Clinically significant depressive symptoms are prevalent in people with extremely short prognoses - A systematic review

Context: Currently, systematic evidence of prevalence of clinically significant depressive symptoms in people with extremely short prognoses is not available to inform its global burden, assessment, and management. Objectives: To determine the prevalence of clinically significant depressive symptoms in people with advanced life-limiting illnesses and extremely short prognoses (range of days to weeks). Methods: A systematic review and meta-analysis (random effects model) were performed (PROSPERO: CRD42019125119). MEDLINE, Embase, PsycINFO, CINAHL, and CareSearch were searched for studies (1994-2019). Data were screened for prevalence of clinically significant depressive symptoms (assessed using validated depression-specific screening tools or diagnostic criteria) of adults with advanced life-limiting illnesses and extremely short prognoses (defined by survival or functional status). Quality assessment was performed using the Joanna Briggs Institute Systematic Reviews Checklist for Prevalence Studies for individual studies, and Grading of Recommendations Assessment, Development and Evaluation (GRADE) across studies. Results: Thirteen studies were included. The overall pooled prevalence of clinically significant depressive symptoms in adults with extremely short prognoses (n = 10 studies; extremely short prognoses: N = 905) using depression-specific screening tools was 50% (95%CI: 29%-70%; I2 = 97.6%). Prevalence of major and minor depression were 10% (95%CI: 4%-16%) and 5% (95%CI: 2%-8%), respectively. Major limitations included high heterogeneity, selection bias and small sample sizes in individual studies. Conclusions: Clinically significant depressive symptoms were prevalent in people with advanced life-limiting illnesses and extremely short prognoses. Clinicians need to be proactive in the recognition and assessment of these symptoms to allow for timely intervention

Enhancing the Prospects for Palliative Care at the End of Life: A Statewide Educational Demonstration Project to Improve Advance Care Planning

Although patients want to participate in discussions and decisions about their end-of-life care, studies show that providers frequently fail to invite them to explore advanced care preferences or goals for living. The purpose of our demonstration project was to provide education and coaching to individuals, health providers, and organizations across the state of Indiana intended to facilitate these conversations, documenting and honoring individuals' life goals and preferences for care during the final stages of life. Education and training engaged community members as well as healthcare providers to: (1) improve participant comfort and facility discussing end-of-life issues; (2) improve knowledge of healthcare choices, including palliative and hospice care; and (3) prepare all participants to explore and document personal values, life goals, and priorities as well as goals of care. Between January of 2013 and June of 2015, the team educated close to 5,000 participants. Participants' ratings of the quality and perceived usefulness of the educational events ranged from 4 to 5 (using a 5-point scale, with 5 = most effective). Participant comments were overwhelmingly favorable and indicated an intention to put the advance care planning resources, communication skills, knowledge of palliative and hospice care, and personal renewal techniques into practice. Participant motivation to foster advance care planning, discussions of palliative care, and end-of-life conversations was facilitated by the reframing of these conversations as identifying goals of care and priorities for living well during an important stage of life. Successful strategies included helping providers and patients to adopt a broader meaning for “sustaining hope” (not for cure, but for engaging in highly valued activities), developing provider communication skills and comfort in initiating potentially difficult discussions, engaging a new community health workforce who will develop trusting relationships with patients in home-based services, and fostering self-awareness and self-care among palliative care providers

Avoiding epic fails: software and standards directions to increase clinical safety

The safety issues related to IT and software are gaining more exposure within the Healthcare industry. While software and computing was seen as a panacea to a range of preventable clinical errors, the introduction of healthcare IT has of itself presented patient safety issues. It is the inherently complex nature of healthcare, and its delivery, that creates increasing patient safety concerns in the application of IT and software. This position paper provides a collation of current work in international standards and highlights the drivers for the necessary change required to address patient safety in the use of healthcare IT software and systems. Software development and deployment has already altered and standards to oversee these are only just catching up. The need to revise such standards has been recognised and is underway, however a clash of cultures is delaying the emergence of Standards traditionally developed and governed by Standards Development Organisations (SDOs). The impact of this is that whilst standards are being informed by current software trends, the standards developers themselves are struggling to assimilate the rapid changes in the market. Whilst SDOs are cooperating more closely, there is an increased need for the involvement of the healthcare software development community and e-health informaticians in the standards process to narrow the gap in standards relevance. Such involvement would expand the currently narrow field of experts with the appropriate skills, background, knowledge, and experience in healthcare software risk analysis, security, privacy, and standards development

Comorbidities and the risk of mortality in patients with bronchiectasis:an international mulitcentre cohort study

Background Patients with bronchiectasis often have concurrent comorbidities, but the nature, prevalence, and impact of these comorbidities on disease severity and outcome are poorly understood. We aimed to investigate comorbidities in patients with bronchiectasis and establish their prognostic value on disease severity and mortality rate. Methods An international multicentre cohort analysis of outpatients with bronchiectasis from four European centres followed up for 5 years was done for score derivation. Eligible patients were those with bronchiectasis confirmed by high-resolution CT and a compatible clinical history. Comorbidity diagnoses were based on standardised definitions and were obtained from full review of paper and electronic medical records, prescriptions, and investigator definitions. Weibull parametric survival analysis was used to model the prediction of the 5 year mortality rate to construct the Bronchiectasis Aetiology Comorbidity Index (BACI). We tested the BACI as a predictor of outcomes and explored whether the BACI added further prognostic information when used alongside the Bronchiectasis Severity Index (BSI). The BACI was validated in two independent international cohorts from the UK and Serbia. Findings Between June 1, 2006, and Nov 22, 2013, 1340 patients with bronchiectasis were screened and 986 patients were analysed. Patients had a median of four comorbidities (IQR 2-6; range 0-20). 13 comorbidities independently predicting mortality rate were integrated into the BACI. The overall hazard ratio for death conferred by a one-point increase in the BACI was 1.18 (95% CI 1.14-1.23; p<0.0001). The BACI predicted 5 year mortality rate, hospital admissions, exacerbations, and health-related quality of life across all BSI risk strata (p<0.0001 for mortality and hospital admissions, p=0.03 for exacerbations, p=0.0008 for quality of life). When used in conjunction with the BSI, the combined model was superior to either model alone (p=0.01 for combined vs BACI; p=0.008 for combined vs BSI). Interpretation Multimorbidity is frequent in bronchiectasis and can negatively affect survival. The BACI complements the BSI in the assessment and prediction of mortality and disease outcomes in patients with bronchiectasis

Heterogeneity In Major Depression: Influence On Treatment Outcomes And Processes-Outcome Relations

Some have proposed that all psychotherapies for depression, as well as for other common mental disorders, are equally efficacious and that they all work through common processes, especially a relationship with a therapist. One reason it may be difficult to discern differential efficacy among treatments, as well as how they exert their effects, is that depression and other disorders are heterogeneous in both presentation and prognosis. The studies presented in the dissertation aimed to explore how heterogeneity in depression may moderate treatment effects and process-outcome relations. In study 1, a prognostic index (PI) was developed and treatment differences along the PI were explored in a sample of patients (N = 622) randomized to treatment as usual (TAU) or stepped care starting with brief therapy (BT) or with cognitive-behavioral therapy (CBT). The PI comprised five variables: unemployment status, depression severity, hostility, sleep problems, and lower positive emotionality, all of which predicted a lower likelihood of recovery. For patients whose PI indicated a high likelihood of recovery (73% of the sample), recovery rates were similarly high across the treatments. Among patients whose PI indicated a lower likelihood of recovery, patients in the CBT condition experienced a substantially higher recovery rate (65%) than patients in TAU (40%) or BT (44%). In study 2, variability in the predictive relationship between the therapeutic alliance and depressive symptom change was explored in a sample of patients receiving cognitive therapy (CT) for depression (N = 60). The alliance predicted outcome in the subgroup of clients with 0–2 prior episodes (r = .52), but not in those with 3 or more prior episodes (r = -.02). In study 3, these findings were replicated in an independent sample of patients receiving CBT for depression, but they did not extend to patients in a psychodynamic therapy condition. Taken together, these findings suggest that there may be identifiable subgroups of patients for whom factors common to all treatments will promote symptom change. By contrast, complementary subgroups, such as those with poorer prognoses or more recurrent histories of depression, may reveal differences in the efficacies of treatments and their active mechanisms

A Practice Improvement Project to Improve Knowledge and Perceptions of Palliative Care among Patients with Heart Failure and Cancer in the Acute Setting Using Video Enhanced Education

Background: Clear communication of the purpose and benefits of palliative care can reduce barriers to acceptance of such services for patients and families. The purpose of this practice improvement project was to assess and improve knowledge and perceptions of palliative care among patients with a diagnosis of heart failure and cancer in the acute setting using a video enhanced education intervention. Methods: This practice improvement project took place at a 555 bed teaching hospital. 18 patients referred to an inpatient palliative care consult service in the acute care setting with a diagnosis of either heart failure or cancer participated. Result: Paired sample t-tests were conducted to examine the effectiveness of the intervention in patients’ scores assessing level of palliative care awareness (Table 2). There was a significant positive difference in the scores for level of palliative care awareness before (M = 2.56, SD = 1.25) and after (M = 3.72, SD = 1.179) a five-minute video describing palliative care; t(17) = 3.82 p = .001. Discussion: Video interventions delivered at the point of care in the acute setting may be an effective tool for improving knowledge and perceptions of palliative care among patient with diagnoses of heart failure or cancer. Conclusion: The benefits of video education may be enhanced when delivered with the addition of face to face interaction by a member of the healthcare team versus a video self-administered by the patient. Further evaluation is needed

\u3cem\u3eBlack Lives Matter: A Conversation on Health and Criminal Justice Disparities\u3c/em\u3e

The quality of the services provided by a library, as well as of any kind of service, depends on several factors: The user requirements (as defined in ISO), prior knowledge about the service, computer systems reliability, availability of resources, personnel qualifications, etc. But when providing the service, the willingness of the staff is essential, because they will be well motivated if the working conditions are adequate. The intent of this research is to investigate how staff perceives the implementation of a Quality Management System (QMS). To that end, two university libraries –one public and one private– that implemented QMS in the city of Cordoba between 2005 and 2013 were studied. The research asks whether the implementation process meant an adequate or excessive effort; how staff assesses the maintainability of the system in operation; if there is noticeable improvement in the quality of service, in the internal work of each library; if in general it is viewed as positive. This paper first presents a bibliographic inquiry on related work and then the application of a survey of the people involved in the implementation in both libraries. It is concluded that employees perceive the application of the Quality Management System as positive even if there were difficulties during the implementation face. Management however has a different view.La calidad de los servicios de una biblioteca, así como la calidad de cualquier tipo de servicio,  depende de varios factores: los requerimientos de los usuarios (tal como se define en las normas ISO), los conocimientos previos sobre el servicio, la fiabilidad del sistema informático, la disponibilidad de recursos, la idoneidad del personal, entre otros. Pero al momento de la prestación del servicio la predisposición del personal es esencial, porque estará bien predispuesto en la medida que las condiciones laborales sean las adecuadas. En el presente trabajo se pretende indagar cómo percibe el personal la implementación de un Sistema de Gestión de Calidad (SGC), para ello se estudiarán casos de dos bibliotecas universitarias que han implementado calidad en la ciudad de Córdoba entre 2005 y 2013, una del ámbito privado y otra del ámbito público. Se pretende saber si el proceso de implementación significó un esfuerzo adecuado o desmedido, cómo valora el personal la viabilidad de mantener el sistema en funcionamiento, si observa mejora en la calidad del servicio, en la labor interna de cada biblioteca, si en general lo aprecia como positivo. Se plantea en primera instancia una indagación bibliográfica sobre trabajos relacionados, luego la aplicación de una encuesta a las personas involucradas en la implementación en ambas bibliotecas. Se concluye que los empleados perciben la implementación como positiva aunque en el transcurso se hayan presentado dificultades. Sin embargo, los directivos expresan posturas diferentes