Compassionate Care in Healthcare Systems: A Systematic Review

BackgroundIn spite of emphasis on patient-centered cares and promotion of their quality, shortcomings have been seen in health systems due to lack of compassion.PurposeThe aim of the present study was to determine the definition, fields, facilitating and inhibiting factors of compassionate care in healthcare systems and the interventions designed to promote it.MethodsThis study was conducted through narrative synthesis which is supposed to do systematic and synthesized review. Searching was done in English databases including Pub Med, CINAHL, Google Scholar, Web of Science, and Cochrane library, Ovid, Science Direct, WILEY by using keywords of Compassionate Care, Delivery of Health Care, Healthcare Systems, Compassion and Health Care Providers from 1987 to 2017.ResultsCompassionate care has some dimensions including ethical, professional, effective communication, human, spiritual/religious and getting involve with patients. Facilitating and inhibiting factors consisted of the nurse's personal characteristics, patients' behavior and organizational factors included workload, role model, and value of compassionate care in healthcare systems. Educational interventions such as providing feedback and reorienting have been mostly used to improve the compassionate care.ConclusionsAlthough compassionate care has been known as the main element of improving services quality in health care system, it has been studied restrictively from the viewpoints of the patients and all personnel in healthcare systems. The improvement of compassionate care through education cannot remove completely the gap between theory and practice, because it seems that clinical environment and organizational values of healthcare system are the largest facilitating and inhibiting factors for filling this gap. Therefore, it is necessary to take measures for promoting organizational culture.     

Implication of invalidation concept in fibromyalgia diagnosis

Clinical Rheumatology - The invalidation or social pain is an important but neglected issue in polysymptomatology of fibromyalgia (FM). This study sought whether tracing-perceived invalidation...     

Morphine and breast tumor metastasis: the role of matrix-degrading enzymes

Opioids including morphine are commonly used in pain management during and after cancer surgery but have been linked to a variety of pro- and anti-tumor effects. In the present study the effect of morphine administration on the localization and growth of breast tumor cells in lungs and the level of extracellular matrix (ECM) proteases were investigated. In a mouse syngeneic model of intravenously inoculated breast cancer cells, morphine administration led to a reduction in the localization and growth of tumors in the lungs and a reduction in circulating matrix metalloproteinase-9 (MMP-9) and urokinase-like plasminogen activator (uPA). To model the involvement of non-malignant cells of the tumor microenvironment in the changes we observed in the level of proteases, we co-cultured breast cancer cells with macrophages, endothelial cells and fibroblasts. We found a significant elevation of matrix proteases as well as matrix protease inhibitors in co-cultures of breast cancer cells with macrophages or endothelial cells. Interestingly, morphine treatment of these co-cultures reduced the level of MMP-9 and increased its endogenous inhibitor, TIMP-1, thereby altering the proteolytic profile. Morphine affected the level of enzymes in co-cultures but not in cells grown individually. This suggests that anti-tumor effects of morphine observed in our in vivo model could be mediated at least in part through modulation of paracrine communication between cancer cells and non-malignant cells in the tumor microenvironment.     

The Relationship Between Pediatric Combination Vaccines and Market Effects

We explored market factors that affect pediatric combination vaccine uptake in the US public-sector pediatric vaccine market. We specifically examined how Pediarix and Pentacel earned a place in the 2009–2012 lowest overall cost formulary.Direct competition between Pediarix and Pentacel is driven by the indirect presence of the Merck Haemophilus influenzae type b vaccine and the Recommended Childhood Immunization Schedule requirement for a hepatitis B birth dose.The resulting analysis suggests that Pentacel would never have earned a place in the lowest overall cost formulary for 2009–2012 federal contract prices for any cost of an injection unless the Merck H influenzae type b advantage was ignored and the hepatitis B birth dose administration cost was recognized by health care providers in designing the lowest overall cost formularies.A limited number of pharmaceutical companies manufacture vaccines for the US pediatric vaccine market. Over the past decade, numerous economic and regulatory factors have made vaccine manufacturing less profitable for such companies, resulting in many of them exiting the market.1 One consequence of this situation is that production problems often translate into vaccine shortages in the market. Because maintaining high immunization levels is a vital societal need, public health administrators are motivated to sustain an adequate supply of vaccines through public health policies that encourage new companies to enter the market.1The Centers for Disease Control and Prevention (CDC) in the United States is the primary public health organization responsible for developing and applying disease prevention and control. The Advisory Committee on Immunization Practices (ACIP) is an independent panel of vaccine stakeholder representatives from the CDC, vaccine manufacturers, scientists, and physician groups. The ACIP reviews technical data on new vaccines, and then makes recommendations after the vaccines are approved by the Food and Drug Administration (FDA) for sale in the United States. The ACIP is also responsible for adding the vaccines to the Recommended Childhood Immunization Schedule (RCIS; Figure 12). The RCIS represents the recommended sequence and timing of pediatric vaccines to protect children from pediatric diseases.Open in a separate windowFIGURE 1—United States 2012 Recommended Childhood Immunization Schedule for birth through age 6 years.Note. DTaP = diphtheria, tetanus, and pertussis; HepA = hepatitis A; HepB = hepatitis B; Hib = Haemophilus influenzae type b; IPV = inactivated poliovirus; MMR = measles, mumps, and rubella; PCV = pneumococcal conjugate vaccine; RV = rotavirus.Source. Centers for Disease Control and Prevention.The CDC is required by law to negotiate vaccine prices for the purchases made by state and local governments. The state and local government public health officials purchase vaccines for the immunization of the children in their administrative areas of responsibility. They seek to satisfy the RCIS for each child to ensure proper immunization coverage. They distribute the vaccines free of charge to the private physicians and public health clinics that are registered as Vaccines for Children (VFC) Program providers.3 The VFC Program is designed to provide vaccines (at no charge) to children whose parents or guardians are not able to afford them. Pediatric vaccines purchased at the federal contract prices, as negotiated by CDC, account for approximately 57% of total pediatric purchases by volume.3 Private vaccine providers who are not registered as VFC Program providers cannot purchase the vaccines through federal contract prices, and as such, purchase the vaccines at private-sector prices (typically higher than the federal contract prices). The private-sector prices are reported by vaccine manufacturers to the CDC.4 In this analysis, we focused on federal contract prices, though the methodology employed could be adapted to separately analyze the private sector.Vaccines are said to compete when 2 or more vaccine manufacturers produce the same vaccine or vaccines that contain the same antigen that can be administered to satisfy the immunization requirements in a given time period. There are 4 competitive antigens: diphtheria, tetanus, and pertussis (DTaP); hepatitis B (HepB); Haemophilus influenzae type b (Hib); and inactivated poliovirus (IPV). In the United States, 3 pharmaceutical companies (Merck, GlaxoSmithKline, and Sanofi Pasteur) manufacture all the competing vaccines.Pediarix (DTaP–HepB–IPV) was the first pentavalent combination vaccine to gain FDA approval (in 2002). In 2008, a second pentavalent combination vaccine, Pentacel (DTaP–IPV/Hib), gained FDA approval for the US market. As Pediarix and Pentacel are the only vaccines that immunize against 5 diseases in a single injection, health care providers welcome them as part of the formulary (defined as a set of pediatric vaccines stocked to satisfy the immunization needs for a pediatric population cohort, as defined by a given set of immunization requirements). On the basis of the RCIS structure, Pediarix and Pentacel are not compatible for use in a single vaccine formulary. By design, the market will gravitate toward the combination vaccine that provides the best value (i.e., yields the lowest overall cost formulary [LOCF], the set of vaccines that satisfies the RCIS at the lowest overall formulary cost5). Therefore, Pediarix and Pentacel are said to serve as the backbone of the LOCF. From the perspective of health care providers, the question to ask is: which pentavalent vaccine earns a place in the LOCF, given a fixed cost of an injection (defined as a constant vaccine administration cost)?Behzad et al.6 reported and discussed the LOCFs across 3 years (2009–2011) for several fixed cost of an injection values. From Behzad et al.,6 Pentacel was not competitively priced compared with Pediarix in 2009–2011 (i.e., Pentacel did not earn a place in the LOCF for any cost of an injection). According to data provided by the CDC7,8 (e-mail communication from Sarah Foster, Centers for Disease Control and Prevention, August 14, 2013), the net number of Pentacel doses distributed in 2009–2011 was greater than the number of Pediarix doses distributed. A natural question to ask is why the uptake by health care providers who administer Pediarix or Pentacel as the backbone of their pediatric formularies is not consistent with the results reported in Behzad et al.6This study answers this question by considering the effects of 2 issues: a special property of the Merck Hib (i.e., a month-6 dose of Hib is not required if Merck Hib is administered in months 2 and 4) and the HepB birth dose. Moreover, this study identifies the equilibrium cost of an injection (defined as the minimum cost of an injection for which Pentacel earns a place in the LOCF) for the 4 possible scenarios associated with recognizing or ignoring these 2 issues by health care providers in designing the LOCF. No attempt has been made before to characterize the effects of the special property of the Merck Hib and HepB birth dose on the uptake of Pediarix and Pentacel. Understanding the market factors that have an impact on the uptake of pediatric combination vaccines could interest those within the pediatric health care community, such as pharmaceutical companies seeking right pricing strategies for their products, as well as the CDC negotiating vaccine prices with manufacturers and government, and public health officials seeking the LOCF for the children in their administrative area.     

Comparison of maxillary and mandibular growth.

In this longitudinal study, serial lateral cephalometric radiographs were used to compare growth patterns of the maxilla and mandible, with hand-wrist radiographs used to assess skeletal maturity. The sample comprised 28 untreated subjects (15 female, 13 male) who were followed from ages 6 to 20 years. All subjects had Class I malocclusions without anterior crossbites. Absolute values and incremental changes for linear and angular cephalometric measurements were recorded and analyzed, and the relative growth-rate formula was used to provide an accurate index of acceleration and deceleration of growth. The SNA angle did not change significantly with age, but the SNB angle increased significantly in the male subjects. The ANB angle decreased continuously until age 14. The palatal plane descended significantly from the horizontal plane. The anterior and posterior nasal spines moved at about the same rate. The mandible grew in length twice as much as the maxilla from ages 6 to 20. With growth, the facial profiles of the male subjects became straighter as the chin became more prominent. The female subjects had less incremental growth and duration of growth of the mandible, so that the profiles remained more convex. Overall, skeletal and chronologic ages did not differ significantly, except at ages 10 and 16 in the female subjects. Individual variability pointed to the need for assessing each patient's pattern in the general guidelines of the group pattern.     

In vitro computer analysis of crown discolouration from commonly used endodontic sealers

The aim of this study was to assess the degree of staining of tooth crowns by commonly used endodontic sealers using a computer analysis method. Crown discolouration by root canal sealers AH26, Endofill, Tubliseal, Zinc oxide eugenol (ZnOE), Apatite root canal sealer III as well as gutta-percha and Cavizol (a filling material containing ZnOE) were tested on extracted human premolar teeth. The roots of the teeth were resected 3 mm below the cemento-enamel junction. The pulp chambers were then cleaned and irrigated. The samples were divided into nine groups of five samples each and filled with test materials. Ten teeth were used as control groups: five positive (amalgam) and five negative (distilled water). The degree of tooth discolouration was analysed at 3, 6 and 9 months. The crown discolouration was assessed by computer analysis of digital images taken from the samples using the CIE Lab colour system. Statistical analysis was carried out using anova, repeated measure anova and Tukey's HSD tests. All sealers caused a degree of tooth discolouration, which increased with time. Endofill and ZnOE caused the greatest discolouration and Apatite root canal sealer III caused the least discolouration after 9 months. The most discolouration during the test periods occurred in the cervical third of the crown.