An overview of the research evidence on ethnicity and communication in healthcare

• The aim of the present study was to identify and review the available research evidence on 'ethnicity and communication' in areas relevant to ensuring effective provision of mainstream services (e.g. via interpreter, advocacy and translation services); provision of services targeted on communication (e.g. speech and language therapy, counselling, psychotherapy); consensual/ participatory activities (e.g. consent to interventions), and; procedures for managing and planning for linguistic diversity

Family-Centered Care to Improve Family Consent for Organ Donation

The need for organ donation has increased over time, but the shortage of available donors is the major limiting factor in transplantation. Organ donation refusal from relatives of potential donors with brain death significantly reduces organ availability. We report a brief analysis about family conflicts in decision-making and causes for refusing donation; moreover, we describe new family-centered strategies in the intensive care unit (ICU) and our systematic communication approach between medical staff and patients’ relatives. In 2016 we conducted a single-center, non-randomized, controlled and before and after study in our ICU, an 18-bed intensive care unit (ICU) of a university hospital. We compared the rate of consent for organ donation before and after the introduction of the new communication approach. The application of a new communication approach between medical staff and relatives of brain-dead patients was associated with a significant increase in the rate of consent to donation. The positive results of the 3-year period 2013–2015 have been confirmed in the 2-year period 2016–2017. Our results highlight the importance of empathy and counselor support of relatives in the ICU

Barnes Hospital Bulletin

https://digitalcommons.wustl.edu/bjc_barnes_bulletin/1233/thumbnail.jp

Information Systems and Health Care VII - When Success Results in Failure: The Challenge of Extending the IT Infrastructure to Support Organ Procurement and Transplantation

Xpedite was a computer-based information system developed by the United Network for Organ Sharing (UNOS) to enhance organ procurement and placement from cadavers. Using state-of-the-art development approaches and technology at the time of its development, Xpedite was built around Lotus Notes, facsimile machines, and alphanumeric pagers. It was developed to integrate and streamline the collection, transfer, and exchange of data on available organs more fully. The concept was to shorten the time from organ availability (i.e., donor death) to transplant, thus reducing organ wastage. Xpedite met design and operational performance goals (i.e., a reduction in placement times and data errors), yet its operation was terminated after barely twenty-four months of operation. Adoption of the new technology throughout the transplant community was limited due to inexperience with integrated information technology systems and the resistance to change that accompanied Xpedite\u27s launch. The individual and organizational resistance was a surprise to UNOS. The technical and organizational lessons learned from this experience helped UNOS with developing subsequent information technology infrastructure components. The complexity of the technology support environment and low levels of user adoption for Xpedite ultimately led to an evolution beyond this tool, resulting in an Internet-based environment that would be more robust, easier to maintain, and better able to support user needs

Rationale, design and conduct of a randomised controlled trial evaluating a primary care-based complex intervention to improve the quality of life of heart failure patients: HICMan (Heidelberg Integrated Case Management) : study protocol

Background: Chronic congestive heart failure (CHF) is a complex disease with rising prevalence, compromised quality of life (QoL), unplanned hospital admissions, high mortality and therefore high burden of illness. The delivery of care for these patients has been criticized and new strategies addressing crucial domains of care have been shown to be effective on patients' health outcomes, although these trials were conducted in secondary care or in highly organised Health Maintenance Organisations. It remains unclear whether a comprehensive primary care-based case management for the treating general practitioner (GP) can improve patients' QoL. Methods/Design: HICMan is a randomised controlled trial with patients as the unit of randomisation. Aim is to evaluate a structured, standardized and comprehensive complex intervention for patients with CHF in a 12-months follow-up trial. Patients from intervention group receive specific patient leaflets and documentation booklets as well as regular monitoring and screening by a prior trained practice nurse, who gives feedback to the GP upon urgency. Monitoring and screening address aspects of disease-specific selfmanagement, (non)pharmacological adherence and psychosomatic and geriatric comorbidity. GPs are invited to provide a tailored structured counselling 4 times during the trial and receive an additional feedback on pharmacotherapy relevant to prognosis (data of baseline documentation). Patients from control group receive usual care by their GPs, who were introduced to guidelineoriented management and a tailored health counselling concept. Main outcome measurement for patients' QoL is the scale physical functioning of the SF-36 health questionnaire in a 12-month follow-up. Secondary outcomes are the disease specific QoL measured by the Kansas City Cardiomyopathy questionnaire (KCCQ), depression and anxiety disorders (PHQ-9, GAD-7), adherence (EHFScBS and SANA), quality of care measured by an adapted version of the Patient Chronic Illness Assessment of Care questionnaire (PACIC) and NTproBNP. In addition, comprehensive clinical data are collected about health status, comorbidity, medication and health care utilisation. Discussion: As the targeted patient group is mostly cared for and treated by GPs, a comprehensive primary care-based guideline implementation including somatic, psychosomatic and organisational aspects of the delivery of care (HICMAn) is a promising intervention applying proven strategies for optimal care. Trial registration: Current Controlled Trials ISRCTN30822978

The Comprehensive Cancer Center

This open access book provides a valuable resource for hospitals, institutions, and health authorities worldwide in their plans to set up and develop comprehensive cancer care centers. The development and implementation of a comprehensive cancer program allows for a systematic approach to evidence-based strategies of prevention, early detection, diagnosis, treatment, and palliation. Comprehensive cancer programs also provide a nexus for the running of clinical trials and implementation of novel cancer therapies with the overall aim of optimizing comprehensive and holistic care of cancer patients and providing them with the best opportunity to improve quality of life and overall survival. This book's self-contained chapter format aims to reinforce the critical importance of comprehensive cancer care centers while providing a practical guide for the essential components needed to achieve them, such as operational considerations, guidelines for best clinical inpatient and outpatient care, and research and quality management structures. Intended to be wide-ranging and applicable at a global level for both high and low income countries, this book is also instructive for regions with limited resources. The Comprehensive Cancer Center: Development, Integration, and Implementation is an essential resource for oncology physicians including hematologists, medical oncologists, radiation oncologists, surgical oncologists, and oncology nurses as well as hospitals, health departments, university authorities, governments and legislators

Barnes Hospital Bulletin

https://digitalcommons.wustl.edu/bjc_barnes_bulletin/1243/thumbnail.jp

Evaluating Telehealth as a Means of Communicating with Living Donors and its Effect on Quality of Care

Background: Despite the advantages of living donor kidney transplantation (LDKT), there are barriers that potential donors face that make living donation less appealing. Research supports the use of telehealth as an effective method of enhancing access to care and building efficiencies. Aims/Objectives: To evaluate access to care, effectiveness, financial impact, and experience after implementing telehealth as a means of communicating with living donors. Methods: Utilizing a pretest-posttest design, an analysis was performed among medically cleared donors evaluated in-person between January 1, 2019 to December 31, 2019 (Control Group; N=64) and donors evaluated via telehealth (Zoom®) between January 1, 2021 to December 31, 2021 (Intervention Group; N=64). Mean outcome measures included referral date to evaluation date (access to care); evaluation date to medical clearance date (effectiveness); and estimated out-of-pocket costs related to travel and lost wages (financial impact). Telehealth Usability Questionnaires (TUQ) were used to evaluate healthcare provider/patient experience. Results:Retrospective analysis of 128 randomly selected donors showed that compared to in- person evaluations, telehealth donors were scheduled for an evaluation faster (51.67 days [SD: 18.92] vs 30.45 days [SD:14.29]; p Conclusion: The use of telehealth may improve access to care and alleviate the financial impact, making living donor evaluations more accessible and convenient for some interested individuals. Nevertheless, there is no best practice guidance available for living donor evaluations via telehealth. Collaborative efforts are needed to advance regulatory policies and ongoing assessment is needed to ensure telehealth remains a safe and effective option for evaluating donors