Communicating about the management of medications as patients move across transition points of care: an observation and interview study

RATIONALE, AIMS AND OBJECTIVES: As patients move across transition points, effective medication management is critical for patient safety. The aims of this study were to examine how health professionals, patients and family members communicate about managing medications as patients moved across transition points of care and to identify possible sources of communication failure.

METHOD: A descriptive approach was used involving observations and interviews. The emergency departments and medical wards of two hospitals were involved. Observations focused on how health professionals managed medications during interactions with other health professionals, patients and family members, as patients moved across clinical settings. Follow-up interviews with participants were also undertaken. Thematic analysis was completed of transcribed data, and descriptive statistics were used to analyse characteristics of communication failure.

RESULTS: Three key themes were identified: environmental challenges, interprofessional relationships, and patient and family beliefs and responsibilities. As patients moved between environments, insufficient tracking occurred about medication changes. Before hospital admission, patients participated in self-care medication activities, which did not always involve exemplary behaviours or match the medications that doctors prescribed. During observations, 432 instances of communication failure (42.8%) were detected, which related to purpose, content, audience and occasion of the communication.

CONCLUSIONS: Extensive challenges exist involving the management of medications at transition points of care. Bedside handovers and ward rounds can be utilized as patient counselling opportunities about changes in the medication regimen. Greater attention is needed on how patients in the community make medication-related decisions.

Patient engagement in clinical communication: an exploratory study

AIM: Existing practice strategies for actively involving patients in care during hospitalisation are poorly understood. The aim of this study was to explore how healthcare professionals engaged patients in communication associated with care transitions.

METHOD: An instrumental, collective case study approach was used to generate empirical data about patient transitions in care. A purposive sample of key stakeholders representing (i) patients and their families; (ii) hospital discharge planning team members; and (iii) healthcare professionals was recruited in five Australian health services. Individual and group semi-structured interviews were conducted to elicit detailed explanations of patient engagement in transition planning. Interviews lasted between 30 and 60 minutes and were digitally recorded and transcribed verbatim. Data collection and analysis were conducted simultaneously and continued until saturation was achieved. Thematic analysis was undertaken.

RESULTS: Five themes emerged as follows: (i) organisational commitment to patient engagement; (ii) the influence of hierarchical culture and professional norms on patient engagement; (iii) condoning individual healthcare professionals' orientations and actions; (iv) understanding and negotiating patient preferences; and (v) enacting information sharing and communication strategies. Most themes illustrated how patient engagement was enabled; however, barriers also existed.

CONCLUSION: Our findings show that strong organisational and professional commitment to patient-centred care throughout the organisation was a consistent feature of health services that actively engaged patients in clinical communication. Understanding patients' needs and preferences and having both formal and informal strategies to engage patients in clinical communication were important in how this involvement occurred.

How calls from carers, friends and family members of someone affected by cancer differ from those made by people diagnosed with cancer; analysis of 4 years of South Australian Cancer Council Helpline data

PURPOSE: The purpose of this study is to determine how people diagnosed with cancer who call the Cancer Council Helpline in South Australia differ from carers/family/friends (caregivers) who call. METHOD: Descriptive, retrospective audit of calls from people who contacted Cancer Council Helpline in South Australia between 16 April 2009 and 16 April 2013 who were diagnosed with cancer (n = 5766) or were the caregivers (n = 5174) of a person with cancer. RESULTS: Caregivers were more likely to be female (p < 0.001); younger in age (p < 0.001); call regarding cancer that was metastasised/widespread/advanced, terminal or at an unknown stage (p < 0.001) and phone requesting general cancer information or emotional support (p < 0.001). This group was more distressed (p < 0.001) but less likely (p = 0.02) to be offered and/or accept referrals to counselling than people diagnosed with cancer who called. Follow-up care was required by 63.5 % of caregivers and 73.1 % of people with cancer according to distress management guidelines; 8.5 and 15.3 %, respectively, accepted referrals to internal services. The most frequently discussed topic for both groups was emotional/psychological concerns. There were no differences in remoteness of residence or call length between groups. CONCLUSIONS: Caregivers represented different demographic groups than people diagnosed with cancer who called this helpline. The two groups phoned for different issues, at different stages of disease progression, displayed different levels of distress and, therefore, may benefit from services being tailored to meet their unique needs. These results also demonstrate the capacity of helplines to complement other health services and confirm that callers to cancer helplines exhibit high levels of distress.

Essays on decision sciences: exploring cognition, information processing, and complexity

This thesis provides three original contributions to the field of Decision Sciences. The first contribution explores the field of heuristics and biases. New variations of the Cognitive Reflection Test (CRT--a test to measure "the ability or disposition to resist reporting the response that first comes to mind"), are provided. The original CRT (S. Frederick [2005] Journal of Economic Perspectives, v. 19:4, pp.24-42) has items in which the response is immediate--and erroneous. It is shown that by merely varying the numerical parameters of the problems, large deviations in response are found. Not only the final results are affected by the proposed variations, but so is processing fluency. It seems that numbers' magnitudes serve as a cue to activate system-2 type reasoning. The second contribution explores Managerial Algorithmics Theory (M. Moldoveanu [2009] Strategic Management Journal, v. 30, pp. 737-763); an ambitious research program that states that managers display cognitive choices with a "preference towards solving problems of low computational complexity". An empirical test of this hypothesis is conducted, with results showing that this premise is not supported. A number of problems are designed with the intent of testing the predictions from managerial algorithmics against the predictions of cognitive psychology. The results demonstrate (once again) that framing effects profoundly affect choice, and (an original insight) that managers are unable to distinguish computational complexity problem classes. The third contribution explores a new approach to a computationally complex problem in marketing: the shelf space allocation problem (M-H Yang [2001] European Journal of Operational Research, v. 131, pp.107--118). A new representation for a genetic algorithm is developed, and computational experiments demonstrate its feasibility as a practical solution method. These studies lie at the interface of psychology and economics (with bounded rationality and the heuristics and biases programme), psychology, strategy, and computational complexity, and heuristics for computationally hard problems in management science.

Demand aggregation and credit risk effects in pooled procurement: evidence from the Brazilian public purchases of pharmaceuticals and medical supplies

Pooled procurement has an important role in reducing acquisition prices of goods. A pool of buyers, which aggregates demand for its members, increases bargaining power and allows suppliers to achieve economies of scale and scope in the production. Such aggregation demand e ect lowers prices paid for buyers. However, when a buyer with a good reputation for paying suppliers in a timely manner is joined in the pool by a buyer with bad reputation may have its price paid increased due to the credit risk e ect on prices. This will happen because prices paid in a pooled procurement should refect the (higher) average buyers' credit risk. Using a data set on Brazilian public purchases of pharmaceuticals and medical supplies, we nd evidence supporting both e ects. We show that the prices paid by public bodies in Brazil are lower when they buy through pooled procurement than individually. On the other hand, federal agencies (i.e. good buyers) pay higher prices for products when they are joined by state agencies (i.e. bad buyers) in a pool. Such evidence suggests that pooled procurement should be carefully designed to avoid that prices paid increase for its members.

Interaction between nitroheterocyclic compounds with beta-cyclodextrins: Phase solubility and HPLC studies

Chagas disease is a serious health problem for Latin America. Nitrofurazone (NF) and Hidroxymethylnitrofurazone (NFOH) are active against Trypanosoma cruzi. The effect of beta-cyclodextrin (beta-CD) and dimethyl-beta-cyclodextrin (DM-beta-CD) complexation on the UV absorption and retention time of nitrofurazone (NF) and its hydroxymethylated analog (NFOH) were studied in solution. The retention behavior was analyzed on a reversed phase C(18) column and the mobile phase used was acetonitrile-water (20/80 v/v), in which cyclodextrins (beta-CD or DM-beta-CD) were incorporated as a mobile phase additive. The decrease in the retention times of NF (or NFOH) with increasing concentration of HP-beta-CD enables the cleternnination of the complex stability constants by HPLC. A phase-solubility Study was performed. according to the method reported by Higuchi and Connors, to evaluate the changes of NF/NFOH in the complexation state, and the diagrams obtained suggested that it forms complexes with a stoichiometry of 1 : 1. This is an important Study for the characterization of potential formulations to be used as therapeutic options for the treatment of Chagas disease. (c) 2008 Elsevier B.V. All rights reserved.

Electrical properties of individual and small ensembles of InAs/InP nanostructures

We investigate electrical properties of InAs/InP semiconductor nanostructures by conductive atomic force microscopy (C-AFM) and current measurements at low temperatures in processed devices. Different conductances and threshold voltages for current onset were observed for each type of nanostructure. In particular, the extremity of the wire could be compared to a dot with similar dimensions. The processed devices were used in order to access the in-plane conductance of an assembly of a reduced number of nanostructures. Here, fluctuations on I-V curves at low temperatures (<40 K) were observed. At these low temperatures and for a suitable range of applied voltages, random telegraph noise (RTN) in the current was observed for devices with dots. These fluctuations can be associated to electrons trapped in dots, as suggested by numerical simulations. A crossover from a semiconductor-like to a metallic transport behavior is also observed for similar parameters. © 2006 WILEY-VCH Verlag GmbH & Co. KGaA.

Income inequality in Central America, Dominican Republic and Mexico: assessing the importance of individual and household characteristics

Includes bibliography

Antioxidant and cytotoxic studies for kaempferol, quercetin and isoquercitrin

The aim of the present study was to investigate a cytotoxic oxidative cell stress related and the antioxidant profile of kaempferol, quercetin, and isoquercitrin. The flavonol compounds were able to act as scavengers of superoxide anion (but not hydrogen peroxide), hypochlorous acid, chloramine and nitric oxide. Although flavonoids are widely described as antioxidants and this activity is generally related to beneficial effects on human health, here we show important cytotoxic actions of three well known flavonoids. They were able to promote hemolysis which one was exacerbated on the presence of hypochlorous acid but not by AAPH radical. Therefore, despite they expected scavenger action over free radicals an oxidants, these compounds could be very lesive to living organisms by acting over erythrocytes and maybe other cellular types.

Managing in the public sector for investment and growth

Includes bibliography

Structural and Phylogenetic Studies with MjTX-I Reveal a Multi-Oligomeric Toxin - a Novel Feature in Lys49-PLA2s Protein Class

The mortality caused by snakebites is more damaging than many tropical diseases, such as dengue haemorrhagic fever, cholera, leishmaniasis, schistosomiasis and Chagas disease. For this reason, snakebite envenoming adversely affects health services of tropical and subtropical countries and is recognized as a neglected disease by the World Health Organization. One of the main components of snake venoms is the Lys49-phospholipases A2, which is catalytically inactive but possesses other toxic and pharmacological activities. Preliminary studies with MjTX-I from Bothrops moojeni snake venom revealed intriguing new structural and functional characteristics compared to other bothropic Lys49-PLA2s. We present in this article a comprehensive study with MjTX-I using several techniques, including crystallography, small angle X-ray scattering, analytical size-exclusion chromatography, dynamic light scattering, myographic studies, bioinformatics and molecular phylogenetic analyses.Based in all these experiments we demonstrated that MjTX-I is probably a unique Lys49-PLA2, which may adopt different oligomeric forms depending on the physical-chemical environment. Furthermore, we showed that its myotoxic activity is dramatically low compared to other Lys49-PLA2s, probably due to the novel oligomeric conformations and important mutations in the C-terminal region of the protein. The phylogenetic analysis also showed that this toxin is clearly distinct from other bothropic Lys49-PLA2s, in conformity with the peculiar oligomeric characteristics of MjTX-I and possible emergence of new functionalities inresponse to environmental changes and adaptation to new preys. © 2013 Salvador et al.

Las principales tesis presentadas y discutidas en el VII Congreso de Sociología sobre Sociología Urbana = The main arguments concerning urban sociology presented and discussed at the seventh National Congress of Sociology

Los documentos del Seminario fueron publicados por UNESCO en 1961 con el título: La urbanización en América Latina/Urbanization in Latin America