The assessment of objective measurement of cardiopulmonary status has helped us achieve better clinical outcomes for patients and develop new therapies through to the point of market access; however, patient surveys indicate that more can be done to improve holistic care and patient engagement. In this multidisciplinary review, we examine how clinical teams can acknowledge and embrace the individual patient's perspective, and thus improve the care for individual patients suffering from pulmonary hypertension by cultivating the importance and relevance of health-related quality of life in direct clinical care. At the individual level, patients should be provided with access to accredited specialist centres which provide a multidisciplinary approach where there is a culture focused on narrative medicine, quality of life, shared decision making and timely access to palliative care, and where there is participation in education. On a larger scale, we call for the development, expansion and promotion of patient associations to support patients and carers, lobby for access to best care and treatments, and provide input into the development of clinical trials and registries, focusing on the patients’ perspective.

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Purpose-To determine the prevalence of follow-up and factors associated with completing an eye exam after a glaucoma public service announcement. Design-Cross-sectional observational studyParticipants-Individuals who participated in the Glaucoma EyeCare Program by calling a tollfree telephone number and receiving referral by meeting inclusion criteria. Methods-TheGlaucoma EyeCare Program uses public service announcements to encourage those at increased risk for glaucoma to obtain an eye exam. The program requires interested persons to dial a toll-free telephone number to collect demographic, medical, and socioeconomic information, and refers those at higher risk of glaucoma to an ophthalmologist for a free eye exam. The ophthalmologist completes an outcome form, which indicates whether the participant obtained an eye exam, and the results of this eye exam. We determined the factors associated with obtaining an eye exam. Main Outcome Measures-Sociodemographic characteristics associated with obtaining an eye exam after referral through the Glaucoma EyeCare ProgramResults-Ophthalmologists returned outcome forms for 24% (1514/6343) of participants. Of those with outcome forms, 671 (44.3%) had an eye exam, 756 (49.9%) did not make an appointment, and 87 (5.7%) made an appointment but did not complete the exam. A multivariate logistic regression model showed younger age, female gender, lack of health insurance, medical history of diabetes, and shorter distance to be associated with obtaining an eye exam. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusion-Public NIH Public Access Author ManuscriptOphthalmology. Author manuscript; available in PMC 2012 July 1. We were interested in the proportion of participants who have an eye exam after the Glaucoma EyeCare Program identifies them as having a higher risk for the development of glaucoma and eligible for an eye exam. Glaucoma screenings with frequency doubling technology perimetry result in 40% to 70%5 , 6 of screening failures having an eye exam. To our knowledge, no study has reported the ability of public service announcements to encourage participants to have an eye exam and the factors associated with obtaining an eye exam. This information will provide guidance for designing and enhancing glaucoma public service announcements in the future to decrease the risk of undiagnosed glaucoma. MethodsThe Glaucoma EyeCare Program provided the authors with a de-identified database. The Institutional Review Board (IRB) of Legacy Health System approved this study. Participants and data collectionThe Glaucoma EyeCare Pro...

Community-led total sanitation (CLTS) has triggered households around the world to adopt latrines, but evidence suggests that CLTS does not usually lead to universal latrine coverage. Additional interventions, such as subsidies for the poor, may be necessary to eliminate open defecation. While subsidies can improve sanitation-related outcomes, no prior studies have compared the net benefits of CLTS plus subsidies to CLTS-only. This paper presents a comparative analysis for rural Ghana, where efforts to reduce open defecation have had limited success. We analyze the costs and benefits of: (1) a CLTS-only intervention, as implemented in Ghana, and (2) a variant of CLTS that provides vouchers for latrines to the poorest households in high sanitation adoption communities. We find that CLTS-only fails a deterministic benefit-cost test and that only about 30% of 10,000 Monte Carlo trials produce positive net benefits. CLTS plus subsidies satisfy a benefit-cost criterion in the deterministic case, and in about 55% of the Monte Carlo trials. This more favorable outcome stems from the high adoption communities passing the threshold needed to generate positive health externalities due to improved community sanitation. The results suggest that a well-targeted CLTS plus subsidies intervention would be more effective in Ghana than CLTS-only.