Conceptualizing Narrative Health and Medicine to Develop Cultural Competence to Improve Communication During the COVID-19 Pandemic

2021 ◽  
Vol 8 (1) ◽  
pp. 32-36
Author(s):  
Kent Willis ◽  
Colleen Marzilli
Keyword(s):  
Healthcare Professional ◽  
Cultural Competence ◽  
Severe Acute Respiratory Syndrome ◽  
Patient Care ◽  
Patient Outcomes ◽  
Healthcare Professionals ◽  
Important Concept ◽  
Healthcare Environment ◽  
Health Narrative ◽  
Improve Patient

Narrative health is a technique that healthcare professionals can use to connect with patients. The events of 2020, including the global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have identified that patient care is largely dependent upon relationships within the healthcare environment. Relationships in the healthcare environment are established through a trusting exchange between the patient and provider, and one technique to develop this relationship and trust is through narrative health. Narrative health provides the exchange of information between patient and provider in a discussion-like manner, or narrative health. This strategy promotes cultural competence amongst the healthcare professional team and improves communication between the patient and provider. Narrative health is an important concept for healthcare professionals to understand, and narrative health should be a part of any healthcare professional’s toolbox, especially in vulnerable times like the COVID pandemic. The inclusion of narrative health in practice has the potential to improve patient outcomes and empower healthcare professionals and patients.

Lower extremity osteoarthritis: optimising musculoskeletal health is a growing global concern: a narrative review

2018 ◽  
Vol 53 (13) ◽  
pp. 806-811 ◽  
Author(s):  
Richard D Leech ◽  
Jillian Eyles ◽  
Mark E Batt ◽  
David J Hunter
Keyword(s):  
Patient Outcomes ◽  
Key Management ◽  
Structural Changes ◽  
Healthcare Professionals ◽  
Disease Process ◽  
Evidence Based ◽  
Musculoskeletal Health ◽  
Proactive Approach ◽  
Global Concern ◽  
Improve Patient

The burden of non-communicable diseases, such as osteoarthritis (OA), continues to increase for individuals and society. Regrettably, in many instances, healthcare professionals fail to manage OA optimally. There is growing disparity between the strength of evidence supporting interventions for OA and the frequency of their use in practice. Physical activity and exercise, weight management and education are key management components supported by evidence yet lack appropriate implementation. Furthermore, a recognition that treatment earlier in the disease process may halt progression or reverse structural changes has not been translated into clinical practice. We have largely failed to put pathways and procedures in place that promote a proactive approach to facilitate better outcomes in OA. This paper aims to highlight areas of evidence-based practical management that could improve patient outcomes if used more effectively.

scholarly journals Orthopedic Research: A golden opportunity to improve patient outcomes

2021 ◽  
Vol 55 (3) ◽  
Author(s):  
Site Administrator ◽  
Czar Louie Gaston
Keyword(s):  
Patient Care ◽  
Patient Outcomes ◽  
Fracture Liaison Service ◽  
The Philippines ◽  
Evidence Based ◽  
The Core ◽  
Fracture Liaison Services ◽  
Randomized Controlled ◽  
Fracture Liaison ◽  
Improve Patient

Research has been one of the core pillars of the Department of Orthopedics of the Philippine General Hospital over its now 50 years of existence. The department established one of the earliest resident’s research contests in the hospital in 1983 and its graduates regularly publish in peer reviewed journals and present their results in international conferences.1 Residents are required to complete 2 original studies prior to graduation and encouraged to document their clinical cases fully for future observational studies. Despite the apparent fascination, questions remain for a lot of trainees and clinicians. “Why do research? How does it  help our patients?” Skepticism abounds as even clinically sound and well-made studies oftentimes do not lead to policy and practice changes needed to improve patient care.2 Given contrarian evidence from randomized controlled trials (RCTs), practices of most established surgeons do not change.3 Hope remains however as evidence-based practice in orthopedics is growing and here to stay.4 Surgeons who accurately examine and diagnose their patient, keep medical records, analyze the medical literature for the best treatment, and explain the available options are subconsciously practicing the scientific methods of observation, documentation, analysis, and reporting conclusions which are the basis of all scientific research. Incorporating research education not just to residency training programs but also to continuing medical education (CME) courses for surgeons may help develop the skills to comprehend new studies and incorporate them into patient care. Reassuringly for the elder surgeon, even old dogs have been shown to learn new tricks for their practice, just not as fast as the younger generation.5 The challenge now presented to Philippine medical practitioners is to develop clinical research that will translate into improved care for patients. As majority of literature dictating treatment for musculoskeletal disorders come from developed countries, case series or observational cohorts reporting local data in our setting is greatly important in guiding patient care.6 The fundamental goal is to produce high quality studies or new breakthroughs that engage discussion amongst a wide audience and lead to system changes that eventually enhance patient outcomes.7 As part of the celebration of the PGH Department of Orthopedics 50th golden anniversary, this orthopedic issue of the ACTA MEDICA PHILIPPINA represents work from the different orthopedic subspecialities of the department and its graduates. Pioneering studies on brachial plexus injuries, computer navigated spine surgery, rotationplasty, artificial intelligence, pedagogy, and much more highlight the growth of orthopedics in the Philippines. A study on one of the newest fields in Philippine orthopedics, orthogeriatrics, exemplifies the importance of blazing a new trail. The publication by Reyes et al. on a multidisciplinary orthogeriatric approach to the treatment of fragility hip fractures has shown improved outcomes consistent with the positive results of other fracture liaison services in Asia and worldwide.8,9 Their work has since led to the UPM-PGH Orthogeriatric Multidisciplinary Fracture Management Model and Fracture Liaison Service being adopted by PGH as a clinical pathway and has served as a model for other hospitals in the Philippines to improve their care of patients with fragility hip fractures. With the follow-through from the initial clinical study to administrative and policy changes, this example aptly illustrates the power of research to effect significant improvements in clinical outcomes and inspires all of us to continue to strive for better care for our patients.   Czar Louie Gaston, MD, FPOA Department of Orthopedics Philippine General Hospital University of the Philippines Manila   REFERENCES College of Medicine University of the Philippines Manila. Orthopedics [Internet]. [cited 2021 May]. Available from: https://cm.upm.edu.ph/p/orthopedics/ Buchbinder R, Maher C, Harris IA. Setting the research agenda for improving health care in musculoskeletal disorders. Nat Rev Rheumatol. 2015 Oct;11(10):597-605. doi: 10.1038/nrrheum.2015.81. Epub 2015 Jun 16. PMID: 26077917. Sonntag J, Landale K, Brorson S, Harris IA. Can the results of a randomized controlled trial change the treatment preferences of orthopaedic surgeons? Bone Jt Open. 2020 Sep 11;1(9):549-555. doi: 10.1302/2633-1462.19.BJO-2020-0093.R1. PMID: 33215153; PMCID: PMC7659699. Griffin XL, Haddad FS. Evidence-based decision making at the core of orthopaedic practice. Bone Joint J. 2014 Aug;96-B(8):1000-1. doi: 10.1302/0301-620X.96B8.34614. PMID: 25086112. Niles SE, Balazs GC, Cawley C, Bosse M, Mackenzie E, Li Y, et al. Translating research into practice: is evidence-based medicine being practiced in military-relevant orthopedic trauma? Mil Med. 2015 Apr;180(4):445-53. doi: 10.7205/MILMED-D-14-00296. PMID: 25826350. Elliott IS, Sonshine DB, Akhavan S, Slade Shantz A, Caldwell A, Slade Shantz J, et al. What factors influence the production of orthopaedic research in East Africa? A qualitative analysis of interviews. Clin Orthop Relat Res. 2015 Jun;473(6):2120-30. doi: 10.1007/s11999-015-4254-5. Epub 2015 Mar 21. PMID: 25795030; PMCID:PMC4419000. Tchetchik A, Grinstein A, Manes E, Shapira D, Durst R. From research to practice: Which research strategy contributes more to clinical excellence? Comparing high-volume versus high-quality biomedical research. PLoS One. 2015 Jun 24;10(6):e0129259. doi: 10.1371/journal.pone.0129259. PMID: 26107296; PMCID: PMC4480880. Chang LY, Tsai KS, Peng JK, Chen CH, Lin GT, Lin CH, et al. The development of Taiwan Fracture Liaison Service network. Osteoporos Sarcopenia. 2018 Jun;4(2):47-52. doi: 10.1016/j.afos.2018.06.001. Epub 2018 Jun 7. PMID: 30775542; PMCID: PMC6362955. Barton DW, Piple AS, Smith CT, Moskal SA, Carmouche JJ. The clinical impact of fracture liaison services: A systematic review. Geriatr Orthop Surg Rehabil. 2021 Jan 11;12:2151459320979978. doi: 10.1177/2151459320979978. PMID: 33489430; PMCID: PMC7809296

scholarly journals IMMERSIVE TECHNOLOGIES IN HEALTHCARE TRAINING & EDUCATION: THREE PRINCIPLES FOR PROGRESS

2021 ◽  
Author(s):  
Centre for Immersive Technologies ◽  
Faisal Mushtaq
Keyword(s):  
Patient Outcomes ◽  
Healthcare Professionals ◽  
Open Science ◽  
Human Behaviour ◽  
Research Practices ◽  
Rigorous Evaluation ◽  
Industry Policy ◽  
Improve Patient ◽  
Healthcare Training ◽  
Immersive Technologies

THIS REPORT HIGHLIGHTS 3 PRINCIPLESTHROUGH WHICH PROGRESS IN THIS AREA CANBE ACCELERATED. THESE PRINCIPLES ARE:1. The design and development of immersive tools thatare driven by learning requirements, and informedby the science of human behaviour and cognition.2. Rigorous evaluation prior to, and during implementationof immersive technologies into the healthcare systemthrough open science and transparent research practices.3. Principles 1 and 2 are best achieved by fostering aculture of collaboration, inclusivity and solidarity betweendevelopers, educators, scientists, industry, policy makersand healthcare professionals to maximise uptake,accelerate learning and improve patient outcomes.

scholarly journals Screening four broad categories of eating disorders: suitability of a clinical algorithm adapted from the SCOFF questionnaire

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Marie-Pierre Tavolacci ◽  
André Gillibert ◽  
Aurélien Zhu Soubise ◽  
Sébastien Grigioni ◽  
Pierre Déchelotte
Keyword(s):  
Body Mass Index ◽  
Eating Disorders ◽  
Patient Outcomes ◽  
Healthcare Professionals ◽  
Youden Index ◽  
Clinical Algorithm ◽  
Dsm 5 ◽  
Sensitivity Specificity ◽  
Improve Patient ◽  
Scoff Questionnaire

Abstract Background We evaluated the performance of a clinical algorithm (Expali™), combining two or more positive answers to SCOFF questionnaire with Body Mass Index (BMI), to identify four Broad Categories of eating disorders (ED) derived from DSM-5. Methods The clinical algorithm (Expali™) was developed from 104 combinations of BMI levels and answers to five SCOFF questions with at least two positive answers. Two senior ED physicians allocated each combination to one of the four Broad Categories of ED derived from DSM-5: restrictive disorder, bulimic disorder, hyperphagic disorder and other unspecified ED diagnosed by ED clinicians. The performance of Expali™ was evaluated on data from 206 patients with ED. Sensitivity, specificity values and Youden index were calculated for each category. Results The 206 patients were diagnosed as follows: 31.5% restrictive disorder, 18.9% bulimic disorder, 40.8% hyperphagic disorder and 8.8% other ED. The sensitivity of Expali™ for restrictive, bulimic, hyperphagic and other unspecified ED were respectively: 76.9, 69.2, 79.7 and 16.7%. The Youden index was respectively 0.73, 0.57, 0.67 and 0.07. Conclusions In a SCOFF-positive ED population (at least two positive answers), the clinical algorithm Expali™ demonstrated good suitability by correctly classifying three of the four Broad Categories of eating disorders (restrictive, bulimic and hyperphagic disorder). It could be useful both to healthcare professionals and the general population to enable earlier detection and treatment of ED and to improve patient outcomes.

Effects of a transsphenoidal surgery quality improvement program on patient outcomes and hospital financial performance

2021 ◽  
pp. 1-10
Author(s):  
Christina E. Sarris ◽  
Scott T. Brigeman ◽  
Estelle Doris ◽  
Maggie Bobrowitz ◽  
Thomas Rowe ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Financial Performance ◽  
Patient Care ◽  
Patient Outcomes ◽  
Transsphenoidal Surgery ◽  
Pituitary Surgery ◽  
Care Pathways ◽  
Improvement Program ◽  
Hospital Financial Performance ◽  
Improve Patient

OBJECTIVE A comprehensive quality improvement (QI) program aimed at all aspects of patient care after pituitary surgery was initiated at a single center. This initiative was guided by standard quality principles to improve patient outcomes and optimize healthcare value. The programmatic goal was to discharge most elective patients within 1 day after surgery, improve patient safety, and limit unplanned readmissions. The program is described, and its effect on patient outcomes and hospital financial performance over a 5-year period are investigated. METHODS Details of the patient care pathway are presented. Foundational elements of the QI program include evidence-based care pathways (e.g., for hyponatremia and pain), an in-house research program designed to fortify care pathways, patient education, expectation setting, multidisciplinary team care, standard order sets, high-touch postdischarge care, outcomes auditing, and a patient navigator, among other elements. Length of stay (LOS), outcome variability, 30-day unplanned readmissions, and hospital financial performance were identified as surrogate endpoints for healthcare value for the surgical epoch. To assess the effect of these protocols, all patients undergoing elective transsphenoidal surgery for pituitary tumors and Rathke’s cleft cysts between January 2015 and December 2019 were reviewed. RESULTS A total of 609 adult patients who underwent elective surgery by experienced pituitary surgeons were identified. Patient demographics, comorbidities, and payer mix did not change significantly over the study period (p ≥ 0.10). The mean LOS was significantly shorter in 2019 versus 2015 (1.6 ± 1.0 vs 2.9 ± 2.2 midnights, p < 0.001). The percentage of patients discharged after 1 midnight was significantly higher in 2019 versus 2015 (75.4% vs 15.6%, p < 0.001). The 30-day unplanned hospital readmission rate decreased to 2.8% in 2019 from 8.3% in 2015. Per-patient hospital profit increased 71.3% ($10,613 ± $19,321 in 2015; $18,180 ± $21,930 in 2019), and the contribution margin increased 42.3% ($18,925 ± $19,236 in 2015; $26,939 ± $22,057 in 2019), while costs increased by only 3.4% ($18,829 ± $6611 in 2015; $19,469 ± $4291 in 2019). CONCLUSIONS After implementation of a comprehensive pituitary surgery QI program, patient outcomes significantly improved, outcome variability decreased, and hospital financial performance was enhanced. Future studies designed to evaluate disease remission, patient satisfaction, and how the surgeon learning curve may synergize with other quality efforts may provide additional context.

scholarly journals Lyme Disease Training and Knowledge Translation Resources Available to Canadian Healthcare Professionals: A Gray Literature Review

2021 ◽  
Vol 12 ◽  
pp. 215013272110507
Author(s):  
Angela M. Coderre-Ball ◽  
Sania Sahi ◽  
Vanessa Anthonio ◽  
Madison Roberston ◽  
Rylan Egan
Keyword(s):  
Lyme Disease ◽  
Literature Review ◽  
Patient Outcomes ◽  
Healthcare Professionals ◽  
Diagnosis And Treatment ◽  
Gray Literature ◽  
Tick Borne Disease ◽  
Flow Charts ◽  
Improve Patient ◽  
Canadian Healthcare

Introduction: Lyme Disease (LD) is the most common tick-borne disease in North America. With the number of cases increasing yearly, Canadian healthcare professionals (HCP) rely on up-to-date and evidence-informed guidelines, instruction, and resources to effectively prevent, diagnose, and treat Lyme disease (LD). This review is the first of its kind to examine gray literature and analyze the diversity of recommendations provided to Canadian HCP about the prevention, diagnosis, and treatment of Lyme disease. Methods: A gray literature review consisting of 4 search strategies was conducted to retrieve materials targeted to Canadian HCP. Searches within targeted websites, targeted Google searches, and gray literature databases, and consultation with content experts were done to look for continuing medical education (CME) events, clinical flow charts, webinars, videos, and reference documents that discussed the prevention, diagnosis, and treatment of Lyme disease. Results: A total of 115 resources were included in this study. Recommendations surrounding prevention strategies were less varied between materials, whereas diagnosis and treatment recommendations were more varied. Our findings suggest that Canadian HCP are met with varying and sometimes contradictory recommendations for diagnosing and treating LD. Conclusions: Due to the increasing incidence of LD in Canada, there is a greater need for resource consistency. Providing this consistency may help mitigate LD burden, standardize approaches to prevention, diagnosis and treatment, and improve patient outcomes.

scholarly journals The Healthcare and Technology Synergy (HATS) Model for Practice and Research

2018 ◽  
Vol 3 (2) ◽  
Keyword(s):  
Patient Care ◽  
Patient Outcomes ◽  
Bloodstream Infections ◽  
Care Patient ◽  
The Past ◽  
Healthcare Environment ◽  
Urinary Infections ◽  
Practice Approach ◽  
Care Outcomes ◽  
Seminal Article

Background: Research models that include a focus on technologies or products are critical in today,s healthcare environment. The Healthcare and Technology Synergy (HATS) model represents a synergy between three major variables, patient, product and practice, with each one affecting and being affected by the other. These variables exist within a total healthcare environment and are applicable to research in the professions of allied health, medicine and nursing. Problem: To understand and review the use of the Healthcare and Technology Synergy (HATS) model in research and practice. Approach: Models that include products can aid in evidence-based research that is translatable to patient care, patient outcomes and cost effectiveness. Outcome: In the past 5 years, five countries (Australia, Canada, China, Ireland, United States) showed interest in the model, with 143 total views of the seminal article, and 5 research studies from medicine and nursing have used the HATS model. Conclusion: Patient, product, and practice are of paramount importance in many areas of research such as bloodstream infections, urinary infections, ventilator assisted pneumonia, safety, and patient and product outcomes. Using the HATS model can strengthen research outcomes, aid in the prioritization of research agendas, establish evidencebased practice guidelines, and help in evaluating patient care outcomes.

scholarly journals Pro: Access to advanced therapies for severe asthma should be restricted to patients with satisfactory adherence to maintenance treatment

Breathe ◽  
2021 ◽  
Vol 17 (2) ◽  
pp. 210024
Author(s):  
Anna C. Murphy ◽  
Claire Boddy ◽  
Peter Bradding
Keyword(s):  
Patient Outcomes ◽  
Healthcare Professionals ◽  
Inhaled Corticosteroids ◽  
Self Management ◽  
Asthma Treatment ◽  
Biologic Therapies ◽  
Core Component ◽  
The Core ◽  
Advanced Therapies ◽  
Improve Patient

Inhaled corticosteroids (ICS) are the core component of asthma treatment and the only maintenance therapy known to prevent asthma death. There is currently no evidence that biologics prevent asthma death in people with asthma, and as such, biologics cannot be recommended as an alternative to ICS therapy. Taking the time to assess adherence and provide interventions and education to support patients in asthma self-management has been shown to improve patient outcomes. It is therefore our responsibility as healthcare professionals to ensure that patients are supported, educated and motivated to adhere to ICS therapy before progressing to biologic therapies.

Current Healthcare Climate: What Does it Mean for SLPs Managing Patients With Dysphagia?

2015 ◽  
Vol 24 (1) ◽  
pp. 5-11 ◽  
Author(s):  
Nancy Swigert
Keyword(s):  
Patient Care ◽  
Patient Outcomes ◽  
Swallowing Disorders ◽  
Direct Patient Care ◽  
Healthcare Team ◽  
Speech Language Pathologists ◽  
Improve Efficiency ◽  
Healthcare Environment ◽  
Important Member ◽  
Implementing Strategies

In every setting, as a result of the changes in reimbursement, speech-language pathologists (SLPs) need to re-think how services are provided to patients with dysphagia and feeding/swallowing disorders. In addition to implementing strategies to increase efficiency (and thus productivity), SLPs must understand the changes in the healthcare environment. It is advisable that they explore ways to make their services valuable to their facility in addition to direct patient care. It is also recommended that SLPs familiarize themselves with the challenges the facility faces and consider ways they can help the facility meet those challenges. They should seek to continually improve efficiency while keeping an eye on achieving patient outcomes and providing value. In this way, the SLP can remain an important member of the healthcare team.

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