The Health Insurance Provisions of the 2009 Congressional Health Reform Bills: Implications for Coverage, Affordability, and Costs

Analyzes the House and Senate healthcare reform bills for the number of people likely to gain coverage and the implications for federal financing, families' insurance premium and out-of-pocket costs, employers, and the potential for price competition

Starting on the Path to a High Performance Health System: Analysis of Health System Reform Provisions of Reform Bills in the House of Representatives and Senate

Compares the reform bills' reform provisions, with a focus on closing the coverage gap by creating an insurance exchange of public and private plans, strengthening Medicare, and expanding Medicaid. Examines implications for the budget and coverage rates

How Health Care Reform Can Lower the Costs of Insurance Administration

Examines the sources of U.S. insurance administration costs and estimates potential cost savings from the creation of a national insurance exchange to replace the individual and small-group markets as part of a public-private approach to reform

The Comprehensive Congressional Health Reform Bills of 2009: A Look at Health Insurance, Delivery System, and Financing Provisions

Provides an overview of the key provisions of the House and Senate healthcare reform bills that are essential to a high-performance health system. Compares approaches to health insurance reforms, health system reforms, and revenue sources and financing

The role of healthcare professionals in encouraging parents to see and hold their stillborn baby: a meta-synthesis of qualitative studies.

Background: Globally, during 2013 there were three million recorded stillbirths. Where clinical guidelines exist some recommend that professionals do not encourage parental contact. The guidance is based on quantitative evidence that seeing and holding the baby is not beneficial for everyone, but has been challenged by bereaved parents' organisations. We aim to inform future guideline development through a synthesis of qualitative studies reporting data relevant to the research question; how does the approach of healthcare professionals to seeing and holding the baby following stillbirth impact parents views and experiences? Methods/Findings: Using a predetermined search strategy of PubMed and PsychINFO we identified robust qualitative studies reporting bereaved parental views and/or experiences relating to seeing and holding their stillborn baby (final search 24 February, 2014). Eligible studies were English language, reporting parental views, with gestational loss >20weeks. Quality was independently assessed by three authors using a validated tool. We used meta-ethnographic techniques to identify key themes and a line of argument synthesis. We included 12 papers, representing the views of 333 parents (156 mothers, 150 fathers, and 27 couples) from six countries. The final themes were: "[Still]birth: Nature of care is paramount", "Real babies: Perfect beauties, monsters and spectres", and "Opportunity of a lifetime lost." Our line-of-argument synthesis highlights the contrast between all parents need to know their baby, with the time around birth being the only time memories can be made, and the variable ability that parents have to articulate their preferences at that time. Thus, we hypothesised that how health professionals approach contact between parents and their stillborn baby demands a degree of active management. An important limitation of this paper is all included studies originated from high income, westernised countries raising questions about the findings transferability to other cultural contexts. We do not offer new evidence to answer the question "Should parents see and hold their stillborn baby?", instead our findings advance understanding of how professionals can support parents to make appropriate decisions in a novel, highly charged and dynamic situation. Conclusions: Guidelines could be more specific in their recommendations regarding parental contact. The role of healthcare professionals in encouraging parents to see and hold their stillborn baby is paramount. Parental choice not to see their baby, apprehension, or uncertainty should be continuously revisited in the hours after birth as the opportunity for contact is fleeting and final

Chaplain development in Clinical Pastoral Education (CPE) in healthcare settings in England: A mixed methods study

Background Clinical Pastoral Education (CPE) is the predominant specialised training for healthcare chaplains in several national contexts. CPE is spiritual care education that uses experiential and action-reflection learning methods to train diverse participants. However, CPE is not established for chaplaincy training in England. Currently, chaplaincy education in England lacks standardisation, leading to inequalities in entry into the profession and inconsistent training and career pathways. CPE has the potential to address these issues. We examined changes associated with participating in CPE and participants’ perceptions about their learning experience. We sought to evaluate the effectiveness of CPE as a viable chaplaincy education model in healthcare settings in England. Methods Convergent mixed methods involved pre-post surveys and focus group sessions to examine the experiences and development of seven chaplains, with diverse experience levels and backgrounds, who participated in the pilot CPE unit in NHS England. We integrated thematic analysis and survey results. Results We identified four overarching themes: Development pathways, Catalysts for development, Advantages of CPE for chaplaincy education, and Experiences with CPE course structure. Participants developed along various pathways: confidence, reflective practice, emotional intelligence, listening and attending skills, diversity in chaplaincy care, and spiritual assessment. Survey results confirmed several themes, indicating gains in chaplaincy capabilities, emotional intelligence, and counselling self-efficacy. Participants emphasised the advantages and effectiveness of the CPE model. Conclusions Quantitative and qualitative findings converged to provide rich evidence that CPE generated personal and professional development, improving chaplaincy practice. General learning pathways moved from personal development, through the interpersonal learning context, and translated into chaplain competency. Participants endorsed CPE, as a robust and effective training model for chaplaincy in the English context, for those entering the profession and experienced chaplains alike. We conceptualised preliminary models for chaplain development and learning pathways in CPE that need validation and refinement by future research

Measures to predict the individual variability of corticospinal responses following transcranial direct current stimulation

Individual responses to transcranial direct current stimulation (tDCS) are varied and therefore potentially limit its application. There is evidence that this variability is related to the contributions of Indirect waves (I-waves) recruited in the cortex. The latency of motor-evoked potentials (MEPs) can be measured through transcranial magnetic stimulation (TMS), allowing an individual\u27s responsiveness to tDCS to be determined. However, this single-pulse method requires several different orientations of the TMS coil, potentially affecting its reliability. Instead, we propose a paired-pulse TMS paradigm targeting I-waves as an alternative method. This method uses one orientation that reduces inter- and intra-trial variability. It was hypothesized that the paired-pulse method would correlate more highly to tDCS responses than the single-pulse method. In a randomized, double blinded, cross-over design, 30 healthy participants completed two sessions, receiving 20 min of either anodal (2 mA) or sham tDCS. TMS was used to quantify Short interval intracortical facilitation (SICF) at Inter stimulus intervals (ISIs) of 1.5, 3.5 and 4.5 ms. Latency was determined in the posterior-anterior (PA), anterior-posterior (AP) and latero-medial (LM) coil orientations. The relationship between latency, SICF measures and the change in suprathreshold MEP amplitude size following tDCS were determined with Pearson\u27s correlations. TMS measures, SICI and SICF were also used to determine responses to Anodal-tDCS (a-tDCS). Neither of the latency differences nor the SICF measures correlated to the change in MEP amplitude from pre-post tDCS (all P > 0.05). Overall, there was no significant response to tDCS in this cohort. This study highlights the need for testing the effects of various tDCS protocols on the different I-waves. Further research into SICF and whether it is a viable measure of I-wave facilitation is warranted