Age Discrimination in the Delivery of Health Care Services to Our Elders

The problem of health care providers making age biased decisions when treating elderly patients has received considerable attention and condemnation from both medical and social science researchers. When health care providers offer inappropriate or less care to patients because of their advanced chronological age, they potentially violate the Age Act of 1975. However, a review of the cases litigated under the Age Act suggests that advocates, regulators, and elders have not used the Age Act to address even the most blatant ageist practices in health care. Using methods developed to identify unlawful discrimination under employment and civil rights laws, this article characterizes certain ageist practices in the delivery of healthcare as potential violations of the Age Act of 1975. It concludes that regulators should undertake certain reforms so that elderly patients and their advocates can make better use of the Age Act’s protections

Welcome Madam President: effects of a female presidential candidate on the mobilisation of young, female voters in Slovakia

Slovakia did not appear frequently in international media headlines until the election of the first female President to the republic, Zuzana Čaputová, in 2019. Women are underrepresented in Slovak politics, and young women are particularly underrepresented and frequently deemed to be disinterested in politics. This research examines whether having a female presidential candidate effects the mobilisation of young, female voters in Slovakia. Twelve in-depth interviews were undertaken with young women in Slovakia, using questions based on a modified version of gender-strategic mobilisation theory. The theory has three core tactics (1. appealing to young women directly, 2. evoking women’s multiple gendered identities; and 3. promising change that appeals particularly to young women). Interviews were transcribed and analysed using predominantly deductive themes. Čaputová was able to mobilise young, female voters in her campaign largely through her transparency, liberal politics, and anti-corruption stance. She was a symbolic change for Slovakia, as the first elected female president, as an ardent defender of human rights, and through her decorum and respect in politics and political discourse. Nonetheless, other factors during the 2018-2019 period threw Slovak politics into flux, and serendipitous timing aided her campaign. These factors help to contextualise Čaputová’s entrance and success in contemporary Slovak politics.https://www.ester.ee/record=b5380735*es

Nurse-reported vs. Patient-reported Symptom Occurrence, Severity, And Agreement Using The Therapy-related Symptoms Checklist (TRSC) In Cancer Patients

PURPOSE: Developments in cancer treatments have resulted in increased survival of patients, but side effects/symptoms continue to be a concern. The Therapy-Related Symptoms Checklist (TRSC) has been used with adults undergoing cancer treatments. Study purposes were to examine among patients who completed the TRSC: (a) patient-reported symptom occurrence and severity; (b) nurse-reported symptom occurrence and severity; and (c) inter-rater agreement between patient-reported and nurse-reported symptoms. No study on this last question has been reported. Theoretical Framework: Orem’s Self-Care Deficit Theory focuses on individuals unable to meet their own self-care requirements. The TRSC is a tool that assists nurses in identifying these deficits, better facilitates supportive interventions to alleviate the symptoms, and promotes the patient’s/caregiver’s ability to enhance self-care. DESIGN: This is a cross-sectional study using primary data collection and analysis. Setting: The study was conducted on patients at a single outpatient cancer center in a rural community of the Midwestern United States. Participants: A convenience sample (N=22) of adult outpatients undergoing cancer therapy. METHODS: All patients and their nurse completed the TRSC, a 25-item checklist, with response choices ranging from “0” (none) to “4” (very severe). Descriptive statistics were used to address Purposes A and B, and a Pearson product-moment correlation analysis for Purpose C. RESULTS: All symptoms on the TRSC were reported in varying degrees. Regarding Purpose A, 40% or more of the patients reported 14 symptoms. Regarding Purpose B, 40% or more of nurse respondents reported 8 symptoms. In addition to higher symptom occurrence, greater symptom severity also was reported by patients compared to nurses. Regarding Purpose C, the percentage agreement between patient-reported and nurse identified symptoms was 77%, and the Pearson product-moment correlation coefficient was r =.77, indicating moderate agreement. CONCLUSIONS: Use of patient self-report of symptoms is a preferred approach. A standardized tool (the TRSC) can guide nurses in providing a more complete, symptom-focused care. This may then enhance treatment compliance and improved outcomes

Complementary Therapy to Relieve Pediatric Cancer Therapy-Related Symptoms in the USA

Children undergoing treatment for cancer often receive chemotherapy or radiation therapy and may experience many symptoms linked to these treatments. This study examined complementary therapies and self-care or dependent-care methods used by pediatric patients and parents to alleviate symptoms during cancer treatments. The specific purposes of this study were to assess symptoms and the complementary therapies and self-care or dependent-care methods used by pediatric patients and parents during cancer treatments. Orem’s self-care/dependent-care concept was used to guide the analysis of the care pediatric patients received. Secondary analysis was done on data collected from a cross-sectional, multi-site study in the Midwestern and Southwestern USA. The sample included 92 parents/children ages 1-17 years old; 52% were females; 16 were less than 5 years old; 53 were 5-11 years old, and 23 were 12-17 years old. Of the cancer diagnoses reported, 56% had leukemia and 44% had other cancer types. The 30-item Therapy-Related Symptom Checklist for Children (TRSC-C) was used to record patients’ symptom occurrence and severity on a 5-pt scale (0, no symptom; 4, “A whole lot”). The Symptom Alleviation: Self-Care Methods (SA:SCM) tool was used to identify methods parents used to alleviate therapy-related symptoms. To address the study purposes, descriptive data and content analyses were conducted. Symptom occurrences of 19 symptoms were reported by 40% or more of the patients and had a mean severity of “2” or “Quite a bit.” The top five symptoms included nausea, feeling sluggish, hair loss, loss of appetite and vomiting. Of the six categories of self-care or dependent-care methods and complementary therapies, four were found useful; herbal treatments were not mentioned. The two categories most utilized were Prescribed Medications and Mind Body Control. Assessing patient-reported and parent-reported symptoms and the use of self-care and dependent-care methods and complementary therapies help parents cope and help their children.University of Kansas School of Nursing. Bachelor of Science in Nursing Honors Progra

Regulating Artificial Intelligence and machine learning-enabled medical devices in Europe and the United Kingdom

Recent achievements in respect of Artificial Intelligence (AI) open up opportunities for new tools to assist medical diagnosis and care delivery. However, the typical process for the development of AI is through repeated cycles of learning and implementation, something that poses challenges to our existing system of regulating medical devices. Product developers face tensions between the benefits of continuous improvement/deployment of algorithms and keeping products unchanged. The latter more easily facilitates collecting evidence for safety assurance processes but sacrifices optimisation of performance and adaptation to user needs gained through learning-implementation cycles. The challenge is how to balance potential benefits with the need to assure their safety. Governance and assurance processes are needed that can accommodate real-time or near-real-time machine learning. Such an approach is of great importance in healthcare and other fields of application. AI has stimulated an intense process of learning as this new technology embeds in application contexts. The process is not only about the application of AI in the real world but also about the institutional arrangements for its safe and dependable deployment, including regulatory experimentation involving new market pathways, monitoring and surveillance, and sandbox schemes. We review the key themes, challenges and potential solutions raised at two stakeholder workshops and highlight recent attempts to adapt the laws for AI-enabled medical devices (AIeMD) with a special focus on the regulatory proposals in the UK and internationally. The UK regulatory trajectory shows signs of alignment with the US thinking, and yet the European Union model is still the most closely aligned framework.</p

myo-Inositol Oxygenase is Required for Responses to Low Energy Conditions in Arabidopsis thaliana

myo-Inositol is a precursor for cell wall components, is used as a backbone of myo-inositol trisphosphate (Ins(1,4,5)P3) and phosphatidylinositol phosphate signaling molecules, and is debated about whether it is also a precursor in an alternate ascorbic acid synthesis pathway. Plants control inositol homeostasis by regulation of key enzymes involved in myo-inositol synthesis and catabolism. Recent transcriptional profiling data indicate up-regulation of the myo-inositol oxygenase (MIOX) genes under conditions in which energy or nutrients are limited. To test whether the MIOX genes are required for responses to low energy, we first examined MIOX2 and MIOX4 gene expression regulation by energy/nutrient conditions. We found that both MIOX2 and MIOX4 expression are suppressed by exogenous glucose addition in the shoot, but not in the root. Both genes were abundantly expressed during low energy/nutrient conditions. Loss-of-function mutants in MIOX genes contain alterations in myo-inositol levels and growth changes in the root. Miox2 mutants can be complemented with a MIOX2:green fluorescent protein fusion. Further we show here that MIOX2 is a cytoplasmic protein, while MIOX4 is present mostly in the cytoplasm, but also occasionally in the nucleus. Together, these data suggest that MIOX catabolism in the shoot may influence root growth responses during low energy/nutrient conditions

The development and application of an oncology Therapy-Related Symptom Checklist for Adults (TRSC) and Children (TRSC-C) and e-health applications.

BACKGROUND: Studies found that treatment symptoms of concern to oncology/hematology patients were greatly under-identified in medical records. On average, 11.0 symptoms were reported of concern to patients compared to 1.5 symptoms identified in their medical records. A solution to this problem is use of an electronic symptom checklist that can be easily accessed by patients prior to clinical consultations. PURPOSE: Describe the oncology Therapy-Related Symptom Checklists for Adults (TRSC) and Children (TRSC-C), which are validated bases for e-Health symptom documentation and management. The TRSC has 25 items/symptoms; the TRSC-C has 30 items/symptoms. These items capture up to 80% of the variance of patient symptoms. Measurement properties and applications with outpatients are presented. E-Health applications are indicated. METHODS: The TRSC was developed for adults (N = 282) then modified for children (N = 385). Statistical analyses have been done using correlational, epidemiologic, and qualitative methods. Extensive validation of measurement properties has been reported. RESULTS: Research has found high levels of patient/clinician satisfaction, no increase in clinic costs, and strong correlations of TRSC/TRSC-C with medical outcomes. A recently published sequential cohort trial with adult outpatients at a Mayo Clinic community cancer center found TRSC use produced a 7.2% higher patient quality of life, 116% more symptoms identified/managed, and higher functional status. DISCUSSION, IMPLICATIONS, AND FOLLOW-UP: An electronic system has been built to collect TRSC symptoms, reassure patients, and enhance patient-clinician communications. This report discusses system design and efforts made to provide an electronic system comfortable to patients. Methods used by clinicians to promote comfort and patient engagement were examined and incorporated into system design. These methods included (a) conversational data collection as opposed to survey style or standardized questionnaires, (b) short response phrases indicating understanding of the reported symptom, (c) use of open-ended questions to reduce long lists of symptoms, (d) directed questions that ask for confirmation of expected symptoms, (e) review of symptoms at designated stages, and (d) alerting patients when the computer has informed clinicians about patient-reported symptoms. CONCLUSIONS: An e-Health symptom checklist (TRSC/TRSC-C) can facilitate identification, monitoring, and management of symptoms; enhance patient-clinician communications; and contribute to improved patient outcomes