Browsing by Subject "CARE"

Now showing 1 - 6 of 6

Open Access
American Society for Enhanced Recovery: Advancing Enhanced Recovery and Perioperative Medicine.
(Anesthesia and analgesia, 2018-06) Gan, Tong J; Scott, Michael; Thacker, Julie; Hedrick, Traci; Thiele, Robert H; Miller, Timothy E
As the population ages, the increasing surgical volume and complexity of care are expected to place additional care delivery burdens in the perioperative setting. In this age of integrated multidisciplinary care of the surgical patients, there is increasing recognition that an evidence-based perioperative pathway is associated with the optimal outcomes. These pathways, collectively referred to as Enhanced Recovery Pathways, have resulted in shortened length of hospital stay, reduced complications, and variance in outcomes, as well as earlier return to baseline activities. The American Society for Enhanced Recovery (ASER) is a multispecialty, nonprofit international organization, dedicated to the practice of enhanced recovery in perioperative patients through education and research. Perioperative Quality Initiatives were formed whose intent is to organize a series of consensus conferences on topics of interest related to perioperative medicine. The journal affiliation between American Society for Enhanced Recovery and Anesthesia & Analgesia will enable these evidence-based practices to be disseminated widely and swiftly to the practicing perioperative health care professionals so they can be adopted to improve the quality of perioperative surgical care.
Open Access
Estimating willingness to pay: Do health and environmental researchers have different methodological standards?
(Applied Economics, 2013-06-01) Özdemir, S; Johnson, FR
Health and environmental economists have been employing Stated-Preference (SP) methods such as conjoint analysis or contingent valuation to estimate the monetary value of public health interventions and environmental goods and services. However, the quality of data and the validity of results are sensitive to a number of decisions researchers make. The aim of this study is to compare the degree of the current consensus among active researchers in the rapidly evolving area of SP methods in health and environmental valuation. We surveyed researchers who have published manuscripts on SP methods in the last 10 years. Researchers were presented with hypothetical SP studies with different attributes. They were first asked which study they would recommend to use to inform policy decisions, and then asked which study has better-quality. Our results show that good-practice SP methods vary among study features and among researchers with different amounts and kinds of research experience. Although health researchers had specific preferences on which study features were better, their quality judgements were not very consistent with their judgements about the acceptability of studies for policy analysis. On the other hand, environmental researchers had similar preferences over the study attributes for the two types of questions. © 2012 Copyright Taylor and Francis Group, LLC.
Open Access
Projecting the Number of Elderly with Cognitive Impairment in China Using a Multi-State Dynamic Population Model
(System Dynamics Review, 2017-04-01) Ansah, JP; Koh, V; Chiu, CT; Chei, CL; Zeng, Y; Yin, ZX; Shi, XM; Matchar, DB
China is aging rapidly, and the number of Chinese elderly with dementia is expected to rise. This paper projects, up to year 2060, the number of Chinese elderly within four distinct cognitive states. A multi-state population model was developed using system dynamics and parametrized with age–gender-specific transition rates (between intact, mild, moderate and severe cognitive impairment and death) estimated from two waves (2012 and 2014) of a community-based cohort of elderly in China aged ≥65 years (N = 1824). Probabilistic sensitivity analysis and the bootstrap method was used to obtain the 95% confidence interval of the transition rates. The number of elderly with any degree of cognitive impairment increases; with severe cognitive impairment increasing the most, at 698%. Among elderly with cognitive impairment, the proportion of very old elderly (age ≥ 80) is expected to rise from 53% to 78% by 2060. This will affect the demand for social and health services China. Copyright © 2017 System Dynamics Society.
Open Access
Rapid, Sample-to-Answer Host Gene Expression Test to Diagnose Viral Infection
(Open Forum Infectious Diseases, 2019-11-01) Tsalik, Ephraim L; Khine, Ayeaye; Talebpour, Abdossamad; Samiei, Alaleh; Parmar, Vilcy; Burke, Thomas W; Mcclain, Micah T; Ginsburg, Geoffrey S; Woods, Christopher W; Henao, Ricardo; Alavie, Tino
Abstract Background Distinguishing bacterial, viral, or other etiologies of acute illness is diagnostically challenging with significant implications for appropriate antimicrobial use. Host gene-expression offers a promising approach although no clinically useful tests have yet been developed to accomplish this. Here, Qvella’s FAST™ HR process was developed to quantify previously identified host gene-expression signatures in whole blood in <45 minutes. Methods Whole blood was collected from 128 human subjects (mean age 47, range 18-88) with clinically adjudicated, microbiologically confirmed viral infection, bacterial infection, non-infectious illness, or healthy controls. Stabilized mRNA was released from cleaned and stabilized RNA-surfactant complexes using e-lysisTM, an electrical process providing a qRT-PCR-ready sample. Threshold cycle values (CT) for 10 host response targets were normalized to HPRT1 expression, a control mRNA. The transcripts in the signature were specifically chosen to discriminate viral from non-viral infection (bacterial, non-infectious illness, or healthy). Classification accuracy was determined using cross-validated sparse logistic regression. Results Reproducibility of mRNA quantification was within 1 cycle as compared to the difference seen between subjects with viral vs. non-viral infection (up to 5.0 normalized CT difference). Classification of 128 subjects into viral or non-viral etiologies demonstrated 90.6% overall accuracy compared to 82.0% for procalcitonin (p=0.06). FASTTM HR achieved rapid and accurate measurement of the host response to viral infection in less than 45 minutes. Conclusions These results demonstrate the ability to translate host gene expression signatures to clinical platforms for use in patients with suspected infection.
Open Access
Suicide and substance use among female veterans: A need for research
(Drug and Alcohol Dependence, 2013) Chapman, SLC; Wu, L-T
Background: The number of female veterans is increasing. Veterans Administration (VA) enrollment increased over 40% from past eras. However, little research has focused on their mental health. We reviewed literature to examine associations of substance use with suicide in female veterans, identify research gaps, and inform future studies. Methods: Google Scholar, Pub Med, and PsychINFO were searched using: substance use, female veteran, and suicide. Exclusion criteria (e.g., not discussing U.S. veterans) left 17 articles. Results: Nine studies examined completed suicide among veterans. In most recent years, rates of deaths were greater for veterans than nonveterans, including females. Completed suicide was associated with past trauma, young age, and a mental disorder. Studies have often not addressed substance use. Three studies examined completed suicide among VA treated veterans without examining substance use as an associated factor. Rates of completed suicides were also higher among veterans than nonveterans, including females. A large proportion of females also had a mental diagnosis. Five studies examined substance use and attempted or completed suicide among VA treated veterans. Veterans in poor mental health had increased odds of suicide mortality; women with a substance use disorder (SUD) had a higher hazard ratio for completed suicide than men with a SUD. Engagement in substance abuse treatment decreased odds of suicide attempt among veterans. Conclusion: Available data suggest that suicide rates are higher among female veterans than women in the general population. Substance use may increase the likelihood of suicidal behaviors among female veterans, particularly those with a mental diagnosis. © 2013 Elsevier Ireland Ltd. All rights reserved.
Open Access
Trajectories of functional ability over the life course: a conceptual model of the interaction of stressor-induced functional loss and resilience.
(System dynamics review, 2018-10) Matchar, David B; Ansah, John P; Koh, Victoria; Whitson, Heather E
Understanding the factors that influence functional ability over the life course is integral to identifying clinical and public health policies to facilitate successful aging. The World Health Organization has advocated a conceptual framework to clarify the policy discussion. We have sought to translate this general framework into an explicit system dynamics model of the interaction of physiological loss, stressors and endogenous responses to produce a familiar variety of trajectories of functional ability over the life courses. Simulation experiments were implemented for both a 30-month duration with only one major stressor; and for the life course with an initial major stressor and subsequent stressors determined by the level of functional ability. For both contexts, variations in the few parameters in the scenarios led to a realistic range of trajectories of function over time.