Patient and family engagement (PFE) has been defined as a partnership between patients, families, and health care providers to achieve positive health care outcomes. There is evidence that PFE is ...critical to improving outcomes. We sought to systematically identify and map the evidence on PFE strategies for adults with chronic conditions and identify areas needing more research.
We searched PubMed, CINAHL, EMBASE, and Cochrane, January 2015 to September 2021 for systematic reviews on strategies for engaging patients with chronic conditions and their caregivers. From each review, we abstracted search dates, number and type of studies, populations, interventions, and outcomes. PFE strategies were categorized into direct patient care, health system, and community-policy level strategies. We found few systematic reviews on strategies at the health system, and none at the community-policy level. In view of this, we also searched for original studies that focused on PFE strategies at those two levels and reviewed the PFE strategies used and study findings.
We found 131 reviews of direct patient care strategies, 5 reviews of health system strategies, and no reviews of community-policy strategies. Four original studies addressed PFE at the health system or community-policy levels. Most direct patient care reviews focused on self-management support (SMS) (n = 85) and shared decision-making (SDM) (n = 43). Forty-nine reviews reported positive effects, 35 reported potential benefits, 37 reported unclear benefits, and 4 reported no benefits. Health system level strategies mainly involved patients and caregivers serving on advisory councils. PFE strategies with the strongest evidence focused on SMS particularly for patients with diabetes. Many SDM reviews reported potential benefits especially for patients with cancer.
Much more evidence exists on the effects of direct patient care strategies on PFE than on the effects of health system or community-policy strategies. Most reviews indicated that direct patient care strategies had positive effects or potential benefits. A limitation of this evidence map is that due to its focus on reviews, which were plentiful, it did not capture details of individual interventions. Nevertheless, this evidence map should help to focus attention on gaps that require more research in efforts to improve PFE.
The chloro and pyridinate derivatives of rhenium(I) tricarbonyl complexes containing the diimine ligands 2,2‘-bipyrazine (bpz) and 5,5‘-dimethyl-2,2‘-bipyrazine (Me2bpz) are reported. Absorption ...maxima occur in the visible and ultraviolet regions of the spectrum; emission is structureless at room temperature and at 77 K; the infrared spectrum consists of three carbonyl stretches; electrochemically, a reversible reduction, an irreversible reduction, and an irreversible oxidation take place. Some ring protons are shielded and others deshielded in the presence of the methyl substituents attached to the bpz ring. DFT and TDDFT calculations provide insight into interpreting electronic and vibrational properties of the complexes. When compared to similar rhenium(I) tricarbonyl complexes of 2,2‘-bipyridine (bpy) and 2,2‘-bipyrimidine (bpm), the Me2bpz complexes are comparable to bpm derivatives and their properties are intermediate between those of bpy and bpz complexes.
Lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual (LGBTQIA+) individuals face barriers to equitable health care access. During clinical encounters, LGBTQIA+ individuals ...interact with nurses and health care providers who often lack a thorough understanding of LGBTQIA+ cultures, terminology, and strategies for culturally affirming care. This article details the process undertaken to include LGBTQIA+ health elective courses.
To outline LGBTQIA+ health education, a curriculum crosswalk was conducted. Course descriptions, objectives, and outcomes were crafted with faculty input. Priority LGBTQIA+ areas were analyzed, and textbook content was cross-referenced to identify topics for inclusion.
In Spring 2022, two LGBTQIA+ courses were launched. Undergraduate students at New York University Meyers (
= 27) and undergraduate and graduate students at the University of Pennsylvania (
= 18) comprised the inaugural classes.
LGBTQIA+ individuals experience poorer health outcomes due to longstanding health inequities. These disparities are partly fueled by the minimal exposure nursing students receive in their undergraduate education. Guidelines on the development of courses designed to highlight needs may address disparities, leading to better health outcomes.
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•Patient and family engagement is important for patient and family-centered care.•Best practices for engagement of pediatric chronic disease are needed.•Direct care strategies focus on ...self-management support and shared decisionmaking.•Asthma is the most frequently studied condition for direct care strategies.•More research on engagement is needed at the health system and community levels.
Patient and family engagement is important for family-centered care, particularly for children and adolescents with chronic disease. We aimed to 1) identify available evidence from systematic reviews on engagement strategies used to help children, adolescents, and their caregivers manage chronic conditions, and 2) identify gaps in the literature.
We searched PubMed and CINAHL from January 2015 to January 2020 for systematic reviews on patient and family engagement strategies in the pediatrics population (<18 years). Strategies were categorized by direct patient care, health system, and community policy levels. We excluded reviews if interventions were unidirectional or without comparison.
We identified 25 systematic reviews. Twenty-two evaluated direct patient care, with 14 (279 unique studies) exclusively in pediatrics and 8 (24 unique studies) that included pediatric results with adults. Three reviews (9 unique studies) evaluated health system strategies. Direct patient care reviews focused on self-management support (n = 16) and shared decisionmaking (n = 6). Asthma was the most frequently evaluated condition (n = 14).
Engagement strategies for children and adolescents with chronic disease are focused on direct patient care, particularly for asthma. More research is needed to address engagement for broader populations, expanded outcomes, and at health system and community levels.
We addressed the problem of developing a model to simulate at a high level of detail the movements of over 6,000 drivers for Schneider National, the largest truckload motor carrier in the United ...States. The goal of the model was not to obtain a better solution but rather to closely match a number of operational statistics. In addition to the need to capture a wide range of operational issues, the model had to match the performance of a highly skilled group of dispatchers while also returning the marginal value of drivers domiciled at different locations. These requirements dictated that it was not enough to optimize at each point in time (something that could be easily handled by a simulation model) but also over time. The project required bringing together years of research in approximate dynamic programming, merging math programming with machine learning, to solve dynamic programs with extremely high-dimensional state variables. The result was a model that closely calibrated against real-world operations and produced accurate estimates of the marginal value of 300 different types of drivers.
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BFBNIB, CEKLJ, DOBA, IZUM, KILJ, NMLJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Improved survival in patients with advanced cancer has increased the need for better understanding of how to manage common symptoms that they may experience, such as breathlessness.
To assess the ...benefits and harms associated with pharmacologic interventions for breathlessness in adults with advanced cancer.
PubMed, Embase, CINAHL, Web of Science, and the Cochrane Central Register of Controlled Trials were searched for studies published from database inception through May 31, 2020, using predefined eligibility criteria within a PICOTS (population, intervention, comparator, outcome, timing, setting) format.
Randomized clinical trials (RCTs), non-RCTs, and observational studies with a comparison group that evaluated benefits and/or harms and cohort studies that reported harms were selected.
Two reviewers independently screened studies for eligibility, serially abstracted data, independently assessed risk of bias, and graded strength of evidence (SOE).
Benefits and harms of pharmacologic interventions were compared, focusing on breathlessness, anxiety, exercise capacity, and health-related quality of life. When possible, meta-analyses were conducted and standardized mean differences (SMDs) calculated.
In this systematic review and meta-analysis, a total of 7729 unique citations were identified, of which 19 studies (17 RCTs and 2 retrospective studies) that included a total of 1424 patients assessed the benefits of medications for management of breathlessness in advanced cancer or reported harms. The most commonly reported type of cancer was lung cancer. Opioids were not associated with more effectiveness than placebo for improving breathlessness (SMD, -0.14; 95% CI, -0.47 to 0.18) or exercise capacity ( SMD, 0.06; 95% CI, -0.43 to 0.55) (SOE, moderate); most studies examined exertional breathlessness. Specific dose and/or route of administration of opioids did not differ in effectiveness for breathlessness (SMD, 0.15; 95% CI, -0.22 to 0.52) (SOE, low). Anxiolytics were not associated with more effectiveness than placebo for breathlessness or anxiety (reported mean between-group difference, -0.52; 95% CI, -1.045 to 0.005) (SOE, low). Evidence for other pharmacologic interventions was limited. Pharmacologic interventions demonstrated some harms compared with usual care, but dropout attributable to adverse events was minimal in these short-term studies (range 3.2%-16%).
Evidence did not support the association of opioids or other pharmacologic interventions with improved breathlessness. Given that studies had many limitations, pharmacologic interventions should be considered in selected patients but need to be considered in the context of potential harms and evidence of an association of nonpharmacologic interventions with improved breathlessness.
A Reader on Preaching Day, David; Astley, Jeff; Francis, Revd Canon Leslie J ...
2005, 20170908, 2017, 2017-09-08
eBook
iEvery Sunday all over the world people rise up and claim to speak in the name of God. It is an astonishing thing to do and an astonishing claim to make. It is small wonder that the sermon has been ...the focus of debate, discussion and investigation. It has been dismissed as irrelevant in today's culture and has become the butt of numerous jokes and caricatures. Yet the claim persists that these human words in some way can become God's message to these hearers.
This collection of twenty-nine articles by international experts in the area of homiletics coincides with the revival of interest in preaching over the last twenty-five years. It is practical without being merely tips for preachers; and it offers the necessary theoretical discussion for anyone who wants to take the art of preaching seriously. No important issue has been omitted and, taken as a whole, the book constitutes a first class introduction to the principles, processes, context and theology of preaching.
Contributors include: Walter Brueggemann, David Buttrick, Fred Craddock, Edward Farley, John Killinger, Richard Lischer, Thomas Long, Elaine Lawless, Jolyon Mitchell, Cheryl Sanders and Thomas Troeger.
Breathlessness is a frequent and debilitating symptom in patients with advanced cancer. Often, in the context of breathlessness, aggressive cancer treatment is not beneficial, feasible, or aligned ...with goals of care. Targeted symptom-focused interventions may be helpful in this scenario.
To evaluate the advantages and harms of nonpharmacological interventions for managing breathlessness in adults with advanced cancer.
PubMed, Embase, CINAHL, Web of Science, and the Cochrane Central Register of Controlled Trials were searched from inception through May 2020 for published randomized clinical trials (RCTs), nonrandomized controlled trials, and observational studies of the advantages and/or harms of nonpharmacological interventions on alleviating breathlessness in adults with advanced cancer. Only English-language studies were screened for eligibility, titles, abstracts, and full text. Risk of bias and strength of evidence (SOE) were independently assessed. The key outcomes reported in studies were breathlessness, anxiety, exercise capacity, health-related quality of life, and harms. Data were analyzed from October 1, 2019, to June 30, 2020.
A total of 29 RCTs (2423 participants) were included. These RCTs evaluated various types of interventions, such as respiratory (9 RCTs), activity and rehabilitation (7 RCTs), behavioral and psychoeducational (3 RCTs), integrative medicine (4 RCTs), and multicomponent (6 RCTs). Several nonpharmacological interventions were associated with improved breathlessness, including fan therapy (standardized mean difference SMD, -2.09; 95% CI, -3.81 to -0.37; I2 = 94.3%; P for heterogeneity = .02; moderate SOE) and bilevel ventilation (estimated slope difference, -0.58; 95% CI, -0.92 to -0.23; low SOE), lasting for a few minutes to hours, in the inpatient setting. In the outpatient setting, nonpharmacological interventions associated with improved breathlessness were acupressure and reflexology (integrative medicine) (low SOE) and multicomponent interventions (combined activity and rehabilitation, behavioral and psychoeducational, and integrative medicine) (low SOE) lasting for a few weeks to months. Five of the 29 RCTs (17%) reported adverse events, although adverse events and study dropouts were uncommon.
Findings of this review include the safety and association with improved breathlessness of several nonpharmacological interventions for adults with advanced cancer. Guidelines and clinical practice should evolve to incorporate nonpharmacological interventions as first-line treatment for adults with advanced cancer and breathlessness.
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