A strategic tool to improve long-term health outcomes in clinical practice: SHOR driver and association diagram

Abstract Quality problem or issue An over-arching principle of healthcare governance in Sweden is to achieve as much health for as many patients as possible given the available resources. With high life expectancy and increased years lived with non-communicable diseases, more effective interventions in prevention and control of non-communicable diseases are needed in order to ensure high-quality healthcare. Initial assessment Few publications have described a generic and resource-effective method of implementing the perspective of health outcomes in relation to costs in a clinical Swedish university hospital context. To fill this gap, a generic method was developed at Sahlgrenska University hospital in Gothenburg, Sweden. Choice of solution A System-based driver and association diagram of Health Outcomes in relation to available Resources (SHOR) was developed. The SHOR driver and association diagram comprised different perspectives: health, patient, process, research and cost perspectives. It enabled the translation from long-term health outcomes to applications in clinical practice. Implementation Three patient groups exemplify the use and implementation of the method of SHOR association and driver diagram; bipolar disorder (psychiatry), primiparous women with spontaneous onset of labour, (obstetric care) and chronic obstructive pulmonary disease (somatic care). Evaluation The SHOR driver and association diagram enabled a structure to monitor and support quality development towards maximised health outcomes in relation to available resources and associated total costs for a specific patient group. Lessons learned This method has connected clinical practice, management and research and has been used for both strategic and operational purposes.

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Effects of the COVID-19 Epidemic on Hospital Admissions for Non-Communicable Diseases in a Large Italian University-Hospital: A Descriptive Case-Series Study

Journal of Clinical Medicine ◽

10.3390/jcm10040880 ◽

2021 ◽

Vol 10 (4) ◽

pp. 880

Author(s):

Caterina Caminiti ◽

Giuseppe Maglietta ◽

Tiziana Meschi ◽

Andrea Ticinesi ◽

Mario Silva ◽

...

Keyword(s):

Hospital Admissions ◽

Case Series ◽

Communicable Diseases ◽

University Hospital ◽

Negative Consequences ◽

Non Communicable Diseases ◽

Case Series Study ◽

And Gender ◽

Long Term Impact ◽

Series Study

Background: Concern is growing about the negative consequences that response measures to the COVID-19 epidemic may have on the management of other medical conditions. Methods: A retrospective descriptive case-series study conducted at a large University-hospital in northern Italy, an area severely hit by the epidemic. Results: Between 23 February and 14 May 2020, 4160 (52%) COVID-19 and 3778 (48%) non-COVID-19 patients were hospitalized. COVID-19 admissions peaked in the second half of March, a period characterized by an extremely high mortality rate (27.4%). The number of admissions in 2020 was similar to 2019, but COVID-19 patients gradually occupied all available beds. Comparison between COVID-19 and non-COVID-19 admissions in 2020 revealed significant differences concerning all age classes and gender. Specifically, COVID-19 patients were older, predominantly male, and exhibited more comorbidities. Overall, admissions for non-communicable diseases (NCDs) in 2020 vs. 2019 dropped by approximately one third. Statistically significant reductions were observed for acute myocardial infarction (−78, −33.9%), cerebrovascular disease (−235, −41.5%), and cancer (−368, −31.9%). While the first two appeared equally distributed between COVID-19 and non-COVID-19 patients, chronic NCDs were statistically significantly more frequent in the former, except cancer, which was less frequent in COVID-19 patients. Conclusions: Prevention of collateral damage to patients with other diseases should be an integral part of epidemic response plans. Prospective cohort studies are needed to understand the long-term impact.

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Mentoring upcoming researchers for non-communicable diseases’ research and practice in Malawi

Trials ◽

10.1186/s13063-020-05006-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Adamson S. Muula ◽

Mina C. Hosseinipour ◽

Martha Makwero ◽

Johnstone Kumwenda ◽

Prosper Lutala ◽

...

Keyword(s):

Research Capacity ◽

Communicable Diseases ◽

Lessons Learned ◽

National Institutes Of Health ◽

Non Communicable Diseases ◽

Mentorship Program ◽

Research And Practice ◽

Blood Institute ◽

Research Mentorship ◽

National Heart Lung

AbstractThe Malawi College of Medicine and its partners are building non-communicable diseases’ (NCDs’) research capacity through a grant from the National Heart, Lung and Blood Institute (NHLBI) of the National Institutes of Health. Several strategies are being implemented including research mentorship for junior researchers interested to build careers in NCDs’ research. In this article, we present the rationale for and our experiences with this mentorship program over its 2 years of implementation. Lessons learned and the challenges are also shared.

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Personalized medicine in non-communicable diseases: latest advances and future prospects

Kardiologiia ◽

10.18087/cardio.2021.11.n1233 ◽

2021 ◽

Vol 61 (11) ◽

pp. 98-103

Author(s):

O. M. Drapkina ◽

A. A. Ivanova

Keyword(s):

Risk Assessment ◽

Clinical Practice ◽

Personalized Medicine ◽

Human Genome ◽

Communicable Diseases ◽

Future Prospects ◽

Significant Progress ◽

Non Communicable Diseases ◽

New Methods ◽

Genomic Technologies

Since the human genome was decoded more than 15 years ago, there has been a huge leap forward in the development of genomic and post-genomic technologies. Personalized medicine is engaged in implementing these technologies in clinical practice by developing new methods for risk assessment, diagnosis, and treatment of diseases taking into account individual features of the patient. Significant progress has been achieved in decoding genetic bases of chronic noninfectious diseases; new markers for the risk of complications and targets for effects of drugs are being searched for. This review highlights promising directions in the development of personalized medicine, the problems facing modern scientists, and possible ways to solve them

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Health Literacy in Non-Communicable Diseases

Research Anthology on Public Health Services, Policies, and Education ◽

10.4018/978-1-7998-8960-1.ch013 ◽

2021 ◽

pp. 257-297

Author(s):

Christina Zarcadoolas ◽

Barbara K. Kondilis

Keyword(s):

New York ◽

Health Literacy ◽

Communicable Diseases ◽

Behavior Changes ◽

Non Communicable Diseases ◽

Case Examples ◽

Education Material ◽

Short And Long Term ◽

Patient Outreach

The chapter highlights some of the methods used to embed health literacy principles into patient outreach and education materials about non-communicable diseases: chronic conditions including mental health conditions. A person's or population's understanding and engagement with health represents its health literacy. Health literacy is a form social capital. The authors use an ecological, socially contextualized model of health literacy and demonstrate how it guides the structure and content of health education material in case examples from New York City, United States, and Greece in Europe. While the specific methods used in these cases vary, the essential principal is that it is critical to identify and build on information about an individual's health literacy contextualized in the individual's or group's socio-cultural and lived experiences. Only this way can an individual's or group's health literacy be advanced so that they can engage in behavior changes for both short- and long-term health outcomes.

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Long Term Risks to Neonatal Health from Exposure to War—9 Years Long Survey of Reproductive Health and Contamination by Weapon-Delivered Heavy Metals in Gaza, Palestine

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17072538 ◽

2020 ◽

Vol 17 (7) ◽

pp. 2538 ◽

Cited By ~ 4

Author(s):

Paola Manduca ◽

Nabil Al Baraquni ◽

Stefano Parodi

Keyword(s):

Heavy Metals ◽

Reproductive Health ◽

Birth Defects ◽

Progressive Increase ◽

Communicable Diseases ◽

Data Sets ◽

Long Term Effects ◽

Negative Effects ◽

Non Communicable Diseases

Introduction: High levels of environmental contaminants with long term effects and teratogenic and carcinogenic potential, such as heavy metals, were introduced by weaponry in war areas in the last decades. Poorer reproductive health and increases in non-communicable diseases were reported after wars and are the suspected long term effects of contamination by stable war remnants. Although potentially affecting millions of people, this is still an understudied issue of public health. Background: Gaza, Palestine since 2006 has been an object of repeated severe military attacks that left heavy metals remnants in the environment, in wound tissues and that were assumed by the population. Retrospective studies showed a progressive increase in birth defects since the 2006 attacks. In 2011 we started surveillance at birth alongside analysis of the heavy metals load carried by pregnant women and their babies. Methods: We used protocols for birth registration which also document the extent of exposures to attacks, war remnants and to other environmental risks that allow comparison of 3 data sets—2011, 2016 and 2018–2019 (4000–6000 women in each set). By ICP/MS analysis we determined the content of 23 metals in mothers’ hair. Appropriate statistical analysis was performed. Results: Comparison of data in birth registers showed a major increase in the prevalence in birth defects and preterm babies between 2011 and 2016, respectively from 1.1 to 1.8% and from 1.1 to 7.9%, values remaining stable in 2019. Negative outcomes at birth in 2016 up to 2019 were associated with exposure of the mothers to the attacks in 2014 and/or to hot spots of heavy metals contamination. Metal loads since the attacks in 2014 were consistently high until 2018–2019 for barium, arsenic, cobalt, cadmium, chrome, vanadium and uranium, pointing to these metals as potential inducers for the increased prevalence of negative health outcomes at birth since 2016. Conclusions: Bodily accumulation of metals following exposure whilst residing in attacked buildings predispose women to negative birth outcomes. We do not know if the metals act in synergy. Trial for mitigation of the documented negative effects of high metal load on reproductive health, and ensuing perinatal deaths, could now be done in Gaza, based on this documentary record. High load of heavy metals may explain recent increases in non-communicable diseases and cancers at all ages in Gaza. Modern war’s legacy of diseases and deaths extends in time to populations and demands monitoring.

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The need for an integrated approach for chronic disease research and care in Africa

Global Health Epidemiology and Genomics ◽

10.1017/gheg.2016.16 ◽

2016 ◽

Vol 1 ◽

Cited By ~ 5

Author(s):

A. L. Barr ◽

E. H. Young ◽

L. Smeeth ◽

R. Newton ◽

J. Seeley ◽

...

Keyword(s):

Integrated Approach ◽

Communicable Diseases ◽

Design Strategies ◽

Term Care ◽

Middle Income ◽

Effective Prevention ◽

Non Communicable Diseases ◽

Middle Income Countries ◽

Epidemiological Transitions

With the changing distribution of infectious diseases, and an increase in the burden of non-communicable diseases, low- and middle-income countries, including those in Africa, will need to expand their health care capacities to effectively respond to these epidemiological transitions. The interrelated risk factors for chronic infectious and non-communicable diseases and the need for long-term disease management, argue for combined strategies to understand their underlying causes and to design strategies for effective prevention and long-term care. Through multidisciplinary research and implementation partnerships, we advocate an integrated approach for research and healthcare for chronic diseases in Africa.

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Peritoneal Morphology after Long-Term Peritoneal Dialysis with Biocompatible Fluid: Recent Clinical Practice in Japan

Peritoneal Dialysis International ◽

10.3747/pdi.2010.00234 ◽

2012 ◽

Vol 32 (2) ◽

pp. 159-167 ◽

Cited By ~ 35

Author(s):

Nobuhiro Ayuzawa ◽

Yoshitaka Ishibashi ◽

Yutaka Takazawa ◽

Haruki Kume ◽

Toshiro Fujita

Keyword(s):

Peritoneal Dialysis ◽

Clinical Practice ◽

University Hospital ◽

Dialysis Therapy ◽

Compact Zone ◽

Peritoneal Biopsy ◽

The Mean ◽

The Impact ◽

Peritoneal Morphology

♦BackgroundMorphology changes of the peritoneal membrane after long-term peritoneal dialysis (PD) consist of denudation of peritoneal mesothelial cells, interstitial sclerosis, and hyalinizing vasculopathy. Those changes are considered to be the result of uremia and bioincompatible effects of conventional acidic lactate-buffered dialysate with glucose degradation products (GDPs). In the last decade, biocompatible dialysate with neutral pH and low GDPs has become widely used. Clinical practice has been modified in Japan, especially for anuric patients, and now includes the use of hybrid therapy. The impact on peritoneal morphology has not been well reported.♦ ObjectiveThe aim of the present study was to investigate the long-term effect on peritoneal morphology and function of biocompatible fluid use and current clinical practice in Japan, including hybrid dialysis therapy.♦MethodsWe evaluated peritoneal biopsy specimens from patients who had undergone PD for more than 3 years. We used the average peritoneal thickness (APT) of the submesothelial compact zone as a marker of interstitial sclerosis and the lumen/vessel diameter ratio (L/V ratio) at postcapillary venules as a marker of hyalinizing vasculopathy. Demography and other data for the patients, including dialysate-to-plasma (D/P) ratio of creatinine, were obtained at baseline and every 6 months by peritoneal equilibration test.♦ResultsBetween 2002 and 2009, 110 patients started PD therapy with biocompatible dialysate at Tokyo University Hospital. Among them, 11 patients (8 men, 3 women; age: 54.2 ± 11.8 years; 1 with diabetes mellitus) were enrolled into this morphology study. The mean duration of PD in this group was 61 ± 11.3 months, and the mean time to peritoneal biopsy was 58 ± 15.1 months. The median APT was 180 μm (96 – 1424 μm), and the median L/V ratio was 0.66 (0.46 – 0.74). No obvious correlations between APT, L/V ratio, and PD duration were detected. The D/P creatinine of the 11 patients was maintained at a favorably low value, comparable with that of the other 99 patients.♦ConclusionsPeritoneal dialysis therapy using biocompatible dialysate in conjunction with modification of clinical practice may minimize the progression of peritoneal interstitial sclerosis and hyalinizing vasculopathy, preserving favorable peritoneal function for more than 3 years.

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