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Brain and Behavior Dec 2022Childhood cancer and cancer-related treatments disrupt brain development and maturation, placing survivors at risk for cognitive late effects. Given that assessment... (Review)
Review
OBJECTIVE
Childhood cancer and cancer-related treatments disrupt brain development and maturation, placing survivors at risk for cognitive late effects. Given that assessment tools vary widely across researchers and clinicians, it has been daunting to identify distinct patterns in outcomes across diverse cancer types and to implement systematic neurocognitive screening tools. This review aims to operationalize processing efficiency skill impairment-or inefficient neural processing as measured by working memory and processing speed abilities-as a worthwhile avenue for continued study within the context of childhood cancer.
METHODS
A comprehensive literature review was conducted to examine the existing research on cognitive late effects and biopsychosocial risk factors in order to conceptualize processing efficiency skill trends in childhood cancer survivors.
RESULTS
While a frequently reported pattern of neurobiological (white matter) and cognitive (working memory and processing speed) disruption is consistent with processing efficiency skill impairment, these weaknesses have not yet been fully operationalized in this population. We offer a theoretical model that highlights the impacts of a host of biological and environmental factors on the underlying neurobiological substrates of cancer survivors that precede and may even predict long-term cognitive outcomes and functional abilities following treatment.
CONCLUSION
The unified construct of processing efficiency may be useful in assessing and communicating neurocognitive skills in both outcomes research and clinical practice. Deficits in processing efficiency may serve as a possible indicator of cognitive late effects and functional outcomes due to the unique relationship between processing efficiency skills and neurobiological disruption following cancer treatment. Continued research along these lines is crucial for advancing childhood cancer outcomes research and improving quality of life for survivors.
Topics: Child; Humans; Cancer Survivors; Quality of Life; Survivors; Memory, Short-Term; Neoplasms; Outcome Assessment, Health Care
PubMed: 36330565
DOI: 10.1002/brb3.2809 -
British Journal of Anaesthesia Oct 2022Thirty-day mortality is widely used in medical and surgical outcomes research as a quality indicator, and as an endpoint in perioperative clinical trials. However, the...
Thirty-day mortality is widely used in medical and surgical outcomes research as a quality indicator, and as an endpoint in perioperative clinical trials. However, the validity of this metric has recently been questioned. In this issue of the British Journal of Anaesthesia, Fowler and colleagues quantify, update, and put into perspective the looming suspicion that perioperative adverse events cast a 'long shadow' of increased mortality, far beyond the 30-day time frame. Their work not only raises important questions on how we should think about, analyse, and report 'perioperative' complications and mortality, but also stresses anaesthesiologist and surgeon roles as key stakeholders in patient long-term survival.
Topics: Anesthesia; Anesthesiologists; Anesthesiology; Humans; Outcome Assessment, Health Care; Postoperative Complications
PubMed: 35410788
DOI: 10.1016/j.bja.2022.03.014 -
Journal of Alzheimer's Disease : JAD 2020Dementia has been described as the greatest global health challenge in the 21st Century on account of longevity gains increasing its incidence, escalating health and... (Review)
Review
BACKGROUND
Dementia has been described as the greatest global health challenge in the 21st Century on account of longevity gains increasing its incidence, escalating health and social care pressures. These pressures highlight ethical, social, and political challenges about healthcare resource allocation, what health improvements matter to patients, and how they are measured. This study highlights the complexity of the ethical landscape, relating particularly to the balances that need to be struck when allocating resources; when measuring and prioritizing outcomes; and when individual preferences are sought.
OBJECTIVE
Health outcome prioritization is the ranking in order of desirability or importance of a set of disease-related objectives and their associated cost or risk. We analyze the complex ethical landscape in which this takes place in the most common dementia, Alzheimer's disease.
METHODS
Narrative review of literature published since 2007, incorporating snowball sampling where necessary. We identified, thematized, and discussed key issues of ethical salience.
RESULTS
Eight areas of ethical salience for outcome prioritization emerged: 1) Public health and distributive justice, 2) Scarcity of resources, 3) Heterogeneity and changing circumstances, 4) Knowledge of treatment, 5) Values and circumstances, 6) Conflicting priorities, 7) Communication, autonomy and caregiver issues, and 8) Disclosure of risk.
CONCLUSION
These areas highlight the difficult balance to be struck when allocating resources, when measuring and prioritizing outcomes, and when individual preferences are sought. We conclude by reflecting on how tools in social sciences and ethics can help address challenges posed by resource allocation, measuring and prioritizing outcomes, and eliciting stakeholder preferences.
Topics: Alzheimer Disease; Delivery of Health Care; Humans; Outcome Assessment, Health Care
PubMed: 32716354
DOI: 10.3233/JAD-191300 -
The Journal of Allergy and Clinical... Sep 2023
Topics: Humans; Outcome Assessment, Health Care
PubMed: 37684077
DOI: 10.1016/j.jaip.2023.05.018 -
Journal of Neurosurgical Anesthesiology Jan 2023Neurodevelopmental outcomes research in children following extracorporeal membrane oxygenationis a complex and evolving field. From systematic reviews to multi-center... (Review)
Review
Neurodevelopmental outcomes research in children following extracorporeal membrane oxygenationis a complex and evolving field. From systematic reviews to multi-center prospective cohort studies, a variety of research endeavors in this domain have already been conducted. Recent attention has redirected the focus on biomarkers and imaging studies to help better understand the neurological, developmental, and behavioral effects of extracorporeal membrane oxygenation on surviving children. This review provides an overview of major research in the field, ongoing and future studies, and a summary of lessons learned from these efforts.
Topics: Child; Humans; Infant; Prospective Studies; Extracorporeal Membrane Oxygenation; Outcome Assessment, Health Care; Respiratory Insufficiency; Biomarkers
PubMed: 36745174
DOI: 10.1097/ANA.0000000000000878 -
American Journal of Obstetrics and... May 2022
Topics: Delphi Technique; Humans; Outcome Assessment, Health Care
PubMed: 35500999
DOI: 10.1016/j.ajog.2022.03.001 -
The Journal of Evidence-based Dental... Jan 2024Dental patient-centered outcomes can improve the relevance of clinical study results to dental patients and generate evidence to optimize health outcomes for dental...
Dental patient-centered outcomes can improve the relevance of clinical study results to dental patients and generate evidence to optimize health outcomes for dental patients. Dental patient-reported outcomes (dPROs) are of great importance to patient-centered dental care. They can be used to evaluate the health outcomes of an individual patient about the impact of oral diseases and treatment, and to assess the quality of oral health care delivery for a health care entity. dPROs are measured with dental patient-reported outcome measures (dPROMs). dPROMs should be validated and tested before wider dissemination and application to ensure that they can accurately capture the intended dPROs. Evidence suggests inadequate dPRO usage among dental trials, as well as potential flaws in some existing dPROMs. This Glossary presents a collection of main terms in dental patient-centered outcomes to help clinicians and researchers read and understand patient-centered clinical studies in dentistry.
Topics: Humans; Outcome Assessment, Health Care; Patient Reported Outcome Measures; Patient-Centered Care; Health Facilities; Quality of Life
PubMed: 38401954
DOI: 10.1016/j.jebdp.2023.101951 -
Wiener Klinische Wochenschrift Nov 2019The aims of this article are to provide an overview and discuss current concepts and future trends in outcomes research in non-specific low back pain, specifically... (Review)
Review
OBJECTIVE
The aims of this article are to provide an overview and discuss current concepts and future trends in outcomes research in non-specific low back pain, specifically considering the perspective of patients, patient-reported outcomes and outcome measures as well as to facilitate knowledge transfer into clinical practice.
REVIEW STRATEGY
The breadth of this work and the required brevity of this article were not amenable to a formal approach, such as a systematic literature review or a formal scoping review. Literature sources were identified through medical databases but different sources of information and of various methodologies were also included. Furthermore, outcomes meaningful for patients and examples of outcome measures that are applicable in clinical practice were extracted. Areas for future research were identified and discussed.
RESULTS
Patient-reported outcomes and outcome measures are essential in patient-centered care. The assessment of the patients' perspective is important to ensure motivation, active involvement, self-management and adherence, especially in non-pharmacological interventions for low back pain. To facilitate the use of outcome measurements for low back pain in clinical practice, future studies should focus on a clinically feasible index, which includes patient-reported as well as clinician-reported or performance-based variables. Relationships between different types of outcomes and outcome measures as well as resource and outcome-based healthcare constitute important topics for future research. New digital technologies can support continuous outcome measurement and might enable new patient-driven models of care.
CONCLUSION
Active patient involvement is an essential part of non-pharmacological treatment in low back pain and needs to be considered in terms of outcomes and outcome measurement.
Topics: Humans; Low Back Pain; Outcome Assessment, Health Care; Patient Participation; Patient Satisfaction; Patient-Centered Care; Treatment Outcome
PubMed: 31236662
DOI: 10.1007/s00508-019-1523-4 -
Advanced Data Visualisation in Health Economics and Outcomes Research: Opportunities and Challenges.Applied Health Economics and Health... Aug 2019Data visualisation techniques are valuable tools for exploring, synthesising and communicating the results of research studies. Advanced data visualisation techniques,...
Data visualisation techniques are valuable tools for exploring, synthesising and communicating the results of research studies. Advanced data visualisation techniques, including dynamic and interactive visualisations, are just beginning to be used in health economics and outcome research (HEOR). In HEOR, there is the potential to use these techniques both to explore methodological challenges that are central to the design and interpretation of the findings of pharmacoeconomic and outcomes research studies, but also to communicate research findings to various stakeholders. In this manuscript, we discuss opportunities and methodological challenges for data visualisation specific to HEOR, describe external barriers that may impact the use of data visualisation methods, and discuss future applications of this technology in HEOR. While there are a number of obvious applications within the data-heavy field of HEOR, caution is required to ensure that visualisations, particularly advanced ones, accurately and fairly reflect the underlying data. However, researchers will benefit from adopting these increasingly sophisticated techniques to help ensure that decisionmakers and other stakeholders can understand, digest and communicate the data-which is critical for achieving the ultimate goal of improving patient outcomes.
Topics: Data Visualization; Economics, Medical; Outcome Assessment, Health Care
PubMed: 31054095
DOI: 10.1007/s40258-019-00476-5 -
American Journal of Health-system... May 2021Health-system specialty pharmacies (HSSPs) provide high-quality, efficient, and collaborative care to patients receiving specialty therapy. Despite proven benefits of...
PURPOSE
Health-system specialty pharmacies (HSSPs) provide high-quality, efficient, and collaborative care to patients receiving specialty therapy. Despite proven benefits of the integrated model, manufacturer and payer restrictions challenge the viability and utility of HSSPs. Vanderbilt Specialty Pharmacy developed a health outcomes and research program to measure and communicate the value of this model, drive improvement in patient care delivery, and advocate for recognition of HSSP pharmacists' role in patient care. The purpose of this descriptive report is to describe the development and results of this program.
SUMMARY
The health outcomes and research program began as an initiative for pharmacists to evaluate and convey the benefits they provide to patients, providers, and the health system. Early outcomes data proved useful in communicating the value of an integrated model to key stakeholders and highlighted the need to further develop research efforts. The department leadership invested resources to build a research program with dedicated personnel, engaged research experts to train pharmacists, and fostered internal and external collaborations to facilitate research efforts. As of March 2021, the health outcomes and research program team has published 33 peer-reviewed manuscripts, presented 88 posters and 7 podium presentations at national conferences, and received 4 monetary research awards. Further, the program team engages other HSSP teams to initiate and expand their own health outcomes research in an effort to empower all HSSPs in demonstrating their value.
CONCLUSIONS
The health outcomes and research program described has pioneered outcomes research among HSSPs nationwide and has proven valuable to specialty pharmacists, the health system, and key specialty pharmacy stakeholders.
Topics: Humans; Outcome Assessment, Health Care; Pharmaceutical Services; Pharmacies; Pharmacists; Pharmacy
PubMed: 33693451
DOI: 10.1093/ajhp/zxab082