5,371 research outputs found

    Word Adjacency Graph Modeling: Separating Signal From Noise in Big Data

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    There is a need to develop methods to analyze Big Data to inform patient-centered interventions for better health outcomes. The purpose of this study was to develop and test a method to explore Big Data to describe salient health concerns of people with epilepsy. Specifically, we used Word Adjacency Graph modeling to explore a data set containing 1.9 billion anonymous text queries submitted to the ChaCha question and answer service to (a) detect clusters of epilepsy-related topics, and (b) visualize the range of epilepsy-related topics and their mutual proximity to uncover the breadth and depth of particular topics and groups of users. Applied to a large, complex data set, this method successfully identified clusters of epilepsy-related topics while allowing for separation of potentially non-relevant topics. The method can be used to identify patient-driven research questions from large social media data sets and results can inform the development of patient-centered interventions

    Evidence-Based Best Practice Toolkit for Social Determinants of Health: A Program Evaluation Review

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    Despite an increase in healthcare expenditure, racial and ethnic disparities remain a substantial concern among adult primary care patients in the United States. This is largely due to the focus on medical intervention and disregard for the underlying factors that contribute significantly to health outcomes such as economic stability, educational access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. The PICOT question that guided this program evaluation review project is: In adult clients seeking care at a primary care clinic (P), how does a SDOH toolkit based on the CDC framework (I) compared to no SDOH toolkit (C) affect identification of unmet health related social needs (O)? The evidence suggests that screening for SDOH identifies unmet social needs, improves provider referrals to relevant resources, and improves overall health outcomes. In addition, the literature supports the use and development of nursing toolkits to influence evidence-based interventions in healthcare. A detailed and thorough program evaluation review of the Centers for Disease Control and Prevention, Healthy People 2030, and the Health Leads Network SDOH programs revealed that the evaluated SDOH programs meet the requirements of a program per the CDC Program Evaluation framework. Additionally, the evidence supported the use of these programs as established to support the development of an SDOH screening toolkit for the specialty population of adult primary care patients. Screening for SDOH in adult primary care is a necessary component for improving health outcomes and use of an SDOH screening toolkit in the clinical practice setting will help assist in the smooth and successful implementation of SDOH screening for all adult primary care patients

    Heath Network Clinicians Use and Need for Clinical Information Sources: Results of a Survey

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    The Dana Medical Library, part of the University of Libraries system, with the support of the University of Vermont Health Network, assessed the needs of UVM Health Network clinicians for evidence-based clinical resources such as: medical databases, journal articles, topic summaries, or electronic/print textbooks. Results are compiled and discussed

    Optimising the use of ICTs by health & social care professionals in the community

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    This research was commissioned as part of the Department of Health's Information and Communication Technology (ICT) Research Initiative, to identify ways in which ICTs might provide benefits to health and social care professionals working across boundaries and to the clients/ patients that they serve. The project aimed to examine the use of existing ICTs in supporting isolated users in the community (principally professionals but also lay users), and to consider ways in which use of such ICTs might be improved, focusing initially on non-person identifiable information. A single patient group was selected as the main focus of the study - older people (and their carers). This group was chosen because the needs of older people and their carers reflect those of the wider isolated populations served by health and social welfare professionals in terms of their clinical, psychological and social care needs. Other isolated groups might include the physically disabled, the mentally ill, or those socially and potentially service isolated through geography, lifestyles or other factors. Older people would be represented in all these categories. Therefore, a study focusing on the information needs of professionals who support older patients or clients should provide findings that are generalisable to other groups, such as those mentioned above. Furthermore, it was evident that this is an important group on which to focus in terms of inter-agency working because of the various policy initiatives that aim to enhance working between professionals across the health and social care interface in relation to older people

    Integrated primary health care in Greece, a missing issue in the current health policy agenda: a systematic review

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    Background: Over the past years, Greece has undergone several endeavors aimed at modernizing and improving national health care services with a focus on PHC. However, the extent to which integrated primary health care has been achieved is still questioned. <br><br> Purpose: This paper explores the extent to which integrated primary health care (PHC) is an issue in the current agenda of policy makers in Greece, reporting constraints and opportunities and highlighting the need for a policy perspective in developing integrated PHC in this Southern European country. <br><br> Methods: A systematic review in PubMed/Medline and SCOPUS, along with a hand search in selected Greek biomedical journals was undertaken to identify key papers, reports, editorials or opinion letters relevant to integrated health care. <br><br> Results: Our systematic review identified 198 papers and 161 out of them were derived from electronic search. Fifty-three papers in total served the scope of this review and are shortly reported. A key finding is that the long-standing dominance of medical perspectives in Greek health policy has been paving the way towards vertical integration, pushing aside any discussions about horizontal or comprehensive integration of care. <br><br> Conclusion: Establishment of integrated PHC in Greece is still at its infancy, requiring major restructuring of the current national health system, as well as organizational culture changes. Moving towards a new policy-based model would bring this missing issue on the discussion table, facilitating further development

    Receiving in-home respite when caring for a palliative family member at the end-of-life: family caregivers’ experiences of the eShift model of care

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    Family caregivers are an important component of home-based palliative care as they provide the majority of unpaid assistance to their palliative family member, during their last days and weeks of life. The demands of caregiving often escalate at the end-of-life, which can result in substantial emotional and physical issues for the family caregiver. In 2010, in London Ontario, the South West Community Care Access Centre (now the South West Local Health Integration Network (SW LHIN)) developed a new model of palliative home care called “eShift” led by an interdisciplinary team of healthcare professionals, that focused care both on the patient and their family caregiver. The eShift model connects personal support workers, called eShift technicians, to a remote registered nurse (via technology) to offer palliative care in a client’s home and simultaneously provide family caregivers with respite. The purpose of this secondary data analysis was to explore the experiences of in-home respite among family caregivers who were caring for a palliative family member receiving eShift palliative home care, at the end-of-life. Overall, the fifteen family caregivers that participated in this study had a positive experience of in-home respite with eShift palliative home care, which enabled them to keep their family member at home until death. Specifically, family caregivers developed trust, had an opportunity for self-care and other activities and felt that the arrangement of services with eShift was comprehensive. This study has implications for public health policy as it offers insights into family caregivers’ experiences of in-home respite with the eShift model of palliative home care. In addition, it serves as a basis for future research on family caregivers’ experiences of in-home respite with eShift and other technology-enabled models of palliative home care

    Increasing Equitable Access to Care: Implementation of Universal Palliative Care Screening in the Intensive Care Unit

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    Practice Problem: At a small community hospital in Virginia, there is an absence of standardized screening processes for identifying intensive care unit (ICU) patients with unmet palliative care needs, contributing to delayed and unequitable access to palliative care consultations. PICOT: The PICOT question that guided this project was “In adult ICU patients, how does implementing a palliative care screening tool upon ICU admission, as compared to standard ICU admission protocol, affect palliative care consultations within an 8-week time frame? Evidence: This project was guided by consensus reports from the World Health Organization and the Centers to Advance Palliative Care, systematic reviews, and retrospective cohort studies evaluating the use of palliative care screening tools in the acute care setting. Intervention: In a 6-bed ICU, a validated palliative care screening tool was implemented over an 8-week period to screen all ICU patients within 24 hours of admission. Pre and post-implementation data were collected from the electronic medical record to analyze the number of ICU patients screened, patients with positive screenings, and palliative care consultations placed. Outcome: Overall screening compliance was 71 percent for all ICU patients, with 66 percent screened within 24 hours of admission. Although there was not a significant increase in palliative care consultations, the time from ICU admission to consultation decreased by 2.88 days and the ICU mortality rate for patients with consultations decreased by 83 percent. Conclusion: The palliative care screening tool did not generate more palliative care consultations; however, this tool facilitated identification and consultation for patients earlier in the ICU stay. More work is needed to overcome barriers to consultation and expand access to palliative care services throughout all inpatient units

    Diabetic Ketoacidosis (DKA) Insulin Infusion Protocol Update Using Evidence-Based Practice: A Quality Improvement Project

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    Diabetic Ketoacidosis is a life-threatening side effect to Diabetes Mellitus. Standards of treatment and recommendations are made by the American Diabetes Association. The project was to evaluate and provide the latest evidence-based practice to update the hospital policy for the treatment of DKA in the Intensive Care Unit and Emergency Department. Retrospective chart reviews were conducted to review the number of patients admitted with diabetic ketoacidosis and treated on the DKA Insulin Infusion Protocol before and after the update. Rapid correction of blood glucose levels proved to be an issue at this facility both before and after the updates were made to the DKA Insulin Infusion Protocol. The data supports the need for change in protocol, staff development in the use of the protocol and the need for change in the emergency department as well as the intensive care unit
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