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Leadership in Health Services... Jul 2017Purpose The purpose of this paper is to describe the use of group concept mapping (GCM) as a tool for developing a conceptual model of an episode of acute, unscheduled...
Purpose The purpose of this paper is to describe the use of group concept mapping (GCM) as a tool for developing a conceptual model of an episode of acute, unscheduled care from illness or injury to outcomes such as recovery, death and chronic illness. Design/methodology/approach After generating a literature review drafting an initial conceptual model, GCM software (CS Global MAX) is used to organize and identify strengths and directionality between concepts generated through feedback about the model from several stakeholder groups: acute care and non-acute care providers, patients, payers and policymakers. Through online and in-person population-specific focus groups, the GCM approach seeks feedback, assigned relationships and articulated priorities from participants to produce an output map that described overarching concepts and relationships within and across subsamples. Findings A clustered concept map made up of relational data points that produced a taxonomy of feedback was used to update the model for use in soliciting additional feedback from two technical expert panels (TEPs), and finally, a public comment exercise was performed. The results were a stakeholder-informed improved model for an acute care episode, identified factors that influence process and outcomes, and policy recommendations, which were delivered to the Department of Health and Human Services's (DHHS) Assistant Secretary for Preparedness and Response. Practical implications This study provides an example of the value of cross-population multi-stakeholder input to increase voice in shared problem health stakeholder groups. Originality/value This paper provides GCM results and a visual analysis of the relational characteristics both within and across sub-populations involved in the study. It also provides an assessment of observational key factors supporting how different stakeholder voices can be integrated to inform model development and policy recommendations.
Topics: Acute Disease; Feedback; Focus Groups; Health Policy; Humans; Models, Theoretical; Policy Making; Software; United States
PubMed: 28693397
DOI: 10.1108/LHS-07-2016-0034 -
European Journal of Emergency Medicine... Apr 2023
Topics: Humans; Adrenal Cortex Hormones; Inflammation; Heart Failure; Acute Disease
PubMed: 36787237
DOI: 10.1097/MEJ.0000000000001015 -
Advances in Experimental Medicine and... 2020Over the last few decades, intestinal microbial communities have been considered to play a vital role in host liver health. Acute liver injury (ALI) is the manifestation... (Review)
Review
Over the last few decades, intestinal microbial communities have been considered to play a vital role in host liver health. Acute liver injury (ALI) is the manifestation of sudden hepatic injury and arises from a variety of causes. The studies of dysbiosis in gut microbiota provide new insight into the pathogenesis of ALI. However, the relationship of gut microbiota and ALI is not well understood, and the contribution of gut microbiota to ALI has not been well characterized. In this chapter, we integrate several major pathogenic factors in ALI with the role of gut microbiota to stress the significance of gut microbiota in prevention and treatment of ALI.
Topics: Acute Disease; Dysbiosis; Gastrointestinal Microbiome; Humans; Liver; Liver Diseases
PubMed: 32323178
DOI: 10.1007/978-981-15-2385-4_3 -
Pediatric Critical Care Medicine : a... Jan 2020
Topics: Acute Disease; Child; Humans; Status Epilepticus
PubMed: 31899752
DOI: 10.1097/PCC.0000000000002124 -
PloS One 2016Household air pollution from solid fuel burning kills over 4 million people every year including half a million children from acute lower respiratory infections.... (Review)
Review
INTRODUCTION
Household air pollution from solid fuel burning kills over 4 million people every year including half a million children from acute lower respiratory infections. Although biologically plausible, it is not clear whether household air pollution is also associated with acute lower respiratory infections in adults. We systematically reviewed the literature on household air pollution and acute lower respiratory infection in adults to identify knowledge gaps and research opportunities.
METHODS
Ten bibliographic databases were searched to identify studies of household air pollution and adult acute lower respiratory infection. Data were extracted from eligible studies using standardised forms.
RESULTS
From 4617 titles, 513 abstracts and 72 full-text articles were reviewed. Eight studies met the inclusion criteria of which 2 found a significant adjusted increased risk of acute lower respiratory infection, 2 identified a univariate association whilst 4 found no significant association. Study quality was generally limited. Heterogeneity in methods and findings precluded meta-analysis.
DISCUSSION
A systematic review of the literature found limited evidence for an association between household air pollution and risk of acute lower respiratory infection in adults. Additional research, with carefully defined exposure and outcome measures, is required to complete the risk profile caused by household air pollution in adults.
REGISTRATION NUMBER
CRD42015028042.
Topics: Acute Disease; Adult; Air Pollution; Air Pollution, Indoor; Child; Environmental Exposure; Family Characteristics; Humans; Male; Respiratory Tract Infections
PubMed: 27907205
DOI: 10.1371/journal.pone.0167656 -
Global Health Research and Policy Apr 2021In 2016, diarrhea killed around 7 children aged under 5 years per 1000 live births in Burundi. The objective of this study was to estimate the economic burden associated...
BACKGROUND
In 2016, diarrhea killed around 7 children aged under 5 years per 1000 live births in Burundi. The objective of this study was to estimate the economic burden associated with diarrhea in Burundi and to examine factors affecting the cost to provide economic evidence useful for the policymaking about clinical management of diarrhea.
METHODS
The study was designed as a prospective cost-of-illness study using an incidence-based approach from the societal perspective. The study included patients aged under 5 years with acute non-bloody diarrhea who visited Buyenzi health center and Prince Regent Charles hospital from November to December 2019. Data were collected through interviews with patients' caregivers and review of patients' medical and financial records. Multiple linear regression was performed to identify factors affecting cost, and a cost model was used to generate predictions of various clinical and care management costs. All costs were converted into international dollars for the year 2019.
RESULTS
One hundred thirty-eight patients with an average age of 14.45 months were included in this study. Twenty-one percent of the total patients included were admitted. The average total cost per episode of diarrhea was Int$109.01. Outpatient visit and hospitalization costs per episode of diarrhea were Int$59.87 and Int$292, respectively. The costs were significantly affected by the health facility type, patient type, health insurance scheme, complications with dehydration, and duration of the episode before consultation. Our model indicates that the prevention of one case of dehydration results in savings of Int$16.81, accounting for approximately 11 times of the primary treatment cost of one case of diarrhea in the community-based management program for diarrhea in Burundi.
CONCLUSION
Diarrhea is associated with a substantial economic burden to society. Evidence from this study provides useful information to support health interventions aimed at prevention of diarrhea and dehydration related to diarrhea in Burundi. Appropriate and timely care provided to patients with diarrhea in their communities and primary health centers can significantly reduce the economic burden of diarrhea. Implementing a health policy to provide inexpensive treatment to prevent dehydration can save significant amount of health expenditure.
Topics: Acute Disease; Burundi; Child Health; Child, Preschool; Cost of Illness; Diarrhea; Female; Humans; Incidence; Infant; Infant, Newborn; Male; Prospective Studies
PubMed: 33845920
DOI: 10.1186/s41256-021-00194-3 -
The Nurse Practitioner Jun 2018
Review
Topics: Acute Disease; Ambulatory Care; Chronic Disease; Clinical Coding; Humans; Long-Term Care; Nurse Practitioners
PubMed: 29757829
DOI: 10.1097/01.NPR.0000531924.32043.f9 -
Veterinary Pathology Jan 2018
Topics: Acute Disease; Animals; Horses; Leukemia
PubMed: 29254473
DOI: 10.1177/0300985817738315 -
JAMA Internal Medicine Nov 2016Determining innovative approaches that better align health needs to the appropriate setting of care remains a key priority for the transformation of US health care;... (Review)
Review
IMPORTANCE
Determining innovative approaches that better align health needs to the appropriate setting of care remains a key priority for the transformation of US health care; however, to our knowledge, no comprehensive assessment exists of alternative management strategies to hospital admission for acute medical conditions.
OBJECTIVE
To examine the effectiveness, safety, and cost of managing acute medical conditions in settings outside of a hospital inpatient unit.
EVIDENCE REVIEW
MEDLINE, Scopus, CINAHL, and the Cochrane Database of Systematic Reviews (January 1995 to February 2016) were searched for English-language systematic reviews that evaluated alternative management strategies to hospital admission. Two investigators extracted data independently on trial design, eligibility criteria, clinical outcomes, patient experience, and health care costs. The quality of each review was assessed using the revised AMSTAR tool (R-AMSTAR) and the strength of evidence from primary studies was graded according to the Oxford Centre for Evidence-Based Medicine.
FINDINGS
Twenty-five systematic reviews (representing 123 primary studies) met inclusion criteria. For outpatient management strategies, several acute medical conditions had no significant difference in mortality, disease-specific outcomes, or patient satisfaction compared with inpatient admission. For quick diagnostic units, the evidence was more limited but did demonstrate low mortality rates and high patient satisfaction. For hospital-at-home, a variety of acute medical conditions had mortality rates, disease-specific outcomes, and patient and caregiver satisfaction that were either improved or no different compared with inpatient admission. For observation units, several acute medical conditions were found to have no difference in mortality, a decreased length of stay, and improved patient satisfaction compared to inpatient admission; results for some conditions were more limited. Across all alternative management strategies, cost data were heterogeneous but showed near-universal savings when assessed.
CONCLUSIONS AND RELEVANCE
For low-risk patients with a range of acute medical conditions, evidence suggests that alternative management strategies to inpatient care can achieve comparable clinical outcomes and patient satisfaction at lower costs. Further study and application of such opportunities for health system redesign is warranted.
Topics: Acute Disease; Ambulatory Care Facilities; Chest Pain; Evidence-Based Medicine; Health Care Costs; Hospitalization; Humans; Inpatients; Meta-Analysis as Topic; Patient Admission; Patient Satisfaction; Randomized Controlled Trials as Topic; United States
PubMed: 27695822
DOI: 10.1001/jamainternmed.2016.5974 -
Annual Review of Pharmacology and... 2016Mitochondrial dysfunction is a key pathophysiological component of many acute and chronic diseases. Maintenance of mitochondrial homeostasis through the balance of... (Review)
Review
Mitochondrial dysfunction is a key pathophysiological component of many acute and chronic diseases. Maintenance of mitochondrial homeostasis through the balance of mitochondrial turnover, fission and fusion, and generation of new mitochondria via mitochondrial biogenesis is critical for tissue health. Pharmacological activation of mitochondrial biogenesis can enhance oxidative metabolism and tissue bioenergetics, and improve organ function in conditions characterized by mitochondrial dysfunction. However, owing to the complexity of mitochondrial assembly and maintenance, identification of specific activators of mitochondrial biogenesis has been difficult. This review provides an overview of the role of mitochondrial dysfunction in acute and chronic diseases, details the current state of therapeutics for the stimulation of mitochondrial biogenesis and their effects on disease outcomes, describes new screening methodologies to identify novel stimulators and noncanonical pathways of mitochondrial biogenesis, and discusses potential hurdles of mitochondrial biogenesis as a therapeutic strategy.
Topics: Acute Disease; Animals; Chronic Disease; Humans; Mitochondria; Mitochondrial Diseases; Organelle Biogenesis
PubMed: 26566156
DOI: 10.1146/annurev-pharmtox-010715-103155