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"Patient values"

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https://www.readbyqxmd.com/read/28448386/barriers-to-goal-concordant-care-for-older-patients-with-acute-surgical-illness-communication-patterns-extrinsic-to-decision-aids
#1
Lauren J Taylor, Sara K Johnson, Michael J Nabozny, Jennifer L Tucholka, Nicole M Steffens, Kristine L Kwekkeboom, Karen J Brasel, Toby C Campbell, Margaret L Schwarze
OBJECTIVE: We sought to characterize patterns of communication extrinsic to a decision aid that may impede goal-concordant care. BACKGROUND: Decision aids are designed to facilitate difficult clinical decisions by providing better treatment information. However, these interventions may not be sufficient to effectively reveal patient values and promote preference-aligned decisions for seriously ill, older adults. METHODS: We conducted a secondary analysis of 31 decision-making conversations between surgeons and frail, older inpatients with acute surgical problems at a single tertiary care hospital...
April 26, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28446383/development-and-validation-of-the-parenteral-nutrition-impact-questionnaire-pniq-a-patient-centric-outcome-measure-for-home-parenteral-nutrition
#2
Jeanette Wilburn, Stephen P McKenna, Alice Heaney, Matthew Rouse, Michael Taylor, Alison Culkin, Simon Gabe, Sorrel Burden, Simon Lal
BACKGROUND & AIMS: Patients with Type 3 Intestinal Failure (IF) who need Home Parenteral Nutrition (HPN) face several clinical, psychological and social problems. The study was designed to produce and test the first patient-centric measure for HPN ('PNIQ: Parenteral Nutrition Impact Questionnaire'). The new measure focused on the extent to which patients were able to fulfil their human needs. METHODS: Questionnaire content was derived from the analysis of transcripts of interviews conducted with UK HPN patients...
April 12, 2017: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28446164/core-information-sets-for-informed-consent-to-surgical-interventions-baseline-information-of-importance-to-patients-and-clinicians
#3
Barry G Main, Angus G K McNair, Richard Huxtable, Jenny L Donovan, Steven J Thomas, Paul Kinnersley, Jane M Blazeby
BACKGROUND: Consent remains a crucial, yet challenging, cornerstone of clinical practice. The ethical, legal and professional understandings of this construct have evolved away from a doctor-centred act to a patient-centred process that encompasses the patient's values, beliefs and goals. This alignment of consent with the philosophy of shared decision-making was affirmed in a recent high-profile Supreme Court ruling in England. The communication of information is central to this model of health care delivery but it can be difficult for doctors to gauge the information needs of the individual patient...
April 26, 2017: BMC Medical Ethics
https://www.readbyqxmd.com/read/28445100/remap-a-framework-for-goals-of-care-conversations
#4
Julie W Childers, Anthony L Back, James A Tulsky, Robert M Arnold
Conversations regarding goals of care with patients who have advanced cancer still occur too late, and oncologists say they lack the training to have these conversations effectively. Experts recommend a number of strategies when having these discussions, including discussing prognosis, responding to patient emotion, exploring values, and often making a recommendation for medical treatments that fit those values. To help learners, from residents to attending oncologists, learn these complex conversational skills, we have developed a framework with a mnemonic, REMAP: Reframe, Expect emotion, Map out patient goals, Align with goals, and Propose a plan...
April 26, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28444821/has-the-autonomy-pendulum-swung-too-far
#5
Paul Walker
BACKGROUND: This paper aims to contribute to the discussion about patient-centred care in surgery. It is contended here that the paradigm shift towards patient-centred decision-making in health care does not mean that patient values alone (or those of their proxies) should, uncritically, be the lead decision makers in determining surgical care. METHODS: In support of that contention, three clarifications to our conception of autonomy will be offered. RESULTS: First, autonomy may not be best positioned as the lead principle guiding healthcare decision-making...
April 25, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/28441973/treatment-limiting-decisions-in-patients-with-severe-traumatic-brain-injury-in-a-norwegian-regional-trauma-center
#6
Annette Robertsen, Reidun Førde, Nils Oddvar Skaga, Eirik Helseth
BACKGROUND: Treatment-limiting decisions (TLD) for severe traumatic brain injury (sTBI) have been sparsely studied. This study determine prevalence, main reason for, categories and timing of TLDs in a Norwegian regional trauma setting. METHODS: A retrospective study of a 2-year cohort of 579 sTBI patients admitted to Oslo University Hospital (OUH). Prospectively collected data in the OUH Trauma Registry were combined with retrospective data from a chart review regarding TLDs...
April 26, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28428019/radiation-therapy-for-oropharyngeal-squamous-cell-carcinoma-executive-summary-of-an-astro-evidence-based-clinical-practice-guideline
#7
David J Sher, David J Adelstein, Gopal K Bajaj, David M Brizel, Ezra E W Cohen, Aditya Halthore, Louis B Harrison, Charles Lu, Benjamin J Moeller, Harry Quon, James W Rocco, Erich M Sturgis, Roy B Tishler, Andy Trotti, John Waldron, Avraham Eisbruch
PURPOSE: To present evidence-based guidelines for the treatment of oropharyngeal squamous cell carcinoma (OPSCC) with definitive or adjuvant radiation therapy (RT). METHODS AND MATERIALS: The American Society for Radiation Oncology convened the OPSCC Guideline Panel to perform a systematic literature review investigating the following key questions: (1) When is it appropriate to add systemic therapy to definitive RT in the treatment of OPSCC? (2) When is it appropriate to deliver postoperative RT with and without systemic therapy following primary surgery for OPSCC? (3) When is it appropriate to use induction chemotherapy in the treatment of OPSCC? (4) What are the appropriate dose, fractionation, and volume regimens with and without systemic therapy in the treatment of OPSCC? RESULTS: Patients with stage IV and stage T3 N0-1 OPSCC treated with definitive RT should receive concurrent high-dose intermittent cisplatin...
April 11, 2017: Practical Radiation Oncology
https://www.readbyqxmd.com/read/28412775/defining-value-in-radiation-oncology-approaches-to-weighing-benefits-vs-costs
#8
REVIEW
Andre A Konski
The passage of the Affordable Care Act in 2010 initiated discussion regarding transitioning from a fee-for-service arrangement of care reimbursement to value-based care. Cost-effectiveness analysis (CEA) has been used in the past to quantify value as it relates to the provision of healthcare. New treatments or techniques being compared with other new or existing therapies or approaches to care were determined to be cost-effective if the incremental cost-effectiveness ratio was less than $50,000/life-year or quality-adjusted life-year...
April 15, 2017: Oncology (Williston Park, NY)
https://www.readbyqxmd.com/read/28409064/value-based-health-care-delivery-preventive-medicine-and-the-medicalization-of-public-health
#9
REVIEW
Andreas Vilhelmsson
The real paradigm shift for healthcare is often stated to include a transition from accentuating health care production and instead emphasize patient value by moving to a 'value-based health care delivery'. In this transition, personalized medicine is sometimes referred to as almost a panacea in solving the current and future health challenges. In theory, the progress of precision medicine sounds uncontroversial and most welcomed with its promise of a better healthcare for all, with real benefits for the individual patient provided a tailored and optimized treatment plan suitable for his or her genetic makeup...
March 1, 2017: Curēus
https://www.readbyqxmd.com/read/28405531/will-the-meikirch-model-a-new-framework-for-health-induce-a-paradigm-shift-in-healthcare
#10
REVIEW
Johannes Bircher, Eckhart G Hahn
Over the past decades, scientific medicine has realized tremendous advances. Yet, it is felt that the quality, costs, and equity of medicine and public health have not improved correspondingly and, both inside and outside the USA, may even have changed for the worse. An initiative for improving this situation is value-based healthcare, in which value is defined as health outcomes relative to the cost of achieving them. Value-based healthcare was advocated in order to stimulate competition among healthcare providers and thereby reduce costs...
March 6, 2017: Curēus
https://www.readbyqxmd.com/read/28405529/defining-health-in-the-era-of-value-based-care-lessons-from-england-of-relevance-to-other-health-systems
#11
REVIEW
Sarah Gentry, Padmanabhan Badrinath
The demand for healthcare is rising due to aging populations, rising chronic disease prevalence, and technological innovations. There are currently more effective and cost-effective interventions available than can be afforded within limited budgets. A new way of thinking about the optimal use of resources is needed. Ensuring that available resources are used for interventions that provide outcomes that patient's most value, rather than a focus just on effectiveness and cost-effectiveness, may help to ensure that resources are used optimally...
March 6, 2017: Curēus
https://www.readbyqxmd.com/read/28385026/scaling-lean-in-primary-care-impacts-on-system-performance
#12
Dorothy Y Hung, Michael I Harrison, Meghan C Martinez, Harold S Luft
OBJECTIVES: We examined a wide range of performance outcomes after Lean methodology-a leading strategy to enhance efficiency and patient value-was implemented and scaled across all primary care clinics in a nonprofit, ambulatory care delivery system. STUDY DESIGN: Using a stepped wedge approach, we assessed changes associated with the phased introduction of Lean-based redesigns across 46 primary care departments in 17 different clinic locations. Longitudinal analysis of operational metrics included: workflow efficiency, physician productivity, operating expenses, clinical quality, and satisfaction among patients, physicians, and staff...
March 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28381224/informing-primary-care-reform-in-greece-patient-expectations-and-experiences-the-qualicopc-study
#13
Christos Lionis, Sophia Papadakis, Chrysanthi Tatsi, Antonis Bertsias, George Duijker, Prodromos-Bodosakis Mekouris, Wienke Boerma, Willemijn Schäfer
BACKGROUND: Primary health care is the cornerstone of a high quality health care system. Greece has been actively attempting to reform health care services in order to improve heath outcomes and reduce health care spending. Patient-centered approaches to health care delivery have been increasingly acknowledged for their value informing quality improvement activities. This paper reports the quality of primary health care services in Greece as perceived by patients and aspects of health care delivery that are valued by patients...
April 5, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28370922/identification-and-content-validation-of-wound-therapy-clinical-endpoints-relevant-to-clinical-practice-and-patient-values-for-fda-approval-part-1-survey-of-the-wound-care-community
#14
Vickie R Driver, Lisa J Gould, Peggy Dotson, Gary W Gibbons, William W Li, William J Ennis, Robert S Kirsner, William H Eaglstein, Laura L Bolton, Marissa J Carter
Wounds that exhibit delayed healing add extraordinary clinical, economic, and personal burdens to patients, as well as to increasing financial costs to health systems. New interventions designed to ease such burdens for patients with cancer, renal, or ophthalmologic conditions are often cleared for approval by the U.S. Food and Drug Administration (FDA) using multiple endpoints but the requirement of complete healing as a primary endpoint for wound products impedes FDA clearance of interventions that can provide other clinical or patient-centered benefits for persons with wounds...
April 3, 2017: Wound Repair and Regeneration
https://www.readbyqxmd.com/read/28366592/patients-preferences-for-the-treatment-of-metastatic-castrate-resistant-prostate-cancer-a-discrete-choice-experiment
#15
Lina Eliasson, Hayley M de Freitas, Lindsay Dearden, Brian Calimlim, Andrew J Lloyd
PURPOSE: Patient treatment preferences are increasingly being used to inform health care decision making. This discrete choice experiment assessed how men perceive the risks and benefits of hypothetical treatment options for metastatic castrate-resistant prostate cancer (mCRPC). METHODS: Treatment attributes for inclusion were identified through a review of the literature and product labels. Expert interviews confirmed clinical appropriateness and patient relevance of the attributes, which included effectiveness (delay in months before chemotherapy), steroid use, possible drug interactions (additional hospital visits for monitoring), fogginess (effects on cognition and memory), fatigue (extreme tiredness), food restrictions, and bone pain...
March 30, 2017: Clinical Therapeutics
https://www.readbyqxmd.com/read/28348619/comparative-study-of-substance-p-and-neurokinin-a-in-gingival-crevicular-fluid-of-healthy-and-painful-carious-permanent-teeth
#16
Alireza Heidari, Mahdi Shahrabi, Mehrak Rokouei, Aliakbar Amirzargar, Pegah Rahbar
BACKGROUND: It is shown that neuropeptides can be transported from pulp chamber to periodontal ligament through apical foramen and accessory canals. Therefore, clinical pulpal pain leads to expression of preinflammatory neuropeptides such as substance P (SP) and neurokinin A (NKA) in gingival crevicular fluid (GCF). This study aimed to evaluate levels of SP and NKA in GCF of carious and healthy permanent teeth, comparatively. MATERIALS AND METHODS: This cross-sectional study was performed on twenty children referred to Department of Pediatric Dentistry, Tehran University of Medical Sciences, who had a painful permanent first molar...
January 2017: Dental Research Journal
https://www.readbyqxmd.com/read/28344507/patients-experience-of-using-primary-care-services-in-the-context-of-indonesian-universal-health-coverage-reforms
#17
Fitriana Murriya Ekawati, Mora Claramita, Krishna Hort, John Furler, Sharon Licqurish, Jane Gunn
BACKGROUND: The World Health Organization (WHO) recommendation on universal coverage has been implemented in Indonesia as Jaminan Kesehatan Nasional (JKN). It was designed to provide people with equitable and high-quality health care by strengthening primary care as the gate-keeper to hospitals. However, during its first year of implementation, recruitment of JKN members was slow, and the referral rates from primary to secondary care remained high. Little is known about how the public views the introduction of JKN or the factors that influence their decision to enroll in JKN...
2017: Asia Pacific Family Medicine
https://www.readbyqxmd.com/read/28342435/-therapeutic-aggressiveness-and-liquid-oncology
#18
F J Barón Duarte, M S Rodríguez Calvo, J R Amor Pan
Aggressiveness criteria proposed in the scientific literature a decade ago provide a quality judgment and are a reference in the care of patients with advanced cancer, but their use is not generalized in the evaluation of Oncology Services. In this paper we analyze the therapeutic aggressiveness, according to standard criteria, in 1.001 patients with advanced cancer who died in our Institution between 2010 and 2013. The results seem to show that aggressiveness at the end of life is present more frequently than experts recommend...
January 2017: Cuadernos de Bioética: Revista Oficial de la Asociación Española de Bioética y Ética Médica
https://www.readbyqxmd.com/read/28341494/how-do-patients-choose-between-active-surveillance-radical-prostatectomy-and-radiotherapy-the-effect-of-a-preference-sensitive-decision-aid-on-treatment-decision-making-for-localized-prostate-cancer
#19
Romy E D Lamers, Maarten Cuypers, Marieke de Vries, Lonneke V van de Poll-Franse, J L H Ruud Bosch, Paul J M Kil
PURPOSE: To determine the effect of a decision aid (DA) on treatment preferences and to investigate which patient preferences are important for final treatment preferences. We also determined if the patient׳s treatment decision was influenced by the urologist׳s treatment preference. PATIENTS AND METHODS: Between August 2014 and July 2015, newly diagnosed patients with low-/intermediate-risk prostate cancer were offered to use a web-based DA after diagnosis. Treatment preferences and patient׳s values were extracted from the DA...
February 2017: Urologic Oncology
https://www.readbyqxmd.com/read/28322487/methodology-for-senior-proof-guidelines-a-practice-example-from-the-netherlands
#20
Barbara C van Munster, Johanna E A Portielje, Andrea B Maier, Arend J Arends, Johannes J A de Beer
RATIONALE, AIMS AND OBJECTIVES: Evidence-based guidelines constitute a foundation for medical decision making. It is often unclear whether recommendations in general guidelines also apply to older people. This study aimed to develop a methodology to increase the focus on older people in the development of guidelines. METHODS: The methodology distinguishes 4 groups of older people: (1) relatively healthy older people; (2) older people with 1 additional specific (interfering) comorbid condition; (3) older people with multimorbidity; and (4) vulnerable older people...
March 21, 2017: Journal of Evaluation in Clinical Practice
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