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The article discusses the challenges involved in prognosis and end-of-life care. It states that misunderstanding one's prognosis add to bad decision making. An expert panel used a question prompt list to study this. Patients with advanced cancer and health professionals participated. Analysis identified themes including reinforcement of known benefits of question prompt list, appraisal of content and suggestions for further development, and contrast feedbacks in Australian and U. S. patients.

Background: Previous studies have demonstrated gaps in achievement of low-density lipoprotein-cholesterol (LDL-C) goals among U.S. individuals at high cardiovascular disease risk; however, recent studies in selected populations indicate improvements. Objective: We sought to define the longitudinal trends in achieving LDL-C goals among high-risk United States adults from 1999–2008. Methods We analyzed five sequential population-based cross-sectional National Health and Nutrition Examination Surveys 1999–2008, which included 18,656 participants aged 20–79 years. We calculated rates of LDL-C goal achievement and treatment in the high-risk population. Results: The prevalence of high-risk individuals increased from 13% to 15.5% (p = 0.046). Achievement of LDL-C <100 mg/dL increased from 24% to 50.4% (p<0.0001) in the high-risk population with similar findings in subgroups with (27% to 64.8% p<0.0001) and without (21.8% to 43.7%, p<0.0001) coronary heart disease (CHD). Achievement of LDL-C <70 mg/dL improved from 2.4% to 17% (p<0.0001) in high-risk individuals and subgroups with (3.4% to 21.4%, p<0.0001) and without (1.7% to 14.9%, p<0.0001) CHD. The proportion with LDL-C ≥130 mg/dL and not on lipid medications decreased from 29.4% to 18% (p = 0.0002), with similar findings among CHD (25% to 11.9% p = 0.0013) and non-CHD (35.8% to 20.8% p<0.0001) subgroups. Conclusion: The proportions of the U.S. high-risk population achieving LDL-C <100 mg/dL and <70 mg/dL increased over the last decade. With 65% of the CHD subpopulation achieving an LDL-C <100 mg/dL in the most recent survey, U.S. LDL-C goal achievement exceeds previous reports and approximates rates achieved in highly selected patient cohorts. [ABSTRACT FROM AUTHOR]

Background: The Reynolds Risk Score (RRS) is one alternative to the Framingham Risk Score (FRS) for cardiovascular risk assessment. The Adult Treatment Panel III (ATP III) integrated the FRS a decade ago, but with the anticipated release of ATP IV, it remains uncertain how and which risk models will be integrated into the recommendations. We sought to define the effects in the United States population of a transition from the FRS to the RRS for cardiovascular risk assessment. Methods: Using the National Health and Nutrition Examination Surveys, we assessed FRS and RRS in 2,502 subjects representing approximately 53.6 Million (M) men (ages 50-79) and women (ages 45-79), without cardiovascular disease or diabetes. We calculated the proportion reclassified by RRS and the subset whose LDL-C goal achievement changed. Results: Compared to FRS, the RRS assigns a higher risk category to 13.9% of women and 9.1% of men while assigning a lower risk to 35.7% of men and 2% of women. Overall, 4.7% of women and 1.1% of men fail to meet newly intensified LDLC goals using the RRS. Conversely, 10.5% of men and 0.6% of women now meet LDL-C goal using RRS when they had not by FRS. Conclusion: In the U.S. population the RRS assigns a new risk category for one in six women and four of nine men. In general, women increase while men decrease risk. In conclusion, adopting the RRS for the 53.6 million eligible U.S. adults would result in intensification of clinical management in 1.6 M additional women and 2.10 M fewer men. [ABSTRACT FROM AUTHOR]

Background: The Framingham Global Cardiovascular Disease (FRS-CVD) risk assessment is a proposed alternative for the assessment of hard coronary heart disease (FRS-CHD) event risk. Beyond heart attack and death, FRS-CVD risk adds the end points of cerebrovascular disease, angina, heart failure, and peripheral vascular disease. Objective: We sought to estimate the population impact of using FRS-CVD instead of FRS-CHD risk prediction on U.S. adults. Methods: We analyzed FRS-CHD and FRS-CVD risk in men age 45–74 and women age 55–74 without cardiovascular disease or diabetes, using the National Health and Nutrition Examination Survey 2005–2006. We stratified the population into 10-year risk categories: low: <6%, moderate ≥6 to <10%, moderate high ≥10 to <20%, and high ≥20% by both risk models, and assessed change in risk category distribution and achievement of lipid goals. Results: We analyzed 1020 subjects who statistically represent approximately 50 million U.S. adults. When the FRS-CVD was used, we found that 63% of men and 74% of women increase at least one risk category compared with when the FRS-CHD is used. Overall, the low-risk population decreases from 52% to 16% and the high-risk group increases from 4% to 20%. Of the subjects changing risk categories, 30% will now fail to meet their new corresponding lipid goals. Conclusions: FRS-CVD end points are more comprehensive, yet the population implications of such a change may be profound. The use of a FRS-CVD risk model significantly increases the intermediate and high-risk groups, thus increasing the number of individuals eligible for novel risk assessment tools such as high-sensitivity C-reactive protein, coronary calcium scoring, and more frequent use of pharmacotherapy. [ABSTRACT FROM AUTHOR]

The article reports on a study which examined the adequacy of policies at 20 medical schools in Australia regarding disclosure and management of conflict of interest with the pharmaceutical industry. Researchers used the American Medical Student Association's PharmFree Scorecard for the national survey and compared the Australian medical schools' policies with those of U.S. medical schools. They concluded that improved self-regulation of conflicts of interest in Australian medical schools is still required.

Big data, like MOOCs, altmetrics and open access, is a term that has been commonplace in the library community for some time yet, despite its prevalence, many in the library and information sector remain unsure of the relationship between big data and their roles. This editorial explores what big data could mean for the day-to-day practice of health library and information workers, presenting examples of big data in action, considering the ethics of accessing big data sets and the potential for new roles for library and information workers. [ABSTRACT FROM AUTHOR]

Purpose — Union-community collaboration is an increasingly common practice in industrialised nations where union power and density have declined. This paper proposes a framework for defining and evaluating community unionism, through a definition of the term "community." Design/methodology/approach — The author explores this framework drawing on campaigns in Sydney and Chicago. Findings — It defines the term community in three discrete but mutually reinforcing ways, as (community) organisation; common interest identity, and local neighbourhood or place. The term is used to then define community unionism as three discrete union strategies, and finally to examine one type of community unionism — coalition unionism. Successful coalition practice is defined by partner organisational relationships (coalition structure, bridge brokers, and coalition offices); common concern (common interest operates as mutual direct interest of organisation and members), and the element of scale (where success increases as coalitions operate at multiple scales such as the local, as well as the scale of government and/or business decision makers). Originality/value — The paper identifies three elements of coalition unionism. [ABSTRACT FROM AUTHOR]

This article presents and explores a theoretical framework of common features across labor-community coalitions. While researchers in both the U.S. and Australia have written about labor-community coalitions, most of their work has focused on profiling “best practices” rather than building a framework for understanding coalition and such work in general. This article argues that all coalitions are defined by four common elements: the nature of common concern, the structure of organizational relationships, organizational capacity and commitment, and the scale of coalition activity. It then uses these elements to identify four different ideal types of coalitions, varying from ad hoc coalitions, to simple coalitions, to mutual interest coalitions to deep coalitions. The article illustrates the usefulness of this framework by using it to examine sample coalition experiences in the U.S. and Australia. The Australian case displays variation in coalition type within a single ongoing campaign around public education. By contrast, eight samples of U.S. living wage efforts demonstrate variation in coalition type among different campaigns. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To explore patients’ perspectives across two cultures (Australia and USA) regarding communication about prognosis and end-of-life care issues and to consider the ways in which these discussions can be optimised. Methods: Fifteen Australian and 11 US patients completed individual semi-structured qualitative interviews. A further 8 US patients participated in a focus group. Interviews and focus group recordings were transcribed verbatim and interpreted using thematic text analysis with an inductive, data-driven approach. Results: Global themes identified included readiness for and outcomes of discussions of prognosis and end-of-life issues. Contributing to readiness were sub themes including patients’ adjustment to and acceptance of their condition (together with seven factors promoting this), doctor and patient communication skills, mutual understandings and therapeutic relationship elements. Outcomes included sub themes of achievement of control and ability to move on. A model of the relationships between these factors, emergent cross cultural differences, and how factors may help to optimise these discussions are presented. Conclusion: Identified optimising factors illustrate Australian and US patients’ perspectives regarding how prognosis and end-of-life issues can be discussed with minimised negative impact. Practice implications: Recognition of factors promoting adjustment, acceptance and readiness and use of the communication skills and therapeutic relationship elements identified may assist in optimising discussions and help patients plan care, achieve more control of their situation and enjoy an optimal quality-of-life. [Copyright &y& Elsevier]