Search

Background: Over the past 5 years, China has invested substantially in palliative care programs to meet the rising demand for such services. In China's mainland, most palliative care programs are embedded within an established hospital unit, but a small subset of providers practice exclusively in a stand-alone inpatient palliative care department. Objective: To explore the lived experience of professionals at an independently operating palliative care hospital department in China's mainland. Design: We used purposive sampling to select palliative care physicians and nurses. Semistructured in-depth interviews were conducted in person. Thematic analysis was used to elicit key themes that pertained to participants' lived experience. Setting/Subjects: Ten palliative care physicians and seven nurses at the palliative medicine department in the West China Fourth Hospital of Sichuan University in Chengdu, Sichuan Province, participated in the interviews. Results: Three themes related to participants' lived experience were (1) interactions with patients and families (e.g., frequent encounters with death, communication difficulties, witnessing family struggles, and developing mutually trusting relationships); (2) factors influencing their work life (e.g., supportive working environment, unmet training needs, policy restrictions, and lack of public awareness); and (3) perceived nature of work (e.g., complex and demanding, underappreciation, encroachment of work stress into personal life, deriving accomplishment from work, and personal growth). Conclusion: This study helps fill the void in the palliative care literature regarding the lived experience of inpatient palliative care professionals in China's mainland. Our findings revealed factors influencing the well-being of palliative care professionals that are meaningful to policymakers.

Background Complex Care for Kids Ontario (CCKO) is a multi-year strategy aimed at expanding a hub-and-spoke model to deliver coordinated care for children with medical complexity (CMC) across Ontario. Objective This paper aims to identify the facilitators, barriers and lessons learned from the implementation of the Ontario CCKO strategy. Method Alongside an outcome evaluation of the CCKO strategy, we conducted a process evaluation to understand the implementation context, process and mechanisms. Semi-structured interviews were conducted with 38 healthcare leaders, clinicians and support staff from four regions involved in CCKO care delivery and/or governance. Results Facilitators to CCKO implementation were sustained engagement of system-wide stakeholders, inter-organizational partnerships, knowledge sharing and family engagement. Barriers to CCKO implementation were resources and funding, fragmentation of care, aligning perspectives between providers and clinical staff recruitment and retention. Conclusion A flexible approach is required to implement a complex, multi-centre policy strategy. Other jurisdictions considering such a model of care delivery would benefit from attention to contextual variations in implementation setting, building cross-sector engagement and buy-in, and offering continuous support for modifications to the intervention as and when required.

Introduction: A provincial strategy to expand care coordination and integration of care for children with medical complexity (CMC) was launched in Ontario, Canada in 2015. A process evaluation of the roll-out examined the processes, mechanisms of impact, and contextual factors affecting the implementation of the Complex Care for Kids Ontario (CCKO) intervention strategy.Methods: This process evaluation was conducted and analyzed according to the United Kingdom Medical Research Council (UK-MRC) process evaluation framework. To evaluate the implementation of the CCKO intervention, a multi-method study design was used, including semi-structured interviews with 38 key informants and 10 families of CMC involved in CCKO. To further understand implementation details across regional sites, provincial-level implementation plans, and process documents were reviewed.Discussion: Strengths of CCKO included novel collaborations and partnerships between complex care teams, community partners and regional sites. Issues relating to communication and coordination across care sectors created challenges to holistic care coordination objectives. Provincial system fragmentation limited the ability of CCKO to provide seamless care coordination due to the multiple care sectors involved.Conclusion: This study adds to the understanding of the processes involved in a population-level care coordination intervention for CMC. Lessons learned through CCKO can help facilitate reproducibility and necessary adjustments of the intervention in different settings.

Weight change from childhood to adolescence has been understudied in Asian Americans. Known studies lack disaggregation by Asian subgroups. This retrospective study assessed the weight status change in 1500 Chinese American children aged 5–11 years from an urban primary care health center between 2007 and 2017. Weight status was categorized using the 2000 CDC growth charts into “underweight/normal weight” and “overweight/obese.” The overweight/obesity prevalence in 2007 and 2017 were determined. McNemar’s test and logistic regression were performed. The prevalence of overweight/obesity decreased from 29.9% in 2007 to 18.6% in 2017. Children who were overweight/obese at 5–11 years had 10.3 increased odds of staying overweight/obese over time (95% CI = 7.6–14.0, p < 0.001) compared to their underweight/normal weight counterparts. Of the children who were overweight/obese in 2007, 45.7% remained overweight/obese ten years later. Childhood overweight/obesity strongly predicts adult overweight/obesity in Chinese Americans. Targeted education and intervention are warranted to prevent adult obesity.

This study explored Asian American youth experiences in peer-led youth development programming delivered at a federally qualified community health center. We used a qualitative approach to examine narrative data from in-depth interviews with 18 study participants. Our analysis involved data immersion, coding, thematic sorting of coded excerpts, and comparisons of themes across interviews. Several features identified by participants as being important to positive experiences were consistent with key features of positive youth development programs described in existing literature. These included: 1) an abundance of opportunities for skill development and active participation, 2) an atmosphere promulgating positive social norms, 3) a safe space for youth to explore deeply personal issues, 4) an inclusive environment, and 5) a supportive organizational culture and program staff. Participants perceived positive development across individual, peer, family, school, and community contexts of their lives, and reported various aspects of growth in identity development, interpersonal relationships, practical life skills, healthy behaviors, career choice, and civic engagement. This study contributes to the knowledge about aspects of youth development programs that are successful in engaging and supporting Asian American youth.

IntroductionTechnological and medical advances have led to a growing population of children with medical complexity (CMC) defined by substantial medical needs, healthcare utilisation and morbidity. These children are at a high risk of missed, fragmented and/or inappropriate care, and families bear extraordinary financial burden and stress. While small in number (Methods and analysisOur primary objective is to evaluate the CCKO intervention using a randomised waitlist control design. The waitlist approach involves rolling out an intervention over time, whereby all participants are randomised into two groups (A and B) to receive the intervention at different time points determined at random. Baseline measurements are collected at month 0, and groups A and B are compared at months 6 and 12. The primary outcome is the family-prioritized Family Experiences with Coordination of Care (FECC) survey at 12 months. The FECC will be compared between groups using an analysis of covariance with the corresponding baseline score as the covariate. Secondary outcomes include reports of child and parent health outcomes, health system utilisation and process outcomes.Ethics and disseminationResearch ethics approval has been obtained for this multicentre RCT. This trial will assess the effect of a large population-level complex care intervention to determine whether dedicated key workers and coordinated care plans have an impact on improving service delivery and quality of life for CMC and their families.Trial registration numberNCT02928757.

Biodegradable plastics are thought to be the possible directions in managing plastic pollutions. Unfortunately, they are not recycled in most countries since they are designed to decompose even though recycling is a more pragmatic method than landfill or incineration. Thus, it is more constructive to develop methods to recycle biodegradable plastics or to develop biodegradable yet recyclable plastics. In this study, we used cutlery with a composite of poly(lactic acid) (PLA) and talc. The possibility to recycle it to make foams was studied even though it will have lowered mechanical strength from the recycling process as it is less significant for this product. Tensile properties of solid PLA and foams showed no significant decrease in the strength up to three processes of compression molding and foaming. We performed shear rheometry to determine the thermal stability and dependences of the complex viscosity on frequency and temperature. The magnitude of the complex viscosity dramatically increased with decreasing frequency and such an upturn increased with temperature, but time-temperature superposition was valid at high temperatures. The extensional rheometry showed no strain hardening, but physical foaming using supercritical carbon dioxide (CO2) could still occur, and the operating conditions to obtain various foamed structures were determined. We also compared the effects of one-directional against three-dimensional expansion. Overall, the concentration of CO2 in PLA and crystallinity of the foams are the two key variables to describe the bulkiness of foams. Surprisingly, the lower the CO2 concentration, the bulkier the foams at any sorption temperature and pressure.

Children with medical complexity (CMC) in rural and northern communities have more difficulty accessing subspecialty health providers than those in urban centres. This article describes an alignment cascade in which leaders engaged peers and staff to rapidly roll out the implementation of a sustainably designed complex care model, integrated in the Champlain Complex Care Program and delivered in Timmins, Ontario. The Provincial Council for Maternal and Child Health's Complex Care for Kids Ontario (CCKO) strategy supports the implementation and expansion of a hub-and-spoke model of interprofessional complex care for CMC and their families. A nurse practitioner is the primary point of contact for the family and oversees coordination and integration of care; regional CCKO programs are committed to building capacity to provide safe, high-quality care for CMC in communities closer to their homes.

Brain and behavior 6(4), 1-14 (2016). doi:10.1002/brb3.451, Published by Wiley, Malden, Mass.