bluuebunny/crossref_metadata_2025 huggingface dataset:
PATIENT EXPERIENCE WITH CARE AND CLINICAL OUTCOMES IN DIABETES: A CASE FOR MORE PERSON-CENTERED MEASUREMENT
Authors: McCoy Rozalina , Fan Jiaquan , Smith Steven , Deming James , Ziegenfuss Jeanette , Montori Victor , Shah Nilay
Published: October 2016

Rationale, aims and objectives: Diabetes performance metrics are widely used to assess care, inform the public, guide reimbursement, and facilitate quality improvement efforts.  The most common, the D5, is a composite process and intermediate outcome measure that may not capture key patient-important outcomes.  This study assesses the ability of the D5 and the Patient Assessment of Chronic Illness Care (PACIC) instrument to evaluate patient experience with care. Method: Postal surveys with the PACIC instrument, and questions about demographics, health status, and self-efficacy were mailed to 4796 adults from a diabetes registry maintained by 34 primary care clinics in November 2009.  D5 measures for 2009 (glycosylated hemoglobin <8%, blood pressure <140/90 mmHg, low density lipoprotein cholesterol <100 mg/dL (2.59 mmol/L), non-smoking, aspirin therapy) were obtained from electronic medical records.  Logistic regression analysis evaluated the association of PACIC, self-reported health, demographics, and D5.Results: The 2055 (42.8%) respondents had mean age 64.9 years (standard deviation (SD), 12.3), HbA1c 6.9% (SD, 1.2%), and PACIC 3.0 (SD, 1.1); 43.8% achieved the D5.  Self-reported diabetes control and lack of perceived financial barriers to medical care were associated with achieving the D5; however, PACIC and other patient-reported measures of health were not associated with achieving the D5.  In contrast, diabetes self-management education, social support network, and self-efficacy were associated with higher PACIC scores.Conclusions: Efforts to improve patient-centered care necessitates the assessment of patient experience of health and healthcare.  The PACIC may be an important adjunct to the D5 to measure the quality of diabetes care.
MOBILE APPLICATION (‘APP’) USAGE PATTERNS AND PERCEPTIONS OF PATIENTS ON A PROPOSED PHARMACY MOBILE APP
Authors: Yap Kevin Yi-Lwern , Koh Eraine Yan Ting , Artika Ummi , Goh Vanessa Zi Hui , Low Sheng Fong , Tan Daphne Sze Ling , Teo Mya Mei , Tiang Yi Long
Published: October 2016

Objective:This studyaims to determinepatients’perceptions in relation to apharmacymobile application (‘app’) that comprises ofmultiple functions to improve convenience forpatients, enhancequality of care, changethewaytheymanagetheirdiseaseand provideasourceofmedical information.Methods: A storyboard fortheintended mobile app was designed on Microsoft Powerpoint with six main functions:GettingAround, DrugCatalogue,QueueStatus, MyAccount, PharmacyClinic and Contact Us.It was shown to300 outpatients usingSamsungand iPad Tablets. Patients completed an interviewer-administered 13-item surveywhich asked about the respondents’demographics, theirmobile appusagepatternsand theirperceptions regardingtheintended mobile app and its functions.Results:The smartphonepenetration rateamongtherespondents was high, with 274 (97.2%) respondents owningasmartphone and/ora Tablet.A total of248 (89.5%)respondents used mobile apps everydayand 267 (96.4%)ofthem were comfortablewith usingmobile apps. The majorityofrespondents (94%)indicated that theywould usetheproposed pharmacymobile app ifit was availablein themarket. All 6 functions werewell received with morethan 90% of respondents agreeingthat the functions wereuseful. Thetop 3 most popular functions wereSearch byDrug/Disease,Information Videoand OrderList(276 respondents for each function, 97.9%).Conclusion:The majorityofrespondents wereopen tousingthemobile app. Most found the proposed functions useful. The results ofthis studywill be submitted to our hospital executives so that a development of this work and its relevance to person-centered healthcare can be formally considered.
A MULTIDISCIPLINARY APPROACH TO DISABILITY REHABILITATION: THE CASE OF A PERSON WITH DISABILITY
Authors: Darain Haider , Alkitani Abdulhameed , Kashif Muhammad , Ghani Javaid , Ibrar Muhammad , El-ziq Najat Soboh
Published: October 2016

Background and purpose: Community-based rehabilitation programs focus on identifying available resources in the community in order to support the patients. Resource Information Centers (RICs) play a vital role in mobilizing these resources by disseminating appropriate information among the stakeholders. However, little has been reported in the literature about the specific roles associated with RICs. In this study, we report the role of RICs as part of a community-based rehabilitation program (CBRP) for a person with disability.Method: A 34-year-old male with left leg above knee amputation was identified during our field visit. The field visit was undertaken by members of a RIC visit to the areas affected by an earthquake in Pakistan in October 2005. The Government of Pakistan, in collaboration with some national and international organizations, had introduced a 3-year program (2007-2010) in which community-based rehabilitation programs were made available for areas affected by earthquakes. The patient was initially referred to another organization that was working on providing rehabilitation service for persons with disability. He was provided with an artificial leg prosthesis for which he had been referred. Results: After receiving the artificial limb, the patient managed to return to his previous occupation which ultimately improved his financial status. Moreover, an improvement in his social integration was observed in the form of his ability to attend social meetings and ceremonies. Conclusion: The patient case we discuss is, we suggest, illustrative of the majority of people with disabilities (PWDs) in countries such as Pakistan are unaware of the exiting services designed to help them to manage their disability. The financial constraints of the PWDs might be overcome by offering guidance on how to access the available resource in their community. Such actions significantly increase the provision of person-centered healthcare.
WHAT IS “FAMILY-CENTRED CARE”?
Authors: Shields Linda
Published: October 2016

Family-centred care is a ubiquitous term in paediatric health facilities. It means that an admitted child can never be treated as a single individual patient, that the family is the unit of care, as the parents and family are central to the child’s wellbeing, especially during traumatic experiences. There is no rigorous evidence that family-centred care works, but qualitative research is drawing out some grave concerns with how it is implemented. Part of the problem is that there are many descriptions of family-centred care, but few definitions, and some of its component parts may be in place in some health services without the whole model being in place. This causes confusion amongst health professionals and parents and children, and makes it impossible to test in a randomised controlled trial. This paper discusses these problems and suggests that a new model, child-centred care, may be a better model of care for children.
Analysis of an intervention on discharge summary quality and timeliness
Authors: Mourra Natalie Rose , Fish Jason S , Pfeffer Michael Adam
Published: October 2016

Objective: Deficits in communication between inpatient and outpatient physicians in the post-hospital discharge period are common and potentially detrimental to person-centered doctor-patient relationships and to patient health. This study assesses the impact of a hospital discharge improvement project implemented at an urban academic hospital, aimed at improving the timeliness and quality of discharge summaries using a standardized discharge template, education and a small monetary incentive. Methods: A random sample of 624 charts from an academic, urban hospitalist medicine service was analyzed from the pre- and post-project implementation time periods: 2009-2010 and 2010-2011. The sampling was evenly distributed throughout the months of the year. Ordinary linear regression modeling was used to evaluate the impact of the intervention on time to completion; logistic regression modeling was used to assess the impact on the quality of the discharge summaries. Both models control for patient characteristics, hospitalization acuity and in-hospital continuity of care.Results: Unadjusted time to discharge summary completion rates decreased by 2.4 days (p<0.001) between the pre- and post-implementation times. Controlling for patient demographics, acuity of hospitalization and hand-offs between physicians, time to completion of discharge summaries was decreased by 2.17 days (p< 0.001). The odds of including at least 50% of the recommended information into a discharge summary post-intervention was 6.44 (p<0.001) compared to the odds before the intervention, controlling for patient demographics, acuity of hospitalization and hand-offs between physicians. Conclusion: The use of education, a simple formatted recommended discharge template and a small monetary incentive improved both the timeliness and quality of the information exchanged between inpatient and outpatient providers and contributes significantly to a person-centered healthcare.
Consumer engagement in the development of a video to inform health service clients about the risks and prevention of venous thromboembolism
Authors: Sykes Pamela K , FitzGerald Mary
Published: October 2016

Objective: To develop a patient education program, including an instructional video, on the prevention of venous thromboembolism. Method: A consumer focus group was conducted to garner participants’ experiences, thoughts and ideas on the development of an educational video on the prevention of venous thromboembolism.  Results: A combined approach using a printed pamphlet and educational video can supplement healthcare professional verbal instructions. Major points to inform the production of an educational video include: (1) consistency of key messages; (2) keep video short; (3) use storytelling; (4) layer and re-enforce messages; (5) demonstrate simple instructions through behaviour modelling and visual imaging and (6) use humour but interspersed with serious messages and include statistics to enhance credibility.  Conclusion: The provision of quality patient education is vital and can positively influence patient outcomes. Conducting a focus group to ascertain consumer views and ideas on the introduction of a video proved beneficial and insightful for both researchers and consumers. Comparison of key findings from both the focus group discussions and the evidence in the literature were consistent. The availability of a patient education video can supplement verbal instructions, but will require a practice change by staff.
Results, not intentions: why assisted suicide has no place in person-centered healthcare and where it does belong
Authors: Van Bommel Harry
Published: October 2016

Veiwpoint article - No abstract
Evaluation of a tactic to engage hard-to-reach patients during the exercise referral process: a longitudinal qualitative study
Authors: Queen Martyn , Crone Diane , Parker Andrew
Published: October 2016

Objectives General practitioners (GPs) have been reluctant to promote physical activity with overweight and obese patients, due to concerns about damaging the GP patient relationship. A longitudinal qualitative study was conducted to evaluate a small group of health professionals (HPs) and their patients’ perspectives of the referral process for exercise in a Primary Care setting.Methods 12 patients aged 55-74 and their 6 referring HPs, including 5 GPs and 1 Practice Nurse. Semi-structured interviews took place on two occasions over an 8 month period in a Primary Care Health Centre. Transcripts of recorded interviews were coded and thematically analysed using a grounded theory approach.Results HPs and patients identified difficulties associated with broaching the subject of obesity. HPs identified that tensions could arise when discussing weight management and exercise. Patients identified disliking the way that their HP had introduced the subject of obesity and the need for physical activity. The patients later acknowledged that the consultation where a direct approach was used (shock tactic), was the motivation necessary to engage them with the exercise referral scheme.Conclusion Shock tactics by HPs can be an effective method of engaging hard-to-reach patients with a physical activity intervention. NHS service commissioners should consider training HPs to identify and engage patients that would benefit from such an approach.
A survey of women’s birth experiences in Scotland using the Birth Satisfaction Scale (BSS)
Authors: Hollins Martin Caroline , Martin Colin
Published: October 2016

Background: ‘Birth satisfaction’ is important since experience of labour can influence women’s post-natal adjustment. Objective: To explore: (1) childbearing women’s experiences of ‘birth satisfaction’ and (2) identify contexts in which it is more appropriate to use the 30-item Birth Satisfaction Scale (BSS) or the 10-item BSS-Revised (BSS-R). Study design: A quantitative survey was conducted using the 30-item BSS. As a function of completing the 30-item BSS, participants also completed the short-form 10-item BSS-R. Participants: A convenience sample of post-natal women (n=228) attending for National Health Service (NHS) care at the Ayrshire Maternity Unit in the West of Scotland (UK) participated. Participants were within their first 10 post-natal days.Results: The 30-item BSS mean scores = 115.84 (SD 14.05). The thematically determined subscale mean scores of quality of care provision (BSS-QC; 8-items), women’s personal attributes (BSS-WA; 8-items) and stress experienced during labour (BSS-SL;14-items) subscales, were 32.2 (4.09), 31.9 (4.16) and 51.73 (8.04) respectively. Women experienced greater ‘birth satisfaction’ when they had a Spontaneous Vertex Delivery compared with a complicated delivery. Primigravidas were generally less ‘birth satisfied’ than multiparous women. Key conclusions: Overall assessment of care was complimentary, with global levels of ‘birth satisfaction’ generally high. In response to psychometric tests, the 30-item BSS has been trimmed down to a statistically robust, valid and reliable 10-item BSS-R.Implications for practice: Now that a valid and reliable 10-item BSS has been developed to measure women’s experiences of childbirth, it can be used to assess differences between variables such as home and hospital birth, or to establish correlates with other valid measures. We advance our study as an important contribution to person-centered maternal healthcare.
Without a reconceptualisation of ‘evidence base’ evidence-based person-centred healthcare is an oxymoron.
Authors: Kaltoft Mette Kjer , Nielson Jesper Bo , Eiring Oystein , Salkeld Glenn , Dowie Jack
Published: October 2016

The call for a renaissance in Evidence-Based Medicine will not result in the delivery of person-centred healthcare. In person-centred healthcare the relative importance of the considerations that matter to the person is elicited and combined, at the point of decision, with the best estimates available on the performance of the available options on those criteria. Prior option evaluations based on average preferences that constitute the conventional 'evidence-base' cannot be part of this process, even if some of the underlying data may be of use. The ethics of transparent person-centred care require the evidence-base to be reconceptualised as the unsynthesised matrix of option performance rates on person-important criteria. Abdicating in the face of the challenges resulting from this reconception is a case of the methodological tail wagging the ethical dog.
A cognitive model of converting scientific evidence on treatment effects into prognostic information in clinical practice
Authors: Kriston Levente
Published: October 2016

Rationale, aims and objectives: Little is known about the cognitive processes of how population-based scientific evidence is utilized in the treatment of individual patients. The present work aims to outline a formalized framework of converting scientific evidence on treatment effects into prognostic information in clinical practice and describes a pilot study for illustration of how the framework can be used in research.Method:The proposed theoretical framework considers the human mind as a limited capacity information processing system. This system codes external stimuli into internal inputs, which are then processed through several steps towards an evidence-informed clinical output. A small-scale pilot study including 130 laypersons was performed. Participants were asked to make probabilistic prognostic statements based on a fictional study (“evidence”) and a fictional case vignette (“clinical context”).Results: Several cognitive processes were defined, including coding of the attributes of the evidence and the clinical context, integration of the information in a similarity-dissimilarity matrix and calculating the prognostic output. Frequently required operations, such as extrapolation, individualization, particularization, generalization and absolutization of the information were outlined. The presented framework was shown to be useful in analyzing and interpreting the pilot study data.Conclusions:The postulated model holds great potential for investigating cognitive processes included in evidence-informed clinical care.
Assessment and follow-up of suicidal ideation when screening for depression in hospitalized coronary heart disease patients – development of a protocol
Authors: Beer Katja , Rieckmann Nina , Ertl Mira , Grosse Laura , Zeidler Thorsten , Arolt Volker , Haverkamp Wilhelm , Waltenberger Johannes , Müller-Nordhorn Jacqueline , Ströhle Andreas
Published: October 2016

Rationale, aims and objectives: Depression is common in coronary heart disease (CHD) patients and routine depression screening is often performed in research settings and recommended for clinical practice. Many depression screening instruments contain an item assessing suicidal ideation. A positive answer for suicidal ideation requires timely follow-up evaluation by trained clinicians; however, the process of transferal of this information is not without its problems. We aimed to develop and implement a step-by-step action protocol for the timely follow-up evaluation of positive screenings for suicidal ideation in hospitalized CHD patients who complete a depression screening in a research study.Method: The protocol was developed by a team of psychiatrists and psychologists as part of a two-site prospective cohort study which includes 1265 hospitalized CHD patients with and without co-morbid depression. Patients were presented with two depression screening instruments as part of the baseline assessment, the Patient Health Questionnaire (PHQ-9) and the Hospital Anxiety and Depression Scale (HADS). All participants underwent a standardized computer based evaluation for clinical depression, anxiety and post-traumatic stress disorder using the Composite International Diagnostic Interview (CIDI). The protocol was adapted continuously with the aims to optimize information transfer between study team and clinic staff and to initiate potentially required care.Results: The protocol was adapted to site-specific exigencies, resulting in a stepped approach of handling suicidal ideation, starting with suicidality assessment in a depression screening questionnaire. In case of positive screening, a detailed procedure for following-up on suicidal ideation was developed, including guidelines for various eventualities. In case of insufficient or doubtful distance from suicidal intent as assessed by clinical psychologists in training, psychiatric consultation was initiated. Conclusions:Implementation of a protocol to follow-up on a positive suicidality screening in a research setting at two coronary care hospital sites was a logistical challenge, but proved feasible and acceptable to patients and staff.
How discrete choice experiments contribute to person-centered healthcare. A commentary on Kaltoft et al. (2015): ”Can a Discrete Choice Experiment contribute to person-centred healthcare?”
Authors: Pedersen Line Bjørnskov , Bech Mickael , Kløgaard Mirja , Søgaard Rikke , Veldwijk Jorien , De Wit G.Ardine , Lambooij Mattijs
Published: October 2016

No abstract
Hypertension Control Strategies in a Patient Centered Medical Home
Authors: Khanna Niharika , Shaya Fadia , Chirikov Viktor , Steffen Ben , Sharp David
Published: October 2016

Background: Partnership betweenMaryland’sMulti-payerPatient CenteredMedical Home programand Maryland Million Hearts programhasbeen thecatalyst for focused quality improvementstrategiesspecific to chronic disease managementandcontrol.Methods: This project was initiated in the 52 NCQA recognizedPCMH practices from theMMPP. A nested cohort of19 practices received technical assistance to includestaff training, new workflows implementation, dissemination ofevidence-based guidelines, optimizing HITuse, patientself-managementand linkage to communityand state resources. Observations weredocumented in 2011, 2012, 2013 and at the end of the PDSA in June2014. Annually reported quality metricsbypractices during this time period were analyzed byeach individual metric and theoverallaverage change was calculated and tested forstatistical significance. All tests were two-tailed.Results: NQF 18 and NQF 28A maintained theirachievement threshold from December 2013 toJune2014. NQF 28Ademonstratednon-significantdecrease from94.6% in December2013 to93.4% in June 2014 (p value=0.646),but maintained values greater than achievement threshold. NQF 28Bdemonstrated significant change from2011 at 23.5% followed bypractices trainingand resource linkages to 52.2% in June 2014 (p value<0.01 for totalchange from2011-2014). NQF 59 demonstratedan increase from17% in December2013 to 24.9% inJune2014, which wasnot statisticallysignificant (p value= 0.342). NQF 575 demonstrated a non-significant increase from62.8% December2013 to 71.1% inJune2014 (p value=0.217).Conclusions: Focusedquality improvementprograms have greatpropensity forsuccess inchronic disease management whensystematically implemented.
The Empathy in Young Students of Health Professions
Authors: Mento Carmela , Rizzo Amelia , Barberis Nadia , Settineri Salvatore
Published: October 2016

Objective: The assessment of empathy among different health professions has been focused almost exclusively on the cognitive and affective aspects or on specific professions, such as doctors. The Empathy Scale for Health Professions (ESHP) is a 12 item instrument developed by Mento and Settineri, including the expressive component of empathy.  Method: In the present study the scale has been administered during 2013 to a total of 420 undergraduate students of different degree courses, belonging to thehealth professions.  Results: Cronbach’s alpha value of total scale was 0.75 and both the Exploratory Factor Analysis (EFA) and the Confirmatory Factor Analysis (CFA) revealed a 3 component structure as hypothesised. There were no differences between males and females, neither between the professions considered.  Conclusions:The results suggest that the ESHP should be a valid instrument to assess empathy during the laurea degree course, to provide the possibility of reflection about a transverse skill, involved in all health professions.
Beliefs about Medicines Questionnaire (BMQ) in inflammatory bowel disease patients in Greece. Ιs this useful?
Authors: Tsianos Epameinondas V , Tsianou Konstantina , Tsipouras Markos G , Giannakeas Nikolaos , Skamnelos Alexandros , Katsanos Konstantinos H , Tatsioni Athina , Karvounis Evaggelos C , Tsianos Vasileios , Tzallas Alexandros T , Vlcek Jiri
Published: October 2016

Background and Aims: The aim of this study is the revalidation of the Beliefs about Medicine Questionnaire (BMQ) in outpatient gastroenterology clinic patients, in Greece. Methods: A cohort of 163 patients diagnosed with inflammatory bowel disease (IBD), ulcerative colitis (UC) and Crohn’s disease (CD) was included in the study, with the majority of them being in the remission phase. Diagnosis of IBD was established using standard diagnostic criteria. Statistical analysis included descriptive statistics and frequency analysis, Pearson's correlation and analysis of variance (ANOVA). Results: Internal consistency of the BMQ validated with Cronbach's α, being 0.757 in overall and 0.795 and 0.691 for the specific and general parts, respectively. The data adequacy for factor analysis was determined with Kaiser-Meyer-Olkin (KMO) measure > 0.5, while inter-item correlations were found to be significant in all cases. Conclusions: The Greek version of BMQ presented satisfactory psychometric/measurement properties indicating its reliability for use in patients with IBD who receive care in an outpatient hospital clinic.
The chronic illness problem. The person-centered solution.
Authors: Miles Andrew , Asbridge Jonathon E
Published: October 2016

No abstract
Australian Indigenous cancer patients’ self-report of diagnosis, treatment and comorbidity data: how does it compare to medical chart review.
Authors: Maresch Bernardes Christina , Diaz Abbey , Baade Peter , Garvey Gail , Valery Patricia Casarolli
Published: October 2016

Rationale: The quality of patient-centred care relies upon the reliability of the data used to produce performance measures. The agreement between patient self-report and medical chart review among Aboriginal and Torres Strait Islander cancer patients is unknown.Objective: To examine the concordance between patient self-report and medical chart review in determining cancer type, current and previous cancer treatment, comorbidities and patient characteristics associated with agreement.Method: Aboriginal and Torres Strait Islander cancer patients (≥18 years) who had received cancer treatment in the past 30 days (n=208) were recruited. The prevalence, sensitivity, specificity, total agreement and Kappa coefficients (K) were estimated to determine the agreement (yes + yes; no + no) between self-reported data and medical records.Results: 13.5% of the patients could not accurately identify their cancer type. For treatment variables, raw agreement ranged from 70.5% to 92.4%, although, after correcting for chance, there was a lack of consistency for current radiation and past treatment variables (K= -0.01 to 0.48). Sensitivity and specificity were moderate to high for current surgery and chemotherapy. The greatest crude prevalence difference by data source was observed for comorbidities not specified in the questionnaire. Sensitivity and specificity were high for diabetes. Conclusion: investigators and policy makers may rely upon patient self-report for diabetes, current cancer treatment of surgery and chemotherapy. However, should be cautious when considering patient self-report for past treatment and other comorbid conditions.
Use of patient-reported outcomes in outpatient settings as a means of patient involvement and self-management support – a qualitative study of the patient perspective
Authors: Trillingsgaard Caroline , Nielsen Berit Kjærside , Hjøllund Niels Henrik , Lomborg Kirsten
Published: October 2016

Rationale, aims and objectives Patient-reported outcomes (PRO) is being implemented in clinical practice across different healthcare settings with various purposes. Involving the patients in reporting outcomes may increase their attention to symptoms and thereby support their self-management. The aim of the present study was to describe patients’ experiences with a web-based PRO system where patients fill in a PRO questionnaire at home or in the outpatient clinic prior to a consultation. Moreover, the study aimed to explore how PRO influenced the interaction between patients and clinicians during the consultation.Methods Through participant observations of nine consultations and 12 semi-structured interviews with patients after the consultation this interpretive description study explored patients’ experiences with the PRO system. The PRO included self-assessment on health-related quality of life, symptoms, and well-being. Patients who visited the outpatient clinic at Department of Renal Medicine at Aarhus University Hospital in the Central Denmark Region in February and March 2014 and in March and August 2015 were invited to participate. We used a convenience sampling approach to recruit patients who had completed at least two PRO questionnaires.Results The analysis revealed rudiments of PRO in clinical practice leading to an increased understanding of their chronic disease, patient-centred communication and an additional focus on psychosocial problems. However, the very application of PRO in the outpatient clinic and the patient attitudes were substantial and crucial barriers for PRO as a method to achieve patient involvement and self-management.Conclusion The use of PRO in outpatient consultations may support patients' self-management by a) impelling patient-centred communication in the consultation, b) legitimising talk about psychosocial problems, and c) increasing the patients' understanding of their disease. Yet, applying PRO into clinical practice does not automatically involve the patients and support their self-management. We suggest supplementary clinical initiatives to strengthen the patient involving benefits of PRO.
Process mapping appointments to identify improvements in care delivered to patients who screen positive for depression
Authors: Kim Bo , Rodrigues Stephanie , Dell Natalie S , Elwy Rani
Published: October 2016

Rationale, aims and objectives  After screening positive for depression, many patients do not receive effective medication or maintain optimal contact with practitioners.  Our objective was to examine how appointments that patients have after screening positive may affect the delivery of evidence-based and guideline-concordant depression care. Methods  We reviewed treatment records for 271 patients who screened positive for depression in primary care across three United States Veterans Health Administration medical facilities.  For each patient, we mapped the process of appointments that took place following the positive screen, noting the number of appointments, the service line in which each appointment was held, as well as whether guideline-concordant depression care was in turn received over four months. Results  We found that (i) approximately half of the patients who screened positive had no follow-up appointments, (ii) all patients who had two or more follow-up appointments received some – but not necessarily guideline-concordant – mental health treatment, and (iii) there were distinct patterns across the three facilities regarding which service lines’ appointments most often resulted in treatment. Conclusions  Our work offers a novel approach of using data on appointments that patients have after screening positive for depression to shed light on current care practices.  The number of post-screening appointments can be an informative process measure for improving depression care to become more guideline-concordant.  Facilities vary substantially in terms of which service lines they use to attain guideline-concordance, likely due to notable differences in how their primary care, integrated primary care behavioral health, and mental health services are organized.
Patient Experience in an Era of Primary Care Transformation: Revisiting the PACIC
Authors: Noel Polly Hitchcock , Jones Salene , Parchman Michael
Published: October 2016

Rationale, Aims and Objective: The validation study of thePatient Assessment of Chronic Illness Care (PACIC) questionnaire suggested a 5-factor structure determined a priori, but subsequent analyses have questioned the validity of the original factor structure. This study analyzed the factor structure of the PACIC using a large and diverse patient sample and evaluated the identified factors through the lens of recent transformational initiatives in primary care.Methods: Exploratory and confirmatory factor analyses were conducted on baseline and follow-up patient questionnaire data from a cluster randomized controlled trial. Convenience samples of adults completed surveys in waiting rooms during clinic visits. Primary care patients with 1 or more chronic illnesses with complete PACIC responses at baseline from 39 clinics (n=1,567) and at follow-up from 36 clinics (n=1,536) participated. Identified factors were evaluated in terms of item loadings, content, reliability and the extent to which items reflected advances in the delivery of chronic illness care.Results: Analyses supported the use of the PACIC summary score. Although a 5-factor model was retained, factor loadings were different from the original PACIC validation study. All factors had sufficient reliability, but findings suggested potential revisions to enhance the factor structure.Conclusions: It may be time to revise the PACIC to enhance the stability of the subscales (factors) and better reflect recent transformations in the delivery of chronic illness care.
COMMENTARY. Defining ‘true medicine’ – some considerations. A Commentary on Newell and Lewith’s “Alternative, Complementary or Orthodox: What is real medicine?”
Authors: Fuller Richard
Published: October 2016

No abstract
A comparative study of the mastery of fundamental movement skills between different cultures
Authors: Dos Santos Fernando Garbeloto , Pacheco Matheus Maia , Basso Luciano , Tani Go
Published: October 2016

It has been suggested that guidance, encouragement and opportunity are crucial factors for children’s motor development. They are especially important to promote the mastery of fundamental movement skills. The present study investigated the association between two elements related to those factors – proposed curriculum of physical education and the most popular sport in a given country – and the incidence of mastery in the FMS in children from 4 to 10 years of age. In order to carry out a cross-cultural comparison, three studies from different countries (Portugal, China and USA) that used TGMD-II were selected. The results indicated association between proposed curriculum and the number of children mastering FMS. This association increases in older age groups of children from USA, the most structured curriculum related to FMS, presenting the highest average percentage of mastery.  Additionally, we did not find association of the most popular sports in a given country with the mastery of the related skill. These results are interpreted as evidence for the importance of guidance on the mastery of FMS.
Disclosing in utero HIV/ARV exposure to the HIV‐exposed uninfected adolescent: is it necessary?
Authors: Jao Jennifer , Hazra Rohan , Mellins Claude A , Remien Robert H , Abrams Elaine J
Published: October 2016

Introduction

The tremendous success of antiretroviral therapy has resulted in a diminishing population of perinatally HIV‐infected children on the one hand and a mounting number of HIV‐exposed uninfected (HEU) children on the other. As the oldest of these HEU children are reaching adolescence, questions have emerged surrounding the implications of HEU status disclosure to these adolescents. This article outlines the arguments for and against disclosure of a child's HEU status.

Discussion

Disclosure of a child's HEU status, by definition, requires disclosure of maternal HIV status. It is necessary to weigh the benefits and harms which could occur with disclosure in each of the following domains: psychosocial impact, long‐term physical health of the HEU individual and the public health impact. Does disclosure improve or worsen the psychological health of the HEU individual and extended family unit? Do present data on the long‐term safety of in utero HIV/ARV exposure reveal potential health risks which merit disclosure to the HEU adolescent? What research and public health programmes or systems need to be in place to afford monitoring of HEU individuals and which, if any, of these require disclosure?

Conclusions

At present, it is not clear that there is sufficient evidence on whether long‐term adverse effects are associated with in utero HIV/ARV exposures, making it difficult to mandate universal disclosure. However, as more countries adopt electronic medical record systems, the HEU status of an individual should be an important piece of the health record which follows the infant not only through childhood and adolescence but also adulthood. Clinicians and researchers should continue to approach the dialogue around mother–child disclosure with sensitivity and a cogent consideration of the evolving risks and benefits as new information becomes available while also working to maintain documentation of an individual's perinatal HIV/ARV exposures as a vital part of his/her medical records. As more long‐term adult safety data on in utero HIV/ARV exposures become available these decisions may become clearer, but at this time, they remain complex and multi‐faceted.
NMNAT1 inhibits axon degeneration via blockade of SARM1-mediated NAD+ depletion
Authors: Sasaki Yo , Nakagawa Takashi , Mao Xianrong , DiAntonio Aaron , Milbrandt Jeffrey
Published: October 2016

Overexpression of the NAD+ biosynthetic enzyme NMNAT1 leads to preservation of injured axons. While increased NAD+ or decreased NMN levels are thought to be critical to this process, the mechanism(s) of this axon protection remain obscure. Using steady-state and flux analysis of NAD+ metabolites in healthy and injured mouse dorsal root ganglion axons, we find that rather than altering NAD+ synthesis, NMNAT1 instead blocks the injury-induced, SARM1-dependent NAD+ consumption that is central to axon degeneration.
Photoresponse in graphene induced by defect engineering
Authors: Du Ruxia , Wang Wenhui , Du Jianxin , Guo Xitao , Liu Er , Bing Dan , Bai Jing
Published: October 2016

We present a photoresponse study on a lateral defect/pristine graphene junction device fabricated by a simple plasma irradiation method. The junction between pristine graphene and plasma-modified graphene was created by controlling the location of Ar+ plasma treatment. We found that a distinct photocurrent was generated at the junction by photocurrent line scanning measurements, and further analysis reveals that the photo-thermoelectric (PTE) effect, instead of the photovoltaic (PV) effect, dominates the photocurrent generation at the interface. Additionally, the obtained results suggest that tuning the defect density could be effective in modulating the optoelectronic performance of junctions in our device.
Achievement of a high-mobility FET with a cloud-aligned composite oxide semiconductor
Authors: Yamazaki Shunpei , Shima Yukinori , Hosaka Yasuharu , Okazaki Kenichi , Koezuka Junichi
Published: October 2016

We have recently discovered that films of a widely used In–Ga–Zn oxide (IGZO) with

have different material composition states when sputter-deposited under different conditions using the same polycrystalline IGZO target. Significant improvements in on-state current and mobility (as high as 40 cm2·V−1·s−1) are obtained. The results of local composition analysis indicate that the deposited film is not composed of any known homogeneous IGZO compound and that the components of this film are separated into two types of nanoparticle regions: one type is composed mainly of GaO
x
and GaZnO
x
, which contribute to on/off (switching) characteristics, and the other is composed mainly of InO
x
and InZnO
x
, which contribute to on-state characteristics. These regions constitute a new type of oxide semiconductor (OS) film. The nanoparticles with a blurry boundary extend like a cloud, probably complementing one another. We consider that this OS film has a novel composition, which can be described as a “cloud-aligned composite OS” (CAC-OS).
Judgement bias in goats (Capra hircus): investigating the effects of human grooming
Authors: Baciadonna Luigi , Nawroth Christian , McElligott Alan G.
Published: October 2016

Animal emotional states can be investigated by evaluating their impact on cognitive processes. In this study, we used a judgement bias paradigm to determine if short-term positive human-animal interaction (grooming) induced a positive affective state in goats. We tested two groups of goats and trained them to discriminate between a rewarded and a non-rewarded location over nine training days. During training, the experimental group (n= 9) was gently groomed by brushing their heads and backs for five min over 11 days (nine training days, plus two testing days, total time 55 min). During training, the control group (n= 10) did not experience any direct interaction with the experimenter, but was kept unconstrained next to him for the same period of time. After successful completion of the training, the responses (latency time) of the two groups to reach ambiguous locations situated between the two reference locations (i.e., rewarded/non-rewarded) were compared over two days of testing. There was not a positive bias effect after the animals had been groomed. In a second experiment, 10 goats were tested to investigate whether grooming induced changes in physiological activation (i.e., heart rate and heart rate variability). Heart rate increased when goats were groomed compared to the baseline condition, when the same goats did not receive any contact with the experimenter. Also, subjects did not move away from the experimenter, suggesting that the grooming was positively accepted. The very good care and the regular positive contacts that goats received from humans at the study site could potentially account for the results obtained. Good husbandry outcomes are influenced by animals’ perception of the events and this is based on current circumstances, past experiences and individual variables. Taking into account animals’ individual characteristics and identifying effective strategies to induce positive emotions could increase the understanding and reliability of using cognitive biases paradigms to investigate and promote animal welfare.
Evaluation of reference genes for gene expression in red-tailed phascogale (Phascogale calura) liver, lung, small intestine and spleen
Authors: Ong Oselyne T.W. , Young Lauren J. , Old Julie M.
Published: October 2016

Background

Reference genes serve an important role as an endogenous control/standard for data normalisation in gene expression studies. Although reference genes have recently been suggested for marsupials, independent analysis of reference genes on different immune tissues is yet to be tested. Therefore, an assessment of reference genes is needed for the selection of stable, expressed genes across different marsupial tissues.

Methods

The study was conducted on red-tailed phascogales (Phascogale calura) using five juvenile and five adult males. The stability of five reference genes (glyceraldehyde-3-phosphate dehydrogenase,GAPDH;β-actin,ACTB;18SrRNA,18S; 28SrRNA, 28S;and ribosomal protein L13A,RPL13A) was investigated using SYBR Green and analysed with the geNorm application available in qBasePLUSsoftware.

Results

Gene stability for juvenile and adult tissue samples combined show thatGAPDHwas most stable in liver and lung tissue, and18Sin small intestine and spleen. While all reference genes were suitable for small intestine and spleen tissues, all reference genes except28Swere stable for lung and only18Sand28Swere stable for liver tissue. Separating the two age groups, we found that two different reference genes were considered stable in juveniles (ACTBandGAPDH) and adults (18Sand28S), andRPL13Awas not stable for juvenile small intestine tissue. Except for28S, all reference genes were stable in juvenile and adult lungs, and all five reference genes were stable in spleen tissue.

Discussion

Based on expression stability,ACTBandGAPDHare suitable for all tissues when studying the expression of marsupials in two age groups, except for adult liver tissues. The expression stability between juvenile and adult liver tissue was most unstable, as the stable reference genes for juveniles and adults were different. Juvenile and adult lung, small intestine and spleen share similar stable reference genes, except for small intestine tissues where all reference genes were stable in adults butRPL13Awas not suitable in juveniles.
Endovenous Laser Ablation for Incompetent Saphenous Vein Combined With Fluoroscopy-Guided Endovenous Foam Sclerotherapy in Varicose Tributaries: Long-Term Follow-up Results
Authors: Lee Song Am , Park Sang Woo , Yun Ik Jin , Hwang Jae Joon , Kim Jun Seok , Chee Hyun Keun , Chang Il Soo
Published: October 2016

The aim of this study is to describe the long-term results of 980-nm endovenous laser ablation (EVLA) combined with fluoroscopy-guided endovenous foam sclerotherapy using a microcatheter into varicose tributaries. This report reviewed experiences with fluoroscopy-guided endovenous foam sclerotherapy using a microcatheter followed by EVLA, from July 2005 to November 2007. The sclerosing foam was injected through the microcatheter using 1% polidocanol or sodium tetradecyl sulfate. Patients were evaluated clinically and with duplex ultrasound from 1 week to 3 years to assess treatment efficacy and adverse reactions. Technical success was seen in 460 of 461 limbs (99.8%). Continued closure of the saphenous veins and complete sclerosis of varicose tributaries were noted in 351 of 408 limbs (86%) at 1-month follow-up, all 328 limbs at 3-month follow-up, all 299 limbs at 6-month follow-up, all 146 limbs at 1-year follow-up, all 94 limbs at 2-year follow-up, and all 32 limbs at 3-year follow-up. No serious complications were noted. Bruising was noted in 79.0%, and pain or tightness was noted in 68.4%. Hyperpigmentation was noted in 54.2%. EVLA for incompetent saphenous vein combined with endovenous foam sclerotherapy appears to offer the obvious benefits of less additional percutaneous sclerotherapy. However, many problems, like long-lasting pain and hyperpigmentation, can lessen the value of this procedure.
Usuários de crack atendidos em unidade de emergência psiquiátrica: perfil de uma série de casos Crack users treated in psychiatric emergency units: profile of a series of cases
Authors: Seleghim Maycon Rogério , Galera Sueli Aparecida Frari , Oliveira Magda Lúcia Félix de
Published: October 2016

Objetivo: estabelecer o perfil sociodemográfico e do uso de crack e outras drogas de uma série de casos composta de dez usuários de crack. Métodos: pesquisa descritiva, realizada em uma unidade de emergência psiquiátrica em Maringá-PR, por meio de um roteiro de entrevista semiestruturado. Resultados: os sujeitos pesquisados eram homens, com idade entre 20 a 49 anos, mais de nove anos estudados, separados, pais, católicos e desempregados. Grande parte iniciou o uso de drogas com álcool ou tabaco, em média aos 14 anos, fumava habitualmente o crack em cachimbo de metal há menos de oito anos e já havia praticado atividades criminosas para aquisição da droga. Conclusão: o perfil dos usuários foi semelhante ao descrito na literatura, mas apresentou como especificidades o nível de escolaridade e o meio utilizado para consumir o crack.