Medicare Advantage: Options for Standardizing Benefits and Information to Improve Consumer Choice

Describes the complex choices Medicare Advantage enrollees face. Discusses whether providing better information and decision-support tools, limiting out-of-pocket expenses, or standardizing benefits and cost-sharing would lead to better-informed choices

Continuing Bonds with Children and Bereaved Young People: A Narrative Review

Background:- Finding alternative ways to reconnect with the deceased is a common feature of bereavement. However, it is currently unclear how bereaved children/young people establish and develop a ‘continuing bond’ with deceased family members. Aim:- To investigate how bereaved young people continue bonds with deceased family members. Design:- A systematically conducted narrative review was conducted using six electronic databases; CINAHL, Medline, EMBASE, PsycINFO, PubMed and BNI. Limiters were applied to peer-reviewed articles published in English. Studies were assessed for methodological quality using the JBI Critical Appraisal Tools. Results:- Nineteen articles were included in the review. Three overarching themes were generated; unintended connections, intended connections, and internalised connections. Conclusion:- Bereaved young people establish a sense of connection with deceased family members through various means (e.g. unprovoked/spontaneous reminders, physical mementos, internalised memories). Some connections are unintended and occur spontaneously. However, other young people will specifically seek ways to remember the deceased to provide a sense of enduring connection

Locally Optimally Emitting Clouds and the Origin of Quasar Emission Lines

The similarity of quasar line spectra has been taken as an indication that the emission line clouds have preferred parameters, suggesting that the environment is subject to a fine tuning process. We show here that the observed spectrum is a natural consequence of powerful selection effects. We computed a large grid of photoionization models covering the widest possible range of cloud gas density and distance from the central continuum source. For each line only a narrow range of density and distance from the continuum source results in maximum reprocessing efficiency, corresponding to ``locally optimally-emitting clouds'' (LOC). These parameters depend on the ionization and excitation potentials of the line, and its thermalization density. The mean QSO line spectrum can be reproduced by simply adding together the full family of clouds, with an appropriate covering fraction distribution. The observed quasar spectrum is a natural consequence of the ability of various clouds to reprocess the underlying continuum, and can arise in a chaotic environment with no preferred pressure, gas density, or ionization parameter.Comment: 9 pages including 1 ps figure. LaTeX format using aaspp4.st

Improving end of life care in care homes; an evaluation of the six steps to success programme

BACKGROUND: There are approximately 426,000 people residing within care homes in the UK. Residents often have complex trajectories of dying, which make it difficult for staff to manage their end-of-life care. There is growing recognition for the need to support care homes staff in the care of these residents with increased educational initiatives. One educational initiative is The Six Steps to Success programme. METHOD: In order to evaluate the implementation of Six Steps with the first cohort of care homes to complete the end-of-life programme in the North West of England., a pragmatic evaluation methodology was implemented in 2012–2013 using multiple methods of qualitative data collection; online questionnaire with facilitators (n = 16), interviews with facilitators (n = 9) and case studies of care homes that had completed the programme (n = 6). The evaluation explored the implementation approach and experiences of the programme facilitators and obtain a detailed account of the impact of Six Steps on individual care homes. Based upon the National Health Service (NHS) End of Life Care (EoLC) Programme, The Route to Success in EoLC – Achieving Quality in Care Homes. RESULTS: The programme was flexibly designed so that it could be individually tailored to the geographical location and the individual cohort requirements. Facilitators provided comprehensive and flexible support to care homes. Challenges to programme success were noted as; lack of time allocated to champions to devote to additional programme work, inappropriate staff selected as ‘Champions’ and staff sickness/high staff turnover presented challenges to embedding programme values. Benefits to completing the programme were noted as; improvement in Advance Care Planning, improved staff communication/confidence when dealing with multi-disciplinary teams, improved end-of-life processes/documentation and increased staff confidence through acquisition of new knowledge and new processes. CONCLUSIONS: The findings suggested an overall positive impact from the programme. This flexibly designed programme continues to be dynamic, iteratively amended and improved which may affect the direct transferability of the results to future cohorts. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12904-016-0123-6) contains supplementary material, which is available to authorized users

Development of the Carers’ Alert Thermometer for Stroke Family Caregivers (CAT-S): A Multiphase Action Research Study

An estimated 1.3 million stroke survivors living in the United Kingdom (UK) currently rely on family caregivers for daily support. The needs of stroke family caregivers are, however, not routinely assessed by most clinical services. Early identification of their needs and support is crucial to maintain their well-being and caregiver role. At present, stroke-specific caregiver screening tools are lacking. This mixed method, the multiphase study aimed to develop a Carers’ Alert Thermometer for stroke family caregivers (CAT-S) by adapting the CAT, a short screening tool developed in the context of end-of-life care. Underpinned by principles of action research, qualitative and quantitative data were collected sequentially between February 2016 to December 2017 from purposive samples of stroke family caregivers (n = 76) and staff working within stroke services (n = 238) in the UK. Semistructured interviews were conducted to inform the contents of the CAT-S. Key items for inclusion were identified through a modified Delphi survey and consultation with an expert panel. The CAT-S was then piloted in North West England to test its usability and usefulness in practice to identify the needs of stroke family caregivers. Thematic and content analysis were used to analyse qualitative data. Quantitative data were analysed using descriptive statistics. The CAT-S comprises the key challenges that are experienced by stroke family caregivers. Two additional items not present on the original CAT were identified and included; training needs of family caregivers to provide care and support for caregivers’ emotional needs. The CAT-S was found to be useful and acceptable by both staff and stroke family caregivers and resulted in action plans and support being provided. The CAT-S is a supportive tool for achieving person-centred care and prioritising stroke family caregivers requiring comprehensive assessments