Diverse Health Care Systems Research Articles

Global e-Learning in Early Nutrition and Lifestyle for International Healthcare Professionals: Design and Evaluation of the Early Nutrition Specialist Programme (ENS).

Background: Every encounter a healthcare professional has with new or expecting parents offers an opportunity for addressing improved early nutrition and lifestyle. Evidence-based qualification programmes via e-learning offer valuable tools for attenuating the world’s huge double burden of both under- and overnutrition in early childhood. We evaluated use and learner satisfaction of a global e-learning programme on early nutrition and lifestyle addressing international healthcare professionals. Methods: We implemented the Early Nutrition Specialist Programme (ENS) with six interactive e-learning courses on early nutrition building on more than ten years of experience with global e-learning platforms, expert knowledge and an international network in the subject field. We collected descriptive and explorative evaluation data on usage and learner satisfaction with a questionnaire and log data over three years among 4003 learners from 48 countries. Results: Results show high completion of the ENS programme, with 85.5% of learners finalizing the programme after enrollment into the first of six courses. Very good results were provided for learner satisfaction with the courses (96.7% of users), for increasing understanding of the topic (97.4%) and matching the indicated time investment (94.4%). Most predominant themes in the open text fields of user feedback questionnaires were “Increase interactivity or number of audio-visuals”, “Content suggestions or more examples” and “Technical (quality) issues or navigation problems”. Conclusions: The ENS programme evaluation shows high completion rates and level of satisfaction by learners from numerous countries. The different needs for Continuing Medical Education (CME) of healthcare professionals in diverse healthcare system settings can be met by a joint e-learning qualification programme. Further optimizations will be implemented based on user feedback. More research with a learning analytics approach may help to further identify the most effective and efficient didactic and pedagogic elements of e-learning.

Use of complementary and alternative medicine and factors affecting their use among Libyan children with rheumatic diseases at Tripoli Children's Hospital 2019

Background: Complementary and alternative medicine (CAM) is defined as a group of diverse medical and health care systems, practices, and products that are not presently considered as conventional medicine. Aim of the study: To determine the prevalence, types, and factors affecting use of complementary and alternative medicine among Libyan children with rheumatic diseases. Methodology: A descriptive cross-sectional study was conducted in rheumatology clinic at Tripoli Children's Hospital, in which parents of children with different rheumatic diseases were interviewed by using a pre formed questionnaire at their routine visits. Data were managed and analyzed by SPSS data base (version 19). Result: Of 103 interviewed parents, 71(69%) were mothers with mean age of 41.21 years, 39% of whom had a university degree, and 50% of whom were employed. 31% were fathers with mean age of 47.7 years, 74% of whom were employed and 38% of whom had a university degree. 65\103(63%) of parents were living outside Tripoli. Majority of patients were females (75%) with a mean age of 12.8 years, 95% of the patients living with both their father and mother together. 63% of patients had juvenile idiopathic arthritis. Overall, 83% of patients were CAM users, 77% of theme was females and 65% had been diagnosed as JIA. The most frequently used CAM were Natural health products (69.8%) as honey and Meringa. Almost all CAM users (96.5%) did not change or stop their conventional therapy nor did they deviate from their scheduled visits in the rheumatology clinic. Conclusion & recommendation: CAM use was common among patients followed in the pediatric rheumatology clinic; Natural health products were the most commonly used CAM. Very little is known about the benefits or potential harms of CAM despite its widespread use. Education and counseling programs to patients and parents about CAM use can help in the management of such chronic diseases.

The COVID-19 crisis as an opportunity to strengthen global regulatory coordination for sustained enhanced access to diagnostics and therapeutics.

The coronavirus disease 2019 (COVID-19) pandemic presents an unparalleled opportunity for regulators globally to strengthen coordination, advance alignment initiatives, and exercise regulatory agility to facilitate access to the surge in diagnostics, therapies and vaccines without compromising public safety. We describe international collaborative initiatives, summarise key experiences, and urge the global regulatory community to apply lessons from the current pandemic to strengthen and sustain cooperation for future public health emergencies and enhanced health products access.

Study of awareness, attitude, and utilization of Complementary and Alternative Medicine among patients visiting urban and rural health centers

Worldwide there is a recent increase in the usage of Complementary and Alternative Medicine (CAM), which has been defined as a group of diverse medical and healthcare systems, practices and products that are presently not considered to be a part of conventional medicine. The objectives were to assess and to compare the awareness, perspective, and utilization of CAM among urban and rural patients. A cross-sectional study was conducted among 200 out-patients attending the urban and rural health centers with a standardized questionnaire. MS Excel and Epi Info were used for data entry and analysis. The awareness of CAM was 71% of urban patients and 63% of rural patients. Despite the awareness of CAM, the urban patient either liked CAM (32%) or apathetic towards CAM (32%) and rural patients mostly apathetic towards CAM (47%). Both areas of patients (41%) used CAM, of which 36% were urban patients and 46% were rural patients. There is a higher proportion of aware patients in rural areas (73%) used CAM when compared to the usage of CAM by aware patients in the urban area (51%). Despite the usage of CAM, both areas of patients preferred Allopathy. In summary, this study demonstrated that most patients are aware of CAM, but patients were mostly apathetic towards CAM. Around half of the patients utilized alternative medicine.

Perceptions of Treatment Burden Among Elders With Diabetes and Comorbid Alzheimer’s Disease and Related Dementias

Background: An estimated 25% of older adults with diabetes (DM) may have co-occurring Alzheimer’s Disease and Related Dementias (ADRD), complicated by multiple treatment plans and providers. Assessing treatment burden has been limited to patients’ perspectives; little is known about caregiver perceptions of treatment burden despite their important role in personal care and treatment adherence. The purpose of this qualitative study was to describe caregiver perceptions of treatment burden for older adults with DM-ADRD. Methods: This qualitative study was conducted in the formative phase of “Enhanced Quality in Primary care for Elders with DM-ADRD (EQUIPED-ADRD) a pragmatic randomized controlled trial in a large, diverse healthcare system. A diverse sample of caregivers (n=15) of patients enrolled in the RCT participated in interviews about their caregiver role and perceptions of treatment burden of DM-ADRD clinical management. Qualitative data were analyzed using content analysis and themes about treatment burden were compared to domains on the Treatment Burden Questionnaire (TBQ). Results: Caregivers reported high levels of burden related to treatment plans for patients with DM-ADRD. Themes related to complexity and burden of medication management, monitoring (e.g., blood pressure, glucose monitoring), dietary and physical activity regimens, navigating healthcare providers and financial burden were reported. Caregivers also described high levels of emotional burden that was associated with patient’s cognitive decline and family functioning stress. Conclusions: Interventions to reduce treatment burden for patients and caregiver should include activating social/nursing services, respite care and care coordination that may support caregivers especially as patient treatment increases in complexity over time.

Multilevel influences on resilient healthcare in six countries: an international comparative study protocol

IntroductionResilient healthcare (RHC) is an emerging area of theory and applied research to understand how healthcare organisations cope with the dynamic, variable and demanding environments in which they operate, based...

At the intersection of precision medicine and population health: an implementation-effectiveness study of family health history based systematic risk assessment in primary care

BackgroundRisk assessment is a precision medicine technique that can be used to enhance population health when applied to prevention. Several barriers limit the uptake of risk assessment in health care systems; and little is known about the potential impact that adoption of systematic risk assessment for screening and prevention in the primary care population might have. Here we present results of a first of its kind multi-institutional study of a precision medicine tool for systematic risk assessment.MethodsWe undertook an implementation-effectiveness trial of systematic risk assessment of primary care patients in 19 primary care clinics at four geographically and culturally diverse healthcare systems. All adult English or Spanish speaking patients were invited to enter personal and family health history data into MeTree, a patient-facing family health history driven risk assessment program, for 27 medical conditions. Risk assessment recommendations followed evidence-based guidelines for identifying and managing those at increased disease risk.ResultsOne thousand eight hundred eighty-nine participants completed MeTree, entering information on N = 25,967 individuals. Mean relatives entered = 13.7 (SD 7.9), range 7–74. N = 1443 (76.4%) participants received increased risk recommendations: 597 (31.6%) for monogenic hereditary conditions, 508 (26.9%) for familial-level risk, and 1056 (56.1%) for risk of a common chronic disease. There were 6617 recommendations given across the 1443 participants. In multivariate analysis, only the total number of relatives entered was significantly associated with receiving a recommendation.ConclusionsA significant percentage of the general primary care population meet criteria for more intensive risk management. In particular 46% for monogenic hereditary and familial level disease risk. Adopting strategies to facilitate systematic risk assessment in primary care could have a significant impact on populations within the U.S. and even beyond.Trial registrationClinicaltrials.gov number NCT01956773, registered 10/8/2013.

Model for End-Stage Liver Disease-Lactate and Prediction of Inpatient Mortality in Patients With Chronic Liver Disease.

Compared to other chronic diseases, patients with chronic liver disease (CLD) have significantly higher inpatient mortality; accurate models to predict inpatient mortality are lacking. Serum lactate (LA) may be elevated in patients with CLD due to both tissue hypoperfusion as well as decreased LA clearance. We hypothesized that a parsimonious model consisting of Model for End-Stage Liver Disease (MELD) and LA at admission may predict inpatient mortality in patients with CLD. We examined all patients with CLD in two large and diverse health care systems in Texas (North Texas [NTX] and Central Texas [CTX]) between 2010 and 2015. We developed (n=3,588) and validated (n=1,804) a model containing MELD and LA measured at the time of hospitalization. We further validated the model in a second cohort of 14 tertiary care hepatology centers that prospectively enrolled nonelective hospitalized patients with cirrhosis (n=726). MELD-LA was an excellent predictor of inpatient mortality in development (concordance statistic [C-statistic]=0.81, 95% confidence interval [CI] 0.79-0.82) and both validation cohorts (CTX cohort, C-statistic =0.85, 95% CI 0.78-0.87; multicenter cohort C-statistic =0.82, 95% CI 0.74-0.88). MELD-LA performed especially well in patients with specific cirrhosis diagnoses (C-statistic =0.84, 95% CI 0.81-0.86) or sepsis (C-statistic =0.80, 95% CI 0.78-0.82). For MELD score 25, inpatient mortality rates were 11.2% (LA=1mmol/L), 19.4% (LA=3 mmol/L), 34.3% (LA=5mmol/L), and >50% (LA>8mmol/L). A linear increase (P<0.01) was seen in MELD-LA and increasing number of organ failures. Overall, use of MELD-LA improved the risk prediction in 23.5% of patients compared to MELD alone. MELD-LA (bswh.md/meldla) is an early and objective predictor of inpatient mortality and may serve as a model for risk assessment and guide therapeutic options.

Introduction to the special issue: Complementary medicine and integrative health approaches to trauma therapy and recovery.

The popularity of complementary and integrative health (also complementary integrated health; CIH) approaches has significantly increased in recent years. According to the National Center for Complementary and Integrative Health (NCCIH), part of the National Institutes of Health, about 1 in 3 adults and 1 in 9 children used CIH approaches to healing. Some reports estimate that the use of CIH approaches will continue to increase (Clarke et al., 2015) as these therapies are cost effective and also due to the difficulties in finding trained mental health professionals (Simon et al., 2020). For the purpose of this special issue, we use the NCCIH's definition of CIH as "a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine" (Barnes et al., 2004, p. v). However, the integration of these therapies into the health system has not followed the same pattern despite the fact that patients report the need to discuss CIH therapies with their doctors or are actually using them (de Jonge et al., 2018; Jou & Johnson, 2016; Stapleton et al., 2015). This inability to keep up with the demand or patients' preference is possibly due to providers' lack of understanding and/or knowledge of these therapies, as well as scientific skepticism (Ali & Katz, 2015; Fletcher et al., 2017). Using data from the 2012 National Health Interview Survey, Jou & Johnson (2016) identified patterns of CIH use in the United States and reasons for patients' nondisclosure of the use of these therapies. Patients' fear of disclosure due to perceived skepticism or disapproval from their provider was frequently attributed as a cause of patients' nondisclosures to providers about the use of these therapies (Eisenberg et al., 2001; Jou & Johnson, 2016; Thomson et al., 2012). The arrival of patient-centered care models is beginning to shift the ways we understand the patient's role in treatment engagement. Patient-centered approaches often emphasize the use of preventative and holistic wellness models that go beyond the use of evidence-based treatments. This approach also seeks to be culturally responsive, which is a key factor in addressing health disparities in the United States (American Psychological Association [APA], 2019). The Institute of Medicine, in its report on CIH therapies, highlighted the importance of engaging patients in their own care, including having a decision about therapeutic options (Bondurant et al., 2005). Likewise, the Race and Ethnicity Guidelines in Psychology (APA, 2019) recommend psychologists engage the patient's cultural beliefs, or what Kleinman called the "explanatory belief model" (Kleinman, 1978)- for example, by "aim[ing] to understand and encourage indigenous/ ethnocultural sources of healing within professional practice" (APA, 2019, p. 24). (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Obstructive Sleep Apnea and Risk of COVID-19 Infection, Hospitalization and Respiratory Failure.

PurposeTo study the relationship between OSA and risk of COVID-19 infection and disease severity, identified by the need for hospitalization and progression to respiratory failure.MethodsWe queried the electronic medical record system for an integrated health system of 10 hospitals in the Chicago metropolitan area to identify cases of COVID-19. Comorbidities and outcomes were ascertained by ICD-10-CM coding and medical record data. We evaluated the risk for COVID-19 diagnosis, hospitalization, and respiratory failure associated with OSA by univariate tests and logistic regression, adjusting for diabetes, hypertension, and BMI to account for potential confounding in the association between OSA, COVID-19 hospitalization, and progression to respiratory failure.ResultsWe identified 9405 COVID-19 infections, among which 3185 (34%) were hospitalized and 1779 (19%) were diagnosed with respiratory failure. OSA was more prevalent among patients requiring hospitalization than those who did not (15.3% versus 3.4%, p < 0.0001; OR 5.20, 95% CI (4.43, 6.12)), and among those who progressed to respiratory failure (19.4% versus 4.5%, p < 0.0001; OR 5.16, 95% CI (4.41, 6.03)). After adjustment for diabetes, hypertension, and BMI, OSA was associated with increased risk for hospitalization (OR 1.65; 95% CI (1.36, 2.02)) and respiratory failure (OR 1.98; 95% CI (1.65, 2.37)).ConclusionsPatients with OSA experienced approximately 8-fold greater risk for COVID-19 infection compared to a similar age population receiving care in a large, racially, and socioeconomically diverse healthcare system. Among patients with COVID-19 infection, OSA was associated with increased risk of hospitalization and approximately double the risk of developing respiratory failure.

Complementary and alternative medicines usage in elderly patients in tertiary care teaching hospital of North India

Background: Complementary and alternative medicine (CAM) is defined as a group of diverse medical health care systems, practices and products that are not presently considered to be part of conventional medicine. Its use is highly prevalent in elderly population because of presence of chronic diseases. So, present study was planned to assess CAM usage in elderly patients.Methods: This observational, questionnaire-based study was conducted at department of pharmacology, in association with department of medicine and included all adult patients of more than 60 years of age who have taken any CAM therapy. Demographic data, name of CAM preparation, its characteristics and behavioral pattern for its usage were recorded.Results: Out of 200 patients of more than 60 years attending medicine outpatient department, 115 were found to be CAM users. CAM usage was more in females (59.1%); age group of 60-69 years (49.57%); rural residents (66.08%); low socioeconomic status (81.73%). Most common CAM preparations used were dietary supplements (61.7%) and vitamins and minerals (56.52%) for indications such as chronic pain and endocrine disorders because it was thought to be safe. 76.52 % of CAM users did not discuss CAM with their health care provider.Conclusions: CAM use is highly prevalent in elderly patients and more so in females of low socioeconomic status. Most common CAM therapy used was dietary supplements. Continuous educational efforts are needed to enhance the awareness of patients and healthcare providers regarding the CAM therapy.

A New Approach for Developing "Implementation Plans" for Cognitive Stimulation Therapy (CST) in Low and Middle-Income Countries: Results From the CST-International Study.

Background: Even with a strong evidence base, many healthcare interventions fail to be translated to clinical practice due to the absence of robust implementation strategies. For disorders such as Alzheimer's disease and other dementias, access to evidence-based interventions beyond research settings is of great importance. Cognitive Stimulation Therapy (CST) is a brief, group-based intervention, with consistent evidence of effectiveness.Methods: An implementation focused, three-phase methodology was developed using extensive stakeholder engagement. The methods resulted in a standardized Implementation Plan for the successful translation of CST from research to practice. The methodology was developed using the Consolidated Framework for Implementation Research (CFIR) and refined in three countries that vary in levels of economic development and healthcare systems (Brazil, India and Tanzania).Results: Five Implemention Plans for CST were produced. Each plan contained implementation strategies and action plans devised in conjunction with policy professionals, healthcare professionals, people with dementia and family carers, and an international team of researchers and clinicians.Conclusion: This novel methodology can act as a template for implementation studies in diverse healthcare systems across the world. It is an effective means of devising socio-culturally informed Implementation Plans that account for economic realities, health equity and healthcare access.

Policy recommendations for a sustainable biosimilars market: lessons from Europe

Approximately 25% of all new medicines approved in recent years and in development today are biologicals. The complexity of biologicals, the investment needed to meet ever more stringent regulatory and payer requirements, combined with the needs of an ageing population, mean the cost of these medicines and the burden on governments and insurance companies is growing. However, the introduction of biosimilars has broadened treatment choices for physicians and their patients and, by increasing competition, reduced healthcare expenditures. The biosimilar market in Europe is the largest in the world, representing approximately 60% of the global biosimilar market and growing consistently year on year. As of October 2019, 54 biosimilars of 15 originator biological medicines have marketing authorization in Europe. European countries, with their large biosimilar markets and diverse healthcare systems, serve as valuable examples of different approaches to biosimilar policy. Several studies, research papers and position statements have been published on such policies. These findings, along with real-world policy and procurement examples from European countries, provide an opportunity for other countries to learn from. This paper will review the different approaches to biosimilar policy across the European continent, highlighting principles which can be applied to develop an efficient and sustainable biosimilar market.

Validation of an Electronic Health Record–Based Suicide Risk Prediction Modeling Approach Across Multiple Health Care Systems

Suicide is a leading cause of mortality, with suicide-related deaths increasing in recent years. Automated methods for individualized risk prediction have great potential to address this growing public health threat. To facilitate their adoption, they must first be validated across diverse health care settings. To evaluate the generalizability and cross-site performance of a risk prediction method using readily available structured data from electronic health records in predicting incident suicide attempts across multiple, independent, US health care systems. For this prognostic study, data were extracted from longitudinal electronic health record data comprising International Classification of Diseases, Ninth Revision diagnoses, laboratory test results, procedures codes, and medications for more than 3.7 million patients from 5 independent health care systems participating in the Accessible Research Commons for Health network. Across sites, 6 to 17 years' worth of data were available, up to 2018. Outcomes were defined by International Classification of Diseases, Ninth Revision codes reflecting incident suicide attempts (with positive predictive value >0.70 according to expert clinician medical record review). Models were trained using naive Bayes classifiers in each of the 5 systems. Models were cross-validated in independent data sets at each site, and performance metrics were calculated. Data analysis was performed from November 2017 to August 2019. The primary outcome was suicide attempt as defined by a previously validated case definition using International Classification of Diseases, Ninth Revision codes. The accuracy and timeliness of the prediction were measured at each site. Across the 5 health care systems, of the 3 714 105 patients (2 130 454 female [57.2%]) included in the analysis, 39 162 cases (1.1%) were identified. Predictive features varied by site but, as expected, the most common predictors reflected mental health conditions (eg, borderline personality disorder, with odds ratios of 8.1-12.9, and bipolar disorder, with odds ratios of 0.9-9.1) and substance use disorders (eg, drug withdrawal syndrome, with odds ratios of 7.0-12.9). Despite variation in geographical location, demographic characteristics, and population health characteristics, model performance was similar across sites, with areas under the curve ranging from 0.71 (95% CI, 0.70-0.72) to 0.76 (95% CI, 0.75-0.77). Across sites, at a specificity of 90%, the models detected a mean of 38% of cases a mean of 2.1 years in advance. Across 5 diverse health care systems, a computationally efficient approach leveraging the full spectrum of structured electronic health record data was able to detect the risk of suicidal behavior in unselected patients. This approach could facilitate the development of clinical decision support tools that inform risk reduction interventions.

BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA: UPDATE ON TREATMENTS, MECHANISMS AND MANAGEMENT IN THE CLINIC AND COMMUNITY

Behavioral and Psychological Symptoms of Dementia (BPSD) are common and challenging, with no consistently effective pharmacological or non-pharmacological treatments available. Among psychotropics, atypical antipsychotics have the strongest evidence, but adverse effects and safety concerns often outweigh benefit. SSRIs are often better tolerated, and the strongest evidence is for citalopram, but QTc prolongation is a limiting factor. Evidence for mood stabilizers is weak. Some evidence supports the use of dronabinol, prazosin, and dextromethorphan/quinidine. Pimvanserin is FDA approved for psychosis in Parkinson's disease. Options for psychosis in Dementia with Lewy bodies include cholinesterase inhibitor, quetiapine, and clozapine. Some promising results have been reported with ECT for agitation and aggression in dementia. An algorithm approach for BPSD in Alzheimer's disease (AD) and mixed dementia has been used on several inpatient units in Canada. Insights into possible biological mechanisms of BPSD throughout the spectrum of AD severity may be useful for treatment development. Areas with the best evidence include depression, anxiety and apathy in preclinical and prodromal AD. BPSD are associated with a mix of “core” mechanisms and “non-core” mechanisms of AD and may be associated with the earliest stages of AD pathology, but data remains relatively sparse. Other factors contributing to BPSD include physical and social conditions, as well as the dynamic between caregivers and persons with dementia. The MIND at Home multidisciplinary intervention is designed to support persons with dementia and their caregivers at home. Features include: completing an in home patient and caregiver-centered dementia-related needs assessment, building an evidence based care plan around patient and caregiver-specific needs, a Memory Care Coordinator (MCC) providing dementia education, support and guidance to help the dyad prioritize and follow through on care plan recommendations, and a multidisciplinary clinical team supporting the MCC, with regular team meetings, with telephone and video visit access to other team members from patients’ homes. Prior studies demonstrate that dementia care co-management models contribute to better health-related quality of life, fewer behavioral symptoms of dementia, less severe functional and cognitive symptoms, reduce stress and depression in caregivers and lead to reduced utilization of acute care services. Imperative and opportunity exist for implementing an evidence-based model of integrated dementia care across a health care system that places an emphasis on quality and reducing health care costs. Partners HealthCare, a large and diverse health care system, is in the process developing and launching such a model.

Evaluating Lung Cancer Screening Across Diverse Healthcare Systems: A Process Model from the Lung PROSPR Consortium.

Numerous organizations, including the United States Preventive Services Task Force, recommend annual lung cancer screening (LCS) with low-dose CT for high risk adults who meet specific criteria. Despite recommendations and national coverage for screening eligible adults through the Centers for Medicare and Medicaid Services, LCS uptake in the United States remains low (<4%). In recognition of the need to improve and understand LCS across the population, as part of the larger Population-based Research to Optimize the Screening PRocess (PROSPR) consortium, the NCI (Bethesda, MD) funded the Lung PROSPR Research Consortium consisting of five diverse healthcare systems in Colorado, Hawaii, Michigan, Pennsylvania, and Wisconsin. Using various methods and data sources, the center aims to examine utilization and outcomes of LCS across diverse populations, and assess how variations in the implementation of LCS programs shape outcomes across the screening process. This commentary presents the PROSPR LCS process model, which outlines the interrelated steps needed to complete the screening process from risk assessment to treatment. In addition to guiding planned projects within the Lung PROSPR Research Consortium, this model provides insights on the complex steps needed to implement, evaluate, and improve LCS outcomes in community practice.

Calcipotriol/betamethasone dipropionate aerosol foam for the treatment of psoriasis vulgaris: a review of real-world evidence (RWE)

Background Randomized controlled trials (RCTs) demonstrated the advantages of an aerosol foam formulation of calcipotriol/betamethasone dipropionate (Cal/BD) in patients with psoriasis. In this review, we investigated whether such benefits could also be obtained in real-world clinical practice. Methods PubMed was searched for studies reporting real-world data in patients with psoriasis treated with Cal/BD aerosol foam. Results Three large real-world studies with Cal/BD aerosol foam were identified: a prospective non-interventional study from Germany, a medical chart review from the US, and a retrospective non-interventional study from Spain. Some key findings included the following: high levels of adherence to treatment (82–93%); after 4 weeks, about 50% of patients achieved complete/almost complete responses; at final assessment, 85–95% of patients were extremely satisfied/very satisfied/satisfied with Cal/BD aerosol foam; all healthcare providers were satisfied or somewhat satisfied with the efficacy of Cal/BD foam and they reported similar findings for symptom improvements (itch, pain, erythema/redness, flaking, and plaque thickness). Global ratings by investigators/healthcare providers for symptom control, overall efficacy and the emotional status of patients were also very high (75–100%). Conclusion The results from real-world studies undertaken in diverse healthcare systems reinforce the positive findings reported in RCTs with Cal/BD aerosol foam in patients with psoriasis.

Women With Schizophrenia Only Half as Likely to Receive Mammograms

Women With Schizophrenia Only Half as Likely to Receive Mammograms

COVID-19 Pandemic: Marked Global Disparities in Fatalities According to Geographic Location and Universal Health Care.

Since its outbreak, COVID-19 pandemic has been the biggest global concern with exponentially increasing number of cases and associated deaths across all habitable continents. Various countries around the world with their diverse health care systems, have responded to the pandemic in very distinctive ways. In this paper, we: compared COVID-19 mortality rates across global geographic regions; and assessed differences in COVID-19-related case fatality rate (CFR) based on presence or absence of Universal Health Coverage (UHC). We found that as of May 6, 2020, Europe had experienced the highest CFR globally of 9.6%, followed by 5.9% in North America. Although the pandemic originated in Asia, the continent ranked second to the last in terms of CFR (3.5%). Countries with UHC had lower number of cases of 37.6%, but the CFR of countries with UHC was twice that of countries without UHC (10.5% versus 4.9%). In conclusion, UHC does not appear to protect against mortality in a pandemic environment such as with COVID-19.

Moral Distress in Nephrology: Perceived Barriers to Ethical Clinical Care

Moral distress occurs when individuals are unable to act in accordance with what they believe to be ethically correct or just. It results from a discrepancy between a clinician's perception of "the right thing to do" and what is actually happening and is perpetuated by perceived constraints that limit the individual from speaking up or enacting change. Moral distress is reported by many clinicians in caring for patients with serious illness, including chronic kidney disease and kidney failure. If left unidentified, unexpressed, or unaddressed, moral distress may cause burnout, exhaustion, detachment, and ineffectiveness. At an extreme, moral distress may lead to a desire to abandon the speciality entirely. This article offers an international perspective on moral distress in nephrology in diverse contexts and health care systems. We examine and discuss the sociocultural factors that contribute to moral distress in nephrology and offer suggestions for interventions from individual provider, facility, and health care systems perspectives to reduce the impact of moral distress on nephrology providers.