Redesigning pictographs for patients with low health literacy and establishing preliminary steps for delivery via smart phones.

BackgroundPictographs (or pictograms) have been widely utilized to convey medication related messages and to address nonadherence among patients with low health literacy. Yet, patients do not always interpret the intended messages on commonly used pictographs correctly and there are questions how they may be delivered on mobile devices.ObjectiveOur objectives are to refine a set of pictographs to use as medication reminders and to establish preliminary steps for delivery via smart phones.MethodsCard sorting was used to identify existing pictographs that focus group members found "not easy" to understand. Participants then explored improvements to these pictographs while iterations were sketched in real-time by a graphic artist. Feedback was also solicited on how selected pictographs might be delivered via smart phones in a sequential reminder message. The study was conducted at a community learning center that provides literacy services to underserved populations in Seattle, WA. Participants aged 18 years and older who met the criteria for low health literacy using S-TOFHLA were recruited.ResultsAmong the 45 participants screened for health literacy, 29 were eligible and consented to participate. Across four focus group sessions, participants examined 91 commonly used pictographs, 20 of these were ultimately refined to improve comprehensibility using participatory design approaches. All participants in the fifth focus group owned and used cell phones and provided feedback on preferred sequencing of pictographs to represent medication messages.ConclusionLow literacy adults found a substantial number of common medication label pictographs difficult to understand. Participative design processes helped generate new pictographs, as well as feedback on the sequencing of messages on cell phones, that may be evaluated in future research

Redesigning Health Care for an Older America

With the goal of creating a new vision of health care for an older America, the International Longevity Center assembled a Health Care Task Force, a cadre of specialists in the fields of economics, social work, political science, and medicine. Its mandate is to focus on the development of an intergenerational life-span perspective of disease prevention and health maintenance, built on a strong foundation of structural reform medical care, by showing how strategies that enhance healthy aging can save money as well as improve quality of life. Midway into this ambitious four-year project, and with the hope of contributing to the national debate on health care, the Task Force established a list of guiding principles, with the belief that the longevity and healthy aging of today's older adults, the aging baby boomer generation and the generations that will follow, depend upon the health care decisions that are made today

Effects of Implementing a Health Team Communication Redesign on Hospital Readmissions Within 30 Days

Background and Rationale Poor communication between health team members can interfere with timely, coordinated preparation for hospital discharge. Research on daily bedside interprofessional health team rounds and nursing bedside shift handoff reports provides evidence that these strategies can improve communication. Aims To improve health team communication and collaboration about hospital discharge; improve patient experience of discharge measured by patient‐reported quality of discharge teaching, readiness for discharge, and postdischarge coping difficulty; and reduce readmissions and emergency department (ED) visits postdischarge. Methods A two‐sample pre‐ and postintervention design provided baseline data for redesign of health team communication processes and comparison data for evaluation of the new process’ impact. Health team members (n = 105 [pre], n = 95 [post]) from two surgical units of an academic medical center in the midwestern United States provided data on discharge‐related communication and collaboration. Patients (n = 413 [pre], n = 191 [post]) provided data on their discharge experience (quality of discharge teaching, readiness for discharge, postdischarge coping difficulty) and outcomes (readmissions, ED visits). Chi‐square and t tests were used for unadjusted pre‐ and postintervention comparisons. Logistic regression of readmissions with a matched pre‐ and postintervention sample included adjustments for patient characteristics and hospitalization factors. Results Readmissions decreased from 18% to 12% (p \u3c .001); ED visits decreased from 4.4% to 1.5% (p \u3c .001). Changes in health team communication and collaboration and patients’ experience of discharge were minimal. Discussion The targeted outcomes of readmission and ED visits improved after the health team communication process redesign. The process indicators did not improve; potential explanations include unmeasured hospital and unit discharge, and other care process changes during the study timeframe. Linking Evidence to Practice Evidence from daily interprofessional team bedside rounding and bedside shift report studies was translated into a redesign of health team communication for discharge. These strategies support readmission reduction efforts

Implementing scanned medical record systems in Australia : a structured case study on envisioned changes to elective admissions process in a Victorian hospital

In recent years, influenced by the pervasive power of technology, standards and mandates, Australian hospitals have begun exploring digital forms of keeping this record. The main rationale is the ease of accessing different data sources at the same time by varied staff members. The initial step in this transition was implementation of scanned medical record systems, which converts the paper based records to digitised form, which required process flow redesign and changes to existing modes of work. For maximising the benefits of scanning implementation and to better prepare for the changes, Austin Hospital in the State of Victoria commissioned this research focused on elective admissions area. This structured case study redesigned existing processes that constituted the flow of external patient forms and recommended a set of best practices at the same time highlighting the significance of user participation in maximising the potential benefits anticipated. In the absence of published academic studies focused on Victorian hospitals, this study has become a conduit for other departments in the hospital as well as other hospitals in the incursion.<br /

Feasibility study of early outpatient review and early cardiac rehabilitation after cardiac surgery: mixed-methods research design-a study protocol.

INTRODUCTION: Following cardiac surgery, patients currently attend an outpatient review 6 weeks after hospital discharge, where recovery is assessed and suitability to commence cardiac rehabilitation (CR) is determined. CR is then started from 8 weeks. Following a median sternotomy, cardiac surgery patients are required to refrain from upper body exercises, lifting of heavy objects and other strenuous activities for 12 weeks. A delay in starting CR can prolong the recovery process, increase dependence on family/carers and can cause frustration. However, current guidelines for activity and exercise after median sternotomy have been described as restrictive, anecdotal and increasingly at odds with modern clinical guidance for CR. This study aims to examine the feasibility of bringing forward outpatient review and starting CR earlier. METHODS AND ANALYSES: This is a multicentre, randomised controlled, open feasibility trial comparing postoperative outpatient review 6 weeks after hospital discharge, followed by CR commencement from 8 weeks (control arm) versus, postoperative outpatient review 3 weeks after hospital discharge, followed by commencement of CR from 4 weeks (intervention arm). The study aims to recruit 100 eligible patients, aged 18-80 years who have undergone elective or urgent cardiac surgery involving a full median sternotomy, over a 7-month period across two centres. Feasibility will be measured by consent, recruitment, retention rates and attendance at appointments and CR sessions. Qualitative interviews with trial participants and staff will explore issues around study processes and acceptability of the intervention and the findings integrated with the feasibility trial outcomes to inform the design of a future full-scale randomised controlled trial. ETHICS AND DISSEMINATION: Ethics approval was granted by East Midlands-Derby Research Ethics Committee on 10 January 2019. The findings will be presented at relevant conferences disseminated via peer-reviewed research publications, and to relevant stakeholders. TRIAL REGISTRATION NUMBER: ISRCTN80441309

Ethics, space, and somatic sensibilities: comparing relationships between scientific researchers and their human and animal experimental subjects

Drawing on geographies of affect and nature-society relations, we propose a radical rethinking of how scientists, social scientists, and regulatory agencies conceptualise human and animal participants in scientif ic research. The scientific rationale for using animal bodies to simulate what could be done in human bodies emphasises shared somatic capacities that generate comparable responses to clinical interventions. At the same time, regulatory guidelines and care practices stress the differences between human and animal subjects. In this paper we consider the implications of this differentiation between human and animal bodies in ethical and welfare protocols and practices. We show how the bioethical debates around the use of human subjects tend to focus on issues of consent and language, while recent work in animal welfare reflects an increasing focus on the affectual dimensions of ethical practice. We argue that this attention to the more-than-representational dimensions of ethics and welfare might be equally important for human subjects. We assert that paying attention to these somatic sensibilities can offer insights into how experimental environments can both facilitate and restrict the development of more care-full and response-able relations between researchers and their experimental subjects. <br/

Paving the Way to Simpler: Experiencing from Maximizing Enrollment States in Streamlining Eligibility and Enrollment

Since 2009, the eight states (Alabama, Illinois, Louisiana, Massachusetts, New York, Utah, Virginia, and Wisconsin) participating in the Robert Wood Johnson Foundation's Maximizing Enrollment program have worked to streamline and simplify enrollment systems, policies, and processes for children and those eligible for health coverage in 2014. The participating states aimed to reduce enrollment barriers for consumers and administrative burdens in processing applications and renewals for staff by making improvements and simplifications at every step of the enrollment process. Although the states began their work before the enactment of the Affordable Care Act (ACA), their efforts positioned them well for implementation in 2014, and offer experiences and lessons that other states may find useful in their efforts to improve efficiency, lower costs, and promote responsible stewardship of limited public resources

Unlocking medical leadership’s potential:a multilevel virtuous circle?

Background and aim: Medical leadership (ML) has been introduced in many countries, promising to support healthcare services improvement and help further system reform through effective leadership behaviours. Despite some evidence of its success, such lofty promises remain unfulfilled. Method: Couched in extant international literature, this paper provides a conceptual framework to analyse ML's potential in the context of healthcare's complex, multifaceted setting. Results: We identify four interrelated levels of analysis, or domains, that influence ML's potential to transform healthcare delivery. These are the healthcare ecosystem domain, the professional domain, the organisational domain and the individual doctor domain. We discuss the tensions between the various actors working in and across these domains and argue that greater multilevel and multistakeholder collaborative working in healthcare is necessary to reprofessionalise and transform healthcare ecosystems

Rethinking the Priorities for Indian Agricultural Research, Institutions and Policy: Learning from the Grassroots

Sometimes having succeeded in a mission, we fail because we tend to persist with the same strategy even when times have changed. The success, thus, becomes the reason for failure. Indian agriculture research has been an outstanding success in terms of achieving food self-reliance and converting a perennially importing country to an exporting country. But, the trend in the last decade has been disappointing and reasons are not far to seek. I will take this opportunity to reflect on the three decades of my engagement with the agricultural research community so that some new pointers can be identified. I will also share the lessons learnt from the grassroots innovators and traditional knowledge holders through Honey Bee Network activities in the last two decades. It is possible that some of my views cause discomfort. But, it is with great respect that I submit these ideas. The agricultural research community has always considered me as an insider and therefore the liberty that they have allowed me to take with the ideas. The interface of science and society, which has become a bit weaker in recent years, was taken as a matter of deep concern and commitment. It is a privilege for me to share my views in Dr B P Pal's memory. I hope to help in triggering some thoughts towards revitalisation of our institutions, policy making approach and our relationship with the common people and their creativity. Paper deals with mainly four issues, viz., (i) Managing genetic resources, (ii) Rethinking sustainability, (iii) Redesigning research organisations for sustainable, accessible and affordable outcomes and (iv) Ethical and institutional issues in agricultural research. The quality of education, development of entrepreneurial spirit, monitoring eco system health and developing longitudinal research facilities are some of the other important concerns in the Indian agricultural research system. When plant breeding got dominated by the practice of making selections in international nurseries and releasing varieties instead of painstaking seven to eight year breeding cycles of complex crossing programmes, the faster mortality of such rapidly released varieties was inevitable. The incentive systems for scientists unfortunately have not been upgraded and calibrated in a manner that social, professional and individual interests can converge. The organisational design does not let new forms of partnerships and networks to emerge. The current crisis in Indian agriculture is a consequence of the outdated policies and irrelevant organisational and institutional designs. There is no escape from major restructuring of agricultural research policy and institutions. I may be forgiven for being too critical at several places in my submission. Thousands of innovations and traditional knowledge identified from more than 500 districts have proved, if a proof was needed that Indian farmers, artisans, pastoralists and mechanics are extremely creative and engagement with them can not be avoided by institutional science for too long without inviting an unfortunate backlash.