Comparing the physical, psychological, social, and spiritual needs of patients with non-cancer and cancer diagnoses in a tertiary palliative care setting.

OBJECTIVE: The purpose was to describe the physical, psychological, social, and spiritual needs of patients with non-cancer serious illness diagnoses compared to those of patients with cancer. METHOD: We conducted a retrospective chart review of all patients with a non-cancer diagnosis admitted to a tertiary palliative care unit between January 2008 and December 2017 and compared their needs to those of a matched cohort of patients with cancer diagnoses. The prevalence of needs within the following four main concerns was recorded and the data analyzed using descriptive statistics and content analysis: •Physical: pain, dyspnea, fatigue, anorexia, edema, and delirium•Psychological: depression, anxiety, prognosis, and dignity•Social: caregiver burden, isolation, and financial•Spiritual: spiritual distress. RESULTS: The prevalence of the four main concerns was similar among patients with non-cancer and cancer diagnoses. Pain, nausea/vomiting, fatigue, and anorexia were more prevalent among patients with cancer. Dyspnea was more commonly the primary concern in patients with non-cancer diagnoses (39%), who also had a higher prevalence of anxiety and concerns about dignity. Spirituality was addressed more often in patients with cancer. SIGNIFICANCE OF RESULTS: The majority of patients admitted to tertiary palliative care settings have historically been those with cancer. The tertiary palliative care needs of patients with non-cancer diagnoses have not been well described, despite the increasing prevalence of this population. Our description of the palliative care needs of patients with non-cancer diagnoses will help guide future palliative care for the increasing population of patients with non-cancer serious illness diagnoses.

Regional Training Needs Assessment: A First Look at High-Priority Training Needs Across the United States by Region.

CONTEXT: Although core scientific skills remain a priority to public health, preventing and responding to today's leading causes of death require the workforce to build additional strategic skills to impact the social, community-based, and economic determinants of health. The 2017 Public Health Workforce Interests and Needs Survey allows novel regional analysis of training needs, both individually and across 8 strategic skill domains. OBJECTIVE: The purpose of this article is to describe the training needs of public health staff nationally, across the 10 Department of Health and Human Services Regions. DESIGN: The Public Health Workforce Interests and Needs Survey was a Web-based survey fielded to 100 000 staff nationwide across 2 major frames: state health agency-central office and local health department. State-based respondents were fielded on a census approach, with locals participating in a more complex sampling design. Balanced repeated replication weights were used to address nonresponse and sampling. SETTING: State and local health departments. PARTICIPANTS: Respondents from state and local health departments. MAIN OUTCOME MEASURES: This article draws from the training needs portion of Public Health Workforce Interests and Needs Survey. Descriptive statistics are generated, showing training needs gaps. Inferential analyses pertain to gaps across Region and supervisory status, using Pearson χ test and Rao-Scott design-adjusted χ test. RESULTS: Training needs varied across regions and work setting. Certain strategic skills tended to see larger, consistent gaps regardless of Region or setting, including Budgeting & Finance, Change Management, Systems Thinking, and Developing a Vision for a Healthy Community. CONCLUSIONS: Overall, the data suggest substantial interregional variation in training needs. Until now, this picture has been incomplete; disparate assessments across health departments, Regions, and disciplines could not be combined into a national picture. Regionally focused training centers are well situated to address Region-specific needs while supporting the broader building of capacity in strategic skills nationwide.

The integrated palliative care outcome scale for patients with palliative care needs: Factors related to and experiences of the use in acute care settings.

OBJECTIVE: Implementation of patient-reported outcome measures for patients with palliative care needs is characterized by both enablers and barriers. The ways in which healthcare professionals experience the use of assessment tools is important. Our aims were to explore factors contributing to or hindering patients with palliative care needs in assessing their symptoms with the Integrated Palliative Care Outcome Scale (IPOS) and to explore healthcare professionals' experiences of the use of IPOS in acute care settings. METHOD: Data were collected as a part of the evaluation of the feasibility of an implementation strategy for introducing IPOS. Data from three participating acute care units were included. We used descriptive and analytical statistics; a qualitative content analysis was also performed. RESULT: A total of 309 patients were eligible to be offered assessment of symptoms with IPOS. Of these 69 (22%) had completed IPOS. A significant positive association was found between healthcare professionals' participation in training sessions and completed IPOS. The experiences of IPOS were split into two categories: "IPOS acting as a facilitator" and "barriers to the use of IPOS." The use of IPOS was described as contributing to person-centered care of patients with palliative care needs and inspiration to improved routines. Healthcare professionals' feelings of uncertainty about how to approach severely ill patients and their family members appear to have hindered their use of IPOS. SIGNIFICANCE OF RESULTS: We found an association between healthcare professionals' participation in training sessions and patients who completed IPOS, indicating the need for a high degree of attendance at the training to achieve successful implementation. The healthcare professionals expressed feelings of insecurity concerning the use of IPOS indicating a need for further education and clinical support in its use of IPOS. Nevertheless, use of IPOS was considered to contribute to improved care of patients with palliative care needs.

Does using the interRAI Palliative Care instrument reduce the needs and symptoms of nursing home residents receiving palliative care?

OBJECTIVE: This study aimed to evaluate whether using the interRAI Palliative Care instrument (the interRAI PC) in nursing homes is associated with reduced needs and symptoms in residents nearing the end of their lives. METHOD: A quasi-experimental pretest-posttest study using the Palliative care Outcome Scale (POS) was conducted to compare the needs and symptoms of residents nearing the end of their lives in the control and intervention nursing homes. Care professionals at the intervention nursing homes filled out the interRAI PC over the course of a year for all residents aged 65 years and older who were nearing the end of their lives. This intervention was not implemented in the control nursing homes. RESULTS: At baseline, POS scores in the intervention nursing homes were lower (more favorable) than in the control nursing homes on the items "pain", "other symptoms", "family anxiety", and the total POS score. Posttest POS scores for "wasted time" were higher (less favorable) than pretest scores in the intervention nursing homes. In the intervention nursing homes where care professionals did not have prior experience with the interRAI Long-Term Care Facilities (LTCF) assessment instrument (n = 8/15), total POS scores were lower (more favorable) at posttest. SIGNIFICANCE OF RESULTS: One year after introducing the interRAI PC, no reduction in residents' needs and symptoms were detected in the intervention nursing homes. However, reductions in needs and symptoms were found in the subgroup of intervention nursing homes without prior experience with the interRAI LTCF instrument. This may suggest that the use of an interRAI instrument other than the interRAI PC specifically can improve care. Future research should aim at replicating this research with a long-term design in order to evaluate the effect of integrating the use of the interRAI PC in the day-to-day practices at nursing homes.

A Comparison of Three Orthodontic Treatment Indices with Regard to Angle Classification.

OBJECTIVES: To calculate the agreement between the Dental Aesthetic Index (DAI) and the Index of Complexity, Outcome and Need (ICON) in assessing orthodontic treatment need and to determine correlations between the Peer Assessment Rating (PAR) and DAI and ICON scores according to Angle classification among patients referred for orthodontic evaluation. STUDY DESIGN: This study included 457 randomly selected patients between 9 to 17 years of age. Patients were divided into four groups according to Angle classification [Class I (n=154), Class II division 1(Class II/1) (n=155), Class II division 2(Class II/2) (n=52) and Class III (n=96)]. Relationships between PAR scores and ICON and DAI scores were evaluated with the Spearman correlation test. Unweighted kappa statistics were used to analyse agreement between the ICON and DAI on the need for treatment, according to Angle classification. RESULTS: Class I malocclusions scored significantly lower than other Angle classifications in all indices. Both the ICON and DAI showed significant positive correlations with the PAR in the general study population. For Class II/2 patients, no correlation was found between PAR and DAI scores. There was significant agreement between the ICON and DAI on treatment need among Class I, Class II/1 and Class II/2 patients however, no agreement was found for Class III malocclusions. CONCLUSIONS: The ICON, DAI and PAR produce similar results and can be used interchangeably for the general orthodontic patient population. However, based on Angle classification, prominent differences exist in scoring certain occlusal features.

A model of job activity description for workplace accommodation assessment.

Workplace accommodations to enable employees with disabilities to perform essential job tasks are an important strategy ways for increasing the presence of people with disabilities in the labor market. However, assessments, which are crucial to identifying necessary accommodations, are typically conducted using a variety of methods that lack consistent procedures and comprehensiveness of information. This can lead to the rediscovery of the same solutions over and over, inability to replicate assessments and a failure to effectively meet all of an individual's accommodation needs. To address standardize assessment tools and processes, a taxonomy of demand-producing activity factors is needed to complement the taxonomies of demand-producing person and environment factors already available in the International Classification of Functioning, Disability and Health (ICF). The purpose of this article is to propose a hierarchical model of accommodation assessment based on level of specificity of job activity. While the proposed model is neither a taxonomy nor an assessment process, the seven-level hierarchical model provides a conceptual framework of job activity that is the first step toward such a taxonomy as well as providing a common language that can bridge the many approaches to assessment. The model was designed and refined through testing against various job examples. Different levels of activity are defined to be easily linked to different accommodation strategies. Finally, the levels can be cross-walked to the ICF, which enhances its acceptability, utility and universality.

The use of occlusal indices in high-impact literature.

UNLABELLED: Malocclusion is difficult to define because individuals and cultures vary widely in their perceptions of what constitutes an occlusal problem. A number of occlusal indices have been devised but, probably because of this perceptual problem, none has ever emerged as a standard. OBJECTIVE: The main objective was to review the use of the principal occlusal indices. BASIC RESEARCH DESIGN: The PUBMED database was searched for the main occlusal indices employed, journals with an impact in dentistry and specialist orthodontics journals. RESULTS: The occlusal indices most frequently employed were IOTN (163 studies), PAR (132 studies), DAI (68 studies) and ICON (32 studies). The journals publishing the greatest number of studies using these occlusal indices are those specialising in orthodontics. CONCLUSIONS: In the high-impact scientific literature, the indices in greatest use are IOTN, followed by PAR, DAI and ICON. DAI and IOTN are mainly used in epidemiological or prevalence studies, while PAR is generally used for longitudinal studies. IOTN is used more in Europe. DAI is used worldwide; though least in Europe.

An appraisal and comparison of three methods of selecting patients for orthodontic treatment.

AIM: The selection of patients for orthodontic treatment is necessary where third party payment occurs. Selection can be based on one of several systems and in this report three methods are compared. METHODS: The examination was performed on a population of 790 Polish children with a mean age of 12 years and 2 months. In this report three methods of assessment are used. The authors' specific method relates malocclusion to the estimated risk of problems arising as a result of the malocclusion itself. The IOTN score system assesses the severity of different aspects of malocclusion, thus dividing patients into 5 groups. The DAL index quantifies the aesthetic appearance of the mouth. RESULTS: The results show that using our specific method, approximately 23% of patients should undergo treatment. The figure is approximately the same using the IOTN, though there is a slight difference in the actual patients chosen. The DAI results in an entirely different orthodontic treatment need. CONCLUSION: Our specific method is highly recommended.

Identification of Unmet Healthcare Needs: A National Survey in Thailand.

OBJECTIVES: This study examined demographic factors hampering access to healthcare at hospitals and suggests policy approaches to improve healthcare management in Thailand. METHODS: The data for the study were drawn from a health and welfare survey conducted by the National Statistical Office of Thailand in 2017. The population-based health and welfare survey was systematically carried out by skilled interviewers, who polled 21 519 384 individuals. The independent variables related to demographic data (age, sex, religion, marital status, education, occupation, and area of residence), chronic diseases, and health insurance coverage. The dependent variable was the degree of access to healthcare. Multiple logistic regression analysis was subsequently performed on the variables found to be significant in the univariate analysis. RESULTS: Only 2.5% of the population did not visit a hospital when necessary for outpatient-department treatment, hospitalization, or the provision of oral care. The primary reasons people gave for not availing themselves of the services offered by government hospitals when they were ill were-in descending order of frequency-insufficient time to seek care, long hospital queues, travel inconvenience, a lack of hospital beds, unavailability of a dentist, not having someone to accompany them, and being unable to pay for the transportation costs. Multiple logistic regression analysis showed that failure to access the health services provided at hospitals was associated with demographic, educational, occupational, health welfare, and geographic factors. CONCLUSIONS: Accessibility depends not only on health and welfare benefit coverage, but also on socioeconomic factors and the degree of convenience associated with visiting a hospital.

Psychosocial care for patients and their families is integral to supportive care in cancer: MASCC position statement.

This position paper, written on behalf of the MASCC Psychosocial Study Group, reviews the most common psychosocial concerns and needs of cancer patients during all phases of the cancer continuum, from diagnosis to death or survivorship. Developments in psychosocial care at both individual and systems levels are surveyed and summarized, along with gaps in knowledge and research and needed improvements in the dissemination and application of acquired knowledge and expertise. The roles of culture, spirituality, and religion as part of psychosocial care are reviewed, along with families' and caregivers' specific psychosocial concerns and needs, and areas of needed psychosocial interventions in supportive cancer care. Deficits in recognizing and meeting patients' psychosocial needs at the system level are examined, and international guidelines and models of psychosocial care are reviewed, including their potential applications to local contexts. The paper calls for a shift to a new paradigm of care through adoption of an integrated approach to identify and meet the psychosocial needs of cancer patients and survivors as part of supportive care worldwide.

Exploration of the unmet health care needs of people who inject drugs.

BACKGROUND AND PURPOSE: Access to adequate health care in the United States is often hindered by an individual's location, socioeconomic status, and lifestyle. Among those underserved are people who inject drugs (PWID), who are affected by stigma and discrimination. The purpose of this study was to describe the utilization of preventative health care services obtained by PWID. METHODS: A survey querying participants about their utilization of preventative health care services and health education over the past year was administered to PWID at 2 syringe access programs. Descriptive statistics were used to analyze the data. CONCLUSION: Of the 141 participants surveyed, 60.6% saw a provider within the past year and 62.1% indicated that their provider was aware of their drug use. Data analysis revealed that providers counseled PWID on three of nine drug-related harm reduction items. Only 30% of PWID talked with their provider about five or more items. Mean number of items discussed was significantly different between PWID whose provider was aware of their drug use and PWID whose provider was unaware of drug use (t = 10.7, p < 0.001). IMPLICATIONS FOR PRACTICE: Results indicated that PWID are not receiving adequate preventative services or harm reduction education from their primary care provider. A need for assessment of substance use, preventative vaccinations, counseling and testing for infectious diseases, and harm reduction education is essential during health care visits. Nurse practitioners and nurses have a role in screening for and educating PWID in a variety of health care settings.

Barriers, activities and participation: incorporating ICF into service planning datasets.

PURPOSE: Guided by the World Health Organization's International Classification of Functioning, Disability and Health (ICF), a measure of activity and participation (MAP) was developed and incorporated into the National Physical and Sensory Disability Database in Ireland. The aims of this article are to investigate and explore the relationship between the barriers, participation restriction and functioning levels experienced by people with disabilities. METHOD: Seven thousand five hundred and sixty-two personal interviews with people meeting specific eligibility criteria for registering onto the database were conducted across four health service executive regions in Ireland. RESULTS: Overall, differences in barriers, participation restriction and activity limitations experienced by people with different types of disabilities were found to be significant. Furthermore, low functioning and experience of barriers were indicators of participation restriction. CONCLUSIONS: This article has shown that elements of the ICF have been successfully operationalised in a service planning tool through the development of the MAP. This provides a more holistic view of disability and will enable the impact of service interventions to be measured over time.

The association of malocclusion complexity and orthodontic treatment outcomes.

OBJECTIVE: To determine the relationship of the ABO Discrepancy Index (DI) to outcomes for routine malocclusions, and to ascertain whether significant trends in DI scores could be noted among annual samples of patients taken from 1998 to 2004. MATERIALS AND METHODS: A total of 716 consecutive patients with permanent dentition from a large urban graduate orthodontics program were sampled over the 7-year span. A group of six researchers with a dental background were trained and calibrated in the various components of the DI method to ensure reproducible criteria and accurate recording of clinical and radiographic data across researchers. Data management and analyses were undertaken by two other investigators who were not involved in data coding. RESULTS: Only a weak positive association was seen between the DI and Objective Grading System (OGS) and Comprehensive Clinical Assessment (CCA) scores. The DI was not significantly related to a general time trend. CONCLUSION: The DI was found to be a reliable and relatively stable index for measuring malocclusion complexity in annual samples of patients. Although the DI is significantly related to outcomes for the most severe malocclusions, it was not a good predictor of outcome for more routine malocclusions. If the minimal acceptable outcome is defined as 30 OGS points, the mean DI (15.7) and the average OGS score (28.2) indicate that many of the malocclusions in patients in the present sample were of potential board quality.

Index of Complexity, Outcome and Need scored on plaster and digital models.

The aim of this study was to compare standard plaster models with their digital counterparts for the applicability of the Index of Complexity, Outcome, and Need (ICON). Generated study models of 30 randomly selected patients: 30 pre- (T(0)) and 30 post- (T(1)) treatment. Two examiners, calibrated in the ICON, scored the digital and plaster models. The overall ICON scores were evaluated for reliability and reproducibility using kappa statistics and reliability coefficients. The values for reliability of the total and weighted ICON scores were generally high for the T(0) sample (range 0.83-0.95) but less high for the T(1) sample (range 0.55-0.85). Differences in total ICON score between plaster and digital models resulted in mostly statistically insignificant values (P values ranging from 0.07 to 0.19), except for observer 1 in the T(1) sample. No statistically different values were found for the total ICON score on either plaster or digital models. ICON scores performed on computer-based models appear to be as accurate and reliable as ICON scores on plaster models.

Measuring the Needs of Family Caregivers of People With Dementia: An Assessment of Current Methodological Strategies and Key Recommendations.

While dementia caregivers are regarded as a population with high unmet needs, there is little consensus as to how caregivers' needs should be conceptualized and measured. This article describes how dementia caregivers' needs are currently assessed in the scientific literature with the goal of suggesting guidelines for the enhancement of future measurement of caregiver needs. A review of 26 articles identified overarching themes within measurement approaches including variation in methodological rigor, proxy indicators of need, dual needs assessment of caregiver and person with dementia (PWD), and third-party needs assessment. We recommend future research dedicate theoretical attention to the conceptualization and classification of caregivers' needs to build a stronger foundation for measurement. The measurement development process should capitalize on mixed-methodology and follow instrument development and validation guidelines set forth by measurement theory. Reliable and valid instruments are essential to developing services and policies that address dementia caregivers' needs.

Priority and appropriateness of upper endoscopy out-patient referrals: Two-period comparison in an open-access unit.

BACKGROUND: In the early 2000s we introduced a prioritization model for referrals based on involvement of primary care physicians (PCPs) and specialists. AIMS: Assess the application of that model of prioritisation, comparing gastroscopies performed 8 years apart, with respect to priority level, appropriateness and relevant endoscopic findings (REFs). METHODS: The studies included 247 and 354 out-patients, who had undergone gastroscopy in 2006 and in 2014, respectively. To reduce interspecialists variability, both studies were performed by the same specialist as investigator. RESULTS: In both years, most patients were assigned low-priority referral by PCPs (78.6% and 75.1% respectively). The agreement PCPs versus specialist on referral priority was moderate in 2006 (0.60, Landis-Koch scale 0.41-0.60) and high in 2014 (0.81, Landis-Koch scale 0.81-1.00). In both years we observed a similar rate of inappropriateness: 27.5% and 27.1%, respectively. Due to multiple logistic regression, the odds ratio (OR) for REF increased when: (i) very high-priority referral versus nopriority referral was indicated (8.813 OR, p = 0.0012), (ii) referral followed the guidelines (9.29 OR, p<0.0001), and (iii) agreement of priority occurred (1.911 OR, p = 0.0308). CONCLUSIONS: Our findings highlighted that the issues of low-priority referrals should be addressed in order to discontinue gastroscopy overusing and reduce related operational costs.

Improving the appropriateness of referrals and waiting times for endoscopic procedures.

OBJECTIVE: There is a lack of standard methods for determining the clinical priority of patients referred by general practitioners (GPs) for specialist outpatient consultations. We introduced a system of progressive involvement by general practitioners and specialists with 80 diagnostic procedures. The aim of this study was to evaluate this new method of prioritization of patients suffering from significant gastroenterological disorders needing rapid access to diagnostic procedures. METHODS: The study included 438 outpatients who were referred for and underwent a gastroscopy or colonoscopy. GPs used a ranking of waiting times for different levels of clinical priority, called 'homogeneous waiting groups'. Specialists also assigned a priority level for each patient as well as evaluating the appropriateness of the referral and the presence of significant endoscopic disorders. Agreement between GPs' and specialists' priority assessments was evaluated by the kappa statistic. RESULTS: Most referrals (74.4%) were deemed low priority by GPs, with no maximum waiting time assigned. The level of agreement between GPs and specialists as regards patients' priorities was poor or moderate: for gastroscopy the kappa was 0.31 (weighted kappa 0.47) and for colonoscopy 0.44 (weighted kappa 0.46). There was an association between the proportion of significant disorders identified with endoscopy and the priority assigned to the referral (chi2 = 18.9, 1 df, p < 0.001). The overall proportion of referrals deemed inappropriate by specialists was 22.1%. CONCLUSIONS: There is value in liaison between GPs and specialists for achieving timely referrals and avoiding delayed diagnosis though higher levels of agreement need to be achieved.

Reliability and validity of the CCNCS: a dependency workload measurement system.

AIM: To refine, test and evaluate the Community Client Need Classification System (CCNCS). BACKGROUND: Workload assessment in community nursing is complicated by the range of services that may be delivered in one patient interaction. The CCNCS is a workload measurement system designed to capture the direct and indirect elements of community nursing work and is suitable for use with all care groups in the community. DESIGN: Survey. METHOD: Forty-four community nurses implemented the CCNCS with all clients in their caseload for four weeks. Community nursing in the Irish Republic is known as public health nursing. The Public Health Nurses (PHNs) recorded the total time in minutes that was spent on each client each week. The satisfaction with and experiences of PHNs using the CCNCS during the study period was also recorded. RESULTS: Participants endorsed the utility of the CCNCS for use in community nursing. Inter-rater and intra-rater reliability results were positive with high level of agreement between raters in relation to scoring community clients. The amount of time the PHNs spent with clients correlated with ascending level of client need. CONCLUSIONS: The CCNCS affords insight into the complex nature of community nursing. It discriminates between levels of need and has potential to provide a standardised assessment of need in all community-nursing clients. Adequate resources are required to conduct further testing of the reliability and predictive validity of this system. RELEVANCE TO CLINICAL PRACTICE: The CCNCS can provide objective evidence of community nursing workload and thus facilitate workforce planning.

Occlusal indexes as judged by subjective opinions.

INTRODUCTION: An orthodontic index is validated by comparing its scores with a gold standard, commonly the consensus opinion of a group of experienced orthodontists. The purpose of this investigation was to evaluate contemporary occlusal indexes against the subjective opinions of people with varying levels of dental knowledge. METHODS: Randomly selected orthodontic study models (n = 25) with full permanent dentitions were scored according to the peer assessment rating (PAR) index, the index of complexity, outcome, and need (ICON), and the occlusal index (OI). The models were also scored according to the subjective opinion of orthodontists (n = 10), general dentists (n = 10), and social workers (n = 10) by using a Q-sort assessment. RESULTS: High correlation coefficients were found between the panelists and the occlusal indexes. The average correlation was about 0.8. CONCLUSIONS: Regardless of background and clinical experience, people with various levels of dental knowledge have similar opinions when quantifying relationships of teeth and dental arches.

Public health research priorities in Europe seen by non-governmental organizations.

BACKGROUND: Public health research is concerned with population health, determinants of health, health systems research, health promotion, environmental health, health protection, disease prevention and research in other fields of public health. During the last decades, non-governmental organisations (NGOs) are more often entering the field of public health research. This paper presents results of work within SPHERE (Strengthening Public Health Research in Europe), a European Commission funded study aimed to gather information and produce knowledge on the state of public health research in Europe. METHODS: A questionnaire survey was developed and conducted among NGOs enrolled in a database held by the European Public Health Alliance (EPHA). There were 80 replies, and the response rate for NGOs that were members of EPHA was 53%. RESULTS: There were no significant statistical differences in the responses when analysed for three European groups ['old' member states (EU 15), accession members states in 2004 (EU 10) and EU-associated countries]. The NGOs reported a relatively large international experience, expressed by participation in international public health research, and more often practice work. The main research priorities reported were general public health, environmental health, ADHD, obesity, nutrition, tobacco control. NGOs showed low correlation between their work field and their proposed public health research priorities. CONCLUSION: There are growing numbers of NGOs in Europe concerned with public health. This survey indicates their interest also in public health research priorities.