Improving guideline-mandated care of patients with implantable cardiac defibrillators

2020 ◽  
Vol 81 (8) ◽  
pp. 1-10
Author(s):  
Daniel Garner ◽  
Matthew Blackburn ◽  
David J Wright ◽  
Archana Rao
Keyword(s):  
Cardiac Death ◽  
State Of Health ◽  
Implantable Cardiac Defibrillator ◽  
Improvement Project ◽  
Disease Trajectory ◽  
Current State ◽  
Audit Data ◽  
Cardiac Centre ◽  
Improve Patient ◽  
Implantable Cardiac Defibrillators

Background/Aims Implantable cardiac defibrillators reduce the risk of sudden cardiac death in selected patients. The value of an implantable cardiac defibrillator declines as the patient's disease progresses. Guidelines suggest that the appropriateness of maintaining implantable cardiac defibrillator therapy be regularly reviewed as part of monitoring of the patient's disease trajectory. It is recommended that implantable cardiac defibrillators are deactivated as patients approach the end of life. Patients with a better understanding of their current state of health and the role that the implantable cardiac defibrillator plays within it are more likely to make informed decisions about the timing of deactivation. Methods: A quality improvement project was undertaken on appropriate deactivation of implantable cardiac defibrillators within a large tertiary cardiac centre. This was driven by audit data showing inadequate patient communication and documentation around deactivation. Drivers for change included the introduction of electronic data records, clinical review of comorbid patients approaching elective battery change and an ongoing forum for patient and carer education. Measured outcomes included the number of deactivations performed, evidence of patient discussion and consent, and timing of deactivation of the implantable cardiac defibrillator. Results There were increased numbers of timely device deactivations undertaken following the interventions with improved documented evidence of patient discussion and consent. The educational forum was received favourably. Conclusions Focused multidisciplinary interventions can impact favourably on appropriate implantable cardiac defibrillator deactivation and improve patient engagement.

scholarly journals Preference measurement in health using experiments

2021 ◽  
Author(s):  
Peter Zweifel
Keyword(s):  
Health Care ◽  
Discrete Choice ◽  
Discrete Choice Experiments ◽  
State Of Health ◽  
Preference Measurement ◽  
Health Econ ◽  
Economic Criterion ◽  
Lay Persons ◽  
Current State ◽  
Treatment Of Diabetes

AbstractThis contribution has three objectives. First, it seeks to justify the use of the economic criterion, “Provision of health care in accordance with the preferences of current and potential patients” for guiding decisions concerning the adoption of costly innovation in health. Next, it proposes the measurement of these preferences in the guise of willingness to pay (WTP) values through Discrete Choice Experiments (DCEs). Third, it purports to examine two popular arguments against accepting lay persons´ preferences, viz. that they are unwilling or unable to express preferences with regard to health and health care, and that their preferences are unstable, depending on the current state of health. Both of these arguments are refuted by the findings of four DCEs designed to measure WTP for attributes of health insurance and of the treatment of diabetes, respectively [Zweifel in J Regul Econ 29(3): 319–332, 2006; MacNeil Vrooman and Zweifel in Eur J Health Econ 12(1): 87–95, 2011; Sennhauser and Zweifel in: Jakovlijevic M (ed.), Health Economics and Policy Challenges in Global Emerging Markets. NOVA Publishers, Hauppauge NY, 2016].

Respiratory gymnastics as a means of strengthening the health of student youth

2021 ◽  
pp. 135-137
Author(s):  
N. Shashlov
Keyword(s):  
Healthy Lifestyle ◽  
Human Life ◽  
Effective Means ◽  
Specific Effect ◽  
The Body ◽  
External Respiration ◽  
State Of Health ◽  
Critical Systems ◽  
Breathing Exercises ◽  
Current State

The article analyzes the current state of health of students of higher education institutions. The importance of breathing exercises for student youth in a pandemic is determined. The necessity of using respiratory techniques to harden the body, improve the work of the respiratory and cardiovascular systems is substantiated. It is established that breathing exercises are a system of breathing exercises and an effective means of strengthening human health. During respiratory gymnastics our body is saturated with oxygen, blood circulation improves, metabolic processes are accelerated, emotional state is stabilized, immunity is strengthened. Breathing exercises improve and activate the function of external respiration, promote its faster recovery after exercise and have a specific effect on some respiratory diseases. Health is the main value of human life, to which man himself does not pay due attention. An important preventive factor in strengthening it is a healthy lifestyle. There are basic requirements for maintaining a healthy lifestyle - physical activity, nutrition, comfortable conditions and a rational mode of work and rest, optimal exercise, abandonment of bad habits, the use of traditional and non-traditional means of health. The problem of health, especially of students, is receiving more and more attention. The state of health of students can be classified as high risk. The transition from one learning environment to another, more intensive, requires the body of the future student to pay more attention to the work of critical systems, including respiratory. There are many issues related to the formation of new approaches to health promotion.

scholarly journals Immunotherapy in gastroesophageal cancers: Current state and future directions

2020 ◽  
pp. 107815522096353
Author(s):  
Hira Shaikh ◽  
Amir Kamran ◽  
Dulabh K Monga
Keyword(s):  
Patient Outcomes ◽  
Molecular Targeted Therapy ◽  
Treatment Options ◽  
Cell Cycle Checkpoints ◽  
Future Directions ◽  
Alternative Strategies ◽  
Current State ◽  
Dismal Prognosis ◽  
The World ◽  
Improve Patient

While gastroesophageal (GE) cancers are one of the most common cancers worldwide, unfortunately, the mortality remains high. Commonly used treatment options include surgical resection, chemotherapy, radiotherapy, and molecular targeted therapy, which improve survival only minimally; thus, affirming the dire need for exploring alternative strategies to improve patient outcomes. Immunotherapy, which has revolutionized the world of oncology, has somewhat lagged behind in GE malignancies. Tumor-associated microenvironment and regulatory T cells, alongside cell cycle checkpoints, have been proposed by various studies as the mediators of carcinogenesis in GE cancers. Thus, inhibition of each of these could serve as a possible target of treatment. While the approval of pembrolizumab has provided some hope, it is not enough to override the dismal prognosis that this disease confers. Herein, we discuss the prospects of immunotherapy in this variety of cancer.

Current state of Health Canada regulation for cellular and gene therapy products: potential cures on the horizon

Cytotherapy ◽  
2019 ◽  
Vol 21 (7) ◽  
pp. 686-698 ◽  
Author(s):  
Jolene Chisholm ◽  
Crystal Ruff ◽  
Sowmya Viswanathan
Keyword(s):  
Gene Therapy ◽  
State Of Health ◽  
Current State ◽  
Health Canada

scholarly journals Quality Initiative Using Theory of Change and Visual Analytics to Improve Controlled Substance Documentation Discrepancies in the Operating Room

2019 ◽  
Vol 10 (03) ◽  
pp. 543-551
Author(s):  
Jenny E. Dolan ◽  
Hannah Lonsdale ◽  
Luis M. Ahumada ◽  
Amish Patel ◽  
Jibin Samuel ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Operating Room ◽  
Visual Analytics ◽  
Theory Of Change ◽  
Free Standing ◽  
Model Framework ◽  
Improvement Project ◽  
Audit Data ◽  
Framework Approach ◽  
Controlled Substance

Background Discrepancies in controlled substance documentation are common and can lead to legal and regulatory repercussions. We introduced a visual analytics dashboard to assist in a quality improvement project to reduce the discrepancies in controlled substance documentation in the operating room (OR) of our free-standing pediatric hospital. Methods Visual analytics were applied to collected documentation discrepancy audit data and were used to track progress of the project, to motivate the OR team, and in analyzing where further improvements could be made. This was part of a seven-step improvement plan based on the Theory of Change with a logic model framework approach. Results The introduction of the visual analytics dashboard contributed a 24% improvement in controlled substance documentation discrepancy. The project overall reduced documentation errors by 71% over the studied period. Conclusion We used visual analytics to simultaneously analyze, monitor, and interpret vast amounts of data and present them in an appealing format. In conjunction with quality-improvement principles, this led to a significant improvement in controlled substance documentation discrepancies.

Pathway to professionalizing health leadership in Canada: The two faces of Janus

2019 ◽  
Vol 33 (1) ◽  
pp. 25-29 ◽  
Author(s):  
Graham Dickson ◽  
John Van Aerde ◽  
Bill Tholl
Keyword(s):  
Social Contract ◽  
Public Services ◽  
State Of Health ◽  
Body Of Knowledge ◽  
Current State ◽  
Health Leadership ◽  
The Future ◽  
Knowledge And Practice ◽  
Do So

This article looks at the current state of health leadership in terms of expectations for professionalism: controlled entry, exit, and licensure/certification; a social contract to provide public services for the good of Canadians; and a unique body of knowledge and practice generally accepted. Looking to the future, and using the same three criteria, a compelling case for pursuing the professionalization of health leadership is made using LEADS as a roadmap. The article also outlines how to realize the professionalization of health leadership in Canada and why it is important to do so.

Expectations for Tinnitus Treatment and Outcomes: A Survey Study of Audiologists and Patients

2018 ◽  
Vol 29 (04) ◽  
pp. 313-336 ◽  
Author(s):  
Fatima T. Husain ◽  
Phillip E. Gander ◽  
Jaclyn N. Jansen ◽  
Sa Shen
Keyword(s):  
Patient Satisfaction ◽  
Treatment Options ◽  
Treatment Success ◽  
Survey Study ◽  
Hierarchical Regression ◽  
Current State ◽  
Tinnitus Treatment ◽  
Definition Of ◽  
Improve Patient ◽  
Scale Format

AbstractRoughly 10–15% of the general population is affected by tinnitus and this percentage is estimated to rise in future. Because there is currently no cure for tinnitus, treatment is limited and is primarily achieved through management of symptoms and counseling.This study compared audiologists’ and patients’ responses to related survey questions about their expectations regarding tinnitus treatment. Two separate surveys were created, one for patients with tinnitus, and one for practicing audiologists who may treat such patients. The surveys included several related questions, such that comparison of the two could reveal where patients’ and audiologists’ expectations for tinnitus care were in agreement and areas in which they differed.The surveys for audiologists and adults with tinnitus were 31- and 38-item questionnaires, respectively. Both surveys comprised demographic questions followed by several tinnitus-related questions in either multiple-choice or Likert-scale format.We received 230 completed Patient Surveys and 68 completed Audiologist Surveys.All survey recruitment was completed online. Responses were collected via the Survey Monkey web tool (http://www.surveymonkey.com/). Responses were analyzed within and between surveys and grouped into topical categories (assessment, counseling, current available tinnitus information, satisfaction and expectations, improving tinnitus management). For data within each survey, descriptive statistics and correlation analyses were used. For selected comparisons between surveys, cross-tabulations were used. Hierarchical regression modeling was conducted to further explore (1) the perceived effectiveness of treatment received, and (2) how each group defined treatment success.Differences were noted between the two groups’ responses to the question on the definition of treatment success; audiologists reported decreased awareness (77%), stress/anxiety relief (63%), and increased knowledge of tinnitus (63%) most commonly, whereas patients reported reduction of tinnitus loudness (63%) and complete elimination of tinnitus (57%) most often. The topic of greatest agreement was the desire for more information on tinnitus; 62% of patients felt more information from their healthcare provider would be the most important factor for improved tinnitus management, and 67% of audiologists reported currently having “some access” or less to appropriate resources for tinnitus treatment. Modeling results for effective tinnitus management and definitions of treatment success highlighted the importance of resource access and information sharing for both audiologists and patients.Patients and audiologists differed in terms of their expectations for successful treatment, with the patients focusing on perceptual factors and the audiologists on the reaction to the sound. Patient satisfaction with tinnitus treatment may be improved through access to more information, specifically, more information about current tinnitus treatment options and how these focus on the patient’s reaction to the tinnitus rather than the percept itself. Providing credible tinnitus information resources to audiologists, and focusing resources on training a small number of tinnitus specialist audiologists could greatly improve patient satisfaction with the current state of tinnitus palliative care.

scholarly journals Current State of Regulatory Oversight of Biosimilars in India and Its Implications on the Quality of Drugs: A Comparative Assessment with EU and FDA Regulations

2021 ◽  
pp. 1-7
Author(s):  
Vikram Gota ◽  
◽  
Diana Varghese ◽  
Shayma Karbelkar ◽  
◽  
...  
Keyword(s):  
Quality Characteristics ◽  
Patient Access ◽  
Approval Process ◽  
Regulatory Oversight ◽  
Medical Needs ◽  
Current State ◽  
The Us ◽  
Improve Patient ◽  
Unmet Medical Needs

Biosimilars are biologic products that are highly similar to a licensed reference biologic, with no clinically meaningful differences in quality characteristics, biological activity, safety, or efficacy. Biosimilars can help to fulfill unmet medical needs due to their cost effectiveness while at the same time being as efficacious as the innovator drug. They can also improve patient access to otherwise costly innovator biologics. India has the largest number of approved biosimilars as compared to the US and Europe. However, the numbers of clinical studies that are conducted to prove the biosimilarity are lesser than the number of biosimilars approved, which is evident by the number of CTRI registrations done. Some studies have shown the quality of biosimilars approved and marketed in India to be inferior to the innovator drug. This raises concerns regarding the quality of the biosimilars. In this review, the similarities and differences in the guidelines, the approval process, and quality enforcement measures prevailing in the three regulatory regions of USA, Europe and India are discussed. Changes in the approval process and post approval monitoring of drugs and manufacturing facilities are recommended in order to ensure sustained quality standards of drugs entering the market.

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