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1.
J Med Internet Res. 2019 Jan 21;21(1):e10008. doi: 10.2196/10008.

Assessing the Effectiveness of Engaging Patients and Their Families in the Three-Step Fall Prevention Process Across Modalities of an Evidence-Based Fall Prevention Toolkit: An Implementation Science Study.

Author information

1
Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States.
2
NewYork-Presbyterian Hospital, Columbia University, Manhattan, NY, United States.
3
Montefiore Medical Center, Bronx, NY, United States.
4
Harvard Medical School, Boston, MA, United States.

Abstract

BACKGROUND:

Patient falls are a major problem in hospitals. The development of a Patient-Centered Fall Prevention Toolkit, Fall TIPS (Tailoring Interventions for Patient Safety), reduced falls by 25% in acute care hospitals by leveraging health information technology to complete the 3-step fall prevention process-(1) conduct fall risk assessments; (2) develop tailored fall prevention plans with the evidence-based interventions; and (3) consistently implement the plan. We learned that Fall TIPS was most effective when patients and family were engaged in all 3 steps of the fall prevention process. Over the past decade, our team developed 3 Fall TIPS modalities-the original electronic health record (EHR) version, a laminated paper version that uses color to provide clinical decision support linking patient-specific risk factors to the interventions, and a bedside display version that automatically populates the bedside monitor with the patients' fall prevention plan based on the clinical documentation in the EHR. However, the relative effectiveness of each Fall TIPS modality for engaging patients and family in the 3-step fall prevention process remains unknown.

OBJECTIVE:

This study aims to examine if the Fall TIPS modality impacts patient engagement in the 3-step fall prevention process and thus Fall TIPS efficacy.

METHODS:

To assess patient engagement in the 3-step fall prevention process, we conducted random audits with the question, "Does the patient/family member know their fall prevention plan?" In addition, audits were conducted to measure adherence, defined by the presence of the Fall TIPS poster at the bedside. Champions from 3 hospitals reported data from April to June 2017 on 6 neurology and 7 medical units. Peer-to-peer feedback to reiterate the best practice for patient engagement was central to data collection.

RESULTS:

Overall, 1209 audits were submitted for the patient engagement measure and 1401 for the presence of the Fall TIPS poster at the bedside. All units reached 80% adherence for both measures. While some units maintained high levels of patient engagement and adherence with the poster protocol, others showed improvement over time, reaching clinically significant adherence (>80%) by the final month of data collection.

CONCLUSIONS:

Each Fall TIPS modality effectively facilitates patient engagement in the 3-step fall prevention process, suggesting all 3 can be used to integrate evidence-based fall prevention practices into the clinical workflow. The 3 Fall TIPS modalities may prove an effective strategy for the spread, allowing diverse institutions to choose the modality that fits with the organizational culture and health information technology infrastructure.

KEYWORDS:

clinical decision support; fall prevention; fall prevention toolkit; health information technology; implementation science; patient safety

PMID:
30664454
DOI:
10.2196/10008
Icon for South & East Metropolitan Health Service Library, Australia
2.
Educ Prim Care. 2019 Jan 21:1-6. doi: 10.1080/14739879.2018.1563503. [Epub ahead of print]

Legitimate participation of medical students in community attachments.

Author information

1
a Department of General Practice , The University of Auckland , Auckland , New Zealand.

Abstract

INTRODUCTION:

Social theories of learning consider learning and thinking as social activities. These activities may occur within a community of practice. Communities of practice may position learners as legitimate peripheral participants. This study tests whether legitimate peripheral participation provides an overarching theory to assist in evaluating learning and teaching of medical students undertaking short primary care attachments.

METHODS:

A questionnaire was delivered to all Year 4 students at the University of Auckland in 2015. A deductive content analysis was undertaken on the data utilising a categorisation matrix. Legitimate peripheral participation theory was used to develop the categorisation matrix.

RESULTS:

Three broad themes explained legitimate peripheral participation by medical students undertaking a short primary care attachment. These three themes were 'hospitality,' 'collegiality' and 'responsibility.'

CONCLUSION:

Legitimate peripheral participation, in the context of undergraduate primary health care attachments, appears to depend upon positive social activities between students and health professionals and patients. Using legitimate peripheral participation as a theory to underpin evaluations of general practice attachments it is possible to determine improvements in the learning and teaching experience of medical students.

KEYWORDS:

Medical education undergraduate; community of practice; legitimate peripheral participation; primary care

3.
JAMA Netw Open. 2018 Nov 2;1(7):e184273. doi: 10.1001/jamanetworkopen.2018.4273.

Association of a Care Coordination Model With Health Care Costs and Utilization: The Johns Hopkins Community Health Partnership (J-CHiP).

Author information

1
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
2
NORC at the University of Chicago, Bethesda, Maryland.
3
Johns Hopkins HealthCare, Glen Burnie, Maryland.
4
Johns Hopkins Health System, Baltimore, Maryland.
5
Substance Abuse Mental Health Services Administration, Department of Health and Human Services, Washington, DC.
6
Centers for Medicare & Medicaid Services, Baltimore, Maryland.
7
Sisters Together and Reaching, Baltimore, Maryland.
8
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
9
Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland.
10
Men and Families Center, Baltimore, Maryland.
11
Johns Hopkins Community Physicians, Baltimore, Maryland.

Abstract

Importance:

The Johns Hopkins Community Health Partnership was created to improve care coordination across the continuum in East Baltimore, Maryland.

Objective:

To determine whether the Johns Hopkins Community Health Partnership (J-CHiP) was associated with improved outcomes and lower spending.

Design, Setting, and Participants:

Nonrandomized acute care intervention (ACI) and community intervention (CI) Medicare and Medicaid participants were analyzed in a quality improvement study using difference-in-differences designs with propensity score-weighted and matched comparison groups. The study spanned 2012 to 2016 and took place in acute care hospitals, primary care clinics, skilled nursing facilities, and community-based organizations. The ACI analysis compared outcomes of participants in Medicare and Medicaid during their 90-day postacute episode with those of a propensity score-weighted preintervention group at Johns Hopkins Community Health Partnership hospitals and a concurrent comparison group drawn from similar Maryland hospitals. The CI analysis compared changes in outcomes of Medicare and Medicaid participants with those of a propensity score-matched comparison group of local residents.

Interventions:

The ACI bundle aimed to improve transition planning following discharge. The CI included enhanced care coordination and integrated behavioral support from local primary care sites in collaboration with community-based organizations.

Main Outcomes and Measures:

Utilization measures of hospital admissions, 30-day readmissions, and emergency department visits; quality of care measures of potentially avoidable hospitalizations, practitioner follow-up visits; and total cost of care (TCOC) for Medicare and Medicaid participants.

Results:

The CI group had 2154 Medicare beneficiaries (1320 [61.3%] female; mean age, 69.3 years) and 2532 Medicaid beneficiaries (1483 [67.3%] female; mean age, 55.1 years). For the CI group's Medicaid participants, aggregate TCOC reduction was $24.4 million, and reductions of hospitalizations, emergency department visits, 30-day readmissions, and avoidable hospitalizations were 33, 51, 36, and 7 per 1000 beneficiaries, respectively. The ACI group had 26 144 beneficiary-episodes for Medicare (13 726 [52.5%] female patients; mean patient age, 68.4 years) and 13 921 beneficiary-episodes for Medicaid (7392 [53.1%] female patients; mean patient age, 52.2 years). For the ACI group's Medicare participants, there was a significant reduction in aggregate TCOC of $29.2 million with increases in 90-day hospitalizations and 30-day readmissions of 11 and 14 per 1000 beneficiary-episodes, respectively, and reduction in practitioner follow-up visits of 41 and 29 per 1000 beneficiary-episodes for 7-day and 30-day visits, respectively. For the ACI group's Medicaid participants, there was a significant reduction in aggregate TCOC of $59.8 million and the 90-day emergency department visit rate decreased by 133 per 1000 episodes, but hospitalizations increased by 49 per 1000 episodes and practitioner follow-up visits decreased by 70 and 182 per 1000 episodes for 7-day and 30-day visits, respectively. In total, the CI and ACI were associated with $113.3 million in cost savings.

Conclusions and Relevance:

A care coordination model consisting of complementary bundled interventions in an urban academic environment was associated with lower spending and improved health outcomes.

4.
Foot (Edinb). 2018 Oct 9;38:54-60. doi: 10.1016/j.foot.2018.10.001. [Epub ahead of print]

Establishing a multidisciplinary partnership integrating podiatric care into the Quebec public health-care system to improve diabetic foot outcomes: A retrospective cohort.

Author information

1
Université du Québec à Trois-Rivières, Podiatric Medicine Program, 3351, boul. des Forges, C.P. 500, Trois-Rivières, Québec, G9A 5H7, Canada. Electronic address: Virginie.Blanchette@uqtr.ca.
2
Université du Québec à Trois-Rivières, Podiatric Medicine Program, 3351, boul. des Forges, C.P. 500, Trois-Rivières, Québec, G9A 5H7, Canada. Electronic address: Sebastien.Hains@uqtr.ca.
3
Université du Québec à Trois-Rivières, Nursing Department, 3351, boul. des Forges, C.P. 500, Trois-Rivières, Québec, G9A 5H7, Canada. Electronic address: Lyne.Cloutier@uqtr.ca.

Abstract

Diabetic foot ulcers (DFUs) are one of the main complications of diabetes affecting many Canadians that need to be effectively managed. There is limited data concerning outcomes of Canadian patients with DFUs treated with a team approach in the public health system. Podiatrists are known to be key members of a multidisciplinary team approach to DFUs management, but in Quebec, Canada, they are only available in private practice. The aim of this study is to evaluate diabetic foot outcomes after integrating podiatric care into in-hospital wound care clinic settings. A 12-month retrospective cohort study was conducted into a new organization named the Pododiabetology University Center (PUC), which is described in this article. Healing rate and healing time were the outcomes measured. The analysis was performed by comparing data collected before and after the integration of the podiatrists. Preliminary results indicate that 73.2% of DFUs (n=52) healed in an average of 19.8 weeks (time to wound closure). Previous data collected on 15 individuals before the integration of podiatric care showed a 27.3% of DFUs resolved in 44.6 weeks. The findings suggest that a patient with DFUs who receives wound care from a multidisciplinary team that includes a podiatrist can improve both their healing rate and time. An integrated multidisciplinary approach including podiatrists for patients affected by acute DFU is highly suggested in the literature in order to reduce the number of hospitalizations, amputations and financial burden, which are variables that could be evaluated in further studies.

KEYWORDS:

Clinical management; Diabetic foot ulceration (DFU); Multidisciplinary team (MDT) approach; Podiatrist; Podiatry

5.
Subst Use Misuse. 2019 Jan 14:1-9. doi: 10.1080/10826084.2018.1528459. [Epub ahead of print]

Methamphetamine Use in German Families: Parental Substance Use, Parent-Child Interaction and Risks for Children Involved.

Author information

1
a German Institute of Addiction and Prevention Research, Catholic University of Applied Sciences , Koeln , Germany.
2
b Ruhr-University Bochum , Bochum, Germany.

Abstract

BACKGROUND:

With an immense increase in methamphetamine use in Germany in the past decade, large sections of the drug-using community have been identified as parents of young children.

OBJECTIVE:

With the fast-emerging issue of psychosocial and familial consequences of methamphetamine use, this study focused on gaining an insight into substance use, parenthood, and parenting by German methamphetamine users, with special emphasis on the psychological outcomes for the children involved.

METHODS:

We conducted 24 qualitative interviews with parents (16 mothers and eight fathers), who were in outpatient treatment for their Crystal Meth use and were currently abstinent from using drugs. Personal information on parenting, drug use, and effects on the children was supplemented by standardized parents' reports on the children's behavioral patterns.

RESULTS:

Parenting was described as challenging and often emotionally neglectful, impulsive, and inconsistent. The interview results further indicated an inter-relatedness of substance use and the parental role. Overall, children of methamphetamine users appeared to be at an increased risk of pre-and postnatal substance exposure and great psychosocial distress, especially evident in externalizing behavior such as hyperactivity and behavioral problems.

CONCLUSION:

Results demonstrate the complex problems of methamphetamine-involved parents and suggest the need for a close cooperation between addiction treatment and child welfare services in providing appropriate psychological and educational support for parents and children.

KEYWORDS:

Crystal meth; Germany; addiction; family; methamphetamine; neglect; parenting; substance use

6.
Acad Psychiatry. 2019 Jan 7. doi: 10.1007/s40596-018-1010-7. [Epub ahead of print]

Religious Community Partnerships: a Novel Approach to Teaching Psychiatry Residents about Religious and Cultural Factors in the Mental Health Care of African-Americans.

Author information

1
Children's National Health System, Washington, DC, USA. Faith.Kelley@ChildrensNational.org.
2
VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
3
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
4
PGSP-Stanford Psy.D. Consortium, Palo Alto, CA, USA.

Abstract

OBJECTIVE:

Promoting awareness in residency training about the influence of religion on the doctor's and patient's ability to negotiate a patient-centered treatment plan is challenging and yet important for improving the quality of mental health care for religious individuals. This paper aims to explore the use of community partners and non-psychiatry faculty to provide this education within psychiatry residency programs.

METHODS:

Fifty-one psychiatry residents at an academic psychiatric hospital took part in a 4-h interdisciplinary workshop aimed at improving doctors' overall approach to treating African-American Christian patients. Community-based African-American clergy and mental health professionals, hospital-based psychiatrists, and primary care physicians facilitated educational sessions. A majority of the facilitators were African-American. A pre- and post-workshop survey was administered to measure change in participant attitudes and comfort levels associated with exposure to the workshop. Paired t tests on three subscales were used to calculate change in attitudes on pre- to post-workshop surveys.

RESULTS:

Resident scores on each of the three factor subscales increased significantly between pre- and post-workshop assessments: comfort in discussions with patients about spirituality [t [17] = 2.758; p = 0.013]; willingness to collaborate with clergy [t [16] = 3.776; p = 0.002]; and importance of religion to mental health [t [17] = 3.645; p = 0.002].

CONCLUSION:

Findings suggest that collaboration between academic and community-based clergy, physicians, and other mental health providers may be a feasible method of improving psychiatry trainees' comfort in addressing religion in psychiatric care to ultimately provide more culturally competent care.

KEYWORDS:

Cross-cultural psychiatry; Evaluation; Residents

7.
Nurs Philos. 2018 Dec 27:e12234. doi: 10.1111/nup.12234. [Epub ahead of print]

Patient involvement and institutional logics: A discussion paper.

Author information

1
Department of Public Health, Section for Nursing, Aarhus University, Aarhus C, Denmark.

Abstract

The research into patient involvement is seldom concerned with the significance of cultural and structural factors. In this discussion paper, we illustrate our considerations on some of the challenges in implementing the ideal of patient involvement by showing how such factors take part in shaping the ways in which the intentions to involve patients are converted to practical interventions. The aim was to contribute to the approach dealing with contextual and structural factors of significance for patient involvement. With the idea of "institutional logics," borrowed from the Danish scholar, Erik Riiskjaer, we first demonstrate, with examples from our own research, how patient involvement is interpreted differently within the different logics. Then, we show how the different interpretations of patient involvement meet and conflict in mutual competition as the ideals are sought to be converted to practical interventions. At last, we argue that an adequate theoretical model for the development in the future health care system should be expanded with a "patient logic."

KEYWORDS:

health service; hospital; institutional logics; patient involvement

PMID:
30592122
DOI:
10.1111/nup.12234
Icon for Wiley Icon for South & East Metropolitan Health Service Library, Australia
8.
Fam Syst Health. 2018 Dec;36(4):493-506. doi: 10.1037/fsh0000375.

Observing the influence of the physical environment on family involvement in a rehabilitation setting.

Author information

1
School of Rehabilitation Sciences, Faculty of Health Sciences.
2
Faculty of Education.

Abstract

INTRODUCTION:

Health professionals and institutions need to understand how to facilitate family involvement within settings designed prior to the adoption of patient- and family-centered philosophies. This study sought to explore how the physical environment of an inpatient rehabilitation setting influenced family involvement in health care delivery.

METHOD:

We conducted this study on the inpatient acquired brain injury ward of a Canadian adult rehabilitation center. This study used a basic interpretive qualitative approach. We conducted observations of how the physical environment influenced the conversations, interactions, and activities, which were central to family involvement, in this setting. We used a systematic qualitative analysis method. This study received research ethics board approval prior to commencing.

RESULTS:

We conducted 26 2-hr observation sessions. Five sessions occurred in the morning, 17 in early and late afternoon, and 4 in the evening. Eighteen sessions occurred on a weekday and 8 on a weekend day. The following 6 categories emerged from the field data: (a) accessing health professionals, (b) awareness of family presence, (c) facilitating family presence, (d) facilitating patient-family activities, (e) providing information for families, and (f) facilitating family involvement in therapy.

DISCUSSION:

This study provided information to inform future discussions and strategies for facilitating family involvement within the existing physical environments of health care institutions. Initial steps should consider ways to help families feel welcomed, such as including additional seating in spaces, posting signage inviting families into spaces, having resources tailored to families readily available, and creating a visible sign-in/sign-out board for families. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

9.
Qual Manag Health Care. 2019 Jan/Mar;28(1):33-38. doi: 10.1097/QMH.0000000000000199.

Patient Involvement in Evaluation of Safety in Oral Antineoplastic Treatment: A Failure Mode and Effects Analysis in Patients and Health Care Professionals.

Author information

1
Department of Oncology (Dr Mattsson) and Hospital Pharmacy, Funen (Dr Pottegård), Odense University Hospital, Odense, Denmark; Department of Documentation & Quality, Danish Cancer Society, Copenhagen, Denmark (Dr Lipczak); and Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark (Dr Pottegård).

Abstract

OBJECTIVES:

To identify risks associated with delivery of treatment with oral antineoplastic agents in an outpatient setting and to evaluate additional value and feasibility of engaging patients in a proactive risk analysis.

METHODS:

We conducted 2 separate but parallel failure mode and effects analyses (FMEAs) among patients and health care professionals (HCPs) at a clinical oncology department in Denmark. Comparative analyses were performed using the FMEA process maps and risk priority numbers (RPNs) as main outcome measures. The FMEAs were augmented by semistructured interviews with HCPs and patients on acceptability and feasibility of FMEAs analyzed using systematic text condensation.

RESULTS:

Patients and HCPs found failures in information regarding treatment (cause, aim, and plan) to be of high risk. Also, HCPs found failures in checking for potential interactions to be of high risk. HCPs focused on the in-hospitals procedures, whereas patients identified risks related to both the hospital and the home setting. Both HCPs and patients found participation in the FMEA process meaningful but found the use of RPNs difficult.

CONCLUSIONS:

Patient engagement in proactive risk analysis using FMEA is acceptable, meaningful, and feasible, with patients providing a different perspective on the risks associated with oral antineoplastic treatment compared with HCPs.

10.
J Am Psychiatr Nurses Assoc. 2018 Dec 22:1078390318820127. doi: 10.1177/1078390318820127. [Epub ahead of print]

Converging Cultures: Partnering in Affirmative and Inclusive Health Care for Members of the Lesbian, Gay, Bisexual, and Transgender Community.

Author information

1
1 Lindsey Schweiger-Whalen, DNP, PMHNP-BC, RN, Santa Fe, NM, USA.
2
2 Shelly Noe, DNP, PMHNP-BC, RN, New Mexico State University, Las Cruces, NM, USA.
3
3 Stephanie Lynch, PhD, PMHNP-BC, FNP-BC, RN, New Mexico State University, Las Cruces, NM, USA.
4
4 Linda Summers, PhD, FNP-BC, PFNP-BC, RN, New Mexico State University, Las Cruces, NM, USA.
5
5 Eve Adams, PhD, New Mexico State University, Las Cruces, NM, USA.

Abstract

BACKGROUND:

Members of the lesbian, gay, bisexual, and transgender (LGBT) community suffer from disproportionate rates of physical and mental illness. This population experiences enhanced vulnerability to illness as a result of societal marginalization, known as minority stress, which is compounded by insufficient LGBT education for health care professionals and stigmatizing experiences within medical institutions.

OBJECTIVES:

The aims of this study were to review the literature on LGBT cultural competence interventions; evaluate the effect of a 4-hour pilot workshop, "Converging Cultures," on the development of cultural competence; and make recommendations for best practices in developing LGBT cultural competence among health care providers.

METHOD:

The study used a repeated-measures pre-/posttest design among a sample of 130 hospital employees and undergraduate nursing students. The GAP (Gay Affirmative Practice scale) scale, a measure of LGBT-affirmative practice beliefs, and an objective Knowledge Quiz were administered before and directly following the training. The posttest included three open-ended questions to elicit self-reflection and capture the development of cultural competence according to Campinha-Bacote's theory, the process of cultural competence in the delivery of healthcare services.

RESULTS:

Paired sample t tests revealed significant improvement on the GAP and Knowledge Quiz. Open-ended responses reflected the five constructs of Campinha-Bacote's theory.

CONCLUSIONS:

Self-reflection is an essential component of LGBT cultural competence education to uncover personal biases that affect clinical behavior. Future educational efforts for sexual and gender minorities should strive to avoid inadvertent marginalization of LGBT people through integration of concepts with existing curricula and workplace training.

KEYWORDS:

LGBT; cultural competence; health care professionals; intervention; panel presentation; training

11.

Patient involvement in improving the evidence base on mental health inpatient care: the PERCEIVE programme.

Source

Southampton (UK): NIHR Journals Library; 2018 Dec.
Programme Grants for Applied Research.

Author information

1
Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
2
Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
3
Department of Biostatistics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK

Excerpt

BACKGROUND:

Despite the movement towards care in the community, 40% of the NHS budget on mental health care is still attributed to inpatient services. However, long before the Francis Report highlighted grave shortcomings in inpatient care, there were reports by service user groups on the poor quality of these services in mental health. The programme provides a particular focus on the inclusion of the patient’s perspective in the development and evaluation of evidence.

OBJECTIVES:

To understand how changes to inpatient care affect the perceptions of the ward by service users and staff by using stakeholder participatory methods.

DESIGN:

The programme consisted of four work packages (WPs). (1) Lasting Improvements for Acute Inpatient SEttings (LIAISE): using participatory methods we developed two new scales [Views On Therapeutic Environment (VOTE) for staff and Views On Inpatient CarE (VOICE) for service users]. (2) Client Services Receipt Inventory – Inpatient (CITRINE): working with nurses and service users we developed a health economic measure of the amount of contact service users have with staff. The self-report measure records interactions with staff as well as the number of therapeutic activities attended. (3) Delivering Opportunities for Recovery (DOORWAYS): a stepped-wedge randomised controlled trial to test if training ward nurses to deliver therapeutic group activities would improve the perception of the ward by service users and staff. A total of 16 wards were progressively randomised and we compared the VOICE, VOTE and CITRINE measures before and after the intervention. A total of 1108 service users and 539 staff participated in this trial. (4) Bringing Emergency TreatmenT to Early Resolution (BETTER PATHWAYS) was an observational study comparing two service systems. The first was a ‘triage’ system in which service users were admitted to the triage ward and then either transferred to their locality wards or discharged back into the community within 7 days. The second system was routine care. We collected data from 454 service users and 284 nurses on their perceptions of the wards.

MAIN OUTCOME MEASURES:

The main outcomes for the DOORWAYS and BETTER project were service user and staff perceptions of the ward (VOICE and VOTE, respectively) and the health economic measure was CITRINE. All were developed in WPs 1 and 2.

RESULTS:

We developed reliable and valid measures of (1) the perceptions of inpatient care from the perspectives of service users and nurses (VOICE and VOTE) and (2) costs of interactions that were valued by service users (CITRINE). In the DOORWAYS project, after adjusting for legal status, we found weak evidence for benefit (standardised effect of –0.18, 95% CI 0.38 improvement to 0.01 deterioration; p = 0.062). There was only a significant benefit for involuntary patients following the staff training (N582, standardised effect of –0.35, 95% CI –0.57 to –0.12; p = 0.002; interaction p-value 0.006). VOTE scores did not change over time (standardised effect size of 0.04, 95% CI –0.09 to 0.18; p = 0.54). We found no evidence of an improvement in cost-effectiveness (estimated effect of £33, 95% CI –£91 to £146; p = 0.602), but resource allocation did change towards patient-perceived meaningful contacts by an average of £12 (95% CI –£76 to £98; p = 0·774). There were no significant differences between the triage and routine models of admission in terms of better perceptions by service users (estimated effect 0.77-point improvement in VOICE score on the triage ward; p = 0.68) or nurses (estimated effect of 1.68-point deterioration in VOTE on the triage ward; p = 0.38) or in terms of the cost of the length of care provided (£391 higher on triage; p = 0.77).

STRENGTHS AND LIMITATIONS:

We have developed measures using methods involving both service users and staff from mental health services. The measures were developed specifically for acute inpatient services and, therefore, cannot be assumed to be useful for other services. For instance, extensions of the measures are under construction for use in mother and baby units. The strength of the BETTER PATHWAYS and DOORWAYS projects is the large-scale data collection. However, we were testing specific services based in inner city areas and stretching to inner urban areas. It may be that different effects would be found in more rural communities or in different types of inpatient care.

FUTURE WORK:

Our database will be used to develop an understanding of the mediating and moderating factors for improving care quality.

TRIAL REGISTRATION:

Current Controlled Trials ISRCTN06545047.

FUNDING:

This project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 6, No. 7. See the NIHR Journals Library website for further project information.

Copyright © Queen’s Printer and Controller of HMSO 2018. This work was produced by Wykes et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.

12.
BMC Nurs. 2018 Dec 12;17:54. doi: 10.1186/s12912-018-0323-x. eCollection 2018.

Testing a pain self-management intervention by exploring reduction of analgesics' side effects in cancer outpatients and the involvement of family caregivers: a study protocol (PEINCA-FAM).

Author information

1
1Nursing Science, Department Public Health, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland.
2
2Department of Hematology, University Hospital Basel, Basel, Switzerland.
3
3Department of Nursing Science, University of Witten/ Herdecke, Witten, Germany.
4
4School of Nursing, University of California San Francisco (UCSF), San Francisco, USA.
5
5Department of Radiation Oncology, Stadtspital Triemli, Zurich, Switzerland.
6
6Department of Radiation Oncology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
7
7Head Office of Nursing and Allied Health Professionals, Inselspital, University Hospital Bern, Bern, Switzerland.

Abstract

Background:

Pain is one of cancer patients' most frequent and distressing symptoms; however, analgesics' side effects often increase symptom burden. Further, with the home rapidly becoming the primary cancer care setting, family caregivers (FCs) commonly play central roles in patients' pain self-management, but with little or no preparation. One US-tested intervention, the PRO-SELF© Plus Pain Control Program (PCP), designed to support cancer outpatients and their FCs in pain self-management, is currently being tested in the Swiss multi-centre PEINCA study. The current PEINCA-FAM study is a sub-study of PEINCA. The aims of PEINCA-FAM are: a) to test the efficacy of the adapted German PRO-SELF © Plus PCP to reduce side effects of analgesics; b) to enhance patients'/FCs' knowledge regarding cancer pain; and c) to explore FCs' involvement in patients' pain self-management.

Methods:

This mixed methods project combines a multi-centre randomized controlled clinical trial with qualitative data collection techniques and includes 210 patients recruited from three oncology outpatient clinics. FCs involved in patients' pain self-management are also invited to participate. After baseline evaluation, eligible participants are randomized to a 6-week intervention group and a control group. Both groups complete a daily pain and symptom diary. Intervention group patients/FCs receive the weekly psychoeducational PRO-SELF© Plus PCP interventions; control group patients receive usual care. After completing the six-week study procedures, a subsample of 7-10 patients/FCs per group and hospital (N = 42-60) will be interviewed regarding their pain management experiences. Data collection will take place from April 2016 until December 2018. An intent-to-treat analysis and generalized linear mixed models will be applied. Qualitative data will be analysed by using interpretive description. Quantitative and qualitative results will be combined within a mixed method matrix.

Discussion:

In clinical practice, specially trained oncology nurses in outpatient clinics could apply the intervention to reduce side effects and to enhance patients'/FCs' self-efficacy and pain management knowledge.

Trial registration:

The PEINCA study is registered in the Clinical Trials.gov site (code: NCT02713919, 08 March 2016).

KEYWORDS:

Adverse effects; Caregivers; Health behaviour; Health knowledge, attitudes, practice; Neoplasms; Pain management; Patient education; Randomized controlled trial; Self-care

Conflict of interest statement

The PEINCA study was approved by the ethics committees of Basel, Bern and Zurich (EKNZ BASEC 2015–00012). The study has been recorded in Clinical Trials.gov site with the code NCT02713919, is performed in accordance with the study protocol, the Declaration of Helsinki, the Good Clinical Practice Guidelines (ICH-GCP), national legal and regulatory requirements and respect the basic ethical principles of autonomy, beneficence, non-maleficence and distributive justice. Participation of patients and FCs is entirely voluntary. After comprehensive oral and written information, the RA obtains written informed consent from all study participants. Permission was obtained from the participating University Hospitals to access patient data for the medical record review form.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

13.
Health Policy. 2018 Nov 27. pii: S0168-8510(18)30646-8. doi: 10.1016/j.healthpol.2018.11.009. [Epub ahead of print]

A comparative performance analysis of a renowned public private partnership for health care provision in Spain between 2003 and 2015.

Author information

1
Health Services and Policy Research Group, Institute for Health Sciences in Aragón, IACS, Aragon, Spain; REDISSEC-Research Network for Health Services on Chronic Patients, Avda. San Juan Bosco 13 (CIBA Building), 50009, Zaragoza, Spain. Electronic address: mcomendeiro.iacs@aragon.es.
2
Health Services and Policy Research Group, Institute for Health Sciences in Aragón, IACS, Aragon, Spain; REDISSEC-Research Network for Health Services on Chronic Patients, Avda. San Juan Bosco 13 (CIBA Building), 50009, Zaragoza, Spain. Electronic address: mridao.iacs@aragon.es.
3
Department of Management, School of Engineering and Architecture, University of Zaragoza, Aragon, Spain. Electronic address: sgorge@unizar.es.
4
Health Services and Policy Research Group, Institute for Health Sciences in Aragón, IACS, Aragon, Spain; REDISSEC-Research Network for Health Services on Chronic Patients, Avda. San Juan Bosco 13 (CIBA Building), 50009, Zaragoza, Spain. Electronic address: ebernal.iacs@aragon.es.

Abstract

BACKGROUND:

Recently, the once archetype of the public private partnership (PPP) in the Spanish National Health System (SNHS), namely the Alzira's Model, has come to an end. Advocates defended the superiority of PPPs over public-tenured provision, in terms of quality and technical efficiency. This paper profiles and compares Alzira's life-cycle performance with similar public-tenured providers.

METHODS:

Observational study on secondary data from virtually all hospital care episodes produced in 51 integrated providers (i.e., administrative healthcare areas) and 67 hospitals, in 2003 and 2015. Alzira's 2015 performance (and its variation since 2003) was compared with all public-tenured peers in the SNHS, using 26 indicators analysing the differences in age-sex standardized rates of events or risk-adjusted mortality, severity-adjusted hospital expenditure and hospital technical efficiency.

RESULTS:

In comparison with the corresponding public-tenured peers, Alzira's 2015 performance was statistically worse than the benchmark in the majority of indicators (15 out of 26); yet, its performance was one of the best in the SNHS in adjusted-mortality after Percutaneous Coronary Intervention (PCI). Over time, Alzira showed a statistically greater 2003-2015 improvement than its peers' average in eleven of the indicators, and a lower improvement in nine.

CONCLUSIONS:

In this comprehensive comparative study on Alzira's performance, this PPP has not generally outperformed public-tenured providers, although in some areas of care its developments have been outstanding.

KEYWORDS:

Administrative data; Health care reforms; Performance assessment; Policy decision making; Public private partnerships; Public-tenured provision

PMID:
30554791
DOI:
10.1016/j.healthpol.2018.11.009
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14.
J Sci Med Sport. 2019 Jan;22(1):2-10. doi: 10.1016/j.jsams.2018.06.002. Epub 2018 Jun 9.

The behaviour change techniques used by Australian physiotherapists to promote non-treatment physical activity to patients with musculoskeletal conditions.

Author information

1
Faculty of Health, Federation University Australia, Australia. Electronic address: breannekunstler@students.federation.edu.au.
2
La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Australia.
3
School of Psychology and Public Health, La Trobe University, Australia.
4
School of Medical and Health Sciences, Edith Cowan University, Australia.

Abstract

OBJECTIVES:

To determine: (i) the behaviour change techniques used by a sample of Australian physiotherapists to promote non-treatment physical activity; and (ii) whether those behaviour change techniques are different to the techniques used to encourage adherence to rehabilitation exercises.

DESIGN:

Cross-sectional survey.

METHOD:

An online self-report survey was advertised to private practice and outpatient physiotherapists treating patients with musculoskeletal conditions. The use of 50 behaviour change techniques were measured using five-point Likert-type scale questions.

RESULTS:

Four-hundred and eighty-six physiotherapists responded to the survey, with 216 surveys fully completed. Most respondents (85.1%) promoted non-treatment physical activity often or all of the time. Respondents frequently used 29 behaviour change techniques to promote non-treatment physical activity or encourage adherence to rehabilitation exercises. A similar number of behaviour change techniques was frequently used to encourage adherence to rehabilitation exercises (n=28) and promote non-treatment physical activity (n=26). Half of the behaviour change techniques included in the survey were frequently used for both promoting non-treatment physical activity and encouraging adherence to rehabilitation exercises (n=25). Graded tasks was the most, and punishment was the least, frequently reported technique used to promote non-treatment physical activity and encourage adherence to rehabilitation exercises.

CONCLUSIONS:

Respondents reported using similar behaviour change techniques to promote non-treatment physical activity and encourage adherence to rehabilitation exercises. The variability in behaviour change technique use suggests the behaviour the physiotherapist is promoting influences their behaviour change technique choice. Including the frequently-used behaviour change techniques in non-treatment physical activity promotion interventions might improve their efficacy.

KEYWORDS:

Exercise; Health behavior; Health promotion; Physical therapists

PMID:
30554613
DOI:
10.1016/j.jsams.2018.06.002
[Indexed for MEDLINE]
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15.
J Clin Nurs. 2018 Dec 14. doi: 10.1111/jocn.14740. [Epub ahead of print]

Relationships among general health, job satisfaction, work engagement and job features in nurses working in a public hospital: A cross-sectional study.

Author information

1
Maimónides Biomedical Research Institute (IMIBIC) Group-GA 2, Córdoba, Spain.
2
Multidisciplinary Group of Integral Cares (GIMCI), Córdoba, Spain.
3
Nursing Department, University of Valladolid, Valladolid, Spain.
4
A&E Department, Hospital Clínico Universitario de Valladolid (HCUV), Valladolid, Spain.
5
Nursing and Physiotherapy Department, Universidad de León, León, Spain.
6
SALBIS Research Group, Nursing and Physiotherapy Department, Universidad de León, León, Spain.
7
Nursing Department, Facultad de Medicina y Enfermería, University of Córdoba, Córdoba, Spain.
8
Reina Sofía University Hospital (HURS), Córdoba, Spain.

Abstract

AIM AND OBJECTIVE:

To describe relations among health, job satisfaction, work engagement and job features in Spanish nurses working in a public hospital.

BACKGROUND:

It has been established that nursing staff health affects the quality of their work and is associated with job satisfaction, work engagement and different job features. Understanding the relationships among these variables could provide useful information to improve staff performance and prevent work-related illnesses.

DESIGN:

A descriptive, cross-sectional, correlational and comparative study was performed between January-April 2016. This research adheres to the Strengthening the Reporting of Observational Studies in Epidemiology guideline.

METHODS:

A total of 926 nurses were requested to complete an online questionnaire. Nurses on sick leave or in period of unpaid leave during data collection were excluded. The final study population reached 392 nurses. The online survey was fully completed by 373 nurses. General health, job satisfaction and work engagement were measured. Tools used were as follows: sociodemographic questions, the General Health Questionnaire, the Overall Job Satisfaction Scale and the Utrecht Work Engagement Scale.

RESULTS:

Significant correlations among general health, job satisfaction and work engagement were found. Specifically, general health levels were negatively correlated with job satisfaction and work engagement subscales. Job features with influence on these constructs were the type of shift, type of contract, type of service, salary, type of continuous formation and having a specialty/profile.

CONCLUSIONS:

Our results indicate that job-related features affect job satisfaction, general health and work engagement. The organisation should make interventions over these features to increase job satisfaction and work engagement levels, since they are relevant for nursing staff health and patient security.

RELEVANCE TO CLINICAL PRACTICE:

The analysis of the relationships among general health, job satisfaction, work engagement and job features in nurses could offer a basis to design preventive programmes to improve staff performance and prevent work-related illnesses.

KEYWORDS:

health status; job features; job satisfaction; nursing; work engagement

16.
Pediatr Ann. 2018 Dec 1;47(12):e487-e493. doi: 10.3928/19382359-20181116-02.

Percent Body Fat Measurement in the Medical Management of Children with Obesity.

Abstract

Sustaining weight loss can be challenging, as physiological responses to weight loss, including metabolic and hormonal adaptations and decreased energy expenditure, promote weight regain. Paired with sustained dietary changes, physical activity can promote weight maintenance after successful weight loss, as physical activity can help maintain fat-free mass. We present several illustrative cases to highlight the potential use of body composition measurement using a bioelectrical impedance analysis (BIA) scale to augment obesity management counseling in a tertiary care pediatric weight-management clinic. BIA does require some interpretation, as it can be affected by hydration status and time of day, as well as patient age, sex, and body mass index. Nonetheless, BIA can be a helpful aid to obesity counseling. More research is needed to better understand how to use change in percent body fat over time as a motivational tool for management of children with obesity. [Pediatr Ann. 2018;47(12):e487-e493.].

PMID:
30543377
DOI:
10.3928/19382359-20181116-02
[Indexed for MEDLINE]
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17.
J Spinal Cord Med. 2018 Dec 12:1-10. doi: 10.1080/10790268.2018.1543094. [Epub ahead of print]

Engaging in the prevention of pressure injuries in spinal cord injury: A qualitative study of community-dwelling individuals' different styles of prevention in Switzerland.

Author information

1
a Department of Health Sciences and Health Policy , University of Lucerne and Swiss Paraplegic Research , Lucerne/Nottwil , Switzerland.
2
b Swiss Paraplegic Research , Nottwil , Switzerland.
3
c Swiss Paraplegic Centre , Nottwil , Switzerland.
4
d Swiss Paraplegic Association , Nottwil , Switzerland.

Abstract

CONTEXT:

Spinal cord injury (SCI) is a complex chronic condition with multiple self-management requirements and a high prevalence of complications. Pressure injuries (PIs) are among the most common ones and represent a frequent reason for re-hospitalization. This study aimed to identify styles of prevention that individuals with SCI adopt to deal with the risk of developing PIs.

DESIGN:

Qualitative explorative interview study. Data was collected through semi-structured interviews, which were transcribed verbatim and analyzed following the principles of thematic analysis.

SETTING:

Switzerland.

PARTICIPANTS:

The participants were a purposive sample of community-dwelling Swiss residents with SCI for at least five years.

INTERVENTIONS:

Not applicable.

OUTCOME MEASURES:

Not applicable.

RESULTS:

Although all participants (N = 20) showed at least a basic knowledge of prevention of PIs by describing some preventive measures, they had different prevention styles characterized by different behavioral patterns (i.e. complying with all recommended measures, performing only a selection of them or delegating them to others) and different beliefs and attitudes towards prevention.

CONCLUSION:

By identifying the style of prevention of an individual, it is possible to develop tailored interventions that have an impact on the factors which seem to play a role in determining the adoption of preventive behaviors (i.e. perceived susceptibility to PIs, attitudes towards prevention, and self-efficacy). Such interventions would constitute a concrete effort to support individuals with SCI during their self-management. Besides alleviating a frequent and disabling medical complication and contributing to an enhanced quality of life, these interventions might also help decrease healthcare costs.

KEYWORDS:

Bedsores; Complications; Facilitators; Self-management; Semi-structured interviews; Thematic analysis

PMID:
30540555
DOI:
10.1080/10790268.2018.1543094
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18.
J Public Health Manag Pract. 2019 Jan/Feb;25(1):E1-E6. doi: 10.1097/PHH.0000000000000707.

The HEAAL Project: Applying Community-Based Participatory Research (CBPR) Methodology in a Health and Mental Health Needs Assessment With an African Immigrant and Refugee Faith Community in Lowell, Massachusetts.

Author information

1
Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts (Ms Oppenheim and Drs Tam, Henderson, and Borba); Department of Psychiatry, Boston Medical Center, Boston, Massachusetts (Ms Oppenheim and Drs Tam, Henderson, and Borba); Innovations in Healthcare, Duke University, Durham, North Carolina (Ms Axelrod); and Christ Jubilee International Ministries, Lowell, Massachusetts (Mr Menyongai and Ms Chukwuezi).

Abstract

Community-based participatory research methodology is driven by community interests and rooted in community involvement throughout the research process. This article describes the use of community-based participatory research methodology in the HEAAL project (Health and Mental Health Education and Awareness for Africans in Lowell), a research collaboration between Christ Jubilee International Ministries-a nondenominational Christian church in Lowell, Massachusetts, that serves an African immigrant and refugee congregation-and the Massachusetts General Hospital Department of Psychiatry. The objective of the HEAAL project was to better understand the nature, characteristics, scope, and magnitude of health and mental health issues in this faith community. The experience of using community-based participatory research in the HEAAL project has implications for research practice and policy as it ensured that research questions were relevant and meaningful to the community; facilitated successful recruitment and navigation through challenges; and can expedite the translation of data to practice and improved care.

PMID:
30507809
PMCID:
PMC6287270
[Available on 2020-01-01]
DOI:
10.1097/PHH.0000000000000707
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19.
Scand J Caring Sci. 2018 Dec 3. doi: 10.1111/scs.12631. [Epub ahead of print]

Patient and family members' perceptions of family participation in care on acute care wards.

Author information

1
School of Nursing, Midwifery and Paramedicine, Menzies Health Institute Queensland, University of the Sunshine Coast and Griffith University, Maroochydore, DC, QLD, Australia.
2
School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University and Intensive Care Unit, Princess Alexandra Hospital, Brisbane, QLD, Australia.
3
School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, and Gold Coast Health, Southport, QLD, Australia.

Abstract

BACKGROUND:

Hospital leaders, policymakers and healthcare professionals are realising the benefits of delivering care that promotes family participation because it is known to enhance the quality of care, and improve patient satisfaction.

AIM:

The aim of this study was to explore, from the perspective of patients and family members within an adult acute care ward: (a) their beliefs and attitudes towards family participation in patient care and (b) staff behaviours that support or hinder family participation in patient care.

DESIGN AND METHODS:

A naturalistic approach with an exploratory sequential design was used in a medical assessment and planning unit of a regional referral hospital in Australia. Purposeful maximum variation sampling was used to recruit patients and family members who differed in age, ethnicity, relationship to patient and gender. Observer-as-participant observation data and semi-structured interviews were undertaken. Following separate inductive content analysis, data were triangulated.

RESULTS:

Thirty-two patients and 26 family members were recruited. Thirty hours of observational data were gathered. Eighteen patients and 15 family members were interviewed. Analysis uncovered two contrasting categories: (a) disconnected communication and (b) family influence quality.

CONCLUSION:

The findings of our study demonstrated that most patients and families perceived staff communication as disconnected and inadequate, which constrained them from engaging in care processes or decision-making. However, when family felt empowered and participated in patient care, the quality of health care was enhanced. Healthcare professionals can use these findings to make informed evidence-based changes to the way they practice and communicate to ensure family participation in patient care is optimised in the acute care setting.

KEYWORDS:

acute care; attitudes; collaboration; family; hospitalisation; medical units; mixed methods; nursing; participation; patient and family-centred care

PMID:
30507038
DOI:
10.1111/scs.12631
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20.
Value Health. 2018 Dec;21(12):1357-1364. doi: 10.1016/j.jval.2018.06.003. Epub 2018 Aug 30.

Cost-Effectiveness of a Comprehensive Approach for Hypertension Control in Low-Income Settings in Argentina: Trial-Based Analysis of the Hypertension Control Program in Argentina.

Author information

1
Institute for Clinical Effectiveness and Health Policy (IECS/CONICET), Buenos Aires, Argentina; School of Public Health, University of Buenos Aires, Buenos Aires, Argentina. Electronic address: faugustovski@iecs.org.ar.
2
Institute for Clinical Effectiveness and Health Policy (IECS/CONICET), Buenos Aires, Argentina.
3
Department of Global Health Management and Policy, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.
4
Institute for Clinical Effectiveness and Health Policy (IECS/CONICET), Buenos Aires, Argentina; School of Public Health, University of Buenos Aires, Buenos Aires, Argentina.
5
Department of Epidemiology and Tulane University Translational Science Institute, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.

Abstract

BACKGROUND:

A recent cluster randomized trial evaluating a multicomponent intervention showed significant reductions in blood pressure in low-income hypertensive subjects in Argentina.

OBJECTIVES:

To assess the cost-effectiveness of this intervention.

METHODS:

A total of 1432 hypertensive participants were recruited from 18 primary health care centers. The intervention included home visits led by community health workers, physician education, and text messaging. Resource use and quality of life data using the three-level EuroQol five-dimensional questionnaire were prospectively collected. The study perspective was that of the public health care system, and the time horizon was 18 months. Intention-to-treat analysis was used to analyze cost and health outcomes (systolic blood pressure [SBP] change and quality-adjusted life-years [QALYs]). A 1 time gross domestic product per capita per QALY was used as the cost-effectiveness threshold (US $14,062).

RESULTS:

Baseline characteristics were similar in the two arms. QALYs significantly increased by 0.06 (95% confidence interval [CI] 0.04-0.09) in the intervention group, and SBP net difference favored the intervention group: 5.3 mm Hg (95% CI 0.27-10.34). Mean total costs per participant were higher in the intervention arm: US $304 in the intervention group and US $154 in the control group (adjusted difference of US $140.18; 95% CI US $75.41-US $204.94). The incremental cost-effectiveness ratio was $3299 per QALY (95% credible interval 1635-6099) and US $26 per mm Hg of SBP (95% credible interval 13-46). Subgroup analysis showed that the intervention was cost-effective in all prespecified subgroups (age, sex, cardiovascular risk, and body mass index).

CONCLUSIONS:

The multicomponent intervention was cost-effective for blood pressure control among low-income hypertensive patients.

KEYWORDS:

cost-effectiveness; hypertension; low-income setting; primary care

PMID:
30502778
DOI:
10.1016/j.jval.2018.06.003
[Indexed for MEDLINE]
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