Family Coverage: Covering Parents Along With Their Children

Explores the high uninsured rate among parents compared to children, due to the lack of both employer-sponsored and public insurance options. Argues for expanding state Medicaid coverage to parents. Offers strategies for addressing costs and other issues

Implementing State-Level Policy and Operational Processes That Enhance Access to Medicaid Family Planning Program Services

Medicaid provides a critical source of health care coverage for low-income individuals in the United States, including 13 million women of reproductive age. Medicaid is also the primary source of family planning coverage, accounting for 75% of public expenditures for family planning services in the United States. State Medicaid programs have a long-standing requirement to provide family planning services in the benefits package that is provided to people enrolled in full-scope coverage. In order to expand the number of people who can access family planning services, states have also taken the option to establish Medicaid family planning programs that cover a suite of family planning services for individuals not otherwise eligible for full-scope Medicaid.States have considerable flexibility in designing their Medicaid family planning programs. As a result, access to and utilization of Medicaid family planning programs are largely impacted by the policies and operational processes a state Medicaid program chooses to implement. The decisions a state makes related to its application process, consumer outreach, confidentiality policies, scope of covered benefits and provider network are all critical programmatic features that determine how easy or difficult it is for an individual to enroll in and receive services through Medicaid family planning programs.To promote access and utilization, this issue brief provides an array of best practice strategies in place across the nation to serve as an actionable road map for states that might be considering adopting such a program as well as states with existing programs looking to bolster participation and utilization rates. The strategies are derived from a review of national literature and policies and practices across the country and informed by an analysis of participation rates and utilization of services in 22 of the 30 states with programs in place

Management of multimorbidity using a patient-centred care model:a pragmatic cluster-randomised trial of the 3D approach

Background: The management of people with multiple chronic conditions challenges health-care systems designed around single conditions. There is international consensus that care for multimorbidity should be patient-centred, focus on quality of life, and promote self-management towards agreed goals. However, there is little evidence about the effectiveness of this approach. Our hypothesis was that the patient-centred, so-called 3D approach (based on dimensions of health, depression, and drugs) for patients with multimorbidity would improve their health-related quality of life, which is the ultimate aim of the 3D intervention. Methods: We did this pragmatic cluster-randomised trial in general practices in England and Scotland. Practices were randomly allocated to continue usual care (17 practices) or to provide 6-monthly comprehensive 3D reviews, incorporating patient-centred strategies that reflected international consensus on best care (16 practices). Randomisation was computer-generated, stratified by area, and minimised by practice deprivation and list size. Adults with three or more chronic conditions were recruited. The primary outcome was quality of life (assessed with EQ-5D-5L) after 15 months' follow-up. Participants were not masked to group assignment, but analysis of outcomes was blinded. We analysed the primary outcome in the intention-to-treat population, with missing data being multiply imputed. This trial is registered as an International Standard Randomised Controlled Trial, number ISRCTN06180958. Findings: Between May 20, 2015, and Dec 31, 2015, we recruited 1546 patients from 33 practices and randomly assigned them to receive the intervention (n=797) or usual care (n=749). In our intention-to-treat analysis, there was no difference between trial groups in the primary outcome of quality of life (adjusted difference in mean EQ-5D-5L 0·00, 95% CI −0·02 to 0·02; p=0·93). 78 patients died, and the deaths were not considered as related to the intervention. Interpretation: To our knowledge, this trial is the largest investigation of the international consensus about optimal management of multimorbidity. The 3D intervention did not improve patients' quality of life. Funding: National Institute for Health Research

The Benefits of and Barriers to Using Social Robot PARO in Care Settings: A Scoping Review

Background Given the complexity of providing dementia care in hospitals, integrating technology into practice is a high challenge and an important opportunity. Although there are a growing demand and interest in using social robots in a variety of care settings to support dementia care, little is known about the impacts of the robotics and their application in care settings, i.e., what worked, in which situations, and how.   Methods Scientific databases and Google Scholar were searched to identify publications published since 2000. The inclusion criteria consisted of older people with dementia, care setting, and social robot PARO.   Results A total of 29 papers were included in the review. Content analysis identified 3 key benefits of and 3 barriers to the use of PARO. Main benefits include: reducing negative emotion and behavioral symptoms, improving social engagement, and promoting positive mood and quality of care experience. Key barriers are: cost and workload, infection concerns, and stigma and ethical issues. This review reveals 3 research gaps: (a) the users’ needs and experiences remain unexplored, (b) few studies investigate the process of how to use the robot effectively to meet clinical needs, and (c) theory should be used to guide implementation.   Conclusions Most interventions conducted have been primarily researcher-focused. Future research should pay more attention to the clinical needs of the patient population and develop strategies to overcome barriers to the adoption of PARO in order to maximize patient benefits

The Benefits of and Barriers to Using Social Robot PARO in Care Settings: A Scoping Review

Background Given the complexity of providing dementia care in hospitals, integrating technology into practice is a high challenge and an important opportunity. Although there are a growing demand and interest in using social robots in a variety of care settings to support dementia care, little is known about the impacts of the robotics and their application in care settings, i.e., what worked, in which situations, and how.   Methods Scientific databases and Google Scholar were searched to identify publications published since 2000. The inclusion criteria consisted of older people with dementia, care setting, and social robot PARO.   Results A total of 29 papers were included in the review. Content analysis identified 3 key benefits of and 3 barriers to the use of PARO. Main benefits include: reducing negative emotion and behavioral symptoms, improving social engagement, and promoting positive mood and quality of care experience. Key barriers are: cost and workload, infection concerns, and stigma and ethical issues. This review reveals 3 research gaps: (a) the users’ needs and experiences remain unexplored, (b) few studies investigate the process of how to use the robot effectively to meet clinical needs, and (c) theory should be used to guide implementation.   Conclusions Most interventions conducted have been primarily researcher-focused. Future research should pay more attention to the clinical needs of the patient population and develop strategies to overcome barriers to the adoption of PARO in order to maximize patient benefits

Assessing function in patients undergoing joint replacement: a study protocol for a cohort study

BACKGROUND: Joint replacement is an effective intervention for people with advanced arthritis, although there is an important minority of patients who do not improve post-operatively. There is a need for robust evidence on outcomes after surgery, but there are a number of measures that assess function after joint replacement, many of which lack any clear theoretical basis. The World Health Organisation has introduced the International Classification of Functioning, Disability and Health (ICF), which divides function into three separate domains: Impairment, activity limitations and participation restrictions. The aim of this study is to compare the properties and responsiveness of a selection of commonly used outcome tools that assess function, examine how well they relate to the ICF concepts, and to explore the changes in the measures over time. METHODS/DESIGN: Two hundred and sixty three patients listed for lower limb joint replacement at an elective orthopaedic centre have been recruited into this study. Participants attend the hospital for a research appointment prior to surgery and then at 3-months and 1-year after surgery. At each assessment time, function is assessed using a range of measures. Self-report function is assessed using the WOMAC, Aberdeen Impairment, Activity Limitation and Participation Restriction Measure, SF-12 and Measure Yourself Medical Outcome Profile 2. Clinician-administered measures of function include the American Knee Society Score for knee patients and the Harris Hip Score for hip patients. Performance tests include the timed 20-metre walk, timed get up and go, sit-to-stand-to-sit, step tests and single stance balance test. During the performance tests, participants wear an inertial sensor and data from motion analysis are collected. Statistical analysis will include exploring the relationship between measures describing the same ICF concepts, assessing responsiveness, and studying changes in measures over time. DISCUSSION: There are a range of tools that can be used to assess function before and after joint replacement, with little information about how these various measures compare in their properties and responsiveness. This study aims to provide this data on a selection of commonly used assessments of function, and explore how they relate to the ICF domains

Retrospective evaluation of whole exome and genome mutation calls in 746 cancer samples

Funder: NCI U24CA211006Abstract: The Cancer Genome Atlas (TCGA) and International Cancer Genome Consortium (ICGC) curated consensus somatic mutation calls using whole exome sequencing (WES) and whole genome sequencing (WGS), respectively. Here, as part of the ICGC/TCGA Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium, which aggregated whole genome sequencing data from 2,658 cancers across 38 tumour types, we compare WES and WGS side-by-side from 746 TCGA samples, finding that ~80% of mutations overlap in covered exonic regions. We estimate that low variant allele fraction (VAF < 15%) and clonal heterogeneity contribute up to 68% of private WGS mutations and 71% of private WES mutations. We observe that ~30% of private WGS mutations trace to mutations identified by a single variant caller in WES consensus efforts. WGS captures both ~50% more variation in exonic regions and un-observed mutations in loci with variable GC-content. Together, our analysis highlights technological divergences between two reproducible somatic variant detection efforts

Salmonella regrowth potential of two sewage sludge products

The disposal of sewage sludge is becoming an ever-increasing problem and a range of re-use options are being developed, with traditional composting and advanced alkaline stabilisation emerging as priority re-use alternatives in NSW. However, concerns have been raised regarding the dissemination of sludge related pathogens in the environment. Salmonella spp pose the greatest risk since they have the ability to proliferate in the absence of human and animal hosts. Composting processes eliminate salmonellae from sludge, but the opportunity for post-processing recontamination is considerable. This project examined the significance of post-processing recontamination of Salmonella broughton, introduced into composted sludge and N-Virosoil. In compost, inactivation rates of S. broughton showed an inverse relationship with simulated processing temperatures, with competitive exclusion by autocthonous compost flora thought to be the major mechanism of inhibition. S. broughton numbers were reduced to below the limits of detection after several weeks. S. broughton inactivation was also assessed in processed N-Virosoil and was found to be more immediate. It was concluded that both compost and N.Virosoil products have a low potential to support the regrowth of Salmonella spp