Healthcare Agents Research Articles

Strategic alliances: an analysis of Catalan hospitals

To analyze the strategic alliances that Catalan hospitals form with other health care entities and other types of institutions to foster technological and organizational innovation. Qualitative case studies were conducted at a sample of 16 public hospitals in Catalonia, Spain. The sample was limited to three (Level 1-3) of Catalonia's four levels of hospitals (classified according to the complexity of the diagnoses and treatments they provide), but Level 4 hospitals were considered as part of the network in the analysis of the alliances. At each hospital, interviews were conducted with the manager, the medical director, and the service director, using a questionnaire that gathered information on strategic alliances with a focus on telemedicine. Qualitative data processing was applied to identify patterns of alliances between hospitals and other institutions. Catalan hospitals interact with other health care agents through three main types of associations: alliances with other hospitals (the most frequent type); alliances with primary care centers (reported mostly by Level 2 hospitals); and alliances with other institutions (e.g., local government, medical companies, and universities). Human resource-sharing (staff mobility) and training were reported most frequently as reasons for creating the alliances. Strategic alliances are formed between hospitals and other health care agents to help improve performance, competitiveness, and services provided to users. These results may help health care system managers promote strategic alliances as a means of optimizing system efficiency without reducing user satisfaction-a key challenge within the context of the current economic situation.

End-of-Life Care for Children and Adults With Intellectual and Developmental Disabilities

End-of-Life Care for Children and Adults With Intellectual and Developmental Disabilities

Implementation of e-Bug in Denmark

Bacterial resistance to antimicrobial agents in primary healthcare is low in Denmark compared with most other European countries. Denmark has a vaccination programme for children that recommends immunization against 10 infectious diseases, including a heptavalent pneumococcal conjugate vaccine (PCV7) and a vaccine against human papillomavirus (HPV). Outbreaks in schools due to other infectious illnesses are well recognized and have seasonal variations. A quarter of young people have had a sexually transmitted disease before the age of 25 years. Denmark had a considerable interest in joining the e-Bug project to keep a focus on the low prevalence of bacterial resistance and the prevention of infectious diseases, and to maintain the acceptance of the immunization programme. Furthermore, the Danish Folkeskole, which is the Danish municipal primary and lower secondary school, uses the principle of differentiated teaching, integrating information technology, and there are no recommended textbooks in the curriculum. The teaching is organized so that it both strengthens and develops an individual student's ability to act and care for themselves and for society in general. e-Bug, in its design, was seen as a tool that could be implemented well in the Danish Folkeskole, as it fulfils the goals on teaching methods and output. Two thousand e-Bug packs were printed, 100 local education authorities and 1507 school principals were contacted, and e-Bug was presented to important stakeholders in relevant scientific magazines and at meetings. It has been well accepted.

Key Role of Social Work in Effective Communication and Conflict Resolution Process: Medical Orders for Life-Sustaining Treatment (MOLST) Program in New York and Shared Medical Decision Making at the End of Life

In this article, the authors review the development of the Medical Orders for Life-Sustaining Treatment (MOLST) Program and recent landmark legislation in New York State in the context of advance care planning and shared medical decision making at the end of life. Social workers are central health care professionals in working with patients, families, practitioners, health care agents, and surrogates in the health systems and in the communication and conflict resolution process that is integral to health care decision making. The critical importance of ethics and end-of-life training and education for social workers is also addressed. Data from a pilot study evaluating interdisciplinary ethics training on legal and ethical content in communication and conflict resolution skills in health care decision making are reported. Recommendations are made for research on education and training of social workers, and investigation of the role and influence of systems in shaping social work involvement in end-of-life and palliative care.

Life Imitates Work

Life Imitates Work

Utilitarianism Impacting Care of those with Disabilities and those at Life's End.

Society's understanding of the nature of suffering impacts the development of health-care public policy, having a significant impact on care of the elderly and those with disabilities. With scientific advances comes a societal expectation that one can have "the perfect life," not just for one's self, but also for one's offspring. Thus extinguishing the imperfect life, at its earliest or later stages through physician-assisted suicide, becomes an accepted recourse. The Catholic tradition is rich in providing meaning to those who suffer and their families, particularly those at the end-of-life or those with disabilities. The Ethical and Religious Directives for Catholic Health Care Services address the importance of advanced directives to assure that the health-care wishes of patients, no longer able to express them, are respected. However, such directives cannot anticipate all of the health-care scenarios that could arise. Thus the role of a health-care agent (surrogate), who through extensive discussions knows the will of the patient and the mind of the Church, is critical. However, increasingly public policies, especially as they pertain to the allocation of costly resources such as health care, are impacting the health-care choices available to patients, their families, and the health-care provider. Consistent with the utilitarian ethic, state sanctioned killing of those deemed to have "lost their dignity" is hailed as a "good." This essay explores the challenges for all of us who are members of a profession once entrusted with protecting the most vulnerable among us.

Lost in Translation: The Unintended Consequences of Advance Directive Law on Clinical Care

Advance directive law may compromise the clinical effectiveness of advance directives. To identify unintended legal consequences of advance directive law that may prevent patients from communicating end-of-life preferences. Advance directive legal statutes for all 50 U.S. states and the District of Columbia and English-language searches of LexisNexis, Westlaw, and MEDLINE from 1966 to August 2010. Two independent reviewers selected 51 advance directive statutes and 20 articles. Three independent legal reviewers selected 105 legal proceedings. Two reviewers independently assessed data sources and used critical content analysis to determine legal barriers to the clinical effectiveness of advance directives. Disagreements were resolved by consensus. Legal and content-related barriers included poor readability (that is, laws in all states were written above a 12th-grade reading level), health care agent or surrogate restrictions (for example, 40 states did not include same-sex or domestic partners as default surrogates), and execution requirements needed to make forms legally valid (for example, 35 states did not allow oral advance directives, and 48 states required witness signatures, a notary public, or both). Vulnerable populations most likely to be affected by these barriers included patients with limited literacy, limited English proficiency, or both who cannot read or execute advance directives; same-sex or domestic partners who may be without legally valid and trusted surrogates; and unbefriended, institutionalized, or homeless patients who may be without witnesses and suitable surrogates. Only appellate-level legal cases were available, which may have excluded relevant cases. Unintended negative consequences of advance directive legal restrictions may prevent all patients, and particularly vulnerable patients, from making and communicating their end-of-life wishes and having them honored. These restrictions have rendered advance directives less clinically useful. Recommendations include improving readability, allowing oral advance directives, and eliminating witness or notary requirements. U.S. Department of Veterans Affairs and the Pfizer Foundation.

Anticoagulants and anti-platelet agents in palliative home healthcare

Anticoagulants and anti-platelet agents in palliative home healthcare

Intelligent agents in home healthcare

The percentage of the population who are elderly will significantly increase over the next decade due to the aging of the baby-boom generation, putting additional stress on healthcare. The elderly are at higher risk for many disorders, especially cardiac-related problems and diminishing mental capacity. The impact will be felt in various domains, including additional pressures on existing infrastructure and increasing per capita costs for medical care. A potential approach to alleviate these problems is the implementation of home healthcare using new technologies. With remote interventions, the patient can remain at home, not only reducing costs but also benefiting from a familiar environment and support of family members. Methods are outlined that can contribute to the delivery of home healthcare in the areas of monitoring and support using intelligent agent methodologies. The methods are illustrated in two distinct applications: support and intervention for patients with dementia and remote monitoring of cardiac conditions. The methods outlined can also be adapted for use in other areas.

Parvovirus B19 in Solid Organ Transplant Recipients

Parvovirus B19 is a common, ubiquitous human pathogen.It is a small, single-stranded linear, nonenveloped DNAvirus classified into three different genotypes (genotype1, Au and Wi strains; genotype 2, LaLi and A6 strains; andgenotype 3, V9 strains). Its worldwide genetic variability islow, and there is no clear correlation between genotypeand distinctive clinical manifestation. Parvovirus B19 repli-cates most efficiently and preferentially in human erythro-cyte precursors; thus, the virus is classified as a memberof the Erythrovirus genus of the Parvoviridae family. Mostpeople are infected between the ages of 5 and 15 years;by adulthood, up to 80% are seropositive (1). Infection ap-pears to confer lifelong immunity to immunocompetenthosts, but reinfection is possible in a minority of cases(2). It has been hypothesized that Parvovirus B19 can per-sist in the bone marrow and other tissues (3), support-ing possible reactivation rather than reinfection in certainseropositive patients. Parvovirus B19 infection can be ei-ther symptomatic or asymptomatic, depending on the age,hematologic and immunologic status of the host. Whilemostpatientsrecollectonlynonspecificflu-likesymptoms,distinctive clinical entities have been associated with Par-vovirus B19 infection in both immunocompetent hosts (4)and solid organ transplant (SOT) recipients (5). The mostcommonclinicalmanifestationsofParvovirusB19aresum-marizedinTable1.Although large, prospective surveillance studies are lack-ing, earlier studies reported an incidence of Parvovirus B19disease of

Preferences for Psychiatric Advance Directives Among Latinos: Views on Advance Care Planning for Mental Health

Psychiatric advance directives allow persons with mental illness to declare preferences for future treatment through an advance instruction and/or a health care agent. Initial outcomes are promising (1-5). However, the role of psychiatric advance directives in the cross-cultural context of mental health services has not been examined. These documents may play an important role for Latino individuals in US mental health care settings. Psychiatric advance directives may represent an opportunity to align culturally appropriate services with treatment needs in Latino populations. However, no research has examined the acceptability of these documents by Latino mental health stakeholders. This study assessed demand, interest, and attitudes towards psychiatric advance directives for clients, families and clinicians.

Adherence to cervical and breast cancer programs is crucial to improving screening performance

Cervical and breast cancer are the most common malignancies among women worldwide. Effective screening can facilitate early detection and dramatically reduce mortality rates. The interface between those screening patients and patients most needing screening is complex, and women in remote areas of rural counties face additional barriers that limit the effectiveness of cancer prevention programs. This study compared various methods to improve compliance with mass screening for breast and cervical cancer among women in a remote, rural region of Brazil. In 2003, a mobile unit was used to perform 10,156 mammograms and Papanicolaou smear tests for women living in the Barretos County region of São Paulo state, Brazil (consisting of 19 neighbouring cities). To reach the women, the following community outreach strategies were used: distribution of flyers and pamphlets; media broadcasts (via radio and car loudspeakers); and community healthcare agents (CHCAs) making home visits. The most useful intervention appeared to be the home visits by healthcare agents or CHCAs. These agents of the Family Health Programme of the Brazilian Ministry of Health reached an average of 45.6% of those screened, with radio advertisements reaching a further 11.9%. The great majority of the screened women were illiterate or had elementary level schooling (80.9%) and were of 'poor' or 'very poor' socioeconomic class (67.2%). Use of a mobile screening unit is a useful strategy in developing countries where local health systems have inadequate facilities for cancer screening in underserved populations. A multimodal approach to community outreach strategies, especially using CHCAs and radio advertisements, can improve the uptake of mass screening in low-income, low-educational background female populations.

Diferencias de género en los retrasos de ingreso y reperfusión en el síndrome coronario agudo

Objective To study delay times in women with acute coronary syndrome (ACS) and ST segment elevation (STSEACS) until administration of possible reperfusion therapy as well as its possible differences in relationship to the men. Material and methods A study was conducted in 1,849 patients consecutively hospitalized in a Coronary Unit from January 2000 to December 2005 who had been diagnosed of ACS. Different delay times were studied from the beginning of the symptoms, comparing them between genders and correcting this by variable age. Results The percentage of women was 24.4% with a mean age of 71.5 years. Medium delay time from the beginning of the symptoms to contact with the first health care agent was significantly (p < 0.001), longer for women than for men, 164 min. vs 120 min. Reperfusion treatments were used in 57.6% of the subjects, with a significant difference (p < 0.01) of 7.6% between men (59.5%) and women (51.9%). Conclusions Delay times are greater in women than men, above all regarding the beginning of the symptoms until arrival to the first health care agent. Currently, reperfusion treatments are performed more in men than in women, the differences are minimum when adjusted by age.

Miracle products: Spanish pharmacy's great struggle to eradicate them

The Spanish pharmacy model has two fundamental characteristics that may be summarised as the credibility of the community pharmacy as a healthcare establishment and the professionalism of the pharmacist as a healthcare agent. Currently, the professional activity of the pharmacist mainly revolves around the patient, with medicine being a healthcare tool he or she uses to practice his or her profession. However, the pharmacy as a healthcare establishment also covers other fields, such as the case of the Parapharmacy, which also require the pharmacist’s professional capacity, giving priority to the healthcare aspects over the financial ones. The Parapharmacy field includes health products where the professional action of the pharmacist forms an important added value that is recognised as such by society. As opposed to the Parapharmacy products correctly placed on the market, we find the so-called “Miracle Products”. Society is being invaded by products of differing natures and presentations,which try to find a place on the market by virtue of supposed healing or preventive properties for all types of complaints or health problems. Every year, in a seasonal basis, products are being detected (particularly foods or cosmetics) that promote the healing of incurable diseases or weight loss over a short period of time. Generally, the “miracle products” appear surrounded by short term, aggressive advertising campaigns and they disappear as soon as the health authorities act against them. Most of these fraudulent products do not include the clear identification of the company liable for them on the label, just a contact telephone number, web address or P.O. box number. The companies in charge of the marketing of this type of product are also aware of the healthcare value that the community pharmacies provide, and they try to use them for their own benefit. An example of this is that they frequently use, unilaterally, the advertising slogan of “on sale in pharmacies” or “ask your pharmacist for it”. They are also presented using devices, energies or apparatus that influence different parts of the human body alleging to produce effects that prevent, alleviate or cure diseases or complaints or soothe pain. In general, they are expensive and they manage to create expectations of success with their use that do not correspond to reality. Therefore:

La conformaciÓn del sistema sanitario de la Argentina. El caso de la Provincia de CÓrdoba, 1880-1926

This article describes the construction of the health system in Cordoba province between the end of the 19th century and the second half of the 1920s, placing particular emphasis in the national institutions and private charity associations created during this period. The hypothesis of this article is that the Cordoba health system was developed from the initiative of private charity associations and at the level of the nation or municipality, whereas the provincial state had a limited role. These developments occurred despite the hegemony of a liberal discourse that reinforced the role of the state as the main agent in public health care.

Marcas identitárias masculinas e a saúde de homens jovens

This work is mainly aimed to analyze the meaning given by young men to masculinity. By this analysis, discussions involving integral attention to them in health care field can advance. Our methodology is characterized by case study under the social sciences perspective and with hermeneutic-dialectical approach involving 19 male youngsters aged 15 to 17. About the observed results, young men associated being male with playing household provider, dominating man, heterosexual and caregiver roles. This association occurs through dialectical process reflecting the subjective complexity in accepting or rejecting the identity marks. Within this study conclusions, it is emphasized the public heath care need of listening young men's voice about their identity to involve them in health care prevention and promotion actions, assuring to these social agents--traditionally not seen as health care agents--to find a way and different relationship with this area.

Roles and Responsibilities of Health Care Agents: Views of Patients and Agents

Two qualitative methods were used to explore, from the perspectives of both patients and agents, the roles and responsibilities of health care agents related to making end-of-life decisions. Results of the individual interviews revealed that both patients and agents did not have a clear understanding of the role, responsibility, and legal authority of health care agents. The results of the focus group of former agents indicated that when assuming the role, some agents had both knowledge and experience in making end-of-life decisions, whereas others had little understanding of their role. Former agents discussed serious communication difficulties they had encountered with health care professionals when making life-and-death decisions.

An Update on Advance Directives in the Medical Record: Findings from 1186 Consecutive Patients with Unresectable Exocrine Pancreas Cancer

The Terri Schiavo case and other recent events underscore the importance of advance directives. Yet, in the past, only a small subgroup has utilized them. This study from a large tertiary medical center was undertaken to assess current rates of advance directives among patients with incurable pancreas cancer. The medical records of 1,186 consecutive patients with unresectable pancreas cancer were reviewed over a 4-year span. Only 174 patients (15%) had an advance directive in the medical record. Older age and having cancer therapy at our institution were associated with a greater likelihood of having an advance directive with odds ratios (95% confidence intervals) of 8.26 (2.81, 24.93) and 2.86 (2.03, 4.02), respectively, in multivariate analyses. Importantly, 42 patients (24%) had a different person designated as their healthcare agent in their advanced directive than what appeared in the medical record as the "contact person." These findings underscore the ongoing need to discuss advance directives with patients with incurable malignancies and to clarify patients' wishes when seemingly contradictory information appears in other parts of the medical record.

IOC Consensus Statement on Training the Elite Child Athlete

IOC Consensus Statement on Training the Elite Child Athlete

Concepts involved in the training and work processes of community healthcare agents: a bibliographical review

This paper is the outcome of a bibliographical review that aims at systemizing references in the literature to concepts involved in the training and work processes of community health agents under the Community Health Agent Program (PACS) and the Family Health Program. Published in scientific journals, manuals and official documents through to October 2004, 504 articles were consulted, of which 49 were selected and examined in full. The findings were systematically arranged under four themes, reviewing controversial aspects raised by authors, outstanding among which are: the 'discourse of change' statements in official documents, defining the Family Health Program as a reorientation strategy for the Primary Healthcare Model; the scope and ambiguity of understandings of the role of mediator and definitions of the duties and responsibilities of Community Healthcare Agents, as well as the gaps in their training.