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Since ambivalence or skepticism about vaccination is widespread, this discrepancy may result in discussions. selleckchem Travel consultations may therefore generate opportunities to clarify general ambivalences towards vaccinations. Based on the concept of "Motivational Interviewing", we show communicative possibilities to reduce ambivalence and resistance and ideally to promote the willingness to vaccinate through shared decision-making.Importance of the Pap smear in the age of HPV testing Abstract. Screening for cervical cancer prevention is considered a success story. Since the introduction of the Pap test in the 1950s, the incidence and mortality of cervical carcinomas has decreased dramatically in the industrialized world. In developing countries, and especially in certain countries in Africa, cervical cancer is still one of the most common fatal cancers due to the lack of screening and therapeutic options. For decades, Pap tests and colposcopy were the basis of cervical cancer screening. In the early 1980s, it became known that almost without exception cervical carcinomas require infection with certain human papilloma viruses (HPV). Among other things, this finding also revolutionized cervical cancer screening. The quality of the Pap test is influenced by the conditions of collection and by the so-called interobserver variability. Overall, cytology shows a good specificity of 95 % with a lower sensitivity of 70 %. Additional immunohistonly reflects the current viral shedding but does not provide any information about the time and duration of HPV infection. Further studies are necessary to determine long-term results and cost-effectiveness.Prevention of low-value care What's the role of the general practitioner? Abstract. Low-value care, defined as inappropriate care (potential harm exceeding the benefit) or overuse (unnecessary care), is a challenge for patients, healthcare providers, politicians and healthcare systems. We give some examples of low-value interventions in Switzerland. There are many triggers of low-value care. For example, new technology may lead to an earlier detection of disease but this is not necessarily translating into a benefit for the patient (overdiagnosis). Other reasons are organizational shortcomings, supply-driven demand, commercially motivated extension of disease definitions (disease mongering), and the impact of social or cultural beliefs. Correspondingly, it's not a simple task to tackle low-value care. As an answer, several concepts and campaigns have been developed during the last few years, such as Quaternary Prevention, Choosing Wisely or Preventing Overdiagnosis. Their aim is to protect individuals from medical interventions that are likely to cause more harm than benefit. What's the role of the general practitioner (GP) in the prevention of low-value care? First, to be aware of such inappropriate interventions and to be open-minded to question the own professional attitude. Second, as a trusted person by the patient, the GP has the unique opportunity to balance benefit and harm of an intervention together with the patient and to discuss these issues in a participative way (shared decision making), using techniques like team talk, option talk and decision talk. In summary, the protection of patients from inappropriate care, overuse and harm is an important part of our professional performance.Cancer Screening - Prerequesites for a Successful and Meaningful Screening Program Abstract. Benefits and harms of cancer screening should be carefully assessed based on evidence, put into local context and weighed against each other. The success of cancer screening programs depends on many factors beyond the evidence, such as participation rates, the organization and the quality of the program. This article highlights the epidemiologic prerequisites for a cancer screening and explains how a successful screening program is designed.People with intellectual disabilities are more likely to experience adverse childhood experiences than those in the general population. Additionally, the conceptualization of 'trauma' is far broader than traditionally understood in order to encompass the far reaching relational nature of people with intellectual disabilities traumatic experiences. This reflective account details the first steps one service took to embrace trauma-informed care as a whole systems approach. The paper is a response to calls following conference presentations about our work, to share the process of the beginning of this journey, it also aims to provide key learning points, practical considerations and questions for reflection in order to support other services to begin their own relationships with trauma-informed care.Co-therapy with herbal extracts along with current clinical drugs is being increasingly recognized as a useful complementary treatment for cancer. The anti-cancer property of the phyto-derivative acetyl-11 keto β boswellic acid (AKBA) has been studied in many cancers, including prostate cancer. However, the whole extract of the gum resin Boswellia serrata (BS) and anti-androgen enzalutamide has not been explored in prostate cancer to date. We hypothesized that the BS extract containing 30% (AKBA) with enzalutamide acted synergistically in the early phase of cancer, especially in LNCaP cells, by inhibiting androgen receptor (AR) and by reducing cell proliferation, and further, that the extract would be superior to the action of the active ingredient AKBA when used alone or in combination with enzalutamide. To test our hypothesis, we treated LNCaP cells with BS extract or AKBA and enzalutamide both individually and in combination to analyze cell viability under different levels of dihydrotestosterone (DHT). Thete cell killing at equivalent concentrations. The combination of enzalutamide and BS extract containing 30% AKBA because of their synergistic interaction is an attractive therapeutic option for treating early stage (hormone-dependent) prostate cancer and is superior to the use of AKBA alone.A large body of evidence points to the importance of cell adhesion molecules in cancer metastasis. Alterations in adhesion and attachment properties of neoplastic cells are important biomarkers of the metastatic potential of cancer. Loss of intracellular adhesion is correlated with more invasive phenotype by increasing the chances of malignant cells escaping from their site of origin, promoting metastasis. Therefore, there is great demand for rapid and accurate measurements of individual cell adhesion and attachment. Current technologies that measure adhesion properties in either suspension or bulk (microfluidics) remain very complex (e.g., atomic force microscopy [AFM], optical tweezers). Moreover, existing tools cannot provide measurements for fully attached individual adherent cells as they operate outside of such a force range. Even more importantly, none of the existing approaches permit concurrent and automated single-cell adhesion measurement and collection, which prohibits direct correlation between single-cell adhesion properties and molecular profile. Here, we report a fully automated and versatile platform, A-picK, that offers single-cell adhesion assay and isolation in parallel. We demonstrate the use of this approach for a time course analysis of human lung carcinoma A549 cells and substrate-specific adhesion potential using seven different substrates, including fibronectin, laminin, poly-l-lysine, carboxyl, amine, collagen, and gelatin.

Community hospitals account for over 84% of all hospitals and over 94% of hospital admissions in the United States. In academic settings, implementation of an Inpatient Diabetes Management Service (IDMS) model of care has been shown to reduce rates of hyper- and hypoglycemia, hospital length of stay (LOS), and associated hospital costs. However, few studies to date have evaluated the implementation of a dedicated IDMS in a community hospital setting.

This retrospective study examined the effects of changing the model of inpatient diabetes consultations from a local, private endocrine practice to a full-time endocrine hospitalist on glycemic control, LOS, and 30-day readmission rates in a 267-bed community hospital.

Overall diabetes patient days for the hospital were similar pre- and post-intervention (20,191 vs 20,262); however, the volume of patients seen by IDMS increased significantly after changing models. Rates of hyperglycemia decreased both among patients seen by IDMS (53.8% to 42.5%,

< .00sfaction scores, or total cost of care.

The specific aims of this project were to create a fully integrated, nurse-led model of a psychiatric nurse practitioner and behavioral health care team within primary care to facilitate (1) patients receiving an appropriate level of care and (2) care team members performing at the top of their scope of practice.

The guiding model for process implementation was Rapid Cycle Quality Improvement. Three task forces were established to develop interventions in the areas of Roles and Responsibilities, Training and Implementation, and the electronic health record.

The four interventions that emerged from these task forces were (1) the establishment of patient tiers based on diagnosis, medications, and risk assessment; (2) the creation of process maps to engage care team members; (3) just-in-time education regarding psychiatric medication management for primary care providers; and (4) use of a registry to track patients.

The process measures of referrals to the psychiatric care team and psychiatric assessment intakes performed as expected. Both measures were higher at the onset of the project and lower 1 year later. The outcome indicator, number of case reviews, increased dramatically over time.

For psychiatric nurse practitioners, this quality improvement effort provides evidence that a consultative role can be effective in supporting primary care providers. Through providing education, establishing patient tiers, and establishing an effective workflow, more patients may have access to psychiatric services.

For psychiatric nurse practitioners, this quality improvement effort provides evidence that a consultative role can be effective in supporting primary care providers. Through providing education, establishing patient tiers, and establishing an effective workflow, more patients may have access to psychiatric services.Experiences with the application of an interprofessional anamnesis in hospitals - A qualitative accompanying study Abstract. Background Interprofessional cooperation is a key issue today when addressing quality improvement and process optimization in the healthcare sector. Interprofessional documentation systems play an important role here.

This article describes the experiences of 19 nurses and physicians in an acute care hospital before and after the introduction of an interprofessional anamnesis. The aim was to show whether and how interprofessional cooperation changed during the ten months study period.

The data are based on three group discussions at three different times with six to seven newly recruited participants in an interprofessional composition. The data analysis was carried out using the documentary method after Bohnsack.

The group discussions document different phases of a developing interprofessional cooperation. By recognizing different professional perspectives and process structures, areas of responsibility could be clarified and trust could be built.