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  1. Article ; Online: History of Health Policy: Explaining Complexity through Time.

    Keirns, Carla

    Journal of the history of medicine and allied sciences

    2023  Volume 78, Issue 1, Page(s) 34–45

    Abstract: History can be a powerful tool for teaching health policy. Particularly in the United States, with its complex system of public and private payers and providers of health services, understanding the historical origins of policies, programs, and ... ...

    Abstract History can be a powerful tool for teaching health policy. Particularly in the United States, with its complex system of public and private payers and providers of health services, understanding the historical origins of policies, programs, and institutions makes the system's contours legible. Historical analysis may also help health care providers to navigate this system and to advocate for changes within it. The US Medical Licensing Examination (USMLE) and the Accreditation Council on Graduate Medical Education (ACGME) have curricular standards for students to understand specific aspects of health policy and "systems-based practice," and historians working within the curricular structures of US medical education may find reference to these standards useful in explaining and justifying their role in preparing medical students and resident physicians for practice. This paper explores some examples of how to use history to teach health professions students about the historical development of the US health care system, the constraints that defined how it came to be, and possibilities for reform.
    MeSH term(s) Humans ; United States ; Education, Medical, Graduate ; Education, Medical ; Accreditation ; Health Policy ; Health Personnel
    Language English
    Publishing date 2023-02-03
    Publishing country England
    Document type Journal Article
    ZDB-ID 80280-3
    ISSN 1468-4373 ; 0022-5045
    ISSN (online) 1468-4373
    ISSN 0022-5045
    DOI 10.1093/jhmas/jrac048
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Child Developmental Delays and Disorders: Autism Spectrum Disorder.

    Keirns, Carla C

    FP essentials

    2021  Volume 510, Page(s) 28–34

    Abstract: The understanding of autism spectrum disorder (ASD) has changed over the past generation, with recognition of a broader spectrum of severity and a wide diversity of clinical manifestations and co-occurring conditions. Estimates of ASD prevalence in the ... ...

    Abstract The understanding of autism spectrum disorder (ASD) has changed over the past generation, with recognition of a broader spectrum of severity and a wide diversity of clinical manifestations and co-occurring conditions. Estimates of ASD prevalence in the United States have increased from 2 to 4 per 10,000 in the 1960s to 1 in 54 today. Early screening and diagnosis followed by intensive speech and behavioral therapies can make a substantial difference in outcomes for children with ASD.
    MeSH term(s) Autism Spectrum Disorder/diagnosis ; Autism Spectrum Disorder/epidemiology ; Autism Spectrum Disorder/therapy ; Child ; Developmental Disabilities/diagnosis ; Developmental Disabilities/epidemiology ; Humans ; Population Surveillance ; Prevalence ; United States
    Language English
    Publishing date 2021-10-28
    Publishing country United States
    Document type Journal Article
    ISSN 2159-3000
    ISSN 2159-3000
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  3. Article ; Online: A Mother In Wonderland: Securing Services For My Blind Child.

    Keirns, Carla

    Health affairs (Project Hope)

    2020  Volume 39, Issue 10, Page(s) 1832–1836

    Abstract: A parent navigates complex education policy to secure services and supports for her blind child. ...

    Abstract A parent navigates complex education policy to secure services and supports for her blind child.
    MeSH term(s) Child ; Female ; Humans ; Mothers ; Parents
    Language English
    Publishing date 2020-10-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 632712-6
    ISSN 1544-5208 ; 0278-2715
    ISSN (online) 1544-5208
    ISSN 0278-2715
    DOI 10.1377/hlthaff.2020.00140
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  4. Article ; Online: Illusions of Certainty.

    Keirns, Carla C

    Narrative inquiry in bioethics

    2015  Volume 5, Issue 3, Page(s) 210–212

    MeSH term(s) Albinism, Ocular/diagnosis ; Albinism, Ocular/genetics ; Genetic Testing/ethics ; Humans ; Infant ; Male ; Sequence Analysis, DNA ; Uncertainty
    Language English
    Publishing date 2015
    Publishing country United States
    Document type Journal Article ; Personal Narratives
    ZDB-ID 2632728-4
    ISSN 2157-1740 ; 2157-1732
    ISSN (online) 2157-1740
    ISSN 2157-1732
    DOI 10.1353/nib.2015.0079
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  5. Article ; Online: Everyday ethics and Ebola: planning for the unlikely.

    Keirns, Carla C

    The American journal of bioethics : AJOB

    2015  Volume 15, Issue 4, Page(s) 68–70

    MeSH term(s) Analgesics, Opioid/administration & dosage ; Analgesics, Opioid/adverse effects ; Attitude of Health Personnel ; Clinical Trials as Topic/ethics ; Clinical Trials as Topic/methods ; Communication ; Compassionate Use Trials/ethics ; Diagnostic Errors ; Disease Outbreaks ; Hemorrhagic Fever, Ebola/diagnosis ; Hemorrhagic Fever, Ebola/epidemiology ; Hemorrhagic Fever, Ebola/therapy ; Humans ; International Cooperation ; Male ; Multiple Organ Failure/therapy ; Patient Care Team ; Quality of Health Care/ethics ; Research Design ; Resource Allocation/ethics ; Shame ; Therapeutic Human Experimentation/ethics
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2015
    Publishing country United States
    Document type Comment ; Journal Article
    ZDB-ID 2060433-6
    ISSN 1536-0075 ; 1526-5161
    ISSN (online) 1536-0075
    ISSN 1526-5161
    DOI 10.1080/15265161.2015.1010020
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  6. Article ; Online: Watching the clock: a mother's hope for a natural birth in a cesarean culture.

    Keirns, Carla

    Health affairs (Project Hope)

    2015  Volume 34, Issue 1, Page(s) 178–182

    Abstract: A physician and mother on giving birth in a culture that increasingly pushes women toward cesarean sections. ...

    Abstract A physician and mother on giving birth in a culture that increasingly pushes women toward cesarean sections.
    MeSH term(s) Adult ; Attitude of Health Personnel ; Cesarean Section/psychology ; Cesarean Section/utilization ; Choice Behavior ; Decision Making ; Female ; Hope ; Humans ; Infant, Newborn ; Labor, Induced/psychology ; Male ; Mothers/psychology ; Natural Childbirth/psychology ; Natural Childbirth/utilization ; Physician-Patient Relations ; Pregnancy ; Quality of Health Care ; Unnecessary Procedures/statistics & numerical data ; Unnecessary Procedures/trends ; Utilization Review/statistics & numerical data
    Language English
    Publishing date 2015-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 632712-6
    ISSN 1544-5208 ; 0278-2715
    ISSN (online) 1544-5208
    ISSN 0278-2715
    DOI 10.1377/hlthaff.2014.0563
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  7. Article ; Online: July first.

    Keirns, Carla C

    Academic medicine : journal of the Association of American Medical Colleges

    2011  Volume 86, Issue 10, Page(s) 1317

    MeSH term(s) Cardiology/education ; Clinical Competence ; Humans ; Internship and Residency
    Language English
    Publishing date 2011-10
    Publishing country United States
    Document type Journal Article
    ZDB-ID 96192-9
    ISSN 1938-808X ; 1040-2446
    ISSN (online) 1938-808X
    ISSN 1040-2446
    DOI 10.1097/ACM.0b013e31822bbfcf
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    Zs.A 112: Show issues Location:
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  8. Article ; Online: Dying of a treatable disease.

    Keirns, Carla C

    Health affairs (Project Hope)

    2009  Volume 28, Issue 6, Page(s) 1807–1813

    MeSH term(s) Botswana ; Cross-Cultural Comparison ; Female ; HIV Infections/therapy ; Health Care Rationing ; Humans ; Male ; Medical Futility ; Social Justice ; United States
    Language English
    Publishing date 2009-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 632712-6
    ISSN 1544-5208 ; 0278-2715
    ISSN (online) 1544-5208
    ISSN 0278-2715
    DOI 10.1377/hlthaff.28.6.1807
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  9. Article ; Online: Palliative Care's Role Managing Cancer Pain During the Opioid Crisis: A Qualitative Study of Patients, Caregivers, and Clinicians.

    Brooks, Joanna Veazey / Poague, Claire / Formagini, Taynara / Roberts, Andrew W / Sinclair, Christian T / Keirns, Carla C

    Journal of pain and symptom management

    2020  Volume 60, Issue 6, Page(s) 1127–1135.e2

    Abstract: Context: Patients with cancer face symptoms because of disease and treatment, and pain is common and complex. The opioid crisis may complicate patients' and clinicians' experiences of managing pain in cancer care.: Objectives: In our study of ... ...

    Abstract Context: Patients with cancer face symptoms because of disease and treatment, and pain is common and complex. The opioid crisis may complicate patients' and clinicians' experiences of managing pain in cancer care.
    Objectives: In our study of perceptions and experiences with palliative care (PC) at an outpatient cancer center, we examined communication around symptom management throughout cancer care, and pain and its management emerged as particularly salient. The objective of this article is to describe, from the perspectives of patients, caregivers, and oncology health care professionals, the role of PC in navigating the complicated dynamics of pain management amidst the opioid crisis.
    Methods: A qualitative descriptive study with grounded theory components was designed to investigate experiences with and perceptions of specialist PC and symptom management, including pain. Interviews were audiorecorded and transcribed, and focused coding identified themes related to pain and pain management from all three perspectives.
    Results: About 44 patients, caregivers, and non-PC health care professionals completed interviews. Patients with cancer and their caregivers had many concerns about pain management and were specifically concerned about opioid use and stigma. For patients, PC improved pain management and helped to destigmatize appropriate pain management. Oncology clinicians reported that partnering with PC facilitated complex pain management and also provided moral support around difficult opioid recommendations for patients.
    Conclusion: PC offers the potential to uniquely support both patients and other oncology professionals in optimally navigating the complexity around pain management for cancer care in the midst of the opioid crisis.
    MeSH term(s) Cancer Pain/drug therapy ; Caregivers ; Humans ; Neoplasms/complications ; Neoplasms/therapy ; Opioid Epidemic ; Pain Management ; Palliative Care ; Qualitative Research
    Language English
    Publishing date 2020-07-06
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 639142-4
    ISSN 1873-6513 ; 0885-3924
    ISSN (online) 1873-6513
    ISSN 0885-3924
    DOI 10.1016/j.jpainsymman.2020.06.039
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  10. Article ; Online: Asthma mitigation strategies: professional, charitable, and community coalitions.

    Keirns, Carla C

    American journal of preventive medicine

    2009  Volume 37, Issue 6 Suppl 1, Page(s) S244–50

    Abstract: Background: Asthma symptoms, severity, and mortality are known to be affected by personal, family, and neighborhood social factors. Many groups have become involved in asthma research, education, and activism in the past 20 years. This study explores ... ...

    Abstract Background: Asthma symptoms, severity, and mortality are known to be affected by personal, family, and neighborhood social factors. Many groups have become involved in asthma research, education, and activism in the past 20 years. This study explores the approaches to asthma taken by community-based organizations compared with those taken by other organizations that have a focus on asthma.
    Methods: Priorities in asthma research and intervention were assessed through interviews with representatives of urban community-based participatory research (CBPR) coalitions; interviews with staff from charities focused on asthma, allergy, or lung diseases; interviews with physicians and scientists studying and treating asthma; participation in community forums; and participant observation of urban asthma coalitions. Interviews and data analysis were conducted in 2008.
    Results: There are marked differences in priorities and approaches to asthma among experts in the field, organizations and coalitions at the national and local levels, and other stakeholders in asthma research and activism. CBPR coalitions are more likely than asthma-focused organizations to explore environmental and community-level structural factors that exacerbate asthma or complicate its management, while disease-focused organizations, especially physician specialty groups, place more emphasis on individual-level factors. CBPR coalitions have been particularly strong in producing the data needed to demonstrate that individual communities are affected by pollution hot spots or that local neighborhoods lack geographic access to affordable medical care, and in providing this data to improve local policy-making.
    Conclusions: Because of its focus on structural rather than individual factors, CBPR has helped to broaden the debate on asthma beyond clinical care and education into social and environmental justice.
    MeSH term(s) Asthma/mortality ; Asthma/physiopathology ; Asthma/therapy ; Community-Based Participatory Research/organization & administration ; Data Collection ; Family ; Health Policy ; Health Services Accessibility ; Humans ; Policy Making ; Residence Characteristics ; Severity of Illness Index ; Social Justice ; Urban Population
    Language English
    Publishing date 2009-12
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 632646-8
    ISSN 1873-2607 ; 0749-3797
    ISSN (online) 1873-2607
    ISSN 0749-3797
    DOI 10.1016/j.amepre.2009.08.004
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