Next Issue
Previous Issue

Table of Contents

Healthcare, Volume 6, Issue 3 (September 2018)

  • Issues are regarded as officially published after their release is announced to the table of contents alert mailing list.
  • You may sign up for e-mail alerts to receive table of contents of newly released issues.
  • PDF is the official format for papers published in both, html and pdf forms. To view the papers in pdf format, click on the "PDF Full-text" link, and use the free Adobe Readerexternal link to open them.
Cover Story (view full-size image) What begins as a tick bite can evolve into a mental illness. As we overcome fragmentation in [...] Read more.
View options order results:
result details:
Displaying articles 1-49
Export citation of selected articles as:
Open AccessViewpoint The Applicability of N: Ancient Debates and Modern Experimental Design
Healthcare 2018, 6(3), 118; https://doi.org/10.3390/healthcare6030118
Received: 5 July 2018 / Revised: 16 September 2018 / Accepted: 17 September 2018 / Published: 19 September 2018
Viewed by 343 | PDF Full-text (196 KB) | HTML Full-text | XML Full-text
Abstract
Medicine has always been characterized by a tension between the particular and the general. A clinician is obligated to treat the individual in front of her, yet she accomplishes this task by applying generalized knowledge that describes an abstract average but not necessarily
[...] Read more.
Medicine has always been characterized by a tension between the particular and the general. A clinician is obligated to treat the individual in front of her, yet she accomplishes this task by applying generalized knowledge that describes an abstract average but not necessarily a specific person. Efforts to systematize this process of moving between the particular and the general have led to the development of randomized controlled trials and large observational studies. Inclusion of tens of thousands of people in such studies, it is argued, will enhance the applicability of the data to more individual circumstances. Yet, as genetic sequencing data have become more widely obtained and used, there has been an increased focus on what has been broadly termed “precision medicine”, a highly individualized approach to therapeutics. Moreover, advances in statistical methods have enabled researchers to use N-of-1 study data—traditionally considered too individualized to be broadly applicable—in new ways. This paper contextualizes these apparently modern debates with reference to historical arguments about methods of disease diagnosis and treatment, and earlier physicians’ concerns about the tension between the particular and the general that is intrinsic to medical practice. Full article
(This article belongs to the Special Issue Humanities and Healthcare)
Open AccessArticle Physician and Parental Decision—Making Prior to Acute Medical Paediatric Admission
Healthcare 2018, 6(3), 117; https://doi.org/10.3390/healthcare6030117
Received: 17 July 2018 / Revised: 29 August 2018 / Accepted: 14 September 2018 / Published: 17 September 2018
Viewed by 498 | PDF Full-text (219 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Background: The number of acute medical paediatric emergency admissions is rising. We undertook qualitative interviews with parents and clinicians to better understand what factors, other than the health status of the child, may influence decision making leading to emergency admission. Methods: Semi-structured interviews
[...] Read more.
Background: The number of acute medical paediatric emergency admissions is rising. We undertook qualitative interviews with parents and clinicians to better understand what factors, other than the health status of the child, may influence decision making leading to emergency admission. Methods: Semi-structured interviews were conducted with parents; clinicians working in general practice, out-of-hours or the emergency department (referring clinicians); and doctors working in acute medical paediatrics (receiving clinicians). Results: Ten parents, 7 referring clinicians and 10 receiving clinicians were interviewed. Parents described “erring on the side of caution” when seeking medical opinion and one mentioned anxiety. Among themes seen among referring clinicians, “erring on the side of caution” was also identified as was managing “parental anxiety” and acting on “gut instinct”. Among receiving clinicians, themes included managing parental anxiety and increasing parental expectations of the health service. Conclusions: The study of parent and referring clinician decision-making prior to a hospital admission can identify “teachable moments” where interventions might be delivered to slow or even arrest the rise in short-stay acute medical admissions in Britain and other countries. Interventions could assure parents or referring clinicians that hospital referral is not required and help clinicians understand what they perceive as “parental anxiety”. Full article
(This article belongs to the Special Issue Feature Papers in Healthcare in 2018)
Open AccessArticle Provider’s Perceptions of Barriers and Facilitators for Latinas to Participate in Genetic Cancer Risk Assessment for Hereditary Breast and Ovarian Cancer
Healthcare 2018, 6(3), 116; https://doi.org/10.3390/healthcare6030116
Received: 27 June 2018 / Revised: 24 August 2018 / Accepted: 7 September 2018 / Published: 17 September 2018
Viewed by 451 | PDF Full-text (261 KB) | HTML Full-text | XML Full-text
Abstract
The Comprehensive Cancer Network (NCCN) recommends genetic cancer risk assessment (GCRA) referral to women at high risk of hereditary breast and ovarian cancer. Latinas affected by breast cancer have the second highest prevalence of BRCA1/2 mutations after Ashkenazi Jews. Compared to non-Hispanic Whites,
[...] Read more.
The Comprehensive Cancer Network (NCCN) recommends genetic cancer risk assessment (GCRA) referral to women at high risk of hereditary breast and ovarian cancer. Latinas affected by breast cancer have the second highest prevalence of BRCA1/2 mutations after Ashkenazi Jews. Compared to non-Hispanic Whites, Latinas have lower GCRA uptake. While some studies have identified barriers for GCRA use in this population, few studies have focused on health care providers’ perspectives. The purpose of the study was to examine providers’ perceptions of barriers and facilitators for at-risk Latina women to participate in GCRA and their experiences providing services to this population. We conducted semi-structured interviews with 20 healthcare providers (e.g., genetic counselors, patient navigators) recruited nationally through snowballing. Interviews were transcribed. Two coders independently coded each interview and then met to reconcile the codes using Consensual Qualitative Research guidelines. Providers identified several facilitators for GCRA uptake (e.g., family, treatment/prevention decisions) and barriers (e.g., cost, referrals, awareness, stigma). Genetic counselors described important aspects to consider when working with at-risk Latina including language barriers, obtaining accurate family histories, family communication, and testing relatives who live outside the US. Findings from this study can inform future interventions to enhance uptake and quality of GCRA in at-risk Latina women to reduce disparities. Full article
(This article belongs to the Special Issue Precision Public Health and Genomic Medicine)
Open AccessReview Rational Use of Medicines in Neonates: Current Observations, Areas for Research and Perspectives
Healthcare 2018, 6(3), 115; https://doi.org/10.3390/healthcare6030115
Received: 1 September 2018 / Revised: 12 September 2018 / Accepted: 13 September 2018 / Published: 14 September 2018
Viewed by 512 | PDF Full-text (251 KB) | HTML Full-text | XML Full-text
Abstract
A focused reflection on rational medicines use in neonates is valuable and relevant, because indicators to assess rational medicines use are difficult to apply to neonates. Polypharmacy and exposure to antibiotics are common, while dosing regimens or clinical guidelines are only rarely supported
[...] Read more.
A focused reflection on rational medicines use in neonates is valuable and relevant, because indicators to assess rational medicines use are difficult to apply to neonates. Polypharmacy and exposure to antibiotics are common, while dosing regimens or clinical guidelines are only rarely supported by robust evidence in neonates. This is at least in part due to the extensive variability in pharmacokinetics and subsequent effects of medicines in neonates. Medicines utilization research informs us on trends, on between unit variability and on the impact of guideline implementation. We illustrate these aspects using data on drugs for gastroesophageal reflux, analgesics or anti-epileptic drugs. Areas for additional research are drug-related exposure during breastfeeding (exposure prediction) and how to assess safety (tools to assess seriousness, causality, and severity tailored to neonates) since both efficacy and safety determine rational drug use. To further improve rational medicines use, we need more data and tools to assess efficacy and safety in neonates. Moreover, we should facilitate access to such data, and explore strategies for effective implementation. This is because prescription practices are not only rational decisions, but also have psychosocial aspects that may guide clinicians to irrational practices, in part influenced by the psychosocial characteristics of this population. Full article
(This article belongs to the Special Issue Rational Use of Medicines in Children)
Open AccessArticle How a Communication Intervention in Zambia Re-Oriented Health Services to the Needs of the Least-Supported
Healthcare 2018, 6(3), 114; https://doi.org/10.3390/healthcare6030114
Received: 27 August 2018 / Revised: 7 September 2018 / Accepted: 10 September 2018 / Published: 13 September 2018
Viewed by 565 | PDF Full-text (223 KB) | HTML Full-text | XML Full-text
Abstract
Despite decades of training health workers in communication, complaints from clients and communities about poor health worker attitudes abound. This was found to be so in Zambia where the More Mobilizing Access to Maternal Health Services in Zambia (MORE MAMaZ) program was trying
[...] Read more.
Despite decades of training health workers in communication, complaints from clients and communities about poor health worker attitudes abound. This was found to be so in Zambia where the More Mobilizing Access to Maternal Health Services in Zambia (MORE MAMaZ) program was trying to ensure the inclusion of under-supported women in a community-based maternal and newborn health program in five intervention districts. Under-supported women suffer a disproportionate burden of child mortality and are poor users of health services. An exploratory small-scale qualitative survey involving nurses from training schools and health facilities found that nurses knew how to communicate well, but were selective with whom and in what circumstances they did this. In general, those who received the worst communication were under-supported and had low confidence—the very people who needed the best communication. An experiential training program was started to help health workers reflect on the reasons for their poor communication. The training was evaluated after 14 months using semi-structured interviews and focus group discussions with staff at participating health facilities. The results showed improved inclusion of under-supported women but also increased attendance generally for ante-natal clinics, deliveries and under-five clinics. Another outcome was improved communication between, and a sense of job satisfaction among, the health workers themselves. The program demonstrated an effective way to improve the inclusion and involvement of the least-supported women and girls. There are important lessons for other health programs that aim to operationalize the goals of the Global Strategy for Women’s, Children’s and Adolescent’s Health, which include an emphasis on reaching every woman. Full article
(This article belongs to the Special Issue Rural and Remote Nursing)
Open AccessReview Health-Related Quality of Life after Pediatric Severe Sepsis
Healthcare 2018, 6(3), 113; https://doi.org/10.3390/healthcare6030113
Received: 20 June 2018 / Revised: 5 September 2018 / Accepted: 6 September 2018 / Published: 11 September 2018
Viewed by 544 | PDF Full-text (184 KB) | HTML Full-text | XML Full-text
Abstract
Background: Pediatric severe sepsis is a public health problem with significant morbidities in those who survive. In this article, we aim to present an overview of the important studies highlighting the limited data available pertaining to long-term outcomes of survivors of pediatric severe
[...] Read more.
Background: Pediatric severe sepsis is a public health problem with significant morbidities in those who survive. In this article, we aim to present an overview of the important studies highlighting the limited data available pertaining to long-term outcomes of survivors of pediatric severe sepsis. Materials and Methods: A review of literature available was conducted using PUBMED/Medline on pediatric severe sepsis outcomes. Long-term outcomes and health-related quality of life (HRQL) following severe sepsis was defined as any outcome occurring after discharge from the hospital following an episode of severe sepsis which affected either the survivor or the survivor’s family members. Results: Many children are discharged with worse clinical and functional outcomes, depending on their diagnosis, treatments received, psychological effects, and the impact of their illness on their parents. Additionally, they utilize healthcare services more than their peers and are often readmitted soon after discharge. However, pediatric HRQL studies with worthwhile outcome measures are limited and the current data on pediatric sepsis is mainly retrospective. Conclusions: There is significant and longstanding morbidity seen in children and their families following a severe sepsis illness. Further prospective data are required to study the long-term outcomes of sepsis in the pediatric population. Full article
(This article belongs to the Special Issue The Outcome of Sepsis)
Open AccessReview Have Studies that Measure Lumbar Kinematics and Muscle Activity Concurrently during Sagittal Bending Improved Understanding of Spinal Stability and Sub-System Interactions? A Systematic Review
Healthcare 2018, 6(3), 112; https://doi.org/10.3390/healthcare6030112
Received: 23 July 2018 / Revised: 15 August 2018 / Accepted: 7 September 2018 / Published: 8 September 2018
Viewed by 993 | PDF Full-text (573 KB) | HTML Full-text | XML Full-text
Abstract
In order to improve understanding of the complex interactions between spinal sub-systems (i.e., the passive (ligaments, discs, fascia and bones), the active (muscles and tendons) and the neural control systems), it is necessary to take a dynamic approach that incorporates the measurement of
[...] Read more.
In order to improve understanding of the complex interactions between spinal sub-systems (i.e., the passive (ligaments, discs, fascia and bones), the active (muscles and tendons) and the neural control systems), it is necessary to take a dynamic approach that incorporates the measurement of multiple systems concurrently. There are currently no reviews of studies that have investigated dynamic sagittal bending movements using a combination of electromyography (EMG) and lumbar kinematic measurements. As such it is not clear how understanding of spinal stability concepts has advanced with regards to this functional movement of the spine. The primary aim of this review was therefore to evaluate how such studies have contributed to improved understanding of lumbar spinal stability mechanisms. PubMed and Cochrane databases were searched using combinations of the keywords related to spinal stability and sagittal bending tasks, using strict inclusion and exclusion criteria and adhering to PRISMA guidelines. Whilst examples of the interactions between the passive and active sub-systems were shown, typically small sample sizes meant that results were not generalizable. The majority of studies used regional kinematic measurements, and whilst this was appropriate in terms of individual study aims, the studies could not provide insight into sub-system interaction at the level of the spinal motion segment. In addition, the heterogeneity in methodologies made comparison between studies difficult. The review suggests that since Panjabi’s seminal spinal control papers, only limited advancement in the understanding of these theories has been provided by the studies under review, particularly at an inter-segmental level. This lack of progression indicates a requirement for new research approaches that incorporate multiple system measurements at a motion segment level. Full article
Figures

Figure 1

Open AccessReview Sepsis: Personalized Medicine Utilizing ‘Omic’ Technologies—A Paradigm Shift?
Healthcare 2018, 6(3), 111; https://doi.org/10.3390/healthcare6030111
Received: 13 August 2018 / Revised: 4 September 2018 / Accepted: 5 September 2018 / Published: 7 September 2018
Viewed by 682 | PDF Full-text (492 KB) | HTML Full-text | XML Full-text
Abstract
Sepsis has over the years proven a considerable challenge to physicians and researchers. Numerous pharmacological and non-pharmacological interventions have been tested in trials, but have unfortunately failed to improve the general prognosis. This has led to the speculation that the sepsis population may
[...] Read more.
Sepsis has over the years proven a considerable challenge to physicians and researchers. Numerous pharmacological and non-pharmacological interventions have been tested in trials, but have unfortunately failed to improve the general prognosis. This has led to the speculation that the sepsis population may be too heterogeneous to be targeted with the traditional one treatment suits all’ approach. Recent advances in genetic and biochemical analyses now allow genotyping and biochemical characterisation of large groups of patients via the ‘omics’ technologies. These new opportunities could lead to a paradigm shift in the approach to sepsis towards personalised treatments with interventions targeted towards specific pathophysiological mechanisms activated in the patient. In this article, we review the potentials and pitfalls of using new advanced technologies to deepen our understanding of the clinical syndrome of sepsis. Full article
(This article belongs to the Special Issue The Outcome of Sepsis)
Figures

Figure 1

Open AccessReview Mid-Regional Pro-Adrenomedullin (MR-proADM) as a Biomarker for Sepsis and Septic Shock: Narrative Review
Healthcare 2018, 6(3), 110; https://doi.org/10.3390/healthcare6030110
Received: 30 May 2018 / Revised: 19 August 2018 / Accepted: 29 August 2018 / Published: 3 September 2018
Viewed by 823 | PDF Full-text (289 KB) | HTML Full-text | XML Full-text
Abstract
Early identification and diagnosis of sepsis and septic shock is vitally important; despite appropriate management, mortality and morbidity rates remain high. For this reason, many biomarkers and screening systems have been investigated in accordance with the precision medicine concept. A narrative review was
[...] Read more.
Early identification and diagnosis of sepsis and septic shock is vitally important; despite appropriate management, mortality and morbidity rates remain high. For this reason, many biomarkers and screening systems have been investigated in accordance with the precision medicine concept. A narrative review was conducted to assess the role of mid-regional pro-adrenomedullin (MR-proADM) as a biomarker for sepsis and septic shock. Relevant studies were collected via an electronic PubMed, Web of Science, and The Cochrane Library search. The review focused on both diagnosis and prognosis in patients with sepsis and septic shock and specifically in subpopulations of patients with sepsis and septic shock with burns or malignant tumors. No exclusion criteria regarding age, sex, intensive care unit admission, follow-up duration, or co morbidities were used so as to maximize sensitivity and due to lack of randomized controlled trials, opinion paper and reviews were also included in this review. A total of 22 studies, one opinion paper, and one review paper were investigated. MR-proADM levels were found to be useful in assessing patients’ initial evolution and become even more useful during follow-up with increased area under curve values in the mortality prognosis by exceeding values of 0.8 in the data shown in several studies. These results also improve along with other biomarkers or severity scores and especially correlate with the organ failure degree. The results of this study indicate that MR-proADM is a good biomarker for the diagnosis and prognosis of sepsis and septic shock patients as well as for organ failure. Although several publications have discussed its role as a biomarker for pneumonia, its value as a biomarker for sepsis and septic shock should now be assessed in randomized controlled trials and more collaborative prospective studies with larger patient samples. Full article
(This article belongs to the Special Issue The Outcome of Sepsis)
Open AccessReview Assessment of Health Information Technology Interventions in Evidence-Based Medicine: A Systematic Review by Adopting a Methodological Evaluation Framework
Healthcare 2018, 6(3), 109; https://doi.org/10.3390/healthcare6030109
Received: 10 July 2018 / Revised: 15 August 2018 / Accepted: 28 August 2018 / Published: 31 August 2018
Viewed by 870 | PDF Full-text (2336 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Background: The application of Health Information Technologies (HITs) can be an effective way to advance medical research and health services provision. The two-fold objective of this work is to: (i) identify and review state-of-the-art HITs that facilitate the aims of evidence-based
[...] Read more.
Background: The application of Health Information Technologies (HITs) can be an effective way to advance medical research and health services provision. The two-fold objective of this work is to: (i) identify and review state-of-the-art HITs that facilitate the aims of evidence-based medicine and (ii) propose a methodology for HIT assessment. Methods: The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Furthermore, we consolidated existing knowledge in the field and proposed a Synthesis Framework for the Assessment of Health Information Technology (SF/HIT) in order to evaluate the joint use of Randomized Controlled Trials (RCTs) along with HITs in the field of evidence-based medicine. Results: 55 articles met the inclusion criteria and refer to 51 (RCTs) published between 2008 and 2016. Significant improvements in healthcare through the use of HITs were observed in the findings of 31 out of 51 trials—60.8%. We also confirmed that RCTs are valuable tools for assessing the effectiveness, acceptability, safety, privacy, appropriateness, satisfaction, performance, usefulness and adherence. Conclusions: To improve health service delivery, RCTs apply and exhibit formalization by providing measurable outputs. Towards this direction, we propose the SF/HIT as a framework which may help researchers to carry out appropriate evaluations and extend their studies. Full article
(This article belongs to the collection Nutrition and Public Health)
Figures

Graphical abstract

Open AccessArticle Stakeholder Views on Active Cascade Screening for Familial Hypercholesterolemia
Healthcare 2018, 6(3), 108; https://doi.org/10.3390/healthcare6030108
Received: 11 July 2018 / Revised: 22 August 2018 / Accepted: 27 August 2018 / Published: 31 August 2018
Viewed by 738 | PDF Full-text (448 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
In familial hypercholesterolemia (FH), carriers profit from presymptomatic diagnosis and early treatment. Due to the autosomal dominant pattern of inheritance, first degree relatives of patients are at 50% risk. A program to identify healthy relatives at risk of premature cardiovascular problems, funded by
[...] Read more.
In familial hypercholesterolemia (FH), carriers profit from presymptomatic diagnosis and early treatment. Due to the autosomal dominant pattern of inheritance, first degree relatives of patients are at 50% risk. A program to identify healthy relatives at risk of premature cardiovascular problems, funded by the Netherlands government until 2014, raised questions on privacy and autonomy in view of the chosen active approach of family members. Several countries are building cascade screening programs inspired by Dutch experience, but meanwhile, the Netherlands’ screening program itself is in transition. Insight in stakeholders’ views on approaching family members is lacking. Literature and policy documents were studied, and stakeholders were interviewed on pros and cons of actively approaching healthy relatives. Sociotechnical analysis explored new roles and responsibilities, with uptake, privacy, autonomy, psychological burden, resources, and awareness as relevant themes. Stakeholders agree on the importance of early diagnosis and informing the family. Dutch healthcare typically focuses on cure, rather than prevention. Barriers to cascade screening are paying an own financial contribution, limited resources for informing relatives, and privacy regulation. To benefit from predictive, personalized, and preventive medicine, the roles and responsibilities of stakeholders in genetic testing as a preventive strategy, and informing family members, need to be carefully realigned. Full article
(This article belongs to the Special Issue Precision Public Health and Genomic Medicine)
Figures

Figure 1

Open AccessConcept Paper A Population-Based Conceptual Framework for Evaluating the Role of Healthcare Services in Place of Death
Healthcare 2018, 6(3), 107; https://doi.org/10.3390/healthcare6030107
Received: 6 August 2018 / Revised: 24 August 2018 / Accepted: 28 August 2018 / Published: 30 August 2018
Viewed by 806 | PDF Full-text (610 KB) | HTML Full-text | XML Full-text
Abstract
Background: There is a significant geographical disparity in place of death. Socio-demographic and disease-related variables only explain less than a quarter of the variation. Healthcare service factors may account for some (or much) of the remaining variation but their effects have never been
[...] Read more.
Background: There is a significant geographical disparity in place of death. Socio-demographic and disease-related variables only explain less than a quarter of the variation. Healthcare service factors may account for some (or much) of the remaining variation but their effects have never been systematically evaluated, partly due to the lack of a conceptual framework. This study aims to propose a population-based framework to guide the evaluation of the role of the healthcare service factors in place of death. Methods: Review and synthesis of health service models that include the impact of a service component on either place of death/end of life care outcomes or service access/utilization. Results: The framework conceptualizes the impact of healthcare services on the place of death as starting from the end of life care policies that in turn influence service commissioning and shape healthcare service characteristics, including service type, service capacity—facilities, service location, and workforce, through which service utilization and ultimately place of death are affected. Patient socio-demographics, disease-related variables, family and community support and social care also influence place of death, but they are not the focus of this framework and therefore are grouped as needs and other environmental factors. Information on service utilization, together with the place of death, creates loop feedback to inform policy and service commission. Conclusions: The framework provides guidance for analysis aiming to understand the role of healthcare services in place of death. It aids the interpretation of results in the light of existing knowledge and potentially identifies service factors that can be addressed to improve end of life care. Full article
Figures

Figure 1

Open AccessArticle An Exploration of Parent-Youth Agreement on Functional Impairment in Adolescents Utilizing Outpatient Mental Health Services
Healthcare 2018, 6(3), 106; https://doi.org/10.3390/healthcare6030106
Received: 16 July 2018 / Revised: 15 August 2018 / Accepted: 28 August 2018 / Published: 30 August 2018
Viewed by 488 | PDF Full-text (220 KB) | HTML Full-text | XML Full-text
Abstract
Parent-youth agreement on the youth’s functional impairment may have important implications for mental health service utilization, assessment, therapy goal development, and treatment engagement for adolescents. The present study examines parent-youth agreement on their perceptions of youth functional impairment in a predominantly racial/ethnic minority
[...] Read more.
Parent-youth agreement on the youth’s functional impairment may have important implications for mental health service utilization, assessment, therapy goal development, and treatment engagement for adolescents. The present study examines parent-youth agreement on their perceptions of youth functional impairment in a predominantly racial/ethnic minority sample of adolescents utilizing outpatient mental health services. Parent and youth functional impairment ratings were compared, and agreement was estimated in multiple ways. On average, parents indicated higher levels of youth functional impairment compared to youth in their overall scores, and when differences existed between parents and youth at the functioning domain and item level. Although there was similarity in the proportion of parents and youth who reported total impairment above the clinical cut-off, actual agreement between parent-youth pairs was only slight. There appeared to be substantial variation in agreement levels when identifying problems in functional impairment at the domain and item levels, and some areas of strong consensus were identified. These findings highlight the need to consider parent-youth agreement in perceptions of functional impairment and the complexities that may underlie this agreement. Full article
(This article belongs to the Special Issue Feature Papers in Healthcare in 2018)
Open AccessArticle Allostatic Load Biomarker Associations with Depressive Symptoms Vary among US Black and White Women and Men
Healthcare 2018, 6(3), 105; https://doi.org/10.3390/healthcare6030105
Received: 9 July 2018 / Revised: 20 August 2018 / Accepted: 25 August 2018 / Published: 28 August 2018
Viewed by 677 | PDF Full-text (248 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
The prevalence and severity of depression differ in women and men and across racial groups. Psychosocial factors such as chronic stress have been proposed as contributors, but causes of this variation are not fully understood. Allostatic load, a measure of the physiological burden
[...] Read more.
The prevalence and severity of depression differ in women and men and across racial groups. Psychosocial factors such as chronic stress have been proposed as contributors, but causes of this variation are not fully understood. Allostatic load, a measure of the physiological burden of chronic stress, is known to be associated with depression. Using data from the National Health and Nutrition Examination Survey 2005–2010, we examined the associations of nine allostatic load biomarkers with depression among US black and white adults aged 18–64 years (n = 6431). Depressive symptoms were assessed using the Patient Health Questionaire-9; logistic models estimated adjusted odds of depression based on allostatic load biomarkers. High-risk levels of c-reactive protein were significantly associated with increased odds of depression among white women (adjusted odds ratio (aOR) = 1.7, 95% CI: 1.1–2.5) and men (aOR = 1.8, 95% CI: 1.1–2.8) but not black women (aOR = 0.8, 95% CI: 0.6–1.1) or men (aOR = 0.9, 95% CI: 0.5–1.5). Among black men, hypertension (aOR = 1.7, 95% CI: 1.1–2.7) and adverse serum albumin levels (aOR = 1.7, 95% CI: 1.0–2.9) predicted depression, while high total cholesterol was associated with depression among black women (aOR = 1.6, 95% CI: 1.0–2.7). The associations between allostatic load biomarkers and depression varies with gendered race, suggesting that, despite consistent symptomatology, underlying disease mechanisms may differ between these groups. Full article
Open AccessReview Neuropsychiatric Lyme Borreliosis: An Overview with a Focus on a Specialty Psychiatrist’s Clinical Practice
Healthcare 2018, 6(3), 104; https://doi.org/10.3390/healthcare6030104
Received: 10 July 2018 / Revised: 22 August 2018 / Accepted: 23 August 2018 / Published: 25 August 2018
Viewed by 8720 | PDF Full-text (316 KB) | HTML Full-text | XML Full-text
Abstract
There is increasing evidence and recognition that Lyme borreliosis (LB) causes mental symptoms. This article draws from databases, search engines and clinical experience to review current information on LB. LB causes immune and metabolic effects that result in a gradually developing spectrum of
[...] Read more.
There is increasing evidence and recognition that Lyme borreliosis (LB) causes mental symptoms. This article draws from databases, search engines and clinical experience to review current information on LB. LB causes immune and metabolic effects that result in a gradually developing spectrum of neuropsychiatric symptoms, usually presenting with significant comorbidity which may include developmental disorders, autism spectrum disorders, schizoaffective disorders, bipolar disorder, depression, anxiety disorders (panic disorder, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder, intrusive symptoms), eating disorders, decreased libido, sleep disorders, addiction, opioid addiction, cognitive impairments, dementia, seizure disorders, suicide, violence, anhedonia, depersonalization, dissociative episodes, derealization and other impairments. Screening assessment followed by a thorough history, comprehensive psychiatric clinical exam, review of systems, mental status exam, neurological exam and physical exam relevant to the patient’s complaints and findings with clinical judgment, pattern recognition and knowledgeable interpretation of laboratory findings facilitates diagnosis. Psychotropics and antibiotics may help improve functioning and prevent further disease progression. Awareness of the association between LB and neuropsychiatric impairments and studies of their prevalence in neuropsychiatric conditions can improve understanding of the causes of mental illness and violence and result in more effective prevention, diagnosis and treatment. Full article
Open AccessArticle Signs in People with Intellectual Disabilities: Interviews with Managers and Staff on the Identification Process of Dementia
Healthcare 2018, 6(3), 103; https://doi.org/10.3390/healthcare6030103
Received: 4 August 2018 / Revised: 20 August 2018 / Accepted: 23 August 2018 / Published: 25 August 2018
Viewed by 691 | PDF Full-text (563 KB) | HTML Full-text | XML Full-text
Abstract
The life expectancy of people with intellectual disabilities (ID) has steadily increased, which has been accompanied by an increased risk of dementia. Staff and managers are key resources for safety diagnosis since they deliver information about people with ID behavior every day. The
[...] Read more.
The life expectancy of people with intellectual disabilities (ID) has steadily increased, which has been accompanied by an increased risk of dementia. Staff and managers are key resources for safety diagnosis since they deliver information about people with ID behavior every day. The aim of the present study was to explore the identification process employed by staff and managers to detect signs of suspected dementia in people with an ID within intellectual disability services (ID-services). Twenty managers and 24 staff within an ID-service were interviewed and qualitative latent content analysis was applied. A model consisting of three themes on three levels of resources for the identification process of signs of suspected dementia emerged from the analysis. On the first level was the time and continuity in the care relationship, which is crucial for identifying and responding to changes in cognitive ability that indicate dementia. On the second level, the staff identify deficiencies in their own knowledge, seek support from colleagues and managers within their workplace and, on the third level, outside their workplace. Staff and managers expressed a need for early and continuous guidance and education from specialists in dementia and primary healthcare. This finding indicates an urgent need for intervention research and digital support for staff in dementia care. Full article
(This article belongs to the Special Issue Care of People Living with Dementia)
Figures

Figure 1

Open AccessArticle PTSD in U.S. Veterans: The Role of Social Connectedness, Combat Experience and Discharge
Healthcare 2018, 6(3), 102; https://doi.org/10.3390/healthcare6030102
Received: 7 August 2018 / Revised: 16 August 2018 / Accepted: 17 August 2018 / Published: 22 August 2018
Viewed by 934 | PDF Full-text (506 KB) | HTML Full-text | XML Full-text
Abstract
Service members who transition out of the military often face substantial challenges during their transition to civilian life. Leaving military service requires establishing a new community as well as sense of connectedness to that community. Little is known about how social connectedness may
[...] Read more.
Service members who transition out of the military often face substantial challenges during their transition to civilian life. Leaving military service requires establishing a new community as well as sense of connectedness to that community. Little is known about how social connectedness may be related to other prominent transition outcomes, particularly symptoms of posttraumatic stress disorder (PTSD). The purpose of this study was to explore the role of social connectedness in the development of PTSD, as well as its relationship to the known risk factors of combat exposure and discharge status. Data used were drawn from a needs assessment survey of 722 veterans. A path model was specified to test direct and indirect effects of combat experiences, non-honorable discharge status, and social connectedness on PTSD symptoms. Results demonstrated positive direct effects for combat experiences and non-honorable discharge status on PTSD symptoms while social connectedness demonstrated a negative direct effect. Both combat experiences and non-honorable discharge status demonstrated negative direct effects on social connectedness and indirect on PTSD through the social connectedness pathway. Study findings indicate social connectedness may be an important factor related to PTSD in veterans as well as an intervention point for mitigating risk related to combat exposure and discharge status. Full article
(This article belongs to the Special Issue Military Mental Health)
Figures

Figure 1

Open AccessArticle Does Medical Students’ Personality Traits Influence Their Attitudes toward Medical Errors?
Healthcare 2018, 6(3), 101; https://doi.org/10.3390/healthcare6030101
Received: 27 July 2018 / Revised: 12 August 2018 / Accepted: 14 August 2018 / Published: 17 August 2018
Viewed by 604 | PDF Full-text (226 KB) | HTML Full-text | XML Full-text
Abstract
This study examined medical students’ perceptions towards medical errors and the policy of the hospital within the internship curriculum, and explored how aspects of personality traits of medical students relate to their attitude toward medical errors. Based on the theory of the Five-Factor-Model
[...] Read more.
This study examined medical students’ perceptions towards medical errors and the policy of the hospital within the internship curriculum, and explored how aspects of personality traits of medical students relate to their attitude toward medical errors. Based on the theory of the Five-Factor-Model (FFM) and related literature review, this study adopted a self-devised structured questionnaire to distribute to 493 medical students in years five to seven in the top three medical schools, representing a 56.7% valid questionnaire response rate. Results showed that agreeableness is more important than other personality traits, and medical students with high agreeableness are good communicators and have a more positive attitude to avoid errors in the future. On the contrary, students with low neuroticism tended to be more relaxed and gentle. If medical educators can recruit new students with high agreeableness, these students will be more likely to effectively improve the quality of medical care and enhance patient safety. This study anticipates that this method could be easily translated to nearly every medical department entry examination, particularly with regards to a consciousness-based education of future physicians. Full article
(This article belongs to the Special Issue Feature Papers in Healthcare in 2018)
Open AccessEditorial Understanding the Needs of Veterans with PTSD
Healthcare 2018, 6(3), 100; https://doi.org/10.3390/healthcare6030100
Received: 13 August 2018 / Revised: 14 August 2018 / Accepted: 14 August 2018 / Published: 15 August 2018
Viewed by 915 | PDF Full-text (147 KB) | HTML Full-text | XML Full-text
(This article belongs to the Special Issue Post Traumatic Stress Disorder and Veterans)
Open AccessArticle Pilot Study of Immunoblots with Recombinant Borrelia burgdorferi Antigens for Laboratory Diagnosis of Lyme Disease
Received: 17 May 2018 / Revised: 7 August 2018 / Accepted: 10 August 2018 / Published: 14 August 2018
Cited by 1 | Viewed by 1576 | PDF Full-text (872 KB) | HTML Full-text | XML Full-text
Abstract
Accurate laboratory diagnosis of Lyme disease (Lyme borreliosis), caused by the spirochete Borrelia burgdorferi (BB), is difficult and yet important to prevent serious disease. The US Centers for Disease Control and Prevention (CDC) presently recommends a screening test for serum antibodies followed by
[...] Read more.
Accurate laboratory diagnosis of Lyme disease (Lyme borreliosis), caused by the spirochete Borrelia burgdorferi (BB), is difficult and yet important to prevent serious disease. The US Centers for Disease Control and Prevention (CDC) presently recommends a screening test for serum antibodies followed by confirmation with a more specific Western blot (WB) test to detect IgG and IgM antibodies against antigens in whole cell lysates of BB. Borrelia species related to BB cause tick-borne relapsing fever (TBRF). TBRF is increasingly recognized as a health problem in the US and occurs in areas where Lyme disease is prevalent. The two groups of Borrelia share related antigens. We have developed a modified WB procedure termed the Lyme immunoblots (IBs) using recombinant antigens from common strains and species of the BB sensu lato complex for serological diagnosis of Lyme disease. A reference collection of 178 sera from 26 patients with and 152 patients without Lyme disease were assessed by WB and IB in a blinded manner using either criteria for positive antibody reactions recommended by the CDC or criteria developed in-house. The sensitivity, specificity, positive and negative predictive values obtained with the reference sera suggest that the Lyme IB is superior to the Lyme WB for detection of specific antibodies in Lyme disease. The Lyme IB showed no significant reaction with rabbit antisera produced against two Borrelia species causing TBRF in the US, suggesting that the Lyme IB may be also useful for excluding TBRF. Full article
Figures

Figure 1

Open AccessFeature PaperArticle Orthopedic Professionals’ Recognition and Knowledge of Pain and Perceived Barriers to Optimal Pain Management at Five Hospitals
Received: 26 June 2018 / Revised: 6 August 2018 / Accepted: 9 August 2018 / Published: 13 August 2018
Viewed by 772 | PDF Full-text (263 KB) | HTML Full-text | XML Full-text
Abstract
Pain is a challenge for orthopedic healthcare professionals (OHCP). However, pain studies examined the competencies of a single OHCP category, did not consider various pain management domains or barriers to optimal pain service, and are deficient across the Arabic Eastern Mediterranean region. We
[...] Read more.
Pain is a challenge for orthopedic healthcare professionals (OHCP). However, pain studies examined the competencies of a single OHCP category, did not consider various pain management domains or barriers to optimal pain service, and are deficient across the Arabic Eastern Mediterranean region. We surveyed OHCP’s recognition and knowledge of pain and perceived barriers to optimal pain service (361 OHCP, five hospitals). Chi square compared doctors’ (n = 63) vs. nurses/physiotherapists’ (n = 187) views. In terms of pain recognition, more nurses had pain management training, confidently assessed pediatric/elderly pain, were aware of their departments’ pain protocols, and felt that their patients receive proper pain management. More doctors comfortably prescribed opiate medications and agreed that some nationalities were more sensitive to pain. For pain knowledge, more nurses felt patients are accurate in assessing their pain, vital signs are accurate in assessing children’s pain, children feel less pain because of nervous system immaturity, narcotics are not preferred due respiratory depression, and knew pre-emptive analgesia. As for barriers to optimal pain service, less nurses agreed about the lack of local policies/guidelines, knowledge, and skills; time to pre-medicate patients; knowledge about medications; complexity of the clinical environment; and physicians being not comfortable prescribing pain medication. We conclude that doctors required confidence in pain, especially pediatric and geriatric pain, using vital signs in assessing pain and narcotics use. Their most perceived barriers were lack of local policies/guidelines and skills. Nurses required more confidence in medications, caring for patients on narcotics, expressed fewer barriers than doctors, and the complexity of the clinical environment was their highest barrier. Educational programs with clinical application could improve OHCPs’ pain competencies/clinical practices in pain assessment and administration of analgesics. Full article
(This article belongs to the Special Issue Chronic Pain and the Aging Population)
Open AccessArticle Academic Palliative Care Research in Portugal: Are We on the Right Track?
Received: 6 July 2018 / Revised: 7 August 2018 / Accepted: 9 August 2018 / Published: 12 August 2018
Viewed by 741 | PDF Full-text (1082 KB) | HTML Full-text | XML Full-text
Abstract
Background: The narrow link between practice, education, and research is essential to palliative care development. In Portugal, academic postgraduate publications are the main booster for palliative care research. Methods: This is a bibliometric study that aims to identify Portuguese palliative care postgraduate academic
[...] Read more.
Background: The narrow link between practice, education, and research is essential to palliative care development. In Portugal, academic postgraduate publications are the main booster for palliative care research. Methods: This is a bibliometric study that aims to identify Portuguese palliative care postgraduate academic work published in electronic academic repositories between 2000 and 2015. Results: 488 publications were identified. The number of publications has increased, especially in the last five years. The most frequently used method was quantitative, healthcare professionals were the most studied participants, and psychological and psychiatric aspects of care comprised the most current theme. Practice-based priorities are financial costs and benefits of palliative care, awareness and understanding of palliative care, underserved populations, best practices, communication, and palliative care in nonhospital settings. Conclusion: The number of palliative care postgraduate academic publications has increased in Portugal in the past few years. There is academic production in the eight domains of quality palliative care and on the three levels of recommendation for practice-based research priorities. The major research gaps in Portugal are at the system and societal context levels. Full article
(This article belongs to the Special Issue Recent Advances in Palliative Care)
Figures

Figure 1

Open AccessFeature PaperReview What People Want to Know About Their Genes: A Critical Review of the Literature on Large-Scale Genome Sequencing Studies
Received: 13 June 2018 / Revised: 28 July 2018 / Accepted: 30 July 2018 / Published: 8 August 2018
Viewed by 776 | PDF Full-text (218 KB) | HTML Full-text | XML Full-text
Abstract
From a public health perspective, the “All of Us” study provides an opportunity to isolate targeted and cost-effective prevention and early-detection strategies. Identifying motivations for participation in large-scale genomic sequencing (LSGS) studies, and motivations and preferences to receive results will help determine effective
[...] Read more.
From a public health perspective, the “All of Us” study provides an opportunity to isolate targeted and cost-effective prevention and early-detection strategies. Identifying motivations for participation in large-scale genomic sequencing (LSGS) studies, and motivations and preferences to receive results will help determine effective strategies for “All of Us” study implementation. This paper offers a critical review of the literature regarding LSGS for adult onset hereditary conditions where results could indicate an increased risk to develop disease. The purpose of this review is to synthesize studies which explored peoples’ motivations for participating in LSGS studies, and their desire to receive different types of genetic results. Participants were primarily motivated by altruism, desire to know more about their health, and curiosity. When asked about hypothetically receiving results, most participants in hypothetical studies wanted all results except those which were uncertain (i.e., a variant of uncertain significance (VUS)). However, participants in studies where results were returned preferred to receive only results for which an intervention was available, but also wanted VUS. Concerns about peoples’ understanding of results and possible psychosocial implications are noted. Most studies examined populations classified as “early adopters,” therefore, additional research on motivations and expectations among the general public, minority, and underserved populations is needed. Full article
(This article belongs to the Special Issue Precision Public Health and Genomic Medicine)
Open AccessArticle The Link between Posttraumatic Stress Disorder and Functionality among United States Military Service Members Psychiatrically Hospitalized Following a Suicide Crisis
Received: 1 July 2018 / Revised: 18 July 2018 / Accepted: 30 July 2018 / Published: 7 August 2018
Cited by 1 | Viewed by 911 | PDF Full-text (259 KB) | HTML Full-text | XML Full-text
Abstract
Posttraumatic stress disorder (PTSD) is one of the most commonly diagnosed psychiatric disorders in the United States and has been linked to suicidal thoughts and behaviors, yet the role of a PTSD diagnosis on functional impairment among suicidal individuals remains unknown. This study
[...] Read more.
Posttraumatic stress disorder (PTSD) is one of the most commonly diagnosed psychiatric disorders in the United States and has been linked to suicidal thoughts and behaviors, yet the role of a PTSD diagnosis on functional impairment among suicidal individuals remains unknown. This study examined the association between PTSD status and functional impairment among military psychiatric inpatients admitted for acute suicide risk (N = 166) with a lifetime history of at least one suicide attempt. Measures of functionality included: (1) alcohol use; (2) sleep quality; (3) social problem-solving; and (4) work and social adjustment. Thirty-eight percent of the sample met criteria for PTSD. Women were more likely than men to meet criteria for PTSD (p = 0.007), and participants who met PTSD criteria had significantly more psychiatric diagnoses (p < 0.001). Service members who met PTSD criteria reported more disturbed sleep (p = 0.003) and greater difficulties with work and social adjustment (p = 0.004) than those who did not meet PTSD criteria. However, functionality measures were not significantly associated with PTSD status after controlling for gender and psychiatric comorbidity. Gender and number of psychiatric comorbidities other than PTSD were significant predictors of PTSD in logistic regression models across four functionality measures. Future studies should assess the additive or mediating effect of psychiatric comorbidities in the association between impaired functioning and PTSD. Clinicians are encouraged to assess and address functionality during treatment with suicidal individuals, paying particular attention to individuals with multiple psychiatric diagnoses. Full article
(This article belongs to the Special Issue Post Traumatic Stress Disorder and Veterans)
Open AccessArticle Veteran Treatments: PTSD Interventions
Received: 3 July 2018 / Revised: 31 July 2018 / Accepted: 2 August 2018 / Published: 6 August 2018
Cited by 1 | Viewed by 1355 | PDF Full-text (172 KB) | HTML Full-text | XML Full-text
Abstract
Post-traumatic stress disorder (PTSD) has resulted in high social costs in terms of the lingering inability of veterans to adapt to societal norms. These costs accrue to individual veterans, their families, friends, and others. In addition, society suffers from the lost productivity of
[...] Read more.
Post-traumatic stress disorder (PTSD) has resulted in high social costs in terms of the lingering inability of veterans to adapt to societal norms. These costs accrue to individual veterans, their families, friends, and others. In addition, society suffers from the lost productivity of veterans. There is a need to pay greater attention to the extant literature regarding the effectiveness or ineffectiveness of various interventions. This study reviews the most relevant research regarding PTSD, veterans, interventions, treatment, counseling, job training and medication. Increasing awareness of the existing state of knowledge can lead to better targeting of resources and better health outcomes. Full article
(This article belongs to the Special Issue Post Traumatic Stress Disorder and Veterans)
Open AccessArticle Laying Anchor: Inserting Precision Health into a Public Health Genetics Policy Course
Received: 31 May 2018 / Revised: 24 July 2018 / Accepted: 1 August 2018 / Published: 3 August 2018
Viewed by 847 | PDF Full-text (271 KB) | HTML Full-text | XML Full-text
Abstract
The United States Precision Medicine Initiative (PMI) was announced by then President Barack Obama in January 2015. It is a national effort designed to take into account genetic, environmental, and lifestyle differences in the development of individually tailored forms of treatment and prevention.
[...] Read more.
The United States Precision Medicine Initiative (PMI) was announced by then President Barack Obama in January 2015. It is a national effort designed to take into account genetic, environmental, and lifestyle differences in the development of individually tailored forms of treatment and prevention. This goal was implemented in March 2015 with the formation of an advisory committee working group to provide a framework for the proposed national research cohort of one million or more participants. The working group further held a public workshop on participant engagement and health equity, focusing on the design of an inclusive cohort, building public trust, and identifying active participant engagement features for the national cohort. Precision techniques offer medical and public health practitioners the opportunity to personally tailor preventive and therapeutic regimens based on informatics applied to large volume genotypic and phenotypic data. The PMI’s (All of Us Research Program’s) medical and public health promise, its balanced attention to technical and ethical issues, and its nuanced advisory structure made it a natural choice for inclusion in the University of Michigan course “Issues in Public Health Genetics” (HMP 517), offered each fall by the University’s School of Public Health. In 2015, the instructors included the PMI as the recurrent case study introduced at the beginning and referred to throughout the course, and as a class exercise allowing students to translate issues into policy. In 2016, an entire class session was devoted to precision medicine and precision public health. In this article, we examine the dialogues that transpired in these three course components, evaluate session impact on student ability to formulate PMI policy, and share our vision for next-generation courses dealing with precision health. Methodology: Class materials (class notes, oral exercise transcripts, class exercise written hand-ins) from the three course components were inspected and analyzed for issues and policy content. The purpose of the analysis was to assess the extent to which course components have enabled our students to formulate policy in the precision public health area. Analysis of student comments responding to questions posed during the initial case study comprised the initial or “pre-” categories. Analysis of student responses to the class exercise assignment, which included the same set of questions, formed the “post-” categories. Categories were validated by cross-comparison among the three authors, and inspected for frequency with which they appeared in student responses. Frequencies steered the selection of illustrative quotations, revealing the extent to which students were able to convert issue areas into actual policies. Lecture content and student comments in the precision health didactic session were inspected for degree to which they reinforced and extended the derived categories. Results: The case study inspection yielded four overarching categories: (1) assurance (access, equity, disparities); (2) participation (involvement, representativeness); (3) ethics (consent, privacy, benefit sharing); and (4) treatment of people (stigmatization, discrimination). Class exercise inspection and analysis yielded three additional categories: (5) financial; (6) educational; and (7) trust-building. The first three categories exceeded the others in terms of number of student mentions (8–14 vs. 4–6 mentions). Three other categories were considered and excluded because of infrequent mention. Students suggested several means of trust-building, including PMI personnel working with community leaders, stakeholder consultation, networking, and use of social media. Student representatives prioritized participant and research institution access to PMI information over commercial access. Multiple schemes were proposed for participant consent and return of results. Both pricing policy and Medicaid coverage were touched on. During the didactic session, students commented on the importance of provider training in precision health. Course evaluation highlighted the need for clarity on the organizations involved in the PMI, and leaving time for student-student interaction. Conclusions: While some student responses during the exercise were terse, an evolution was detectable over the three course components in student ability to suggest tangible policies and steps for implementation. Students also gained surety in presenting policy positions to a peer audience. Students came up with some very creative suggestions, such as use of an electronic platform to assure participant involvement in the disposition of their biological sample and personal health information, and alternate examples of ways to manage large volumes of data. An examination of socio-ethical issues and policies can strengthen student understanding of the directions the Precision Medicine Initiative is taking, and aid in training for the application of more varied precision medicine and public health techniques, such as tier 1 genetic testing and whole genome and exome sequencing. Future course development may reflect additional features of the ongoing All of Us Research Program, and further articulate precision public health approaches applying to populations as opposed to single individuals. Full article
(This article belongs to the Special Issue Precision Public Health and Genomic Medicine)
Open AccessArticle An Evaluation of Alternatives for Providing Care to Veterans
Received: 22 June 2018 / Revised: 17 July 2018 / Accepted: 30 July 2018 / Published: 2 August 2018
Viewed by 781 | PDF Full-text (256 KB) | HTML Full-text | XML Full-text
Abstract
In 2014, a whistleblower reported that many U.S. veterans died while waiting for care at the Phoenix VHA. Problems with veteran’s care through 2018 reveal ongoing and systematic problem. In March 2018, the VA Inspector General identified critical deficiencies at the Washington, DC
[...] Read more.
In 2014, a whistleblower reported that many U.S. veterans died while waiting for care at the Phoenix VHA. Problems with veteran’s care through 2018 reveal ongoing and systematic problem. In March 2018, the VA Inspector General identified critical deficiencies at the Washington, DC VA Medical Center including failures to track patient safety events accurately, ineffective sterile processing and more than 10 thousand open or pending prosthetic/sensory aid consults. The VHA clearly has problems with access and quality in a budget-constrained environment. In this policy analysis, four separate interventions that address the gap between the magnitude as well as the use of the VHA’s fixed budget versus access and cost expectations are explored. These policy interventions include maintaining the status quo, returning to a “VHA-only” option, transitioning to a CMS central payer system and consolidating care under the DoD TRICARE insurance plans. An objective evaluation suggests that extending TRICARE to veterans during the phasing out the VHA’s care responsibilities, while politically unpalatable, would likely provide the best of four possible solutions under various criterion weighting schemes. A central payer solution under the CMS would also be a viable consideration. Results suggest that TRICARE patient perceptions of quality are superior to VHA and non-VHA/non-DoD, that access provided by the TRICARE program is ranked second in terms of venue acceptance only to the CMS solution set based on primary provider acceptance and that the cost per beneficiary of a TRICARE solution ($6.5 K/beneficiary) is far better than a VHA-only solution ($14.0 K/beneficiary), the CMS central payer solution ($12.2 K/beneficiary), or the status quo (between $12.2 K and $14.0 K/beneficiary). The intent of this paper is to provoke thoughtful consideration of solutions for providing access to high-quality healthcare for veterans within or outside of the VHA. Full article
Open AccessArticle Postpartum Care Service Experience Model: A Case of Postpartum Home Visiting Services
Received: 5 April 2018 / Revised: 22 May 2018 / Accepted: 15 June 2018 / Published: 1 August 2018
Viewed by 701 | PDF Full-text (815 KB) | HTML Full-text | XML Full-text
Abstract
The choice of postpartum care methods has expanded with changes in population structure and social forms. In addition to the traditional provision of postpartum assistance by senior members of the parents’ family, recent years have also seen a rapid growth in care centers
[...] Read more.
The choice of postpartum care methods has expanded with changes in population structure and social forms. In addition to the traditional provision of postpartum assistance by senior members of the parents’ family, recent years have also seen a rapid growth in care centers and postpartum home visiting services. Postpartum home visiting services combine the features and services of senior family members’ assistance and postpartum care centers. Therefore, special attention has been drawn to the postpartum care service experience. This study conducted a survey among mothers participating in the Postpartum Home Visiting Service Project of the Social Affairs Bureau of Kaohsiung City Government, Taiwan. The effective sample included 43 participants. Partial least squares (PLS) analysis was performed. The results indicated that the service experience model could comprehensively reflect the relation between consumer experience, experiential value, and experience satisfaction. With regard to practical implications, the results provide postpartum home visiting service providers with a better understanding of consumers’ feelings and, thus, put them in a better position to improve experience through appropriate service methods. Full article
Figures

Figure 1

Open AccessReview The “Centrality of Sepsis”: A Review on Incidence, Mortality, and Cost of Care
Received: 15 June 2018 / Revised: 24 July 2018 / Accepted: 25 July 2018 / Published: 30 July 2018
Viewed by 995 | PDF Full-text (564 KB) | HTML Full-text | XML Full-text
Abstract
Sepsis is a serious and fatal medical condition that has overburdened the US healthcare system. The purpose of this paper is to provide a review of published literature on severe sepsis with a distinct focus on incidence, mortality, cost of hospital care, and
[...] Read more.
Sepsis is a serious and fatal medical condition that has overburdened the US healthcare system. The purpose of this paper is to provide a review of published literature on severe sepsis with a distinct focus on incidence, mortality, cost of hospital care, and postdischarge care. A review of the nature of postsepsis syndrome and its impact on septic patients is also included. The literature review was conducted utilizing the PubMed database, identifying 34 studies for inclusion. From the evaluation of these studies, it was determined that the incidence of sepsis continues to be on the rise according to three decades of epidemiological data. Readmissions, mortality, and length of stay were all higher among septic patients when compared to patients treated for other conditions. The cost of treating sepsis is remarkably high and exceeds the cost of treating patients with congestive heart failure and acute myocardial infarction. The overall cost of sepsis is reflective of not only the cost of initial hospitalization but also the postdischarge care costs, including postsepsis syndrome and cognitive and functional disabilities that require a significant amount of healthcare resources long term. Sepsis and its impact on patients and the US healthcare system is a current quality-of-life and cost-burden issue that needs to be addressed with a greater focus on preventative strategies. Full article
(This article belongs to the Special Issue The Outcome of Sepsis)
Figures

Figure 1

Open AccessArticle Far-Reaching Dispersal of Borrelia burgdorferi Sensu Lato-Infected Blacklegged Ticks by Migratory Songbirds in Canada
Received: 8 June 2018 / Revised: 9 July 2018 / Accepted: 18 July 2018 / Published: 25 July 2018
Cited by 1 | Viewed by 2044 | PDF Full-text (1586 KB) | HTML Full-text | XML Full-text
Abstract
Lyme disease has been documented in northern areas of Canada, but the source of the etiological bacterium, Borrelia burgdorferi sensu lato (Bbsl) has been in doubt. We collected 87 ticks from 44 songbirds during 2017, and 24 (39%) of 62 nymphs of the
[...] Read more.
Lyme disease has been documented in northern areas of Canada, but the source of the etiological bacterium, Borrelia burgdorferi sensu lato (Bbsl) has been in doubt. We collected 87 ticks from 44 songbirds during 2017, and 24 (39%) of 62 nymphs of the blacklegged tick, Ixodes scapularis, were positive for Bbsl. We provide the first report of Bbsl-infected, songbird-transported I. scapularis in Cape Breton, Nova Scotia; Newfoundland and Labrador; north-central Manitoba, and Alberta. Notably, we report the northernmost account of Bbsl-infected ticks parasitizing a bird in Canada. DNA extraction, PCR amplification, and DNA sequencing reveal that these Bbsl amplicons belong to Borrelia burgdorferi sensu stricto (Bbss), which is pathogenic to humans. Based on our findings, health-care providers should be aware that migratory songbirds widely disperse B. burgdorferi-infected I. scapularis in Canada’s North, and local residents do not have to visit an endemic area to contract Lyme disease. Full article
Figures

Figure 1

Back to Top