Nicholsoncooke4836

These findings suggest that moral considerations take a back seat when it comes to self-improvement.Background Goals of care (GOC) conversations are critical to advance care planning but occur infrequently in nephrology. National workshops have improved trainee comfort with initiating GOC conversations but lack interface with palliative subspecialists and can incur travel-related costs. We developed an educational intervention focused on GOC conversations for nephrology trainees that incorporated into routine schedules and offered feedback from palliative subspecialists. Objective To explore barriers and facilitators to discussing GOC and uncover perceptions of GOC-related behavior change post-intervention. Design Qualitative study. Setting/Subjects Sixteen nephrology trainees at an academic medical center. find more Measurements Analyses of semistructured interviews occurred in phases (1) isolation of quotes; (2) development of a coding system; and (3) creation of a framework of interrelationships between quotes using an inductive/deductive approach. Results We captured the following themes (1) prior knowledge (ability to define GOC, knowledge of communication frameworks and prognostic data, exposure to outpatient GOC conversations; (2) attitudes related to GOC conversations (responsibility, comfort, therapeutic alliance, patient preparedness, partnership with care teams); and (3) potential change in behaviors (increased likelihood to initiate GOC conversations early, more accurate identification of patients appropriate for a GOC conversation). Conclusions Prior knowledge of, exposure to, and attitudes toward advance care planning were key determinants of a nephrology trainees' ability to initiate timely GOC conversations. After our intervention, trainees reported increased comfort with and likelihood to initiate GOC conversations and an improved ability to identify appropriate candidates. Our intervention may be a novel, feasible way to coach nephrologists to initiate timely GOC conversations.Using representative cross-sections from 166 nations (more than 1.7 million respondents), we examined differences in three measures of subjective well-being over the life span. Globally, and in the individual regions of the world, we found only very small differences in life satisfaction and negative affect. By contrast, decreases in positive affect were larger. We then examined four important predictors of subjective well-being and how their associations changed marriage, employment, prosociality, and life meaning. These predictors were typically associated with higher subjective well-being over the life span in every world region. Marriage showed only very small associations for the three outcomes, whereas employment had larger effects that peaked around age 50 years. Prosociality had practically significant associations only with positive affect, and life meaning had strong, consistent associations with all subjective-well-being measures across regions and ages. These findings enhance our understanding of subjective-well-being patterns and what matters for subjective well-being across the life span.Scientific evidence demonstrated a causal relationship between Zika virus infection during pregnancy and neurologic abnormalities and other congenital defects. The U.S. government's Zika Virus Disease Contingency Response Plan recognized the importance of preventing unintended pregnancy through access to high-quality family planning services as a primary strategy to reduce adverse Zika-related birth outcomes during the 2016-2017 Zika virus outbreak. The U.S.-affiliated Pacific Islands (USAPI) includes three U.S. territories American Samoa, the Commonwealth of the Northern Mariana Islands, and Guam, and three independent countries in free association with the United States the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau. Aedes spp. mosquitoes, the primary vector that transmits Zika virus, are common across the Pacific Islands, and in 2016, laboratory-confirmed cases of Zika virus infection in USAPI were reported. CDC conducted a rapid assessment by reviewing available reproductive health data and discussing access to contraception with family planning providers and program staff in all six USAPI jurisdictions between January and May 2017. In this report, we summarize findings from the assessment; discuss strategies developed by jurisdictions to respond to identified needs; and describe a training that was convened to provide technical assistance to USAPI. Similar rapid assessments may be used to identify training and technical assistance needs in other emergency preparedness and response efforts that pose a risk to pregnant women and their infants.Background Patients with limited English proficiency experience disparities in health care access, quality, costs, and outcomes. Providing qualified medical interpreting services (MIS) in the health care setting can reduce these disparities. Unfortunately, health organizations face logistical and financial difficulties in meeting the need for qualified medical interpreters. Introduction This descriptive review evaluated travel, time, and cost savings associated with video interpreting services compared to traditional in-person services. Materials and Methods We conducted a retrospective review of all inpatient and outpatient medical interpreting encounters at a large academic hospital delivered through video and in person between 2006 and 2017. Outcome measures included interpreter travel distance, time, and cost for in-person encounters and savings associated with avoided travel for services provided through video. Results We reviewed 281,701 interpreting encounters, including 249,357 in person and 32,344 by video. Video encounters occurred both for on-site and off-site visits. For on-site encounters, the use of video resulted in an average round trip walking distance saved of 0.75 miles (SD = 0.33) and an average round trip walking time saved of 14.75 min (SD = 6.30) per encounter. For off-site encounters, the use of video resulted in an average round trip driving distance saved of 8.63 miles (SD = 9.13), an average round trip driving time saved of 23.78 min (SD = 9.50), and an average round trip driving cost savings of $4.66 per encounter. Conclusions This single institution review of the travel, time, and cost savings associated with providing MIS through video demonstrates the opportunity for more efficient use of time and resources.