المؤلفون: Williams, Emma E., Arant, Kaetlyn R., Leifer, Valia P., Balcom, Mardi Chadwick, Levy-Carrick, Nomi C., Lewis-O'Connor, Annie, Katz, Jeffrey N.

المصدر: BMC Women's Health; 8/27/2021, Vol. 21 Issue 1, p1-11, 11p

مصطلحات موضوعية: COVID-19 pandemic, INTIMATE partner violence, SOCIAL order, STAY-at-home orders, SOCIAL distancing

مصطلحات جغرافية: BOSTON (Mass.)

مستخلص: Background: Early research suggests the COVID-19 pandemic worsened intimate partner violence (IPV) in the US. In particular, stay-at-home orders and social distancing kept survivors in close proximity to their abusers and restricted access to resources and care. We aimed to understand and characterize the impact of the pandemic on delivery of IPV care in Boston.Methods: We conducted individual interviews with providers of IPV care and support in the Greater Boston area, including healthcare workers, social workers, lawyers, advocates, and housing specialists, who continued to work during the COVID-19 pandemic. Using thematic analysis, we identified themes describing the challenges and opportunites providers faced in caring for survivors during the pandemic.Results: Analysis of 18 interviews yielded four thematic domains, encompassing 18 themes and nine sub-themes. Thematic analysis revealed that the pandemic posed an increased threat to survivors of IPV by exacerbating external stressors and leading to heightened violence. On a system level, the pandemic led to widespread uncertainty, strained resources, amplified inequities, and loss of community. On an individual level, COVID-19 restrictions limited survivors' abilities to access resources and to be safe, and amplified pre-existing inequities, such as limited technology access. Those who did not speak English or were immigrants experienced even more difficulty accessing resources due to language and/or cultural barriers. To address these challenges, providers utilized video and telephone interactions, and stressed the importance of creativity and cooperation across different sectors of care.Conclusions: While virtual care was essential in allowing providers to care for survivors, and also allowed for increased flexibility, it was not a panacea. Many survivors faced additional obstacles to care, such as language barriers, unequal access to technology, lack of childcare, and economic insecurity. Providers addressed these barriers by tailoring services and care modalities to an individual's needs and circumstances. Going forward, some innovations of the pandemic period, such as virtual interactions and cooperation across care sectors, may be utilized in ways that attend to shifting survivor needs and access, thereby improving safe, equitable, and trauma-informed IPV care. [ABSTRACT FROM AUTHOR]

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المؤلفون: Lape, Emma C.¹ (AUTHOR), Katz, Jeffrey N.¹ (AUTHOR), Blucher, Justin A.¹ (AUTHOR), Chen, Angela T.¹ (AUTHOR), Silva, Genevieve S.¹ (AUTHOR), Schwab, Joseph H.² (AUTHOR), Balboni, Tracy A.³ (AUTHOR), Losina, Elena¹ (AUTHOR), Schoenfeld, Andrew J.¹ (AUTHOR) ajschoen@neomed.edu

المصدر: Spine Journal. Jun2020, Vol. 20 Issue 6, p905-914. 10p.

مصطلحات موضوعية: *ACADEMIC medical centers, *METASTASIS, *QUALITATIVE research, *SPINE diseases, *SEMI-structured interviews

مصطلحات جغرافية: BOSTON (Mass.)

مستخلص: Background: In the treatment of spinal metastases the risks of surgery must be balanced against potential benefits, particularly in light of limited life-expectancy. Patient experiences and preferences regarding decision-making in this context are not well explored.Purpose: We performed a qualitative study involving patients receiving treatment for spinal metastatic disease. We sought to understand factors that influenced decision-making around care for spinal metastases.Study Setting: Three tertiary academic medical centers.Patient Sample: We recruited patients presenting for treatment of spinal metastatic disease at one of three tertiary centers in Boston, MA.Outcome Measures: We conducted semistructured interviews using a guide that probed participants' experiences with making treatment decisions.Methods: We performed a thematic analysis that produced a list of themes, subthemes, and statement explaining how the themes related to the study's guiding questions. Patients were recruited until thematic saturation was reached.Results: We interviewed 23 participants before reaching thematic saturation. The enormity of treatment decisions, and of the diagnosis of spinal metastases itself, shaped participant preferences for who should take responsibility for the decision and whether to accept treatments bearing greater risk of complications. Pre-existing participant beliefs about decision-making and about surgery interacted with the clinical context in a way that tended to promote accepting physician recommendations and delaying or avoiding surgery.Conclusions: The diagnosis of spinal metastatic disease played an outsized role in shaping participant preferences for agency in treatment decision-making. Further research should address strategies to support patient understanding of treatment options in clinical contexts-such as spinal metastases-characterized by ominous underlying disease and high-risk, often urgent interventions. [ABSTRACT FROM AUTHOR]

المؤلفون: Dempsey, Kyle E., Ghazinouri, Roya, Diez, Desiree, Alcantara, Luis, Beagan, Carolyn, Aggouras, Barbara, Hoagland, Monica, Thornhill, Thomas S., Katz, Jeffrey N.

المصدر: BMC Musculoskeletal Disorders; 2013, Vol. 14 Issue 1, p1-16, 16p, 2 Charts, 1 Graph

مصطلحات موضوعية: TOTAL hip replacement, ORTHOPEDIC apparatus, ARTIFICIAL joints, BENCHMARKING (Management)

مصطلحات جغرافية: BOSTON (Mass.)

مستخلص: Background: Several organizations seek to address the growing burden of arthritis in developing countries by providing total joint replacements (TJR) to patients with advanced arthritis who otherwise would not have access to these procedures. Because these mission trips operate in resource poor environments, some of the features typically associated with high quality care may be difficult to implement. In the U.S., many hospitals that perform TJRs use the Blue Cross/Shield's Blue Distinction criteria as benchmarks of high quality care. Although these criteria were designed for use in the U.S., we applied them to Operation Walk (Op-Walk) Boston's medical mission trip to the Dominican Republic. Evaluating the program using these criteria illustrated that the program provides high quality care and, more importantly, helped the program to find areas of improvement. Methods: We used the Blue Distinction criteria to determine if Op-Walk Boston achieves Blue Distinction. Each criterion was grouped according to the four categories included in the Blue Distinction criteria-- "general and administrative", "structure", "process", or "outcomes and volume". Full points were given for criteria that the program replicates entirely and zero points were given for criteria that are not replicated entirely. Of the non-replicated criteria, Op-Walk Boston's clinical and administrative teams were asked if they compensate for failure to meet the criterion, and they were also asked to identify barriers that prevent them from meeting the criterion. Results: Out of 100 possible points, the program received 71, exceeding the 60-point threshold needed to qualify as a Blue Distinction center. The program met five out of eight "required" criteria and 11 out of 19 "informational" criteria. It scored 14/27 in the "general" category, 30/36 in the "structure" category, 17/20 in the "process" category, and 10/17 in the "outcomes and volume" category. Conclusion: Op-Walk Boston qualified for Blue Distinction. Our analysis highlights areas of programmatic improvement and identifies targets for future quality improvement initiatives. Additionally, we note that many criteria can only be met by hospitals operating in the U.S. Future work should therefore focus on creating criteria that are applicable to TJR mission trips in the context of developing countries. [ABSTRACT FROM AUTHOR]

: Copyright of BMC Musculoskeletal Disorders is the property of BioMed Central and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Reichmann, William M., Walensky, Rochelle P., Case, Amy, Novais, Anna, Arbelaez, Christian, Katz, Jeffrey N., Losina, Elena

المصدر: PLoS ONE; 2011, Vol. 6 Issue 11, p1-7, 7p

مصطلحات موضوعية: HIV infections, HOSPITAL emergency services, LENTIVIRUS diseases, SEXUALLY transmitted diseases

مصطلحات جغرافية: BOSTON (Mass.), MASSACHUSETTS

مستخلص: Objective: To estimate the prevalence of undiagnosed HIV, the prevalence of diagnosed HIV, and proportion of HIV that is undiagnosed in populations with similar demographics as the Universal Screening for HIV in the Emergency Room (USHER) Trial and the Brigham and Women's Hospital (BWH) Emergency Department (ED) in Boston, MA. We also sought to estimate these quantities within demographic and risk behavior subgroups. Method: We used data from the USHER Trial, which was a randomized clinical trial of HIV screening conducted in the BWH ED. Since eligible participants were HIV-free at time of enrollment, we were able to calculate the prevalence of undiagnosed HIV. We used data from the Massachusetts Department of Public Health (MA/DPH) to estimate the prevalence of diagnosed HIV since the MA/DPH records the number of persons within MA who are HIV-positive. We calculated the proportion of HIV that is undiagnosed using these estimates of the prevalence of undiagnosed and diagnosed HIV. Estimates were stratified by age, sex, race/ethnicity, history of testing, and risk behaviors. Results: The overall expected prevalence of diagnosed HIV in a population similar to those presenting to the BWH ED was 0.71% (95% CI: 0.63%, 0.78%). The prevalence of undiagnosed HIV was estimated at 0.22% (95% CI: 0.10%, 0.42%) and resultant overall prevalence was 0.93%. The proportion of HIV-infection that is undiagnosed in this ED-based setting was estimated to be 23.7% (95% CI: 11.6%, 34.9%) of total HIV-infections. Conclusions: Despite different methodology, our estimate of the proportion of HIV that is undiagnosed in an ED-setting was similar to previous estimates based on national surveillance data. Universal routine testing programs in EDs should use these data to help plan their yield of HIV detection. [ABSTRACT FROM AUTHOR]

: Copyright of PLoS ONE is the property of Public Library of Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)