ParkinsonNet: An Innovative Dutch Approach to Patient-Centered Care for a Degenerative Disease

Key features Multidisciplinary networks of allied health professionals in the Netherlands use evidence-based practice guidelines for treating Parkinson's disease, facilitated by a web-based platform through which patients can provide feedback about their care.Target population Adults with Parkinson's disease, an age-related neurodegenerative disorder for which no cure exists.Why it's important Many patients with degenerative chronic diseases have difficulty accessing the range of specialty medical, nursing, and supportive services they need, and available personnel often lack expertise with particular conditions. Care practices vary, and care coordination can be challenging.Benefits Lower rates of hip fractures and hospitalizations and better self-reported quality-of-life outcomes; greater knowledge of Parkinson's treatment among providers and higher job satisfaction; generally lower treatment costs where model has been implemented.Challenges Provider payment often does not cover care coordination services. The model might work best with a global payment approach

Examination of High-Cost Patients in Ontario

Introduction In Ontario, the top 5% of high-cost users account for 66% of health care costs. The heavy use of resources combined with perceived inefficiencies offer an imperative to target strategies to redesign care to better meet patient needs and increase value. Objectives and Approach As part of a request submitted to the Applied Health Research Question (AHRQ) review team, the main objective of this study was to identify drivers of high health care use in Ontario in order to find better ways to improve the efficiency in healthcare delivery. Using data in fiscal year 2012/13, characteristics of the top 5% of high costs users were described, and further stratified by mental health status. Total spending by sector of care were also described. Data were linked including physician, hospital, medication and long term care databases for each patient. Results In the top 5% of high-cost users, there were 729,870 patients who accounted for $20,179,208,348 of total healthcare spending in 2012/13, with the highest percentage of spending observed among older adults aged 61-80 years old. Mental health high-cost patients accounted for 6.1% of these patients, of which 51.5% were female, had a low socio-economic status and an average age of 44 years. These patients had an average of 4.9 (SD=2.3) ICD chapters and used an average of 8.7 (SD=3.8) drugs. Using the health accounts methodology (ICHA), as described by the OECD and WHO, over 90% of healthcare costs among the top 5% of high-cost patients were from inpatient care, day surgery and clinic care, physician care, outpatients drugs and inpatient rehabilitation and complex/continuing care. Conclusion/Implications This study provides a systematic description of the needs in a high cost patient group, and serves as a platform for international comparisons across healthcare systems to better understand gaps and identify targets for intervention. These cross-comparisons offer a tool to evaluate performance of healthcare systems and to prioritize policies

Medicalisation and Overdiagnosis: What Society Does to Medicine

The concept of overdiagnosis is a dominant topic in medical literature and discussions. In research that targets overdiagnosis, medicalisation is often presented as the societal and individual burden of unnecessary medical expansion. In this way, the focus lies on the influence of medicine on society, neglecting the possible influence of society on medicine. In this perspective, we aim to provide a novel insight into the influence of society and the societal context on medicine, in particularly with regard to medicalisation and overdiagnosi

Medicalization Defined in Empirical Contexts – A Scoping Review

Background: Medicalization has been a topic of discussion and research for over four decades. It is a known concept to researchers from a broad range of disciplines. Medicalization appears to be a concept that speaks to all, suggesting a shared understanding of what it constitutes. However, conceptually, the definition of medicalization has evolved over time. It is unknown how the concept is applied in empirical research, therefore following research question was answered: How is medicalization defined in empirical research and how do the definitions differ from each other? Methods: We performed a scoping review on the empirical research on medicalization. The 5 steps of a scoping review were followed: (1) Identifying the research question; (2) Identifying relevant studies; (3) Inclusion and exclusion criteria; (4) Charting the data; and (5) Collating, summarizing and reporting the results. The screening of 3027 papers resulted in the inclusion of 50 empirical studies in the review.Results: The application of the concept of medicalization within empirical studies proved quite diverse. The used conceptual definitions could be divided into 10 categories, which differed from each other subtly though importantly. The ten categories could be placed in a framework, containing two axes. The one axe represents a continuum from value neutral definitions to value laden definitions. The other axe represents a continuum from a micro to a macro perspective on medicalization. Conclusion: This review shows that empirical research on medicalization is quite heterogeneous in its definition of the concept. This reveals the richness and complexity of medicalization, once more, but also hinders the comparability of studies. Future empirical research should pay more attention to the choice made with regard to the definition of medialization and its applicability to the context of the study

Effective weakly supervised semantic frame induction using expression sharing in hierarchical hidden Markov models

We present a framework for the induction of semantic frames from utterances in the context of an adaptive command-and-control interface. The system is trained on an individual user's utterances and the corresponding semantic frames representing controls. During training, no prior information on the alignment between utterance segments and frame slots and values is available. In addition, semantic frames in the training data can contain information that is not expressed in the utterances. To tackle this weakly supervised classification task, we propose a framework based on Hidden Markov Models (HMMs). Structural modifications, resulting in a hierarchical HMM, and an extension called expression sharing are introduced to minimize the amount of training time and effort required for the user. The dataset used for the present study is PATCOR, which contains commands uttered in the context of a vocally guided card game, Patience. Experiments were carried out on orthographic and phonetic transcriptions of commands, segmented on different levels of n-gram granularity. The experimental results show positive effects of all the studied system extensions, with some effect differences between the different input representations. Moreover, evaluation experiments on held-out data with the optimal system configuration show that the extended system is able to achieve high accuracies with relatively small amounts of training data

Serotonin, cortisol, and stress-related psychopathology : from bench to bed

Stress has been implicated in the etiology of many psychiatric disorders, the most common stress-related disorder being major depressive disorder. However, stressful events do not automatically lead to psychopathology, important is the interaction between the stressor and someone’s vulnerability to stress and psychiatric disorders. This vulnerability is individual and likely to be determined by genetic, psychosocial, and biological factors. Two biological systems that have been related to the development of stress-related psychiatric disorders are the hypothalamus-pituitary-adrenal(HPA)-axis and the serotonergic system. In the present thesis, the interaction of these systems on coping with stress in rats and vulnerability to psychopathology in humans was investigated. The results indicate that changes in serotonergic activity and HPA-axis activity as a consequence of a disease process, treatment condition or other environmental factors may have behavioral consequences in both animals and humans. For example, low serotonergic activity may increase susceptibility to stress and HPA-axis activity, which in combination with individual genetic make-up may result in psychiatric symptoms. Impaired HPA-axis function is associated with more severe symptoms of major depressive disorder. We plead for the inclusion of a separate “serotonergic” symptom profile list in psychiatric questionnaires, and future incarnations of the DSM.