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https://www.readbyqxmd.com/read/28516881/exploring-the-remission-concept-in-rheumatoid-arthritis-with-patients-and-rheumatologists-time-for-a-new-approach
#1
Carlos Acebes, José Luis Andreu, Alejandro Balsa, Enrique Battle, Javier de Toro-Santos, Francisco García Llorente, María Victoria Hernández, Benjamín Fernández-Gutiérrez, Cristina Hidalgo-Calleja, Lucía Mayordomo, Esperanza Naredo, Francisco Javier Narváez, Ana M Ortiz, José Luis Pablos, Trinidad Pérez-Sandoval, Carlos Rodríguez-Lozano, Olga Sánchez-Pernaute, Jacqueline Usón, José B Negrón, Estibaliz Loza, Loreto Carmona, Susana Gómez Castro, María Montoro Alvarez
OBJECTIVES: To explore the remission concept in rheumatoid arthritis (RA) and to compare remission definitions and related concepts between rheumatologists and patients with the purpose of identifying similarities and disparities to comprehend the different perspectives of the disease. METHODS: This was a qualitative study of discourse and content analysis through focus groups, conducted from February to March 2016. Four focus groups were set up, each one with different interests: rheumatologists involved in basic research (BR), rheumatologists with high specialisation in imaging techniques (IR), clinical rheumatologists (CR), and patients (PA)...
May 8, 2017: Clinical and Experimental Rheumatology
https://www.readbyqxmd.com/read/28514910/value-based-healthcare-measurement-as-a-context-for-organizational-learning
#2
Patrik Nordin, Anna-Aurora Kork, Inka Koskela
Purpose The purpose of this paper is to shed light on the potential of organizational learning for developing effectiveness of care. Value-based healthcare measurement recognizes patient value as a driver for improving health outcomes at the societal and individual levels. By using the action learning method, this paper examines the phases of organizational learning in a private healthcare organization that has developed a novel Big Data screening tool for the treatment of patients with type 2 diabetes mellitus (DM2)...
May 2, 2017: Leadership in Health Services
https://www.readbyqxmd.com/read/28495389/clinical-trainees-responses-to-parents-who-question-evidence-based-recommendations
#3
Sydney E Philpott, Holly O Witteman, Katherine M Jones, David S Sonderman, Anne-Sophie Julien, Mary C Politi
OBJECTIVE: We examined clinicians' attitudes, beliefs, and behavioral intentions about discussing evidence and eliciting values when patients question recommendations. METHODS: We randomized trainees to read one of three scenarios about a parent of a one-year-old: 1) overuse (parent requests antibiotics for presumed viral infection); 2) equipoise (tubes for recurrent ear infections); 3) underuse (parent hesitates about vaccination). Participants then answered survey questions...
May 2, 2017: Patient Education and Counseling
https://www.readbyqxmd.com/read/28460638/using-patient-values-and-preferences-to-inform-the-importance-of-health-outcomes-in-practice-guideline-development-following-the-grade-approach
#4
Yuan Zhang, Pablo Alonso Coello, Jan Brożek, Wojtek Wiercioch, Itziar Etxeandia-Ikobaltzeta, Elie A Akl, Joerg J Meerpohl, Waleed Alhazzani, Alonso Carrasco-Labra, Rebecca L Morgan, Reem A Mustafa, John J Riva, Ainsley Moore, Juan José Yepes-Nuñez, Carlos Cuello-Garcia, Zulfa AlRayees, Veena Manja, Maicon Falavigna, Ignacio Neumann, Romina Brignardello-Petersen, Nancy Santesso, Bram Rochwerg, Andrea Darzi, Maria Ximena Rojas, Yaser Adi, Claudia Bollig, Reem Waziry, Holger J Schünemann
BACKGROUND: There are diverse opinions and confusion about defining and including patient values and preferences (i.e. the importance people place on the health outcomes) in the guideline development processes. This article aims to provide an overview of a process for systematically incorporating values and preferences in guideline development. METHODS: In 2013 and 2014, we followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to adopt, adapt and develop 226 recommendations in 22 guidelines for the Ministry of Health of the Kingdom of Saudi Arabia...
May 2, 2017: Health and Quality of Life Outcomes
https://www.readbyqxmd.com/read/28459649/a-necessary-evil-patients-experiences-receiving-tube-feeding-in-acute-care
#5
Cara Green, Virginia Vandall-Walker
BACKGROUND: Tube feeding (TF) is frequently prescribed for adults admitted to acute care facilities to prevent or ameliorate malnutrition, yet little is known about patients' needs and experiences with receiving this therapy. Patients' perspectives regarding the factors influencing their experiences, as well as their information and support needs, are required to inform healthcare providers' (HCPs') patient-centered practices. METHODS: Based on an interpretive description qualitative approach, 12 unstructured face-to-face interviews were conducted with participants admitted to acute care hospitals in Northwestern Ontario, Canada...
April 1, 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28456890/expanding-the-rubric-of-patient-centered-care-pcc-to-patient-and-professional-centered-care-ppcc-to-enhance-provider-well-being
#6
Stephen G Post, Michael Roess
Burnout among physicians, nurses, and students is a serious problem in U.S. healthcare that reflects inattentive management practices, outmoded images of the "good" provider as selflessly ignoring the care of the self, and an overarching rubric of Patient Centered Care (PCC) that leaves professional self-care out of the equation. We ask herein if expanding PCC to Patient and Professional Centered Care (PPCC) would be a useful idea to make provider self-care an explicit part of mission statements, a major part of management strategies and institutional goal setting, and of educational programs...
April 29, 2017: HEC Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
https://www.readbyqxmd.com/read/28448386/barriers-to-goal-concordant-care-for-older-patients-with-acute-surgical-illness-communication-patterns-extrinsic-to-decision-aids
#7
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
#8
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
#9
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
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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