The organizational dynamics enabling patient portal impacts upon organizational performance and patient health: a qualitative study of Kaiser Permanente.

BackgroundPatient portals may lead to enhanced disease management, health plan retention, changes in channel utilization, and lower environmental waste. However, despite growing research on patient portals and their effects, our understanding of the organizational dynamics that explain how effects come about is limited.MethodsThis paper uses qualitative methods to advance our understanding of the organizational dynamics that influence the impact of a patient portal on organizational performance and patient health. The study setting is Kaiser Permanente, the world's largest not-for-profit integrated delivery system, which has been using a portal for over ten years. We interviewed eighteen physician leaders and executives particularly knowledgeable about the portal to learn about how they believe the patient portal works and what organizational factors affect its workings. Our analytical framework centered on two research questions. (1) How does the patient portal impact care delivery to produce the documented effects?; and (2) What are the important organizational factors that influence the patient portal's development?ResultsWe identify five ways in which the patient portal may impact care delivery to produce reported effects. First, the portal's ability to ease access to services improves some patients' satisfaction as well as changes the way patients seek care. Second, the transparency and activation of information enable some patients to better manage their care. Third, care management may also be improved through augmented patient-physician interaction. This augmented interaction may also increase the 'stickiness' of some patients to their providers. Forth, a similar effect may be triggered by a closer connection between Kaiser Permanente and patients, which may reduce the likelihood that patients will switch health plans. Finally, the portal may induce efficiencies in physician workflow and administrative tasks, stimulating certain operational savings and deeper involvement of patients in medical decisions. Moreover, our analysis illuminated seven organizational factors of particular importance to the portal's development--and thereby ability to impact care delivery: alignment with financial incentives, synergy with existing IT infrastructure and operations, physician-led governance, inclusive decision making and knowledge sharing, regional flexibility to implementation, continuous innovation, and emphasis on patient-centered design.ConclusionsThese findings show how organizational dynamics enable the patient portal to affect care delivery by summoning organization-wide support for and use of a portal that meets patient needs

Influence of water on the sulfidation of Co/NaY and Co/CaY prepared by impregnation, A. Mössbauer Emission spectroscopy and EXAFS Study

The influence of physisorbed water on the sulfidation of impregnation type Co/NaY(imp) and Co/CaY(imp) catalysts which contain about 4 wt % Co and are prepared via pore volume impregnation is studied by Mossbauer emission spectroscopy and extended X-ray absorption fine structure. It is found that in the absence as well as in the presence of water, sulfidation of the impregnated samples finally results in the formation of Co9S8-like species at the outer zeolite surface. In the presence of water, this process proceeds via the intermediate formation of a well-ordered ''CoS1+x'' phase (NiAs structure). Water removal prior to sulfidation retards the formation of Co9S8-like species. This retardation in Co9S8 formation is found to be more effective for CaY-zeolite than for NaY- zeolite, which means that a larger part of the formed ''Co- sulfide'' is preserved in highly dispersed ''Co-sulfide'' particles. These findings are clearly different from those obtained earlier with ion exchanged CoNaY(ion ex) samples, for which drying prior to sulfidation resulted in very small ''Co- sulfide'' species with no resemblance to ''Co9S8'

Non-dispensing pharmacists integrated into general practices as a new interprofessional model:A qualitative evaluation of general practitioners’ experiences and views

Background: A new interprofessional model incorporating non-dispensing pharmacists in general practice teams can improve the quality of pharmaceutical care. However, results of the model are dependent on the context. Understanding when, why and how the model works may increase chances of successful broader implementation in other general practices. Earlier theories suggested that the results of the model are achieved by bringing pharmacotherapeutic knowledge into general practices. This mechanism may not be enough for successful implementation of the model. We wanted to understand better how establishing new interprofessional models in existing healthcare organisations takes place. Methods: An interview study, with a realist informed evaluation was conducted. This qualitative study was part of the Pharmacotherapy Optimisation through Integration of a Non-dispensing pharmacist in primary care Teams (POINT) project. We invited the general practitioners of the 9 general practices who (had) worked closely with a non-dispensing pharmacist for an interview. Interview data were analysed through discussions about the coding with the research team where themes were developed over time. Results: We interviewed 2 general practitioners in each general practice (18 interviews in total). In a context where general practitioners acknowledge the need for improvement and are willing to work with a non-dispensing pharmacist as a new team member, the following mechanisms are triggered. Non-dispensing pharmacists add new knowledge to current general practice. Through everyday talk (discursive actions) both general practitioners and non-dispensing pharmacists evolve in what they consider appropriate, legitimate and imaginable in their work situations. They align their professional identities. Conclusions: Not only the addition of new knowledge of non-dispensing pharmacist to the general practice team is crucial for the success of this interprofessional healthcare model, but also alignment of the general practitioners’ and non-dispensing pharmacists’ professional identities. This is essentially different from traditional pharmaceutical care models, in which pharmacists and GPs work in separate organisations. To induce the process of identity alignment, general practitioners need to acknowledge the need to improve the quality of pharmaceutical care interprofessionally. By acknowledging the aspect of interprofessionality, both general practitioners and non-dispensing pharmacists will explore and reflect on what they consider appropriate, legitimate and imaginable in carrying out their professional roles. Trial registration: The POINT project was pre-registered in The Netherlands National Trial Register, with Trial registration number NTR-4389.</p

The possible role of matrix metalloproteinase (MMP)-2 and MMP-9 in cancer, e.g. acute leukemia

In the past decades, a lot of effort has been put in identifying the role of matrix metalloproteinases (MMPs) in cancer. The main role of MMPs in angiogenesis, tumor growth and metastasis is degradation of extracellular matrix (ECM) and release and/or activation of growth factors through their degradative activity. The degradative activity finally results in cancer progression. MMP-inhibitors (MMPIs) have already been designed and tested, based on the degradative role of MMPs in cancer progression. First clinical trials with MMPIs have been performed with disappointing results, showing that in order to use MMP-inhibition the mechanisms underlying MMP-expression in cancer have to be further elucidated. This paper reviews the mechanisms of MMPs on molecular and cellular level and discusses the role for MMPs and MMP-inhibition in cancer with special focus on acute leukemia

Daily Life in Syria

Security and Global Affair

Can kinomics and proteomics bridge the gap between pediatric cancers and newly designed kinase inhibitors?

status: publishe

Malnutrition is associated with worse health-related quality of life in children with cancer

Purpose:\ud Malnutrition in childhood cancer patients has been associated with lower health-related quality of life (HRQOL). However, this association has never actually been tested. Therefore, we aimed to determine the association between nutritional status and HRQOL in children with cancer.\ud \ud Methods:\ud In 104 children, aged 2–18 years and diagnosed with hematological, solid, or brain malignancies, nutritional status and HRQOL were assessed at diagnosis and at 3, 6, and 12 months using the child- and parent-report versions of the PedsQL 4.0 Generic scale and the PedsQL 3.0 Cancer Module. Scores on both scales range from 0 to 100.\ud \ud Results:\ud Undernourished children (body mass index (BMI) or fat-free mass < −2 standard deviation score (SDS)) reported significantly lower PedsQL scores compared with well-nourished children on the domains physical functioning (−13.3), social functioning (−7.0), cancer summary scale (−5.9), and nausea (−14.7). Overnourished children (BMI or fat mass >2 SDS) reported lower scores on emotional (−8.0) and cognitive functioning (−9.2) and on the cancer summary scale (−6.6), whereas parent-report scores were lower on social functioning (−7.5). Weight loss (>0.5 SDS) was associated with lower scores on physical functioning (−13.9 child-report and −10.7 parent-report), emotional (−7.4) and social functioning (−6.0) (child-report), pain (−11.6), and nausea (−7.8) (parent-report). Parents reported worse social functioning and more pain in children with weight gain (>0.5 SDS) compared with children with stable weight status.\ud \ud Conclusions:\ud Undernutrition and weight loss were associated with worse physical and social functioning, whereas overnutrition and weight gain affected the emotional and social domains of HRQL. Interventions that improve nutritional status may contribute to enhanced health outcomes in children with cancer

Hydrodesulfurization catalysis by small metal sulfide particles

Monometallic (Mo, Co and Ni) sulfide particles dispersed in the micropores of zeolites can have a very high initial activity for the hydrodesulfurization of thiophene. Catalyst characterization, using Xe-129 NMR, HREM and Mossbauer Emission Spectroscopy (MES), shows that the location (in- or outside the zeolite pores) and size of the sulfide particles depends strongly on catalyst preparation conditions. The kinetics of thiophene HDS has been studied on metal (Mo, Co, Ph and Pt) sulfides dispersed on a carbon support. The order of thiophene in the HDS reaction appears to be a strong function of metal sulfide and temperature. The catalysts show a large compensation effec

Bestemming Syrië: een exploratieve studie naar de leefsituatie van Nederlandse ‘uitreizigers’ in Syrië

Security and Global Affair

The organizational dynamics enabling patient portal impacts upon organizational performance and patient health: A qualitative study of Kaiser Permanente

Background: Patient portals may lead to enhanced disease management, health plan retention, changes in channel utilization, and lower environmental waste. However, despite growing research on patient portals and their effects, our understanding of the organizational dynamics that explain how effects come about is limited. Methods