Comorbidity indices: a call for the integration of physical and mental health.

Comorbidity indices are commonly used in health services research as a measure of, or as a control for, the severity of a person's medical state. Currently, there is not a comorbidity index for mental health diagnoses, despite the fact that almost half of Americans have a diagnosable mental health condition at least once in their lifetime. This commentary calls for the integration of mental and behavioral health in comorbidity indices to appropriately account for the role of mental health in overall morbidity and mortality.

Fecal microbiota transplantation for recurrent Clostridium difficile infection: The patient experience.

BACKGROUND: Although effectiveness of fecal microbiota transplantation (FMT) has been adequately documented, the patient experience of undergoing FMT has not. METHODS: We carried out a qualitative interview study using semistructured questions relating to aspects of health pre-FMT, during FMT, and post-FMT periods with 17 participants. Inductive coding was used to identify core themes during the periods. RESULTS: Pre-FMT themes included physical (continuous diarrhea and weight loss), mental (depression, wanting to die, and fear), quality of life (unable to perform normal activities), social support, and financial (medication costs) factors. Provider resistance/limited awareness were barriers to FMT. Participants reached a tipping point, experiencing feelings of hopelessness, which led them to pursue FMT. During FMT, participants commented on lack of a so-called ick factor. During the posttreatment period, participants experienced symptom relief, but had residual fears. Patient activation was present during all phases, including information seeking and empowerment. CONCLUSIONS: During the pre-FMT period, participants experienced extreme discomfort and encountered FMT barriers. Undergoing FMT was reported as easy but residual fear remained. There were displays of patient activation at all FMT time periods, including the seeking of FMT. Participants could have benefited from having undergone FMT sooner, demonstrating a need for improvement in provider education and health system barriers regarding FMT.

Health disparities and underserved populations: a potential solution, medical school partnerships with free clinics to improve curriculum.

Health-care educators share the social responsibility to teach medical students about social determinants of health and health-care disparities and subsequently to encourage medical students to pursue residencies in primary care and medical practice in underserved communities. Free clinics provide care to underserved communities, yet collaborative partnerships with such organizations remain largely untapped by medical schools. Free clinics and medical schools in 10 US states demonstrate that such partnerships are geographically feasible and have the potential to mutually benefit both organizational types. As supported by prior research, students exposed to underserved populations may be more likely to pursue primary care fields and practice in underserved communities, improving health-care infrastructure.

Short-term service trips and the interprofessional team: a perspective from Honduras.

Short-term service trips from the USA annually spend over $250 million dollars to provide healthcare to individuals in developing nations. These trips often uniquely define goals as related to changes in the host population and overlook the valuable benefits potentially incurred by the trip volunteers. The Honduras Outreach Medical Brigada Relief Effort utilizes an interprofessional team approach to develop the dual goals of improving health and quality of life in host communities and improving interprofessional teamwork values and skills among participants. This article outlines details of this program, describes on-going evaluation work and discusses the interprofessional implications from this project.

Teaching sonoanatomy to anesthesia faculty and residents: utility of hands-on gel phantom and instructional video training models.

STUDY OBJECTIVE: Thousands of patients worldwide annually receive neuraxial anesthesia and analgesia. Obesity, pregnancy, and abnormal spinal anatomy pose challenges for accurate landmark palpation. Further, spinal sonoanatomy is not uniformly taught in residency education, even though its use has previously been shown to improve identification of relevant structures and decrease procedural complications and failure rates. The aim of this study was to evaluate the use of hands-on gel phantom and instructional video training for teaching spinal sonoanatomy among anesthesiology faculty and residents. DESIGN: Twenty-three residents and 27 anesthesiologists were randomized to gel phantom, video teaching, and control groups. SETTING: Academic Hospital. MEASUREMENTS: Successful identification of spinal sonoanatomy was attempted on a human volunteer before and immediately after the respective intervention and 3 weeks later. Perceived knowledge and training modality satisfaction were assessed using modified Likert scales. INTERVENTIONS: Gel phantom and video teaching groups compared with control (no intervention). MAIN RESULTS: Both interventions significantly improved spine sonoanatomy identification accuracy. Logistic regression analysis demonstrated both interventions improved the odds of transverse process (gel 12.61, P = .013; video 7.93, P = .030) and lamina (gel 65.12, P = .003; video 8.97, P = .031) identification. Perceived knowledge of basic spinal anatomy and spinal sonoanatomy improved in the intervention versus control groups. Mean (SD) modified Likert scale scores for learning satisfaction (1 = unsatisfied, 10= very satisfied) were 8.1 (1.5) and 8.0 (1.7) for hands-on gel phantom and instructional video training participants, respectively. CONCLUSION: Use of hands-on gel phantom or instructional video training can improve anesthesia staff and resident knowledge of lumbar spine sonoanatomy.

Facilitators and barriers to implementing antimicrobial stewardship strategies: Results from a qualitative study.

BACKGROUND: Many hospitals have implemented antimicrobial stewardship programs (ASPs) and have included in their programs strategies such as prior authorization and audit and feedback. However there are few data concerning the facilitators and barriers that ASPs face when implementing their strategies. We conducted a qualitative study to discern factors that lead to successful uptake of ASP strategies. METHODS: Semistructured telephone interviews were conducted from June-July 2013 with 15 ASP member pharmacists and 6 physicians representing 21 unique academic medical centers. RESULTS: Successful implementation of ASP strategies was found to be related to communication style, types of relationships formed between the ASP and non-ASP personnel, and conflict management. Success was also influenced by the availability of resources in the form of adequate personnel, health information technology personnel and infrastructure, and the ability to generate and analyze ASP-specific data. Types of effective strategies commonly cited included audit and feedback; prior authorization, especially with an educative component; and use of real-time alert technology and guidelines. CONCLUSIONS: Several factors may influence ASP success in the implementation of their strategies. ASP members may use these findings to improve upon the success of their programs.

Medical interpreters: improvements to address access, equity, and quality of care for limited-English-proficient patients.

Limited-English-proficient (LEP) patients in the United States experience a variety of health care disparities associated with language barriers, including reduced clinical encounter time and substandard medical treatment compared with their English-speaking counterparts. In most current U.S. health care settings, interpretation services are provided by personnel ranging from employed professional interpreters to untrained, ad hoc interpreters such as friends, family, or medical staff. Studies have demonstrated that untrained individuals commit many interpretation errors that may critically compromise patient safety and ultimately prove to be life-threatening. Despite documented risks, the U.S. health care system lacks a required standardized certification for medical interpreters. The authors propose that the standardization of medical interpreter training and certification would substantially reduce the barriers to equitable care experienced by LEP patients in the U.S. health care system, including the occurrence of preventable clinical errors. Recent efforts of the U.S. federal court system are cited as a successful and realistic example of how these goals may be achieved. As guided by the evolution of the federal court interpreting certification program, subsequent research will be required to demonstrate the improvements and challenges that would result from national certification standards and policy for medical interpreters. Research should examine cost-effectiveness and ensure that certified interpreting services are appropriately used by health care practitioners. Ongoing commitment is required from lawmakers, health care providers, and researchers to remove barriers to care and to demand that equity remain a consistent goal of our health care system.

Addressing health care disparities and access to dental care while improving education: schools of dentistry and federally qualified health centers.

Oral health disparities in the United States are a result of economic, educational, and social barriers faced by vulnerable and underserved individuals. The oral health care infrastructure is continuously challenged to provide access to quality care with a shortage of dental professionals and expanding oral health disparities. Federally qualified health centers (FQHC) provide oral health care in underserved communities, while schools of dentistry strive to provide students and residents with experience in underserved communities to address access to care issues and produce oral health professionals who will practice in these communities. Formal partnerships between these organizations have the potential to address oral health disparities, access to dental care and improve dental education and training. Utilizing ArcGIS (ArcMAP) software, dental schools and FQHC services sites located in the continental United States were geocoded to demonstrate geographic feasibility: on average, dental schools are within 10 miles of 34 FQHC service sites.

Improving public health through student-led interprofessional extracurricular education and collaboration: a conceptual framework.

In the US, health care professionals are trained predominantly in uniprofessional settings independent of interprofessional education and collaboration. Yet, these professionals are tasked to work collaboratively as part of an interprofessional team in the practice environment to provide comprehensive care to complex patient populations. Although many advantages of interprofessional education have been cited in the literature, interprofessional education and collaboration present unique barriers that have challenged educators and practitioners for years. In spite of these impediments, one student-led organization has successfully implemented interprofessional education and cross-disciplinary collaboration. The purpose of this paper is to provide a conceptual framework for successful implementation of interprofessional education and collaboration for other student organizations, as well as for faculty and administrators. Each member of the interprofessional team brings discipline-specific expertise, allowing for a diverse team to attend to the multidimensional health needs of individual patients. The interprofessional team must organize around a common goal and work collaboratively to optimize patient outcomes. Successful interdisciplinary endeavors must address issues related to role clarity and skills regarding teamwork, communication, and conflict resolution. This conceptual framework can serve as a guide for student and health care organizations, in addition to academic institutions to produce health care professionals equipped with interdisciplinary teamwork skills to meet the changing health care demands of the 21st century.

The development of student-led interprofessional education and collaboration.

Prominent healthcare organizations have called upon the academic and health communities to utilize interprofessional education (IPE) and collaboration to meet the changing needs of patients worldwide. Two student-led initiatives have overcome the various barriers that have historically impeded IPE and have embraced the call to improve the health of local and international underserved patients. This short report describes these two organizations, the International Health Service Collaborative at the University of South Florida and the Inter Health Professionals Alliance at Virginia Commonwealth University, and aims to encourage emerging health professional students and educators to embrace student-led IPE.

Health disparities among highly vulnerable populations in the United States: a call to action for medical and oral health care.

Healthcare in the United States (US) is burdened with enormous healthcare disparities associated with a variety of factors including insurance status, income, and race. Highly vulnerable populations, classified as those with complex medical problems and/or social needs, are one of the fastest growing segments within the US. Over a decade ago, the US Surgeon General publically challenged the nation to realize the importance of oral health and its relationship to general health and well-being, yet oral health disparities continue to plague the US healthcare system. Interprofessional education and teamwork has been demonstrated to improve patient outcomes and provide benefits to participating health professionals. We propose the implementation of interprofessional education and teamwork as a solution to meet the increasing oral and systemic healthcare demands of highly vulnerable US populations.