3-IDIBELL, Servicio Catalán de la Salud (CatSalut), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sergi Yun Viladomat
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Medicina Interna, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Coral Fernández Solana
- Servicio de Atención Primaria, Delta del Llobregat e IDIAP, Barcelona, Spain; Servicio de Atención Primaria, Instituto Catalán de la Salud, Barcelona, Spain
| | - Laia Alcober Morte
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Atención Primaria, Delta del Llobregat e IDIAP, Barcelona, Spain; Servicio de Atención Primaria, Instituto Catalán de la Salud, Barcelona, Spain
| | - David Monterde Prat
- Digitalización para la Sostenibilidad del Sistema Sanitario DS3-IDIBELL, Servicio Catalán de la Salud (CatSalut), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Atención Primaria, Instituto Catalán de la Salud, Barcelona, Spain
| | - Encarna Hidalgo Quirós
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Atención Primaria, Delta del Llobregat e IDIAP, Barcelona, Spain; Servicio de Atención Primaria, Instituto Catalán de la Salud, Barcelona, Spain
| | - Esther Calero Molina
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Núria José Bazán
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pedro Moliner Borja
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Piera Jiménez
- Digitalización para la Sostenibilidad del Sistema Sanitario DS3-IDIBELL, Servicio Catalán de la Salud (CatSalut), L'Hospitalet de Llobregat, Barcelona, Spain; Facultad de Informática, Multimedia y Telecomunicaciones, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Marta Ruiz Muñoz
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Corbella Virós
- Grupo de investigación en Enfermedades Sistémicas, Vasculares y Envejecimiento (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Facultad de Medicina, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Santiago Jiménez-Marrero
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alberto Garay Melero
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Raúl Ramos Polo
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lidia Alcoberro Torres
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alexandra Pons Riverola
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Enjuanes Grau
- Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Josep Comín-Colet
- Departamento de Ciencias Clínicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Barcelona, Barcelona, Spain; Bio-Heart, grupo de investigación en enfermedades cardiovasculares, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Programa de Insuficiencia Cardiaca Comunitaria, Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Bellvitge (ICS), L'Hospitalet de Llobregat, Barcelona, Spain.
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Herranz-Pinto P, Figueras Nart I, Monte-Boquet E, Tortajada Goitia B. Improving the Management and Follow-up of Atopic Dermatitis: A Delphi Process Report of Consensus Between Hospital Dermatologists and Pharmacists. Actas Dermosifiliogr 2023; 114:708-717. [PMID: 37088291 DOI: 10.1016/j.ad.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/28/2023] [Accepted: 04/02/2023] [Indexed: 04/25/2023] Open
Abstract
Managing atopic dermatitis, one of the most common dermatologic conditions, is often challenging. To establish consensus on recommendations for responding to various situations that arise when treating atopic dermatitis, a group of hospital pharmacists and dermatologists used the Delphi process. A scientific committee developed a Delphi survey with 2 blocks of questions to explore the group's views on 1) evaluating response to treatment in the patient with atopic dermatitis and 2) cooperation between the dermatology department and the hospital pharmacy service. The experts achieved an overall rate of consensus of 86% during the process. Conclusions were that dermatologists and hospital pharmacists must maintain good communication and coordinate their interventions to optimize the management of atopic dermatitis and patients' responses to treatment.
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Affiliation(s)
- P Herranz-Pinto
- Servicio de Dermatología, Hospital Universitario La Paz, Madrid, España.
| | - I Figueras Nart
- Servicio de Dermatología, Hospital Universitario Bellvitge, Barcelona, España
| | - E Monte-Boquet
- Servicio de Dermatología, Hospital Universitario y Politécnico La Fe, Valencia, España
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Möckli N, Simon M, Denhaerynck K, Martins T, Meyer-Massetti C, Fischer R, Zúñiga F. Care coordination in homecare and its relationship with quality of care: A national multicenter cross-sectional study. Int J Nurs Stud 2023; 145:104544. [PMID: 37354791 DOI: 10.1016/j.ijnurstu.2023.104544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION As health care complexity increases, skilled care coordination is becoming increasingly necessary. This is especially true in homecare settings, where services tend to be highly interprofessional. Poor coordination can result in services being provided twice, at the wrong time, unnecessarily or not at all. In addition to risking harm to the client, such confusion leads to unnecessary costs. From the patient's perspective, then, professional coordination should help both to remove barriers limiting quality of care and to minimize costs. To date, though, studies examining the relationship between care coordination and care quality have faced multiple challenges, leading to mixed results. And in homecare contexts, where the clients are highly vulnerable and diverse care interfaces make coordination especially challenging, such studies are rare. OBJECTIVES Therefore, the aim of this study was to explore the relationship, from the perspectives of clients and of homecare professionals, between coordination and quality of care. For both groups, we hypothesized that better coordination would correlate with higher ratings of quality of care. For the clients, we predicted that higher coordination ratings would lead to lower incidence of unplanned health care use, i.e., emergency department (ED) visits, unscheduled urgent medical visits and hospitalizations. DESIGN AND METHODS This study is part of a national multi-center cross-sectional study in the Swiss homecare setting. We recruited 88 homecare agencies and collected data between January and September 2021 through written questionnaires for agencies' managers, employees (n = 3223) and clients (n = 1509). To test our hypotheses, we conducted multilevel analyses. RESULTS Employee-perceived care coordination ratings correlated positively with employee-rated quality of care (OR = 2.78, p < .001); client-perceived care coordination problems correlated inversely with client-reported quality of care (β = -0.55, p < .001). Client-perceived coordination problems also correlated positively with hospitalizations (IRR = 1.20, p < .05) and unscheduled urgent medical visits (IRR = 1.18, p < .05), but not significantly with ED visits. No associations were discernible between employee-perceived coordination quality and either health care service use or client quality-of-care ratings. DISCUSSION While results indicate relationships between coordination and diverse aspects of care quality, various coordination gaps (e.g., poor information flow) also became apparent. The measurement of both care coordination and quality of care remains a challenge. Further research should focus on developing and validating a coordination questionnaire that measures care coordination.
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Affiliation(s)
- Nathalie Möckli
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056 Basel, Switzerland
| | - Michael Simon
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056 Basel, Switzerland
| | - Kris Denhaerynck
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056 Basel, Switzerland; Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Tania Martins
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056 Basel, Switzerland
| | - Carla Meyer-Massetti
- Clinical Pharmacology & Toxicology, Department of General Internal Medicine, Inselspital - University Hospital of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, CH-3012 Bern, Switzerland
| | - Roland Fischer
- Centre for Primary Health Care, University of Basel, Rheinstrasse 26, CH-4410 Liestal, Switzerland
| | - Franziska Zúñiga
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056 Basel, Switzerland.
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Herranz-Pinto P, Figueras Nart I, Monte-Boquet E, Tortajada Goitia B. [Translated article] Improving the Management and Follow-up of Atopic Dermatitis: A Delphi Process Report of Consensus Between Hospital Dermatologists and Pharmacists. Actas Dermosifiliogr 2023; 114:T708-T717. [PMID: 37453542 DOI: 10.1016/j.ad.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/02/2023] [Indexed: 07/18/2023] Open
Abstract
Managing atopic dermatitis, one of the most common dermatologic conditions, is often challenging. To establish consensus on recommendations for responding to various situations that arise when treating atopic dermatitis, a group of hospital pharmacists and dermatologists used the Delphi process. A scientific committee developed a Delphi survey with two blocks of questions to explore the group's views on (1) evaluating response to treatment in the patient with atopic dermatitis and (2) cooperation between the dermatology department and the hospital pharmacy service. The experts achieved an overall rate of consensus of 86% during the process. Conclusions were that dermatologists and hospital pharmacists must maintain good communication and coordinate their interventions to optimize the management of atopic dermatitis and patients' responses to treatment.
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Affiliation(s)
- P Herranz-Pinto
- Servicio de Dermatología, Hospital Universitario La Paz, Madrid, Spain.
| | - I Figueras Nart
- Servicio de Dermatología, Hospital Universitario Bellvitge, Barcelona, Spain
| | - E Monte-Boquet
- Servicio de Dermatología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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10
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Ku EJ, Yoo WS, Chung HK. Management of Subclinical Hypothyroidism: A Focus on Proven Health Effects in the 2023 Korean Thyroid Association Guidelines. Endocrinol Metab (Seoul) 2023; 38:381-391. [PMID: 37550859 PMCID: PMC10475969 DOI: 10.3803/enm.2023.1778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 08/09/2023] Open
Abstract
Subclinical hypothyroidism (SCH) is characterized by elevated thyroid-stimulating hormone (TSH) and normal free thyroxine levels. The Korean Thyroid Association recently issued a guideline for managing SCH, which emphasizes Korean-specific TSH diagnostic criteria and highlights the health benefits of levothyroxine (LT4) treatment. A serum TSH level of 6.8 mIU/L is presented as the reference value for diagnosing SCH. SCH can be classified as mild (TSH 6.8 to 10.0 mIU/L) or severe (TSH >10.0 mIU/L), and patients can be categorized as adults (age <70 years) or elderly (age ≥70 years), depending on the health effects of LT4 treatment. An initial increase in serum TSH levels should be reassessed with a subsequent measurement, including a thyroid peroxidase antibody test, preferably 2 to 3 months after the initial assessment. While LT4 treatment is not generally recommended for mild SCH in adults, it is necessary for severe SCH in patients with underlying coronary artery disease or heart failure and it may be considered for those with concurrent dyslipidemia. Conversely, LT4 treatment is generally not recommended for elderly patients, regardless of SCH severity. For those SCH patients who are prescribed LT4 treatment, the dosage should be personalized, and serum TSH levels should be regularly monitored to maintain the optimal LT4 regimen.
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Affiliation(s)
- Eu Jeong Ku
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Won Sang Yoo
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Hyun Kyung Chung
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
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11
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Kusmiati M, Prawiradilaga RS, Tursina A. The most influence factor of the medical competence achievement regarding patient management ability on medical school graduates. Korean J Med Educ 2023; 35:143-152. [PMID: 37291843 DOI: 10.3946/kjme.2023.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/10/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE A doctor's professional behavior and clinical competency reflect a range of personal and interpersonal qualities, attributes, commitments, and values. This study aimed to identify the most influential factor of medical competence regarding patient management ability. METHODS We used an analytic observational design with a cross-sectional approach, and gathered the perceptions of medical school graduates of Bandung Islamic University via an online questionnaire scored on a Likert scale. Two hundred and six medical graduates who graduated at least 3 years prior to survey were included in the study. The factors evaluated included humanism, cognitive competence, clinical skill competence, professional behavior, patient management ability, and interpersonal skill. IBM AMOS ver. 26.0 (IBM Corp., Armonk, USA) was used for structural equation modelling of the six variables latent and 35 indicator variables. RESULTS We found that graduates have highly positive perceptions of the humanism (95.67%). Followed by interpersonal skills (91.26%), patient management (89.53%), professional behavior (88.47%), and cognitive competence (87.12%). They rated clinical skill competence the lowest (81.7%). Regarding factors that contribute to patient management ability, the aspects of humanism, interpersonal skill, and professional behavior were found to significantly affect patient management ability (p-value=0.035, 0.00, and 0.00, respectively) with a critical rate of 2.11, 4.31, and 4.26 consecutively. CONCLUSION Humanism and interpersonal skill are two important factors that medical graduates assessed very positively. According to surveyed medical graduates, their expectations of the institution were met regarding humanism. However, there is a need to strengthen medical students' clinical skills and improve their cognitive abilities through educational programs.
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Affiliation(s)
- Mia Kusmiati
- Department of Medical Education, Bioethics and Humanity, Bandung Islamic University, Bandung, Indonesia
| | | | - Alya Tursina
- Department of Neurology, Faculty of Medicine, Bandung Islamic University, Bandung, Indonesia
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12
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Hempel D, Michels G. [Teambuilding interventions in clinical acute and emergency medicine]. Med Klin Intensivmed Notfmed 2023. [PMID: 36912919 DOI: 10.1007/s00063-023-00991-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 11/07/2022] [Accepted: 11/20/2022] [Indexed: 03/14/2023]
Abstract
Good teamwork in clinical acute and emergency medicine is essential, as both patient care and staff health depend on it. Clinical acute and emergency medicine or the emergency room is a high-risk environment: the composition of the teams is heterogeneous, the tasks to be solved are often unpredictable and constantly changing, time pressure is often high, and the environmental conditions fluctuate. Constructive cooperation in the interdisciplinary and interprofessional team is therefore particularly important, but also particularly susceptible to disruptive factors. Team leadership is therefore paramount. This article explains what constitutes a perfect team in acute care and also what the team leader needs to implement in order to build and maintain such a team. In addition, the importance of a healthy communication culture in the process management of team building is discussed.
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13
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Atallah FC, Caruso P, Nassar Junior AP, Torelly AP, Amendola CP, Salluh JIF, Romano TG. High-value care for critically ill oncohematological patients: what do we know thus far? Crit Care Sci 2023; 35:84-96. [PMID: 37712733 PMCID: PMC10275311 DOI: 10.5935/2965-2774.20230405-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/26/2023] [Indexed: 09/16/2023]
Abstract
The number of patients with cancer requiring intensive care unit admission is increasing around the world. The improvement in the pathophysiological understanding of this group of patients, as well as the increasingly better and more targeted treatment options for their underlying disease, has led to a significant increase in their survival over the past three decades. Within the organizational concepts, it is necessary to know what adds value in the care of critical oncohematological patients. Practices in medicine that do not benefit patients and possibly cause harm are called low-value practices, while high-value practices are defined as high-quality care at relatively low cost. In this article, we discuss ten domains with high-value evidence in the care of cancer patients: (1) intensive care unit admission policies; (2) intensive care unit organization; (3) etiological investigation of hypoxemia; (4) management of acute respiratory failure; (5) management of febrile neutropenia; (6) urgent chemotherapy treatment in critically ill patients; (7) patient and family experience; (8) palliative care; (9) care of intensive care unit staff; and (10) long-term impact of critical disease on the cancer population. The disclosure of such policies is expected to have the potential to change health care standards. We understand that it is a lengthy process, and initiatives such as this paper are one of the first steps in raising awareness and beginning a discussion about high-value care in various health scenarios.
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Affiliation(s)
- Fernanda Chohfi Atallah
- Discipline of Anaesthesiology, Pain and Intensive Care, Escola
Paulista de Medicina, Universidade Federal de São Paulo - São Paulo
(SP), Brazil
| | - Pedro Caruso
- AC Camargo Cancer Center - São Paulo (SP), Brazil
| | | | - Andre Peretti Torelly
- Hospital Santa Rita - Santa Casa de Misericórdia de Porto
Alegre - Porto Alegre (RS), Brazil
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Qomi M, Rakhshan M, Ebrahimi Monfared M, Khademian Z. The effect of distance nurse-led fatigue management on fatigue, sleep quality, and self-efficacy in patients with multiple sclerosis: a quasi-experimental study. BMC Neurol 2023; 23:71. [PMID: 36788480 PMCID: PMC9926409 DOI: 10.1186/s12883-023-03115-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Fatigue is one of the most common problems in patients with multiple sclerosis (MS) and has adverse effects on their sleep status and self-efficacy. This study aimed to determine the effect of distance nurse-led fatigue management on fatigue, sleep quality, and self-efficacy in patients with MS. METHODS This quasi-experimental study was performed on 60 patients with MS in Arak, Iran. Subjects were randomly assigned into intervention and control groups. The intervention group received eight sessions of nurse-led fatigue management training through the Skyroom platform. The control group received only the usual programs. Data were collected before and two months after the intervention using the Fatigue Severity Scale, the Pittsburgh Sleep Quality Index, and the Multiple Sclerosis Self-Efficacy Scale. The significance level in this study was determined 0.05. RESULTS After the intervention, the mean score of fatigue severity in the intervention group was significantly lower than the control group (2.52 ± 0.40 vs 5.65 ± 0.52) (P < 0.001). Also, after the intervention, the mean score of self-efficacy in the intervention group was significantly higher than the control group (49.37 ± 3.25 vs 24.43 ± 2.52) (P < 0.001). Furthermore, after the intervention the mean score of sleep quality was lower in intervention group (11.92 ± 2.01) than the control group (15.46 ± 1.40) (P < 0.001). CONCLUSION Distance nurse-led fatigue management improved fatigue, sleep quality, and self-efficacy in patients with MS. We recommend the use of these courses as an important step toward improving fatigue, sleep quality, and self-efficacy among these patients.
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Affiliation(s)
- Mahla Qomi
- grid.412571.40000 0000 8819 4698Student Research Committee, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahnaz Rakhshan
- grid.412571.40000 0000 8819 4698Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Ebrahimi Monfared
- grid.468130.80000 0001 1218 604XDepartment of Neurology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Zahra Khademian
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
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15
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Ruelle Y, Bessah N, Hami L. [The general practitioner in old age homes : an incongruous actor ? Study in old-age homes in a deprived area]. Rev Epidemiol Sante Publique 2023; 71:101423. [PMID: 36731385 DOI: 10.1016/j.respe.2023.101423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/20/2022] [Accepted: 01/05/2023] [Indexed: 02/01/2023] Open
Abstract
CONTEXT Residential facilities for dependent elderly people have difficulties ensuring medical follow-up of their residents by general practitioners. The barriers to medical visits are well-known. Seine-Saint-Denis is particularly affected by the medical demography crisis. OBJECTIVES To describe the organization of visits by general practitioners in residential facilities for dependent elderly people in Seine-Saint-Denis. To assess the influence of the institutions' status on this organization. METHOD Quantitative descriptive cross-sectional study of 65 facilities in Seine Saint-Denis. A questionnaire drawn from the literature on known barriers to medical visits was used. RESULTS Fifty institutions (76.9%) contributed. Most visits (88.0%) took place in patients' rooms. When the practitioner arrived, the patient was present at the site in 80.0% of the facilities, especially when they were private and associative (p = 0.01). The doctor was accompanied by a staff member in 30.0% of the facilities, especially when they were for-profit (p = 0.02). Exchanges between general practitioners and the staff were sporadic and unorganized. All in all, the public facilities seemed to be less well-organized to receive general practitioners. DISCUSSION Residential facilities for the elderly do not seem to have implemented specific organization for visits by general practitioners, who are not integrated in the staff. CONCLUSION Experiments with doctors gainfully employed in institutions could be carried out, following the example of several foreign countries.
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Affiliation(s)
- Yannick Ruelle
- Université Sorbonne Paris Nord, Département universitaire de médecine générale , DUMG, F-93430, Villetaneuse, France; Université Sorbonne Paris Nord, Laboratoire éducations et promotion de la santé, UR 3412, F-93430, Villetaneuse, France; Ville de Pantin, Centres municipaux de santé universitaires, F-93500, Pantin, France.
| | - Nabila Bessah
- Université Sorbonne Paris Nord, Département universitaire de médecine générale , DUMG, F-93430, Villetaneuse, France; Ville de La Courneuve, Centre municipal de santé, F- 93120, La Courneuve, France
| | - Lydia Hami
- Université Sorbonne Paris Nord, Département universitaire de médecine générale , DUMG, F-93430, Villetaneuse, France; Ville de Tremblay-en-France, Centre municipal de santé, F- 93290, Tremblay-en-France, France
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Fabrés Martín C, Ventura Parellada C, Herrero Antón de Vez H, Ordoñez Urgiles CE, Alonso-Rodríguez Piedra J, Mora Guix JM. Telemedicine approach for patient follow-up after total knee and reverse total shoulder arthroplasty: a pilot study. Int J Comput Assist Radiol Surg 2023; 18:595-602. [PMID: 36422767 PMCID: PMC9686457 DOI: 10.1007/s11548-022-02784-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 10/20/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The study aimed to demonstrate the reduction in postoperative follow-up visit time for patients receiving total knee arthroplasty (TKA) or reverse total shoulder arthroplasty (RTSA) by implementing a novel asynchronous telemedicine system compared to face-to-face visits. The range of motion interobserver agreement and patient satisfaction were evaluated in the telemedicine group. METHODS A randomized controlled trial was conducted with a total of 28 patients with a mean age of 71 years (range 13.3). Patients were distributed into two study groups, TKA (n = 14) and RTSA (n = 14), and each group was randomly allocated into a face-to-face or virtual follow-up visit group. For the virtual group, software was designed including patient-specific model items (X-ray, range of motion and functional scores) for each arthroplasty. Functional assessment was conducted using the International Knee Documentation Committee (IKDC) score for TKA and American Shoulder and Elbow score (ASES) and Simple Shoulder Test (SST) for RTSA. The range of motion interobserver concordance was conducted in the virtual follow-up groups via an intraclass correlation coefficient. Finally, a satisfaction survey was performed in the virtual follow-up groups. Mann-Whitney U test was used for statistical analysis. RESULTS Mean time differences between face-to-face and virtual follow-ups were 502.5 s (95% CI 387.8-617.1; p < 0.002) in the RTSA group and 710 s (95% CI 597.91-822; p < 0. 002) in the TKA group. The range of motion interobserver concordance in the virtual group was 0.974 for TKA and 0.804 for RTSA. Finally, virtual follow-up satisfaction using the telematic method was 8.9 out of 10. CONCLUSION The results of this study showed that a virtual follow-up using asynchronous telemedicine systems could reduce visit times, allow a correct articular range of motion evaluation and maintain satisfaction perception for patients. Asynchronous telemedicine could be an efficient method to conduct postoperative follow-up after knee and shoulder arthroplasty.
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Affiliation(s)
- Carles Fabrés Martín
- Department of Orthopedic Surgery, Consorci Sanitari de Terrassa, Terrassa, Spain.
| | | | - Hugo Herrero Antón de Vez
- Clinic for Plastic, Reconstructive, Hand and Burn Surgery, München Klinik Bogenhausen, Munich, Germany
| | | | | | - José María Mora Guix
- Department of Orthopedic Surgery, Consorci Sanitari de Terrassa, Terrassa, Spain
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17
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Baker JA, Houin PR. Comparison of National and Global Asthma Management Guiding Documents. Respir Care 2023; 68:114-128. [PMID: 36566032 PMCID: PMC9993509 DOI: 10.4187/respcare.10254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Asthma is a common chronic disease that affects both adults and children, and that continues to have a high economic burden. Asthma management guidelines were first developed nearly 30 years ago to standardize care, maintain asthma control, improve quality of life, maintain normal lung function, prevent exacerbations, and prevent asthma mortality. The two most common asthma guidelines used today were developed by the National Asthma Education and Prevention Program (NAEPP) Expert Panel Working Group and the Global Initiative for Asthma Science Committee. Both guiding documents use scientific methodology to standardize their approach for formulating recommendations based on pertinent literature. Before the 2020 National Asthma Education and Prevention Program (Expert Panel Report 4), nothing had been released since the 2007 guidelines, whereas the Global Initiative for Asthma publishes updates annually. Although each of these asthma strategies is similar, there are some noted differences. Over the years, the focus of asthma treatment has shifted from acute to chronic management. Frontline respiratory therapists and other health-care providers should have a good understanding of these 2 guiding references and how they can impact acute and chronic asthma management. The primary focus of this narrative is to look at the similarities and differences of these 2 guiding documents as they pertain to the 6 key questions identified by the Expert Panel of the National Asthma Education and Prevention Program.
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Affiliation(s)
- Joyce A Baker
- Breathing Institute, Children's Hospital Colorado, Aurora, Colorado.
| | - Paul R Houin
- Breathing Institute, Children's Hospital Colorado, Aurora, Colorado
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
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Kim YE, Lee HY. The effects of an emergency department length-of-stay management system on severely ill patients' treatment outcomes. BMC Emerg Med 2022; 22:204. [PMID: 36513973 PMCID: PMC9745968 DOI: 10.1186/s12873-022-00760-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE This study aimed to compare the length of stay (LOS) and treatment outcomes based on the application and achievement of a newly developed emergency department (ED) LOS management system for severely ill patients. METHODS Data were retrospectively collected from electronic medical records (EMRs) for the system evaluation and research purpose. The study subjects are severely ill patients whose diagnosis codes are designated by the Ministry of Health and Welfare and who visited the ED of a tertiary hospital from January to December 2019. The control group (Group 1) refers to those who have neither applied nor achieved the goal (5 hours or less) of the ED LOS management system even after it was applied, and the experimental group (Group 2) refers to those who have achieved the 5-hour goal after applying the system. RESULTS A total of 2034 severely ill patients applied the ED LOS management system. Group 1 included 837 patients and Group 2 included 1197 patients. Thirty days in-hospital mortality corresponded to 10.6% in Group 1 and 6.6% in Group 2 (χ2 = 10.58, p = .001). The total duration of hospitalization was 14.66 ± 18.26 days in Group 1 and 10.19 ± 16.00 days in Group 2 (t = 9.03, p < .001). Six hundred forty-two patients (76.6%) in Group 1 were discharged to their home (normal discharge) and 979 patients (81.7%) were discharged to their home in Group 2, but the discharge-as-death rate was 14.1% in Group 1 and 7.5% in Group 2 (χ2 = 29.80, p < .001). CONCLUSION With the application and attainment of the ED LOS management system for severely ill patients, we have concluded the new system produced a lower LOS in the ED, 30 days in-hospital mortality, length of the hospitalization, mortality rate, and a higher rate of normal discharge.
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Affiliation(s)
- Young Eun Kim
- grid.414966.80000 0004 0647 5752Department of Emergency Medicine, Seoul St. Mary’s Hospital, 222 Banpo-daero, Seocho-gu, Seoul, 06591 South Korea
| | - Hyang Yuol Lee
- grid.411947.e0000 0004 0470 4224College of Nursing, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591 Republic of Korea
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Haardt V, Cambriel A, Hubert S, Tran M, Bruel C, Philippart F. General practitioner residents and patients end-of life: involvement and consequences. BMC Med Ethics 2022; 23:123. [PMID: 36463158 PMCID: PMC9719227 DOI: 10.1186/s12910-022-00867-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/25/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The ageing of the population and the increased number of chronic diseases are associated with an increased frequency of end of life care in hospital settings. Residents rotating in hospital wards play a major part in their care, regardless of their specialty. General practitioner (GP) residents are confronted to such activities in hospital settings during their training. Our aim was to know how they feel about taking care of dying patients, as end-of-life care are very different from the clinical activity they are trained to. METHODS We surveyed all GP trainees of "Ile de France". The survey was made of 41 questions regarding advanced directives divided in 7 sections about patients' care, communication, mentoring and repercussion on personal life. The survey was done one time, during two pre-specified days. RESULTS 525 residents (53.8%) accepted to fulfill the survey. 74.1% of the residents thought that palliative care could have been better. Possible ways of improvements were: a reduction of unreasonable obstinacy (or therapeutic overkill, two terms defined in French law as curative treatment without reasonable hope of efficiency) (59.6%), patient's (210 answers, 40%) and relative's communication (information of patients and relatives about the severity of the disease and risk of death) (199 answers 37.9%). Residents also reported a lack of knowledge regarding end-of-life care specific treatments (411 answers, 79.3%) and 298 (47.2%) wished for better mentoring. Those difficulties were associated with repercussion on their private life (353 answers, 67.2%), particularly with their close relatives (55.4%). Finally, 56.2% of trainees thought that a systematic psychologic follow up should be instituted for those working in "at risk" hospital settings. CONCLUSION Self-perception management of dying patients by GP resident emphasize their lack of training and supervision. The feeling of suboptimal care is associated with consequences on personal life.
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Affiliation(s)
- Victoire Haardt
- Marie-Thérèse Medical Center, Paris, France ,REQUIEM study group, Paris, France
| | - Amélie Cambriel
- grid.50550.350000 0001 2175 4109Anesthesiology and Intensive Care Medicine Department, APHP-Tenon University Hospital, Paris, France ,REQUIEM study group, Paris, France
| | - Sidonie Hubert
- grid.414363.70000 0001 0274 7763Internal Medicine Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France ,REQUIEM study group, Paris, France
| | - Marc Tran
- grid.414363.70000 0001 0274 7763Medical and Surgical Intensive Care Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Cédric Bruel
- grid.414363.70000 0001 0274 7763Medical and Surgical Intensive Care Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Francois Philippart
- grid.414363.70000 0001 0274 7763Medical and Surgical Intensive Care Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France ,REQUIEM study group, Paris, France
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20
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Garcіa-Fernandez FP, Soldevilla-Agreda JJ, Rodriguez-Palma M, Parra-Anguita L, Pancorbo-Hidalgo PL. Algorithm for the differential diagnosis between dependence-related skin injuries and severe life-threatening skin injuries. J Tissue Viability 2022; 31:575-578. [PMID: 36175255 DOI: 10.1016/j.jtv.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 08/30/2022] [Accepted: 09/20/2022] [Indexed: 10/14/2022]
Abstract
AIM To develop a diagnostic algorithm to differentiate dependence-related skin injuries (avoidable) from severe life-threatening skin injuries (unavoidable). METHOD A nominal group technique was used. Six experts with extensive knowledge of these types of injuries were selected for the group. All were nurses with a PhD in wound research and had more than 15 years of experience in wound care. The experts were asked only one question: In your opinion, what are the basic and indispensable aspects to differentiate a dependence-related skin injury (DR-SI) from a severe life-threatening skin injury (SLT-SI)? RESULTS The experts identified three basic elements to differentiate DL-SI and SLT-SI (clinical situation, provision of care, and clinical characteristics of the lesions). A diagnostic algorithm was developed to differentiate the two types of skin lesions using the three basic elements identified, a literature review, and what was published in the two articles that define DR-SI and STL-SI. CONCLUSION We developed a diagnostic algorithm to differentiate dependence-related skin injuries (avoidable) from severe life-threatening skin injuries (unavoidable). The algorithm also facilitates the identification of the subtypes of these injuries, depending on its location and characteristics.
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Affiliation(s)
- Francisco P Garcіa-Fernandez
- Faculty of Health Sciences, University of Jaen, Spain. Executive Member of Spanish Pressure Ulcer Advisory Panel, Chair of Advanced Management in Wounds, Spain.
| | | | - Manuel Rodriguez-Palma
- Nursing Home "Josee Matia Calvo" of CadizUlcer Advisory Panel, Chair of Advanced Management in Wounds, Spain.
| | - Laura Parra-Anguita
- Faculty of Health Sciences, University of Jaen, Spain. Executive Member of Spanish Pressure Ulcer Advisory Panel, Chair of Advanced Management in Wounds, Spain.
| | - Pedro L Pancorbo-Hidalgo
- Faculty of Health Sciences, University of Jaen, Spain. Executive Member of Spanish Pressure Ulcer Advisory Panel, Chair of Advanced Management in Wounds, Spain.
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21
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Klastrup LK, Rosendal M, Rask MT, Christensen KS, Rask CU. Functional somatic symptoms in youths in general practice: A cross-sectional study on prevalence, clinical management and perceived burden. J Psychosom Res 2022; 156:110765. [PMID: 35276589 DOI: 10.1016/j.jpsychores.2022.110765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/16/2022] [Accepted: 02/21/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Functional somatic symptoms (FSS) may progress into a functional disorder if poorly managed, which may have serious implications. This cross-sectional study describes the management of youths compared to adults in general practice and estimates the prevalence of FSS in youths in this setting by comparing consultation-related aspects between youths with FSS and 1) youths with a specific diagnosis and 2) adults with FSS. METHODS We used data from a Danish survey (2008-2009), including 3295 face-to-face consultations between GPs and patients aged 15-64 years. Patients were divided into youths (15-24 years) and adults (25-64 years) and then into subgroups according to the GPs' classifications: 1) specific diagnosis, 2) resolving symptom and 3) FSS. Logistic regression analysis was used for all comparisons, and estimates were adjusted for gender, concomitant chronic disorder and GP cluster. RESULTS The GPs more frequently ensured continuity of care in adults (AOR:0.75, 95%CI:0.61-0.92, p < 0.01) and perceived youths as less time consuming (AOR:0.58, 95%CI: 0.43-0.77, p < 0.01) and less burdensome (AOR:0.60; 95%CI: 0.45-0.81, p < 0.01) compared to adults. FSS prevalence was 4.4% in youths and 9.0% in adults. However, GPs perceived youths with FSS as more burdensome (AOR:7.77, 95%CI:2.93-20.04, p < 0.01) and more time consuming (AOR:3.98, 95%CI:1.42-11.12, p < 0.01) than youths with a specific diagnosis. No significant differences were found between youths and adults with FSS, respectively, in regards to perceived burden and consultation time. CONCLUSION The results indicate age-related variations in the prevalence and clinical management of FSS in general practice. The GPs perceived both youths and adults with FSS time consuming, which underlines a need for supportive management strategies.
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Affiliation(s)
- L K Klastrup
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Denmark.
| | - M Rosendal
- Research Clinic for Functional Disorders, Aarhus University Hospital, Denmark; Research Unit for General Practice, Aarhus, Denmark.
| | - M T Rask
- Research Clinic for Functional Disorders, Aarhus University Hospital, Denmark.
| | - K S Christensen
- Research Unit for General Practice, Aarhus, Denmark; Department of Public Health, Aarhus University, Denmark.
| | - C U Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
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22
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Connor KI, Siebens HC, Mittman BS, Ganz DA, Barry F, McNeese-Smith DK, Cheng EM, Vickrey BG. Implementation fidelity of a nurse-led RCT-tested complex intervention, care coordination for health promotion and activities in Parkinson's disease (CHAPS) in meeting challenges in care management. BMC Neurol 2022; 22:36. [PMID: 35073865 PMCID: PMC8785022 DOI: 10.1186/s12883-021-02481-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/19/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) complexity poses challenges for individuals with Parkinson's, providers, and researchers. A recent multisite randomized trial of a proactive, telephone-based, nurse-led care management intervention - Care Coordination for Health Promotion and Activities in Parkinson's Disease (CHAPS) - demonstrated improved PD care quality. Implementation details and supportive stakeholder feedback were subsequently published. To inform decisions on dissemination, CHAPS Model components require evaluations of their fidelity to the Chronic Care Model and to their implementation. Additionally, assessment is needed on whether CHAPS addresses care challenges cited in recent literature. METHODS These analyses are based on data from a subset of 140 intervention arm participants and other CHAPS data. To examine CHAPS Model fidelity, we identified CHAPS components corresponding to the Chronic Care Model's six essential elements. To assess implementation fidelity of these components, we examined data corresponding to Hasson's modified implementation fidelity framework. Finally, we identified challenges cited in current Parkinson's care management literature, grouped these into themes using open card sorting techniques, and examined CHAPS data for evidence that CHAPS met these challenges. RESULTS All Chronic Care Model essential elements were addressed by 17 CHAPS components, thus achieving CHAPS Model fidelity. CHAPS implementation fidelity was demonstrated by adherence to content, frequency, and duration with partial fidelity to telephone encounter frequency. We identified potential fidelity moderators for all six of Hasson's moderator types. Through card sorting, four Parkinson's care management challenge themes emerged: unmet needs and suggestions for providers (by patient and/or care partner), patient characteristics needing consideration, and standardizing models for Parkinson's care management. CHAPS activities and stakeholder perceptions addressed all these themes. CONCLUSIONS CHAPS, a supportive nurse-led proactive Parkinson's care management program, improved care quality and is designed to be reproducible and supportive to clinicians. Findings indicated CHAPS Model fidelity occurred to the Chronic Care Model and fidelity to implementation of the CHAPS components was demonstrated. Current Parkinson's care management challenges were met through CHAPS activities. Thus, dissemination of CHAPS merits consideration by those responsible for implementing changes in clinical practice and reaching people in need. TRIAL REGISTRATION ClinicalTrials.gov as NCT01532986 , registered on January 13, 2012.
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Affiliation(s)
- Karen I Connor
- Veterans Affairs Parkinson's Disease Research, Education and Clinical Center, Los Angeles, CA, USA. .,UCLA David Geffen School of Medicine, Los Angeles, CA, USA. .,, Novato, CA, 94945, USA.
| | | | - Brian S Mittman
- Kaiser Permanente Department of Research and Evaluation, Pasadena, CA, USA
| | - David A Ganz
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA.,Veterans Affairs Geriatric Research, Education and Clinical Center and Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, USA
| | - Frances Barry
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | | | - Eric M Cheng
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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Rachmawaty R, Sinrang AW, Wahyudin E, Bukhari A. Evaluation of health care quality among insured patients in Indonesian mother & child hospital: A secondary data analysis. Gac Sanit 2021; 35 Suppl 2:S613-8. [PMID: 34929913 DOI: 10.1016/j.gaceta.2021.10.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/20/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study aimed to evaluate the health care quality among insured patients hospitalized in the Indonesian mother and child hospital. METHOD A secondary data analysis was performed to evaluate the health care services received by the insured patients hospitalized in the Indonesian mother and child hospital. Data were extracted from the BPJS health insurance e-claim database from January 1 to December 31, 2019 and from January 1 to June 30, 2020. A descriptive and bivariate analysis were used to examine total patients and hospital admissions; INACBGs diagnoses, procedures by severity; types of inpatient wards; length of stay; discharge status; hospital costs; and 30-day readmissions. RESULTS Total inpatient unit admissions were 2870 in 2019 and 1533 in 2020. From total hospital admissions in 2019 and 2020, over 50% were admitted to the 3rd class of inpatient units, less than 10% had length of stays more than 5 days, and over 98% were discharged based on physician approval. However, hospital readmissions were also found for about 20.1% in 2019 and 2.9% in 2020 and about 42.9% in 2019 and 61.3% in 2020 were found causing hospital financial losses. Older patients, longer hospital stays, inpatient ward class 1 & 2, high hospital tariff, inadequate clinical pathway implementation, lack of interprofessional collaboration, and ineffective nurse manager supervision were identified as contributing factors to the hospital financial losses. CONCLUSION Integrated clinical pathways with interprofessional collaboration that are implemented through professional nursing practice model are suggested for health care quality improvement.
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Abstract
Health systems in many countries are currently undergoing an evolution towards more person-centred care. However, an overview of the literature shows that there is little or no guidance available on how to apply person-centred care to pharmaceutical care and clinical pharmacy practices. In this paper we apply a model for person-centred care created by a national multidisciplinary research centre in Gothenburg, Sweden, to the clinical work tasks of outpatient and inpatient pharmacists and describe how pharmaceutical care can become more person-centred.
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Affiliation(s)
- Hanna Gyllensten
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Gothenburg, Sweden. .,Centre for Person-Centred Care (GPCC), University of Gothenburg, Box 457, 405 30, Gothenburg, Sweden.
| | - Joanne M Fuller
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Box 457, 405 30, Gothenburg, Sweden
| | - Malin Johansson Östbring
- eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden.,Pharmaceutical Department, Region Kalmar County, Kalmar, Sweden
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25
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Oelschlägel L, Dihle A, Christensen VL, Heggdal K, Moen A, Österlind J, Steindal SA. Implementing welfare technology in palliative homecare for patients with cancer: a qualitative study of health-care professionals' experiences. BMC Palliat Care 2021; 20:146. [PMID: 34535125 PMCID: PMC8448170 DOI: 10.1186/s12904-021-00844-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/09/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Introducing welfare technology in home-based palliative care has been suggested to be beneficial for improving access to health care at home and enhancing patients' feelings of security and safety. However, little is known about the experiences of municipal health-care professionals using welfare technology in palliative home care. The aim of this study was to explore municipal health-care professionals' experiences regarding the significant challenges, facilitators, and assessments associated with implementing a technological solution named "remote home care" in palliative home care for patients with cancer. METHODS A qualitative, descriptive, exploratory design was used. Data were collected through focus-group interviews and individual semi-structured interviews with interdisciplinary health-care professionals who had experience using remote home care in clinical encounters with cancer patients who were in the palliative phase and living at home. Data were analyzed using qualitative content analysis. RESULTS Three themes were identified: 1) shifting from objective measures to assessing priorities for patients, 2) lack of experience and personal distress regarding cancer inhibits professional care, and 3) prominent organizational challenges undermine the premise of remote home care. CONCLUSION The results showed that shifting from a disease-focused to a person-centered approach enables health-care professionals to assess patients' personal priorities. However, health-care professionals' uncertainty and lack of knowledge and experience, along with organizational issues concerning information-sharing, represent great challenges that have the potential to inhibit professional care. The availability of networks through which difficult issues can be discussed was highlighted as being a fundamental resource for facilitating the provision of care.
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Affiliation(s)
- Lina Oelschlägel
- Lovisenberg Diaconal University College, Lovisenberggata 15B, 0456, Oslo, Norway.
- Department of Nursing, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Alfhild Dihle
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Vivi L Christensen
- Lovisenberg Diaconal University College, Lovisenberggata 15B, 0456, Oslo, Norway
- University of South-Eastern Norway, Drammen, Norway
| | - Kristin Heggdal
- Lovisenberg Diaconal University College, Lovisenberggata 15B, 0456, Oslo, Norway
| | - Anne Moen
- Department of Nursing, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jane Österlind
- Department of Healthcare Sciences/Palliative Research Center, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Simen A Steindal
- Lovisenberg Diaconal University College, Lovisenberggata 15B, 0456, Oslo, Norway
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
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Uritani D, Ikeda A, Shironoki T, Matsubata K, Mutsura Y, Fujii T, Ikeda K. Perceptions, beliefs, and needs of Japanese people with knee osteoarthritis during conservative care: a qualitative study. BMC Musculoskelet Disord 2021; 22:754. [PMID: 34479525 PMCID: PMC8417949 DOI: 10.1186/s12891-021-04641-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/19/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Patients' perceptions and beliefs of disease could be influenced by their lifestyle and culture. Although it is important to understand their perceptions and beliefs toward disease to prevent and manage osteoarthritis (OA) through conservative care, this topic has not been investigated in Japanese people with knee OA. Therefore, this qualitative study aims to clarify how Japanese patients with knee OA experience and perceive their symptoms and disabilities, and how they face them during conservative care. METHODS Participants were recruited by purposive sampling. Face-to-face, semi-structured interviews were conducted with nine patients (2 men and 7 women; mean age, 74.3 ± 5.5 years) with knee OA until data saturation was reached. Interview data comprised participants' accounts of particular personal experiences of living with knee OA, including their perceptions and attitudes toward knee OA-related symptoms and disabilities. Two physiotherapists (one with extensive experience conducting qualitative studies) and four physiotherapy students conducted the interviews. Recorded interview data were transcribed verbatim in Japanese. Data analysis, including developing a coding scheme, was conducted based on a grounded theory approach. RESULTS Two core categories were extracted from the data: 'Negative experiences' and 'Coping with difficulties'. 'Negative experiences' included three main categories: 'Self-analysis on the cause of knee OA', 'Difficulties in daily life due to knee symptoms', and 'Psychological barrier'. 'Coping with difficulties' included three main categories: 'How to deal with knee pain and difficulty in moving', 'Information considered useful to cope with knee OA' and 'Importance of connecting with others'. Japanese patients with knee OA desired evidence-based information and to connect with other people in the same situation to solve problems related to their condition. CONCLUSIONS To address patients' concerns, medical professionals should conduct careful interviews and obtain information regarding patients' past experiences, and understand their experiences related to knee OA. Symptoms and difficulties experienced by patients with knee OA should be managed by evidence-based information integrating their perceptions and beliefs toward knee OA.
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Affiliation(s)
- Daisuke Uritani
- Department of Physical Therapy, Faculty of Health Science, Kio University, 4-2-2, Umaminaka, Koryocho, Kitakatsuragigun, Nara, 6350832, Japan.
| | - Akane Ikeda
- Department of Physical Therapy, Faculty of Health Science, Kio University, 4-2-2, Umaminaka, Koryocho, Kitakatsuragigun, Nara, 6350832, Japan
| | - Toru Shironoki
- Department of Physical Therapy, Faculty of Health Science, Kio University, 4-2-2, Umaminaka, Koryocho, Kitakatsuragigun, Nara, 6350832, Japan
| | - Kentaro Matsubata
- Department of Physical Therapy, Faculty of Health Science, Kio University, 4-2-2, Umaminaka, Koryocho, Kitakatsuragigun, Nara, 6350832, Japan
| | - Yuto Mutsura
- Department of Physical Therapy, Faculty of Health Science, Kio University, 4-2-2, Umaminaka, Koryocho, Kitakatsuragigun, Nara, 6350832, Japan
| | - Tadashi Fujii
- Department of Orthopaedic surgery, Kashiba Asahigaoka Hospital, 839, Kaminaka, Kashiba city, Nara, 6390265, Japan
| | - Koji Ikeda
- Department of Rehabilitation, Faculty of Health Science, Naragakuen University, 3-15-1, Nakatomigaoka, Nara city, Nara, 6318524, Japan
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Lucoveis MDLS, Rolim LCDSP, Pedrosa HC, Roberto de Sá J, Armstrong DG, Boccara de Paula MA, Gamba MA. Development and validation of a pocket guide for the prevention of diabetic foot ulcers. ACTA ACUST UNITED AC 2021; 30:S6-S15. [PMID: 34170740 DOI: 10.12968/bjon.2021.30.12.s6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Diabetic foot ulcers can have serious consequences, including amputation. This project aimed to develop and validate a diabetes care management model-a pocket guide on the prevention of foot ulceration to assist health professionals and scientific societies. METHODS An adaptation of the Iowa method of evidence-based practice to promote high-quality care was employed. After problems are identified, the Iowa method supports the development of an action plan for addressing them. An evidence-based protocol based on the five cornerstones of the 2015 guidance on the diabetic foot by the International Working Group on the Diabetic Foot was developed in two phases and validated using the Delphi technique. RESULTS A model was developed to promote these five cornerstones, which are the main recommendations for managing the diabetic foot. These are: foot examination; risk assessment for ulceration; education in diabetes; appropriate footwear; and treatment of pre-ulcerative lesions. To adapt this into a health information document, the management model was synthesised and designed as a pocket guide. The model's individual and global content validity indices surpass 0.78 and 0.90 respectively. CONCLUSION A management model was created and validated, and produced as a pocket guide to deliver instructions on the care and prevention of diabetic foot problems in people with diabetes.
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Affiliation(s)
| | | | - Hermelinda Cordeiro Pedrosa
- Coordinator, Coordinatory of Research, FEPECS (Health Sciences Teaching and Research Foundation), Endocrinology Unit of Taguatinga Regional Hospital, Health Secretariat, Brasilia, Brazil
| | - João Roberto de Sá
- Affiliate professor, Discipline of Endocrinology and Metabology, Federal University of São Paulo, São Paulo, Brazil
| | - David G Armstrong
- Professor of Surgery and Director, Southwestern Academic Limb Salvage Alliance, Keck School of Medicine of University of Southern California, USA
| | | | - Mônica Antar Gamba
- Associate Professor, Department of Nursing, Federal University of São Paulo, São Paulo, Brazil
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Feletti F, Mellini L, Pironi F, Carnevale A, Parenti GC. Role of the cytopathologist during the procedure of fine-needle aspiration biopsy of thyroid nodules. Insights Imaging 2021; 12:111. [PMID: 34370089 PMCID: PMC8350303 DOI: 10.1186/s13244-021-01053-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 07/05/2021] [Indexed: 01/30/2023] Open
Abstract
Purpose This study aimed to conduct a diagnostic and cost-effective analysis of the cytopathology assistance in the ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) for characterising thyroid nodules. Materials and methods We reviewed the reports relative to 9061 US-guided FNABs for the histologic definition of the nature of thyroid nodules: 45.4% completed with the cytopathologist assistance and 54.6% by the radiologist alone. We also performed the cost-effectiveness analysis (CEA) of the procedure with and without the cytopathologist assistance. Results We found a significant positive correlation between the adoption/non-adoption of cytopathologist assistance and the number of indeterminate (TIR1) (Chi-square; z-score, Z = 10.22; critical value 5%, C = 1.96; p < 0.001). The cytopathologist's absence was correlated with the number of TIR 1 (Pearson correlation, product–moment correlation r = 0.059; critical value 5%, C = 0.008; p < 0.001). The total cost of the model's cytopathologist-assistance branch is 109.87€, while the total cost of the non-cytopathologist-assistance branch is 95.08€. Conclusion The cytopathologist assistance resulted in fewer nondiagnostic results, thus excluding the procedure's repetition but involved a higher expense, mainly due to the professional cost of the pathologist's participation. These data may provide decision-makers in healthcare with a practical evidence based on the opportunity to include the cytopathologist assistance in the thyroid nodule's FNAB depending on the available resources and the population's expectance. Supplementary information The online version contains supplementary material available at 10.1186/s13244-021-01053-y.
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Affiliation(s)
- F Feletti
- Department of Diagnostic Imaging Ausl Romagna, Unit of Radiology, S. Maria Delle Croci Hospital, Viale Randi 5, Ravenna, Italy.
| | - L Mellini
- Department of Diagnostic Imaging Ausl Romagna, Unit of Radiology, S. Maria Delle Croci Hospital, Viale Randi 5, Ravenna, Italy
| | - F Pironi
- DAMeTLab, Unit of Anatomical Pathology, S. M. Delle Croci Hospital, Ravenna, Italy
| | - A Carnevale
- Department of Radiology, University Radiology Unit, Sant'Anna University Hospital, Ferrara, Italy
| | - G C Parenti
- Department of Diagnostic Imaging Ausl Romagna, Unit of Radiology, S. Maria Delle Croci Hospital, Viale Randi 5, Ravenna, Italy
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Coma E, Mora N, Peremiquel-Trillas P, Benítez M, Méndez L, Mercadé A, Fina F, Fàbregas M, Medina M. Influence of organization and demographic characteristics of primary care practices on continuity of care: analysis of a retrospective cohort from 287 primary care practices covering about 6 million people in Catalonia. BMC Fam Pract 2021; 22:56. [PMID: 33761874 PMCID: PMC7992318 DOI: 10.1186/s12875-021-01414-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 03/11/2021] [Indexed: 11/10/2022]
Abstract
Background There is evidence that an ongoing patient-physician relationship is associated with improved health outcomes and more efficient health systems. The main objective of this study is to describe the continuity of care in primary healthcare in Catalonia (Spain) and to analyze whether the organization of primary care practices (PCP) or their patients’ sociodemographic characteristics play a role in its continuity of care. Methods Four indices were used to measure continuity of care: Usual Provider Index (UPC), Modified Modified Continuity Index (MMCI), Continuity of Care Index (COC), and Sequential Continuity Index (SECON). The study was conducted on 287 PCP of the Catalan Institute of Health (Institut Català de la Salut—ICS). Each continuity of care index was calculated at the patient level (3.2 million patients and 35.5 million visits) and then aggregated at the PCP level. We adjusted linear regression models for each continuity index studied, considering the result of the index as an independent variable and demographic and organizational characteristics of the PCP as explanatory variables. Pearson correlation tests were used to compare the four continuity of care indices. Results Indices’ results were: UPC: 70,5%; MMCI: 73%; COC: 53,7%; SECON: 60,5%. The continuity of care indices had the highest bivariate correlation with the percentage of appointments booked with an assigned health provider (VISUBA variable: the lower the value, the higher the visits without an assigned health provider, and thus an organization favoring immediate consultation). Its R2 ranged between 56 and 63%, depending on the index. The multivariate model which explained better the variability of continuity of care indices (from 49 to 56%) included the variables VISUBA and rurality with a direct relationship; while the variables primary care physician leave days and training practices showed an inverse relationship. Conclusion Study results suggest that an organization of primary care favoring immediate consultation is related to a lower continuity of patient care. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01414-y.
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Affiliation(s)
- Ermengol Coma
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007, Barcelona, Spain.
| | - Núria Mora
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007, Barcelona, Spain.,Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Paula Peremiquel-Trillas
- Preventive Medicine and Epidemiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Unit of Molecular Epidemiology and Genetics in Infections and Cancer, IDIBELL, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Mència Benítez
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007, Barcelona, Spain.,Equip d'Atenció Primària Gòtic, Institut Català de La Salut (ICS), Barcelona, Spain
| | - Leonardo Méndez
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007, Barcelona, Spain
| | - Albert Mercadé
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007, Barcelona, Spain
| | - Francesc Fina
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007, Barcelona, Spain
| | - Mireia Fàbregas
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007, Barcelona, Spain
| | - Manuel Medina
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007, Barcelona, Spain
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Beks H, Namara KM, Manias E, Dalton A, Tong E, Dooley M. Hospital pharmacists' experiences of participating in a partnered pharmacist medication charting credentialing program: a qualitative study. BMC Health Serv Res 2021; 21:251. [PMID: 33740978 PMCID: PMC7980669 DOI: 10.1186/s12913-021-06267-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 03/10/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Medication-related errors are one of the most frequently reported incidents in hospitals. With the aim of reducing the medication error rate, a Partnered Pharmacist Medication Charting (PPMC) model was trialled in seven Australian hospitals from 2016 to 2017. Participating pharmacists completed a credentialing program to equip them with skills to participate in the trial as a medication-charting pharmacist. Skills included obtaining a comprehensive medication history to chart pre-admission medications in collaboration with an admitting medical officer. The program involved both theoretical and practical components to assess the competency of pharmacists. METHODS A qualitative evaluation of the multi-site PPMC implementation trial was undertaken. Pharmacists and key informants involved in the trial participated in an interview or focus group session to share their experiences and attitudes regarding the PPMC credentialing program. An interview schedule was used to guide sessions. Transcripts were analysed using a pragmatic inductive-deductive thematic approach. RESULTS A total of 125 participants were involved in interviews or focus groups during early and late implementation data collection periods. Three themes pertaining to the PPMC credentialing program were identified: (1) credentialing as an upskilling opportunity, (2) identifying the essential components of credentialing, and (3) implementing and sustaining the PPMC credentialing program. CONCLUSIONS The PPMC credentialing program provided pharmacists with an opportunity to expand their scope of practice and consolidate clinical knowledge. Local adaptations to the PPMC credentialing program enabled pharmacists to meet the varying needs and capacities of hospitals, including the policies and procedures of different clinical settings. These findings highlight key issues to consider when implementation a credentialing program for pharmacists in the hospital setting.
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Affiliation(s)
- Hannah Beks
- School of Medicine, Deakin University, Geelong, Victoria, Australia.
| | - Kevin Mc Namara
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Deakin University, Burwood, Australia
| | - Andrew Dalton
- School of Health and Social Development, Deakin University, Burwood, Australia
| | - Erica Tong
- Alfred Health, Prahran, Victoria, Australia
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Duarte GDC, Neto FGF, Júnior JFCM, Langhi DM. Implementation of a patient blood management program based on a low-income country-adapted clinical decision support system. Hematol Transfus Cell Ther 2021; 44:374-378. [PMID: 33741301 PMCID: PMC9477781 DOI: 10.1016/j.htct.2020.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/06/2020] [Accepted: 12/08/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction Patient blood management (PBM) programs are associated with better patient outcomes, a reduced number of transfusions and cost-savings The Clinical Decision Support (CDS) systems are valuable tools in this process, but their availability is limited in developing countries This study assesses the feasibility and effectiveness of an adapted CDS system for low-income countries. Methods This was a prospective study of the PBM program implementation, in a 200-bed tertiary hospital, between February 2019 and May 2020. Outcome measures were red blood cell (RBC), fresh frozen plasma (FFP) and platelet unit transfusions, the transfusion of a single unit of red blood cells and an RBC adequacy index (RAI). Results Comparing the post-PBM program era with the pre-PBM system era, there was a decrease in red blood cell transfusions (p = 0.05), with an increase in single unit red blood cell transfusions (p = 0.005) and RAI (p < 0.001). Conclusions The PBM programs, including electronic transfusion guidelines with pre-transfusion medical auditing, was associated with improved transfusion practices and reduced product acquisition-related costs.
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Michael M, Kumle B, Pin M, Kümpers P, Gröning I, Bernhard M. [Nontraumatic resuscitation room management of critically ill patients]. Med Klin Intensivmed Notfmed 2021; 116:405-14. [PMID: 33599782 DOI: 10.1007/s00063-021-00789-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 01/17/2021] [Indexed: 12/03/2022]
Abstract
Kritisch kranke Patienten werden regelmäßig in der prähospitalen Notfallmedizin versorgt. Gerade an der Nahtstelle zwischen prähospitaler und innerklinischer Versorgung besteht eine große Herausforderung darin, die Patientenbehandlung ohne Zeitverlust und auf hohem Niveau fortzuführen. Hierzu gehören die Stabilisierung der Vitalfunktionen (inkl. Atemwegsicherung, nichtinvasive/invasive Beatmung, Kreislaufstabilisierung) und Umsetzung einer geeigneten Diagnostik- und Therapiestrategie (inkl. Laboruntersuchungen, Sonographie, radiologischer Bildgebung). In den letzten Jahren hat sich daher ein Interessens- und Forschungsschwerpunkt zum Thema „nichttraumatologische Schockraumversorgung“ entwickelt. Mittlerweile liegen erste monozentrische Daten vor und es wird kontinuierlich an der Entwicklung eines nichttraumatologischen Schockraummanagements zur optimalen Versorgung von kritisch kranken Patienten in der zentralen Notaufnahme gearbeitet. Der vorliegende Beitrag beschreibt auf der Basis von ersten Studien, Erfahrungen und Expertenmeinungen eine strukturierte Vorgehensweise im nichttraumatologischen Schockraummanagement.
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Patel J, Sharma T, Allan C, Curnew G. Use of Lifestyle Modifications for Management of a Patient with Severely High Total Cholesterol (> 14 mmol/L) and Triglycerides (> 40 mmol/L). J Lifestyle Med 2021; 11:43-46. [PMID: 33763342 PMCID: PMC7957042 DOI: 10.15280/jlm.2021.11.1.43] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/31/2021] [Indexed: 11/22/2022] Open
Abstract
In this report, we describe a case of a 37-year old man who presented with a history of total cholesterol > 14 mmol/L and triglyceride levels > 40 mmol/L. The patient was initially thought to have familial hypercholesterolemia due to his elevated total cholesterol, by his family physician. He was prescribed evolucumab, a proprotein convertase subtilisin/ kexin type 9 inhibitor drug which has shown efficacy for lowering low-density lipoprotein-cholesterol levels, to reduce his high total cholesterol. However, in this patient, the elevated total cholesterol was likely due to hypertriglyceridemia, rather than increased low-density lipoprotein-cholesterol levels. Through this case we provide an approach for the clinical management of patients with elevated total cholesterol with underlying triglycerides ≥ 10 mmol/L. The primary intervention for management of triglycerides ≥ 10 mmol/L involves lifestyle modifications including, changes in diet, exercise, reduction in body mass index, and abstinence from alcohol consumption. Secondary intervention involves management through pharmacotherapy with fibrates and statins. Creating a plan of action with the patient, incorporating lifestyle modifications alone, the patient was able to reduce the triglycerides from an average of 44.94 mmol/L to 3.28 mmol/L.
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Affiliation(s)
| | | | - Connor Allan
- Faculty of Sciences, McMaster University, ON, Canada
| | - Gregory Curnew
- Michael G. DeGroote School of Medicine, ON, Canada.,Division of Cardiology, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, ON, Canada
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Connor KI, Siebens HC, Mittman BS, McNeese-Smith DK, Ganz DA, Barry F, Edwards LK, McGowan MG, Cheng EM, Vickrey BG. Stakeholder perceptions of components of a Parkinson disease care management intervention, care coordination for health promotion and activities in Parkinson's disease (CHAPS). BMC Neurol 2020; 20:437. [PMID: 33267827 PMCID: PMC7708498 DOI: 10.1186/s12883-020-02011-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 11/23/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND A recent nurse-led proactive care management intervention, Care Coordination for Health Promotion and Activities in Parkinson Disease (CHAPS), improved care quality when compared to usual care in a randomized controlled trial. Therefore, stakeholder (patient participants, nurse care managers, and Parkinson disease (PD) specialists) perceptions of key intervention components merit evaluation to inform decisions about dissemination. METHODS This multi-site study occurred in five southwest United States Veterans Health Administration medical centers. Stakeholders were surveyed on their perceptions of CHAPS including the CHAPS Assessment, CHAPS nurse care managers, the Siebens Domain Management Model™ (a practical clinical model), and the Siebens Health Care Notebook (Notebook) (self-care tool). Participants' electronic medical records were abstracted for perceptions of the Notebook. Statistical analysis software was used to provide summary statistics; open card sorting methodology was used to identify themes and attributes in qualitative data including usability of some components. RESULTS Participants, overall, highly rated their medication self-management, acknowledged some challenges with the CHAPS self-care tools, reported knowledge of PD specialist follow-up and PD red flags, and rated CHAPS nurse care managers as helpful. Nurse care manager responses indicated the CHAPS Assessment and Program highly facilitated care of their patients. Most all PD specialists would refer other patients to CHAPS. Nurse care manager and PD specialist responses indicated improved participant management of their PD. Three themes emerged in participant perceptions of the Notebook: Notebook Assets (e.g., benefits and features-liked); Deferring Notebook Review (e.g., no time to review); and Reasons for Not Using (e.g., participant preference). Shared attributes regarding the Siebens Domain Management Model and Notebook usability, reported by nurse care managers, were user-friendly, person/patient-centered, and organized. Some challenges to their use were also reported. CONCLUSIONS Overall, stakeholder perceptions of the proactive nurse-led CHAPS intervention indicated its value in the care of individuals with PD. Responses about the CHAPS Assessment, Siebens Domain Management Model, and Notebook self-care tool signified their usefulness. Stakeholders' constructive suggestions indicated their engagement in CHAPS. These findings support CHAPS dissemination and contribute to research in care management. TRIAL REGISTRATION ClinicalTrials.gov as NCT01532986 , registered on January 13, 2012.
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Affiliation(s)
- Karen I. Connor
- Veterans Affairs Parkinson’s Disease Research, Education and Clinical Center, Los Angeles, CA USA
- UCLA David Geffen School of Medicine, Los Angeles, CA USA
- Novato, CA USA
| | | | | | | | - David A. Ganz
- UCLA David Geffen School of Medicine, Los Angeles, CA USA
- Veterans Affairs Geriatric Research, Education and Clinical Center and Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA USA
| | - Frances Barry
- UCLA David Geffen School of Medicine, Los Angeles, CA USA
| | - Lisa K. Edwards
- Veterans Affairs Parkinson’s Disease Research, Education and Clinical Center, Los Angeles, CA USA
| | - Michael G. McGowan
- Veterans Affairs Parkinson’s Disease Research, Education and Clinical Center, Los Angeles, CA USA
| | - Eric M. Cheng
- UCLA David Geffen School of Medicine, Los Angeles, CA USA
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Schlett CL, Rospleszcz S, Korbmacher D, Lorbeer R, Auweter S, Hetterich H, Selder S, Heier M, Linkohr B, Weckbach S, Ertl-Wagner B, Peters A, Bamberg F. Incidental findings in whole-body MR imaging of a population-based cohort study: Frequency, management and psychosocial consequences. Eur J Radiol 2020; 134:109451. [PMID: 33279799 DOI: 10.1016/j.ejrad.2020.109451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/27/2020] [Accepted: 11/22/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Management of incidental findings (IF) remains controversial but highly relevant. Our aim was to assess the frequency, management and psychosocial consequences of IF reporting in a population-based cohort study undergoing whole-body MR imaging. METHODS The study was nested in a prospective cohort from a longitudinal, population-based cohort (KORA-FF4) in southern Germany. All MR obtained on 3 T MR scanner were reviewed by board-certified radiologists regarding clinically relevant IF. A baseline and follow-up questionnaires including PHQ-9 were completed prior to and 6-month after to the scan. RESULTS Of 400 participants (56.3 ± 9.2years, 58 % male) undergoing whole-body MR, IF were found in 22 % of participants (n = 89); most frequently located in the abdominal sequences. In the pre-scan survey, most participants stated as the motivation that they wanted to "contribute to a scientific purpose" (91 %), while "knowing whether I'm healthy" was the most frequent motivation reported 6 months post-scan (88 %). The desire for IF reporting increased over time (pre- vs. 6-months-post-scan), also for clinically less important IF (72 % vs. 84 %, p = 0.001). Regarding psychosocial impact, a small portion (3.4 %) reported that awaiting the IF report added "definitely" or "very probably" additional stress burden. Of participants with reported IF, 56.8 % classified the results as "very helpful". In the post-scan survey moderate depression was observed in 3.3 % and severe depression in 1.2 %. This did not differ between participants with and without reported IF. CONCLUSION In a cohort with whole-body MR imaging, the prevalence of IF was high. Participants considered reporting of IF highly important and added only minor psychological burden.
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Affiliation(s)
- Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Susanne Rospleszcz
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Dorina Korbmacher
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Roberto Lorbeer
- Department of Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Sigrid Auweter
- Department of Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Holger Hetterich
- Department of Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Sonja Selder
- Department of Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Margit Heier
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany; KORA Study Centre, University Hospital Augsburg, Augsburg, Germany
| | - Birgit Linkohr
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Sabine Weckbach
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Birgit Ertl-Wagner
- Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-University Munich, Munich, Germany; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Levan ML, Waldram MM, DiBrito SR, Thomas AG, Al Ammary F, Ottman S, Bannon J, Brennan DC, Massie AB, Scalea J, Barth RN, Segev DL, Garonzik-Wang JM. Financial incentives versus standard of care to improve patient compliance with live kidney donor follow-up: protocol for a multi-center, parallel-group randomized controlled trial. BMC Nephrol 2020; 21:465. [PMID: 33167882 PMCID: PMC7654057 DOI: 10.1186/s12882-020-02117-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 10/21/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Live kidney donors (LKDs) account for nearly a third of kidney transplants in the United States. While donor nephrectomy poses minimal post-surgical risk, LKDs face an elevated adjusted risk of developing chronic diseases such as hypertension, diabetes, and end-stage renal disease. Routine screening presents an opportunity for the early detection and management of chronic conditions. Transplant hospital reporting requirements mandate the submission of laboratory and clinical data at 6-months, 1-year, and 2-years after kidney donation, but less than 50% of hospitals are able to comply. Strategies to increase patient engagement in follow-up efforts while minimizing administrative burden are needed. We seek to evaluate the effectiveness of using small financial incentives to promote patient compliance with LKD follow-up. METHODS/DESIGN We are conducting a two-arm randomized controlled trial (RCT) of patients who undergo live donor nephrectomy at The Johns Hopkins Hospital Comprehensive Transplant Center (MDJH) and the University of Maryland Medical Center Transplant Center (MDUM). Eligible donors will be recruited in-person at their first post-surgical clinic visit or over the phone. We will use block randomization to assign LKDs to the intervention ($25 gift card at each follow-up visit) or control arm (current standard of care). Follow-up compliance will be tracked over time. The primary outcome will be complete (all components addressed) and timely (60 days before or after expected visit date), submission of LKD follow-up data at required 6-month, 1-year, and 2-year time points. The secondary outcome will be transplant hospital-level compliance with federal reporting requirements at each visit. Rates will be compared between the two arms following the intention-to-treat principle. DISCUSSION Small financial incentivization might increase patient compliance in the context of LKD follow-up, without placing undue administrative burden on transplant providers. The findings of this RCT will inform potential center- and national-level initiatives to provide all LKDs with small financial incentives to promote engagement with post-donation monitoring efforts. TRIAL REGISTRATION ClinicalTrials.gov number: NCT03090646 Date of registration: March 2, 2017 Sponsors: Johns Hopkins University, University of Maryland Medical Center Funding: The Living Legacy Foundation of Maryland.
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Affiliation(s)
- Macey L. Levan
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD USA
| | - Madeleine M. Waldram
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
| | - Sandra R. DiBrito
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
| | - Alvin G. Thomas
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC USA
| | - Fawaz Al Ammary
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
| | - Shane Ottman
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
| | - Jaclyn Bannon
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
| | - Daniel C. Brennan
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
| | - Allan B. Massie
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD USA
| | - Joseph Scalea
- Division of Transplantation, University of Maryland School of Medicine, Baltimore, MD USA
| | - Rolf N. Barth
- Division of Transplantation, University of Maryland School of Medicine, Baltimore, MD USA
| | - Dorry L. Segev
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD USA
| | - Jacqueline M. Garonzik-Wang
- Department of Surgery, Division of Transplantation, Johns Hopkins University School of Medicine, 2000 E. Monument Street, Baltimore, MD 21205 USA
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Shimakawa Y, Lemoine M. Reply to: "Validation of the TREAT-B score for hepatitis B treatment eligibility in a large Asian cohort: TREAT-B improves with age". J Hepatol 2020; 73:1284-1285. [PMID: 32859389 DOI: 10.1016/j.jhep.2020.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/03/2020] [Indexed: 12/04/2022]
Affiliation(s)
- Yusuke Shimakawa
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France.
| | - Maud Lemoine
- Department of Surgery and Cancer, Liver Unit, Imperial College London, UK
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Itoh S, Mori T, Jeon B, Morioka N, Ito T, Jin X, Ogata Y, Tamiya N. Comparison of progression of care-need levels among long-term care recipients with and without advanced care management in a rural municipality of Japan: A population-based observational study. Int J Nurs Stud 2020; 113:103804. [PMID: 33189968 DOI: 10.1016/j.ijnurstu.2020.103804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/06/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Little is known about the association between advanced care management and patient outcomes in home settings. In 2009, the Japanese government introduced a financial incentive scheme for advanced care management by long-term care agencies with at least one advanced care manager. However, it remains unclear whether advanced care management in rural areas is associated with improved outcomes for recipients. OBJECTIVE To compare the progression of care-need levels among long-term care recipients in home settings with and without advanced care management. DESIGN A population-based observational study. SETTING A rural municipality in Japan. PARTICIPANTS Recipients of long-term care (n = 2005). METHODS We used individual-level secondary data provided from a rural municipal government that was collected as part of the Survey of Long-Term Care Benefit Expenditures and medical care claim records between April 2012 and March 2017. We linked these two databases using unique identifiers. The inclusion criteria for study subjects were that they: (1) were aged ≥65 years; (2) were newly certified as care-need level 1, 2, or 3; and (3) used long-term care insurance services in home settings from April 2012 through March 2017. We excluded individuals using long-term care insurance services for less than six months. Ultimately, we selected 1722 propensity-matched recipients with and without advanced care management, and then conducted Kaplan-Meier survival analyses and a log-rank test. The outcome measure was progression of care-need levels. RESULTS The proportions of five-year cumulative progression-free survival in the groups with and without advanced care management were 50.3% and 42.2% for recipients of care-need level 1 (p < .01), 34.3% and 32.3% for recipients of care-need level 2 (p < .01), and 22.3% and 24.5% for recipients of care-need level 3 (p > .05), respectively. The progression-free period lasted a median of 12 (interquartile range, 10-24) months for recipients of care-need level 1, 14 (interquartile range, 11-28) months for recipients of care-need level 2, and 12 (interquartile range, 10-24) months for recipients of care-need level 3. CONCLUSIONS Long-term care recipients with advanced care management in home settings had a higher probability of progression of care-need levels in a rural municipality of Japan. This finding suggests that the governmental policy of providing financial incentive for advanced care management may not be effective in improving the outcome of long-term care recipients in a rural municipality of Japan.
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Affiliation(s)
- Sakiko Itoh
- Nursing Career Pathway Center, Department of Gerontological Nursing and Healthcare Systems Management, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan; Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan.
| | - Takahiro Mori
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan; Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan
| | - Boyoung Jeon
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan; Division of Health Services Development for Persons with Disabilities, National Rehabilitation Center, Seoul, 58, Samgaksan-ro, Gangbuk-gu, Seoul 01022, Republic of Korea
| | - Noriko Morioka
- Nursing Career Pathway Center, Department of Gerontological Nursing and Healthcare Systems Management, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Tomoko Ito
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan
| | - Xueying Jin
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan
| | - Yasuko Ogata
- Nursing Career Pathway Center, Department of Gerontological Nursing and Healthcare Systems Management, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Nanako Tamiya
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan; Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan
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Eck M, Plancke L, Horn M, Amad A, Thomas P, Fovet T. [Health care delivery and psychiatric hospitalizations in the prisons of the North of France: An observational study]. Rev Epidemiol Sante Publique 2020; 68:273-81. [PMID: 32900559 DOI: 10.1016/j.respe.2020.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 05/22/2020] [Accepted: 06/24/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In French prisons, psychiatric care for inmates is organized into three levels: ambulatory care within each jail in "unités sanitaires en milieu pénitentiaire" (USMP: sanitary units in correctional settings), day hospitalizations in the 28 services médico-psychologiques régionaux (SMPR, "regional medical-psychological services") and full-time hospitalizations in one of the nine "unités d'hospitalisation spécialement aménagées" (UHSA: specially equipped hospital units). Despite high prevalence of mental disorders among French prisoners, the efficiency of these specialized psychiatric care units has been insufficiently studied. The main goal of this study is to describe full-time psychiatric hospitalizations for inmates in the twenty prisons located in the North of France. METHODS We conducted a descriptive study based on medical and administrative data and survey results. The following data were collected for each prison regarding 2016: 1) number and occupancy rates for mental health professionals and 2) psychiatric hospitalization rates (in the UHSA of Lille-Seclin and the general psychiatric hospitals). RESULTS Provision of care is incomplete: the vacancy rate in the health units studied reaches 40 %. Moreover, access to UHSA is unequal: it varies pronouncedly according to the location of the prison; only inmates in prisons close to the UHSA benefit from satisfactory access. CONCLUSION Access to psychiatric care for inmates remains problematic in France, particularly due to a lack of mental health professionals in USMPs, the overload of patients in UHSAs and the distance of theses facilities from certain prisons and jails.
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Augustin H, Unger L, Lüthke K, Gräßler A. [Outpatient specialist medical care : Regulations and practical example of rheumatology]. Internist (Berl) 2020; 61:922-8. [PMID: 32681226 DOI: 10.1007/s00108-020-00841-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Outpatient specialist medical care targets the intersectoral and interdisciplinary cooperation between hospital physicians and panel physician structures in the diagnostics and treatment of certain disease symptoms under the same framework conditions. The administrative coordination bundled through one person has contributed to an effective placement of applications. In this way the daunting effect of bureaucratic hurdles for potential team members could be intercepted. A close and constructive collaboration of all participants is helpful to come to terms with the new treatment structure and to achieve the anticipated targets for patients, panel physicians and hospitals.
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Connor KI, Siebens HC, Mittman BS, Ganz DA, Barry F, Ernst EJ, Edwards LK, McGowan MG, McNeese-Smith DK, Cheng EM, Vickrey BG. Quality and extent of implementation of a nurse-led care management intervention: care coordination for health promotion and activities in Parkinson's disease (CHAPS). BMC Health Serv Res 2020; 20:732. [PMID: 32778083 PMCID: PMC7418202 DOI: 10.1186/s12913-020-05594-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 07/29/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A recent nurse-led, telephone-administered 18-month intervention, Care Coordination for Health Promotion and Activities in Parkinson's Disease (CHAPS), was tested in a randomized controlled trial and improved care quality. Therefore, intervention details on nurse care manager activity (types and frequencies) and participant actions are needed to support potential dissemination. Activities include nurse care manager use of a holistic organizing framework, identification of Parkinson's disease (PD)-related problems/topics, communication with PD specialists and care coordination, participant coaching, and participant self-care actions including use of a notebook self-care tool. METHODS This article reports descriptive data on the CHAPS intervention. The study setting was five sites in the Veterans Affairs Healthcare System. Sociodemographic data were gathered from surveys of study participants (community-dwelling veterans with PD). Nurse care manager intervention activities were abstracted from electronic medical records and logbooks. Statistical analysis software was used to provide summary statistics; closed card sorting was used to group some data. RESULTS Intervention participants (n = 140) were primarily men, mean age 69.4 years (standard deviation 10.3) and community-dwelling. All received the CHAPS Initial Assessment, which had algorithms designed to identify 31 unique CHAPS standard problems/topics. These were frequently documented (n = 4938), and 98.6% were grouped by assigned domain from the Organizing Framework (Siebens Domain Management Model™). Nurse care managers performed 27 unique activity types to address identified problems, collaborating with participants and PD specialists. The two most frequent unique activities were counseling/emotional support (n = 387) and medication management (n = 349). Both were among 2749 total performed activities in the category Implementing Interventions (coaching). Participants reported unique self-care action types (n = 23) including use of a new notebook self-care tool. CONCLUSIONS CHAPS nurse care managers implemented multiple activities including participant coaching and care coordination per the CHAPS protocol. Participants reported various self-care actions including use of a personalized notebook. These findings indicate good quality and extent of implementation, contribute to ensuring reproducibility, and support CHAPS dissemination as a real-world approach to improve care quality. TRIAL REGISTRATION ClinicalTrials.gov as NCT01532986 , registered on January 13, 2012.
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Affiliation(s)
- Karen I. Connor
- Veterans Affairs Southwest Parkinson’s Disease Research, Education and Clinical Center, Los Angeles, CA USA
- University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA USA
- Novato, USA
| | | | | | - David A. Ganz
- University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA USA
- Veterans Affairs Geriatric Research, Education and Clinical Center and Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA USA
| | - Frances Barry
- University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA USA
| | - E. J. Ernst
- American Association of Nurse Practitioners, Austin, TX USA
| | - Lisa K. Edwards
- Veterans Affairs Southwest Parkinson’s Disease Research, Education and Clinical Center, Los Angeles, CA USA
| | - Michael G. McGowan
- Veterans Affairs Southwest Parkinson’s Disease Research, Education and Clinical Center, Los Angeles, CA USA
| | | | - Eric M. Cheng
- University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA USA
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Grassi MO, Furino C, Recchimurzo N, De Vitis F, Sborgia G, Sborgia L, Meleleo A, Molfetta T, Piepoli M, Locatelli P, Boscia F, Alessio G. Implementation of Lean healthcare methodology in designing an Intravitreal Injection Center: first Italian experience. Int Ophthalmol 2020; 40:2607-2615. [PMID: 32514665 DOI: 10.1007/s10792-020-01441-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/23/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The principles of the Lean methodology, introduced by Toyota to improve productivity, are relevant to other settings, including healthcare. We aimed to use Lean methodology to design a new setting in our ophthalmology clinic to improve the management of patients receiving an intravitreal injection for ocular diseases. METHODS The location of services, days of operation, scheduling and processing of patients, utilization of staff, data recording methods, and examination and surgical procedures were analyzed, and a new Intravitreal Injection Center was developed according to Lean principles. RESULTS The new setting, which is confined to a single floor, in contrast to the previous system, which necessitated that patients visit various locations spread over three floors of the hospital, demonstrated benefits for patients and improved the flow and management of patients through the system with a need for fewer team members. The intravitreal injection service improved with regard to both the quality and speed of the overall procedure and the efficient use of staff. CONCLUSION Our aim to achieve a fast and one-way route to move patients through intravitreal injection administration was achieved, limiting any waste of time and space and improving the capacity management of the center. The system is of relevance to other ophthalmology clinic settings and facilitates the collection of valuable epidemiological and clinical information on the response of patients to different drugs and treatment regimens.
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Affiliation(s)
- Maria Oliva Grassi
- Eye Clinic, Azienda Ospedaliero-Universitaria Policlinico, University of Bari, Piazza Giulio Cesare, 11, 70124, Bari, BA, Italy.
| | - Claudio Furino
- Eye Clinic, Azienda Ospedaliero-Universitaria Policlinico, University of Bari, Piazza Giulio Cesare, 11, 70124, Bari, BA, Italy
| | - Nicola Recchimurzo
- Eye Clinic, Azienda Ospedaliero-Universitaria Policlinico, University of Bari, Piazza Giulio Cesare, 11, 70124, Bari, BA, Italy
| | - Fabio De Vitis
- Eye Clinic, Azienda Ospedaliero-Universitaria Policlinico, University of Bari, Piazza Giulio Cesare, 11, 70124, Bari, BA, Italy
| | - Giancarlo Sborgia
- Eye Clinic, Azienda Ospedaliero-Universitaria Policlinico, University of Bari, Piazza Giulio Cesare, 11, 70124, Bari, BA, Italy
| | - Luigi Sborgia
- Eye Clinic, Azienda Ospedaliero-Universitaria Policlinico, University of Bari, Piazza Giulio Cesare, 11, 70124, Bari, BA, Italy
| | - Arianna Meleleo
- Eye Clinic, Azienda Ospedaliero-Universitaria Policlinico, University of Bari, Piazza Giulio Cesare, 11, 70124, Bari, BA, Italy
| | - Teresa Molfetta
- Eye Clinic, Azienda Ospedaliero-Universitaria Policlinico, University of Bari, Piazza Giulio Cesare, 11, 70124, Bari, BA, Italy
| | - Marina Piepoli
- Eye Clinic, Azienda Ospedaliero-Universitaria Policlinico, University of Bari, Piazza Giulio Cesare, 11, 70124, Bari, BA, Italy
| | | | - Francesco Boscia
- Eye Clinic, Azienda Ospedaliero-Universitaria Policlinico, University of Bari, Piazza Giulio Cesare, 11, 70124, Bari, BA, Italy
| | - Giovanni Alessio
- Eye Clinic, Azienda Ospedaliero-Universitaria Policlinico, University of Bari, Piazza Giulio Cesare, 11, 70124, Bari, BA, Italy
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Abstract
Critical incidents in hospitals can often be predicted hours before the event and can mostly be detected earlier and presumably avoided. Quality management programs from US hospitals to reduce deaths following a severe postoperative complication (failure to rescue, FTR), have in this form not yet become established in Germany. A sensitive score-based early warning system for looming complications is decisive for successful in-hospital emergency management. In addition to measurement rounds where the frequency is adapted to the severity, this includes effective communication of the results to the ward physician, who in the best case scenario solves the problem alone. If the deployment of a medical rapid response emergency team (MET) is necessary, there must be clear chain of alarm pathways and the personnel on the ward must be able to take initial bridging action until the MET arrives. The MET provides 24/7 emergency and intensive medical expertise for peripheral wards and must be familiar with the location, well-equipped and trained. Communication skills are particularly required not only to be able to handle the immediate emergency situation but also to organize the downstream diagnostics and escalation of treatment; however, the MET is only one of the links in the in-hospital rescue chain, which can only improve the patient outcome when alerted in a timely manner. Feedback systems, such as participation in the German Resuscitation Registry, allow reflection of one's own performance in a national comparison. The chances offered by a MET will only be fully realized when it is integrated into an in-hospital emergency concept and this determines the added value for patient safety.
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Zhang J, Peng P, Li X, Zha YF, Xiang Y, Zhang GN, Zhang Y. [Management strategies for three patients with gynecological malignancies during the outbreak of COVID-19]. Zhonghua Fu Chan Ke Za Zhi 2020; 55:221-226. [PMID: 32174096 DOI: 10.3760/cma.j.cn112141-20200302-00168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the management strategies for patients with gynecological malignant tumors during the outbreak and transmission of COVID-19. Methods: We retrospectively analyzed the clinical characteristics, treatment, and disease outcomes of three patients with gynecological malignancies associated with COVID-19 in Renmin Hospital of Wuhan University, and proposed management strategies for patients with gynecological tumors underriskof COVID-19. Results: Based on the national diagnosis and treatment protocol as well as research progress for COVID-19, three patients with COVID-19 were treated. Meanwhile, they were also appropriately adjusted the treatment plan in accordance with the clinical guidelines for gynecological tumors. Pneumonia was cured in 2 patients, and one patient died of COVID-19. Conclusions: Patients with gynecological malignant tumors are high-risk groups prone to COVID-19, and gynecological oncologists need to carry out education, prevention, control and treatment according to specific conditions. While, actively preventing and controlling COVID-19, the diagnosis and treatment of gynecological malignant tumors should be carried out in an orderly and safe manner.
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Affiliation(s)
- J Zhang
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - P Peng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - X Li
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Y F Zha
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Y Xiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - G N Zhang
- Department of Gynecologic Oncology, Sichuan Cancer Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China
| | - Y Zhang
- Department of Obstetrics and Gynecology, Renmin Hospital of Wuhan University, Wuhan 430060, China
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van Voorst H, Arnold AER. Cost and health effects of case management compared with outpatient clinic follow-up in a Dutch heart failure cohort. ESC Heart Fail 2020; 7:1136-1144. [PMID: 32301235 PMCID: PMC7261554 DOI: 10.1002/ehf2.12692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 03/03/2020] [Accepted: 03/11/2020] [Indexed: 12/28/2022] Open
Abstract
Aims Heart failure reduces quality of life and life expectancy; hospital admissions are frequent and create a burden on public resources. This study aims to quantify the benefits in terms of health effects [quality‐adjusted life years (QALYs)] and costs when heart failure patients receive case management at home compared with outpatient cardiology clinic follow‐up. Methods and results A health state transition (Markov) model was written, and transition probabilities were derived from a cohort of 1114 patients and available literature. QALYs in different health states of heart failure patients were retrieved from the literature, and costs were estimated with data from the financial department of the Noordwest Ziekenhuisgroep and public cost sources. Monthly simulation cycles were repeated 60 times to generate 5 years of virtual follow‐up data. Baseline willingness to pay is assumed €50 000 per QALY. Sensitivity analyses were performed in a one‐way deterministic and a multiway probabilistic approach; the probabilistic approach used uniform and more plausible distributions of the model parameters. Case management reduced costs by €382 and increased QALYs by 0.261 for the baseline simulation; this results in a net monetary benefit of €13 428. Probabilistic sensitivity analysis based on uniform and most plausible distributions of parameters resulted in 96.2% and 83.3% of the simulations, favouring a treatment strategy of case management. Conclusions Case management is cost effective in 83.3% of the probabilistic simulations and has a tendency towards reducing costs and increasing QALYs when considering a real‐world cohort of heart failure patients in the Netherlands.
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Affiliation(s)
- Henk van Voorst
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, VU Amsterdam Main building, De Boelelaan 1105, Amsterdam, 1081 HV, the Netherlands.,Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
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Beazer J, Breck J, Eggerding C, Gordon P, Hacker S, Thompson A; PKU Lost to Follow-Up Recommendations Group. Strategies to engage lost to follow-up patients with phenylketonuria in the United States: Best practice recommendations. Mol Genet Metab Rep 2020; 23:100571. [PMID: 32140415 DOI: 10.1016/j.ymgmr.2020.100571] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 01/24/2020] [Accepted: 01/24/2020] [Indexed: 12/04/2022] Open
Abstract
Background Phenylketonuria (PKU) is a rare autosomal recessive disorder caused by mutations in the gene encoding phenylalanine hydroxylase, an enzyme that converts phenylalanine to tyrosine. Untreated, PKU is characterized by a range of neuropsychological and neurocognitive impairments. Due to ubiquitous newborn genetic screening programs, treatment for PKU can be commenced shortly after birth and can prevent many of the severe manifestations of the disease. However, lifelong management is critical for patients with PKU as high levels of phenylalanine are neurotoxic. As for all chronic diseases, long-term management can be challenging and most adult patients with PKU become lost to follow-up (LTFU). A survey of PKU clinics across the United States and a multidisciplinary Expert Meeting were conducted to develop best practices to engage LTFU patients with PKU. Results We defined LTFU patients with PKU as “patients with no contact with the clinic for at least 2 consecutive years.” Combining the results from our survey and our discussion at the Expert Meeting, we have prepared six best practice recommendations to engage LTFU patients with PKU: 1) Ensure patients are aware of the current treatment guidelines for PKU; 2) Communicate to patients any new treatment and diet options as they become available for PKU; 3) Consider the neuropsychological and neurocognitive aspects of PKU; 4) Prioritize motivated LTFU patients; 5) Explore new approaches of outreach to LTFU patients; and 6) Formalize approaches to track and/or identify PKU patients. Conclusion We strongly advocate the importance of engaging LTFU patients with PKU and encourage implementation of our best practice recommendations. Although it takes time and effort to engage LTFU patients, we believe that clinics are capable of supporting this significant patient group.
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Byrne N, Turner J, Marron R, Lambert DM, Murphy DN, O'Sullivan G, Mason M, Broderick F, Burke MC, Casey S, Doyle M, Gibney D, Mason F, Molony D, Ormond D, O' Sé C, O'Shea C, Treacy EP. The role of primary care in management of rare diseases in Ireland. Ir J Med Sci 2020; 189:771-776. [PMID: 31933130 PMCID: PMC7363724 DOI: 10.1007/s11845-019-02168-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 12/24/2019] [Indexed: 12/12/2022]
Abstract
Background ‘Slaintecare’ aims to address complex patient care needs in an integrated fashion with an emphasis on patient-centred, patient-empowered community care.Currently there is a lack of knowledge of the impact of rare disease management in primary care and of the information tools required by general practitioners to deliver integrated care for rare disease patients. Aims To complete a pilot survey to estimate the general practice clinical workload attributable to selected rare diseases and assess the use of relevant information sources. Methods A retrospective cross-sectional survey was carried out of general practice consultations (2013–2017) for patients with 22 commonly recognised rare diseases. Results Around 31 general practitioners from 10 Irish practices completed information on 171 patients with rare diseases over 3707 consultations. General practice-specific coding systems were inadequate for rare disease patient identification. Over 139 (81.3%) patients were adult, and 32 (18.7%) were children. Management of care was hospital and not primary care based in 63%. Those eligible for state-reimbursed care had a significantly higher median number of consultations (23 consultations, IQR = 13–37, or 5.8 consultations/year) than those who paid privately (10 consultations, IQR = 4–19, or 2.5 consultations/year) (p < 0.005).General practitioners had access to public information resources on rare diseases but few had knowledge of (35.5%), or had ever used (12.9%) Orphanet, the international rare disease information portal. Conclusions Both specific rare disease-specific coding and use of the relevant rare disease information sources are lacking in general practice in Ireland.
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Affiliation(s)
- Niall Byrne
- National Rare Disease Office, Eccles St, Dublin, D07 R2WY, Ireland
| | | | - Rita Marron
- National Rare Disease Office, Eccles St, Dublin, D07 R2WY, Ireland
| | | | - Daniel N Murphy
- National Rare Disease Office, Eccles St, Dublin, D07 R2WY, Ireland
| | - Grace O'Sullivan
- National Rare Disease Office, Eccles St, Dublin, D07 R2WY, Ireland
- National Clinical Programme for Rare Diseases, HSE and RCPI, Dublin, Ireland
| | - Maureen Mason
- National Rare Disease Office, Eccles St, Dublin, D07 R2WY, Ireland
| | | | - Mary C Burke
- Glasnevin Family Practice, Finglas Road, Glasnevin, Dublin, Ireland
| | - Sheila Casey
- Kingscourt Surgery, Kingscourt, Co. Cavan, Ireland
| | | | - David Gibney
- Ballymun Family Practice, Ballymun, Dublin, Ireland
| | - Fergus Mason
- Johnstown Medical Centre, Cabinteely, Dublin, Ireland
| | - David Molony
- The Red House Family Practice, Mallow, Co., Cork, Ireland
| | | | - Colm O' Sé
- Ballyfermot Medical Centre, Dublin, Ireland
| | - Conor O'Shea
- Wheaton Hall Medical Practice, Co Louth, Drogheda, Ireland
| | - Eileen P Treacy
- National Rare Disease Office, Eccles St, Dublin, D07 R2WY, Ireland.
- National Clinical Programme for Rare Diseases, HSE and RCPI, Dublin, Ireland.
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Shimakawa Y, Boucheron P, Luong Nguyen LB, Lemoine M, Sombié R. Performance of two simplified HBV treatment criteria (TREAT-B score and WHO guidelines) in Burkina Faso, West Africa. J Hepatol 2019; 71:842-4. [PMID: 31331666 DOI: 10.1016/j.jhep.2019.06.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 12/04/2022]
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McDowell A, Engel N, Daftary A. In the eye of the multiple beholders: Qualitative research perspectives on studying and encouraging quality of TB care in India. J Clin Tuberc Other Mycobact Dis 2019; 16:100111. [PMID: 31497654 PMCID: PMC6716552 DOI: 10.1016/j.jctube.2019.100111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
This paper outlines insights qualitative research brings to the study of quality of care. It advocates understanding care as sequential, interpersonal action aimed at improving health and documenting the networks in which care occurs. It assesses the strengths and weakness of contemporary quantitative and qualitative approaches to examining quality of care for tuberculosis (TB) before outlining three qualitative research programs aimed at understanding quality of TB in India. Three case studies focus on the diagnosis level in the cascade of TB care and use qualitative research to examine the clinical use of pharmaceuticals as diagnostics, the development of diagnostic tests, and the role of care providers in the utilization of diagnostic services. They show that 1) care must be understood as part of relationships over time, 2) the presence or absence of technologies does not always imply their expected use in care, 3) physicians' provision of care is often inflected by their perceptions of patient desires, and 4) effective care is not always perfectly aligned with global health priorities. Qualitative methods with a networked perspective on care provide novel findings that can and have been used when developing quality of care improvement interventions for TB.
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Affiliation(s)
- Andrew McDowell
- Department of Anthropology, Tulane University, New Orleans, USA
- CERMES3, Institute National de la Santé et la Recherché Médicale, Paris, France
| | - Nora Engel
- Department of Health, Ethics and Society, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Amrita Daftary
- McGill International TB Centre and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- Centre for the AIDS Programme of Research (CAPRISA), University of KwaZulu Natal, Durban, South Africa
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Colombani F, Sibé M, Kret M, Quintard B, Ravaud A, Saillour-Glénisson F. EPOCK study protocol: a mixed-methods research program evaluating cancer care coordination nursing occupations in France as a complex intervention. BMC Health Serv Res 2019; 19:483. [PMID: 31299966 PMCID: PMC6626323 DOI: 10.1186/s12913-019-4307-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/28/2019] [Indexed: 12/20/2022] Open
Abstract
Background Facing the increasing cancer incidence and cancer survivorship, many national strategic cancer plans have identified cancer care coordination as a priority for health service improvement. However, the high variability of practices, the diversity of definitions and underlying concepts increases the existing difficulty to standardise, replicate, transpose and assess care coordination within the French health system context. The EPOCK national study aims at evaluating practices and the working context of hospital-based cancer care coordination nurses, based on a previously designed reference framework for care coordination within the French health system context. Methods EPOCK is based on a comprehensive evaluation of nursing professions in cancer care coordination, considered as a complex intervention. Phase 1 (theoretical phase) will define and design a theoretical reference framework for care coordination in France through an international literature review, aiming to identify relevant models and all components of the expected framework and a structured consensus method, the Nominal group technique, aiming to select and prioritise the most relevant components already found in the literature review with regard to the French healthcare system; phase 2 (Operational phase) will consist in an in-depth analysis of practices, contexts, perceptions and attitudes related to care coordination occupations by nurses in oncology and all stakeholders (related professionals, patients and their caregivers) through a multicentric cross-sectional mixed-method evaluative study. The observed practices and contexts will be finally compared with the theoretical reference framework using both inductive and deductive approaches. Discussion This study will result in an evaluation framework identifying key models and key elements relative to cancer care coordination interventions that can be used to guide management of cancer care coordination nursing occupations within the French healthcare system. EPOCK would also assist in public decision-making to identify optimal targets, skills profiles and scope of actions for cancer coordination professions. Finally, EPOCK will describe typology of nurse practices in cancer care coordination and thus obtain precise preliminary information essential for drafting a medico-economic evaluation study of these new nursing professions’ impact. Trial registration Clinicaltrial.gov registration: NCT03350776, 11/22/2017.
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Affiliation(s)
- F Colombani
- Centre de Coordination en Cancérologie (3C), CHU de Bordeaux (Bordeaux University Hospital), Groupe hospitalier Saint-André, 1 rue Jean Burguet, F-33000, Bordeaux, France. .,Economie et Management des Organisations de Santé (EMOS), INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.
| | - M Sibé
- Economie et Management des Organisations de Santé (EMOS), INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.,ISPED (Bordeaux School of Public Health), Centre INSERM U1219-Bordeaux Population Health, Université de Bordeaux, F-33000, Bordeaux, France
| | - M Kret
- Service d'Information médicale, Unité de soutien méthodologique à la recherche clinique (USMR), CHU de Bordeaux, Pôle de Santé publique, F-33000, Bordeaux, France
| | - B Quintard
- Faculté de Psychologie, Laboratoire EA 4136 Handicap, Activité, Cognition, Santé, Université de Bordeaux, F-33000, Bordeaux, France
| | - A Ravaud
- Centre de Coordination en Cancérologie (3C), CHU de Bordeaux (Bordeaux University Hospital), Groupe hospitalier Saint-André, 1 rue Jean Burguet, F-33000, Bordeaux, France.,Pôle de cancérologie, Service d'Oncologie Médicale, CHU de Bordeaux, F-33000, Bordeaux, France
| | - F Saillour-Glénisson
- Economie et Management des Organisations de Santé (EMOS), INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.,ISPED (Bordeaux School of Public Health), Centre INSERM U1219-Bordeaux Population Health, Université de Bordeaux, F-33000, Bordeaux, France.,Pôle de santé publique, Service d'Information Médicale, Unité Méthodes d'Evaluation en Santé, CHU de Bordeaux, F-33000, Bordeaux, France
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