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PubMed2006

Sharing electronic health records: the patient view.

The introduction of a national electronic health record system to the National Health Service (NHS) has raised concerns about issues of data accuracy, security and confidentiality. The primary aim of this project was to identify the extent to which primary care patients will allow their local electronic record data to be shared on a national database. The secondary aim was to identify the extent of inaccuracies in the existing primary care records, which will be used to populate the new national Spine. Fifty consecutive attenders to one general practitioner were given a paper printout of their full primary care electronic health record. Participants were asked to highlight information which they would not want to be shared on the national electronic database of records, and information which they considered to be incorrect. There was a 62% response rate (31/50). Five of the 31 patients (16%) identified information that they would not want to be shared on the national record system. The items they identified related almost entirely to matters of pregnancy, contraception, sexual health and mental health. Ten respondents (32%) identified incorrect information in their records (some of these turned out to be correct on further investigation). The findings in relation to data sharing fit with the commonly held assumption that matters related to sensitive or embarrassing issues, which may affect how the patient will be treated by other individuals or institutions, are most likely to be censored by patients. Previous work on this has tended to ask hypothetical questions concerning data sharing rather than examine a real situation. A larger study of representative samples of patients in both primary and secondary care settings is needed to further investigate issues of data sharing and consent.

Adult↗
PubMed1976

Correspondence between saying and doing: teaching children to share and praise.

Five small groups of preschool children were taught to share and praise by the modelling of these behaviors and reinforcement of their reports of sharing and praising. Experiment I demonstrated that modelling and reinforcement of any (true or untrue) reports of sharing, and then of praising, promptly increased reports of the corresponding behaviors. Modelling and reinforcement for true reports of each behavior increased both reporting and actual behavior. Experiment II showed that both reported and actual sharing and praising may be increased by modelling and reinforcement for true reports of the target behavior, without previous reinforcement for any (true or untrue) reports of those behaviors. Sharing, but not praising, generalized to a second setting. Experiment III replicated the results of Experiment II for sharing and praising, and demonstrated similar success in increasing a third behavior, specific praising. In general, these experiments show that developing correspondence between children's reports of behavior and actual behavior may be an efficient means of increasing prosocial responses.

Journal Article↗
PubMed1989

Determinants of needle sharing among intravenous drug users.

Data from 110 IV-drug abusing persons in methadone maintenance were analyzed to determine the correlates of needle sharing. Sharing was directly related to peer group behavior, attitudes conducive to sharing, economic motivation to share, not owning injection equipment, and fatalism about developing AIDS. Sharers were aware of their AIDS risk. Indicated measures to reduce needle sharing would be positive peer support groups to help resist pressures to share, legal and free access to fresh injection equipment, education on the utility of risk reduction, and increased treatment options for IV cocaine users.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Sharing of culture: adult grandchildren's perceptions of intergenerational relations.

The current study addressed the sharing of traditions, beliefs, and customs (i.e., culture) between grandparents and grandchildren. Two hundred and forty-six adult grandchildren were surveyed on both existing and newly created measures of grandparenting. Results indicated that extent of shared activities, attitudes toward grandparents, and perceptions of cultural sharing were significantly related. Additionally, it was found that minority and female participants were more likely to engage in intergenerational culture sharing and reported more positive statements about this sharing in response to open-ended questions. Findings highlights the importance of cultural sharing to perceptions of grandchild-grandparent relationships.

Adolescent↗
PubMed2000

Can shared care deliver better outcomes for patients undergoing total hip replacement? A prospective assessment of patient outcomes and associated service use.

OBJECTIVES: To assess whether shared care for patients undergoing total hip replacement delivers better outcomes compared to care as usual. DESIGN: Prospective, observational cohort study. SETTING: Two regions in The Netherlands where different organisational health care models have been implemented: a shared care setting (experimental group) and a care as usual setting (control group). PATIENTS: One hundred and fifteen patients undergoing total hip replacement: 56 in the experimental group and 59 in the control group. MAIN MEASURES: Functional health status according to the sickness impact profile, hip function, patient satisfaction and use of health care services. RESULTS: Two weeks before hip replacement both groups were comparable concerning patient characteristics, hip function and health status. The mean improvement of the total sickness impact profile score between two weeks before hip replacement and six months after was -1.92 in the shared care group, compared to -5.11 in care as usual group, a difference in favour of the control group (p=0.02). The mean length of hospital stay was comparable in both settings: 12.8 days in the shared care group and 13.2 days in the care as usual group. After hip replacement, compared to care as usual, patients in the shared care group received more homecare, with a higher frequency, and for a longer period of time. No differences in patient satisfaction between the two groups were found. CONCLUSIONS: Six months after hip replacement, the health status of patients in the care as usual group, using significantly less home care, was better than the status of patients in the shared care group. DISCUSSION: The utilisation of home care after hip replacement should be critically appraised in view of the need to stimulate patients' independence.

Journal Article↗
PubMed1998

Shared antenatal care fails to rate well with women of non-English-speaking backgrounds.

OBJECTIVES: To compare the views of women from non-English-speaking backgrounds who received antenatal care at a public hospital clinic with those whose care was shared between a public hospital clinic and a general practitioner. DESIGN: Structured interviews in the language of the woman's choice. SETTING: Women were recruited from the postnatal wards of three maternity teaching hospitals in Melbourne between July 1994 and November 1995, and interviewed six to nine months later. PARTICIPANTS: Women born in Vietnam, Turkey and the Philippines who gave birth to a live healthy baby (over 1500 g) were eligible. Of 435 women recruited, 318 (Vietnamese [32.7%], Filipino [33.6%] and Turkish [33.6%]) completed the study. MAIN OUTCOME MEASURES: Women's ratings of their antenatal care overall and views on specific aspects of their antenatal care. RESULTS: Women in shared care (n = 151) were not more likely than women in public clinic care (n = 143) to rate their care as "very good" (odds ratio [OR], 1.38; 95% confidence interval [95% CI], 0.72-2.63). Satisfaction with particular aspects of care (waiting times, opportunity to ask questions, whether caregivers were rushed, whether concerns were taken seriously) did not differ significantly between those in shared care and those in public clinic care. Women in shared care were not happier with their medical care than women in public clinic care (OR, 0.83; 95% CI, 0.35-1.96), but were more likely to see a caregiver who spoke their language (OR, 17.69; 95% CI, 6.15-69.06), although two-thirds still saw a GP who spoke only English. CONCLUSION: Shared antenatal care is not more satisfying than public clinic care for women from non-English-speaking backgrounds. Further evaluation of shared care is clearly needed.

Emigration and Immigration↗
PubMed1982

Medicaid program; cost sharing demonstrations--HCFA. General notice.

HCFA is soliciting applications from State Medicaid agencies for demonstration projects that will permit States to apply cost sharing to any services for Medicaid eligible individuals. Currently, States are permitted to apply nominal cost sharing to any services for the medically needy, but only to optional services for the categorically needy. Research on cost sharing for the general population indicates it can have an effect on utilization of medical services. By allowing the States greater flexibility to apply a variety of approaches to cost sharing under Medicaid, we expect that States will conduct demonstrations to provide additional, useful information to HCFA, and through HCFA, to all the States, on the effectiveness of several methods of cost sharing. This information should enable HCFA to determine whether alternative methods of cost sharing will further the objectives of the Medicaid program by enabling States to continue to provide medical services. This solicitation also contains information about demonstration requirements and application procedures.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2000

Change management of shared and local versions of health-care terminologies.

Local sites that adopt a shared health-care terminology for computer-based systems have local needs that prompt the local-terminology maintainers to make changes to the local version of the shared terminology. If the local site is motivated to conform to the shared terminology, then the burden lies with the local site to manage its own changes and to incorporate the changes of the shared version at periodic intervals. We call this process synchronization. We survey current approaches that address problems of sharing and local modification, and we present the CONCORDIA model, which supports carefully controlled divergence of a local version from a shared terminology. CONCORDIA provides the underlying design and methodology for the implementation of a synchronization-support tool.

Humans↗
PubMedDate not supplied

Mode of inheritance of HLA-DRB1 shared epitope in Japanese familial rheumatoid arthritis.

OBJECTIVE: To clarify the mode of genetic contribution of the HLA-DR shared epitope (SE) to the pathogenesis of familial cases of Japanese rheumatoid arthritis (RA). METHODS: Fifty-three unrelated Japanese RA families that had more than 2 affected sibs were selected. The HLA-DR shared epitope typing was carried out by the PCR method and PCR-SSCP (single stranded DNA conformation polymorphism) method. Affected sib pair analysis was carried out using the MAPMAKER/SIB 2.0 program. The mode of inheritance was also calculated based on the sharing of genes identical by descent (IBD) between siblings in each of the 53 affected sib-pairs (propositus and the 2nd affected sib). RESULTS: The maximum LOD score of HLA-DR was 0.437, and the sharing of 2 IBDs, 1 IBD, and no IBDs between affected sibs were 0.330, 0.500, and 0.170, respectively. The sharing distribution of IBD was confirmed to be compatible with the dominant or additive mode since the observed gene frequency of SE was 0.255. CONCLUSION: The HLA-DR shared epitope participated in the pathogenesis of familial cases of Japanese RA. The SE contributes to this pathogenesis in either the dominant or additive mode of inheritance.

Adult↗
PubMed2004

Towards advanced risk-sharing in health care financing: with a focus on the potential of social health insurance in developing countries.

In this paper, we analyse the major health financing methods and the contribution they can make to improving access to health care among all of a country's population groups. Risk-sharing in health financing is proposed as a powerful method to achieve this improvement. The larger the degree of risk-sharing in a health financing system, the less people will have to bear the financial consequences of their own health risks, and the more they are likely to have access to needed care. Ideally countries should attempt to introduce 'advanced' risk-sharing aiming at equal access among individuals to an adequate package of health services. There are two major ways to implement advanced risk-sharing: general tax revenue may be main source of financing health services, or else social health insurance may be established. An important finding is that about 60% of the world's countries still need to pursue efforts towards the introduction of advanced risk-sharing. We further focus on the potential of social health insurance as an advanced risk-sharing method. In fact, there is recent interest in developing countries such as Côte d'Ivoire, Indonesia, Iran and Kenya in this particular health financing mechanism. Compared to health financing via general tax revenue, social health insurance spreads the immediate burden of financing among various groups, including the workers, the self-employed, enterprises and Government. Time and tedious discussions between these groups may be needed, however, before a consensus is reached, not only on the relative burden of financing but also on ways to achieve overall population coverage. It is suggested that action-research be used to test the adequacy of initial social health insurance policies.

Delivery of Health Care↗
PubMed1992

Implementing shared governance: a false start.

A case study of the implementation of shared governance in a large teaching hospital in Western Canada has been presented. The project was placed in jeopardy due to two major contingencies: turnover in the chief nursing executive position, and a sudden reduction in the operating budget of the nursing division necessitating significant layoffs. Other factors that threatened the survival of shared governance included lack of systematic, long-range planning; the number and diversity of major changes introduced concurrently in the nursing division; and insufficient support systems to sustain organizational change. In particular, some senior and first-line managers could not adapt to or accept the radical philosophical change and so they were unable to empower their staff and to provide the necessary reinforcement needed to ensure the success of shared governance. This combination of these factors contributed to the loss of momentum in the implementation of shared governance. Lowered morale in the wake of layoffs, together with union grievances, and lack of clarity of the role to be played by union representatives in shared governance produced conflict and confrontation within the nursing division and between union and management. Despite the difficulties encountered, there remains optimism and commitment to the challenge of making shared governance succeed. As this article goes to press, remarkable strides have been made in addressing the described issues. A task force composed primarily of staff nurses has developed a "customized" model of governance that meets the needs of the hospital and deals with the identified flaws of the first implementation attempt. The organization is optimistic that by taking time to develop a solid foundation for the proposed change and tending carefully to the details of decision-making processes, an effective structure to support the professional role of the nursing staff will be a reality.

Attitude of Health Personnel↗
PubMed1990

Shared epitopes between the soluble proteins of Hypoderma lineatum and Hypoderma bovis first instars.

Cattle are known to acquire immunological resistance to hypodermyiasis by repeated exposure to both species of cattle grubs, Hypoderma lineatum (Villers) and Hypoderma bovis (L.). Vaccination of cattle with purified proteins of H. lineatum, particularly hypodermin A, is known to protect cattle against hypodermyiasis by this species. The development of a protective recombinant vaccine against both species using hypodermin A isolated from H. lineatum would require that immunological epitopes be shared by complementary proteins in H. bovis. The purpose of this study was to investigate the soluble proteins of H. bovis first-instars for shared epitopes with H. lineatum. Soluble H. lineatum and H. bovis first-instar larval proteins were resolved by nondenaturing polyacrylamide electrophoresis, blotted onto nitrocellulose paper, and probed with selected polyclonal cow, polyclonal rabbit, and mouse monoclonal antisera. Considerable cross-reactivity was demonstrated by antibodies in the serum of an H. lineatum-infested cow as 6 of 10 resolved H. bovis proteins were bound by the antibodies. The most common shared epitope(s) was associated with hypodermin C, a collagenolytic protease. Hypodermin A shared epitope(s) were noted on 1 prominent H. bovis band (HB1-2). Hypodermin B, a prominent protein in H. lineatum, did not appear to share epitopes with H. bovis proteins. Shared epitopes between H. bovis proteins and hypodermins A and C of H. lineatum would suggest that cross-protection of cattle against H. bovis can be expected by vaccination with recombinant proteins of H. lineatum.

Animals↗
PubMed2006

Involve the patient and pass the MRCGP: investigating shared decision making in a consulting skills examination using a validated instrument.

BACKGROUND: Shared decision making is an important aspect of patient centredness. Lack of this consulting behaviour is a common reason for failure in the Membership of the Royal College of General Practitioners (MRCGP) consulting skills examination. AIM: To investigate candidates' performance in shared decision making and overall performance in the MRCGP consulting skills assessment compared with an independently validated measure, the OPTION ('observing patient involvement') scale. DESIGN: Cross-sectional study. SETTING: MRCGP examination, UK. PARTICIPANTS: Two hundred and fifty-two consultations submitted by 36 GPs submitting seven consultations per videotape. METHOD: A stratified sample of 63 candidates, 21 each from fail, pass and merit selected from candidates in the MRCGP consulting skills examination, were approached for participation. Participants' examination videotapes were independently assessed for shared decision making using the OPTION scale by two non-clinical raters. RESULTS: Thirty-six candidates (of 63; 57%) who participated were no different from non-participants. Candidates who passed the 'sharing management options' in the MRCGP had significantly higher OPTION scores than those who did not (35.4 versus 27.3; mean difference = 8.1, P = 0.044). There was a significant difference between OPTION scores of MRCGP candidates with 'fail' and 'pass' (including pass with merit): 28.6 versus 36.1, 95% confidence interval CI = 1.13 to 13.87. Scores decreased as clinician age increased but were not significantly associated with sex of GP, age or sex of patient or consultation duration. The probability of passing the MRGCP increased as OPTION scores increased. CONCLUSION: This study demonstrated concurrent validity of the MRCGP consulting skills assessment of sharing management options against an independent validated instrument for shared decision making, the OPTION scale. Candidates who performed best in the MRCGP exhibited high scores with OPTION. This study provides the basis for further work to demonstrate evidence for the potential of training for professional assessment to improve consulting competence.

Adult↗
PubMedDate not supplied

Job sharing. Part 1.

This article is the first of a three part series discussing the impact of nurses job sharing at University Hospital, London, Ontario. This first article explores the advantages and disadvantages of job sharing for staff nurses and their supervising nurse manager, as discussed in the literature. The results of a survey conducted on a unit with a large number of job sharing positions, concur with literature findings. The second article will present the evaluation of a pilot project in which two nurses job share a first line managerial position in the Operating Room. The third article will relate the effects of job sharing on women's perceived general well being. Job sharing in all areas, is regarded as a positive experience by both nurse and administrators.

Hospitals, University↗
PubMed1996

A shared care approach in obesity management: the general practitioner and a hospital based service.

OBJECTIVE: To describe the process of establishing a Shared Care obesity management programme between general practitioners and a hospital based specialist obesity service and to compare outcomes of the Shared Care programme (SC) to an established hospital based programme (MOS). DESIGN: A comparative study of two obesity management programmes. Patients were matched on gender, age and BMI (kg/m2). SUBJECTS: 29 female and eight male (age: 47.0 +/- 2 years, BMI 35.9 +/- 0.8 kg/m2) patients enrolled in the Shared Care programme (SC) were matched to 81 female and 20 male (age: 45.8 +/- 1.1 years, BMI 35.7 +/- 0.4 kg/m2) patients enrolled in a hospital based programme (MOS). MAIN OUTCOME MEASURES: Relative and absolute weight loss and retention rate were compared between the programmes at 10 and 26 weeks. Food habits were assessed at enrolment and week 10 of the programme in the SC group by a Food Habits Questionnaire and cognitive restraint, disinhibition and hunger were assessed by the Eating Inventory Questionnaire. RESULTS: Shared Care patients (n = 28) lost significantly more weight than the MOS patients (n = 60) (SC 4.8 +/- 0.6 kg and MOS 2.6 +/- 0.4 kg; p = 0.0016) over the 10 weeks of the programme. At 26 weeks both groups demonstrated a 5 kg weight loss. There was a significant improvement in food habits, and cognitive restraint, disinhibition and hunger over the 10 weeks of the programme in the SC group. Patient satisfaction was reflected in a better retention rate at 26 weeks by the Shared Care group. CONCLUSION: The study demonstrated that the obese patient managed in a shared care setting achieved better weight loss in the short term and attrition was lower in the longer term than a similar patient attending a specialist service based in a hospital.

Adult↗
PubMed1996

Association of the shared epitope with radiological severity of rheumatoid arthritis.

OBJECTIVE: To investigate the association between radiological severity of rheumatoid arthritis (RA) and the presence of the shared epitope. METHODS: Ninety unrelated adult Spanish patients with RA with a disease duration of at least 3 years, selected according to the American College of Rheumatology criteria, were radiologically assessed (shoulders, elbows, wrists, hands, hips, knees, and feet) and classified as having severe or nonsevere RA. DNA oligotyping was used to determine DR specificities and to detect DR4 and DR1 alleles. RESULTS: Forty-one patients (45.5%) had severe RA. Sixty-six patients (73.3%) carried the shared epitope and 18 (20%) had double expression of the shared epitope. Thirty-seven (90%) of the 41 patients with severe RA expressed the shared epitope. Logistic regression analysis showed that both single and double expression of the shared epitope were strongly related to the radiological severity of RA (odds ratio = 6.3 and 9.4, respectively). CONCLUSION: Our results show that radiological severity of RA is highly associated to the shared epitope.

Adult↗
PubMedDate not supplied

Shared care: a partnership between parents and nurses.

Shared care refers to the formalisation of parents' participation in the care of their hospitalised children. In this paper the planning, implementation and evaluation of a pilot study of shared care in a New South Wales paediatric unit is described. Surveys conducted before and during the pilot study showed that nurses' attitudes to shared care were mostly positive. Parents who participated in shared care also responded positively to the initiative although most had chosen to limit their participation to basic care activities. According to State Trait Anxiety Inventory scores, 50% fewer parents who had experienced shared care were very anxious at the time their children were discharged than parents whose children were hospitalised prior to the introduction of shared care.

Adult↗
PubMedDate not supplied

Adverse events associated with prescription drug cost-sharing among poor and elderly persons.

CONTEXT: Rising costs of medications and inequities in access have sparked calls for drug policy reform in the United States and Canada. Control of drug expenditures by prescription cost-sharing for elderly persons and poor persons is a contentious issue because little is known about the health impact in these subgroups. OBJECTIVES: To determine (1) the impact of introducing prescription drug cost-sharing on use of essential and less essential drugs among elderly persons and welfare recipients and (2) rates of emergency department (ED) visits and serious adverse events associated with reductions in drug use before and after policy implementation. DESIGN AND SETTING: Interrupted time-series analysis of data from 32 months before and 17 months after introduction of a prescription coinsurance and deductible cost-sharing policy in Quebec in 1996. Separate 10-month prepolicy control and postpolicy cohort studies were conducted to estimate the impact of the drug reform on adverse events. PARTICIPANTS: A random sample of 93 950 elderly persons and 55 333 adult welfare medication recipients. MAIN OUTCOME MEASURES: Mean daily number of essential and less essential drugs used per month, ED visits, and serious adverse events (hospitalization, nursing home admission, and mortality) before and after policy introduction. RESULTS: After cost-sharing was introduced, use of essential drugs decreased by 9.12% (95% confidence interval [CI], 8.7%-9.6%) in elderly persons and by 14.42% (95% CI, 13.3%-15.6%) in welfare recipients; use of less essential drugs decreased by 15.14% (95% CI, 14.4%-15.9%) and 22.39% (95% CI, 20.9%-23.9%), respectively. The rate (per 10 000 person-months) of serious adverse events associated with reductions in use of essential drugs increased from 5.8 in the prepolicy control cohort to 12.6 in the postpolicy cohort in elderly persons (a net increase of 6.8 [95% CI, 5.6-8.0]) and from 14.7 to 27.6 in welfare recipients (a net increase of 12.9 [95% CI, 10.2-15.5]). Emergency department visit rates related to reductions in the use of essential drugs also increased by 14.2 (95% CI, 8.5-19.9) per 10 000 person-months in elderly persons (prepolicy control cohort, 32.9; postpolicy cohort, 47.1) and by 54.2 (95% CI, 33.5-74.8) among welfare recipients (prepolicy control cohort, 69.6; postpolicy cohort, 123.8). These increases were primarily due to an increase in the proportion of recipients who reduced their use of essential drugs. Reductions in the use of less essential drugs were not associated with an increase in risk of adverse events or ED visits. CONCLUSIONS: In our study, increased cost-sharing for prescription drugs in elderly persons and welfare recipients was followed by reductions in use of essential drugs and a higher rate of serious adverse events and ED visits associated with these reductions.

Adult↗