Conceptual frameworks and degrees of patient engagement in the planning and designing of health services: A scoping review of qualitative studies

Increasingly, patients are being recognized as essential partners in the solutions to healthcare system problems. Patient engagement has been referred to as the “holy grail” and next “blockbuster drug” of health care because it may be revolutionary for transforming the design, delivery, and responsiveness of health services. Patients engage in a variety of healthcare activities, and there are multiple frameworks that depict the degrees of patient engagement in these activities. The literature also uses a variety of terms and concepts to depict the degrees of patient engagement. Moreover, meaningful patient engagement is a concept widely utilized in the literature without a clear definition. The conceptual boundaries and differences between degrees of engagement are unclear. This scoping review summarizes the descriptive characteristics, the degrees of engagement, and examines the terms used to depict meaningful engagement as conceptualized by studies on planning and designing of administrative or health services and interventions. The research questions for this study are: What are the descriptive and study characteristics of studies where patients engage in planning and designing activities? What terms do studies use to depict meaningful patient engagement? This review found a variety of terms used by the literature to depict meaningful engagement: collaboration, cooperation, co-production, active involvement, partnership, and consumer and peer leadership. This review also found that studies seldom use patient engagement frameworks to identify the degree of engagement. The implications of these findings are discussed in light of the literature on patient engagement and recommendations for future practice are provided. Experience Framework This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens

Paucity of qualitative research in general medical and health services and policy research journals: analysis of publication rates

Abstract Background Qualitative research has the potential to inform and improve health care decisions but a study based on one year of publications suggests that it is not published in prominent health care journals. A more detailed, longitudinal analysis of its availability is needed. The purpose of this study was to identify, count and compare the number of qualitative and non-qualitative research studies published in high impact health care journals, and explore trends in these data over the last decade. Methods A bibliometric approach was used to identify and quantify qualitative articles published in 20 top general medical and health services and policy research journals from 1999 to 2008. Eligible journals were selected based on performance in four different ranking systems reported in the 2008 ISI Journal Citation Reports. Qualitative and non-qualitative research published in these journals were identified by searching MEDLINE, and validated by hand-searching tables of contents for four journals. Results The total number of qualitative research articles published during 1999 to 2008 in ten general medical journals ranged from 0 to 41, and in ten health services and policy research journals from 0 to 39. Over this period the percentage of empirical research articles that were qualitative ranged from 0% to 0.6% for the general medical journals, and 0% to 6.4% for the health services and policy research journals. Conclusions This analysis suggests that qualitative research it is rarely published in high impact general medical and health services and policy research journals. The factors that contribute to this persistent marginalization need to be better understood

Physical activity scale for the elderly: translation, cultural adaptation, and validation of the Italian version

Objective. The aim of the study was to translate and culturally adapt the Physical Activity Scale for the Elderly into Italian (PASE-I) and to evaluate its psychometric properties in the Italian older adults healthy population. Methods. For translation and cultural adaptation, the "Translation and Cultural Adaptation of Patient-Reported Outcomes Measures" guidelines have been followed. Participants included healthy individuals between 55 and 75 years old. The reliability and validity were assessed following the "Consensus-Based Standards for the Selection of Health Status Measurement Instruments" checklist. To evaluate internal consistency and test-retest reliability, Cronbach's α and Intraclass Correlation Coefficient (ICC) were, respectively, calculated. The Berg Balance Score (BBS) and the PASE-I were administered together, and Pearson's correlation coefficient was calculated for validity. Results. All the PASE-I items were identical or similar to the original version. The scale was administered twice within a week to 94 Italian healthy older people. The mean PASE-I score in this study was 159±77.88. Cronbach's α was 0.815 (p < 0.01) and ICC was 0.977 (p < 0.01). The correlation with the BBS was 0.817 (p < 0.01). Conclusions. The PASE-I showed positive results for reliability and validity. This scale will be of great use to clinicians and researchers in evaluating and managing physical activities in the Italian older adults population

PG-Triggers: Triggers for Property Graphs

Graph databases are emerging as the leading data management technology for storing large knowledge graphs; significant efforts are ongoing to produce new standards (such as the Graph Query Language, GQL), as well as enrich them with properties, types, schemas, and keys. In this article, we propose PG-Triggers, a complete proposal for adding triggers to Property Graphs, along the direction marked by the SQL3 Standard. We define the syntax and semantics of PG-Triggers and then illustrate how they can be implemented on top of Neo4j, one of the most popular graph databases. In particular, we introduce a syntax-directed translation from PG-Triggers into Neo4j, which makes use of the so-called APOC triggers; APOC is a community-contributed library for augmenting the Cypher query language supported by Neo4j. We also illustrate the use of PG-Triggers through a life science application inspired by the COVID-19 pandemic. The main result of this article is proposing reactive aspects within graph databases as first-class citizens, so as to turn them into an ideal infrastructure for supporting reactive knowledge management.Comment: 12 pages, 4 figures, 3 table

Grasses and legumes in mixture: an energy intercropping system intended for anaerobic digestion

Batch testing of biomethanization was conducted on organic matrices from a mixture of grasses (triticale and barley) and legumes (field bean - Vicia faba L. var . minor ). These tests were performed in mesophylic conditions (35°C) on previously chopped and ensiled biomass. The three crops have been cultivated in Southern Italy (Puglia region), both as single-crops and intercropping between triticale or barley and field bean, in different mixture combinations, during the season 2009-2010. Emphasis was placed on the determination of the chemical composition of feedstock from the three single species and their different intercropping ratios, mowed at two subsequent stages (milk and dough development of grasses), also assessing their consequent biogas and methane potential yields after silage. Seven overall treatments have been compared: the three species in monoculture (triticale, barley and field bean, respectively); two mixtures between triticale and field bean (with triticale at 70 and 50%, respectively); two mixtures between barley and field bean (again with barley at 70 and 50%, respectively). Immediately after cutting and for the next 90 days, biomass samples were closed into plastic mini-silos, each having a 5-L capacity, in order to simulate the silage process. Thereafter, the batch testing was performed and biogas and methane production have been determined, with respect to the main chemical characteristics of the chopped and ensiled biomass samples, able to affect biogas and methane yield. Considering the single-crop treatments the highest biogas per hectare production has been found with respect to triticale (8737.1 nm 3 ha -1 ) and barley (8837.6 nm 3 ha -1 ), at the first and second harvesting stage, respectively. Concerning grass-legume intercropping, the highest biogas yield (8635.0 nm 3 ha -1 ) was observed with reference to the 70:30 mixing ratio, specifically on barley mowed at the milk development stage. The methane content in the biogas ranged from 61.1% (on a 50:50 mixing ratio of barley at the milk stage) to 53.7% (on a barley monoculture at the dough stage)

Antioxidant Activity of Free and Bound Compounds in Quinoa (Chenopodium quinoa Willd.) Seeds in Comparison with Durum Wheat and Emmer

Antioxidant activity (AA) of quinoa (Chenopodium quinoa Willd.) seeds, as well as of durum wheat (Triticum turgidum L. ssp. durum Desf.) and of emmer (T. turgidum L. ssp. dicoccum Sch¨ubler) grains, was evaluated by studying hydrophilic (H), lipophilic (L), free-soluble (FSP) and insoluble-bound (IBP) phenolic extracts using the new lipoxygenase/4-nitroso-N,N-dimethylaniline (LOX/RNO) method, able to simultaneously detect different antioxidant mechanisms, as well as using the Oxygen Radical Absorbance Capacity (ORAC) and the Trolox Equivalent Antioxidant Capacity (TEAC) assays, which measure the scavenging activity against peroxyl and ABTS [2,2-azino-bis-(3- ethylbenzothiazoline-6-sulfonate)] radicals, respectively. The species under study were compared with respect to the sum of AA values of H, L and FSP extracts (AAH+L+FSP), containing freely solvent-soluble antioxidants, and AA values of IBP extracts (AAIBP), representing the phenolic fraction ester-linked to insoluble cell wall polymers. The LOX/RNO and ORAC methods measured in quinoa flour a remarkable AAH+L+FSP higher than durum wheat, although lower than emmer; according to the same assays, the IBP component of quinoa resulted less active than the durum wheat and emmer ones. The TEAC protocol also revealed a high AAH+L+FSP for quinoa. Interestingly, the ratio AAH+L+FSP/AAH+L+FSP+IBP, as evaluated by the LOX/RNO and ORAC assays, resulted in quinoa higher than that of both durum wheat and emmer, and much higher than durum wheat, according to the TEAC protocol. This may suggest that antioxidants from quinoa seeds may be more readily accessible with respect to that of both the examined wheat species

How can diagnostic assessment programs be implemented to enhance inter-professional collaborative care for cancer?

BackgroundInter-professional collaborative care (ICC) for cancer leads to multiple system, organizational, professional, and patient benefits, but is limited by numerous challenges. Empirical research on interventions that promote or enable ICC is sparse so guidance on how to achieve ICC is lacking. Research shows that ICC for diagnosis could be improved. Diagnostic assessment programs (DAPs) appear to be a promising model for enabling ICC. The purpose of this study was to explore how DAP structure and function enable ICC, and whether that may be associated with organizational and clinical outcomes.MethodsA case study approach will be used to explore ICC among eight DAPs that vary by type of cancer (lung, breast), academic status, and geographic region. To describe DAP function and outcomes, and gather information that will enable costing, recommendations expressed in DAP standards and clinical guidelines will be assessed through retrospective observational study. Data will be acquired from databases maintained by participating DAPs and the provincial cancer agency, and confirmed by and supplemented with review of medical records. We will conduct a pilot study to explore the feasibility of estimating the incremental cost-effectiveness ratio using person-level data from medical records and other sources. Interviews will be conducted with health professionals, staff, and referring physicians from each DAP to learn about barriers and facilitators of ICC. Qualitative methods based on a grounded approach will be used to guide sampling, data collection and analysis.DiscussionFindings may reveal opportunities for unique structures, interventions or tools that enable ICC that could be developed, implemented, and evaluated through future research. This information will serve as a formative needs assessment to identify the nature of ongoing or required improvements, which can be directly used by our decision maker collaborators, and as a framework by policy makers, cancer system managers, and DAP managers elsewhere to strategically plan for and implement diagnostic cancer services

Helicobacter pylori and Epstein-Barr virus infection in gastric diseases: Correlation with IL-10 and IL1RN polymorphism.

Introduction: Helicobacter pylori and Epstein-Barr virus (EBV) infection have recently 23 been shown to be associated with gastric diseases. Polymorphisms in genes encoding 24 cytokines such as interleukin 10 (IL-10) and interleukin 1 Receptor (IL-1RN) influence 25 cytokine secretion levels and appear to contribute to the risk of developing gastroduodenal 26 diseases. 27 To our knowledge, this is the first preliminary study to address the association of 28 coinfection with H. pylori and EBV and their correlation with genetic predisposition in the 29 development of gastric diseases. 30 Methods: Gastric biopsy samples of 96 patients with different gastric diseases were used. 31 Results: Our results showed that the rate of co-infection was higher in patients with 32 gastric cancer than in patients with normal gastric mucosa, active chronic gastritis and 33 MALT lymphoma. As regards the characterization of H. pilory strains, the 34 polymorphism s1m1i1 of vacA gene was more frequent in patients with MALT 35 Lymphoma in comparison to others, while the polymorphism s2m2i2 was most 36 frequent in patients with normal gastric mucosa. In addition, patients who tested 37 positivefor the cagA gene were more frequently those affected with gastric cancer than 38 those with inactive chronic gastritis. Similarly, the patients with oipA gene ON were more 39 frequently those with gastric cancer than those with inactive chronic gastritis. 40 Conclusion: According to our analysis, there was no correlation between coinfection 41 and polymorphisms in genes encoding IL-10 and IL-1RN. We conclude that various 42 factors can be involved in the development of gastric diseases

Strobilurin Effects on Nitrogen Use Efficiency for the Yield and Protein in Durum Wheat Grown under Rainfed Mediterranean Conditions

In wheat, the increase in nitrogen use efficiency (NUE) and optimization of the nitrogen doses to be used are both very important aspects for improving sustainable and productive agriculture. The aim of this study was to investigate, under rainfed Mediterranean conditions, the influence of strobilurin treatment and N fertilization on durum wheat N use efficiency for yield (NUEy) and protein (NUEp) and on the contribution of their components, nitrogen uptake efficiency (UPE) and nitrogen utilization efficiency (NUtE). Two durum wheat cultivars (Saragolla and Sfinge) were grown for two years in field conditions under five nitrogen treatments (60 kg ha−1 N60; 90 and 120 kg ha−1 given two and three times; N90, N90T3, N120 and N120T3) comparing a control without strobilurin treatment (ST0) and one application of strobilurin (STaz). In Sfinge, STaz caused a decrease in UPE and NUEp and an increase in NUtE and NUEy. In Saragolla, the opposite behavior was observed. Moreover, strobilurin positively affected the contribution of UPE and negatively that of NUtE to NUEy only in Saragolla. Furthermore, strobilurin determined higher NUEy and NUEp values under most of the N treatments adopted in the drier year. With this study, we supported the hypothesis that in Mediterranean conditions, the possibility of reducing N rate application from 120 to 90 kg ha−1 with a strobilurin-based treatment, even in the absence of fungal diseases, could represent a useful agronomic strategy for durum wheat grown under drought conditions as those predicted under the ongoing climate change

How can we improve guideline use? A conceptual framework of implementability

BACKGROUND: Guidelines continue to be underutilized, and a variety of strategies to improve their use have been suboptimal. Modifying guideline features represents an alternative, but untested way to promote their use. The purpose of this study was to identify and define features that facilitate guideline use, and examine whether and how they are included in current guidelines. METHODS: A guideline implementability framework was developed by reviewing the implementation science literature. We then examined whether guidelines included these, or additional implementability elements. Data were extracted from publicly available high quality guidelines reflecting primary and institutional care, reviewed independently by two individuals, who through discussion resolved conflicts, then by the research team. RESULTS: The final implementability framework included 22 elements organized in the domains of adaptability, usability, validity, applicability, communicability, accommodation, implementation, and evaluation. Data were extracted from 20 guidelines on the management of diabetes, hypertension, leg ulcer, and heart failure. Most contained a large volume of graded, narrative evidence, and tables featuring complementary clinical information. Few contained additional features that could improve guideline use. These included alternate versions for different users and purposes, summaries of evidence and recommendations, information to facilitate interaction with and involvement of patients, details of resource implications, and instructions on how to locally promote and monitor guideline use. There were no consistent trends by guideline topic. CONCLUSIONS: Numerous opportunities were identified by which guidelines could be modified to support various types of decision making by different users. New governance structures may be required to accommodate development of guidelines with these features. Further research is needed to validate the proposed framework of guideline implementability, develop methods for preparing this information, and evaluate how inclusion of this information influences guideline use