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Principles of care

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https://www.readbyqxmd.com/read/27921218/from-problem-solving-to-problem-definition-scrutinizing-the-complex-nature-of-clinical-practice
#1
Sayra Cristancho, Lorelei Lingard, Glenn Regehr
In medical education, we have tended to present problems as being singular, stable, and solvable. Problem solving has, therefore, drawn much of medical education researchers' attention. This focus has been important but it is limited in terms of preparing clinicians to deal with the complexity of the 21st century healthcare system in which they will provide team-based care for patients with complex medical illness. In this paper, we use the Soft Systems Engineering principles to introduce the idea that in complex, team-based situations, problems usually involve divergent views and evolve with multiple solution iterations...
December 5, 2016: Perspectives on Medical Education
https://www.readbyqxmd.com/read/27919057/principles-of-precision-medicine-in-stroke
#2
REVIEW
Jason D Hinman, Natalia S Rost, Thomas W Leung, Joan Montaner, Keith W Muir, Scott Brown, Juan F Arenillas, Edward Feldmann, David S Liebeskind
The era of precision medicine has arrived and conveys tremendous potential, particularly for stroke neurology. The diagnosis of stroke, its underlying aetiology, theranostic strategies, recurrence risk and path to recovery are populated by a series of highly individualised questions. Moreover, the phenotypic complexity of a clinical diagnosis of stroke makes a simple genetic risk assessment only partially informative on an individual basis. The guiding principles of precision medicine in stroke underscore the need to identify, value, organise and analyse the multitude of variables obtained from each individual to generate a precise approach to optimise cerebrovascular health...
October 19, 2016: Journal of Neurology, Neurosurgery, and Psychiatry
https://www.readbyqxmd.com/read/27917391/adrift-in-the-gray-zone-irb-perspectives-on-research-in-the-learning-health-system
#3
Sandra Soo-Jin Lee, Maureen Kelley, Mildred K Cho, Stephanie Alessi Kraft, Cyan James, Melissa Constantine, Adrienne N Meyer, Douglas Diekema, Alexander M Capron, Benjamin S Wilfond, David Magnus
BACKGROUND: Human subjects protection in healthcare contexts rests on the premise that a principled boundary distinguishes clinical research and clinical practice. However, growing use of evidence-based clinical practices by health systems makes it increasingly difficult to disentangle research from a wide range of clinical activities that are sometimes called "research on medical practice" (ROMP), including quality improvement activities and comparative effectiveness research. The recent growth of ROMP activities has created an ethical and regulatory gray zone with significant implications for the oversight of human subjects research...
2016: AJOB Empirical Bioethics
https://www.readbyqxmd.com/read/27917219/experience-of-collaboration-between-a-dutch-surgical-team-in-a-ghanaian-orthopaedic-teaching-hospital
#4
T K Timmers, E Kortekaas, Bpc Beyer, E Huizinga, S M V Hezik van, E Twagirayezu, M Bemelman
BACKGROUND: Surgery is an indivisible, indispensable part of healthcare. In Africa, surgery may be thought of as the neglected stepchild of global public health. We describe our experience over a 3-year period of intensive collaboration between specialized teams from a Dutch hospital and local teams of an orthopaedic hospital in Effiduase-Koforidua, Ghana. INTERVENTION: During 2010-2012, medical teams from our hospital were deployed to St. Joseph's Hospital. These teams were completely self-supporting...
September 2016: African Health Sciences
https://www.readbyqxmd.com/read/27916880/emotional-labour-and-wellbeing-what-protects-nurses
#5
Gail Kinman, Sandra Leggetter
Although compassionate care has wide-ranging benefits for patients, it can be emotionally demanding for healthcare staff. This may be a particular problem for those with little experience in a caring role. This study utilises the job demands-resources model to examine links between "emotional labour" and emotional exhaustion in student nurses. In line with the triple-match principle-whereby interactive effects are more likely when job demands, resources, and outcomes are within the same qualitative domain-the protective role of emotional support and emotion-focused coping (i...
November 30, 2016: Healthcare (Basel, Switzerland)
https://www.readbyqxmd.com/read/27916398/ruxolitinib-for-the-treatment-of-inadequately-controlled-polycythaemia-vera-without-splenomegaly-response-2-a-randomised-open-label-phase-3b-study
#6
Francesco Passamonti, Martin Griesshammer, Francesca Palandri, Miklos Egyed, Giulia Benevolo, Timothy Devos, Jeannie Callum, Alessandro M Vannucchi, Serdar Sivgin, Caroline Bensasson, Mahmudul Khan, Nadjat Mounedji, Guray Saydam
BACKGROUND: In the pivotal RESPONSE study, ruxolitinib, a Janus kinase (JAK)1 and JAK2 inhibitor, was superior to best available therapy at controlling haematocrit and improving splenomegaly and symptoms in patients with polycythaemia vera with splenomegaly who were inadequately controlled with hydroxyurea. In this study, we assessed the efficacy and safety of ruxolitinib in controlling disease in patients with polycythaemia vera without splenomegaly who need second-line therapy. METHODS: RESPONSE-2 is a randomised, open-label, phase 3b study assessing ruxolitinib versus best available therapy in patients with polycythaemia vera done in 48 hospitals or clinics across 12 countries in Asia, Australia, Europe, and North America...
December 1, 2016: Lancet Oncology
https://www.readbyqxmd.com/read/27915463/the-our-hope-approach-for-ethics-and-communication-about-neonatal-neurological-injury
#7
REVIEW
Eric Racine, Emily Bell, Barbara Farlow, Steven Miller, Antoine Payot, Lisa Anne Rasmussen, Michael I Shevell, Donna Thomson, Pia Wintermark
Predicting neurological outcomes of neonates with acute brain injury is an essential component of shared decision-making, in order to guide the development of treatment goals and appropriate care plans. It can aid parents in imagining the child's future, and guide timely and ongoing treatment decisions, including shifting treatment goals and focusing on comfort care. However, numerous challenges have been reported with respect to evidence-based practices for prognostication such as biases about prognosis among clinicians...
December 4, 2016: Developmental Medicine and Child Neurology
https://www.readbyqxmd.com/read/27915459/the-role-of-accompagnement-in-the-end-of-life-debate-in-france-from-solidarity-to-autonomy
#8
Marie Gaille, Ruth Horn
This article traces the way autonomy has become a recognised value in health care in France. In a country that based its social fundamentals on the very idea of solidarity for many years, autonomy has long been considered a foreign 'Anglo-American principle'. Taking the example of the end-of-life debate, the article shows, however, how the use of the French term 'accompagnement' allowed autonomy to be redefined and to be associated with the concept of solidarity. Exploring the arguments used over the past 25 years in professional guidelines, parliamentary reports, ethics committee reports, and legal texts, the authors describe the shift that took place in public and legal discourses on end-of-life care...
December 3, 2016: Theoretical Medicine and Bioethics
https://www.readbyqxmd.com/read/27913713/the-allocation-of-sexually-transgressive-juveniles-to-intensive-specialized-treatment-an-assessment-of-the-application-of-rnr-principles
#9
Ellis Ter Beek, Rachel E A van der Rijken, Chris H Z Kuiper, Jan Hendriks, Geert Jan J M Stams
The aim of this study was to compare results of and develop guidelines for mandatory allocation of sexually transgressive juveniles to Multisystemic Therapy - Problem Sexual Behavior (MST-PSB), Secure Youth Care (SYC), or Forensic Youth Care (FYC), based on the risk-need-responsivity model. Results of current allocation showed a population with relatively less treatment needs to receive community-based MST-PSB, compared with populations receiving residential SYC and FYC. Furthermore, estimated recidivism risk levels did not always support the need for risk reduction by the imposition of limitation of freedom of movement and maximum supervision, provided by all three treatment modalities...
December 1, 2016: International Journal of Offender Therapy and Comparative Criminology
https://www.readbyqxmd.com/read/27913539/prevention-of-central-nervous-system-sequelae-in-sickle-cell-disease-without-evidence-from-randomized-controlled-trials-the-case-for-a-team-based-learning-collaborative
#10
Michael R DeBaun, Allison A King
Since 1998, the National Institutes of Health has funded 5 randomized controlled trials (RCTs) for primary and secondary prevention of strokes in children with sickle cell anemia (SCA). In a systematic fashion, these trials have significantly advanced the care of children with SCA. In the absence of an RCT, clinicians are often compelled to make decisions at the bedside, based on experience, observational studies, and principles of hematology. We will provide an initial example that describes how a team-based, learning collaborative developed a multisite standard care protocol with a low budget (<$10 000 per year) to overcome the intrinsic limitations of advancing the care of neurologic complications in sickle cell disease (SCD)...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27913459/children-with-rare-diseases-of-neutrophil-granulocytes-from-therapeutic-orphans-to-pioneers-of-individualized-medicine
#11
Christoph Klein
Neutrophil granulocytes are the most abundant immune cells in the blood yet the pathways orchestrating their differentiation and biological function remain incompletely understood. Studying (ultra-) rare patients with monogenetic defects of neutrophil granulocytes may open new horizons to understand basic principles of hematopoiesis and innate immunity. Here, recent insights into genetic factors controlling myelopoiesis and their more general role in biology will be presented in a clinical perspective. Advances in supportive care, first and foremost the use of recombinant human granulocyte-colony stimulating factor, has made a substantial difference for the quality of life and life expectancy of patients with congenital neutropenia (CN)...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27913155/early-molecular-stratification-of-high-risk-primary-biliary-cholangitis
#12
Claire Hardie, Kile Green, Laura Jopson, Ben Millar, Barbara Innes, Sarah Pagan, Dina Tiniakos, Jessica Dyson, Muzlifah Haniffa, Venetia Bigley, David E Jones, John Brain, Lucy J Walker
High-risk primary biliary cholangitis (PBC), defined by inadequate response at one year to Ursodeoxycholic acid (UDCA), is associated with disease progression and liver transplantation. Stratifying high-risk patients early would facilitate improved approaches to care. Using long-term follow-up data to define risk at presentation, 6 high-risk PBC patients and 8 low-risk patients were identified from biopsy, transplant and biochemical archival records. Formalin-fixed paraffin-embedded (FFPE) liver biopsies taken at presentation were graded (Scheuer and Nakanuma scoring) and gene expression analysed using the NanoString® nCounter PanCancer Immunity 770-gene panel...
November 21, 2016: EBioMedicine
https://www.readbyqxmd.com/read/27912776/improving-stroke-prevention-therapy-for-patients-with-atrial-fibrillation-in-primary-care-protocol-for-a-pragmatic-cluster-randomized-trial
#13
Theresa M Lee, Noah M Ivers, Sacha Bhatia, Debra A Butt, Paul Dorian, Liisa Jaakkimainen, Kori Leblanc, Dan Legge, Dante Morra, Alissia Valentinis, Laura Wing, Jacqueline Young, Karen Tu
BACKGROUND: The prevalence of atrial fibrillation (AF) is growing as the population ages, and at least 15% of ischemic strokes are attributed to AF. However, many high-risk AF patients are not offered guideline-recommended stroke prevention therapy due to a variety of system, provider, and patient-level barriers. METHODS: We will conduct a pragmatic, cluster-randomized controlled trial randomizing primary care clinics to test a "toolkit" of quality improvement interventions in primary care...
December 3, 2016: Implementation Science: IS
https://www.readbyqxmd.com/read/27912763/global-health-partnership-for-student-peer-to-peer-psychiatry-e-learning-lessons-learned
#14
REVIEW
Roxanne C Keynejad
BACKGROUND: Global 'twinning' relationships between healthcare organizations and institutions in low and high-resource settings have created growing opportunities for e-health partnerships which capitalize upon expanding information technology resources worldwide. E-learning approaches to medical education are increasingly popular but remain under-investigated, whilst a new emphasis on global health teaching has coincided with university budget cuts in many high income countries. RESULTS: King's Somaliland Partnership (KSP) is a paired institutional partnership health link, supported by Tropical Health and Education Trust (THET), which works to strengthen the healthcare system and improve access to care through mutual exchange of skills, knowledge and experience between Somaliland and King's Health Partners, UK...
December 3, 2016: Globalization and Health
https://www.readbyqxmd.com/read/27910831/high-z-structures-of-organic-molecules-their-diversity-and-organizing-principles
#15
Carolyn Pratt Brock
A list has been compiled of 284 well determined organic structures having more than four crystallographically independent molecules or formula units (i.e. Z' > 4). Another 22 structures were rejected because the space group or unit cell was probably misassigned; the rate for that type of error is then only 7%. The space-group frequencies are unusual; half the structures are in Sohncke groups, partly because the fraction of enantiopure structures of resolvable enantiomers is higher than for lower Z' structures...
December 1, 2016: Acta Crystallographica Section B, Structural Science, Crystal Engineering and Materials
https://www.readbyqxmd.com/read/27910173/facilitators-and-barriers-to-person-centred-care-in-child-and-young-people-mental-health-services-a-systematic-review
#16
Dawid Gondek, Julian Edbrooke-Childs, Tjasa Velikonja, Louise Chapman, Felicity Saunders, Daniel Hayes, Miranda Wolpert
: Implementation of person-centred care has been widely advocated across various health settings and patient populations, including recent policy for child and family services. Nonetheless, evidence suggests that service users are rarely involved in decision-making, whilst their preferences and goals may be often unheard. The aim of the present research was to systematically review factors influencing person-centred care in mental health services for children, young people and families examining perspectives from professionals, service users and carers...
December 2, 2016: Clinical Psychology & Psychotherapy
https://www.readbyqxmd.com/read/27909857/privacy-autonomy-and-public-policy-french-and-north-american-perspectives
#17
Jennifer Merchant
This article raises the question of whether in both the United States and in France, an individual's autonomy and private decision-making right(s) in matters of health care and access to reproductive technologies can be conciliated with the general interest, and more specifically, the role of the State. Can a full-fledged right to privacy, the ability to exercise one's autonomy, exist alongside the general interest, and depend neither on financial resources like in the United States nor on centralised government decisions or the medical hierarchy like in France? The contrast between these two modern democracies justify the importance of comparing them...
December 2, 2016: Theoretical Medicine and Bioethics
https://www.readbyqxmd.com/read/27909251/-in-principle-we-have-agreement-but-in-practice-it-is-a-bit-more-difficult-obtaining-organizational-buy-in-to-patient-centered-medical-home-transformation
#18
Janelle Applequist, Michelle Miller-Day, Peter F Cronholm, Robert A Gabbay, Deborah S Bowen
The patient-centered medical home (PCMH) is a model of care that emphasizes the coordination of patient treatment among health care providers. Practice transformation to this model, however, presents a number of challenges. One of these challenges is getting the buy-in of all personnel to commit to making organizational changes in the journey to becoming a nationally recognized medical home. This study investigated internal messages of buy-in as communicated by practices transitioning to this type of care. Grounding itself in stakeholder theory, this study analyzed interviews with staff, administration, and practitioners from 20 medical practices in a mid-Atlantic state...
November 30, 2016: Qualitative Health Research
https://www.readbyqxmd.com/read/27908946/strategies-for-acute-and-critical-care-nurses-implementing-complementary-therapies-requested-by-patients-and-their-families
#19
Debra Kramlich
As consumer use of complementary and alternative medicine or modalities continues to increase in the United States, requests for these therapies in the acute and critical care setting will probably continue to expand in scope and frequency. Incorporation of complementary therapies in the plan of care is consistent with principles of patient- and family-centered care and collaborative decision-making and may provide a measure of relief for the distress of admission to an acute or critical care setting. An earlier article provided an overview of complementary and alternative therapies that nurses may encounter in their practices, with specific attention to implications for acute and critical care nurses...
December 2016: Critical Care Nurse
https://www.readbyqxmd.com/read/27906730/understanding-interrater-reliability-and-validity-of-risk-assessment-tools-used-to-predict-adverse-clinical-events
#20
Sandra L Siedlecki, Nancy M Albert
PURPOSE: This article will describe how to assess interrater reliability and validity of risk assessment tools, using easy-to-follow formulas, and to provide calculations that demonstrate principles discussed. DESCRIPTION: Clinical nurse specialists should be able to identify risk assessment tools that provide high-quality interrater reliability and the highest validity for predicting true events of importance to clinical settings. Making best practice recommendations for assessment tool use is critical to high-quality patient care and safe practices that impact patient outcomes and nursing resources...
January 2017: Clinical Nurse Specialist CNS
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