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A multi-pronged approach to health policy and programs related to open defecation (OD) is proposed via a qualitative study conducted in rural India. A dialogic and dialectic perspective is employed to interpret the key findings from nine focus groups, highlighting the dialectical views toward OD and latrines. Findings indicate that current policy may be too narrow as it does not fully deal with the multiple reasons, including social communication as well as gender, cultural, health and work identity issues, for OD. The results suggest that OD is more complicated than it appears and a multi-pronged, poly-vocal approach to health communication campaigns and policy should be considered. [ABSTRACT FROM AUTHOR]

Open defecation persists as a global health problem despite efforts to build and implement better toilets. Based on nine focus group meetings held across two communities in rural Uttar Pradesh, India, this study shows that open defecation is a symbolic practice contributing to social and cultural identity formation. Major themes were derived regarding the positives and negatives of open defecation and latrine use. Open defecation was considered as a means for social communication, particularly for girls and women, and not necessarily as a healthier practice. Issues of politics and class relations emerged, with lower caste people expressing the lack of or poor quality toilets. Yet the persistence of historical and cultural identity played a part in people's preference to go out to the field to defecate, especially for women to sustain their social connectedness and men to sustain their masculine identity. These cultural and communication aspects of open defecation should be considered in ongoing sanitation movements. [ABSTRACT FROM AUTHOR]

After reviewing empathy, narrative, and narrative empathy, the three concepts are combined to create a communication theory-Extended Narrative Empathy ( ENE). The theory supports expanding perspectives via the collection of a rich array of narratives that are not always in agreement (poly-narratives). Empathy is required in order to see similar stories, peripheral stories, contentious stories, and antagonists as protagonists (via protagonist inversion) and overlapping of narratives as crucial to understanding complicated issues. The theory is discussed in light of open defecation in rural India. [ABSTRACT FROM AUTHOR]

In 2008, Kaiser Permanente Northwest identified the transition from hospital to home as a pivotal quality improvement opportunity and used multiple patient-centered data collection methods to identify unmet needs contributing to preventable readmissions. A transitional care bundle that crosses care settings and organizational functions was developed to meet needs expressed by patients. It comprises 5 elements: risk stratification, a specialized phone number for discharged patients, timely postdischarge follow-up, standardized patient discharge instructions and same-day discharge summaries, and pharmacist-supported medication reconciliation. The transitional care bundle has been in place for 6 years. Readmission rates decreased from 12.1% to 10.6%, Hospital Consumer Assessment of Healthcare Providers and Systems scores for the discharge instruction composite moved from below the 50th to above the 90th national percentile, average time to the first postdischarge appointment decreased from 9.7 days to 5.3 days, and error rates on the discharge medication list decreased from 57% to 21% ( P<.0001 for all). The program, which continues to evolve to address sustainability challenges and organizational initiatives, suggests the potential of a multicomponent, patient-centered care bundle to address the complex, interrelated drivers of preventable readmissions. ( Population Health Management 2016;19:56-62) [ABSTRACT FROM AUTHOR]

The elderly population is projected to make up 20% of the total United States population by the year 2030. In addition, epidemiological data suggests increasing prevalence of chronic pain and frailty with advancing age. Pain, being a subjective symptom, is challenging to manage effectively. This is more so in elderly populations with age-specific physiological changes that affect drug action and metabolism. Elderly patients are also more likely to have multiple chronic health pathologies, declining function, and frailty. The barriers present for patients, providers, and health systems also negatively impact efficient and effective pain control. These factors result in disproportionate utilization of health resources by the older population group. The scientific literature is lagging behind in age-specific studies for the elderly population. As a result, there is a lack of age-specific standardized management guidelines for various health problems, including chronic pain. Increasing efforts are now being directed to studies on pain control in the elderly. However, pain management remains inconsistent and suboptimal. This article is an attempt to suggest an informed, comprehensive guide to achieve effective pain control in the presence of these limitations. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To assess the feasibility of scaling advanced care at home (ACAH) (otherwise known as hospital at home) within an integrated health care delivery system. STUDY DESIGN: Retrospective cohort study of patients qualified for hospital-level care who were admitted to either ACAH or a traditional hospital. METHODS: From April 29, 2020, to November 14, 2021, patients requiring hospital-level care received Kaiser Permanente at Home or traditional hospital care. In a subgroup of patients, we compared outcomes for Kaiser Permanente at Home vs traditional hospital care using regression models. RESULTS: A total of 1005 patients were admitted to Kaiser Permanente at Home. Average daily census (ADC) was intentionally increased over time in stages, from 7.2 to 8.8, then to 12.7. The maximum daily census was 22, with a peak ADC of 16, representing 9% of the total hospital inpatient medicine service census. During this time, there were numeric decreases in Kaiser Permanente at Home escalation rates (17.5% to 10.8%), median length of stay (7.43 days to 5.46 days), and readmission rates (9.79% to 9.24%). A subgroup of Kaiser Permanente at Home patients contributed to the comparative analyses, which showed that patients admitted to Kaiser Permanente at Home were 64% less likely to experience delirium than patients admitted for traditional hospital care (OR, 0.36; 95% CI, 0.15-0.88; P = .026). Comparisons of quality metrics across stages of implementation (readmissions, escalations, length of stay) were inconclusive. CONCLUSION: In an integrated delivery system, ACAH care can be scaled and can create hospital capacity. However, our data were inconclusive regarding quality throughout scaling due to the small effective sample size, necessitating replication in a larger prospective study with adequate power/precision. [ABSTRACT FROM AUTHOR]