Elements Affecting Adoption and Implementation of Health Literacy Initiatives in Healthcare Organizations: A Qualitative Study

Nearly nine in ten U.S. adults struggle to use increasingly complex healthcare organizations and to understand the information these organizations provide. However, healthcare organizations are not yet widely addressing the need to make their services and health information easier to navigate, understand, and use. The purpose of this study was to expand knowledge about the facilitators and barriers to adoption and implementation of health literacy initiatives in healthcare organizations. Sixteen qualitative interviews with individuals who lead health literacy initiatives in 16 organizations across the U.S. were conducted. The study identified multiple facilitators and barriers to health literacy adoption and implementation efforts. Many of the elements had already been identified in the literature but four findings of this study were new. Executive level leadership support emerged as the most crucial element for success. Other important facilitators include (a) senior leadership being aware of the importance of addressing health literacy at the organizational level; (b) the person in charge of the health literacy initiative having authorization to meet with senior leaders, directors, and managers across the organization; (c) the health literacy office being located in an area with organization-wide authority; and (d) the use of a structured, strategic approach to plan and carry out change. Each of these elements is potentially influential in adoption and implementation of other change initiatives in healthcare as well as in health literacy initiatives. Further research to explore these elements could contribute to the literature, and to practical applications, in health literacy and other healthcare initiatives

The Anglo-American press and the sensationalization of the Arctic 1855-1910

Presents systematic investigation of role of press in Arctic exploration, finding that newspapers and their proprietors were much more influential in increasing knowledge about and interest in the far north than traditionally acknowledged. Focuses particularly on role of James Gordon Bennett, proprietor of New York Herald

B-type Natriuretic Peptide: Perioperative Patterns in Congenital Heart Disease

B-type natriuretic peptide (BNP) has diagnostic, prognostic, and therapeutic roles in adults with heart failure. BNP levels in children undergoing surgical repair of congenital heart disease (CHD) were characterized broadly, and distinguishable subgroup patterns delineated.Prospective, blinded, observational case series.Academic, tertiary care, free-standing pediatric hospital.Children with CHD; controls without cardiopulmonary disease.None.Preoperative cardiac medications/doses, CHD lesion types, perioperative BNP levels, intraoperative variables (lengths of surgery, bypass, cross-clamp), postoperative outcomes (lengths of ventilation, hospitalization, open chest; averages of inotropic support, central venous pressure, perfusion, urine output; death, low cardiac output syndrome (LCOS), cardiac arrest; readmission; and discharge medications).Median BNP levels for 102 neonatal and non-neonatal controls were 27 and 7 pg/mL, respectively. Serial BNP measures from 105 patients undergoing CHD repair demonstrated a median postoperative peak at 12 hours. The median and interquartile postoperative 24-hour average BNP levels for neonates were 1506 (782–3784) pg/mL vs. 286 (169–578) pg/mL for non-neonates ( P < 0.001). Postoperative BNP correlated with inotropic requirement, durations of open chest, ventilation, intensive care unit stay, and hospitalization (r = 0.33–0.65, all P < 0.001). Compared with biventricular CHD, Fontan palliations demonstrated lower postoperative BNP (median 150 vs. 306 pg/mL, P < 0.001), a 3-fold higher incidence of LCOS ( P < 0.01), and longer length of hospitalization (median 6.0 vs. 4.5 days, P = 0.01).Perioperative BNP correlates to severity of illness and lengths of therapy in the CHD population, overall. Substantial variation in BNP across time as well as within and between CHD lesions limits its practical utility as an isolated point-of-care measure. BNP commonly peaks 6–12 hours postoperatively, but the timing and magnitude of BNP elevation demonstrates notable age-dependency, peaking earlier and rising an order of magnitude higher in neonates. In spite of higher clinical acuity, non-neonatal univentricular CHD paradoxically demonstrates lower BNP levels compared with biventricular physiologies.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79231/1/j.1747-0803.2010.00396.x.pd

Long-Term Educational Sustainability: Educational Innovation in Social Vulnerability Contexts

This paper investigates the behavior of children from low socioeconomic status families and examines the effects of a socioemotional education program on aggression in children. The results of the program are compared according to the children's gender and age, the family structure, the parents' educational attainment, and social status. The results show that applying socioemotional education programs reduces children's aggression and encourages positive development during adolescence. This positive development fosters open, expressive behavior

Computed tomographic angiography for the evaluation of aneurysmal subarachnoid hemorrhage.

OBJECTIVES: Computed tomography (CT) followed by lumbar puncture (LP) is currently the criterion standard for diagnosing subarachnoid hemorrhage (SAH) in the emergency department (ED); however, this is based on studies involving a limited number of patients. The authors sought to assess the ability of CT angiography (CTA), a new diagnostic modality, in conjunction with CT/LP to detect SAH. METHODS: Consecutive patients presenting to the ED with symptoms concerning for SAH were approached. All patients had an intravenous catheter placed and underwent a noncontrast head CT followed by CTA. Patients whose CT did not reveal evidence of SAH or other pathology underwent LP in the ED. CTAs were read within 24 hours by a neuroradiologist blinded to the patient\u27s history. RESULTS: A total of 131 patients were approached, 116 were enrolled, and 106 completed the study. In six of 116 patients (5.1%), aneurysm was found on CTA with normal CT and positive findings on LP; three had a positive CTA with normal CT and LP findings (one of which had a negative cerebral angiogram), and there was one false-positive CTA. Follow-up of all 131 patients showed no previously undiagnosed intracranial pathology. In this patient population, 4.3% (5/116) were ultimately found to have an SAH and/or aneurysm. CONCLUSIONS: In this pilot study, CTA was found to be useful in the detection of cerebral aneurysms and may be useful in the diagnosis of aneurysmal SAH. A larger multicenter study would be useful to confirm these results

Drug Attitude and Adherence to Anti-Glaucoma Medication

PURPOSE: The purpose of this study is to assess patient attitudes towards anti-glaucoma medication and their association with adherence, visual quality of life, and personality traits. MATERIALS AND METHODS: One hundred and forty-seven glaucoma patients were enrolled this study. The participants were divided into 'pharmacophobic' and 'pharmacophilic' groups according to their scores on the Modified Glaucoma Drug Attitude Inventory (MG-DAI). To establish a correlation with patient drug attitude, each group had their subjective drug adherence, visual quality of life, and personality traits examined. For personality traits, the Myers-Briggs Type Indicator (MBTI) was used to sub-classify each group. RESULTS: Among the patients analyzed, 91 (72.80%) patients showed a 'pharmacophobic' attitude and 34 (27.20%) patients showed a 'pharmacophilic' attitude. The pharmacophobic group tended to have worse adherence than the pharmacophilic group. Personality dichotomies from the MBTI also showed different patterns for each group. CONCLUSION: In glaucoma patients, pharmacological adherence was influenced by their attitude towards drugs; an association might exist between drug attitude and underlying personality traits.ope