Universal health care

To inaugurate its fifth year of publication, The American Heart Hospital Journal (AHHJ) focused its Winter 2007 issue on health care systems from around the world, with 8 articles contributed by national leaders in their respective countries. Due to the interest and wide range of expertise in the international cardiac community, we continued to publish Special Reports throughout 2007 on this topic. In this issue we present the final two international perspectives, for a total of 12 individual international perspectives plus a final report from Robert Roberts, MD, that surveys the health care systems of an additional 4 countries, including his own, Canada. Our goal in publishing the series: to highlight the variety of systems currently employed worldwide, in the hope that such an international exchange of commentaries would result in debate and reforms where needed. We welcome your comments on the series, as well as your aspirations and ideas for the future of our national system of health care.     

Academic Skills: A Concise Guide to Grant Writing

We are pleased to offer another brief article for our series on Academic Skills. This series aims at providing short, concrete, and practical tips on how to conduct and improve your life in academia. Whether beginner or fully trained investigator, we share the same challenges in succeeding in our professions, challenges which schooling never prepared us for. Perhaps grant writing, the subject of this article, is the most mysterious, fear-provoking and misunderstood type of skill needed in our careers. In fact, for these reasons, some people have never dared adventure into grant writing. Yet, this activity is not only essential for running our research but also for other numerous purposes including training people, buying equipment, getting a job, and being granted tenure. The tips provided here are widely applicable if you are interested in writing a grant, regardless of your country of origin. Therefore, it is my hope that these tips increase your chances of success in grantmanship along with the satisfaction that may come from achieving all the goals that these funding aids make possible.     

Applied medical informatics for the chest physician: information you can use!--Part 3

In this third and last part in our series on applied medical informatics (AMI), we will examine the following: (1) a concise wrap-up of the practice steps necessary to achieve the benefits from AMI in your practice; (2) an introduction to the patient health-care record and why it is important to physicians; and (3) a look at some of the latest developments in AMI that are of interest to the chest physician.     

Alcoholics anonymous careers: patterns of AA involvement five years after treatment entry

BACKGROUND: Most formal treatment programs recommend Alcoholics Anonymous (AA) attendance during treatment and as a form of aftercare, but we know very little about treatment seekers' patterns of AA involvement over time and how these relate to abstinence. METHOD: This paper applies latent class growth curve modeling to longitudinal data from 349 dependent drinkers recruited when they were entering treatment and were re-interviewed at one or more follow-up interviews one, three and five years later, and who reported having attended AA at least once. RESULTS: Four classes of AA "careers" of meeting attendance emerged: The low AA group mainly just attended AA during the 12 months following treatment entry. The medium and high AA groups were characterized by stable attendance at the second and third follow-ups-at about 60 meetings a year for the medium group and over 200 meetings per year for the high group, followed by slight increases for the medium group and slight decreases for the high group by year five. The declining AA group doubled its meeting attendance postbaseline, to almost 200 meetings during the year following treatment entry, but by year five they were only attending about six meetings on average. Decreases in AA meetings did not necessarily signal disengagement from AA; at the five-year follow-up, a third of the low AA group and over half of the declining AA group said they felt like a member of AA. Activities other than meeting attendance, such as having a sponsor, otherwise paralleled the meeting careers, but social networks were similar by year five. Rates of abstinence by year five (for the past 30 days) were 43% for the low AA group, 73% for the medium group, 79% for the high group and 61% for the declining group. Rates of dependence symptoms and social consequences of drinking did not differ between the groups at year five. CONCLUSIONS: The prototypical AA careers derived empirically are consistent with anecdotal data about AA meetings: some never connect; some connect but briefly; and others maintain stable (and sometimes quite high) rates of AA attendance. However, contrary to AA lore, many who connect only for a while do well afterwards.     

Science of aging knowledge environment: one-stop shopping for researchers in the field of aging

The Science of Aging Knowledge Environment (SAGE KE) was launched in October 2001 to provide an online information source and community-building tool. The site offers a wide range of features, including original commentary articles, a database of genes and interventions related to aging, and a calendar of meetings and events. Users may initiate discussions and post comments on the articles; these features are intended to promote interaction between researchers in the field and to ensure the timeliness of information posted. This paper details SAGE KE's contents and offers suggestions about how to customize the site to save time and maximize information acquisition and exchange.     

Reply: The right place of 18FDG PET for the diagnosis of giant cell arteritis--a response to the article of Brodmann et al.

I read with great interest your response to our article. Infact it was not surprising that ¹⁸FDG PET is not suitable forthe diagnosis of temporal arteritis due to the limited spatialresolution of the PET scanners that are commercially     

Time trends in heavy drinking among middle-aged and older adults in Denmark

Background:  Studies have indicated an increasing proportion of heavy drinking among middle-aged and older Danes. Trends in consumption are often extremely sensitive to influence from various components of the time trends but only few have explored the age, period and cohort-related influences on late life alcohol consumption. By using age, period, and cohort modeling this study explores the time trends in heavy drinking.
Methods:  Data derive from five National Health and Morbidity Surveys conducted by the Danish National Institute of Public Health in 1987, 1994, 2000, 2003, and 2005. A total of 15,144 randomly selected Danes between the age of 50 and 74 were interviewed about their alcohol intake on the last weekday and their alcohol intake in the last week. By applying the age-period-cohort model the probability of heavy alcohol drinking is estimated to separate the influence of age, period (calendar time) and cohort (year of birth).
Results:  The unadjusted probability of heavy drinking declines by age and increases by calendar year and year of birth for both men and women. However, the negative effect of age is attenuated for women when adjusted for birth cohort, indicating that the proportion of heavy drinking women increases in younger birth cohorts. This trend is not observed for men as their drinking pattern mainly increase slightly by calendar year.
Conclusions:  Our Danish observations for older aged individuals correspond to the social and cultural changes in the 1960s and 1970s that possibly have affected the drinking behavior of the cohorts. Time trend analyses, such as this may serve as an excellent opportunity to extrapolate and forecast alcohol mortality and morbidity.     

Terminal digit preference and single-number preference in the Syst-Eur trial: influence of quality control

BACKGROUND: Terminal digit and single-number preference may produce inaccuracy and biased results when measuring blood pressure. We describe these preferences in the Syst-Eur randomized placebo-controlled trial of the treatment of isolated systolic hypertension and describe how we sought to eliminate these problems. METHODS: The Data Monitoring Committee of the trial conducted yearly quality control meetings in Belgium and visited the participating centres to check their adherence to the protocol. These meetings involved identifying terminal digit preference, improving blood pressure control and boosting recruitment. RESULTS: The prevalence of use of terminal digit zero when measuring sitting systolic blood pressure (first readings) reduced from an average of 42.4% in the year prior to the date when a centre first randomized a patient to 31.5, 25, 22.3, 26.3, 23.2 and 22% in the subsequent 6 years. This trend was independent of the calendar year during which a centre entered the trial and supports the hypothesis that data-quality monitoring, including the feedback of digit preference to centres, led to a reduction in terminal digit zero preference. In addition, a higher than expected prevalence of the systolic blood pressure value of 148 mmHg was found in the active treatment groups in the double-blind phase. Selection for 148 mmHg persisted over time and constituted a single-number preference bias. This arose from the instruction to investigators to reduce systolic blood pressure to below 150 mmHg. CONCLUSION: Monitoring and feedback of data quality should be undertaken to minimize digit and number preference. Automatic devices should ideally be employed to help to avoid these problems as long as the devices are fully validated and regularly serviced, and providing that readings are not rejected and repeated.     

Putting Complex Older Persons First: How the Centers for Medicare and Medicaid Services 2019 Payment Proposal Fails Older Americans

In July 2018, the Centers for Medicare and Medicaid Services (CMS) released its proposed Medicare Physician Fee Schedule rule for calendar year 2019 (MPFS2019). The proposal sets forth CMS‐recommended updates to Medicare payment policies, payment rates, and quality provisions for services provided in the next calendar year. From year to year, the rule also can serve as a vehicle for soliciting input on new payment proposals and changes to existing policies. Among the payment and quality proposals in the MPFS2019 proposal, CMS proposed extensive changes to Current Procedural Terminology codes that are the framework for documentation and payment for office‐based evaluation and management (E/M) services. The American Geriatrics Society (AGS) believes the proposed payment methodology changes for E/M services would have had a significant negative impact on care for older Americans. On September 10, 2018, the AGS submitted its comments on this proposal and other aspects of the rule, and the AGS also submitted a comment letter signed by 41 organizations from an AGS‐led multispecialty coalition. The coalition also worked collaboratively on outreach to Congress, which included visits to Capitol Hill and a coalition letter stressing our collective support for reducing the burden of documentation for clinicians and our opposition to the proposed changes in payment methodology. In all letters, we noted that the AGS and members of our coalition hoped to work collaboratively with CMS and other stakeholders to develop a refined approach that would achieve the best possible outcomes for patients, particularly frail older Americans with multiple chronic conditions. In releasing their final MPFS2019, CMS postponed the E/M coding collapse for at least two years, a decision that speaks to the hard work of the AGS, its members, and the multi‐specialty coalition, and which opens the door for further discussions about the future of payment for E/M services so critical to older people. J Am Geriatr Soc 67:145–150, 2019.     

Predictors of alcohol-treatment seeking in a sample of older veterans in the GET SMART program

OBJECTIVES: To examine the predictive value of demographic characteristics and substance abuse indicators to explain treatment seeking for substance abuse problems by older male medical patients. DESIGN: Longitudinal analysis of screening data and treatment-seeking behavior. SETTING: Inpatient medical and outpatient substance abuse treatment center. PARTICIPANTS: Participants in the study were 855 medically ill male veterans aged 55 and older, who were screened for alcohol problems during inpatient medical treatment after clinician referral. MEASUREMENTS: The CAGE alcohol screen (Cut down on your drinking, Annoyed by criticism of your drinking, Guilty about your drinking, Eye-opener), drug use, and demographic measures administered at time of screening. Predictors of treatment seeking in the sample were examined using structural equation modeling. RESULTS: Expressed interest in treatment and later attendance at a pretreatment evaluation were associated with younger age and a higher CAGE alcohol screening score. Being unmarried and using drugs in addition to alcohol were associated with treatment interest but not with evaluation attendance. In the path model tested, the effect of higher CAGE score partially explained the effect of younger age on treatment seeking. CONCLUSION: The model examined shows utility in predicting alcohol-treatment seeking in this sample. Age-related factors may deter treatment seeking by older male medical inpatients.     

Family meetings--a qualitative exploration of improving care planning with older people and their families

OBJECTIVE: To explore the opinions of participants in family meetings to improve the quality of this important rehabilitation tool. DESIGN: Qualitative exploration of opinions and experience from staff, patients and families. SETTING: Tertiary teaching geriatric rehabilitation hospital. PARTICIPANTS: Staff, families and patients who had recently participated in family meetings. METHODS: Focus groups, written surveys and individual semi-structured interviews. RESULTS: Three main themes were identified in the staff focus groups-preparation, staff skills and aftermath. Opinions from family members revealed a high level of satisfaction. The patient interviews revealed a worrying lack of informed consent and lack of clarity of the purpose. All three groups identified an unclear agenda as the underlying reason for unsatisfactory meetings. An unfavourable outcome decision (such as placement in institutional care) also influenced patient opinions on the process. The majority of patients found the family meeting to be helpful. CONCLUSIONS: Family meetings are much appreciated by patients and their families. A model of the family meeting process is proposed to account for our research findings and as a means to improve meetings. Adequate preparation and consent, and skilled facilitation may improve the effectiveness of family meetings while maintaining the patient's sense of autonomy.     

The hazards of cognitive aging

After a review of findings from the Seattle Longitudinal Study of adult cognitive development, this paper discusses the application of event history analysis, a technique pioneered by sociologists, to data involving changes of states in individual behavior related to human aging. The dependent variable of interest for psychologists and other developmentalists should be the age (calendar or functional) at which the event occurs rather than its index in historical time. Using occurrence of significant decline in cognitive abilities as an exemplar, hazard functions are presented that allow the assessment of risk for future decline, as well as the prediction of the calendar age when individuals can expect cognitive decline under alternative assumptions.     

Involvement of women in community-directed treatment with ivermectin for the control of onchocerciasis in Rukungiri district, Uganda: a knowledge, attitude and practice study

A study of knowledge, attitudes and practice was carried out in the Rukungiri district of Uganda, in order to investigate the involvement of women in community-directed treatment with ivermectin (CDTI), for the control of onchocerciasis. The data analysed came from interviews with 260 adult women (one from each of 260 randomly-selected households in 20 onchocerciasis-endemic communities), community informants, and participatory evaluation meetings (PEM) in eight communities. The women who had been treated with ivermectin in 1999 generally had more knowledge of the benefits of taking ivermectin, were more likely to have attended the relevant health-education sessions and were more involved in community decisions on the method of ivermectin distribution than the women who had not received ivermectin in that year. There were fewer female community-directed health workers (CDHW) than male CDHW in the communities investigated. The reasons for not attending health-education sessions, not participating in community meetings concerning the CDTI, and the reluctance of some women to serve as CDHW were investigated. The most common reasons given were domestic chores, a reluctance to express their views in meetings outside their own kinship group, suspicions that other women might take advantage of them, and a lack of interest. Most of the women interviewed (as well as other community members) felt that there were relatively few women CDHW. The women attributed this to a lack of interaction and trust amongst themselves, which resulted in more men than women being selected as CDHW. The rest of the community members were not against women working as CDHW. It is recommended that communities be encouraged to select women to serve as CDHW in the CDTI, and that the performances of male and female CDHW be compared.     

Notices

The Notices section of Gastroenterology publishes announcements of activities that are of interest to our readership. All Notices are limited to 100 words and must contain the following information: title of meeting, date, place, and the address of the contact person. Send announcements and your list of desired publication dates to: Gastroenterology Notices, 4930 Del Ray Avenue, Bethesda, Maryland 20814. We cannot publish Notices received less than 3 months before the desired publication date. The AGA reserves the right to reject any advertisement.     

Notices

The Notices section of Gastroenterology publishes announcements of activities that are of interest to our readership. All Notices are limited to 100 words and must contain the following information: title of meeting, date, place, and the address of the contact person. Send announcements and your list of desired publication dates to: Gastroenterology Notices, 4930 Del Ray Avenue, Bethesda, Maryland 20814. We cannot publish Notices received less than 3 months before the desired publication date. The AGA reserves the right to reject any advertisement.     

Multidisciplinary team discussion: the emerging gold standard for management of cardiopulmonary complications of connective tissue disease

Cardiopulmonary complications of connective tissue diseases (CTDs), particularly pulmonary arterial hypertension (PAH) and interstitial lung disease (ILD), are major determinants of morbidity and mortality. Multidisciplinary meetings may improve diagnostic accuracy and optimise treatment. We review the literature regarding multidisciplinary meetings in CTD-ILD and PAH and describe our tertiary centre experience of the role of the multidisciplinary meeting in managing CTD-PAH.     

Seasonality of birth patterns in an Australian cohort of patients with biopsy‐confirmed idiopathic inflammatory myopathy

Environmental exposures in the foetal period may predispose to autoimmunity. Aim of this study is to investigate whether seasonality in birth patterns exists in idiopathic inflammatory myopathies (IIM). We used Stata (StataCorp USA, version 13.0) and the user‐written routine command ‘circsummarise’ to assess birth seasonality among South Australian patients with histologically confirmed IIM subsequent to 1980 using their date of birth. There was no evidence for a seasonal birth pattern among IIM patients overall (n = 568), however there were some ethnic variances in birth patterns among non‐Caucasian patients. There was evidence for birth seasonality among both Aboriginal (mean = 7 July, Rayleigh P = 0.04) and Asian patients (mean = 12 August, Rayleigh P‐value = 0.038). Non‐Caucasians born in the third quarter of the calendar year may have an increased risk of developing IIM. Large international studies of IIM patients of diverse ethnicity are required to clarify the role of perinatal exposures in disease susceptibility.