When Are Patients Dead? The Cost of Lingering Ambiguity.

Advancing American Kidney Health—New Opportunities for Collaborative Care

The clinical management in extremely severe COPD

COVID-19 in Spain: Transplantation in the midst of the pandemic.

In 1998 ethnic minorities comprised 28% of the US population, and India is the third most common country of origin for immigrants. Many recently immigrated South Asian Indian patients are seen in health care settings in the United States. To deliver health care effectively to these patients, it is helpful for physicians to understand common cultural beliefs and practices of South Asian Indian patients. Two illustrative cases are reported. One author's observations of the care of pregnant and parturient women in India and similar experiences in our own office spurred a literature search of the cultural behaviors surrounding sexuality, fertility, and childbirth. A literature search was conducted in Index Medicus, Grateful Med, and the catalogue of the University of Pennsylvania Arts and Sciences library, using the terms "Indian," "South Asian," "male and female gender roles," "gynecology in third world," "sexuality," "sexual health," "women's health," "women's health education," "obstetrical practices/India," and "female roles/India." Issues surrounding sexuality and childbirth that arise during the US physician-South Asian Indian patient encounter might not correspond to the commonly held knowledge, beliefs, and behaviors of the US health care system. Common cultural beliefs and behaviors of South Asian Indian patients around sexuality and childbirth experience include the role of the individual patient's duty to society, the patient's sense of place in society, lack of formal sexual education, prearranged marriages, importance of the birth of the first child, little premarital contraceptive education, dominance of the husband in contraceptive decisions, and predominant role of women and lack of role for men (including the husband) in the childbirth process. Lack of understanding of the Indian cultural mores surrounding sexual education, sexual behavior, and the childbirth experiences can form barriers to Indian immigrants in need of health care. These misunderstandings can also lead to patient dissatisfaction with the health provider and health system, underutilization of health services, and poorer health outcomes for Indian immigrants and their families. For this reason, it is important to teach cultural issues during undergraduate, graduate, and continuing medical education.

Numerous studies have now demonstrated that integrating behavioral health and medical care can reduce medical costs, improve patient and provider satisfaction, and enhance clinical outcomes. Given this, one might expect that behavioral health programs would be fully integrated into primary care clinics across the country, but in fact integrated primary care programs remain quite rare. One reason for this discrepancy is that implementing such programs has proven to be extraordinarily challenging. Most of the integrated programs that are currently operating successfully are in settings where professionals are all members of the same health care system (e.g., HMOs, the Veterans Administration, Departments of Family Practice, etc.). Many providers, however, are in communities where various services are provided in different locations from different organizations that have very different clinical, administrative, and financial structures. In these situations, the challenges are even greater. The authors describe a set of strategies and techniques providers can use to move their health care system toward a higher level of integration and illustrate how they applied these steps to develop and assess the impact of an integrated primary care program in the state of Rhode Island.

IntroductionSuccessful organ transplantation in patients with end-stage organ failure improves long-term survival, improves quality of life and reduces costs to the NHS. Despite an increase in the number of deceased...

In Ontario, discharge planning is an overarching term referring to patient transitions through the healthcare system. Discharge planning encompasses the continuum of care from primary to acute care to post-acute care in the community or an institutional care setting. Due to its impact on related issues such as emergency department wait times, patient flow through the healthcare system has been an area of emphasis. Patients that are in acute care and awaiting discharge to another institutional setting such as a Long Term Care Home are designated as Alternate Level of Care (ALC). Because ALC patients could be receiving the level of care that meets their needs in another setting, this is considered an inefficient use of healthcare resources, and by extension thereby poses resource allocation concerns.In the authors’ experience, clinical ethics consultants are routinely consulted to assist with complex discharge planning cases. While the comprehensive range of ethical issues associated with discharge planning may vary based on the facts of the particular case there are four broad domains of issues that pertain to most acute care discharge planning in Ontario and include: (1) Resource allocation of finite healthcare resources (2) Supporting patient/substitute decision making (3) Moral distress and (4) Procedural fairness. An illustrative case is used to further draw on the four identified domains of issues and demonstrate the practical contributions of clinical ethics consultants to address complex discharge planning cases.KeywordsDischarge planningResource allocationSubstitute decision-makingMoral distressProcedural fairness

A large study assessing whether inducing hypothermia in brain dead organ donors would affect graft function in recipients of kidney transplants may have violated federal regulations by not considering the...

BackgroundSince 2013, the Veterans Health Administration (VHA) has advanced a person-centered, Whole Health (WH) System of Care, a shift from a disease-oriented system to one that prioritizes “what matters most” to patients in their lives. Whole Health is predicated on patient-provider interactions marked by a multi-level understanding of health and trusted relationships that promote well-being. Presently, WH implementation has been focused largely in primary care settings, yet the goal is to effect a system-wide transformation of care so that Veterans receive WH across VHA clinical settings, including specialty care. This sort of system-wide cultural transformation is difficult to implement.MethodsThis three-aim mixed methods study will result in a co-designed implementation blueprint for spreading WH from primary to specialty care settings. Taking HIV specialty care as an illustrative case- because of its diverse models of relationships to primary care - to explore how to spread WH through specialty care settings. We will use the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to organize quantitative and qualitative data and identify key determinants of WH receipt among Veterans living with HIV. Through a co-design process, we develop an adaptable implementation blueprint that identifies and matches implementation strategies to different HIV specialty care configurations.DiscussionThis study will co-design a flexible implementation blueprint for spreading WH from VHA primary care throughout HIV specialty care settings. This protocol contributes to the science of end-user engagement while also answering calls for greater transparency in how implementation strategies are identified, tailored, and spread.

This article introduces the concept path dependence based on case illustrations mainly from psychiatric health care. The concept path dependence is widely used in economic research, history, social sciences and law, but so far seldom in psychology and health care, although equally applicable here. Two variants of path dependence, one in a narrow sense and one in a broader sense are defined and exemplified by case illustrations from psychiatric health care and patient safety systems.

Acknowledgements List of tables List of figures Preface Part I. Understanding NGOs: 1. Classifying NGOs: definitions, typologies and networks 2. The emergence of NGOs in the context of business-government - societal relationships 3. The emergence of NGOs in the context of ethical and institutional complexity Case illustration: genetically modified organisms, social movements and NGOs Case illustration: protecting the people: environmental NGOs and TXU energy Part II. NGO Advocacy Campaigns: 4. NGO campaigns against corporations and (de-) legitimacy 5. How do they do it? Understanding the power and influence of radical advocacy NGOs 6. NGO campaign types and company responses Case illustration: PETA and KFC Case illustration: Coca-Cola in India Part III. NGO-Corporate Engagement: 7. Corporate-NGO engagements: from conflict to collaboration 8. Globalization, multinationals and NGOs: the next wave Case illustration: conflict diamonds Case illustration: Unilever in Indonesia Case illustration: microfinance and poverty reduction Part IV. The Future of Corporate-NGO Relations: 9. The future of corporate-NGO relations Index.

Excessive alcohol use, in the form of either chronic dependence or binge drinking, is a large economic burden on the U.S. health care system, being responsible for over $2.9 billion yearly in health-related costs [1] and an estimated 1.8 million annual hospital admissions [2]. The classic symptoms of acute alcohol withdrawal include tremors, anxiety, nausea, emesis, palpitations, and irritability; these symptoms could easily be confused with those found in thyrotoxicosis states. Further, thyroid function studies in patients who consume alcohol are often abnormal and sometimes lead to unnecessary work up on the part of clinicians. Previous reports have demonstrated a normalization of thyroid function parameters with alcohol cessation [3]. The following case study describes changes in thyroid levels in a patient with alcohol use and highlights the need for their careful interpretation.

Over the past decade, many health care systems across the Global North have implemented elements of market mechanisms while also dealing with the consequences of the financial crisis. Although effects of these two developments have been researched separately, their combined impact on the governance of health care organizations has received less attention. The aim of this study is to understand how health care reforms and the financial crisis together shaped new roles and interactions within health care. The Netherlands - where dynamics between health care organizations and their financial stakeholders (i.e., banks and health insurers) were particularly impacted - provides an illustrative case. Through semi-structured interviews, additional document analysis and insights from institutional change theory, we show how banks intensified relationship management, increased demands on loan applications and shifted financial risks onto health care organizations, while health insurers tightened up their monitoring and accountability practices towards health care organizations. In return, health care organizations were urged to rearrange their operations and become more risk-minded. They became increasingly dependent on banks and health insurers for their existence. Moreover, with this study, we show how institutional arenas come about through both the long-term efforts of institutional agents and unpredictable implications of economic and societal crises.

Death by neurologic criteria is a legal definition upheld in all 50 states in the United States. Confusion among the public may cause the declaration of death to be disputed and the removal of physiologic support delayed. In this report, a case is described of an infant who died from traumatic brain injury, but whose removal from respiratory and cardiovascular support was delayed due to a legal injunction brought forth from his family against the hospital. In addition, ethical issues faced by the health care team are discussed surrounding continuing medical therapies for a patient after the declaration of death.

This study investigates the correlation between high national debt, healthcare spending, and COVID-19 mortality rates across European countries. The hypothesis is that excessive public debt undermines healthcare and socioeconomic systems, increasing vulnerability to crises like the pandemic. Findings support this theory. Countries with lower COVID-19 death rates exhibited lower debt levels and higher per capita healthcare spending compared to those with higher mortality rates. Despite increased debt burdens, countries with higher fatality rates struggled to boost healthcare expenditures, potentially due to austerity measures imposed by the European Union. The Methods section indicates that this study analyzed data from 27 EU member states, examining healthcare and economic indicators from 2009 and 2019 to evaluate their influence on COVID-19 mortality rates. Using descriptive statistics, a t-test, and a two-stage least squares (2SLS) regression model, the study compared pre-pandemic trends in healthcare spending and public debt, aiming to assess the impact of high government debt on healthcare systems' crisis response capacity. The research demonstrates a strong association between increased health spending and reduced COVID-19 mortality rates, even when accounting for debt levels. These results highlight the detrimental impact of high public debt on healthcare systems and their ability to respond effectively to public health emergencies. The study underscores the need to address public debt to build more resilient healthcare infrastructures.