Identifying mangrove-coral habitats in the Florida Keys.

Coral reefs are degrading due to many synergistic stressors. Recently there have been a number of global reports of corals occupying mangrove habitats that provide a supportive environment or refugium for corals, sheltering them by reducing stressors such as oxidative light stress and low pH. This study used satellite imagery and manual ground-truthing surveys to search for mangrove-coral habitats in the Florida Keys National Marine Sanctuary and then collected basic environmental parameters (temperature, salinity, dissolved oxygen, pH, turbidity) at identified sites using a multi-parameter water quality sonde.

Shed-MEDS: pilot of a patient-centered deprescribing framework reduces medications in hospitalized older adults being transferred to inpatient postacute care.

Background: Polypharmacy is common in hospitalized older adults. Deprescribing interventions are not well described in the acute-care setting. The objective of this study was to describe a hospital-based, patient-centered deprescribing protocol (Shed-MEDS) and report pilot results.

Potentially Avoidable Readmissions of Patients Discharged to Post-Acute Care: Perspectives of Hospital and Skilled Nursing Facility Staff.

Background: Hospital readmissions from skilled nursing facilities (SNFs) are common. Previous research has not examined how assessments of avoidable readmissions differ between hospital and SNF perspectives.

Objectives: To determine the percentage of readmissions from post-acute care that are considered potentially avoidable from hospital and SNF perspectives.

Preventability of Hospital Readmissions From Skilled Nursing Facilities: A Consumer Perspective.

Purpose Of The Study: A structured interview was conducted with Medicare patients readmitted to a private, tertiary teaching hospital from skilled nursing facilities (SNFs) to assess their perspectives of readmission preventability and their role in the readmission.

Design And Methods: Data were collected at Vanderbilt University Medical Center using a 6-item interview administered at the bedside to Medicare beneficiaries with unplanned hospital readmissions from 23 SNFs within 60 days of a previous hospital discharge. Mixed analytical methods were applied, including a content analysis that evaluated factors contributing to hospital readmission as perceived by consumers.

Medications associated with geriatric syndromes and their prevalence in older hospitalized adults discharged to skilled nursing facilities.

Background: More than half of the hospitalized older adults discharged to skilled nursing facilities (SNFs) have more than 3 geriatric syndromes. Pharmacotherapy may be contributing to geriatric syndromes in this population.

Objectives: Develop a list of medications associated with geriatric syndromes and describe their prevalence in patients discharged from acute care to SNFs.

Pain and Satisfaction With Pain Management Among Older Patients During the Transition From Acute to Skilled Nursing Care.

Purpose: Approximately 20% of hospitalized Medicare beneficiaries are discharged from the hospital to skilled nursing facilities (SNFs); and up to 23% of SNF patients return to the hospital within 30 days of hospital discharge, with pain as one of the most common symptoms precipitating hospital readmission. We sought to examine the prevalence of moderate to severe pain at hospital discharge to SNF, the incidence of new moderate to severe pain (relative to prehospitalization), and satisfaction with pain management among older acute care patients discharged to SNF.

Design And Methods: Structured patient interviews were conducted with 188 Medicare beneficiaries discharged to 23 area SNFs from an academic medical center.

Overcoming barriers to cancer-helpline professionals providing decision support for callers: an implementation study.

Purpose/objectives: To evaluate the effect of an intervention on healthcare professionals' perceptions of barriers influencing their provision of decision support for callers facing cancer-related decisions.

Design: A pre- and post-test study guided by the Ottawa Model of Research Use.

Setting: Australian statewide cancer call center that provides public access to information and supportive cancer services.

Health preferences and decision-making needs of disadvantaged women.

Aim: This paper reports the results of a survey of disadvantaged women in La Pintana, a municipality of Santiago, Chile, to determine their health decision-making needs.

Background: Research is needed as there is no published community-based study focusing specifically on health decision-making needs of disadvantaged women.

Methods: From April to November 1999, we conducted a cross-sectional interview survey of women registered at primary healthcare centres in La Pintana, an impoverished municipality of Santiago, Chile.

Reduction of inequalities in health: assessing evidence-based tools.

Background: The reduction of health inequalities is a focus of many national and international health organisations. The need for pragmatic evidence-based approaches has led to the development of a number of evidence-based equity initiatives. This paper describes a new program that focuses upon evidence- based tools, which are useful for policy initiatives that reduce inequities.

Understanding and overcoming the barriers of implementing patient decision aids in clinical practice.

Patient decision aids (ptDAs) have been developed to assist patients with difficult health-related decisions. Despite their proven effects on decision quality in numerous efficacy trials, we lack an evidence-based approach for implementing them as part of the process of care. Pragmatic trials of ptDAs have uncovered a myriad of implementation challenges; therefore we need a better understanding of the barriers and strategies to overcome them to facilitate their widespread uptake.

Decision support: helping patients and families to find a balance at the end of life.

Terminally ill patients and their families face many decisions at the end of life that can sometimes be overwhelming. Nurses play a key role in providing decision support so that patients and their families can make timely decisions about their health care that reflect their individual needs and circumstances. The Ottawa Decision Support Framework can help nurses to assess patients' decision-making needs, provide tailored decision support and evaluate the effect of their interventions.

Factors associated with the difference in score between women's and doctors' decisional conflict about hormone therapy: a multilevel regression analysis.

Objective: To explore factors associated with the difference in score between women's and doctors' decisional conflict about hormone therapy (HT).

Design: Secondary analysis.

Setting And Participants: family doctors were randomized to prepare women for counselling about HT using either a decision aid or a pamphlet.

Validation of a tool to assess health practitioners' decision support and communication skills.

As patients become more involved in decisions affecting their health, it is important to monitor and improve the support clinicians provide to facilitate shared decision making. The Decision Support Analysis Tool (DSAT) was developed as a research tool to evaluate practitioners' use of decision support and related communication skills during a clinical encounter. The DSAT, consisting of six categories of decision support skills and four categories of communication skills, was tested with 34 actual transcripts of patient-physician dialogue.

The effect of decision aids on the agreement between women's and physicians' decisional conflict about hormone replacement therapy.

The aim of this secondary analysis was to compare the effects of a tailored decision aid (DA) with those of a pamphlet on the agreement between women's and physicians' decisional conflict about hormone replacement therapy (HRT). A total of 40 physicians and 184 women provided data. The agreement between women's and physicians' decisional conflict scores was measured using the intraclass correlation coefficient (ICC).

An evidence-based approach to managing women's decisional conflict.

Women who face difficult health decisions are likely to experience decisional conflict. To date, women have been supported in their decision making through informal counseling and client education. The Ottawa Decision Support Framework guides practitioners in assessing decision-making needs in clinical practice, providing support for client decision making, and evaluating the effectiveness of their interventions.

Development and pilot testing of a decision aid for postmenopausal women with osteoporosis.

This study's aim was to develop and pilot test an evidence-based decision aid for postmenopausal women with osteoporosis who are considering options to prevent fractures. The aid was based on the Ottawa Decision Support Framework, and integrated evidence from our Cochrane systematic reviews. Following development by a panel of experts in osteoporosis and decision making, a user review panel of practitioners and women who had already made their decision about osteoporosis therapy reviewed the decision aid for acceptability.