Tomah VA Medical Center

Palliative care improves quality of life for patients and families but may be underused. To assess the association of an intervention to increase social work staffing in Veterans Health Administration primary care teams with use of palliative care among veterans with a recent hospitalization. This cohort study used differences-in-differences analyses of the change in palliative care use associated with implementation of the Social Work Patient Aligned Care Team (PACT) staffing program, conducted from October 1, 2016, to September 30, 2019. The study included 71 VA primary care sites serving rural veterans. Participants were adult veterans who received primary care services from a site enrolled in the program and who received inpatient hospital care. Data were analyzed from January 2020 to August 2022. The PACT staffing program was a clinic-level intervention that provided 3-year seed funding to Veterans Health Administration medical centers to hire 1 or more additional social workers in primary care teams. Staggered timing of the intervention enabled comparison of mean outcomes across sites before and after the intervention. The primary outcome was the number of individuals per 1000 veterans who had any palliative care use in 30 days after an inpatient hospital stay. The analytic sample included 43 200 veterans (mean [SD] age, 65.34 [13.95] years; 37 259 [86.25%] men) and a total of 91 675 episodes of inpatient hospital care. Among the total cohort, 8611 veterans (9.39%) were Black, 77 069 veterans (84.07%) were White, and 2679 veterans (2.92%) were another race (including American Indian or Alaskan Native, Asian, and Native Hawaiian or other Pacific Islander). A mean of 14.5 individuals per 1000 veterans (1329 individuals in all) used palliative care after a hospital stay. After the intervention, there was an increase of 15.6 (95% CI, 9.2-22.3) individuals per 1000 veterans using palliative or hospice care after a hospital stay, controlling for national time trends and veteran characteristics-a 2-fold difference relative to the mean. This cohort study found significant increases in use of palliative care for recently hospitalized veterans whose primary care team had additional social work staffing. These findings suggest that social workers may increase access to and/or use of palliative care. Future work should assess the mechanism for this association and whether the increase in palliative care is associated with other health or health care outcomes.

Animal populations are regulated by the combined effects of top-down, bottom-up and abiotic processes. Ecologists have struggled to isolate these mechanisms because their effects on prey behaviour, nutrition, security and fitness are often interrelated. We monitored how forage, non-consumptive effects (NCEs), consumptive predation and climatic conditions influenced the demography and nutritional state of a wild prey population during predator recolonization. Combined measures of nutrition, survival and population growth reveal that predators imposed strong effects on the prey population through interacting non-consumptive and consumptive effects, and forage mechanisms. Predation was directly responsible for adult survival, while declining recruitment was attributed to predation risk-sensitive foraging, manifested in poor female nutrition and juvenile recruitment. Substituting nutritional state into the recruitment model through a shared term reveals that predation risk-sensitive foraging was nearly twice as influential as summer forage conditions. Our findings provide a novel, mechanistic insight into the complex means by which predators and forage conditions affect prey populations, and point to a need for more ecological studies that integrate behaviour, nutrition and demography. This line of inquiry can provide further insight into how NCEs interactively contribute to the dynamics of terrestrial prey populations; particularly, how predation risk-sensitive foraging has the potential to stabilize predator-prey coexistence.

Since the description of athetosis in 1871 by American neurologist William Alexander Hammond (1828-1900) the disorder has been a source of controversy, as were many aspects of Hammond's career. Primary sources have been used to review controversies in the 50-year period since the initial description of athetosis, in particular those concerning clinical features, differentiation from other movement disorders, associated conditions, and pathology. Controversies concerning treatment will be addressed in a subsequent article. Hammond struggled to establish athetosis as a distinct clinical-pathological entity, and had successfully predicted the striatal pathology in his initial case (albeit somewhat serendipitously). Athetosis was, nevertheless, considered by many neurologists to be a form of post-hemiplegic chorea or part of a continuum between chorea and dystonia. European neurologists, and particularly the French, initially ignored or discounted the concept. Additional controversies arose over whether the movements persisted during sleep, whether athetosis was, or could be, associated with imbecility or insanity, and how it should be treated. Some controversies concerning athetosis served to identify areas where knowledge was insufficient to make accurate statements, despite prior self-assured or even dogmatic statements to the contrary. Other controversies illustrated established prejudices, even if these biases were often only apparent with the greater detachment of hindsight.

Back to table of contents Previous article Next article ArticleNo AccessWhy Patients Do Not Take Their MedicationE. J. MARSHALLE. J. MARSHALLSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.128.5.656AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "Why Patients Do Not Take Their Medication." American Journal of Psychiatry, 128(5), p. 656 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited ByImpotence, Smoking, and β-Blocking DrugsFertility and Sterility, Vol. 31, No. 5Improper prescription instructions: A factor in patient compliancePatient Counselling and Health Education, Vol. 1, No. 3Patient Noncompliance**Presented, in part, before the Academy of Central Practice of Pharmacy at the APhA Annual Meeting in Chicago, Illinois, August 5, 1974.Journal of the American Pharmaceutical Association (1961), Vol. 15, No. 4 Volume 128Issue 5 November 1971Pages 656-656 Metrics PDF download History Published online 1 April 2006 Published in print 1 November 1971