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Shared Care

Pierre Kuhn, Jacques Sizun, Charlotte Casper
AIM: Hospitalised newborn infants may be stressed due to inappropriate sensory stimuli and early separation from their families, that can negatively impact their neurodevelopment. The French Group of Reflection and Evaluation of the Environment of Newborns (GREEN) issues guidelines based on environmental neonatology and family centred care. The first recommendation focuses on private family rooms versus large shared rooms. METHODS: These guidelines are based on a systematic evaluation of the literature providing different grades of evidence...
July 19, 2018: Acta Paediatrica
France Légaré, Rhéda Adekpedjou, Dawn Stacey, Stéphane Turcotte, Jennifer Kryworuchko, Ian D Graham, Anne Lyddiatt, Mary C Politi, Richard Thomson, Glyn Elwyn, Norbert Donner-Banzhoff
BACKGROUND: Shared decision making (SDM) is a process by which a healthcare choice is made by the patient, significant others, or both with one or more healthcare professionals. However, it has not yet been widely adopted in practice. This is the second update of this Cochrane review. OBJECTIVES: To determine the effectiveness of interventions for increasing the use of SDM by healthcare professionals. We considered interventions targeting patients, interventions targeting healthcare professionals, and interventions targeting both...
July 19, 2018: Cochrane Database of Systematic Reviews
Jean P Hall, Adele Shartzer, Noelle K Kurth, Kathleen C Thomas
Before the Patient Protection and Affordable Care Act (ACA), many Americans with disabilities were locked into poverty to maintain eligibility for Medicaid coverage. US Medicaid expansion under the ACA allows individuals to qualify for coverage without first going through a disability determination process and declaring an inability to work to obtain Supplemental Security Income. Medicaid expansion coverage also allows for greater income and imposes no asset tests. In this article, we share updates to our previous work documenting greater employment among people with disabilities living in Medicaid expansion states...
July 19, 2018: American Journal of Public Health
Paul N Uhlig, Joy Doll, Kristy Brandon, Christopher Goodman, Josephine Medado-Ramirez, Michael A Barnes, Mary A Dolansky, Temple A Ratcliffe, Kanapa Kornsawad, W Ellen Raboin, Maggie Hitzeman, Jeffrey Brown, Les Hall
This Invited Commentary is written by co-authors working to implement and study new models of interprofessional practice and education in clinical learning environments. There are many definitions and models of collaborative care, but the essential element is a spirit of collaboration and shared learning among health professionals, patients, and family members. This work is challenging, yet the benefits are striking. Patients and family members feel seen, heard, and understood. Health care professionals are able to contribute and feel appreciated in satisfying ways...
July 17, 2018: Academic Medicine: Journal of the Association of American Medical Colleges
Caroline Wellbery, Perry Sheffield, Kavya Timmireddy, Mona Sarfaty, Arianne Teherani, Robert Fallar
Climate change presents unprecedented health risks and demands universal attention to address them. Multiple intergovernmental organizations, health associations, and health professions schools have recognized the specific importance of preparing physicians to address the health impacts of climate change. However, medical school curricula have not kept pace with this urgent need for targeted training.The authors describe the rationale for inclusion of climate change in medical education and some potential pathways for incorporating this broad topic into physician training and continuing medical education...
July 17, 2018: Academic Medicine: Journal of the Association of American Medical Colleges
Megan E Collins, Steven Rum, Jane Wheeler, Karen Antman, Henry Brem, Joseph Carrese, Michelle Glennon, Jeffrey Kahn, E Magnus Ohman, Reshma Jagsi, Sara Konrath, Stacey Tovino, Scott Wright, Jeremy Sugarman
Grateful patients provide substantial philanthropic funding for health care institutions, resulting in important societal benefits. Although grateful patient fundraising (GPFR) is widespread, it raises an array of ethical issues for patients, physicians, development professionals, and institutions. These issues have not been described comprehensively, and there is insufficient guidance to inform the ethical practice of GPFR. Consequently, the authors convened a summit, The Ethics of Grateful Patient Fundraising, with the goal of identifying primary ethical issues in GPFR and offering recommendations regarding how to manage them...
July 17, 2018: Academic Medicine: Journal of the Association of American Medical Colleges
Rebecca Harris, Christopher Vernazza, Louise Laverty, Victoria Lowers, Stephen Brown, Girvan Burnside, Laura Ternent, Susan Higham, Jimmy Steele
Introduction: A new dental contract being tested in England places patients into traffic light categories according to risk (Red = High risk). This reflects health policy which emphasises patients' shared responsibility for their health, and a growing expectation that clinicians discuss health risk in consultations. Alongside this, there are technological developments such as scans and photographs which have generated new, vivid imagery which may be used to communicate risk information to patients...
September 2018: Contemporary Clinical Trials Communications
Megan R Earls, David C Coleman, Gráinne I Brennan, Tanya Fleming, Stefan Monecke, Peter Slickers, Ralf Ehricht, Anna C Shore
From 2009 to 2011 [transmission period (TP) 1] and 2014 to 2017 (TP2), two outbreaks involving community-associated clonal complex (CC) 88-MRSA spa types t186 and t786, respectively, occurred in the Neonatal Intensive Care Unit (NICU) of an Irish hospital (H1). This study investigated the relatedness of these isolates, their relationship to other CC88 MRSA from Ireland and their likely geographic origin, using whole-genome sequencing (WGS). All 28 CC88-MRSA isolates identified at the Irish National MRSA Reference Laboratory between 2009 and 2017 were investigated including 20 H1 patient isolates, two H1 isolates recovered from a single healthcare worker (HCW) 2 years apart, three patient isolates from a second hospital (H2) and one patient isolate from each of three different hospitals (H3, H4, and H5)...
2018: Frontiers in Microbiology
Ahmad Alharafsheh, Mohamed Alsheikh, Sheraz Ali, Amani A Baraiki, Ghadah Alharbi, Tahani Alhabshi, Amina Aboutaleb
Objective: Little is known about the pattern of antibiotics' prescribing for hospitalized adult patients in the Kingdom of Saudi Arabia. This study explored the prescribing practices of antibiotics in a large tertiary care setting serving diverse population. Methods: This retrospective cross-sectional study included 1.666 antibiotic prescriptions prescribed over a period of 3 months (January 2016-March 2016) in an adult inpatient department of King Saud Medical City (KSMC)...
July 2018: International Journal of Health Sciences
Sofia C Zambrano
Caring for patients at the end of life: Experiences and needs of physicians Abstract. In the context of death and dying, physicians are challenged in many different ways, not only professionally but also personally. Physicians are described as having a hard time accepting the finality of life. Medical practitioners find difficulties balancing their emotional involvement and their anxiety in facing death. Many specialists focus their treatment on pressing physiological problems at the time of acute crises, and have difficulty accepting that the limits of treatment effectiveness have been reached...
July 2018: Therapeutische Umschau. Revue Thérapeutique
Steffen Eychmüller, Sibylle Felber
Anticipation at the end of life - a critical appraisal for the clinical practice Abstract. Advance planning or anticipation in health care is based on prognosis, and that is no more (and no less) than dealing with probabilities. Knowledge about prognostic factors in medicine is needed here, and competencies how to communicate it. In medicine, advance planning is currently more and more regarded as an elementary right as an expression of the implementation of patient autonomy - but what content can or must be discussed and defined? The terminology on the subject of "advance planning" is inconsistent both nationally and internationally...
July 2018: Therapeutische Umschau. Revue Thérapeutique
Kazuki Yoshida, Susan Gruber, Bruce H Fireman, Sengwee Toh
PURPOSE: Privacy-protecting analytic and data-sharing methods that minimize the disclosure risk of sensitive information are increasingly important due to the growing interest in utilizing data across multiple sources. We conducted a simulation study to examine how avoiding sharing individual-level data in a distributed data network can affect analytic results. METHODS: The base scenario had four sites of varying sizes with 5% outcome incidence, 50% treatment prevalence, and seven confounders...
July 18, 2018: Pharmacoepidemiology and Drug Safety
Jennifer L Wolff, Debra L Roter, Cynthia M Boyd, David L Roth, Diane M Echavarria, Jennifer Aufill, Judith B Vick, Laura N Gitlin
BACKGROUND: Establishing priorities for discussion during time-limited primary care visits is challenging in the care of patients with cognitive impairment. These patients commonly attend primary care visits with a family companion. OBJECTIVE: To examine whether a patient-family agenda setting intervention improves primary care visit communication for patients with cognitive impairment DESIGN: Two-group pilot randomized controlled study PARTICIPANTS: Patients aged 65 + with cognitive impairment and family companions (n = 93 dyads) and clinicians (n = 14) from two general and one geriatrics primary care clinic INTERVENTION: A self-administered paper-pencil checklist to clarify the role of the companion and establish a shared visit agenda MEASUREMENTS: Patient-centered communication (primary); verbal activity, information disclosure including discussion of memory, and visit duration (secondary), from audio recordings of visit discussion RESULTS: Dyads were randomized to usual care (n = 44) or intervention (n = 49)...
July 18, 2018: Journal of General Internal Medicine
Jingbo Meng, Syed Ali Hussain, David C Mohr, Mary Czerwinski, Mi Zhang
BACKGROUND: Today, college students are dealing with depression at some of the highest rates in decades. As the primary mental health service provider, university counseling centers are limited in their capacity and efficiency to provide mental health care due to time constraints and reliance on students' self-reports. A mobile behavioral-sensing platform may serve as a solution to enhance the efficiency and accessibility of university counseling services. OBJECTIVE: The main objectives of this study are to (1) understand the usefulness of a mobile sensing platform (ie, iSee) in improving counseling services and assisting students' self-management of their depression conditions, and (2) explore what types of behavioral targets (ie, meaningful information extracted from raw sensor data) and feedback to deliver from both clinician and students' perspectives...
July 17, 2018: Journal of Medical Internet Research
Willem Venter, Jesse Coleman, Vincent Lau Chan, Zara Shubber, Mothepane Phatsoane, Marelize Gorgens, Lynsey Stewart-Isherwood, Sergio Carmona, Nicole Fraser-Hurt
BACKGROUND: In HIV treatment program, gaps in the "cascade of care" where patients are lost between diagnosis, laboratory evaluation, treatment initiation, and retention in HIV care, is a well-described challenge. Growing access to internet-enabled mobile phones has led to an interest in using the technology to improve patient engagement with health care. OBJECTIVE: The objectives of this trial were: (1) to assess whether a mobile phone-enabled app could provide HIV patients with laboratory test results, (2) to better understand the implementation of such an intervention, and (3) to determine app effectiveness in improving linkage to HIV care after diagnosis...
July 17, 2018: JMIR MHealth and UHealth
Frances Bunn, Claire Goodman, Bridget Russell, Patricia Wilson, Jill Manthorpe, Greta Rait, Isabel Hodkinson, Marie-Anne Durand
BACKGROUND: Health care systems are increasingly moving towards more integrated approaches. Shared decision making (SDM) is central to these models but may be complicated by the need to negotiate and communicate decisions between multiple providers, as well as patients and their family carers; particularly for older people with complex needs. The aim of this review was to provide a context relevant understanding of how interventions to facilitate SDM might work for older people with multiple health and care needs, and how they might be applied in integrated care models...
July 18, 2018: BMC Geriatrics
Kenneth S Kendler, Henrik Ohlsson, Paul Lichtenstein, Jan Sundquist, Kristina Sundquist
OBJECTIVE: The authors examined the heritability of treated major depression in a twin and full/half-sibling design, to describe key genetic epidemiological features of major depression and to determine which clinical indices of genetic liability optimally predict risk of depression in relatives. METHOD: The authors examined all treated cases of major depression in Sweden recorded in inpatient, specialist, and primary care registries and, using OpenMx, estimated the etiologic role of genetic and environmental factors from monozygotic and dizygotic twin pairs and full and half siblings reared together and apart (total N=1,718,863 pairs)...
July 19, 2018: American Journal of Psychiatry
Margje H Haverkamp, David Peiris, Alexander J Mainor, Gert P Westert, Meredith B Rosenthal, Thomas D Sequist, Carrie H Colla
OBJECTIVES: Accountable care organizations (ACOs) are groups of healthcare providers responsible for quality of care and spending for a defined patient population. The elimination of low-value medical services will improve quality and reduce costs and, therefore, ACOs should actively work to reduce the use of low-value services. We set out to identify ACO characteristics associated with implementation of strategies to reduce overuse. STUDY DESIGN: Survey analysis...
July 1, 2018: American Journal of Managed Care
Mariétou H Ouayogodé, Ellen Meara, Chiang-Hua Chang, Stephanie R Raymond, Julie P W Bynum, Valerie A Lewis, Carrie H Colla
OBJECTIVES: Alternative payment models, such as accountable care organizations, hold provider groups accountable for an assigned patient population, but little is known about unassigned patients. We compared clinical and utilization profiles of patients attributable to a provider group with those of patients not attributable to any provider group. STUDY DESIGN: Cross-sectional study of 2012 Medicare fee-for-service beneficiaries 21 years and older. METHODS: We applied the Medicare Shared Savings Program attribution approach to assign beneficiaries to 2 mutually exclusive categories: attributable or unattributable...
July 1, 2018: American Journal of Managed Care
A J Pols, Bernike Pasveer, Dick L Willems
The concept of dignity is often used in palliative care, and, in particular, as a concept to illustrate what is important to those involved. However, philosophers, ethicists and laypersons cannot agree on what dignity actually is. In this paper, we analyse what caregivers told us about situations in which they thought dignity was at stake. From two focus group meeting of health care professionals concerning the end of life, we learned that dignity could mean different things, but that there were also shared themes...
April 30, 2018: Nederlands Tijdschrift Voor Geneeskunde
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