Easton, Tiffany; Milte, Rachel; Crotty, Maria; Ratcliffe, Julie
Long-term care for older people is provided in both residential and non-residential settings, with residential settings tending to cater for individuals with higher care needs. Evidence relating to the costs and effectiveness of different workforce structures and care processes is important to facilitate the future planning of residential aged care services to promote high quality care and to enhance the quality of life of individuals living in residential care. A systematic review conducted up to December 2015 identified 19 studies containing an economic component; seven included a complete economic evaluation and 12 contained a cost analysis only. Key findings include the potential to create cost savings from a societal perspective through enhanced staffing levels and quality improvement interventions within residential aged care facilities, while integrated care models, including the integration of health disciplines and the integration between residents and care staff, were shown to have limited cost-saving potential. Six of the 19 identified studies examined dementia-specific structures and processes, in which person-centred interventions demonstrated the potential to reduce agitation and improve residents' quality of life. Importantly, this review highlights methodological limitations in the existing evidence and an urgent need for future research to identify appropriate and meaningful outcome measures that can be used at a service planning level.
Hang, Jo-Aine; Francis-Coad, Jacqueline; Burro, Bianca; Nobre, Debbie; Hill, Anne-Marie
Falls are a serious problem in residential aged care settings. The aims of the study were to determine the feasibility of surveying care staff regarding falls prevention, and describe care staff levels of knowledge and awareness of residents' risk of falls, knowledge about falls prevention, motivation and confidence to implement falls prevention strategies. A custom designed questionnaire was administered to care staff at one site of a large residential aged care organization in Australia. The survey response was 58.8%. Feedback from staff was used to inform the administration of the survey to the wider organization. Seven (29.2%) care staff reported they were unsure or thought residents were at low risk of falls. Only five (20.8%) care staff were able to suggest more than three preventive strategies. These preliminary findings suggest that education to change care staff behavior regarding falls prevention should target improving care staff knowledge and awareness of falls.
van Hateren, Kornelis J J; Drion, Iefke; Kleefstra, Nanne; Groenier, Klaas H; Houweling, Sebastiaan T; van der Meer, Klaas; Bilo, Henk J G
Objective The Zwolle Outpatient Diabetes project Integrating Available Care (ZODIAC) study was initiated in 1998 to investigate the effects of shared care for patients with type 2 diabetes mellitus (T2DM) in the Netherlands, and to reduce the number of diabetes-related complications. Benchmarking the performance of diabetes care was and is an important aspect of this study. We aimed to investigate trends in diabetes care, within the ZODIAC study for a wide variety of quality indicators during a long follow-up period (1998–2008), with special interest for different age groups. Design Prospective observational cohort study. Setting Primary care, Zwolle, The Netherlands. Participants Patients with T2DM. Methods A dataset of quality measures was collected annually during the patient's visit to the practice nurse or general practitioner. Linear time trends from 1998 to 2008 were estimated using linear mixed models in which we adjusted for age and gender. Age was included in the model as a categorical variable: for each follow-up year all participants were categorised into the categories <60, 60–75 and >75 years. Differences in trends between the age categories were investigated by adding an interaction term to the model. Results The number of patients who were reported to participate increased in the period 1998–2008 from 1622 to 27 438. All quality indicators improved in this study, except for body mass index. The prevalence albuminuria decreased in an 11-year-period from 42% to 21%. No relevant differences between the trends for the three age categories were observed. During all years of follow-up, mean blood pressure and body mass index were the lowest and highest, respectively, in the group of patients <60 years (data not shown). Conclusions Quality of diabetes care within the Dutch ZODIAC study, a shared care project, has considerably improved in the period 1998–2008. There were no relevant differences between trends across various age categories
Weed, Elizabeth D
Attention-deficit/hyperactivity disorder is considered one of the most common neurodevelopmental disorders of childhood. Primary care providers are in the unique position of providing comprehensive care-routine care, well child visits, immunizations, and other healthcare needs-to a majority of children and adolescents with attention-deficit/hyperactivity disorder. As such, primary care providers are pivotal in the diagnosis, management, and treatment of this population. This article will address special treatment considerations to aid in the management of attention-deficit/hyperactivity disorder in the primary care setting, including substance use disorders and diversion, cardiac issues and stimulant medication, medication holidays and follow-up monitoring. The database of PubMed was searched using keywords that included attention-deficit/hyperactivity disorder, children, prevalence, medication holidays, safety, cardiovascular, cardiac, blood pressure, substance use, diversion, adverse drug reactions; inclusion dates were January 1, 2011 to September 30, 2015.
Tiholova, Mayda; Gopala, Kusuma; Berberova, Magda; Strokova-Stoilova, Margarita; Tafalla, Monica
Background Rotavirus (RV) causes a high proportion of acute gastroenteritis (AGE) cases, especially among children under the age of five years old. This surveillance study was undertaken to study the incidence and severity of rotavirus gastroenteritis (RVGE) in primary care settings in Bulgaria over a one-year period. Methods In this prospective, observational study of AGE cases in children under five years of age presenting in the primary care setting over a one year period, stool samples were collected and tested for RV using a rapid visual immunochromatographic test kit. After the first visit, parents monitored their child for about two weeks and reported the symptoms experienced by the child during the follow-up period to the physician in a follow-up phone call. The percentage of RVGE cases among AGE was calculated and the severity of AGE (according to the 20-point Vesikari scale) was assessed by the physician based on the symptoms reported by the parents. The seasonality of RVGE was also studied. Results The proportion of RVGE among the 624 AGE cases examined was 25.5%. Severe AGE was experienced by 81.8% RV-positive and 54.6% RV-negative children (p-value <0.001) and a third of all severe AGE cases occurred in RV-positive patients. A multivariate logistic regression analysis of the determinants of hospitalization indicated that severity of disease and RV-positivity were the statistically significant variables explaining hospitalization of AGE cases; even controlling for severity, RV-positive patients were more often hospitalized than RV-negative ones. RVGE cases occurred throughout the year, with peaks during August and September. Conclusion Our study emphasizes that RV is an important cause of AGE in children under five presenting in primary care settings in Bulgaria and a disproportionately high proportion of severe AGE cases may be attributed to RV infections. Trial registration number NCT01733849 PMID:27622162
Corless, Inge B.
Examines topics related to delivery of terminal care services: ability of various hospice programs to survive financially, contributions of various models of hospice care, impact of Medicare legislation on hospice movement, demonstration of unique hospice intervention, integration of spiritual care into hospice, and role of hospice in care of…
Weigl, Bernhard H; Neogi, Tina; McGuire, Helen
The emergence of point-of-care (POC) diagnostics specifically designed for low-resource settings coupled with the rapid increase in need for routine care of patients with chronic diseases should prompt reconsideration of how health care can be delivered most beneficially and cost-effectively in developing countries. Bolstering support for primary care to provide rapid and appropriate integrated acute and chronic care treatment may be a possible solution. POC diagnostics can empower local and primary care providers and enable them to make better clinical decisions. This article explores the opportunity for POC diagnostics to strengthen primary care and chronic disease diagnosis and management in a low-resource setting (LRS) to deliver appropriate, consistent, and integrated care. We analyze the requirements of resource-appropriate chronic disease care, the characteristics of POC diagnostics in LRS versus the developed world, the many roles of diagnostics in the care continuum in LRS, and the process and economics of developing LRS-compatible POC diagnostics.
Drugli, May Britt; Larsson, Bo
In this study, generalisation effects to day-care/school settings were examined in an outpatient clinic sample of 127 children aged 4-8 years treated because of oppositional conduct problems in the home with parent training (PT) and parent training combined with child therapy (CT) ("Incredible Years"). Before treatment all children scored above the 90th percentile on the Eyberg Child Behavior Inventory (ECBI) for home problems, and met criteria for a possible or a confirmed diagnosis of either an oppositional defiant (ODD) or a conduct (CD) disorder. Further, 83% of the children showed clinical levels of conduct problems both at home and in day-care/school before treatment. Although most children improved at home, the majority still showed clinical levels of conduct problems in day-care/school settings after treatment and 1-year later. Combined PT and CT produced the most powerful and significant generalisation effects across the treatment period, however these improvements were not maintained 1-year later for most areas. The results of the present study, therefore, underline the need to target conduct problems not only exhibited at home but also in day-care/school settings, and to develop strategies to maintain positive generalisation effects after treatment for this age and problem-group.
Drury, Lisbeth; Abrams, Dominic; Swift, Hannah J; Lamont, Ruth A; Gerocova, Katarina
Caring is a positive social act, but can it result in negative attitudes towards those cared for, and towards others from their wider social group? Based on intergroup contact theory, we tested whether care workers' (CWs) positive and negative contact with old-age care home residents (CHRs) predicts prejudiced attitudes towards that group, and whether this generalises to other older people. Fifty-six CWs were surveyed about their positive and negative contact with CHRs and their blatant and subtle attitudes (humanness attributions) towards CHRs and older adults. We tested indirect paths from contact with CHRs to attitudes towards older adults via attitudes towards CHRs. Results showed that neither positive nor negative contact generalised blatant ageism. However, the effect of negative, but not positive, contact on the denial of humanness to CHRs generalised to subtle ageism towards older adults. This evidence has practical implications for management of CWs' work experiences and theoretical implications, suggesting that negative contact with a subgroup generalises the attribution of humanness to superordinate groups. Because it is difficult to identify and challenge subtle prejudices such as dehumanisation, it may be especially important to reduce negative contact. © 2016 The Authors. Journal of Community & Applied Social Psychology Published by John Wiley & Sons Ltd.
Speech-language pathologists who serve elders in a variety of long-term care settings have a variety of professional skills and responsibilities. Fundamental to quality service is knowledge of aging and communication changes and disorders associated with this process, institutional alternatives, and the changing nature of today's elders in…
Aged care is well and truly back on the political agenda in Australia. While the mainstream media has recently exposed a number of horrific cases of alleged abuse in aged care facilities it has done little to highlight the failings of social policy over time or to foster debate on how to improve the care of older Australians. What are the barriers to providing safe and quality aged care to a growing number of our citizens and how do we overcome them? If you relied on the recent media coverage for your impression of aged care you could be forgiven for thinking it is all bad news. But there are facilities providing high quality care and stories of nurses working wonders in the face of adversity. Cathy Beadnell considers some of the broader cultural and workforce issues in aged care.
Little, Priscilla M.
This brief identifies the features of high-quality after-school settings that have emerged from the research and are reflected in program quality tools. It also examines key research linking program quality to positive developmental outcomes; it reviews current practice in program quality assessment; and it offers considerations for policymakers…
There are many ways in which long-term care facilities attempt to cope with the mental health problems of the elderly. The author reviews five factors crucial to effective care for the aged in these facilities. (Author/RK)
Jones, W. L.
Space age health care delivery is being delivered to both NASA astronauts and employees with primary emphasis on preventive medicine. The program relies heavily on comprehensive health physical exams, health education, screening programs and physical fitness programs. Medical data from the program is stored in a computer bank so epidemiological significance can be established and better procedures can be obtained. Besides health care delivery to the NASA population, NASA is working with HEW on a telemedicine project STARPAHC, applying space technology to provide health care delivery to remotely located populations.
Luz Rentero, Maria; Carbonell, Cristina; Casillas, Marta; González Béjar, Milagros; Berenguer, Rafael
Introduction Osteoporosis (OP) is a major, highly prevalent health problem and osteoporosis-related fractures account for high morbidity and mortality. Therefore, prevention and early detection of osteoporosis should strive to substantially reduce this risk of fracture. Objective The present observational, descriptive, cross-sectional study sought to assess the prevalence of risk factors for osteoporosis and fractures in a large sample of postmenopausal women aged 50 to 65 years attending Primary Care facilities in Spain. Methods We recruited 4,960 women, at 96 Primary Care centers. Demographic and anthropometrical data, as well as information regarding risk factors for OP were collected using a questionnaire. Results The prevalence rates for the major osteoporosis risk factors in our population were: low calcium intake, 43%; benzodiazepine use, 35.1%, and height loss, 30.1%. Other relatively prevalent factors include: having suffered at least one fall during the preceding year; positive family history of falls (particularly on the mother’s side), smoking, kyphosis, presence of any disease affecting bone metabolism, personal history of falls, and inability to rise from a chair without using one’s arms. The least frequent factors were weight loss of greater than 10% over the preceding 10 years and problems in sensory perception that affect patient’s ability to walk. Conclusions The main risk factors for osteoporosis in women 50-65 years of age are low calcium intake, use of benzodiazepines, and observed loss of height. Our results may help physicians to identify groups at risk for OP and fractures at early stages and consequently, optimize prevention and early diagnosis of osteoporosis in postmenopausal women. PMID:19088873
Reymond, Liz; Israel, Fiona J; Charles, Margaret A
The objective of this study was to develop, implement and evaluate an end-of-life (terminal) care pathway and associated infrastructure suitable for Australian residential aged care facilities that improves resident and health system outcomes. The residential aged care end-of-life care pathway was developed by a multidisciplinary collaboration of government and non-government professionals and incorporated best clinical management for dying residents to guide care and increase palliative care capacity of generalist staff. Implementation included identifying and up-skilling Link Nurses to champion the pathway, networking facilities with specialist palliative care services, delivering education to generalists and commencing a Palliative Care Medication Imprest System in each facility. The primary outcome measure for evaluation was transfer to hospital; secondary measures included staff perceived changes in quality of palliative care provided and family satisfaction with care. Results indicated that the pathway, delivered within a care framework that guides provision of palliative care, resulted in improved resident outcomes and decreased inappropriate transfers to acute care settings.
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Sfakianaki, Efrosyni; Sfakianakis, George N; Georgiou, Mike; Hsiao, Bernard
Renal scintigraphy is a powerful imaging method that provides both functional and anatomic information, which is particularly useful in the acute care setting. In our institution, for the past 2 decades, we have used a 25-minute renal diuretic protocol, technetium-99m ((99m)Tc) mercaptoacetyltriglycine with simultaneous intravenous injection of furosemide, for all ages and indications, including both native and transplant kidneys. As such, this protocol has been widely used in the workup of acutely ill patients. In this setting, there are common clinical entities which affect patients with native and transplant kidneys. In adult patients with native kidneys one of the most frequent reasons for emergency room visits is renal colic due to urolithiasis. Although unenhanced computed tomography is useful to assess the anatomy in cases of renal colic, it does not provide functional information. Time zero furosemide renal scintigraphy can do both and we have shown that it can effectively stratify patients with renal colic. To this end, 4 characteristic patterns of scintirenography have been identified, standardized, and consistently applied: no obstruction, partial obstruction (mild vs high grade), complete obstruction, and stunned (postdecompressed) kidney. With the extensive use of this protocol over the past 2 decades, a pattern of "regional parenchymal dysfunction" indicative of acute pyelonephritis has also been delineated. This information has proved to be useful for patients presenting with urinary tract infection and suspected pyelonephritis, as well as for patients who were referred for workup of renal colic but were found to have acute pyelonephritis instead. In instances of abdominal trauma, renal scintigraphy is uniquely suited to identify urine leaks. This is also true in cases of suspected leak following renal transplant or from other iatrogenic/postsurgical causes. Patients presenting with acute renal failure can be evaluated with renal scintigraphy. A
Pressure ulcer prevention in the care home setting can be challenging and is often compromised by a lack of access to education and resources. There are measures that have been shown to consistently improve outcomes in pressure ulcer prevention including assessment of the patient and their individual risks, delivery of a consistent plan of care that meets patients' needs, and regular evaluation to identify shortfalls. In addition, there should be a robust approach to investigating events that lead to a person developing a pressure ulcer and that information should be used to improve future practice. Pressure ulcer prevention in care homes is achievable and nurses should all be aware of the necessary measures detailed in this article.
Beaulieu, Marie-Dominique; Geneau, Robert; Grande, Claudio Del; Denis, Jean-Louis; Hudon, Éveline; Haggerty, Jeannie L.; Bonin, Lucie; Duplain, Réjean; Goudreau, Johanne; Hogg, William
Abstract Objective To gain a deeper understanding of how primary care (PC) practices belonging to different models manage resources to provide high-quality care. Design Multiple-case study embedded in a cross-sectional study of a random sample of 37 practices. Setting Three regions of Quebec. Participants Health care professionals and staff of 5 PC practices. Methods Five cases showing above-average results on quality-of-care indicators were purposefully selected to contrast on region, practice size, and PC model. Data were collected using an organizational questionnaire; the Team Climate Inventory, which was completed by health care professionals and staff; and 33 individual interviews. Detailed case histories were written and thematic analysis was performed. Main findings The core common feature of these practices was their ongoing effort to make trade-offs to deliver services that met their vision of high-quality care. These compromises involved the same 3 areas, but to varying degrees depending on clinic characteristics: developing a shared vision of high-quality care; aligning resource use with that vision; and balancing professional aspirations and population needs. The leadership of the physician lead was crucial. The external environment was perceived as a source of pressure and dilemmas rather than as a source of support in these matters. Conclusion Irrespective of their models, PC practices’ pursuit of high-quality care is based on a vision in which accessibility is a key component, balanced by appropriate management of available resources and of external environment expectations. Current PC reforms often create tensions rather than support PC practices in their pursuit of high-quality care. PMID:24829023
Rodriguez-Blazquez, Carmen; Forjaz, Maria João; Prieto-Flores, Maria-Eugenia; Rojo-Perez, Fermina; Fernandez-Mayoralas, Gloria; Martinez-Martin, Pablo
The objective is to identify the differences and the main factors influencing health status and well-being variables between institutionalized and non-institutionalized older adults, as well as the interaction effect of institutionalization and age. Data on a total of 468 older adults from a national survey on non-institutionalized and from a study on institutionalized older people were analyzed. Socio-demographic variables and measures on well-being (Personal Well-being Index, PWI), health status (EQ-5D), functional ability (Barthel Index), depression (Hospital Anxiety and Depression Scale-Depression subscale), loneliness and comorbidity were used. Analysis of variance and Kruskal-Wallis tests to examine differences between groups and multiple regression analyses to identify factors associated to health and well-being were performed. Significant differences in health status variables, but not in well-being were detected between groups. Controlling for age, differences in health status (EQ-VAS) were found to be not significant in both groups. In the non-institutionalized group, people aged 78 years or more reported a significantly lower well-being (PWI) than younger counterparts. Step-wise multiple regression analysis showed that depression, functional dependence, loneliness and sex were associated with health status; while depression, health status, loneliness and the interaction of age-institutionalization were related to well-being. The results suggest that age influences community-dwelling older adults' well-being to a greater extent than it does to institutionalized older people. This finding has implications for resource allocation and interventions addressed to improve health and well-being in older adults.
Ergas, Henry; Paolucci, Francesco
This article focuses on the provision and financing of aged care in Australia. Demand for aged care will increase substantially as a result of population aging, with the number of Australians aged 85 and over projected to increase from 400,000 in 2010 to over 1.8 million in 2051. Meeting this demand will greatly strain the current system, and makes it important to exploit opportunities for increased efficiency. A move to greater beneficiary co-payments is also likely, though its extent may depend on whether aged care insurance and other forms of pre-payment can develop. PMID:22312229
Youth transitioning out of foster care face significant medical and mental health care needs. Unfortunately, these youth rarely receive the services they need because of lack of health insurance. Through many policies and programs, the federal government has taken steps to support older youth in foster care and those aging out. The Fostering Connections to Success and Increasing Adoptions Act of 2008 (Pub L No. 110-354) requires states to work with youth to develop a transition plan that addresses issues such as health insurance. In addition, beginning in 2014, the Patient Protection and Affordable Care Act of 2010 (Pub L No. 111-148) makes youth aging out of foster care eligible for Medicaid coverage until age 26 years, regardless of income. Pediatricians can support youth aging out of foster care by working collaboratively with the child welfare agency in their state to ensure that the ongoing health needs of transitioning youth are met.
This booklet examines four aspects of day care services for school-age children: (1) national availability and trends, (2) parents' views, (3) program planning, and (4) recommended program models. A nationwide survey of 58 day care programs enrolling school-age children was conducted, and the general findings are presented. Information on parents'…
Hillen, Jodie B; Vitry, Agnes; Caughey, Gillian E
Given the growing aged care population, the complexity of their medication-related needs and increased risk of adverse drug events, there is a necessity to systematically monitor and manage medication-related quality of care. The aim of this systematic review was to identify and synthesise medication-related quality of care indicators with respect to application to residential aged care. MEDLINE (Ovid), Psychinfo, CINAHL, Embase and Google® were searched from 2001 to 2013 for studies that were in English, focused on older people aged 65+ years and discussed the development, application or validation of original medication-related quality of care indicators. The quality of selected articles was appraised using the Critical Appraisal Skills Program and psychometric qualities extracted and synthesised using content analysis. Indicators were mapped to six medication-related quality of care attributes and a minimum indicator set derived. Thirty three articles describing 25 indicator sets met the inclusion criteria. Thirteen (52%) contained prescribing quality indicators only. Eight (32%) were developed specifically for aged care. Twenty three (92%) were validated and seven (28%) assessed for reliability. The most common attribute addressed was medication appropriateness (n = 24). There were no indicators for evaluating medication use in those with limited life expectancy, which resulted in only five of the six attributes being addressed. The developed minimum indicator set contains 28 indicators representing 22 of 25 identified indicator sets. Whilst a wide variety of validated indicator sets exist, none addressed all aspects of medication-related quality of care pertinent to residential aged care. The minimum indicator set is intended as a foundation for comprehensively evaluating medication-related quality of care in this setting. Future work should focus on bridging identified gaps.
Child Trends, 2009
Measures assessing the quality of children's environments and interactions in nonparental care settings were developed originally for use in child care research and as self-assessment tools for practitioners. Within the last decade, these measurement tools have moved into the public policy arena, where they are now used to make programmatic…
Davis, Melinda M.; Bond, Lynne A.; Howard, Alan; Sarkisian, Catherine A.
Purpose: Expectations regarding aging (ERA) in community-dwelling older adults are associated with personal health behaviors and health resource usage. Clinicians' age expectations likely influence patients' expectations and care delivery patterns; yet, limited research has explored clinicians' age expectations. The Expectations Regarding Aging…
You, Emily Chuanmei; Dunt, David; Doyle, Colleen
Case management has been widely implemented in the community aged care setting. In this study, we aimed to explore influences on case-managed community aged care practice from the perspectives of community aged care case managers. We conducted 33 semistructured interviews with 47 participants. We drew these participants from a list of all case managers working in aged care organizations that provided publicly funded case management program(s)/packages in Victoria, Australia. We used a multilevel framework that included such broad categories of factors as structural, organizational, case manager, client, and practice factors to guide the data analysis. Through thematic analysis, we found that policy change, organizational culture and policies, case managers' professional backgrounds, clients with culturally and linguistically diverse backgrounds, and case management models stood out as key influences on case managers' practice. In the future, researchers can use the multilevel framework to undertake implementation research in similar health contexts.
Wyse, Linda; Casarotto, Nadia
Australia's Aged Care Act of 1997 mandates a number of key reforms aimed at ensuring consistency in the quality of care and well-being for all residents of aged care facilities. The law required residential aged care facilities to provide high-quality care within a framework of continuous improvement which requires aged care workers to perform the…
Zweig, Richard A; Siegel, Lawrence; Hahn, Steven; Kuslansky, Gail; Byrne, Kathy; Fyffe, Denise; Passman, Vicki; Stewart, Douglas; Hinrichsen, Gregory A
Most older adults diagnosed with a mental disorder receive treatment in primary care settings that lack personnel skilled in geropsychological diagnosis and treatment. The Ferkauf Older Adult Program of Yeshiva University endeavors to bridge this gap by providing training in geriatric psychology, through coursework and diverse clinical practica, to clinical psychology doctoral students within a large urban professional psychology program. In an innovative effort to provide the most disadvantaged elderly with comprehensive mental health treatment and maximize trainee exposure to an interdisciplinary treatment model, the program also pairs selected doctoral psychology trainees with medical residents to optimize integrated mental health service delivery for primary care elderly. The program has the following core objectives: (1) Infuse the mental health and aging knowledge base into the regular graduate curriculum; (2) Provide interdisciplinary training in geropsychological diagnostic and consultative services within an urban primary care setting; (3) Provide interdisciplinary training in the practice of psychological and neuropsychological evaluation of elderly; (4) Provide training in geropsychological psychotherapeutic intervention, including individual, couples/family, and brief/psycho-educational therapies with outpatient older adults. These objectives are achieved by pooling the resources of a graduate school of psychology, a local public hospital, and an academic medical center to achieve educational and clinical service goals.
Certain aspects of the economics of caring for the aged in South Africa are considered. The few years before an accelerated growth rate of the population in South Africa takes place should be used to prepare the economic and other resources of the country. The increasing per capita income of the non-White population should supply the resources to meet the needs of its aged. The use of various accommodations facilities is reviewed. Guidance of medical and paramedical experts, who are specially trained to care for the aged, is needed.
The impact of a longer life on future health care expenditures will be quite moderate because of the high costs of dying and the compression of mortality in old age. If not age per se but proximity to death determines the bulk of expenditures, a shift in the mortality risk to higher ages will not significantly affect lifetime health care expenditures, as death occurs only once in every life. A calculation of the demographic effect on health care expenditures in Germany up until 2050 that explicitly accounts for costs in the last years of life leads to a significantly lower demographic impact on per-capita expenditures than a calculation based on crude age-specific health expenditures.
Mitchell, Lori A.; Strain, Laurel A.; Blandford, Audrey A.
This study employs a longitudinal design to examine rural-urban differences in home care service use over time, drawing on data from the Manitoba Study of Health and Aging (MSHA). Characteristics of community-dwelling, cognitively intact adults aged 65 years or older not receiving home care services in the province of Manitoba (n = 855) were…
The purpose of this article is to explore the way preschool teachers teach reflective care in Japan. The article builds on a two-month ethnographic study conducted in Japanese kindergartens and nurseries among children aged 3-6 years. The data were analysed using concepts of age and gender. The results show that care in Japan, in contrast to…
Knickman, James R; Snell, Emily K
Objective To assess the coming challenges of caring for large numbers of frail elderly as the Baby Boom generation ages. Study Setting A review of economic and demographic data as well as simulations of projected socioeconomic and demographic patterns in the year 2030 form the basis of a review of the challenges related to caring for seniors that need to be faced by society. Study Design A series of analyses are used to consider the challenges related to caring for elders in the year 2030: (1) measures of macroeconomic burden are developed and analyzed, (2) the literatures on trends in disability, payment approaches for long-term care, healthy aging, and cultural views of aging are analyzed and synthesized, and(3)simulations of future income and assets patterns of the Baby Boom generation are developed. Principal Findings The economic burden of aging in 2030 should be no greater than the economic burden associated with raising large numbers of baby boom children in the 1960s. The real challenges of caring for the elderly in 2030 will involve: (1) making sure society develops payment and insurance systems for long-term care that work better than existing ones, (2) taking advantage of advances in medicine and behavioral health to keep the elderly as healthy and active as possible, (3) changing the way society organizes community services so that care is more accessible, and (4) altering the cultural view of aging to make sure all ages are integrated into the fabric of community life. Conclusions To meet the long-term care needs of Baby Boomers, social and public policy changes must begin soon. Meeting the financial and social service burdens of growing numbers of elders will not be a daunting task if necessary changes are made now rather than when Baby Boomers actually need long-term care. PMID:12236388
McCarthy, Christopher J.; Hart, Sonia
This article provides an overview of the special issue on groups in health care settings and describes how each contribution addresses challenges and opportunities in the health care field for group work. Fundamental criteria for evaluating groups in such settings are applied to each contribution. Finally, trends and opportunities about the future…
Dockett, Sue; Perry, Bob
While a great deal of research has focused on children's experiences as they start school, less attention has been directed to their experiences--and those of their families and educators--as they start school age care. This paper draws from a recent research project investigating practices that promote positive transitions to school and school…
Daly, Donnelle; Matzel, Stephen Chavez
A transdisciplinary team is an essential component of palliative and end-of-life care. This article will demonstrate how to develop a transdisciplinary approach to palliative care, incorporating nursing, social work, spiritual care, and pharmacy in an acute care setting. Objectives included: identifying transdisciplinary roles contributing to care in the acute care setting; defining the palliative care model and mission; identifying patient/family and institutional needs; and developing palliative care tools. Methods included a needs assessment and the development of assessment tools, an education program, community resources, and a patient satisfaction survey. After 1 year of implementation, the transdisciplinary palliative care team consisted of seven palliative care physicians, two social workers, two chaplains, a pharmacist, and End-of-Life Nursing Consortium (ELNEC) trained nurses. Palomar Health now has a palliative care service with a consistent process for transdisciplinary communication and intervention for adult critical care patients with advanced, chronic illness.
Asthma prevalence in low-to middle-income countries is at least the same or higher than in rich countries, but with increased severity. Lack of control in these settings is due to various factors such as low accessibility to effective medications, multiple and uncoordinated weak infrastructures of medical services for the management of chronic diseases such as asthma, poor compliance with prescribed therapy, lack of asthma education, and social and cultural factors. There is an urgent requirement for the implementation of better ways to treat asthma in underserved populations, enhancing the access to preventive medications and educational approaches with modern technological methods. PMID:23282401
Watanabe, Go; Yamagiwa, Tetsuya; Nakayama, Shinya; Ito, Satoko; Fukuda, Akiko; Shiotani, Tomohiro; Yamaoka, Yoshio
Home hospice care is not merely an extension of hospital-based medical care administered at the hospital, but refers to hospice care for patients with life-threatening diseases that can only be given at their homes. The rapid growth of the elderly population in Japan has led to not only the need for home hospice care, but also social problems such as living alone, living with only one elderly family member, and problems that are particularly acute in cancer patients with dementia. We analyzed data for 262 patients for whom home hospice care was provided by our clinic. Overall, elderly persons with dementia tended to request admission before death, but most elderly persons living alone preferred home hospice care. We found that 58% of the patients living with only one elderly family member requested admission before death, which was lower than the rate of the study group as a whole. We further performed an in-depth analysis of the current situation in order to improve home hospice care of terminally ill patients in Japan, focusing on problems related to the aging population.
Miller, Carla K; Bauman, Jennifer
Goal setting is a widely used behavior change tool in diabetes education and training. Prior research found specific relatively difficult but attainable goals set within a specific timeframe improved performance in sports and at the workplace. However, the impact of goal setting in diabetes self-care has not received extensive attention. This review examined the mechanisms underlying behavioral change according to goal setting theory and evaluated the impact of goal setting in diabetes intervention studies. Eight studies were identified, which incorporated goal setting as the primary strategy to promote behavioral change in individual, group-based, and primary care settings among patients with type 2 diabetes. Improvements in diabetes-related self-efficacy, dietary intake, physical activity, and A1c were observed in some but not all studies. More systematic research is needed to determine the conditions and behaviors for which goal setting is most effective. Initial recommendations for using goal setting in diabetes patient encounters are offered.
For the first time across Australia, early education and care services are subject to a single, national set of regulations and standards governing the quality of provision. Concurrently, a set of outcomes for all children aged from birth to 5 years and a ranking system to make transparent the performance of programmes have been developed. This…
Story, Mary; Kaphingst, Karen M.; French, Simone
Mary Story, Karen Kaphingst, and Simone French argue that researchers and policymakers focused on childhood obesity have paid insufficient attention to child care. Although child care settings can be a major force in shaping children's dietary intake, physical activity, and energy balance--and thus in combating the childhood obesity…
McCune, Renee L.
Patient health literacy skills are critical to effective healthcare communication and safe care delivery in primary care settings. Methods and strategies to identify patient health literacy (HL) capabilities and provider/staff knowledge, attitudes and beliefs (KAB) regarding HL must be known before addressing provider/staff communication skills.…
This paper reports a retrospective study undertaken to determine if differences existed in obstetric outcome, contraceptive usage, and repeat pregnancy rates of teenage patients cared for in three different health care settings: the Rochester Adolescent Maternity Project (RAMP), a traditional obstetric clinic, and a neighborhood health center.…
Bober, Kenneth F.; And Others
A second-year clinical course composed of weekly observation sessions of interactions between patients and health care professionals in a variety of health care settings within a hospital is described. Weekly discussion sessions summarize the observations and introduce such topics as communication skills, patients' rights, patient relationships,…
Huefner, Jonathan C.; Ringle, Jay L.
There has been ongoing concern about the negative impact of residential treatment on youth in care. Research examining the impact of negative peer influence in juvenile justice, education, and residential care settings is reviewed. A study was conducted to examine the impact of negative peer contagion on the level of problem behavior in a…
Kelly, R. Patrick; Stoll, Shelley C.; Bryant-Stephens, Tyra; Janevic, Mary R.; Lara, Marielena; Ohadike, Yvonne U.; Persky, Victoria; Ramos-Valencia, Gilberto; Uyeda, Kimberly; Malveaux, Floyd J.
Asthma affects 7.1 million children in the United States, disproportionately burdening African American and Latino children. Barriers to asthma control include insufficient patient education and fragmented care. Care coordination represents a compelling approach to improve quality of care and address disparities in asthma. The sites of The Merck Childhood Asthma Network Care Coordination Programs implemented different models of care coordination to suit specific settings—school district, clinic or health care system, and community—and organizational structures. A variety of qualitative data sources were analyzed to determine the role setting played in the manifestation of care coordination at each site. There were inherent strengths and challenges of implementing care coordination in each of the settings, and each site used unique strategies to deliver their programs. The relationship between the lead implementing unit and entities that provided (1) access to the priority population and (2) clinical services to program participants played a critical role in the structure of the programs. The level of support and infrastructure provided by these entities to the lead implementing unit influenced how participants were identified and how asthma care coordinators were integrated into the clinical care team. PMID:26232778
Dubovsky, Amelia N; Kiefer, Meghan M
Borderline personality disorder is estimated to be present in approximately 6% of outpatient primary care settings. However, the time and energy spent on this population can greatly exceed what primary care doctors are able to spend. This article gives an overview of borderline personality disorder, including the clinical characteristics, epidemiology, and comorbidities, as well as pharmacologic and most important behavioral management. It is our hope that, with improved understanding of the disorder and skills for managing this population, caring for patients with the disorder can be more satisfying and less taxing for both primary care doctors and their patients.
Landman, W A; Henley, L D
The new South African constitution commits the government to guarantee "basic health services" for every child under 18. Primary health care for pregnant women and children under six and elements of essential primary health care have received priority. At present, there is little analysis of the moral considerations involved in making choices about more advanced or costly health care which may, arguably, also be "basic". This paper illustrates some of the tensions in setting priorities for a just macro-allocation of children's health care, given the realities of need and scarce resources, and the commitment to equality of basic opportunities. PMID:9752631
Built on the premise that good school-age care jobs are the cornerstone of high-quality services for school-age youth and their families, this guide presents model work standards for school-age care providers. The guide begins with a description of the strengths and challenges of the school-age care profession. The model work standards are…
Stellefson, Michael; Stopka, Christine
Introduction The Chronic Care Model (CCM) uses a systematic approach to restructuring medical care to create partnerships between health systems and communities. The objective of this study was to describe how researchers have applied CCM in US primary care settings to provide care for people who have diabetes and to describe outcomes of CCM implementation. Methods We conducted a literature review by using the Cochrane database of systematic reviews, CINAHL, and Health Source: Nursing/Academic Edition and the following search terms: “chronic care model” (and) “diabet*.” We included articles published between January 1999 and October 2011. We summarized details on CCM application and health outcomes for 16 studies. Results The 16 studies included various study designs, including 9 randomized controlled trials, and settings, including academic-affiliated primary care practices and private practices. We found evidence that CCM approaches have been effective in managing diabetes in US primary care settings. Organizational leaders in health care systems initiated system-level reorganizations that improved the coordination of diabetes care. Disease registries and electronic medical records were used to establish patient-centered goals, monitor patient progress, and identify lapses in care. Primary care physicians (PCPs) were trained to deliver evidence-based care, and PCP office–based diabetes self-management education improved patient outcomes. Only 7 studies described strategies for addressing community resources and policies. Conclusion CCM is being used for diabetes care in US primary care settings, and positive outcomes have been reported. Future research on integration of CCM into primary care settings for diabetes management should measure diabetes process indicators, such as self-efficacy for disease management and clinical decision making. PMID:23428085
Unco, Inc., Washington, DC.
This report provides some perspectives on existing school-age child care and proposes some alternative school-age care program models which maximize the use of community resources and, thus, reduce potentially high costs. Chapters One and Two examine the current school-age "child care" services both nationally and in Region X (Oregon, Washington…
Levine, Darren G.; Ducharme, Joseph M.
The current study evaluated the effects of a teacher-conducted play intervention on preschool-aged children's compliance in child care settings. Study participants included 8 children ranging in age from 3 to 5 years and 5 early childhood education teachers within 5 classrooms across 5 child care centers. A combination ABAB and multiple baseline…
Feet are not necessarily the most attractive part of the body as it ages, and given the choice, most older adults would rather ignore them. In fact, many older adults cannot even see them, reach them, or care for them properly. And when they ache or look misshapen and oddly colored; well, that's just part of growing old, isn't it? The feet are important for weight bearing, balance, and mobility. Over an average life span, the feet are subject to considerable stress and trauma. Age-related changes of the foot predispose the older adult to discomfort if not pain, fungal infection, reduced range of motion, and itchy dry skin. More than three fourths of older adults (i.e., those age over 65 years) complain of foot pain that is associated with a significant foot problem and have evidence of arthritic changes on x-ray. Impaired ambulation can make the difference between independence versus dependency on others, engagement versus isolation. Assisted living is about choices. Being unable to get where one wants to go or do what one wants to do because of foot problems is a barrier to full enjoyment of the opportunities in assisted living communities. This article describes foot problems associated with aging, diabetes, nursing assessment of the feet, and nursing interventions in the service of accessing and optimizing choices for quality of life.
Research suggests that the experience of being a lesbian or bisexual woman influences women's interactions with health care providers, and their perception of the quality of care. Limited research to date, however, has examined how ageing and sexuality mediates women's experiences of quality, when accessing health care in the community. To fill a gap in the literature, this study investigated older lesbian and bisexual women's perspectives on the meaning of quality of care in the context of receiving home care services. This was a qualitative single case study. Sixteen participants, aged 55-72 from Ontario, Canada, participated in semi-structured interviews between 2011 and 2012. The interviews were recorded and transcribed. The interview data were analysed using iterative thematic analysis and guided by a feminist ethic of care perspective. Participants described quality of care in ways that were in line with a feminist ethic of care; that is, they wanted care providers to be responsive and attentive to their needs, to involve them in the caring process and to demonstrate respect and caring. Participants also indicated that providers' comfort with, and knowledge of, sexual diversity was important for enabling quality of care. These findings deepen our understanding of how to support quality of care for this population through changes to provider education and training, and health policy.
Hall, Nicole; Hipple, Bethany; Friebely, Joan; Ossip, Deborah J; Winickoff, Jonathan P
OBJECTIVE: To discuss strategies for integrating evidence-based tobacco use screening, cessation assistance, and referral to outside services into visits with families in outpatient child health care settings. METHODS: Presentation of counseling scenarios used in the Clinical Effort Against Secondhand Smoke Exposure (CEASE) training video and commentary. RESULTS: Demonstrated strategies include: eliciting information about interest and readiness to quit smoking, respectfully setting an agenda to discuss smoking, tailoring advice and education to the specific circumstances, keeping the dialogue open, prescribing cessation medication, helping the smoker set an action plan for cessation, enrolling the smoker in free telephone counseling through the state quitline, and working with family members to establish a completely smoke-free home and car. Video demonstrations of these techniques are available at www.ceasetobacco.org. CONCLUSION: Child health care clinicians have a unique opportunity to address family smoking and can be most effective by adapting evidence-based tobacco cessation counseling strategies for visits in the pediatric setting.
McSwain, S David; Marcin, James P
Telemedicine is by no means a new technology, given that audio-video telecommunication links have been utilized for the provision of medical services since the 1950s. Nonetheless, telemedicine is currently in a phase of rapid growth and evolution. The combination of increasingly affordable and powerful networking, computing, and communication technology, along with the continued nationwide crisis in health care access and costs, has created a "tipping point," whereby telemedicine has progressed from a novel means of practicing medicine to practical tool to help address our nation's health care needs. Telemedicine has also evolved beyond a means of providing care to remote communities to becoming a versatile tool in the delivery of health care in a variety of non-rural settings. Although no one can be everywhere at once, telemedicine allows us to be in more places at once than we've ever been before. The problems of disparities and access to care are even more evident in pediatrics, where subspecialists are fewer in number and more regionalized than adult providers. Numerous successful telemedicine programs across the country have demonstrated the impact that these technologies can have in pediatrics, with many more programs in development. As a versatile means of delivering care, telemedicine can be used at any point during the course of a health care encounter as not only a means of expanding our reach, but also as a means of increasing efficiency. Using telemedicine to provide consultations to community hospitals has been shown to improve quality of care, strengthen the referral base for the consulting facilities, facilitate cost savings, and improve the financial bottom line for both referring and consulting facilities. This review highlights some of the ways in which telemedicine is being used to facilitate timely and effective pediatric care in a variety of hospital settings.
Sluggett, Janet K; Ilomäki, Jenni; Seaman, Karla L; Corlis, Megan; Bell, J Simon
Eight percent of Australians aged 65 years and over receive residential aged care each year. Residents are increasingly older, frailer and have complex care needs on entry to residential aged care. Up to 63% of Australian residents of aged care facilities take nine or more medications regularly. Together, these factors place residents at high risk of adverse drug events. This paper reviews medication-related policies, practices and research in Australian residential aged care. Complex processes underpin prescribing, supply and administration of medications in aged care facilities. A broad range of policies and resources are available to assist health professionals, aged care facilities and residents to optimise medication management. These include national guiding principles, a standardised national medication chart, clinical medication reviews and facility accreditation standards. Recent Australian interventions have improved medication use in residential aged care facilities. Generating evidence for prescribing and deprescribing that is specific to residential aged care, health workforce reform, medication-related quality indicators and inter-professional education in aged care are important steps toward optimising medication use in this setting.
Shah, Melissa Ford; Liu, Qinghua; Mark Eddy, J; Barkan, Susan; Marshall, David; Mancuso, David; Lucenko, Barbara; Huber, Alice
This study examines risk and protective factors associated with experiencing homelessness in the year after "aging out" of foster care. Using a state-level integrated administrative database, we identified 1,202 emerging adults in Washington State who exited foster care between July 2010 and June 2012. Initial bivariate analyses were conducted to assess the association between candidate predictive factors and an indicator of homelessness in a 12-month follow-up period. After deploying a stepwise regression process, the final logistic regression model included 15 predictive factors. Youth who were parents, who had recently experienced housing instability, or who were African American had approximately twice the odds of experiencing homelessness in the year after exiting foster care. In addition, youth who had experienced disrupted adoptions, had multiple foster care placements (especially in congregate care settings), or had been involved with the juvenile justice system were more likely to become homeless. In contrast, youth were less likely to experience homelessness if they had ever been placed with a relative while in foster care or had a high cumulative grade point average relative to their peers.
Veenstra, Christine M.; Epstein, Andrew J.; Liao, Kaijun; Morris, Arden M.; Pollack, Craig E.; Armstrong, Katrina A.
BACKGROUND The effect of care setting on value of colon cancer care is unknown. METHODS A Surveillance, Epidemiology, and End Results (SEER)-Medicare cohort study of 6544 patients aged ≥66 years with stage IV colon cancer (based on the American Joint Committee on Cancer staging system) who were diagnosed between 1996 and 2005 was performed. All patients were followed through December 31, 2007. Using outpatient and carrier claims, patients were assigned to a treating hospital based on the hospital affiliation of the primary oncologist. Hospitals were classified academic or nonacademic using the SEER-Medicare National Cancer Institute Hospital File. RESULTS Of the 6544 patients, 1605 (25%) received care from providers affiliated with academic medical centers. The unadjusted median cancer-specific survival was 16.0 months at academic medical centers versus 13.9 months at nonacademic medical centers (P<.001). After adjustment, treatment at academic hospitals remained significantly associated with a reduced risk of death from cancer (hazard ratio, 0.87; 95% confidence interval [95% CI], 0.82–0.93 [P<.001]). Adjusted mean 12-month Medicare spending was $8571 higher at academic medical centers (95% CI, $2340–$14,802; P =.007). The adjusted median cost was $1559 higher at academic medical centers; this difference was not found to be statistically significant (95% CI, −$5239 to $2122; P =.41). A small percentage of patients who received very expensive care skewed the difference in mean cost; the only statistically significant difference in adjusted costs in quantile regressions was at the 99.9th percentile of costs (P<.001). CONCLUSIONS Among Medicare beneficiaries with stage IV colon cancer, treatment by a provider affiliated with an academic medical center was associated with a 2 month improvement in overall survival. Except for patients in the 99.9th percentile of the cost distribution, costs at academic medical centers were not found to be significantly
Daddario, Rosemarie; Anhalt, Karla; Barton, Lyle E.
This study investigated the effectiveness of implementing Differential Reinforcement of Other behavior (DRO) at the classwide level to decrease the disruptive behavior of seven typically developing preschool-aged children in a child care setting. After baseline data were collected, a whole interval DRO reinforcement schedule using edible rewards…
de Guzman, Allan B.; Satuito, James Cyril B.; Satumba, Miko Anne E.; Segui, Diego Rey A.; Serquina, Faith Evelyn C.; Serrano, Lawrence Jan P.; Sevilla, Madelyn D.
The use of traditional art in recreational therapies is unexplored. This paper, thus, attempts to surface the unique power of traditional Filipino arts (TFA) as synergizing lens in capturing the individual and the collective experiences of a select group of Filipino elderly in an institutionalized care setting relative to their feelings of…
Moos, Rudolf H.; Lemke, Sonne
The Physical and Architectural Features Checklist (PAF) measures physical resources of sheltered care settings in terms of nine derived dimensions. Data show that facilities which have more physical resources are seen as attractive by outside observers and pleasant by residents. Cost is not related to any PAF dimension. (Author)
Zweig, Richard A.; Siegel, Lawrence; Hahn, Steven; Kuslansky, Gail; Byrne, Kathy; Fyffe, Denise; Passman, Vicki; Stewart, Douglas; Hinrichsen, Gregory
Most older adults diagnosed with a mental disorder receive treatment in primary care settings that lack personnel skilled in geropsychological diagnosis and treatment. The Ferkauf Older Adult Program of Yeshiva University endeavors to bridge this gap by providing training in geriatric psychology, through coursework and diverse clinical practica,…
Mills, Rachel; Voora, Deepak; Peyser, Bruce; Haga, Susanne B
Pharmacogenetic testing refers to a type of genetic test to predict a patient’s likelihood to experience an adverse event or not respond to a given drug. Despite revision to several labels of commonly prescribed drugs regarding the impact of genetic variation, the use of this testing has been limited in many settings due to a number of factors. In the primary care setting, the limited office time as well as the limited knowledge and experience of primary care practitioners have likely attributed to the slow uptake of pharmacogenetic testing. This paper provides talking points for primary care physicians to discuss with patients when pharmacogenetic testing is warranted. As patients and physicians become more familiar and accepting of pharmacogenetic testing, it is anticipated that discussion time will be comparable to that of other clinical tests. PMID:24101877
Children represent the most vulnerable members of our global society, a truth that is magnified when they are physically wounded. In much of the developed world, society has responded by offering protection in the form of law, injury prevention guidelines, and effective trauma systems to provide care for the injured child. Much of our world, though, remains afflicted by poverty and a lack of protective measures. As the globe becomes smaller by way of ease of travel and technology, surgeons are increasingly able to meet these children where they live and in doing so offer their hands and voices to care and protect these young ones. This article is intended as an overview of current issues in pediatric trauma care in the developing world as well as to offer some tips for the volunteer surgeon who may be involved in the care of the injured child in a setting of limited resource availability.
Bond, Penny; Goudie, Karen
Delirium is an acute medical emergency affecting about one in eight acute hospital inpatients. It is associated with poor outcomes, is more prevalent in older people and it is estimated that half of all patients receiving intensive care or surgery for a hip fracture will be affected. Despite its prevalence and impact, delirium is not reliably identified or well managed. Improving the identification and management of patients with delirium has been a focus for the national improving older people's acute care work programme in NHS Scotland. A delirium toolkit has been developed, which includes the 4AT rapid assessment test, information for patients and carers and a care bundle for managing delirium based on existing guidance. This toolkit has been tested and implemented by teams from a range of acute care settings to support improvements in the identification and immediate management of delirium.
Austin, Wendy; Goble, Erika; Strang, Vicki; Mitchell, Agnes; Thompson, Elizabeth; Lantz, Helen; Balt, Linda; Lemermeyer, Gillian; Vass, Kelly
In this Canadian study, a participatory action research approach was used to examine the relationships between families of residents of traditional continuing care facilities and the health care team. The objectives were to (a) explore the formation and maintenance of family-staff relationships, with attention paid to the relational elements of engagement and mutual respect; (b) explore family and staff perspectives of environmental supports and constraints; and (c) identify practical ways to support and enhance these relationships. Results indicate that the resource-constrained context of continuing care has directly impacted family and staff relationships. The nature of these relationships are discussed using the themes of "Everybody Knows Your Name," "Loss and Laundry," "It's the Little Things That Count," and "The Chasm of Us Versus Them." Families' and staff's ideas of behaviors that support or undermine relationships are identified, as are concrete suggestions for improving family- staff relationships in traditional continuing care settings in Canada.
Spigolon, Dandara Novakowski; Moro, Claudia Maria Cabral
This study aimed to develop an Essential Data Set for Nursing Care of Patients with Endometriosis (CDEEPE), represented by archetypes. An exploratory applied research with specialists' participation that was carried out at Heath Informatics Laboratory of PUCPR, between February and November of 2010. It was divided in two stages: CDEEPE construction and evaluation including Nursing Process phases and Basic Human Needs, and archetypes development based on this data set. CDEEPE was evaluated by doctors and nurses with 95.9% of consensus and containing 51 data items. The archetype "Perception of Organs and Senses" was created to represents this data set. This study allowed identifying important information for nursing practices contributing to computerization and application of nursing process during care. The CDEEPE was the basis for archetype creation, that will make possible structured, organized, efficient, interoperable, and semantics records.
Canally, Culum; Doherty, Sean; Doran, Diane M; Goubran, Rafik A
The growing need to gain efficiencies within a home care setting has prompted home care practitioners to focus on health informatics to address the needs of an aging clientele. The remote and heterogeneous nature of the home care environment necessitates the use of non-intrusive client monitoring and a portable, point-of-care graphical user interface. Using a grounded theory approach, this article examines the simulated use of a graphical user interface by practitioners in a home care setting to explore the salient features of monitoring the activity of home care clients. The results demonstrate the need for simple, interactive displays that can provide large amounts of geographical and temporal data relating to patient activity. Additional emerging themes from interviews indicate that home care professionals would use a graphical user interface of this type for patient education and goal setting as well as to assist in the decision-making process of home care practitioners.
Abstract Objective To explore the experiences and clinical challenges that nurses and nursing assistants face when providing high-quality diabetes-specific management and care for elderly people with diabetes in primary care settings. Design Focus-group interviews. Subjects and setting Sixteen health care professionals: 12 registered nurses and four nursing assistants from nursing homes (10), district nursing service (5), and a service unit (1) were recruited by municipal managers who had local knowledge and knew the workforce. All the participants were women aged 32–59 years with clinical experience ranging from 1.5 to 38 years. Results Content analysis revealed a discrepancy between the level of expertise which the participants described as important to delivering high-quality care and their capacity to deliver such care. The discrepancy was due to lack of availability and access to current information, limited ongoing support, lack of cohesion among health care professionals, and limited confidence and autonomy. Challenges to delivering high-quality care included complex, difficult patient situations and lack of confidence to make decisions founded on evidence-based guidelines. Conclusion Participants lacked confidence and autonomy to manage elderly people with diabetes in municipal care settings. Lack of information, support, and professional cohesion made the role challenging. PMID:24205973
Ratzliff, Anna; Phillips, Kathryn E.; Sugarman, Jonathan R.; Unützer, Jürgen; Wagner, Edward H.
Behavioral health problems are common, yet most patients do not receive effective treatment in primary care settings. Despite availability of effective models for integrating behavioral health care in primary care settings, uptake has been slow. The Behavioral Health Integration Implementation Guide provides practical guidance for adapting and implementing effective integrated behavioral health care into patient-centered medical homes. The authors gathered input from stakeholders involved in behavioral health integration efforts: safety net providers, subject matter experts in primary care and behavioral health, a behavioral health patient and peer specialist, and state and national policy makers. Stakeholder input informed development of the Behavioral Health Integration Implementation Guide and the GROW Pathway Planning Worksheet. The Behavioral Health Integration Implementation Guide is model neutral and allows organizations to take meaningful steps toward providing integrated care that achieves access and accountability. PMID:26698163
Elmore, James L.
Dissociative disorders have a lifetime prevalence of about 10%. Dissociative symptoms may occur in acute stress disorder, posttraumatic stress disorder, somatization disorder, substance abuse, trance and possession trance, Ganser's syndrome, and dissociative identity disorder, as well as in mood disorders, psychoses, and personality disorders. Dissociative symptoms and disorders are observed frequently among patients attending our rural South Carolina community mental health center. Given the prevalence of mental illness in primary care settings and the diagnostic difficulties encountered with dissociative disorders, such illness may be undiagnosed or misdiagnosed in primary care settings. We developed an intervention model that may be applicable to primary care settings or helpful to primary care physicians. Key points of the intervention are identification of dissociative symptoms, patient and family education, review of the origin of the symptoms as a method of coping with trauma, and supportive reinforcement of cognitive and relaxation skills during follow-up visits. Symptom recognition, Education of the family, Learning new skills, and Follow-up may be remembered by the mnemonic device SELF. We present several cases to illustrate dissociative symptoms and our intervention. Physicians and other professionals using the 4 steps and behavioral approaches will be able to better recognize and triage patients with dissociative symptoms. Behaviors previously thought to be secondary to psychosis or personality disorders may be seen in a new frame of reference, strengthening the therapeutic alliance while reducing distress and acting-out behaviors. PMID:15014580
Sivaranjini, R; Jaisankar, TJ; Thappa, Devinder Mohan; Kumari, Rashmi; Chandrasekhar, Laxmisha; Malathi, M; Parija, SC; Habeebullah, S
Introduction: Vaginal discharge is one of the common reasons for gynecological consultation. Many of the causes of vaginitis have a disturbed vaginal microbial ecosystem associated with them. Effective treatment of vaginal discharge requires that the etiologic diagnosis be established and identifying the same offers a precious input to syndromic management and provides an additional strategy for human immunodeficiency virus prevention. The present study was thus carried out to determine the various causes of vaginal discharge in a tertiary care setting. Materials and Methods: A total of 400 women presenting with vaginal discharge of age between 20 and 50 years, irrespective of marital status were included in this study and women who had used antibiotics or vaginal medication in the previous 14 days and pregnant women were excluded. Results: Of the 400 women with vaginal discharge studied, a diagnosis was established in 303 women. Infectious causes of vaginal discharge were observed in 207 (51.75%) women. Among them, bacterial vaginosis was the most common cause seen in 105 (26.25%) women. The other infections observed were candidiasis alone (61, 15.25%), trichomoniasis alone (12, 3%), mixed infections (22, 5.5%) and mucopurulent cervicitis (7 of the 130 cases looked for, 8.46%). Among the non-infectious causes, 72 (18%) women had physiological vaginal discharge and 13 (3.3%) women had cervical in situ cancers/carcinoma cervix. Conclusion: The pattern of infectious causes of vaginal discharge observed in our study was comparable with the other studies in India. Our study emphasizes the need for including Papanicolaou smear in the algorithm for evaluation of vaginal discharge, as it helps establish the etiology of vaginal discharge reliably and provides a valuable opportunity to screen for cervical malignancies. PMID:24470998
Moore, Tara L; Killiany, Ronald J; Herndon, James G; Rosene, Douglas L; Moss, Mark B
Understanding the nature of changes in cognition with aging has increased in importance as the number of individuals over the age of 65 years grows. To date, studies have demonstrated that age-related changes occur most extensively in the cognitive domains of memory and executive function. Whereas a large number of studies have been conducted about the effects of aging on memory, far less have explored the effects of aging on the so called "executive function" which include abilities essential for successful performance of higher level activities of daily living. As part of our ongoing effort to better characterize these changes, we assessed executive function in a non-human primate model of normal human aging using the Conceptual Set Shifting Task (CSST). This recently developed task assesses abstraction, concept formation and set shifting in the monkey in a way analogous to the Wisconsin Card Sorting Test (WCST) in humans. Relative to young adult monkeys, aged monkeys evidenced significant difficulty in both acquisition and performance on this task, and moreover, demonstrated a high degree of perseverative responding. The pattern of performance displayed by the aged monkeys suggests an age-related decline in prefrontal cortex (PFC) functioning.
Kumar, Chandrika; Bensadon, Benjamin A.; Van Ness, Peter H.; Cooney, Leo M.
Most geriatric care is provided in non-hospital settings. Internal Medicine and Family Medicine residents should therefore learn about these different clinical sites and acuity levels of care. To help facilitate this learning, a geriatrics training curriculum for internal medicine residents was developed that focused on cognition, function, goals…
Khatutsky, Galina; Anderson, Wayne L; Wiener, Joshua M
We analyzed survey data from 2,325 Medicaid home and community-based services (HCBS) beneficiaries in six States to estimate satisfaction with personal care services. We constructed an eight-item scale rating various aspects of paid assistance and estimated satisfaction for the total sample and for older and younger persons with disabilities. Younger persons with significant health problems and those residing in group settings were less satisfied. Higher unmet need for assistance with activities of daily living (ADLs), and instrumental activities of daily living (IADLs) was associated with decreased satisfaction, and matching race between a client and paid caregiver was associated with significantly increased satisfaction in all age groups.
Karantzas, Gery C.; Mellor, David; McCabe, Marita P.; Davison, Tanya E.; Beaton, Paul; Mrkic, Dejan
Purpose of the Study: The aged care industry experiences high rates of staff turnover. Staff turnover has significant implications for the quality of care provided to care recipients and the financial costs to care agencies. In this study, we applied a model of intention to quit to identify the contextual and personal factors that shape aged care…
Bradley-Springer, Lucy; Kang Dufour, Mi-Suk; Koester, Kimberly A.; Beane, Stephanie; Warren, Nancy; Beal, Jeffrey; Frank, Linda Rose
Objectives. We examined the efforts of the US network of AIDS Education and Training Centers (AETCs) to increase HIV testing capacity across a variety of clinical settings. Methods. We used quantitative process data from 8 regional AETCs for July 1, 2008, to June 30, 2009, and qualitative program descriptions to demonstrate how AETC education helped providers integrate HIV testing into routine clinical care with the goals of early diagnosis and treatment. Results. Compared with other AETC training, HIV testing training was longer and used a broader variety of strategies to educate more providers per training. During education, providers were able to understand their primary care responsibility to address public health concerns through HIV testing. Conclusions. AETC efforts illustrate how integration of the principles of primary care and public health can be promoted through professional training. PMID:22515867
... skin care products Dermatologists share their insider tips Shopping for an anti-aging skin care product can ... every day can make a noticeable difference. When shopping for sunscreen, select one that offers all of ...
Provisional NQF (n=13) ANA (n=10) Death in low mortality DRG X Decubitus /pressure ulcer X X X Failure to rescue X X X Infection due to medical care X...overlap in these measure sets, with the exception of decubitus /pressure ulcer and failure to rescue. Caution should be taken since the measure intent...patient falls, pressure ulcers , and mortality, with increasing detail in measure specification.11 For example, nosocomial infections are broken down into
Clark, Melinda B; Slayton, Rebecca L
Dental caries remains the most common chronic disease of childhood in the United States. Caries is a largely preventable condition, and fluoride has proven effectiveness in the prevention of caries. The goals of this clinical report are to clarify the use of available fluoride modalities for caries prevention in the primary care setting and to assist pediatricians in using fluoride to achieve maximum protection against dental caries while minimizing the likelihood of enamel fluorosis.
Payne, Sarah; Cole, Elaine
Many patients with minor burns present at emergency departments and urgent care centres, where their management is often undertaken by experienced nurses rather than experts in treating burns. This article describes a small study of the clinical decision making that underpins nurses' management of minor burns in these non-specialist settings. The results suggest that, due to a lack of relevant research, nurses base their decisions on previous experience or expert colleagues' opinions and advice rather than on the evidence.
Marsden, Janet; Davies, Richard
Rationale and key points Eye care is an important aspect of the nursing management of patients who are critically ill. All patients in acute care settings with absent or compromised eye defence mechanisms are at risk of eye complications and ocular surface disease. This article aims to assist nurses to care for the eyes of patients in critical care settings to enable early detection and routine management of ophthalmic issues, thereby avoiding visual compromise on patient discharge from critical care settings. » Corneal exposure is reported to occur in many patients who are critically ill. » Incomplete eyelid closure and lack of lubrication are the main mechanisms that underlie the development of corneal damage in patients who are critically ill. » Unconscious, sedated and/or paralysed patients and those with a reduced Glasgow Coma Scale score depend on healthcare professionals to maintain their ocular surface to prevent complications such as corneal abrasion, infection and ulceration, perforations and blindness. » Meticulous nursing care is required to prevent ophthalmic complications that can result from corneal exposure in this patient group. Regular, evidence-based eye care should be part of routine nursing practice for patients who are critically ill. Reflective activity 'How to' articles can help you update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: 1. How this article might change your practice? 2. How you could use this resource to educate your colleagues in eye care of the unconscious patient?
Robinson, Andrew; See, Catherine; Lea, Emma; Bramble, Marguerite; Andrews, Sharon; Marlow, Annette; Radford, Jan; McCall, Michael; Eccleston, Claire; Horner, Barbara; McInerney, Fran
This paper reports on the design of a program that aims to prototype teaching aged care facilities in Australia. Beginning in two Tasmanian residential aged care facilities, the intent of the program is to support large-scale inter-professional student clinical placements, positively influence students' attitudes toward working in aged care and drive development of a high-performance culture capable of supporting evidence-based aged care practice. This is important in the context of aged care being perceived as an unattractive career choice for health professionals, reinforced by negative clinical placement experiences. The Teaching Aged Care Facilities Program features six stages configured around an action research/action learning method, with dementia being a key clinical focus.
Bähler, Caroline; Signorell, Andri; Reich, Oliver
Background Many efforts are undertaken in Switzerland to enable older and/or chronically ill patients to stay home longer at the end-of-life. One of the consequences might be an increased need for hospitalisations at the end-of-life, which goes along with burdensome transitions for patients and higher health care costs for the society. Aim We aimed to examine the health care utilisation in the last six months of life, including transitions between health care settings, in a Swiss adult population. Methods The study population consisted of 11'310 decedents of 2014 who were insured at the Helsana Group, the leading health insurance in Switzerland. Descriptive statistics were used to analyse the health care utilisation by age group, taking into account individual and regional factors. Zero-inflated Poisson regression model was used to predict the number of transitions. Results Mean age was 78.1 in men and 83.8 in women. In the last six months of life, 94.7% of the decedents had at least one consultation; 61.6% were hospitalised at least once, with a mean length of stay of 28.3 days; and nursing home stays were seen in 47.4% of the decedents. Over the same time period, 64.5% were transferred at least once, and 12.9% experienced at least one burdensome transition. Main predictors for transitions were age, sex and chronic conditions. A high density of home care nurses was associated with a decrease, whereas a high density of ambulatory care physicians was associated with an increase in the number of transitions. Conclusions Health care utilisation was high in the last six months of life and a considerable number of decedents were being transferred. Advance care planning might prevent patients from numerous and particularly from burdensome transitions. PMID:27598939
The gap between rich and resource-poor countries has continued to grow as reproductive care providers integrate interventions to limit mother-to-child transmission (MTCT) of HIV in a manner consistent with existing information. There are two major reasons for this difference: access to prophylactic antiretroviral therapy (ARV) for HIV-infected pregnant mothers and availability of alternative feeding for babies. In resource-poor settings, these options are beyond reach for the majority of the women. Infant and under-five mortality rates from other infections are high in these settings and breastfeeding remains the norm. Answering the question, What is an achievable standard of care in resource-poor settings? still remains a major challenge today. Dialogue has begun in most resource-poor settings to address the key elements in the package of interventions to reduce MTCT of HIV. These elements include the following: (1) overall prevention of HIV in mothers and fathers; (2) provision of good-quality voluntary testing and counseling (VCT) in antenatal clinics; (3) a comprehensive package of interventions during pregnancy, during labor, and after delivery, including screening for sexually transmitted diseases (STDs), family planning, and--where possible--ARVs; (4) provision of infant and maternal nutrition within the socioeconomic realities; (5) advocacy and program communication; and (6) other supportive measures, including community mobilization to address issues such as stigmatization of and violence against HIV-infected women. This paper discusses the challenges faced by most resource-poor settings in integrating some of these activities into reproductive care services.
Byatt, Nancy; Levin, Leonard L.; Ziedonis, Douglas; Moore Simas, Tiffany A.; Allison, Jeroan
Objective To examine a wide range of study designs and outcomes to estimate the extent to which interventions in outpatient perinatal care settings are associated with an increase in the uptake of depression care. Data Sources PubMed, CINAHL, PsycINFO, ClinicalTrials.gov, and Scopus (EMBASE) were searched for studies published between 1999 and 2014 that evaluated mental health care use after screening for depression in perinatal care settings. Methods of Study Selection Inclusion criteria were: 1) English language; 2) pregnant and postpartum women who screened positive for depression; 3) exposure (validated depression screening in outpatient perinatal care setting); and, 4) outcome (mental health care use). Searches yielded 392 articles, 42 met criteria for full text review, and 17 met inclusion criteria. Study quality was assessed using a modified Downs and Black scale. Tabulation, Integration, and Results Articles were independently reviewed by two abstractors and consensus reached. Study design, intervention components and mental health care use were defined and categorized. Seventeen articles representing a range of study designs, including one randomized controlled trial (RCT) and one cluster RCT, were included. The average quality rating was 61% (31.0-90.0%). When no intervention was in place, an average of 22% (13.8-33.0%) of women who screened positive for depression had at least one mental health visit. The average rate of mental health care use was associated with a doubling of this rate with patient engagement strategies (44%, 29.0-90.0%), on-site assessments (49%, 25.2-90.0%), and perinatal care provider training (54%, 1.0-90.0%). High rates of mental health care use (81%, 72.0-90.0%) was associated with implementation of additional interventions, including resource provision to women, perinatal care provider training, on-site assessment, and access to mental health consultation for perinatal care providers. Conclusion Screening alone was associated
Borgès Da Silva, Roxane; Contandriopoulos, André-Pierre; Pineault, Raynald; Tousignant, Pierre
Abstract Objective To define a physician classification system based on practice settings and to analyze the service provision associated with those classifications. Design A cross-sectional, retrospective study. Setting Province of Quebec. Participants All GPs in Quebec in 2002 who had been practising for at least 2 years. Main outcome measures Practice setting variables were based on physician income in the different settings. Service provision was assessed using indicators related to continuity, comprehensiveness, accessibility, and productivity of services provided by the GPs. A multiple correspondence analysis with ascending hierarchical classification was conducted to construct the taxonomy of GPs based on their practice settings. Results Our study produced 7 practice setting models. Two were essentially single-practice models. The 5 others combined several settings. Service provision varied from one model to another. Continuity was greater in the private practice model, in which older GPs were predominant, while accessibility was greater in multi-institutional practice models, in which younger GPs were more active. Conclusion To ensure balance between continuity, accessibility, and comprehensiveness in primary care services provided by GPs, it is important to consider the service provision associated with different practice models. PMID:25316763
Hall, Nicole; Hipple, Bethany; Friebely, Joan; Ossip, Deborah J.; Winickoff, Jonathan P.
Objective To discuss strategies for integrating evidence-based tobacco use screening, cessation assistance, and referral to outside services into visits with families in outpatient child health care settings. Methods Presentation of counseling scenarios used in the Clinical Effort Against Secondhand Smoke Exposure (CEASE) training video and commentary. Results Demonstrated strategies include: eliciting information about interest and readiness to quit smoking, respectfully setting an agenda to discuss smoking, tailoring advice and education to the specific circumstances, keeping the dialogue open, prescribing cessation medication, helping the smoker set an action plan for cessation, enrolling the smoker in free telephone counseling through the state quitline, and working with family members to establish a completely smoke-free home and car. Video demonstrations of these techniques are available at www.ceasetobacco.org. Conclusion Child health care clinicians have a unique opportunity to address family smoking and can be most effective by adapting evidence-based tobacco cessation counseling strategies for visits in the pediatric setting. PMID:20448841
Leigh, Andrew James; O'Hanlon, Katie; Sheldrick, Russell; Surr, Claire; Hare, Dougal Julian
Person-centred care can improve the well-being of patients and is therefore a key driver in healthcare developments in the UK. The current study aims to investigate the complex relationship between cognitive impairment, dependency and well-being in people with a wide range of acquired brain and spinal injuries. Sixty-five participants, with varied acquired brain and spinal injuries, were selected by convenience sampling from six inpatient clinical neuroscience settings. Participants were observed using Dementia Care Mapping - Neurorehabilitation (DCM-NR) and categorised based on severity of cognitive impairment. A significant difference in the behaviours participants engaged in, their well-being and dependency was found between the severe cognitive impairment group and the mild, moderate or no cognitive impairment groups. Dependency and cognitive impairment accounted for 23.9% of the variance in well-ill-being scores and 17.2% of the variance in potential for positive engagement. The current study highlights the impact of severe cognitive impairment and dependency on the behaviours patients engaged in and their well-being. It also affirms the utility of DCM-NR in providing insights into patient experience. Consideration is given to developing DCM-NR as a process that may improve person-centred care in neuroscience settings.
Kollef, Marin H
Antibiotics are one of the most common therapies administered in the intensive care unit setting. In addition to treating infections, antibiotic use contributes to the emergence of resistance among pathogenic microorganisms. Therefore, avoiding unnecessary antibiotic use and optimizing the administration of antimicrobial agents will help to improve patient outcomes while minimizing further pressures for resistance. This review will present several strategies aimed at achieving optimal use of antimicrobial agents. It is important to note that each intensive care unit should have a program in place which monitors antibiotic utilization and its effectiveness. Only in this way can the impact of interventions aimed at improving antibiotic use (e.g. antibiotic rotation, de-escalation therapy) be evaluated at the local level. PMID:11511331
Bush, Matthew L; Alexander, David; Noblitt, Bryce; Lester, Cathy; Shinn, Jennifer B
Diagnosis and intervention for infant hearing loss is often delayed in areas of healthcare disparity, such as rural Appalachia. Primary care providers play a key role in timely hearing healthcare. The purpose of this study was to assess the practice patterns of rural primary care providers (PCPs) regarding newborn hearing screening (NHS) and experiences with rural early hearing diagnosis and intervention programs in an area of known hearing healthcare disparity. Cross sectional questionnaire study. Appalachian PCP's in Kentucky were surveyed regarding practice patterns and experiences regarding the diagnosis and treatment of congenital hearing loss. 93 Appalachian primary care practitioners responded and 85% reported that NHS is valuable for pediatric health. Family practitioners were less likely to receive infant NHS results than pediatricians (54.5 versus 95.2%, p < 0.01). A knowledge gap was identified in the goal ages for diagnosis and treatment of congenital hearing loss. Pediatrician providers were more likely to utilize diagnostic testing compared with family practice providers (p < 0.001). Very rural practices (Beale code 7-9) were less likely to perform hearing evaluations in their practices compared with rural practices (Beale code 4-6) (p < 0.001). Family practitioners reported less confidence than pediatricians in counseling and directing care of children who fail newborn hearing screening. 46% felt inadequately prepared or completely unprepared to manage children who fail the NHS. Rural primary care providers face challenges in receiving communication regarding infant hearing screening and may lack confidence in directing and providing rural hearing healthcare for children.
Yury, Craig A
The purpose of this case study was to examine the potential of using noncontingent reinforcement (NCR) to reduce the frequency of disruptive behaviors of three elderly persons in personal care home (PCH) settings. Assessment indicated that participants were engaging in the disruptive behaviors to obtain social attention from PCH staff. Social attention, up to 1 min of staff making eye contact with the participant and directing positive verbal statements toward the participant, was given on a fixed time interval (from morning through early evening) beginning every 20 min and fading to every 30 min. Results indicate that NCR reduced the frequency of the disruptive behaviors.
Jordans, Mark J D; Tol, Wietse A
Mental health in low- and middle income countries has received increasing attention. This attention has shifted focus, roughly moving from demonstrating the burden of mental health problems, to establishing an evidence base for interventions, to thinking about care delivery frameworks. This paper reviews these trends specifically for humanitarian settings and discusses lessons learned. Notably, that mental health assessments need to go beyond measuring the impact of traumatic events on circumscribed psychiatric disorders; that evidence for effectiveness of interventions is still too weak and its focus too limited; and that development of service delivery in the context of instable community and health systems should be an area of key priority.
Skin-to-skin contact, or kangaroo care (KC), has benefits for babies and parents, improving clinical outcomes, temperature control, breastfeeding rates and child-parent bonding; it reduces morbidity and mortality. Barriers to KC for neonates may include a lack of training for nurses, lack of time, maternal or child physical or mental ill health, and inappropriate settings. With education and helpful management, neonatal nurses can advocate for KC for all babies. Parents may need information and encouragement to begin with. Therefore, nurses can improve the experiences of their patients and, in the long run, free time to perform clinical procedures.
Prescott, Elizabeth; Milich, Cynthia
This report on group day care is designed to: (1) examine the kinds of group programs for school-age children which exist in Los Angeles County, (2) describe the conditions necessary for program operation, and (3) consider the issue of quality as it relates to community expansion of day care services for children of school age. The report is…
McCabe, Marita P.; Davison, Tanya; Mellor, David; George, Kuruvilla
The current study evaluated barriers to detection of depression among older people. Focus groups were conducted with 21 professional carers, 4 nurses, 10 general practitioners, and 7 aged care managers. The results demonstrated that care for older people is primarily focused on physical care. Further, staff resources, a lack of continuity of care,…
In this electronically wired world of the 21 st century, the health care system has tapped into technology available at the touch of a button. Scientific discoveries, high-tech equipment, electronic medical records, Smarticards, and long distance diagnosis using telehealth technology have all been embraced. But Natalie Dragon asks, what are the implications for nurses and the outcomes on patient care?
Costin, Lela B.; And Others
This paper examines child day care needs and ways that federal and state approaches to day care standard setting and enforcement might be improved. Chapter I documents the magnitude of child day care needs, citing Department of Labor, Census, and other survey statistics on the numbers of children needing day care and the number of day care centers…
Loader, S.; Caldwell, P.; Kozyra, A.; Levenkron, J. C.; Boehm, C. D.; Kazazian, H. H.; Rowley, P. T.
To determine the receptivity of prenatal care providers and their patients to carrier testing for cystic fibrosis (CF), we offered free carrier screening, followed by genetic counseling of carriers, to all prenatal care providers in Rochester, NY, for all their female patients of reproductive age, pregnant or not. Of 124 prenatal care providers, only 37 elected to participate, but many of these offered screening only to pregnant women. The acceptance rate among pregnant women was approximately 57%. The most common reasons for accepting screening were to obtain reassurance (50.7%) and to avoid having a child with CF (27.8 %). The most common reasons for declining screening were not intending to terminate a pregnancy for CF (32.4%) and believing that the chance of having a CF child was very low (32.2%). Compared with decliners, acceptors were more likely to have no children, regarded having a child with CF as more serious, believed themselves more susceptible to having such a child, knew more about CF, would be more likely to terminate a pregnancy if the fetus were shown to have CF, and more strongly supported offering CF screening to women of reproductive age. Of 4,879 women on whom results were obtained, 124 were found to be carriers. Of these 124 carriers, the partners of 106 were tested. Of the five at-risk couples, four requested prenatal diagnosis and one requested neonatal diagnosis. No woman found to be a carrier whose partner tested negative requested prenatal diagnosis. Except for the imperfect knowledge of those testing negative, none of the adverse outcomes predicted for CF carrier testing in the general population were observed in this study. Images p236-a p236-b p236-c PMID:8659530
Schaper, Elizabeth; Padwa, Howard; Urada, Darren; Shoptaw, Steven
The Affordable Care Act (ACA) expands health insurance coverage for substance use disorder (SUD) treatment, underscoring the value of improving SUD service integration in primarily physical health care settings. It is not yet known to what degree specialized privacy regulations-Code of Federal Regulations Title 42, Part 2 (42 CFR Part 2), in particular-will affect access to or the utilization and delivery of SUD treatment in primary care. In addition to exploring the emerging benefits and barriers that specialized confidentiality regulations pose to treatment in early adopting integrated health care settings, this article introduces and explicates 42 CFR Part 2 to support provider and administrator implementation of SUD privacy regulations in integrated settings. The authors also argue that, although intended to protect patients with SUD, special SUD information protection may inadvertently reinforce stigma against patients by purporting the belief that SUD is different from other health problems and must be kept private. In turn, this stigma may inhibit the delivery of comprehensive integrated care.
Nöstlinger, Christiana; Rojas Castro, Daniela; Platteau, Tom; Dias, Sonia; Le Gall, Jean
This cross-sectional European study assessed self-reported HIV-related discrimination and its associated factors in health care settings. Socio-demographics, health status, support needs relating to sexual and reproductive health (SRH), and self-reported HIV-related discrimination were measured using an anonymous survey in a sample of 1549 people living with HIV from 14 countries. Thirty-two per cent of the participants had experienced HIV-related discrimination during the previous 3 years; almost half of them felt discriminated against by health care providers. For this type of discrimination, logistic regression analysis revealed significant associations with not being a migrant (OR: 2.0; IC 1.0-3.7; p<0.05), having been forced into sexual activities (OR: 1.6; IC 1.2-2.2; p<0.001), reporting lack of time to discuss SRH during service provision (OR: 1.7; IC 1.0-2.7; p<0.05), and insufficient openness among service providers to discuss SRH (OR: 2.0; IC 1.1-3.4; p<0.05). Other significant associations related to unmet support needs on safer sex practices (OR: 1.8; IC 1.0-3.2; p<0.05), partner communication about sexuality (OR: 2.0; IC 1.1-3.4; p<0.05), and prevention of sexually transmitted infections (OR: 1.7; IC 1.0-3.0; p<0.05). Female gender had a protective effect (OR: 0.2; IC 0.0-0.9; p<0.05). Being denied the opportunity to discuss SRH may translate in feelings of discrimination. Improving health care providers' communication skills, and fostering openness about SRH topics in HIV care could contribute to destigmatization of PLHIV.
Rojas Castro, Daniela; Platteau, Tom; Dias, Sonia; Le Gall, Jean
Abstract This cross-sectional European study assessed self-reported HIV-related discrimination and its associated factors in health care settings. Socio-demographics, health status, support needs relating to sexual and reproductive health (SRH), and self-reported HIV-related discrimination were measured using an anonymous survey in a sample of 1549 people living with HIV from 14 countries. Thirty-two per cent of the participants had experienced HIV-related discrimination during the previous 3 years; almost half of them felt discriminated against by health care providers. For this type of discrimination, logistic regression analysis revealed significant associations with not being a migrant (OR: 2.0; IC 1.0–3.7; p<0.05), having been forced into sexual activities (OR: 1.6; IC 1.2–2.2; p<0.001), reporting lack of time to discuss SRH during service provision (OR: 1.7; IC 1.0–2.7; p<0.05), and insufficient openness among service providers to discuss SRH (OR: 2.0; IC 1.1–3.4; p<0.05). Other significant associations related to unmet support needs on safer sex practices (OR: 1.8; IC 1.0–3.2; p<0.05), partner communication about sexuality (OR: 2.0; IC 1.1–3.4; p<0.05), and prevention of sexually transmitted infections (OR: 1.7; IC 1.0–3.0; p<0.05). Female gender had a protective effect (OR: 0.2; IC 0.0–0.9; p<0.05). Being denied the opportunity to discuss SRH may translate in feelings of discrimination. Improving health care providers' communication skills, and fostering openness about SRH topics in HIV care could contribute to destigmatization of PLHIV. PMID:24568694
Thompson, S C
An increase in the number of preschool children cared for within groups in child care centres has been associated with increasing numbers of women in the workforce. Children at this age are at high risk for gastrointestinal diseases caused by a large number of enteric pathogens, and the risk is increased by the greater potential for person-to-person transmission within group care. This report considers the pathogens that may cause diarrhoeal illness in children, with particular reference to those that have been reported in formal day care settings. The major risk factors for transmission of these agents and a high rate of diarrhoeal illness in the child care setting include attendance of non-toilet-trained children, staff combining nappy changing and food preparation duties, large enrollment, low staff-to-child ratio, and poor hygiene and child handling practices. Investigations undertaken during an outbreak of diarrhoea have frequently used limited diagnostic testing, often suitable for identifying only bacterial and protozoal agents. Such limited investigations have tended to incriminate agents that have prolonged carriage and are easily identifiable in standard microbiology laboratories. Finding a pathogen in these circumstances needs to be interpreted with caution. Prevention and control measures include training and education in good personal hygiene, emphasis on the need for frequent handwashing, separation of change areas from food handling and eating areas, routine cleaning and disinfection of environmental surfaces and personal items, and exclusion of any child or child care worker with diarrhoea.
Creating an environment in which patient's responsibility for self is fostered and nurses can practice professional and autonomous nursing practice is a challenge in today's hospitals. Innovative systems and structures need to be developed to assure quality of patient care and a high quality work environment. Newark Beth Israel Medical Center responded to the many demands of the mid-1980s, including increasing acuity of patients hospitalized, personnel shortages in nursing, physical therapy and other disciplines, and diminishing dollars available to the health care institution, through the creation of Self-Care Units. This article reviews how they came about, the way in which Self-Care Units function within the acute care setting and the management philosophy and structure which make them work. The experience at Newark Beth Israel Medical Center demonstrates that the potential exists to put control back at the bedside with the patient and the health care team working with the patient to achieve mutual goals. The focus of care has shifted from a "doing for" to a "working with" patients to identify interventions which promote active participation in hospitalization and a sense of self responsibility.
Schewe, C D; Spotts, H E
The health-care marketplace is aging by leaps and bounds and bringing with it new and different medical needs. As costs soar and public assistance programs dwindle in impact, health-care providers will need better marketing strategies to bring treatments to patients/consumers. This article looks at the research findings of behavioral scientists and offers guidelines for effective communication with aging audiences. Health-care providers can use these findings to design more effective advertising, promotional brochures, newsletters, and a host of other communication tools targeted at an older market. Health-care managers and other professionals should find the guidelines useful in their daily interactions with patients and colleagues.
Wade, Gail Holland; Herrman, Judy; McBeth-Snyder, Lisa
Preconception healthcare is a way to enhance positive pregnancy outcomes by encouraging women to engage in healthy lifestyles before they become pregnant. Because approximately 50% of pregnancies are unplanned, fetal development may be affected before a woman receives prenatal care. Young women are especially vulnerable to poor outcomes due to risky behaviors. Education about preconception health is not common practice. This article describes a peer education preconception health program for college women that provided a basis for an expanded program with larger, more diverse populations. Nursing students as peer educators presented the program to over 100 young women using the mnemonic REFRAMED PLUS to address eight preconception risk areas and reproductive life planning. Materials to augment the program, developed by peer educators, included a brochure on preconception health, a risk assessment tool, a DVD with stories of young women who experienced unplanned pregnancies, and a Reproductive Life Plan book. Peer educators administered a pretest, showed the DVD, guided discussions, assessed each woman's health risks and administered a posttest. The risk assessment revealed that young women have several preconception health risks. Following the preconception program, posttest scores indicated increased knowledge of preconception health. For preconception healthcare to be successful, preconception risk assessments, education and counseling must be addressed by nurses every time a young woman receives care. When possible, peer educators should be used to disseminate the message to all women of childbearing age.
McCabe, Margaret; Patricia, Branowicki
Nurses commonly assess their patients for symptoms and intervene to ease any patient distress, yet children are seldom asked about feeling fatigued. The existing pediatric literature suggests that fatigue goes unrecognized and therefore untreated in children, particularly children experiencing stressful events, such as illness and/or hospitalization. In an effort to better understand the presence of the symptom in our environment we conducted a program specific point prevalence survey. Data were collected on nine inpatient and 11 outpatient units of a university affiliated tertiary care children's hospital. Overall, this sample reported higher levels of fatigue than published data from their healthy and chronically ill peers by total fatigue score and sub scores. This brief description of the symptom in our inpatient and ambulatory settings has provided information that will inform our nursing practice and drive future research.
Kurre, Paula A
The role of the nurse as care coordinator is important in all patient populations, including orthopaedic settings, and is essential in promoting safe patient care for the intellectually and developmentally disabled (I/DD) person living in the residential setting. Care coordination for this population is challenging. Most healthcare providers, as well as nurses, are not familiar with the residential group home setting or with the special needs of this population, especially when presented with orthopaedic challenges. These factors, as well as funding issues, make for a "perfect storm" for care coordination. Educating nurses can help open the door to communication, smoother transitions, and collaboration among care coordinators in all settings.
School nurses are in a unique position to provide care for students with special health care needs in the school setting. The incidence of chronic conditions and improved technology necessitate care of complex health care needs that had formerly been managed in inpatient settings. Delegation is a tool that may be used by registered nurses to allow…
Langhan, Melissa L; Riera, Antonio; Kurtz, Jordan C; Schaeffer, Paula; Asnes, Andrea G
Technologies are not always successfully implemented into practice. This study elicited experiences of acute care providers with the introduction of technology and identified barriers and facilitators in the implementation process. A qualitative study using one-on-one interviews among a purposeful sample of 19 physicians and nurses within 10 emergency departments and intensive care units was performed. Grounded theory, iterative data analysis and the constant comparative method were used to inductively generate ideas and build theories. Five major categories emerged: decision-making factors, the impact on practice, technology's perceived value, facilitators and barriers to implementation. Barriers included negative experiences, age, infrequent use and access difficulties. A positive outlook, sufficient training, support staff and user friendliness were facilitators. This study describes strategies implicated in the successful implementation of newly adopted technology in acute care settings. Improved implementation methods and evaluation of implementation processes are necessary for successful adoption of new technology.
Ewing, Whitney Merrill; Allen, Patricia Jackson
Cow milk protein intolerance (CMPI) affects 3% of infants under the age of 12 months and is often misdiagnosed as GERD or colic, risking dangerous exposure to antigens. Most infants out grow CMPI by 12 months; however, those with IgE-mediated reactions usually continue to be intolerant to cow's milk proteins and also develop other allergens including environmental allergens that cause asthmatic symptoms. Clinical manifestations of CMPI include diarrhea, bloody stools, vomiting, feeding refusal, eczema, atopic dermatitis, urticaria, angioedema, allergic rhinitis, coughing, wheezing, failure to thrive, and anaphylaxis. The research and literature showed that CMPI is easily missed in the primary care setting and needs to be considered as a cause of infant distress and clinical symptoms. This article focuses on correctly diagnosing CMPI and managing it in the primary care setting.
It is a challenge to provide experiences for nursing students that allow them to experience a professional relationship with older adults in the home setting. Home health agencies are under pressure related to productivity demands and may not provide preceptored experiences for students. Nursing students may not know any older adults outside of the institutional setting and consequently may have many misconceptions about what is and is not normal aging. This article describes an undergraduate nursing class and the out-of-classroom assignments that increased student understanding of nursing practice in the home, the effects of the home environment on the care of older adults, and the experiences of older adults living in the community. This article has relevance to nurses because it is important that we participate in creative methods of teaching students to value older adults and how to care for them in the community.
SCHRÖDER-BUTTERFILL, ELISABETH; FITHRY, TENGKU SYAWILA
The provision of physical care is a sensitive matter in all cultures and is circumscribed by moral injunctions and personal preferences. Research on Western cultures has shown care networks to be narrow subsets of people’s wider networks and revealed dependence to be deeply undermining of full personhood. In non-Western societies these issues have received little attention, although it is sometimes assumed that care provision and dependence are much less problematic. This paper uses longitudinal ethnographic data from two ethnic groups in rural Indonesia to compare care preferences and practices in old age and to examine the implications of care dependence. The groups manifest varying degrees of daughter preference in care and differ in the extent to which notions of shame and avoidance prohibit cross-gender intimate care and care by ‘non-blood’ relatives. Demographic and social constraints often necessitate compromises in actual care arrangements (e.g. dependence on in-laws, neighbours or paid carers), not all of which are compatible with quality care and a valued identity. We argue that by probing the norms and practices surrounding care provision in different socio-cultural settings, it becomes possible to arrive at a deeper understanding of kinship, personhood and sociality. These insights are not only of sociological interest but have implications for people’s vulnerability to poor quality care in old age. PMID:24518962
Heflin, Mitchell T
North Carolina's aging population will require a health care workforce prepared to meet patients' complex care needs. The keys to training this workforce include continuing to mobilize the state's educational infrastructure to provide interprofessional, community-based experiences and maximizing exposure to new models of care.
Doering, G T
The focus of the study was to prioritize six emergency medical service treatment factors in terms of their impact upon patient satisfaction in the prehospital setting. The six treatment areas analyzed were: EMS response time; medical care provided on scene; explanation of care by the provider; the provider's ability to reduce patient anxiety; the provider's ability to meet the patient's non-medical needs; and the level of courtesy/politeness shown by the EMS provider toward the patient. Telephone interviews were conducted with both patients and bystanders to obtain their perception of how well the system met their needs. The study analyzed how the six issues were rated and then evaluated the impact an individual's low score in a category had on that person's overall rating of the service provided. The overall satisfaction rating is not a calculated score, but an overall score specified by the respondent. The effect each issue had on the respondent's overall rating was determined by averaging the overall ratings for a category's low scorers, averaging the overall ratings for high scorers and then measuring the difference. Results of the study indicate that the factor with the greatest negative impact on patient satisfaction came from a perceived lack of crew courtesy and politeness. Respondents who indicated a fair to poor score in this category decreased their overall score by 60.2%. Ratings in other categories yielded the following results: When respondents rated the response time as fair to poor, their average overall rating showed an 18.4% decrease. When respondents rated the quality of medical care as fair to poor, their average overall rating showed a decrease of 22.6%. When the crew's ability to explain what was happening to the patient was rated as fair to poor, the average overall score dropped 33.6%. When the EMT's and medic's ability to reduce the patient's anxiety was rated fair to poor, average overall score declined by 32.6%. Finally, when the crew
Broussard, Brenda S; Broussard, Anne B
Nurses are increasingly using mobile and other devices, such as cell phones, smartphones, tablets, bar-coding scanners, monitoring equipment and bedside computers, to communicate with members of the health care team and with patients. Communication accomplished with such devices includes direct verbal communication, text-messaging, emailing, obtaining patient care information and accessing medical records for order entry and for documenting nursing care. Problems that could occur with such communication methods include distraction, errors, de-personalized care, violation of confidentiality and transmission of nosocomial pathogens. Policies are needed to prevent inappropriate use of technological devices in patient care and to promote patient safety and quality care with their use.
Project Kiddum functions in nine Mother and Child Health Care Centers in culturally deprived areas of Jerusalem. The project integrates a large scale infant intervention program into ongoing primary preventive mother and child health care. (Author/GC)
Polivka, Larry; Zayac, Helen
Since the early 1980s, service providers and area agencies on aging, that is, the aging network, have developed a number of strengths as they built a community-based long-term-care system in most states. Many area agencies and providers now have the capacity to assess the needs of older persons, identify appropriate services, and administer…
Dunn, Loraine; And Others
Examined how preschoolers' experiences with mixed-age peers in family child care homes affect development. Found that interaction with younger and same-age peers was associated with less complex social and cognitive play and lower receptive language scores. Interaction with older peers was related to more complex cognitive play. The setting…
Sanders, Scott R; Erickson, Lance D; Call, Vaughn R A; McKnight, Matthew L
This study assesses the prevalence of primary-care physician (PCP) bypass among rural middle-aged and older adults. Bypass is a behavior where people travel beyond local providers to obtain health care. This article applies a precise Geographic Information System (GIS)-based measure of bypass and examines the role of community and non-health-care-related characteristics on bypass. Our results indicate that bypass behavior among rural middle-aged and older adults is multifaceted. In addition to the perceived quality of local primary care, dissatisfaction with local services, such as shopping, creates an effect that increases the likelihood of bypass, whereas strong community ties decrease the likelihood of bypass. The results suggest that the "outshopping theory," where respondents select services in larger regional economic centers rather than local "mom and pop" providers, now extends to older adult health care selection.
Kotarba, Joseph A.
Addresses nontraditional health care issues by placing internship students in different health care agencies such as (1) workplace wellness programs; (2) centers for independent living for the physically handicapped; and (3) an Acquired Immune Deficiency Syndrome (AIDS) intervention program. Examines new problems in health care and the importance…
Gupta, D.; And Others
Although elder abuse has received much attention in recent years, little is known about long-term care staff perceptions of active and passive abuse. Health care professionals (N=72) responsible for direct care of patients within a 275-bed skilled nursing facility completed questionnaires on elder abuse. Responses were from physicians (N=6),…
Palese, Alvisa; Ambrosi, Elisa; Prosperi, Letizia; Guarnier, Annamaria; Barelli, Paolo; Zambiasi, Paola; Allegrini, Elisabetta; Bazoli, Letizia; Casson, Paola; Marin, Meri; Padovan, Marisa; Picogna, Michele; Taddia, Patrizia; Salmaso, Daniele; Chiari, Paolo; Marognolli, Oliva; Canzan, Federica; Gonella, Silvia; Saiani, Luisa
Missed nursing care (MNC), such as nursing care omitted or delayed, has not been measured in the Italian context where several cost containment interventions affect the care offered in medical units. The aim of the study is to identify the amount, type, and reasons for MNC in the Italian medical care setting and to explore the factors that affect the occurrence of MNC. A 3-month longitudinal survey was carried out followed by a cross-sectional study design in 12 north eastern acute medical units. A total of 314 nursing staff members were involved. Multivariate logistic regression was performed to identify the predictors of MNC. Patient ambulation (91.4 %), turning the patient every 2 h (74.2 %), and right timing in administering medications (64.6 %) were the most perceived MNC. Among the most frequent reasons were the unexpected rise in patient volume or critical conditions (95.2 %), inadequate numbers of staff (94.9 %), and large numbers of admissions/discharges (93.3 %). The R (2) 33.2 % of the variance in MNC were explained by a full-time position (OR 4.743, 95 % CI 1.146-19.629), communication tensions between Registered Nurses and Nurses' Aides (OR 1.601, 95 % CI 1.020-2.515), the amount of experience in medical unit (OR 1.564, 95 % CI 1.021-2.397), and the amount of daily care offered by Nurses' Aides (1.039, 95 % CI 1.011-1.067). A substantial amount of basic and clinically relevant nursing interventions was perceived to be missed, and this may lead to an increase in negative outcomes for patients admitted to a medical unit. Appropriate standards of nursing care should be adopted urgently in medical units aiming to protect frail patients.
Lee, Todd A.; Valenstein, Marcia; Weiss, Kevin B.
Background Patients with chronic obstructive pulmonary disorder (COPD) frequently have co-occurring depressive disorders and are often seen in multiple-care settings. Existing research does not assess the impact of care setting on delivery of evidence-based depression care for these patients. Objective To examine the prevalence of guideline-concordant depression treatment among these co-morbid patients, and to examine whether the likelihood of receiving guideline-concordant treatment differed by care setting. Design Retrospective cohort study. Patients A total of 5,517 veterans with COPD that experienced a new treatment episode for major depressive disorder. Measurements and Main Results Concordance with VA treatment guidelines for depression; multivariate analyses of the relationship between guideline-concordant depression treatment and care setting. More than two-thirds of the sample was over age 65 and 97% were male. Only 50.6% of patients had guideline-concordant antidepressant coverage (defined by the VA). Fewer than 17% of patients received guideline recommended follow-up (≥3 outpatient visits during the acute phase), and only 9.9% of the cohort received both guideline-concordant antidepressant coverage and follow-up visits. Being seen in a mental health clinic during the acute phase was associated with a 7-fold increase in the odds of receiving guideline-concordant care compared to primary care only. Patients seen in pulmonary care settings were also more likely to receive guideline-concordant care compared to primary care only. Conclusions Most VA patients with COPD and an acute depressive episode receive suboptimal depression management. Improvements in depression treatment may be particularly important for those patients seen exclusively in primary care settings. PMID:17687614
Roark, G A; Tucker, S L
Military health care leaders must recognize the importance of satisfied consumers. As part of this recognition, the focus of military medicine must change from a coercive-power to a reward-power system. This change highlights the need for business practices such as marketing. Encouraging military health care administrators to learn and understand the applications of the marketing variables will enhance demand management and health care delivery for beneficiaries. This paper describes some applications of marketing variables, informs the military health care administrator about the process of marketing, and describes the utility of marketing in the current paradigm shift in military health care delivery.
Clark, Shannon J; Parker, Rhian M; Davey, Rachel
Meeting the primary health care needs of an aging population is an increasing challenge for many Western nations. In Australia, the federal government introduced a program to develop, test, and evaluate nurse practitioner models in aged care settings. In this article, we present a documentary analysis of 32 project proposals awarded funding under the Nurse Practitioner-Aged Care Models of Practice Program. Successfully funded models were diverse and were operated by a range of organizations across Australia. We identified three key priorities as underlying the proposed models: "The right care," "in the right place," and "at the right time." In this article, we explore how these priorities were presented by different applicants in different ways. Through the presentation of their models, the program's applicants identified and proposed to address current gaps in health services. Applicants contrasted their proposed models with available services to create persuasive and competitive applications for funding.
Self-care is a central concept in health care and may be considered as a means to maintain, restore, and improve one’s health and well-being. When performed effectively, self-care contributes not only to human functioning but also to human structural integrity and human development (ie, to a dynamic and holistic state of health). Self-care as a clinical concept is relevant for health care professionals, and it should be meaningful to investigate it at a philosophical level and to further elaborate upon this concept. The aim of this article is to discuss and elaborate upon a phenomenological perspective on self-care in aging that is relevant for the health sciences. Self-care may be preliminarily regarded as a fundamental perspective for the conscious older individual, and as a way of being in the world with both the objective body and with the lived body. The lived body is the personal center of perception and the field of action, and it is also the center of self-care. The potentiality or ability for self-care activity and self-care activity itself are structures given to perception, with self-care ability as an integral part of the lived body. The actualization of self-care ability comes about through a certain meaning, which can be regarded as an important driving force. It is constituted by communication, a healthy lifestyle, and by building meaning and socializing. Successful self-care involves having contacts with the health care system, being conscious of a sound lifestyle, being physically and mentally active, being engaged, having social contacts with family and others, as well as being satisfied, positive, and being able to look forward. One fundamental cornerstone is serenity on behalf of the individual. Self-care can facilitate transitions, and it may also be an outcome of transitions. PMID:23807842
MacKinlay, Elizabeth B; Trevitt, Corinne
Providing spiritual care is about tapping into the concept of spirituality: core meaning, deepest life meaning, hope and connectedness. The search for meaning, connectedness and hope becomes more significant as older people are faced with the possibilities of frailty, disability and dementia. Spirituality, ageing and meaning in life can be discussed in the context of an alternative view of "successful ageing". A model of spiritual tasks in older age can help explain the spiritual dimension and provide a starting point for spiritual assessment.
Bernard, Kristin; Peloso, Elizabeth; Laurenceau, Jean-Philippe; Zhang, Zhiyong; Dozier, Mary
The transition to out-of-home child care brings a number of challenges for children, including complex peer interactions and extended separations from parents. Children often show a midmorning to afternoon rise in cortisol on child-care days, compared to the typical diurnal decline seen at home. Changes in cortisol were examined in a wide age range of children (N = 168; 1.2 months to 8 years, M = 3.27 years) during the 10-week transition to a new child-care setting. Structural equation modeling using latent change scores showed that children experienced an increase in the cortisol rise at child care across the 10-week transition. Furthermore, child age moderated the difference between home- and child-care cortisol patterns. Findings are placed in a developmental context, and potential implications and future directions are discussed.
Fotiadou, Elpida; Malliarou, Maria; Zetta, Stella; Gouva, Mary; Kotrotsiou, Evaggelia
Introduction-Aim: The concept of nursing care in learning disability community settings has not been investigated in Greece. The aim of this paper is to investigate how nurses working in learning disability community settings perceive the meaning of nursing care. Material and Methods: The sample consisted of 100 nurses and nursing assistants working in a social care hospice. Participants were asked to answer questions about socio- demographic characteristics of the sample and fill in a questionnaire of care (GR-NDI-24), the “Job-Communication-Satisfaction-Importance” (JCSI) questionnaire and the altruism scale of Ahmed and Jackson. The data analysis was realized with statistical methods of descriptive and inductive statistics. The analysis was made with the use of SPSS (version 19). Results: The majority of the sample was women (78%). The majority of participants were married (66 %), DE graduates (66%) without postgraduate studies (96.7%). The mean age of respondents was 36.98±6.70 years. On the scales of caring and altruism, the mean values were 40.89±15.87 and 28.12±4.16 respectively. Very or fully satisfied with his work was 72% of the sample. The scope of work emerges as the most important factor influencing job satisfaction. The wages and working conditions (73% and 40% respectively) are the parameters of work which gathers the most dissatisfaction, while the salary is emerging as the most important parameter, the improvement of which would provide the highest satisfaction. Marginally statistically significant difference was observed in the range between TE graduates (d=40) and those of the DE grade (d=37), p=0.053. No statistically significant differences were observed in relation to other working and demographic characteristics (p>0.05). Greater care importance was associated with greater job satisfaction (p<0.01), while the latter was associated with high levels of altruism (p<0.05). Conclusion: The scope of work provides high satisfaction to nurses
Kane, Robert; Kane, Rosalie
The tendency in the United States to view the nursing home as an all-purpose solution to the health problems of the elderly has created a set of self-made problems: increased dependency, depression and social isolation among the aged. In the United States, unlike in many European nations, institutional care of the elderly is conceived of and…
Polivka, Larry; Zayac, Helen
Since the early 1980s, service providers and area agencies on aging, that is, the aging network, have developed a number of strengths as they built a community-based long-term-care system in most states. Many area agencies and providers now have the capacity to assess the needs of older persons, identify appropriate services, and administer cost-effective community programs while operating within fixed, capped budgets. They have also been able to identify and maintain roles for informal caregivers, draw on community resources through donations and the use of volunteers, and create substantial political support. In this article we argue that the aging network should draw on these strengths to develop integrated long-term-care systems designed to shift the balance of state long-term-care systems from institutional to home- and community-based services. We also argue that the nonprofit aging network, because it is made up of area agencies on aging and service providers, provides a potentially more effective framework for the integration of long-term-care resources than do proprietary managed care organizations.
Sayarifard, Fatemeh; Imcheh, Fereshteh Bakhshi; Badri, Shirinsadat; Faghihi, Toktam; Qorbani, Mostafa; Radfar, Mania
Objective: One of the main problems facing public health providers and administrators in many countries is ensuring the rational use of high-cost drugs. In this regard, on-going process of medication use evaluation can be considered as a useful tool. In this study, we evaluated certain usage aspects of a highly-cost medication, that is, recombinant growth hormone (GH). Methods: This cross-sectional study conducted from August 2012 to August 2014. Children receiving GH ± gonadotropin releasing hormone (GnRH) analogs were included in the study. A researcher-designed checklist was developed to evaluate the GH utilization in these patients. Baseline demographic characteristics and background clinical and growth data, as well as any aspects of drug therapy including indications, dosing, monitoring, and discontinuation were collected from the patients' medical records. Findings: Seventy children receiving GH entered the study, of which 23 patients (32.85%) received GH and GnRH analogs simultaneously. At the baseline, 67 children (95.7%) had GH stimulation test, whereas serum insulin-like growth factor-1 (IGF-1) levels were measured in 63 (90%) patients. Sixty-seven patients (95.71%) had thyroid function test, whereas bone age was determined in 68 children (97.14%). The mean ± standard deviation of GH dose for idiopathic short stature, GH deficiency, Turner's syndrome and born small for gestational age in our study was 0.22 ± 0.025 mg/kg/week, 0.23 ± 0.04 mg/kg/week, 0.22 ± 0.015 mg/kg/week, and 0.23 ± 0.02 mg/kg/week, respectively. Height and weight of all patients were followed every 3–6 months, regularly. Thirty patients were treated with GH for at least 1 year, of which thyroid hormones and IGF-1 levels were measured annually in 25 (83.33%) and 26 (86.66%) patients, respectively; while bone age was evaluated in 13 (43.33%) children, annually. GH treatment was discontinued in 15 patients (21.42%), while financial problem was the major reason. Conclusion
Sosinsky, Laura Stout; Kim, Se-Kang
Building on prior variable-oriented research which demonstrates the independence of the associations of child care quality, quantity, and type of setting with family factors and child outcomes, the current study identifies four profiles of child care dimensions from the NICHD Study of Early Child Care and Youth Development. Profiles accounted for…
Tariq, Amina; Douglas, Heather E; Smith, Cheryl; Georgiou, Andrew; Osmond, Tracey; Armour, Pauline; Westbrook, Johanna I
Little is known about the types of incidents that occur to aged care clients in the community. This limits the development of effective strategies to improve client safety. The objective of the study was to present a profile of incidents reported in Australian community aged care settings. All incident reports made by community care workers employed by one of the largest community aged care provider organizations in Australia during the period November 1, 2012, to August 8, 2013, were analyzed. A total of 356 reports were analyzed, corresponding to a 7.5% incidence rate per client year. Falls and medication incidents were the most prevalent incident types. Clients receiving high-level care and those who attended day therapy centers had the highest rate of incidents with 14% to 20% of these clients having a reported incident. The incident profile indicates that clients on higher levels of care had higher incident rates. Incident data represent an opportunity to improve client safety in community aged care.
Affronti, Melissa L.; Levison-Johnson, Jody
Residential programs for children and youth are increasingly implementing engagement strategies to promote family-centered and family-driven models of care (Leichtman, 2008). The practice of engagement is a fairly new area of research, especially in residential care. Driven by their goal to increase the use of state-of-the-art family engagement…
Primer, M A
Quality specifications can be used as an information resource by purchasers of health care. The nature of service provision and nursing care can be positively influenced by the formalisation of standards and quality specifications. Auditing is essential in the ongoing evaluation of a quality system.
Ayranci, Unal; Yenilmez, Cinar; Balci, Yasemin; Kaptanoglu, Cem
This study sought to investigate the contributing factors to and frequency of violence against health care workers (HCWs) working in western Turkey. The population is composed of a random sample of 1,209 HCWs from 34 health care workplaces. Written questionnaires were given to HCWs at all sites, where staff were instructed to register all types of…
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Khoury-Kassabri, Mona; Attar-Schwartz, Shalhevet
Physical victimization by peers was examined among 1,324 Jewish and Arab adolescents, aged 11 to 19, residing in 32 residential care settings (RCS) for children at-risk in Israel. Hierarchical Linear Modeling (HLM) was used to examine the relationships between physical victimization and adolescents' characteristics (age, gender, self-efficacy, adjustment difficulties, maltreatment by staff, and perceived social climate) as well as institution-level characteristics (care setting type, size, structure, and ethnic affiliation). For this study, we define physical violence as being grabbed, shoved, kicked, punched, hit with a hand, or hit with an object. Over 50% (56%) of the adolescents surveyed reported having experienced at least one form of physical violence by peers. Boys and younger adolescents were more likely to be victimized than girls and older adolescents. The results show that adolescents with adjustment difficulties or low social self-efficacy, and adolescents who perceive an institution's staff as strict and/or had experienced maltreatment by staff, are vulnerable groups for peer victimization. Lower levels of victimization were found in RCS with a familial element than in traditional group settings. Institutions with high concentrations of young people with adjustment difficulties and violent staff behaviors had higher levels of violence among residents. Applying an ecological perspective to an investigation of peer victimization in RCS enables the identification of risk factors at adolescent and institution levels. This type of examination has implications for child welfare practice and policy that can help in the development of prevention and intervention methods designed to tackle the involvement in violence of youth in care.
Resnick, Daniel K.; Tosteson, Anna N. A.; Groman, Rachel F.; Ghogawala, Zoher
Study Design Topic review Objective Describe value measurement in spine care and discuss the motivation for, methods for, and limitations of such measurement. Summary of Background Data Spinal disorders are common and are an important cause of pain and disability. Numerous complimentary and competing treatment strategies are used to treat spinal disorders and the costs of these treatments is substantial and continues to rise despite clear evidence of improved health status as a result of these expenditures. Methods The authors present the economic and legislative imperatives forcing the assessment of value in spine care. The definition of value in health care and methods to measure value specifically in spine care are presented. Limitations to the utility of value judgements and caveats to their use are presented. Results Examples of value calculations in spine care are presented and critiqued. Methods to improve and broaden the measurement of value across spine care are suggested and the role of prospective registries in measuring value is discussed. Conclusions Value can be measured in spine care through the use of appropriate economic measures and patient reported outcomes measures. Value must be interpreted in light of the perspective of the assessor, the duration of the assessment period, the degree of appropriate risk stratification, and the relative value of treatment alternatives. PMID:25299258
Shima, Razatul; Farizah, Mohd Hairi; Majid, Hazreen Abdul
Purpose The aim of this study was to explore patients’ experiences with their illnesses and the reasons which influenced them in not following hypertensive care recommendations (antihypertensive medication intake, physical activity, and diet changes) in primary health clinic settings. Patients and methods A qualitative methodology was applied. The data were gathered from in-depth interviews with 25 hypertensive patients attending follow-up in nine government primary health clinics in two districts (Hulu Langat and Klang) in the state of Selangor, Malaysia. The transcribed data were analyzed using thematic analysis. Results There was evidence of lack of patient self-empowerment and community support in Malaysian society. Most of the participants did not take their antihypertensive medication or change their physical activity and diet after diagnosis. There was an agreement between the patients and the health care professionals before starting the treatment recommendation, but there lacked further counseling and monitoring. Most of the reasons given for not taking antihypertensive medication, not doing physical activity and not following diet recommendations were due to side effects or fear of the side effects of antihypertensive medication, patients’ attitudes, lack of information from health care professionals and insufficient social support from their surrounding environment. We also observed the differences on these reasons for nonadherence among the three ethnic groups. Conclusion Health care professionals should move toward supporting adherence in the management of hypertensive patients by maintaining a dialogue. Patients need to be given time to enable them to overcome their inhibition of asking questions and to accept the recommendations. A self-management approach must be responsive to the needs of individuals, ethnicities, and communities. PMID:25484577
Kapiriri, Lydia; Norheim, Ole Frithjof
OBJECTIVE: To explore stakeholders' acceptance of criteria for setting priorities for the health care system in Uganda. METHODS: A self-administered questionnaire was used. It was distributed to health workers, planners and administrators working in all levels of the Ugandan health care system. It was also distributed to members of the public. Participants were asked how strongly they agreed or disagreed with 18 criteria that could be used to set priorities for allocating health care. A total of 408 people took part. Data were entered and analysed using SPSS statistical software. Predetermined cut-off points were used to rank the criteria into three different categories: high weight (>66% of respondents agreed), average weight (33-66% of respondents agreed) and low weight (<33% of respondents agreed). We also tested for associations between respondents' characteristics and their degree of agreement with the criteria. FINDINGS: High-weight criteria included severity of disease, benefit of the intervention, cost of the intervention, cost-effectiveness of the intervention, quality of the data on effectiveness, the patients age, place of residence, lifestyle, importance of providing equity of access to health care and the community's views. The average-weight criteria included the patient's social status, mental features, physical capabilities, political views, responsibilities for others and gender. Low-weight criteria included the patient's religion, and power and influence. There were few associations between respondents' characteristics and their preferences. CONCLUSION: There was a high degree of acceptance for commonly used disease-related and society-related criteria. There was less agreement about the patient-related criteria. We propose that average-weight criteria should be debated in Uganda and other countries facing the challenge of distributing scarce health care resources. PMID:15112005
Deo, Maneka S; Vandal, Alain C; Jarrett, Paul
Objectives To estimate the prevalence of dermatological disease in aged care facilities, and the relationship between cognitive or physical disability and significant disease. Setting 2 large aged care facilities in Auckland, New Zealand, each providing low and high level care. Participants All 161 residents of the facilities were invited to participate. The only exclusion criterion was inability to obtain consent from the individual or designated guardian. 88 participants were recruited—66 females (75%), 22 males (25%) with average age 87.1 years (SD 5.5 years). Primary and secondary outcome measures Primary—presence of significant skin disease (defined as that which in the opinion of the investigators needed treatment or was identified as a patient concern) diagnosed clinically on full dermatological examination by a dermatologist or dermatology trainee. Secondary—functional and cognitive status (Rehabilitation Complexity Scale and Abbreviated Mental Test Score). Results 81.8% were found to have at least one significant condition. The most common disorders were onychomycosis 42 (47.7%), basal cell carcinoma 13 (14.8%), asteototic eczema 11 (12.5%) and squamous cell carcinoma in situ 9 (10.2%). Other findings were invasive squamous cell carcinoma 7 (8%), bullous pemphigoid 2 (2.3%), melanoma 2 (2.3%), lichen sclerosus 2 (2.3%) and carcinoma of the breast 1 (1.1%). Inflammatory disease was more common in those with little physical disability compared with those with serious physical disability (OR 3.69; 95% CI 1.1 to 12.6, p=0.04). No significant association was found between skin disease and cognitive impairment. Conclusions A high rate of dermatological disease was found. Findings ranged from frequent but not life-threatening conditions (eg, onychomycosis), to those associated with a significant morbidity (eg, eczema, lichen sclerosus and bullous pemphigoid), to potentially life-threatening (eg, squamous cell carcinoma, melanoma and breast cancer
Noonan, Kelly; Corman, Hope; Schwartz-Soicher, Ofira; Reichman, Nancy E.
Objectives The broad goal of contemporary prenatal care is to promote the health of the mother, child, and family through the pregnancy, delivery, and the child’s development. Although the vast majority of mothers giving birth in developed countries receive prenatal care, past research has not found compelling evidence that early or adequate prenatal care has favorable effects on birth outcomes. It is possible that prenatal care confers health benefits to the child that do not become apparent until after the perinatal period. Methods Using data from a national urban birth cohort study in the U.S., we estimate the effects of prenatal care on four markers of child health at age 5—maternal-reported health status, asthma diagnosis, overweight, and height. We implement a number of different strategies to address the issue of potential omitted variables bias as well as a large number of specification checks to validate the findings. Results and Conclusions Prenatal care, defined a number of different ways, does not appear to have any effect on the outcomes examined. The findings are robust and suggest that routine health care encounters during the prenatal period could potentially be used more effectively to enhance children’s health trajectories. However, future research is needed to explore the effects of prenatal care on additional child health and developmental outcomes as well as the effects of preconceptional and maternal lifetime helathcare on child health. PMID:22374319
Noonan, Kelly; Corman, Hope; Schwartz-Soicher, Ofira; Reichman, Nancy E
The broad goal of contemporary prenatal care is to promote the health of the mother, child, and family through the pregnancy, delivery, and the child's development. Although the vast majority of mothers giving birth in developed countries receive prenatal care, past research has not found compelling evidence that early or adequate prenatal care has favorable effects on birth outcomes. It is possible that prenatal care confers health benefits to the child that do not become apparent until after the perinatal period. Using data from a national urban birth cohort study in the US, we estimate the effects of prenatal care on four markers of child health at age 5-maternal-reported health status, asthma diagnosis, overweight, and height. Prenatal care, defined a number of different ways, does not appear to have any effect on the outcomes examined. The findings are robust and suggest that routine health care encounters during the prenatal period could potentially be used more effectively to enhance children's health trajectories. However, future research is needed to explore the effects of prenatal care on additional child health and developmental outcomes as well as the effects of preconceptional and maternal lifetime healthcare on child health.
McDonald, Tracey; Russell, Frances
This study determined the impact of a computerized care documentation system on client outcomes, regulatory compliance, and staff workloads after 3 years of use. The survey was conducted at an 800-bed aged care facility, and staff using the computerized care system were invited to participate (n = 112). The survey was an adapted version of the Nurses Computer Attitudes to Technology Inventory, which was refined to make it relevant to the aged care workplace. Four multiple regression models were produced, assessing the impact of the computerized care management system on staff and workload; time; accuracy, and regulatory data; and resident care. The analysis showed that the perceived benefits of the computerized system were influenced by personal attitudes towards computer use and feelings of empowerment related to the computer system. Even those with poor computer skills and feelings of insecurity about using computers believed that there were significant benefits to be gained by using the system. This result has implications with regards to the training and recruitment of staff in the aged care sector, as facilities introduce computerized care systems.
Hoffses, Kathryn W; Ramirez, Lisa Y; Berdan, Louise; Tunick, Rachel; Honaker, Sarah Morsbach; Meadows, Tawnya J; Shaffer, Laura; Robins, Paul M; Sturm, Lynne; Stancin, Terry
OBJECTIVES : In the midst of large-scale changes across our nation's health care system, including the Affordable Care Act and Patient-Centered Medical Home initiatives, integrated primary care models afford important opportunities for those in the field of pediatric psychology. Despite the extensive and growing attention, this subspecialty has received in recent years, a comprehensive set of core professional competencies has not been established. METHODS : A subset of an Integrated Primary Care Special Interest Group used two well-established sets of core competencies in integrated primary care and pediatric psychology as a basis to develop a set of integrated pediatric primary care-specific behavioral anchors. CONCLUSIONS : The current manuscript describes these behavioral anchors and their development in the context of professional training as well as with regard to Triple Aim goals and securing psychology's role in integrated pediatric primary care settings.
Population ageing is poised to become a major challenge to the health system as Malaysia progresses to becoming a developed nation by 2020. This article aims to review the various ageing policy frameworks available globally; compare aged care policies and health services in Malaysia with Australia; and discuss various issues and challenges in translating these policies into practice in the Malaysian primary care system. Fundamental solutions identified to bridge the gap include restructuring of the health care system, development of comprehensive benefit packages for older people under the national health financing scheme, training of the primary care workforce, effective use of electronic medical records and clinical guidelines; and empowering older people and their caregivers with knowledge, skills and positive attitudes to ageing and self care. Ultimately, family medicine specialists must become the agents for change to lead multidisciplinary teams and work with various agencies to ensure that better coordination, continuity and quality of care are eventually delivered to older patients across time and settings. PMID:21385446
Saravanakumar, K; Davies, L; Lewis, M; Cooper, G M
Our objective was to establish the utilisation and pattern of high dependency care in a tertiary referral obstetric unit. Data of pregnant or recently pregnant women admitted to the obstetric high dependency unit from 1984 to 2007 were included to evaluate the admission rate. Four years' information of an ongoing prospective audit was collated to identify the indications for admission, maternal monitoring, transfers to intensive care unit, and location of the baby. The overall high dependency unit admission rate is 2.67%, but increased to 5.01% in the most recent 4 years. Massive obstetric haemorrhage is now the most common reason for admission. Invasive monitoring was undertaken in 30% of women. Two-thirds of neonates (66.3%) stayed with their critically ill mothers in the high dependency unit. Transfer to the intensive care unit was needed in 1.4 per 1000 deliveries conducted. We conclude that obstetric high dependency care provides holistic care from midwives, obstetricians and anaesthetists while retaining the opportunity of early bonding with babies for critically ill mothers.
Guberman, Nancy; Lavoie, Jean-Pierre; Blein, Laure; Olazabal, Ignace
Purpose: Many Baby Boomers are faced with the care of aging parents, as well as that of disabled or ill spouses or children. This study examines how Baby Boomers in Quebec, Canada, perceive and play their role as caregivers and how this might differ from their parents' generation. Design and methods: This was a qualitative and empirical study…
ERS Spectrum, 1992
Innovative school-age day care programs include Tennessee's Extended School Program; Hawaii's After-School Plus program; San Antonio's Kid's Involvement Network (offering middle school supervision); Aurora, Colorado's state-licensed Year-Round School Recreation Plan; and Pomona, California's Child Development Program. These public school programs…
Chou, Shu-Chiung; Boldy, Duncan P.; Lee, Andy H.
Purpose: The aim of this study was to identify the important factors influencing residents' satisfaction in residential aged care and to provide a better understanding of their interrelationships. Design and Methods: A cross-sectional survey design was used to collect the required information, including resident satisfaction, resident dependency…
Sydnor, Emily R. M.; Perl, Trish M.
Summary: Health care-associated infections (HAIs) have become more common as medical care has grown more complex and patients have become more complicated. HAIs are associated with significant morbidity, mortality, and cost. Growing rates of HAIs alongside evidence suggesting that active surveillance and infection control practices can prevent HAIs led to the development of hospital epidemiology and infection control programs. The role for infection control programs has grown and continues to grow as rates of antimicrobial resistance rise and HAIs lead to increasing risks to patients and expanding health care costs. In this review, we summarize the history of the development of hospital epidemiology and infection control, common HAIs and the pathogens causing them, and the structure and role of a hospital epidemiology and infection control program. PMID:21233510
Collins, Sandra K; Collins, Kevin S
With the workforce growing older and the supply of younger workers diminishing, it is critical for health care managers to understand the factors necessary to capitalize on their vintage employees. Retaining this segment of the workforce has a multitude of benefits including the preservation of valuable intellectual capital, which is necessary to ensure that health care organizations maintain their competitive advantage in the consumer-driven market. Retaining the aging employee is possible if health care managers learn the motivators and training differences associated with this category of the workforce. These employees should be considered a valuable resource of human capital because without their extensive expertise, intense loyalty and work ethic, and superior customer service skills, health care organizations could suffer severe economic repercussions in the near future.
Mort, Maggie; Roberts, Celia; Callén, Blanca
In recent years images of independence, active ageing and staying at home have come to characterise a successful old age in western societies. 'Telecare' technologies are heavily promoted to assist ageing-in-place and a nexus of demographic ageing, shrinking healthcare and social care budgets and technological ambition has come to promote the 'telehome' as the solution to the problem of the 'age dependency ratio'. Through the adoption of a range of monitoring and telecare devices, it seems that the normative vision of independence will also be achieved. But with falling incomes and pressure for economies of scale, what kind of independence is experienced in the telehome? In this article we engage with the concepts of 'technogenarians' and 'shared work' to illuminate our analysis of telecare in use. Drawing on European-funded research we argue that home-monitoring based telecare has the potential to coerce older people unless we are able to recognise and respect a range of responses including non-use and 'misuse' in daily practice. We propose that re-imagining the aims of telecare and redesigning systems to allow for creative engagement with technologies and the co-production of care relations would help to avoid the application of coercive forms of care technology in times of austerity.
S Barnert, Elizabeth; S Abrams, Laura; Maxson, Cheryl; Gase, Lauren; Soung, Patricia; Carroll, Paul; Bath, Eraka
Purpose Despite the existence of minimum age laws for juvenile justice jurisdiction in 18 US states, California has no explicit law that protects children (i.e. youth less than 12 years old) from being processed in the juvenile justice system. In the absence of a minimum age law, California lags behind other states and international practice and standards. The paper aims to discuss these issues. Design/methodology/approach In this policy brief, academics across the University of California campuses examine current evidence, theory, and policy related to the minimum age of juvenile justice jurisdiction. Findings Existing evidence suggests that children lack the cognitive maturity to comprehend or benefit from formal juvenile justice processing, and diverting children from the system altogether is likely to be more beneficial for the child and for public safety. Research limitations/implications Based on current evidence and theory, the authors argue that minimum age legislation that protects children from contact with the juvenile justice system and treats them as children in need of services and support, rather than as delinquents or criminals, is an important policy goal for California and for other national and international jurisdictions lacking a minimum age law. Originality/value California has no law specifying a minimum age for juvenile justice jurisdiction, meaning that young children of any age can be processed in the juvenile justice system. This policy brief provides a rationale for a minimum age law in California and other states and jurisdictions without one.
Bickimer, David A.
Two motifs of the Prehensive Leadership Model (PLM) are applied to efforts to solve problems related to stepchild status and low morale that are typical of campus child care centers. The importance of the PLM distinction between general and special leadership is discussed. (SH)
Heidgerken, Amanda, D.; Geffken, Gary; Modi, Avani; Frakey, Laura
The current study extends research by Stone [Cross-disciplinary perspectives on autism? "Journal of Pediatric Psychology, 12", (1988) 615; A comparison of teacher and parent views of autism. "Journal of Autism and Development Disorders, 18", (1988) 403] exploring the knowledge and beliefs about autism across multiple health care professions. One…
Decker, P J; Sullivan, E; Moore, R
Behavior modeling is one training method found effective in helping health care managers deal with their day-to-day management problems. This article defines and explains the five basic steps of behavior modeling training, suggests the workshop format as its most effective mode of instruction, and presents examples of successful use of the method.
Maslach, Christina; Pines, Ayala
Results of a study of personal job-stress factors among day care center personnel focus on impact of staff-child ratio, working hours, time out, staff meetings and program structure. Recommended institutional changes for prevention of staff "burn-out" involve reduction in amount of direct staff-child contact, development of social-professional…
Weber, Deanne; Wolff, Lisa S; Orleans, Tracy; Mockenhaupt, Robin E; Massett, Holly A; Vose, Kathryn Kahler
This study describes a new segmentation strategy exploring smokers' interest levels in counseling in the medical care setting in order to understand how public health communications can be designed to increase consumer demand for cessation services within this population. A subsample of 431 smokers from a large, nationally representative mail survey was analyzed and categorized into three cessation-demand groups: Low demand (LD), medium demand (MD), and high demand (HD). HD smokers were most likely to be heavy smokers, to make quitting a high priority, and to have self-efficacy in quitting. MD and LD smokers were less likely than HD smokers to have been told to quit smoking by a health care provider in the past or to believe that counseling is effective. The first step in the regression analysis revealed that age, cigarettes smoked per month, whether smokers were currently trying to quit, and whether they were ever told to quit smoking by their health care provider accounted for 21% of the variance in smokers' interest in smoking cessation counseling, F(4, 234) = 16.49, p<.001. When additional variables on attitudes toward smoking and quitting and perceived effectiveness of receiving counseling in the medical care setting were added to the model, an additional 11% of the variance in smokers' interest in cessation counseling was explained, F(12, 234) = 10.07, p<.001. Results suggest that by categorizing smokers by interest level in cessation counseling, we emerge with three distinct portraits of smokers who might be activated in different ways to increase consumer demand for cessation counseling.
Foos, Paul W.; Clark, M. Cherie
Groups of 40 older and 40 younger adults were tested using cue sets of 25 U.S. states and 25 movie stars. No overall differences in total recall appeared. Those who did not study cues had better recall of noncued items. Younger adults performed better on noncued sets, older adults on the cued condition for movie stars. (SK)
Baglin, Carol Ann, Ed.; Bender, Michael, Ed.
Intended primarily for professionals teaching early childhood and infant intervention courses, this handbook presents an overview of child care as both a support to families and an economic necessity, meeting changing and dynamic needs. Child care settings and types of care are discussed, along with quality indicators, licensing, and provider…
Bauer, Michael; Fetherstonhaugh, Deirdre; Tarzia, Laura; Chenco, Carol
The aim of the study was to examine staff and family members' perceptions of each other's roles and responsibilities in the Australian residential aged care setting. Data was collected by interview and focus group from 27 staff and 14 family members at five residential aged care facilities in the state of Victoria, Australia. Findings highlight "communication" as the core category supporting the formation of constructive staff-family relationships, as described by three main themes; "building trust," "involvement," and "keeping the family happy." Staff attitudes, mutual cooperation, meaningful engagement, and shared expectations lay the foundation for relationships. Findings suggest that further efforts to establish and sustain good relationships with families are required by facilities. Characteristics, roles, and expectations of staff and family that can both promote and hinder the formation of constructive staff-family relationships are discussed.
By 2050, it is predicted that 26% of the population will be aged 80 and over. Although older people have much to contribute, one challenging aspect of an aging population is the increasing rate of dementia. Palliative care is now included as part of the care pathway of a wide variety of nonmalignant diseases. The European Association for Palliative Care (EAPC) and the European Union Geriatric Medicine Society (EUGMS) have jointly called for every older citizen with chronic disease to be offered the best possible palliative care approach wherever they are cared for. This report is adapted from paineurope 2013; Issue 2, ©Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International LTD. and is distributed free of charge to healthcare professionals in Europe. Archival issues can be accessed via the website: http://www.paineurope.com at which European health professionals can register online to receive copies of the quarterly publication.
Gill, Preetinder S; Kamath, Ashwini; Gill, Tejkaran S
Smartphone use in health care work settings presents both opportunities and challenges. The benefits could be severely undermined if abuse and overuse are not kept in check. This practice-focused research paper examines the current panorama of health software applications. Findings from existing research are consolidated to elucidate the level and effects of distraction in health care work settings due to smartphone use. A conceptual framework for crafting guidelines to regulate the use of smartphones in health care work settings is then presented. Finally, specific guidelines are delineated to assist in creating policies for the use of smartphones in a health care workplace. PMID:22969308
Portwood, Sharon G.; Boyd, A. Suzanne; Murdock, Tamera B.
Background: There is a need to examine behavioral and mental health outcomes for children in out-of-home care across settings. Objective: Using a participatory research approach, researchers and agency personnel aimed to implement a program of scientific outcomes research in residential care settings. Data were used to examine children's…
Lay-Yee, Roy; Pearson, Janet; Davis, Peter; von Randow, Martin; Kerse, Ngaire; Brown, Laurie
The demographic ageing of New Zealand society, as elsewhere in the developed world, has dramatically increased the proportion of older people (aged 65 years and over) in the population. This has major policy implications for the future organisation of social care. Our objective was to test the effects on social care use, first, of putative changes in the overall disability profile of older people, and second, of alterations to the balance of their care, i.e. whether it was community-based or residential. In order to undertake these experiments, we developed a microsimulation model of the later life course using individual-level data from two official national survey series on health and disability, respectively, to generate a synthetic version which replicated original data and parameter settings. A baseline projection under current settings from 2001 to 2021 showed moderate increases in disability and associated social care use. Artificially decreasing disability levels, below the baseline projection, only moderately reduced the use of community care (both informal and formal). Scenarios implemented by rebalancing towards informal care use moderately reduced formal care use. However, only moderate compensatory increases in community-based care were required to markedly decrease the transition to residential care. The disability impact of demographic ageing may not have a major negative effect on system resources in developed countries like New Zealand. As well as healthy ageing, changing the balance of social care may alleviate the impact of increasing demand due to an expanding population of older people.
Purpose Pharmacists are uniquely trained to provide guidance to patients in the selection of appropriate non-prescription therapy. Physicians in Qatar may not always recognize how pharmacists function in assuring safe medication use. Both these health professional groups come from heterogeneous training and experiences before migrating to the country and these backgrounds could influence collaborative patient care. Qatar Petroleum (QP), the largest private employer in the country, has developed a pharmacist-guided medication consulting service at their primary care clinics, but physician comfort with pharmacists recommending drug therapy is currently unknown. The objective of this study is to characterize physician perceptions of pharmacists and their roles in a primary care patient setting in Qatar. Methods This cross-sectional survey was developed following a comprehensive literature review and administered in English and Arabic. Consenting QP physicians were asked questions to assess experiences, comfort and expectations of pharmacist roles and abilities to provide medication-related advice and recommend and monitor therapies. Results The median age of the 62 (77.5%) physicians who responded was between 40 and 50 years old and almost two-third were men (64.5%). Fourteen different nationalities were represented. Physicians were more comfortable with pharmacist activities closely linked to drug products than responsibilities associated with monitoring and optimization of patient outcomes. Medication education (96.6%) and drug knowledge (90%) were practically unanimously recognized as abilities expected of pharmacists, but consultative roles, such as assisting in drug regimen design were less acknowledged. They proposed pharmacist spend more time with physicians attending joint meetings or education events to help advance acceptance of pharmacists in patient-centered care at this site. Conclusions Physicians had low comfort and expectations of patient
Nguyen, Nguyen-Lan D; Hunt, D Daniel; Scott, Craig S
A Vietnamese Depression Scale (VDS) was developed in 1982 in the United States and has been used as a screening tool for depression and as the basis for a standardized interview to assess depression in the Vietnamese refugee populations. In this current study, the VDS was used in Ho Chi Minh City, Vietnam, to assess depression in patients who were already diagnosed with depression by Vietnamese psychiatrists and in patients presenting at a local primary care clinic. Of the 177 primary care clinic patients, 8.4% met the criteria for clinical depression based on the VDS. Results indicate a higher risk for depression among married and/or less than high school educated individuals. Discrepancies were found between the depression diagnosis by Vietnamese psychiatrists and VDS screening results. Among the participants interviewed who met the VDS criteria for depression, culture-specific phrases such as "desperate," "going crazy," and "low spirited and bored" were highly associated with symptoms of depression.
Emmerson, A. M.
Water is used in vast quantities in health-care premises. Many aquatic microorganisms can survive and flourish in water with minimal nutrients and can be transferred to vulnerable hospital patients in direct (e.g., inhalation, ingestion, surface absorption) and indirect ways (e.g., by instruments and utensils). Many outbreaks of infection or pseudoinfection occur through lack of prevention measures and ignorance of the source and transmission of opportunistic pathogens. PMID:11294722
Johnson, Jennifer Leigh; Beard, Joyce; Evans, Dena
Annually, over 80,000 refugees enter the United States as a result of political or religious persecution. Of these, approximately 35% to 40% are children and adolescents. Refugees are faced with challenges associated with living conditions, cultural and social norms, and socioeconomic status due to problems occurring in their homelands. These challenges include but are not limited to malnutrition, communicable disease, questionable immunization status, lack of formal education, sexual abuse, violence, torture, human trafficking, homelessness, poverty, and a lack of access to health care. Moreover, the psychological impact of relocation and the stress of acculturation may perpetuate many of these existing challenges, particularly for refugee youth, with limited or underdeveloped coping skills. School nurses are uniquely poised to support refugee youth in the transition process, improve overall health, and facilitate access to primary health services. The purpose of this article is to provide an overview of the unique refugee experience, examine the key health care needs of the population, and present school nurses with timely and relevant resources to assist in caring for refugee youth.
Kaiser, Robert M; Kaiser, Susan L
As professionals in geriatric medicine and social work, we are caregivers for our widowed mother of 90 years, a woman with neurocognitive disorder and multiple medical conditions. She has had repeated, problematic encounters with the health care system over the past 4 years. Caring successfully for an aging parent requires a comprehensive understanding of her unique medical, psychological, and functional status; need for social support; and overall goals of care. Poor communication between and among clinical teams-and with patients and families-is ubiquitous. The patient and family are not consistently listened to, or integrated, into the clinical team. We recount our experiences of one hospitalization and how we addressed the recurring obstacles we faced. Our training and experience gave us a firm understanding of the hazards of hospitalizing an elderly person and the need to be present, engaged, attentive, active, and vigilant. We caught and corrected major mistakes: failure to follow-up abnormal test results, multiple medication errors, undertreatment of pain, poor fall prevention, and inappropriate assessment and placement for rehabilitation. In a dysfunctional health care system, the family is, and must be, the ultimate fail-safe mechanism. We identify potentially effective solutions for the problems we encountered: adoption of dementia-sensitive and patient- and family-centered care, improved communication, better management of information (including better systems for monitoring lab results and for dispensing and reconciling medications), expediting care, changing reimbursement and regulation, and improving discharge planning and placement.
Liebig, Phoebe S
Although generational co-residence continues to be the dominant form of housing and care for Indian elders and only 1% live in old-age homes, the numbers and types of these homes are growing. This article describes a recent study of 48 old-age homes in different parts of India, approximately 12%-15% of all homes. They included the more traditional free homes for the aged poor who have no family to care for them and the more recent for-pay homes for the middle-class. A small number of day-care centers, also a new phenomenon, were investigated. Two- to three-hour structured interviews were conducted with managers, supervisors, and trustees, augmented by a checklist of environmental and neighborhood features. Most homes house small numbers of residents, have common spaces for dining, TV and prayer, have access to medical care and transportation, provide meals and some assistance with activities of daily living, and are open to all castes. All are run by non-governmental organizations (NGOs), only one-third with any government assistance. Free homes tend to be bigger and older, serve nonaged clients, have less privacy and emphasize occupational therapy and income-generating activities, and are more like board-and-care homes. For-pay homes have more privacy and western-style amenities, focus on local community outreach and provide fewer meals. The gradual increase of all old-age homes has given rise to debates about their appropriate roles in Indian society and about their quality. Government grants to NGOs for homes and day-care centers (often considered more appropriate support for elders) are limited. With the National Policy on Older Persons looking to NGOs and village councils to be the primary sources of non-familial aged care, several ways to build their capacity are suggested.
Alzheimer's disease and most other causes of dementia are regressive by nature. As such one can expect patients with such types of mental impairment to gradually decline in function and ability to participate in day care activities. This paper attempts to show that with the right kind of orientation, staff can "tune into" the more advanced dementia patients, find the key to their personal needs, desires and remaining abilities and design a program that allows them not only to continue to participate in a social and therapeutic framework, but also to gain some meaningful human contact and quality of life despite their cognitive deterioration.
Kydd, Angela; Fleming, Anne
Ageism and age discrimination are terms used in best practice statements and in the literature to define negative attitudes towards older people and towards people because of their age (whether old or young). However, 'old age' is a nebulous concept with definitions ranging from the over 50s to the over 85s. In seeking to explore ageism and age discrimination within health care, this paper discusses the concept of 'old' and discusses the findings of a narrative review of the literature on these two concepts. Results show that negative attitudes have been perceived by users of health care services, but the reasons are not clear. Such attitudes are usually reported in acute health care settings, where targets and quick turnover are encouraged. Thus people, usually those with complex needs, who require longer periods of recuperation and rehabilitation following an episode of ill health, are troublesome to staff working in a system geared up for early discharges. This type of service user is usually over the age of 85. Recommendations from this paper include the need for acute frailty units, with well trained staff, where frail older people can be comprehensively assessed, receive timely and targeted care, followed by a supported discharge.
Hirdes, John P.; Poss, Jeffrey W.; Mitchell, Lori; Korngut, Lawrence; Heckman, George
Background Persons with certain neurological conditions have higher mortality rates than the population without neurological conditions, but the risk factors for increased mortality within diagnostic groups are less well understood. The interRAI CHESS scale has been shown to be a strong predictor of mortality in the overall population of persons receiving health care in community and institutional settings. This study examines the performance of CHESS as a predictor of mortality among persons with 11 different neurological conditions. Methods Survival analyses were done with interRAI assessments linked to mortality data among persons in home care (n = 359,940), complex continuing care hospitals/units (n = 88,721), and nursing homes (n = 185,309) in seven Canadian provinces/territories. Results CHESS was a significant predictor of mortality in all 3 care settings for the 11 neurological diagnostic groups considered after adjusting for age and sex. The distribution of CHESS scores varied between diagnostic groups and within diagnostic groups in different care settings. Conclusions CHESS is a valid predictor of mortality in neurological populations in community and institutional care. It may prove useful for several clinical, administrative, policy-development, evaluation and research purposes. Because it is routinely gathered as part of normal clinical practice in jurisdictions (like Canada) that have implemented interRAI assessment instruments, CHESS can be derived without additional need for data collection. PMID:24914546
Grassi, Luigi; Caruso, Rosangela; Sabato, Silvana; Massarenti, Sara; Nanni, Maria G; The UniFe Psychiatry Working Group Coauthors
Psychiatric and psychosocial disorders among cancer patients have been reported as a major consequence of the disease and treatment. The problems in applying a pure psychiatric approach have determined the need for structuring more defined methods, including screening for distress and emotional symptoms and a more specific psychosocial assessment, to warrant proper care to cancer patients with psychosocial problems. This review examines some of the most significant issues related to these two steps, screening and assessment of psychosocial morbidity in cancer and palliative care. With regard to this, the many different variables, such as the factors affecting individual vulnerability (e.g., life events, chronic stress and allostatic load, well-being, and health attitudes) and the psychosocial correlates of medical disease (e.g., psychiatric disturbances, psychological symptoms, illness behavior, and quality of life) which are possibly implicated not only in "classical" psychiatric disorders but more broadly in psychosocial suffering. Multidimensional tools [e.g., and specific psychosocially oriented interview (e.g., the Diagnostic Criteria for Psychosomatic Research)] represent a way to screen for and assess emotional distress, anxiety and depression, maladaptive coping, dysfunctional attachment, as well as other significant psychosocial dimensions secondary to cancer, such as demoralization and health anxiety. Cross-cultural issues, such as language, ethnicity, race, and religion, are also discussed as possible factors influencing the patients and families perception of illness, coping mechanisms, psychological response to a cancer diagnosis.
Wedemeyer, Dan J.
This overview provides a technological context for the telecommunications age by describing existing and emerging systems--telephone, broadcasting, cable television, fiber optic, satellite, optical disk, and computer technology--and services available via these systems. It is suggested that educators need to become technologically literate and…
Taunton, Roma Lee; Swagerty, Daniel L; Smith, Barbara; Lasseter, Joyce A; Lee, Robert H
This study was designed to describe the care-planning process used in nursing homes and identify links among care planning, care provided, and the Resident Assessment Instrument and Minimum Data Set (MDS). Study participants in three Midwestern nursing homes included residents and family members, MDS coordinators, direct care staff, administrators, directors of nursing, and medical directors. Data were collected via semi-structured interview, observation, and resident record audit. The care-planning process differed among the three facilities despite the common MDS system structure. Care planning and the MDS system were linked to the care provided to residents through documentation in residents' records, translation of the MDS care plan to the documents used for daily care, and ongoing communication through end-of-shift report and other venues.
Stephens, Samuel A.
Child care centers, Head Start programs, and family child care providers serving young children--as well as after school programs and homeless shelters that reach older children, adults, and families--are supported in providing healthy meals and snacks by reimbursements through the Child and Adult Care Food Program (CACFP). Administered by the…
Cheong, Chin Yee; Tan, Jane An Qi; Foong, Yi-Lin; Koh, Hui Mien; Chen, Denise Zhen Yue; Tan, Jessie Joon Chen; Ng, Chong Jin; Yap, Philip
Background/Aims The acute hospital ward can be unfamiliar and stressful for older patients with impaired cognition, rendering them prone to agitation and resistive to care. Extant literature shows that music therapy can enhance engagement and mood, thereby ameliorating agitated behaviours. This pilot study evaluates the impact of a creative music therapy (CMT) programme on mood and engagement in older patients with delirium and/or dementia (PtDD) in an acute care setting. We hypothesize that CMT improves engagement and pleasure in these patients. Methods Twenty-five PtDD (age 86.5 ± 5.7 years, MMSE 6/30 ± 5.4) were observed for 90 min (30 min before, 30 min during, and 30 min after music therapy) on 3 consecutive days: day 1 (control condition without music) and days 2 and 3 (with CMT). Music interventions included music improvisation such as spontaneous music making and playing familiar songs of patient's choice. The main outcome measures were mood and engagement assessed with the Menorah Park Engagement Scale (MPES) and Observed Emotion Rating Scale (OERS). Results Wilcoxon signed-rank test showed a statistically significant positive change in constructive and passive engagement (Z = 3.383, p = 0.01) in MPES and pleasure and general alertness (Z = 3.188,p = 0.01) in OERS during CMT. The average pleasure ratings of days 2 and 3 were higher than those of day 1 (Z = 2.466, p = 0.014). Negative engagement (Z = 2.582, p = 0.01) and affect (Z = 2.004, p = 0.045) were both lower during CMT compared to no music. Conclusion These results suggest that CMT holds much promise to improve mood and engagement of PtDD in an acute hospital setting. CMT can also be scheduled into the patients' daily routines or incorporated into other areas of care to increase patient compliance and cooperation. PMID:27489560
Gopichandran, Vijayaprasad; Chetlapalli, Satish Kumar
Background Trust in health care has been intensely researched in resource rich settings. Some studies in resource poor settings suggest that the dimensions and determinants of trust are likely to be different. Objectives This study was done as a qualitative exploration of the dimensions and determinants of trust in health care in Tamil Nadu, a state in south India to assess the differences from dimensions and determinants in resource rich settings. Methodology The participants included people belonging to marginalized communities with poor access to health care services and living in conditions of resource deprivation. A total of thirty five in depth interviews were conducted. The interviews were summarized and transcribed and data were analyzed following thematic analysis and grounded theory approach. Results The key dimensions of trust in health care identified during the interviews were perceived competence, assurance of treatment irrespective of ability to pay or at any time of the day, patients’ willingness to accept drawbacks in health care, loyalty to the physician and respect for the physician. Comfort with the physician and health facility, personal involvement of the doctor with the patient, behavior and approach of doctor, economic factors, and health awareness were identified as factors determining the levels of trust in health care. Conclusions The dimensions and determinants of trust in health care in resource poor settings are different from that in resource rich settings. There is a need to develop scales to measure trust in health care in resource poor settings using these specific dimensions and determinants. PMID:23874904
Montano, C Brendan; Rasgon, Natalie L; Herman, Barry K
Binge eating disorder (BED), now recognized as a distinct eating disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, is the most prevalent eating disorder. Although nearly half of individuals with BED are obese, BED also occurs in nonobese individuals. Despite the relatively high percentage of weight loss treatment-seeking individuals meeting BED criteria, primary care physicians may not be familiar with or have ever diagnosed BED. Many providers may also have difficulty distinguishing BED as a contributory factor in obesity. This review differentiates BED from other causes of obesity by describing how obese individuals with BED differ from obese individuals without BED and from nonobese individuals with BED in areas including psychopathology, behavior, genetics, physiology, quality of life and productivity. The ways in which health-care providers can identify individuals who may have BED are also highlighted so the proper course of treatment is pursued. Overall, obese individuals with BED demonstrate a number of key characteristics that differentiate them from obese individuals without eating disorders, including increased impulsivity in response to food stimuli with loss of control over eating, resulting in the consumption of more calories. They also experience significant guilt and other negative emotions following a meal. In addition, individuals with BED patients have more psychiatric comorbidity, display more psychopathology, exhibit longer binge durations, consume more meals as snacks during the day and have less dietary restraint compared with individuals with BED who are not obese. However, the differences between individuals with BED who are obese versus not obese are not as prominent. Taken together, the evidence appears to support the conclusion that BED is a unique and treatable neurobehavioral disorder associated with distinct behavioral and psychological profiles and distinct medical and functional outcomes, and that
Richardson, Laura P; McCarty, Carolyn A; Radovic, Ana; Suleiman, Ahna Ballonoff
Despite the recognition that behavioral and medical health conditions are frequently intertwined, the existing health care system divides management for these issues into separate settings. This separation results in increased barriers to receipt of care and contributes to problems of underdetection, inappropriate diagnosis, and lack of treatment engagement. Adolescents and young adults with mental health conditions have some of the lowest rates of treatment for their conditions of all age groups. Integration of behavioral health into primary care settings has the potential to address these barriers and improve outcomes for adolescents and young adults. In this paper, we review the current research literature for behavioral health integration in the adolescent and young adult population and make recommendations for needed research to move the field forward.
Ahia, Chad L.; Blais, Christopher M.
Background Primary palliative care consists of the palliative care competencies required of all primary care clinicians. Included in these competencies is the ability to assist patients and their families in establishing appropriate goals of care. Goals of care help patients and their families understand the patient's illness and its trajectory and facilitate medical care decisions consistent with the patient's values and goals. General internists and family medicine physicians in primary care are central to getting patients to articulate their goals of care and to have these documented in the medical record. Case Report Here we present the case of a 71-year-old male patient with chronic obstructive pulmonary disorder, congestive heart failure, and newly diagnosed Alzheimer dementia to model pertinent end-of-life care communication and discuss practical tips on how to incorporate it into practice. Conclusion General internists and family medicine practitioners in primary care are central to eliciting patients' goals of care and achieving optimal end-of-life outcomes for their patients. PMID:25598737
Increasingly, long-term care facilities are using technology to improve safety, reduce costs, and save time. The growing role of high-tech tools in this setting is driven partly by regulations calling for facilities to improve outcomes and streamline costs. One tool that long-term pharmacies and their facilities are turning to is the automated dispensing system. These systems vary in term of type, size, cost, and function; and they are approved for use in long-term care facilities in some but not all states. However, where they can be and are used, they often result in reduced medication management costs and improved safety and accuracy. At the same time, automated dispensing systems may make medication administration easier for nurses. While challenges to their implementation and use remain, automated dispensing systems likely will be a key part of health care's future. This article serves as an introduction to the automated dispensing systems, their use in long-term care, and their potential use as a new era of health care begins.
Su, Chuan-Jun; Chiang, Chang-Yu
As the elderly population has been rapidly expanding and the core tax-paying population has been shrinking, the need for adequate elderly health and housing services continues to grow while the resources to provide such services are becoming increasingly scarce. Thus, increasing the efficiency of the delivery of healthcare services through the use of modern technology is a pressing issue. The seamless integration of such enabling technologies as ontology, intelligent agents, web services, and cloud computing is transforming healthcare from hospital-based treatments to home-based self-care and preventive care. A ubiquitous healthcare platform based on this technological integration, which synergizes service providers with patients’ needs to be developed to provide personalized healthcare services at the right time, in the right place, and the right manner. This paper presents the development and overall architecture of IAServ (the Intelligent Aging-in-place Home care Web Services Platform) to provide personalized healthcare service ubiquitously in a cloud computing setting to support the most desirable and cost-efficient method of care for the aged-aging in place. The IAServ is expected to offer intelligent, pervasive, accurate and contextually-aware personal care services. Architecturally the implemented IAServ leverages web services and cloud computing to provide economic, scalable, and robust healthcare services over the Internet. PMID:24225647
Su, Chuan-Jun; Chiang, Chang-Yu
As the elderly population has been rapidly expanding and the core tax-paying population has been shrinking, the need for adequate elderly health and housing services continues to grow while the resources to provide such services are becoming increasingly scarce. Thus, increasing the efficiency of the delivery of healthcare services through the use of modern technology is a pressing issue. The seamless integration of such enabling technologies as ontology, intelligent agents, web services, and cloud computing is transforming healthcare from hospital-based treatments to home-based self-care and preventive care. A ubiquitous healthcare platform based on this technological integration, which synergizes service providers with patients' needs to be developed to provide personalized healthcare services at the right time, in the right place, and the right manner. This paper presents the development and overall architecture of IAServ (the Intelligent Aging-in-place Home care Web Services Platform) to provide personalized healthcare service ubiquitously in a cloud computing setting to support the most desirable and cost-efficient method of care for the aged-aging in place. The IAServ is expected to offer intelligent, pervasive, accurate and contextually-aware personal care services. Architecturally the implemented IAServ leverages web services and cloud computing to provide economic, scalable, and robust healthcare services over the Internet.
Ordúñez García, Pedro; Pérez Flores, Enrique; Hospedales, James
The recommendations from the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) were compared with those of a recent article by Aram V. Chobanian, Chairman of the JNC 7. The purpose was to identify the changes that this author proposed and determine how they might affect clinical work, as well as the health services and public health implications. The JNC 7 and the article in question coincide on all essential points, except that the article is more flexible when it comes to the use of diuretics at the start of treatment for high blood pressure. Chronic disease management should take place in health systems with primary care approach, where the epidemiology of such diseases and scientific advances in prevention offer an excellent opportunity for redesigning the health services and making them more effective. High blood pressure, as a public health problem, demands health interventions aimed not only at reducing harm but modifying its etiologic determinants. The challenge is to recognize that an integrated approach to clinical medicine, health services, and public health would offer an attractive opportunity to interrupt and prevent the continuous and costly vicious circle that managing high blood pressure and its complications implies.
Ching, Siew-Mooi; Pang, Yong-Kek; Price, David; Cheong, Ai-Theng; Lee, Ping-Yein; Irmi, Ismail; Faezah, Hassan; Ruhaini, Ismail; Chia, Yook-Chin
Background and objective Early diagnosis of chronic obstructive pulmonary disease (COPD) in primary care settings is difficult to achieve chiefly due to lack of availability of spirometry. This study estimated the prevalence of airflow limitation among chronic smokers using a handheld spirometer in this setting. Methods This is a cross-sectional study performed on consecutive patients who were ≥40 years old with ≥10 pack-years smoking history. Face-to-face interviews were carried out to obtain demographic data and relevant information. Handheld spirometry was performed according to a standard protocol using the COPd-6 device (Model 4000, Vitalograph, Ennis, Ireland) in addition to standard spirometry. Airflow limitation was defined as ratio of forced expiratory volume in 1 s (FEV1)/forced expiratory volume in 6 s <0.75 (COPd-6) or FEV1/forced vital capacity <0.7. Multiple logistic regression analyses were used to determine predictors of airflow limitation. Results A total of 416 patients were recruited with mean age of 53 years old. The prevalence of airflow limitation was 10.6% (n = 44) with COPd-6 versus 6% as gauged using standard spirometry. Risk factors for airflow limitation were age >65 years (odds ratio (OR) 3.732 95% confidence interval (CI): 1.100–1.280), a history of ‘bad health’ (OR 2.524, 95% CI: 1.037–6.142) and low to normal body mass index (OR 2.914, 95% CI: 1.191–7.190). Conclusions In a primary care setting, handheld spirometry (COPd-6) found a prevalence of airflow limitation of ∼10% in smokers. Patients were older, not overweight and had an ill-defined history of health problems. SUMMARY AT A GLANCE Prevalence of COPD is unknown in Malaysia. The prevalence of COPD using a handheld spirometer (COPd-6TM) was 10.6% versus 6% as gauged using standard spirometry. Predictors of COPD were older age, lower BMI and a history of ‘bad health’. Case-finding for COPD should be targeted in this special population. PMID:24708063
Background Frailty in the elderly increases their vulnerability and leads to a greater risk of adverse events. According to various studies, the prevalence of the frailty syndrome in persons age 65 and over ranges between 3% and 37%, depending on age and sex. Walking speed in itself is considered a simple indicator of health status and of survival in older persons. Detecting frailty in primary care consultations can help improve care of the elderly, and walking speed may be an indicator that could facilitate the early diagnosis of frailty in primary care. The objective of this work was to estimate frailty-syndrome prevalence and walking speed in an urban population aged 65 years and over, and to analyze the relationship between the two indicators from the perspective of early diagnosis of frailty in the primary care setting. Methods Population cohort of persons age 65 and over from two urban neighborhoods in northern Madrid (Spain). Cross-sectional analysis. Bivariate and multivariate analysis with binary logistic regression to study the variables associated with frailty. Different cut-off points between 0.4 and 1.4 m/s were used to study walking speed in this population. The relationship between frailty and walking speed was analyzed using likelihood ratios. Results The study sample comprised 1,327 individuals age 65 and older with mean age 75.41 ± 7.41 years; 53.4% were women. Estimated frailty in the study population was 10.5% [95% CI: 8.9-12.3]. Frailty increased with age (OR = 1.14; 95% CI: 1.10-1.19) and was associated with poor self-rated health (OR = 2.52; 95% CI: 1.43-4.44), number of drugs prescribed (OR = 1.17; 95% CI: 1.08-1.26) and disability (OR = 6.58; 95% CI: 3.92-11.05). Walking speed less than 0.8 m/s was found in 42.6% of cases and in 56.4% of persons age 75 and over. Walking speed greater than 0.9 m/s ruled out frailty in the study sample. Persons age 75 and older with walking speed <0.8 m/s are at particularly high
Benzer, Justin K.; Beehler, Sarah; Miller, Christopher; Burgess, James F.; Sullivan, Jennifer L.; Mohr, David C.; Meterko, Mark; Cramer, Irene E.
Objective. There is limited theory regarding the real-world implementation of mental health care in the primary care setting: a type of organizational coordination intervention. The purpose of this study was to develop a theory to conceptualize the potential causes of barriers and facilitators to how local sites responded to this mandated intervention to achieve coordinated mental health care. Methods. Data from 65 primary care and mental health staff interviews across 16 sites were analyzed to identify how coordination was perceived one year after an organizational mandate to provide integrated mental health care in the primary care setting. Results. Standardized referral procedures and communication practices between primary care and mental health were influenced by the organizational factors of resources, training, and work design, as well as provider-experienced organizational boundaries between primary care and mental health, time pressures, and staff participation. Organizational factors and provider experiences were in turn influenced by leadership. Conclusions. Our emergent theory describes how leadership, organizational factors, and provider experiences affect the implementation of a mandated mental health coordination intervention. This framework provides a nuanced understanding of the potential barriers and facilitators to implementing interventions designed to improve coordination between professional groups. PMID:22900158
Christovam, Barbara Pompeu; Porto, Isaura Setenta; de Oliveira, Denise Cristina
The objective of this study was to build and present a theoretical definition of the concept of nursing care management in hospital settings, based on specific literature. We chose to use Concept Analysis strategies for building concepts, the rules of Archeological Analysis for forming concepts, and Lexical Analysis as the theoretical-methodological framework. The operationalization of the strategies and rules for forming the concept permitted the construction of the concept of nursing care in hospital settings. The constructed concept presented, by its nature, the capacity to form a dialectic integration of the aspects relative to the knowing-doing of care and management. The theoretical definition of the concept of Nursing Care Management in Hospital Settings assigned meaning to the term, in the initial context of the construction of a theory of Nursing Care Management in Health Services.
Brown, Jeremy; Grudzen, Corita; Kyriacou, Demetrios N; Obermeyer, Ziad; Quest, Tammie; Rivera, Donna; Stone, Susan; Wright, Jason; Shelburne, Nonniekaye
To identify research priorities and appropriate resources and to establish the infrastructure required to address the emergency care of patients with cancer, the National Institutes of Health's National Cancer Institute and the Office of Emergency Care Research sponsored a one-day workshop, "Cancer and Emergency Medicine: Setting the Research Agenda," in March 2015 in Bethesda, MD. Participants included leading researchers and clinicians in the fields of oncology, emergency medicine, and palliative care, and representatives from the National Institutes of Health. Attendees were charged with identifying research opportunities and priorities to advance the understanding of the emergency care of cancer patients. Recommendations were made in 4 areas: the collection of epidemiologic data, care of the patient with febrile neutropenia, acute events such as dyspnea, and palliative care in the emergency department setting.
Di Lorenzo, Rosaria; Cameli, Michela; Bolondi, Marisa; Landi, Giulia; Moretti, Valentina; Piemonte, Chiara; Pollutri, Gabriella
Objectives To evaluate paliperidone palmitate (PP) effectiveness, safety and adherence to treatment. Methods We collected data of all patients (n = 50) affected by Schizophrenia Disorders, treated with PP for a 3 month minimum period in the outpatient setting of Mental Health Department in Modena, from 01/01/2014 to 31/01/2015. We evaluated reasons and modality for PP implementation, improvement in symptom and functioning scales, adverse effects, discontinuations and relapses. We statistically correlated socio-demographic and clinical variables of our sample with PP therapeutic variables. Results We registered an improvement in all scales, with a superior percentage in PANSS positive subscale. The mean PP dose in some patients was lower than official indications, although our sample was clinically severe. Illness relapses affected 60% and dropout 18% of patients. PP was well tolerated and in just a few cases adverse events required treatment interruption. The risk factors for discontinuation were represented by “lack of therapeutic compliance” (HR = 4.11, p < 0.0001) and “inefficacy” (HR = 1.67, p < 0.0001). Conclusions With limitations of observational design, this research highlights that PP was well tolerated and effective in improving both psychotic symptoms and functioning, but moderately effective in preventing relapse, probably due to clinical severity of our patients associated with extremely cautious and flexible PP prescriptions. PMID:27738372
Zheng, Feng; Ding, Siqing; Luo, Aijing; Zhong, Zhuqing; Duan, Yinglong; Shen, Zhiying
Objective To assess medication literacy status and to examine risk factors of inadequate medication literacy of outpatients in ambulatory care settings. Methods Study participants were recruited randomly from outpatient departments in four tertiary hospitals (Xiangya Hospital of Central South University, Second Xiangya Hospital of Central South University, Third Xiangya Hospital of Central South University, People's Hospital of Hunan Province) in Changsha, Hunan, China, between October 2014 and January 2015. Medication literacy was assessed using the Medication Literacy Scale, Chinese version. Demographic and clinical data were collected using structured interviews. Multiple logistic regression analysis was used to estimate the independent effects of demographic and clinical factors on medication literacy. Results Of 465 participants, 425 (91.4%) produced valid responses for analysis. The mean medication literacy score was 8.31 (standard deviation = 3.47). Medication literacy was adequate in 131 participants (30.8%), marginally adequate in 248 (58.4%), and inadequate in 46 (10.8%). The risk of inadequate medication literacy was greater for older and unmarried patients but lower for more educated patients. Conclusion Many Chinese outpatients in ambulatory care have inadequate medication literacy. Greater age, low education, and unmarried status are important risk factors of inadequate medication literacy.
Yeung, Albert; Slipp, Lauren E; Jacquart, Jolene; Fava, Maurizio; Denninger, John W; Benson, Herbert; Fricchione, Gregory L
Background. This pilot study examined the feasibility and efficacy of providing Qigong treatment in a health center to Chinese Americans with major depressive disorder (MDD). Methods. Fourteen Chinese Americans with MDD were enrolled, and they received a 12-week Qigong intervention. The key outcome measurement was the 17-item Hamilton Rating Scale for Depression (HAM-D17); the Clinical Global Impressions-Severity (CGI-S) and -Improvement (CGI-I), the Quality of Life Enjoyment and Satisfaction Questionnaire, Short Form (Q-LES-Q-SF), and the Multidimensional Scale of Perceived Social Support (MSPSS) were also administered. Positive response was defined as a decrease of 50% or more on the HAM-D17, and remission was defined as HAM-D17 ≤ 7. Patients' outcome measurements were compared before and after the Qigong intervention. Results. Participants (N = 14) were 64% female, with a mean age of 53 (±14). A 71% of participants completed the intervention. The Qigong intervention resulted in a positive treatment-response rate of 60% and a remission rate of 40% and statistically significant improvement, as measured by the HAM-D17, CGI-S, CGI-I, Q-LES-Q-SF, and the family support subscale of the MSPSS. Conclusions. The Qigong intervention provided at a health care setting for the treatment of primary care patients with MDD is feasible. Further studies with larger sample sizes are warranted.
Cespedes, Elizabeth; Andrade, Gloria Oliva Martínez; Rodríguez-Oliveros, Guadalupe; Perez-Cuevas, Ricardo; González-Unzaga, Marco A.; Trejo, Amalia Benitez; Haines, Jess; Gillman, Matthew W.; Taveras, Elsie M.
Background The purpose of this study was to examine Mexican caregivers’ perceptions of the role of primary care in childhood obesity management, understand the barriers and facilitators of behavior change, and identify opportunities to strengthen obesity prevention and treatment in clinical settings. Methods We conducted 52 in-depth interviews with parents and caregivers of overweight and obese children age 2–5 years in 4 Ministry of Health (public, low SES) and 4 Social Security Institute (insured, higher SES) primary care clinics in Mexico City and did systematic thematic analysis. Results In both health systems, caregivers acknowledged childhood overweight but not its adverse health consequences. Although the majority of parents had not received nutrition or physical activity recommendations from health providers, many were open to clinician guidance. Despite knowledge of healthful nutrition and physical activity, parents identified several barriers to change including child feeding occurring in the context of competing priorities (work schedules, spouses’ food preferences), and cultural norms (heavy as healthy, food as nurturance) that take precedence over adherence to dietary guidelines. Physical activity, while viewed favorably, is not a structured part of most preschooler’s routines as reported by parents. Conclusions The likelihood of success for clinic-based obesity prevention among Mexican preschoolers will be higher by addressing contextual barriers such as cultural norms regarding children’s weight and support of family members for behavior change. Similarities in caregivers’ perceptions across 2 health systems highlight the possibility of developing comprehensive interventions for the population as a whole. PMID:25530836
Quesenberry, Amanda C.; Hemmeter, Mary Louise; Ostrosky, Michaelene M.; Hamann, Kira
In this study, 9 teachers from 5 child care centers were interviewed to examine their perceptions on including children with challenging behavior in their classrooms. The findings provide a firsthand view into how child care teachers support children's social and emotional development and address challenging behavior. Results confirm previous…
Bridgeman, Mary Barna; Abazia, Daniel T
The authors review the historical use of medicinal cannabis and discuss the agent's pharmacology and pharmacokinetics, select evidence on medicinal uses, and the implications of evolving regulations on the acute care hospital setting.
Bodenmann, Patrick; Wolff, Hans; Bischoff, Thomas; Herzig, Lilli; Warin, Philippe; Chatelard, Sophia; Burnand, Bernard; Vaucher, Paul; Favrat, Bernard; Panese Francesco; Jackson, Yves L; Vu, Francis; Guessous, Idris
Although the performance of the Swiss health system is high, one out of ten patients in general practitioner's (GP) office declares having foregone care in the previous twelve months for economic reasons. Reasons for foregoing care are several and include a lack of knowledge of existing social aids in getting health insurance, unavailability of GPs and long waiting lists for various types of care. Although long term knowledge of patients or a psychosocial history of deprivation or poverty may help identify individuals at risk of foregoing care, many may remain undetected. We propose then a few instruments to help GPs to identify, in a simple and structured approach, patients at risk of forgoing care for economic reasons; these patients are frequently deprived and sometimes poor.
Background Improving palliative care management in acute hospital settings has been identified as a priority internationally. The aim of this study was to establish the proportion of inpatients within one acute hospital in New Zealand who meet prognostic criteria for palliative care need and explore key aspects of their management. Methods A prospective survey of adult hospital inpatients (n = 501) was undertaken. Case notes were examined for evidence that the patient might be in their last year of life according to Gold Standards Framework (GSF) prognostic indicator criteria. For patients who met GSF criteria, clinical and socio-demographic information were recorded. Results Ninety-nine inpatients met GSF criteria, representing 19.8% of the total census population. The patients’ average age was 70 years; 47% had a primary diagnosis of cancer. Two thirds had died within 6 months of their admission. Seventy-eight of the 99 cases demonstrated evidence that a palliative approach to care had been adopted; however documentation of discussion about goals of care was very limited and only one patient had evidence of an advance care plan. Conclusion One fifth of hospital inpatients met criteria for palliative care need, the majority of whom were aged >70 years. Whilst over three quarters were concluded to be receiving care in line with a palliative care approach, very little documented evidence of discussion with patients and families regarding end of life issues was evident. Future research needs to explore how best to support ‘generalist’ palliative care providers in initiating, and appropriately recording, such discussions. PMID:23537092
US Department of Education, 2014
Providing high-quality education in juvenile justice secure care settings presents unique challenges for the administrators, teachers, and staff who are responsible for the education, rehabilitation, and welfare of youths committed to their care. The United States departments of Education (ED) and Justice (DOJ) recognize that while these…
McKinney, David D., Ed.; And Others
A feasibility study regarding the training and information needs of preschool and day care administrators, staff, and teachers regarding HIV/AIDS was conducted. This study also examined the issues associated with the presence of HIV-positive children in preschool and day care settings and the need for designing a program to help preschools and day…
Thompson, Edward H.
Examined sociodemographic background, nursing unit, amount of experience caring for dying patients, death anxiety, and attitudes toward working with dying patients among 56 nurses in palliative, surgical, and pediatric services. Work setting was found to be a more significant force in shaping attitudes toward caring for the dying than was…
Hammer, Jeffrey S.; Lyons, John S.; Strain, James J.
This paper presents a flexible software system that is adaptable to a variety of information management uses across different psychosocial service departments in hospital settings. Initially developed for Consultation Liaison Psychiatry, the present system has now been adapted for a Social Work department and is being adapted to Hospice, Home Care, Patient Representative, and Pastoral Care departmental uses.
Drum, David; Becker, Martin Swanbrow; Hess, Elaine
Changes in the health care arena and within the specialty of group work are contributing to the increased utilization of groups in health care settings. Psychoeducational, theme, and interpersonal therapy groups are highlighted for their contributions to treating challenging health conditions. An understanding of the evolution of these group…
Massey, Philip M.; Prelip, Michael; Calimlim, Brian M.; Quiter, Elaine S.; Glik, Deborah C.
The current emphasis on preventive health care and wellness services suggests that measures of skills and competencies needed to effectively navigate the health care system need to be better defined. We take an expanded perspective of health literacy and define it as a set of skills used to organize and apply health knowledge, attitudes and…
It is not only in families that young children are influenced to become members of their culture. Around the world and within individual countries, culture influences how care is provided to infants and toddlers in child care settings. In turn, infants and toddlers begin to learn how to act and think as members of their culture. From ways that…
Adams, Carolyn D.; Hinojosa, Sara; Armstrong, Kathleen; Takagishi, Jennifer; Dabrow, Sharon
This article discusses an innovative example of integrated care in which doctoral level school psychology interns and residents worked alongside pediatric residents and pediatricians in the primary care settings to jointly provide services to patients. School psychologists specializing in pediatric health are uniquely trained to recognize and…
Levy, Linda S.; Sexton, Patrick; Willeford, K. Sean; Barnum, Mary G.; Guyer, M. Susan; Gardner, Greg; Fincher, A. Louise
The purpose of this literature review is to compare both clinical instructor and student perceptions of helpful and hindering clinical instructor characteristics, behaviors and skills in athletic training and allied health care settings. Clinical education in athletic training is similar to that of other allied health care professions. Clinical…
Nocon, Robert S.; Lee, Sang Mee; Sharma, Ravi; Ngo-Metzger, Quyen; Mukamel, Dana B.; Gao, Yue; White, Laura M.; Shi, Leiyu; Chin, Marshall H.; Laiteerapong, Neda; Huang, Elbert S.
Objectives To compare health care use and spending of Medicaid enrollees seen at federally qualified health centers versus non–health center settings in a context of significant growth. Methods Using fee-for-service Medicaid claims from 13 states in 2009, we compared patients receiving the majority of their primary care in federally qualified health centers with propensity score–matched comparison groups receiving primary care in other settings. Results We found that health center patients had lower use and spending than did non–health center patients across all services, with 22% fewer visits and 33% lower spending on specialty care and 25% fewer admissions and 27% lower spending on inpatient care. Total spending was 24% lower for health center patients. Conclusions Our analysis of 2009 Medicaid claims, which includes the largest sample of states and more recent data than do previous multistate claims studies, demonstrates that the health center program has provided a cost-efficient setting for primary care for Medicaid enrollees. PMID:27631748
Simon, Carl P; Percha, Bethany; Riolo, Rick; Foxman, Betsy
Health-care associated infections are a major problem in our society, accounting for tens of thousands of patient deaths and millions of dollars in wasted health care expenditures each year. Many of these infections are caused by bacteria that are transmitted from patient to patient either through direct contact or via the hands or clothing of health care workers. Because of the complexity of bacterial transmission routes in health care settings, computational approaches are essential, though often analytically intractable. Here we describe the construction and detailed analysis of a model for bacterial transmission in health care settings. Our model includes both colonization and disease stages for patients and health care workers, as well as an isolation ward and both patient-patient and patient-HCW-patient transmission pathways. We explicitly derive the basic reproductive ratio for this complex model, a nine-term expression that contains all nine ways with which a new colonization can occur. Using key parameters found in the medical literature, we use our model to gain insight into the relative importance of various bacterial transmission pathways within health care facilities, and to identify which forms of interventions are likely to prove most effective in hospitals and long-term care settings. We show that analytical and numerical approaches can complement each other as we seek to untangle the complex web of interactions that occur within a health care facility.
Lesauskaite, Vita; Macijauskiene, Jurate; Rader, Erin
The aim of this paper is to present the Lithuanian experience in creating a geriatric care system with the hope that it can be of some use to other countries undergoing similar transitions and changes. The Lithuanian population is old with 20% of the population being 60 years and older, and 15% being 65 years and older, with the trend toward a rapidly aging society. In 1990, Soviet rule in Lithuania ceased and the country regained its independence. With its recent acceptance into the European Union, the nation has set goals to meet the recommended requirements for the care of the elderly. The changes began with specialist training in gerontology and geriatrics, and were an essential first step to bridge the gap between the real and the future needs. Later, the Geriatric Care System Development Program was approved by the Ministry of Health. Despite its difficult past, Lithuania is confronting the challenges of health and social care of the aging population. It is embracing the opportunities to initiate policies and related measures to meet these challenges, and is potentially setting an example of good practice as a new European community.
Fraisse, Alain; Le Bel, Stéphane; Mas, Bertrand; Macrae, Duncan
Over recent decades, specialized paediatric cardiac intensive care has emerged as a central component in the management of critically ill, neonatal, paediatric and adult patients with congenital and acquired heart disease. The majority of high-volume centres (dealing with over 300 surgical cases per year) have dedicated paediatric cardiac intensive care units, with the smallest programmes more likely to care for paediatric cardiac patients in mixed paediatric or adult intensive care units. Specialized nursing staff are also a crucial presence at the patient's bedside for quality of care. A paediatric cardiac intensive care programme should have patients (preoperative and postoperative) grouped together geographically, and should provide proximity to the operating theatre, catheterization laboratory and radiology department, as well as to the regular ward. Age-appropriate medical equipment must be provided. An optimal strategy for running a paediatric cardiac intensive care programme should include: multidisciplinary collaboration and involvement with paediatric cardiology, anaesthesia, cardiac surgery and many other subspecialties; a risk-stratification strategy for quantifying perioperative risk; a personalized patient approach; and anticipatory care. Finally, progressive withdrawal from heavy paediatric cardiac intensive care management should be institutionalized. Although the countries of the European Union do not share any common legislation on the structure and organization of paediatric intensive care or paediatric cardiac intensive care, any paediatric cardiac surgery programme in France that is agreed by the French Health Ministry must perform at least '150 major procedures per year in children' and must provide a 'specialized paediatric intensive care unit'.
Hubble, Rosemary; Trowbridge, Kelly; Hubbard, Claudia; Ahsens, Leslie; Ward-Smith, Peggy
The capability of effectively communicating is crucial when providing palliative care, especially when the patient is a child. Communication among healthcare professionals with the child and family members must be clear, concise, and consistent. Use of a communication tool provides documentation for conversations, treatment plans, and specific desires related to care. This paper describes communication theory, portrays the use of this theory to develop a communication tool, and illustrates the use of this tool by multidisciplinary members of a healthcare team to provide pediatric palliative care.
Tees, Bob; Budd, Jennifer
The article describes how music has been integrated into spiritual and supportive care for palliative care patients at Brantford General Hospital (Ontario). Numerous case examples illustrate how a song or piece of music can play a vital role in the spiritual dimension of end of life care. The article expands the concept of the "living human document" by positing that a life story has an accompanying soundtrack: a musical memory and sensorial attunement that can be energized when music is offered at the bedside. The writers suggest that music provides an alternate spiritual language for patients whether or not they have a religious affiliation.
Javaid, Mehwish; Ashrawi, Dana; Landgren, Rachel; Stevens, Lori; Bello, Rosalind; Foxhall, Lewis; Mims, Melissa; Ramondetta, Lois
The purpose of this study was to identify barriers to and facilitators of human papillomavirus (HPV) vaccination in children aged 9-17 years across Texas. A literature review informed the development of a web-based survey designed for people whose work involves HPV vaccination in settings serving pediatric patients. The survey was used to examine current HPV vaccine recommendation practices among healthcare providers, barriers to HPV vaccination, reasons for parent/caregiver vaccine refusal, staff and family education practices, utilization of reminder and recall systems and status of vaccine administration (payment, ordering and stocking). 1132 responses were received representing healthcare providers, administrative and managerial staff. Respondents identified perceived barriers to HPV vaccination as parental beliefs about lack of necessity of vaccination prior to sexual debut, parental concerns regarding safety and/or side effects, parental perceptions that their child is at low risk for HPV-related disease, and parental lack of knowledge that the vaccine is a series of three shots. Of responding healthcare providers, 94 % (n = 582) reported they recommend the vaccine for 9-12 year olds; however, same-day acceptance of the vaccine is low with only 5 % (n = 31) of providers reporting the HPV vaccine is "always" accepted the same day the recommendation is made. Healthcare providers and multidisciplinary care teams in pediatric care settings must work to identify gaps between recommendation and uptake to maximize clinical opportunities. Training in methods to communicate an effective HPV recommendation and patient education tailored to address identified barriers may be helpful to reduce missed opportunities and increase on-time HPV vaccinations.
This manual was designed to assist concerned individuals and organizations within communities in New Mexico to develop and plan effective school-age child care programs. Emphasized are the first steps in initiating and implementing school-age child care in a community. Chapter I discusses the need for school-age child care programs and the…
Aberdeen, Sue; Angus, Jocelyn
The concept of leadership is frequently used in aged-care service provision. Yet, it is a concept that is not well understood or defined. This paper reports on a systematic review of national and international multi- disciplinary aged-care literature (1999 to 2004) to identify the attributes and functions of leaders in aged-care delivery systems.…
Cardiovascular disease (CVD), the leading cause of death, disability, and lost productivity in adults, drains our society physically and economically. Once considered a male domain, hospital mortality attributed to CVD has become more prevalent among women. As a result of this trend, critical care nurses can expect to care for more women with CVD. The psychobiological model of CVD suggests that psychological factors, such as anxiety and depression, contribute to the development and progression of CVD. Anxiety and depression occur more often in women than in men and possibly could be explained by the fact that women report experiencing physical and sexual abuse at a much higher rate than do men. Women with a history of physical and sexual abuse report more anxiety and depression than do women without such a history. A possible means by which abuse may begin and continue within the lives of women is marginality. Marginality serves as a perspective for viewing women's health in terms of physical and psychological health outcomes. By understanding marginality and its impact on health outcomes, critical care nurses may recognize patients at risk for adverse CVD health outcomes while in their care. These patients present unique health care challenges in critical care.
This report details a national survey study of parents, age 54 or younger, living with children under age 18. The study examined parents' physical health status, stress levels and negative feelings, health habits, and access to health care. Findings indicated that one in eight parents reported health problems, with health related to education,…
Rushton, Carole; Edvardsson, David
Relationships are central to enacting person-centred care of the older person with cognitive impairment. A fuller understanding of relationships and the role they play facilitating wellness and preserving personhood is critical if we are to unleash the productive potential of nursing research and person-centred care. In this article, we target the acute care setting because much of the work about relationships and older people with cognitive impairment has tended to focus on relationships in long-term care. The acute care setting is characterized by archetypal constraints which differentiate it from long-term care, in terms of acuity and haste, task-orientated work patterns and influence from "the rule of medicine," all of which can privilege particular types of relating. In this article, we drew on existing conceptualizations of relationships from theory and practice by tapping in to the intellectual resources provided by nurse researchers, the philosophy of Martin Buber and ANT scholars. This involved recounting two examples of dyadic and networked relationships which were re-interpreted using two complementary theoretical approaches to provide deeper and more comprehensive conceptualizations of these relationships. By re-presenting key tenets from the work of key scholars on the topic relationships, we hope to hasten socialization of these ideas into nursing into the acute care setting. First, by enabling nurses to reflect on how they might work toward cultivating relationships that are more salutogenic and consistent with the preservation of personhood. Second, by stimulating two distinct but related lines of research enquiry which focus on dyadic and networked relationships with the older person with cognitive impairment in the acute care setting. We also hope to reconcile the schism that has emerged in the literature between preferred approaches to care of the older person with cognitive impairment, that is person-centred care versus relationship-centred care
DeMarco, Rosanna F; Brennan-Ing, Mark; Sprague, Courtenay; Brown, Shelley M
Ageism, in the form of prejudice, stereotyping, and discrimination targeting older adults, represents a barrier to addressing the graying of the HIV epidemic. There is widespread misperception on the part of older adults themselves, as well as service providers and society in general that HIV risk is low as one ages. In addition, internalized ageism may play a role in poorer physical and mental health outcomes, as the negative stereotypes associated with aging become a self-fulfilling prophecy. A number of steps can be taken to address HIV and aging in the context of ageism with regard to: prevention, education, and outreach; treatment guidelines for older adults with HIV; funding to address the aging of the epidemic; engagement of communities, health and social service organizations, and other providers around mental health and social support, and addressing the needs of special populations. Caring for an aging population with HIV represents a challenge, which is exacerbated in low and/or middle-income countries that typically lack the infrastructure of high resource settings. How we address the aging-related issues of the HIV epidemic across regions and settings could serve as a model in dealing with aging in our society in general regardless of HIV status.
Mapp, Fiona; Hutchinson, Jane; Estcourt, Claudia
HIV shared care is uncommon in the UK although shared care could be a beneficial model of care. We review the literature on HIV shared care to determine current practice and clinical, economic and patient satisfaction outcomes. We searched MEDLINE, EMBASE, NICE Evidence, Cochrane collaboration, Google and websites of the British HIV Association, Aidsmap, Public Health England, World Health Organization and Terrence Higgins Trust using relevant search terms in August 2014. Studies published after 2000, from healthcare settings comparable to the UK that described links between primary care and specialised HIV services were included and compared using principles of the Critical Appraisal Skills Programme and Authority, Accuracy, Coverage, Objectivity, Date, Significance frameworks. Three of the nine included models reported clinical or patient satisfaction outcomes but data collection and analyses were inadequate. None reported economic outcomes although some provided financial costings. Facilitators of shared care included robust clinical protocols, training and timely communication. Few published examples of HIV shared care exist and quality of evidence is poor. There is no consistent association with improved clinical outcomes, cost effectiveness or acceptability. Models are context specific, driven by local need, although some generalisable features could inform novel service delivery. Further evaluative research is needed to determine optimal components of shared HIV care.
Paz, Amira; Doron, Israel; Tur-Sinai, Aviad
The world is aging, and the percentages of older people are on a dramatic ascent. This dramatic demographic aging of human society is not gender neutral; it is mostly about older women. One of the key policy approaches to address the aging revolution is known as "active aging," crystalized by the WHO in 2002 by three pillars: participation, health, and security. The active aging policy has financial and economic aspects and affects both men and women. However, as argued in this article, a gender-based approach has not been adopted within the existing active aging framework. Therefore, a new gender-specific research agenda is needed, one that focuses on an interrelation between gender and different economic aspects of "active aging" from international, comparative, cultural, and longitudinal perspectives.
Specchia, Maria Lucia; Veneziano, Maria Assunta; Cadeddu, Chiara; Ferriero, Anna Maria; Capizzi, Silvio; Ricciardi, Walter
In the last few years, the need of public reporting of health outcomes has acquired a great importance. The public release of performance results could be a tool for improving health care quality and many attempts have been made in order to introduce public reporting programs within the health care context at different levels. It would be necessary to promote the introduction of a standardized set of outcome and performance measures in order to improve quality of health care services and to make health care providers aware of the importance of transparency and accountability.
Thomson, E M
In 1985, the ADHA, in response to the changing health care environment, identified six roles for the future of dental hygiene. The administrator/manager role, one of the six, is an expansion of dental hygiene skills to facilitate the provision of quality oral health care. Oral health care settings require personnel trained in management to accomplish practice-related goals and objectives. Dental hygiene is preparing individuals to assume managerial roles to fill this health care need. This paper discusses the skills and knowledge level required to assume managerial roles and strategies for marketing the dental hygienist as a manager.
Poghosyan, Lusine; Nannini, Angela; Stone, Patricia W; Smaldone, Arlene
The expansion of the nurse practitioner (NP) workforce in primary care is key to meeting the increased demand for care. Organizational climates in primary care settings affect NP professional practice and the quality of care. This study investigated organizational climate and its domains affecting NP professional practice in primary care settings. A qualitative descriptive design, with purposive sampling, was used to recruit 16 NPs practicing in primary care settings in Massachusetts. An interview guide was developed and pretested with two NPs and in 1 group interview with 7 NPs. Data collection took place in spring of 2011. Individual interviews lasted from 30-70 minutes, were audio recorded, and transcribed. Data were analyzed using Atlas.ti 6.0 software by 3 researchers. Content analysis was applied. Three previously identified themes, NP-physician relations, independent practice and autonomy, and professional visibility, as well as two new themes, organizational support and resources and NP-administration relations emerged from the analyses. NPs reported collegial relations with physicians, challenges in establishing independent practice, suboptimal relationships with administration, and lack of support. NP contributions to patient care were invisible. Favorable organizational climates should be promoted to support the expanding of NP workforce in primary care and to optimize recruitment and retention efforts.
Sharkey, Alyssa B; Chopra, Mickey; Jackson, Debra; Winch, Peter J; Minkovitz, Cynthia S
Summary The purpose of this study was to examine care-seeking during fatal infant illnesses in under-resourced South African settings to inform potential strategies for reducing infant mortality. We interviewed 22 caregivers of deceased infants in a rural community and 28 in an urban township. We also interviewed seven local leaders and 12 health providers to ascertain opinions about factors contributing to infant death. Despite the availability of free public health services in these settings, many caregivers utilised multiple sources of care including allopathic, indigenous and home treatments. Urban caregivers reported up to eight points of care while rural caregivers reported up to four points of care. The specific pathways taken and combinations of care varied, but many caregivers used other types of care shortly after presenting at public services, indicating dissatisfaction with the care they received. Many infants died despite caregivers’ considerable efforts, pointing to critical deficiencies in the system of care serving these families. Initiatives that aim to improve assessment, management and referral practices by both allopathic and traditional providers (for example, through training and improved collaboration), and caregiver recognition of infant danger signs may reduce the high rate of infant death in these settings. PMID:22136954
Becker-Dreps, Sylvia; Paniagua, Margarita; Zambrana, Luis Enrique; Bucardo, Filemon; Hudgens, Michael G.; Weber, David J.; Morgan, Douglas R.; Espinoza, Félix
Nicaragua was the first developing nation to implement universal infant rotavirus immunization with the pentavalent rotavirus vaccine (RV5). Initial studies of vaccine effectiveness in Nicaragua and other developing nations have focused on the prevention of hospitalizations and severe rotavirus diarrhea. However, rotavirus diarrhea is more commonly treated in the primary care setting, with only 1–3% of rotavirus cases receiving hospital care. We measured the prevalence of rotavirus infection in primary care clinics in León, Nicaragua, after introduction of the immunization program. In the post-vaccine period, 3.5% (95% confidence interval = 1.9–5.8) of children seeking care for diarrhea tested positive for rotavirus. A high diversity of rotavirus genotypes was encountered among the few positive samples. In conclusion, rotavirus was an uncommon cause of childhood diarrhea in this primary care setting after implementation of a rotavirus immunization program. PMID:22049057
People living with HIV (PLWH) continue to endure stigma and discrimination in the context of health care. This paper presents the findings of a qualitative study designed to (a) describe stigmatizing and discriminatory practices in health care settings, and (b) explore both symbolic and structural stigma from the perspectives of PLWH. For the purpose of this qualitative study, 21 semi-structured in-depth interviews were conducted in the province of Quebec, Canada. The data were analyzed following the principles of thematic analysis. During analysis, three themes were identified, and relations between these themes were delineated to reflect the experiences of participants. The findings suggest that HIV-related stigma in health care settings is episodic in nature. The findings also suggest that HIV-related stigma is experienced through interactions with health care providers (symbolic stigma) and, finally, that it is applied systematically to manage risk in the context of health care (structural stigma).
Lysaght, Susan; Ersek, Mary
Although place of death has been routinely studied in end-of-life (EOL) care, more analysis on place of death within hospice is needed because of the recent, dramatic rise in the number of hospice patients dying in inpatient settings. Using a case study to illustrate the complexity of determinants of place of death within hospice, this article highlights important known factors and elucidate gaps for further research. Individual and system level factors, sociocultural meanings, caregiving and preferences are shown to have important implications. Additionally, the unique components of home hospice, inpatient hospice and transitions between these settings may have a fundamental role in the future of quality EOL care. Further research on determinants of hospice settings of care is essential to the care of older adults at the end of life. PMID:23853526
Apker, Julie; Propp, Kathleen M; Zabava Ford, Wendy S; Hofmeister, Nancee
This study explored how nurses communicate professionalism in interactions with members of their health care teams. Extant research show that effective team communication is a vital aspect of a positive nursing practice environment, a setting that has been linked to enhanced patient outcomes. Although communication principles are emphasized in nursing education as an important component of professional nursing practice, actual nurse interaction skills in team-based health care delivery remain understudied. Qualitative analysis of interview transcripts with 50 participants at a large tertiary hospital revealed four communicative skill sets exemplified by nursing professionals: collaboration, credibility, compassion, and coordination. Study findings highlight specific communicative behaviors associated with each skill set that exemplify nurse professionalism to members of health care teams. Theoretical and pragmatic conclusions are drawn regarding the communicative responsibilities of professional nurses in health care teams. Specific interaction techniques that nurses could use in nurse-team communication are then offered for use in baccalaureate curriculum and organizational in-service education.
Perez-Cuevas, Ricardo; Fraser, William; Reyes, Hortensia; Reinharz, Daniel; Daftari, Ashi; Heinz, Cristina S; Roberts, James M
Background Preeclampsia is a complex disease in which several providers should interact continuously and in a coordinated manner to provide proper health care. However, standardizing criteria to treat patients with preeclampsia is problematical and severe flaws have been observed in the management of the disease. This paper describes a set of critical pathways (CPs) designed to provide uniform criteria for clinical decision-making at different levels of care of pregnant patients with preeclampsia or severe preeclampsia. Methods Clinicians and researchers from different countries participated in the construction of the CPs. The CPs were developed using the following steps: a) Definition of the conceptual framework; b) Identification of potential users: primary care physicians and maternal and child health nurses in ambulatory settings; ob/gyn and intensive care physicians in secondary and tertiary care levels. c) Structural development. Results The CPs address the following care processes: 1. Screening for preeclampsia, risk assessment and classification according to the level of risk. 2. Management of preeclampsia at primary care clinics. 3. Evaluation and management of preeclampsia at secondary and tertiary care hospitals: 4. Criteria for clinical decision-making between conservative management and expedited delivery of patients with severe preeclampsia. Conclusion Since preeclampsia continues to be one of the primary causes of maternal deaths and morbidity worldwide, the expected impact of these CPs is the contribution to improving health care quality in both developed and developing countries. The CPs are designed to be applied in a complex health care system, where different physicians and health providers at different levels of care should interact continuously and in a coordinated manner to provide care to all preeclamptic women. Although the CPs were developed using evidence-based criteria, they could require careful evaluation and remodelling according to
Perez-Cuevas, Ricardo; Fraser, William; Reyes, Hortensia; Reinharz, Daniel; Daftari, Ashi; Heinz, Cristina S; Roberts, James M
BACKGROUND: Preeclampsia is a complex disease in which several providers should interact continuously and in a coordinated manner to provide proper health care. However, standardizing criteria to treat patients with preeclampsia is problematical and severe flaws have been observed in the management of the disease. This paper describes a set of critical pathways (CPs) designed to provide uniform criteria for clinical decision-making at different levels of care of pregnant patients with preeclampsia or severe preeclampsia. METHODS: Clinicians and researchers from different countries participated in the construction of the CPs. The CPs were developed using the following steps: a) Definition of the conceptual framework; b) Identification of potential users: primary care physicians and maternal and child health nurses in ambulatory settings; ob/gyn and intensive care physicians in secondary and tertiary care levels. c) Structural development. RESULTS: The CPs address the following care processes: 1. Screening for preeclampsia, risk assessment and classification according to the level of risk. 2. Management of preeclampsia at primary care clinics. 3. Evaluation and management of preeclampsia at secondary and tertiary care hospitals: 4. Criteria for clinical decision-making between conservative management and expedited delivery of patients with severe preeclampsia. CONCLUSION: Since preeclampsia continues to be one of the primary causes of maternal deaths and morbidity worldwide, the expected impact of these CPs is the contribution to improving health care quality in both developed and developing countries. The CPs are designed to be applied in a complex health care system, where different physicians and health providers at different levels of care should interact continuously and in a coordinated manner to provide care to all preeclamptic women. Although the CPs were developed using evidence-based criteria, they could require careful evaluation and remodelling according
Since 2006, UK policy has identified a professionalisation agenda for staff working in early childhood education and care settings. This has included the development of graduate leaders with a specific purpose to lead improvements in these settings by leading change, and hence improving outcomes for children. This article reports on findings from…
Fleming, M; Manwell, L B
Primary health care providers identify and treat many patients who are at risk for or are already experiencing alcohol-related problems. Brief interventions--counseling delivered by primary care providers in the context of several standard office visits--can be a successful treatment approach for many of these patients. Numerous trials involving a variety of patient populations have indicated that brief interventions can reduce patients' drinking levels, regardless of the patients' ages and gender. In clinical practice, brief interventions can help reduce the drinking levels of nondependent drinkers who drink more than the recommended limits, facilitate therapy and abstinence in patients receiving pharmacotherapy, and enhance the effectiveness of assessment and treatment referral in patients who do not respond to brief interventions alone. Despite the evidence for their usefulness, however, brief interventions for alcohol-related problems have not yet been widely implemented in primary care settings.
Lewis-Byers, Kari; Thayer, Debra
Caring for the skin of patients with incontinence is an essential activity in long-term care. A prospective descriptive study to compare the effect of two skin care protocols on skin condition, pain, and caregiver time was conducted. Thirty-two (32) skilled nursing facility residents with incontinence participated in the 3-week study. Patients were randomly assigned to a standard care regimen (soap and water cleansing after each incontinence episode, followed by application of a moisturizing lotion) or study care protocol (no-rinse skin cleanser after each episode and application of a barrier cream with durable properties after the first incontinence episode of each shift). Number and type of incontinence episodes, skin condition, pain, and caregiver time spent were assessed. Skin integrity was maintained in the majority of control (69%) and study group (72%) patients and improvement occurred in 8% of control and 17% of the study group (NS). Study protocol procedures took less time to complete than control procedures (a savings of 79 minutes/patient/day). A positive correlation between pain intensity and level of skin impairment was observed (r = 0.88). The results of this study suggest that at this facility, use of soap, water, and a moisturizer may be less effective and more time-consuming than using a no-rinse cleanser and a durable barrier product.
Thomson, Linda J M; Chatterjee, Helen J
The extent to which a museum object-handling intervention enhanced older adult well-being across three health care settings was examined. The program aimed to determine whether therapeutic benefits could be measured objectively using clinical scales. Facilitator-led, 30 to 40 min sessions handling and discussing museum objects were conducted in acute and elderly care (11 one-to-ones), residential (4 one-to-ones and 1 group of five), and psychiatric (4 groups of five) settings. Pre-post measures of psychological well-being (Positive Affect and Negative Affect Schedule) and subjective wellness and happiness (Visual Analogue Scales) were compared. Positive affect and wellness increased significantly in acute and elderly and residential care though not psychiatric care whereas negative affect decreased and happiness increased in all settings. Examination of audio recordings revealed enhanced confidence, social interaction, and learning. The program allowed adults access to a museum activity who by virtue of age and ill health would not otherwise have engaged with museum objects.
Dutson-Mallory, Cate; And Others
This coursebook provides materials for a course to improve the oral communication skills of workers in health care settings. The course is designed to be delivered in eight sessions over a 4-week period. Stated objectives for the participants are as follows: feel more comfortable with communication in the hospital, avoid becoming defensive or…
Warren, Jared S.; Nelson, Philip L.; Mondragon, Sasha A.; Baldwin, Scott A.; Burlingame, Gary M.
Objective: The authors compared symptom change trajectories and treatment outcome categories in children and adolescents receiving routine outpatient mental health services in a public community mental health system and a private managed care organization. Method: Archival longitudinal outcome data from parents completing the Youth Outcome…
Bae, Byoungjun; Choi, Bo Ram; Song, Inmyung
Patient cost-sharing change was implemented on August 1, 2007, for outpatient care in the clinic setting in Korea from copayment to coinsurance. This study aims to estimate the effect of the policy change on medical care usage and expenditure in older Koreans. By using national health insurance claims data from the Health Insurance Reimbursement Assessment Service, this study analyzed the entire 137 million claims for a total of approximately 4.1 million patients aged 60 to 69 years who had been diagnosed and/or treated for outpatient care in clinics from January 1, 2007, to December 31, 2008. Medical care usage was defined as the proportion of all beneficiaries in each group who visited clinics and the mean number of visit days per beneficiary. Medical care expenditure per visit day was expressed as total costs, reimbursed amount, and patient's out-of-pocket payment. Data on January through June of 2008 were analyzed as compared with the same months of 2007. Raw difference-in-difference and multiple regression analyses were performed. The interaction coefficients, which measured the impact of cost-sharing change, was -0.078 in model 1 and -0.039 in model 2 (P < .0001). In conclusion, a cost-sharing change from copayment to coinsurance reduced medical care usage and expenditure.
Foster, Mandie Jane; Whitehead, Lisa; Maybee, Patricia; Cullens, Victoria
The delivery of family centered care (FCC) occurs within varied pediatric care settings with a belief that this model of care meets the psychosocial, emotional, and physical needs of the hospitalized child and family. The aim of this review was to explore the attitudes, experiences, and implementation of FCC from many studies and to facilitate a wider and more thorough understanding of this practice from a diverse sample of parents, hospitalized children, and their health care providers within a pediatric critical care setting. A metasynthesis is an integration of qualitative research findings based on a systematic review of the literature. Thirty original research articles focusing on family-centered care experiences from the hospitalized child's, parents', and health care providers' perception published between 1998 and 2011 met the criteria for the review. Nine syntheses from 17 themes emerged from the synthesis of the literature: Prehospital, Entry into the Hospital, Journeying Through Unknown Waters, Information, Relationships, The hospital Environment, The Possibility of Death, Religion and Spirituality, and The Journey Home. The individual cultures of the critical care units helped create and reinforce the context of parental needs where satisfaction with communication, information, and relationships were interconnecting factors that helped maintain the positive or negative experiences for the parent, hospitalized child, and/or health care providers.
Hunt, R W
Daniel Callahan has argued that economic and social benefits would result from a policy of withholding medical treatments which prolong life in persons over a certain age. He claims 'the real goal of medicine' is to conquer death and prolong life with the use of technology, regardless of the age and quality of life of the patient, and this has been responsible for the escalation of health care expenditure. Callahan's proposal is based on economic rationalism but there is little evidence to suggest that substantial economic savings could be achieved. Moreover, his argument raises serious moral objections. A policy of withholding treatments from members of a social group involves elements of compulsion and discrimination, both of which would intrude on the doctor-patient relationship, undermine the autonomy of elderly patients, and invoke the slippery slope towards involuntary forms of euthanasia. Life-death decisions should be based on more than the one criterion of age, and take account of more relevant factors such as the patient's usual state of well-being, her/his expressed wishes, informed consent and the type of illness. Any move to the implementation and enforcement of the policy Callahan recommends would be rejected by health professionals and the public. PMID:8459434
Seedat, Jaishika; Penn, Claire
Oral care is a crucial routine for patients with dysphagia that, when completed routinely, can prevent the development of aspiration pneumonia. There is no standardised protocol for oral care within government hospitals in South Africa. This study aimed to investigate the outcome of an oral care protocol. Participants were patients with oropharyngeal dysphagia, with either stroke or traumatic brain injury as the underlying medical pathology, and nurses. All participants were recruited from one tertiary level government hospital in Gauteng, South Africa. 139 nurses participated in the study and received training on the oral care protocol. There were two groups of participants with oropharyngeal dysphagia. Group one (study group, n = 23) was recruited by consecutive sampling, received regular oral care and were not restricted from drinking water; however, all other liquids were restricted. Group two (comparison group, n = 23) was recruited via a retrospective record review, received inconsistent oral care and were placed on thickened liquids or liquid restricted diets. Results showed that a regimen of regular oral care and free water provision when combined with dysphagia intervention did prevent aspiration pneumonia in patients with oropharyngeal dysphagia. The article highlights two key findings: that regular and routine oral care is manageable within an acute government hospital context and a strict routine of oral care can reduce aspiration pneumonia in patients with oropharyngeal dysphagia. An implication from these findings is confirmation that teamwork in acute care settings in developing contexts must be prioritised to improve dysphagia management and patient prognosis.
Wurm, Susanne; Wolff, Julia K; Schüz, Benjamin
Self-perceptions of aging, important indicators of successful aging, are closely linked to health. Previous research has mainly examined the role of individual factors on self-perceptions of aging, but health is partly dependent on contextual factors such as primary care supply. This study therefore examined whether the impact of diseases on self-perceptions of aging is buffered by primary care supply in the district, as it ensures sustained health care continuity. Nationally representative German survey data on health and self-perceptions of aging (N = 4,442, 40-85 years) were linked to primary care supply (general practitioner density in regional districts). Multilevel modeling shows that the impact of disease burden (multiple illnesses) was buffered by primary care supply: Disease burden was less strongly associated with negative self-perceptions of aging in districts with good primary health care supply. This underlines the importance of health care resources for successful aging.
Olusanya, Bolajoko O.
Introduction The level of clinical care and facilities to support the often more viable full-term newborns with normal birth weight compared with preterm/low birth weight newborns that require special care at birth are likely to be attainable in many resource-poor settings. However, the nature of the required care is not evident in current literature. This study therefore set out to determine maternal and perinatal profile of surviving full-term newborns with normal birth weight in a poorly-resourced setting. Methods A retrospective cohort study of newborns with gestational age ≥37 weeks and birth weight ≥2500g recruited in an inner-city maternity hospital in Lagos, Nigeria. Primary factors/outcomes were determined by multivariate logistic regression analyses and population attributable risk (PAR). Results Of the 2687 full-term newborns with normal birth weight studied, 242 (9.0%) were admitted into special care baby unit (SCBU) representing 53.6% of all SCBU admissions. Fetal distress, low 5-minute Apgar scores, neonatal sepsis and hyperbilirubinemia as well as maternal factors such as primiparity, type of employment, lack of antenatal care and emergency cesarean delivery were predictive of SCBU admission. The leading contributors to SCBU admission were neonatal sepsis (PAR=96.8%), and hyperbilirubinemia (PAR=58.7%). Conclusion A significant proportion of newborns requiring special care are full-term with normal birth weight and are associated with modifiable risk factors that can be effectively addressed at appropriately equipped secondary-level hospitals. Prenatal maternal education on avoidable risk factors is warranted. PMID:24062865
Bergstrom, Joan M.; Dreher, Donna L.
As part of an evaluation of the existing Federal Interagency Day Care Requirements (FIDCR), this paper reviews the current regulations and presents recommendations for modifications in the requirements as they relate to group or family day care services for school age children from 5 to 14 years of age. The paper is divided into five major…
Background Healthcare systems are challenged by a demand that exceeds available resources. One policy to meet this challenge is task substitution-transferring tasks to other professions and settings. Our study aimed to explore stakeholders’ perceived feasibility of transferring hospital-based monitoring of stable glaucoma patients to primary care optometrists. Methods A case study was undertaken in the Rotterdam Eye Hospital (REH) using semi-structured interviews and document reviews. They were inductively analysed using three implementation related theoretical perspectives: sociological theories on professionalism, management theories, and applied political analysis. Results Currently it is not feasible to use primary care optometrists as substitutes for optometrists and ophthalmic technicians working in a hospital-based glaucoma follow-up unit (GFU). Respondents’ narratives revealed that: the glaucoma specialists’ sense of urgency for task substitution outside the hospital diminished after establishing a GFU that satisfied their professionalization needs; the return on investments were unclear; and reluctant key stakeholders with strong power positions blocked implementation. The window of opportunity that existed for task substitution in person and setting in 1999 closed with the institutionalization of the GFU. Conclusions Transferring the monitoring of stable glaucoma patients to primary care optometrists in Rotterdam did not seem feasible. The main reasons were the lack of agreement on professional boundaries and work domains, the institutionalization of the GFU in the REH, and the absence of an appropriate reimbursement system. Policy makers considering substituting tasks to other professionals should carefully think about the implementation process, especially in a two-step implementation process (substitution in person and in setting) such as this case. Involving the substituting professionals early on to ensure all stakeholders see the change as a
Abdou, Cleopatra M; Fingerhut, Adam W
The first of its kind, the present experiment applied stereotype threat-the threat of being judged by or confirming negative group-based stereotypes-to the health sciences. Black and White women (N = 162) engaged in a virtual health care situation. In the experimental condition, one's ethnic identity and negative stereotypes of Black women specifically were made salient. As predicted, Black women in the stereotype threat condition who were strongly identified as Black (in terms of having explored what their ethnic identity means to them and the role it plays in their lives) reported significantly greater anxiety while waiting to see the doctor in the virtual health care setting than all other women. It is hypothesized that stereotype threat experienced in health care settings is one overlooked social barrier contributing to disparities in health care utilization and broader health disparities among Black women.
Palfrey, J S; Haynie, M; Porter, S; Bierle, T; Cooperman, P; Lowcock, J
The increasing number of children assisted by medical technology in the U.S. has led to a need for systematic planning for the children's care in community settings such as schools. Project School Care in Massachusetts provides consultation to school systems as schools respond to the challenge of integrating children assisted by medical technology into educational settings. The model of practice described includes the step-wise planning process and the ensuing training, enrollment, and monitoring procedures. Implications are explored with particular emphasis on upgrading of skills at all medical and educational levels. More input from school health personnel in administrative decision-making around enrollment of children with special health care needs is recommended. For these children, a health care plan should be incorporated into their Individualized Education Plans and into their school records.
Bratsch-Hines, Mary E.; Vernon-Feagans, Lynne
Research Findings: Recent work has demonstrated that the changes young children experience in their child care settings before age 5 may be related to subsequent development, especially social development. Several of these studies have included samples of middle-class children, with almost no emphasis on understanding these processes for…
Lee, Jin Yong; Eun, Sang Jun; Kim, Hyun Joo; Jo, Min-Woo
Objective This study aimed to identify private clinics that have a potential to perform the role of primary care providers (PCPs) in a primary care setting in Korea where private specialists are dominant. Methods The 2013 National Patient Sample claim data of Health Insurance Review and Assessment Service in Korea was used. Two-step cluster analysis was performed using characteristics of private clinics, and patient and utilization characteristics of 27,797 private clinics. External validation of clusters was performed by assessing the association among clusters and outcomes of care provided by private clinics. Stability of clusters was cross-validated using discriminant analysis. Results The result classified more than a half of private clinics into a potential PCP cluster. These were private clinics with specialties considered to be those of primary care physicians and were more likely to be located in non-metropolitan areas than specialized PCPs were. Compared to specialized PCPs, they had a higher percentage of pediatric and geriatric patients, patients with greater disease severity, a higher percentage of patients with complex comorbidities or with simple or minor disease groups, a higher number of patients and visits, and the same or higher quality of primary care. The most important factor in explaining variations between PCP clusters was the number of simple or minor disease groups per patient. Conclusion This study identified potential PCPs and suggested the identifying criteria for PCPs. It will provide useful information for formulation of a primary care strengthening policy to policy makers in Korea as well as other countries with similar specialist-dominant primary care settings. PMID:27560181
Haynes-Maslow, Lindsey; Roberts, Megan C.; Dusetzina, Stacie B.
Background Individuals with mental illness experience poor health and may die prematurely from chronic illness. Understanding whether the presence of co-occurring chronic physical health conditions complicates mental health treatment is important, particularly among patients seeking treatment in primary care settings. Objectives Examine (1) whether the presence of chronic physical conditions is associated with mental health service use for individuals with depression who visit a primary care physician, and (2) whether race modifies this relationship. Research Design Secondary analysis of the National Ambulatory Medical Care Survey, a survey of patient-visits collected annually from a random sample of 3,000 physicians in office-based settings. Subjects Office visits from 2007–2010 were pooled for adults ages 35–85 with a depression diagnosis at the time of visit (N=3,659 visits). Measures Mental health services were measured using a dichotomous variable indicating whether mental health services were provided during the office visit or a referral made for: (1) counseling, including psychotherapy and other mental health counseling and/or (2) prescribing of psychotropic medications. Results Most patient office visits (70%) where a depression diagnosis was recorded also had co-occurring chronic physical conditions recorded. The presence of at least one physical chronic condition was associated with a 6% decrease in the probability of receiving any mental health services (p<0.05). There were no differences in service use by race/ethnicity after controlling for other factors. Conclusions Additional research is needed on medical care delivery among patients with co-occurring health conditions, particularly as the health care system moves towards an integrated care model. PMID:26147863
Focuses on alternative self-care practices in terms of collaboration with the primary care physician and individual exploration of self-care practices such as acupuncture, meditation, and nutrition counseling. (JOW)
Innovations adopted through organizational change initiatives are often not sustained leading to diminished quality, productivity, and consumer satisfaction. Research explaining variance in the use of adopted innovations in health care settings is sparse, suggesting the need for a theoretical model to guide research and practice. In this article, we describe the development of a hybrid conjoint decision theoretic model designed to predict the sustainability of organizational change in health care settings. An initial test of the model’s predictive validity using expert scored hypothetic profiles resulted in an r-squared value of .77. The test of this model offers a theoretical base for future research on the sustainability of change in health care settings. PMID:22262947
Beane, Stephanie N.; Culyba, Rebecca J.; DeMayo, Michael; Armstrong, Wendy
Amid increased attention to the cost of health care, health information technology, and specialization and fragmentation in medicine, the medical home has achieved recognition as a model for more effective and efficient health care. Little data are available on recently funded HIV medical home demonstration projects, and no research richly describes existing medical home characteristics, implementation challenges, and impact on outcomes in longstanding HIV outpatient settings. The Ryan White HIV/AIDS Program (RWP) provides federal funding for primary and specialty care for people living with HIV. Although RWP clinics developed independently of the medical home model, existing data indirectly support that, with emphasis on primary, comprehensive, and patient-centered care, RWP clinics operate as medical homes. This study explores the development, definition, and implementation of medical home characteristics by RWP-funded providers in order to better understand how it fits with broader debates about medical homes and health care reform. PMID:24560357
Marouf, Fatma E; Esplin, Bryn S
For the past few decades, there has been intense debate in bioethics about the standard of care that should be provided in clinical trials conducted in developing countries. Some interpret the Declaration of Helsinki to mean that control groups should receive the best intervention available worldwide, while others interpret this and other international guidelines to mean the best local standard of care. Questions of justice are particularly relevant where limited resources mean that the local standard of care is no care at all. Introducing human rights law into this complex and longstanding debate adds a new and important perspective. Through non-derogable rights, including the core obligations of the right to health, human rights law can help set a minimum standard of care.
Rosenstein, Alan H
Disruptive behaviors can have a significant negative impact on staff relationships, communication flow, task responsibility, and team collaboration, all of which can adversely impact patient outcomes of care. Addressing disruptive behaviors in a positive manner by emphasizing the benefits of mutual understanding, shared goals and priorities, and adherence to accepted standards of care will enhance communication flow and improve the process and outcomes of care. This is particularly relevant in the obstetrics setting, where care is delivered over a continuum of time, with multiple different members of the health care team playing a vital role as the patient progresses from labor to delivery. Critical strategies for success include having strong organizational commitment and leadership support, raising provider insight and awareness, implementing appropriate policies and procedures, providing appropriate educational and training programs, and facilitating action-oriented interventional support.
Kornhaber, Rachel; Walsh, Kenneth; Duff, Jed; Walker, Kim
Therapeutic interpersonal relationships are the primary component of all health care interactions that facilitate the development of positive clinician–patient experiences. Therapeutic interpersonal relationships have the capacity to transform and enrich the patients’ experiences. Consequently, with an increasing necessity to focus on patient-centered care, it is imperative for health care professionals to therapeutically engage with patients to improve health-related outcomes. Studies were identified through an electronic search, using the PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO databases of peer-reviewed research, limited to the English language with search terms developed to reflect therapeutic interpersonal relationships between health care professionals and patients in the acute care setting. This study found that therapeutic listening, responding to patient emotions and unmet needs, and patient centeredness were key characteristics of strategies for improving therapeutic interpersonal relationships. PMID:27789958
Jones, R D; Jampani, H B; Newman, J L; Lee, A S
Triclosan is a widely accepted antimicrobial ingredient because of its safety and antimicrobial efficacy. Triclosan is a unique antimicrobial well suited for use in the health care industry in which mildness is a necessity to protect the health care worker during repeated use and antimicrobial activity is a necessity to protect public health. Triclosan has demonstrated immediate, persistent, broad-spectrum antimicrobial effectiveness and utility in clinical health care settings. This review highlights the utility and effectiveness of a 1% triclosan formulation for use in high-risk, high-frequency handwashing.
Ngoh, Hui Lee Sharon; Ng, Mark Chung Wai
Primary care practitioners play an important role in administering and advocating vaccinations against vaccine-preventable infectious diseases and ensuring herd immunity in our population. This is a follow-up article to an earlier one which dealt with the principles of vaccine scheduling and administration. This article describes several false contraindications to vaccination that a primary care practitioner may encounter, including pregnancy, current breastfeeding, history of febrile seizures, and having immunosuppressed or pregnant household contacts. We aimed to provide a guide for safe and timely vaccine administration in the primary care setting.
Blanchard, May Hsieh; Kriebs, Jan M
When building an integrated practice, the ability of each team member to work comfortably with other professionals is key. Midwives need to understand departmental expectations for participation in resident/student education, be willing to provide midwifery care in a high-acuity setting with limited opportunities for low-intervention care, and understand expectations for clinical leadership. Physicians need to build on the group expectation of mutual respect and best use of each group member. Confusion about midwifery and physician roles in maternity care still exists.
Rojas-Fernandez, Carlos H; Patel, Tejal; Lee, Linda
Pharmacists have developed innovative practices in various settings as singular providers or as members of multidisciplinary or interdisciplinary teams. Examples include pharmacists practicing in heart failure, hypertension, or hyperlipidemia clinics. There is a paucity of literature describing pharmacists in interdisciplinary memory clinics and specifically pharmacists practicing in interdisciplinary, primary care-based memory clinics. New practice models should be disseminated to guide others in the development of similar models given the complexity of this population. Patients with dementia are more difficult to manage because of cognitive impairment, behavioral and psychological symptoms, the common presence of multiple comorbidities, and related polypharmacy and caregiver issues. These challenges require expertise in neurodegenerative disorders and geriatrics. The purpose of this article is to describe the role of clinical pharmacists providing care to patients with cognitive complaints in a primary care-based, interdisciplinary memory clinic, with a focus on how the pharmacist practices and is integrated in this collaborative care setting. Patients are assessed using an interdisciplinary approach, with team consensus for assessment and planning of care. Pharmacists' activities include assessment of (1) appropriateness of medications based on frailty, (2) medications that can impair cognition and/or function, (3) medication adherence and management skills, and (4) vascular risk factor control. Pharmacists provide education regarding medications and diseases, ensure appropriate transitions in care, and conduct home visits. Pharmacist participation in this clinic represents a novel opportunity to advance pharmacy practice in primary care, interdisciplinary models. Work is ongoing to describe outcomes attributable to pharmacist participation in this clinic.
Qadeer, Aayesha; Akhtar, Aftab; Ain, Qurat Ul; Saadat, Shoab; Mansoor, Salman; Ishtiaq, Wasib; Ilyas, Abid; Khan, Ali Y; Ajam, Yousaf
Objective: To determine the frequency of micro-organisms causing sepsis as well as to determine the antibiotic susceptibility and resistance of microorganisms isolated in a medical intensive care unit. Materials and methods: This is a cross-sectional analysis of 802 patients from a medical intensive care unit (ICU) of Shifa International Hospital, Islamabad, Pakistan over a one-year period from August 2015 to August 2016. Specimens collected were from blood, urine, endotracheal secretions, catheter tips, tissue, pus swabs, cerebrospinal fluid, ascites, bronchoalveolar lavage (BAL), and pleural fluid. All bacteria were identified by standard microbiological methods, and antibiotic sensitivity/resistance was performed using the disk diffusion technique, according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Data was collected using a critical care unit electronic database and data analysis was done by using the Statistical Package for Social Sciences (SPSS), version 20 (IBM SPSS Statistics, Armonk, NY). Results: Gram-negative bacteria were more frequent as compared to gram-positive bacteria. Most common bacterial isolates were Acinetobacter (15.3%), Escherichia coli (15.3%), Pseudomonas aeruginosa (13%), and Klebsiella pneumoniae (10.2%), whereas Enterococcus (7%) and methicillin-resistant staphylococcus aureus (MRSA) (6.2%) were the two most common gram-positive bacteria. For Acinetobacter, colistin was the most effective antibiotic (3% resistance). For E.coli, colistin (0%), tigecycline (0%), amikacin (7%), and carbapenems (10%) showed low resistance. Pseudomonas aeruginosa showed low resistance to colistin (7%). For Klebsiella pneumoniae, low resistance was seen for tigecycline (0%) and minocycline (16%). Overall, ICU mortality was 31.3%, including miscellaneous cases. Conclusion: Gram-negative infections, especially by multidrug-resistant organisms, are on the rise in ICUs. Empirical antibiotics should be used according to the local
Ogrinc, Greg; Hoffman, Kimberly G.; Stevenson, Katherine M.; Shalaby, Marc; Beard, Albertine S.; Thörne, Karin E.; Coleman, Mary T.; Baum, Karyn D.
Problem Current models of health care quality improvement do not explicitly describe the role of health professions education. The authors propose the Exemplary Care and Learning Site (ECLS) model as an approach to achieving continual improvement in care and learning in the clinical setting. Approach From 2008–2012, an iterative, interactive process was used to develop the ECLS model and its core elements—patients and families informing process changes; trainees engaging both in care and the improvement of care; leaders knowing, valuing, and practicing improvement; data transforming into useful information; and health professionals competently engaging both in care improvement and teaching about care improvement. In 2012–2013, a three-part feasibility test of the model, including a site self-assessment, an independent review of each site’s ratings, and implementation case stories, was conducted at six clinical teaching sites (in the United States and Sweden). Outcomes Site leaders reported the ECLS model provided a systematic approach toward improving patient (and population) outcomes, system performance, and professional development. Most sites found it challenging to incorporate the patients and families element. The trainee element was strong at four sites. The leadership and data elements were self-assessed as the most fully developed. The health professionals element exhibited the greatest variability across sites. Next Steps The next test of the model should be prospective, linked to clinical and educa tional outcomes, to evaluate whether it helps care delivery teams, educators, and patients and families take action to achieve better patient (and population) outcomes, system performance, and professional development. PMID:26760058
Background Evidence-based quality improvement models for depression have not been fully implemented in routine primary care settings. To date, few studies have examined the organizational factors associated with depression management in real-world primary care practice. To successfully implement quality improvement models for depression, there must be a better understanding of the relevant organizational structure and processes of the primary care setting. The objective of this study is to describe these organizational features of routine primary care practice, and the organization of depression care, using survey questions derived from an evidence-based framework. Methods We used this framework to implement a survey of 27 practices comprised of 49 unique offices within a large primary care practice network in western Pennsylvania. Survey questions addressed practice structure (e.g., human resources, leadership, information technology (IT) infrastructure, and external incentives) and process features (e.g., staff performance, degree of integrated depression care, and IT performance). Results The results of our survey demonstrated substantial variation across the practice network of organizational factors pertinent to implementation of evidence-based depression management. Notably, quality improvement capability and IT infrastructure were widespread, but specific application to depression care differed between practices, as did coordination and communication tasks surrounding depression treatment. Conclusions The primary care practices in the network that we surveyed are at differing stages in their organization and implementation of evidence-based depression management. Practical surveys such as this may serve to better direct implementation of these quality improvement strategies for depression by improving understanding of the organizational barriers and facilitators that exist within both practices and practice networks. In addition, survey information can
Lawlis, Tanya; Mikhailovich, Katja; Morrison, Paul
In the past 10 years the prevalence of childhood obesity has increased considerably and there is growing recognition of the need to establish positive attitudes to healthy lifestyle practices from an early age if this trend is to be reversed. Childcare centres provide ideal environments from which to develop these positive attitudes. A literature…
Single-session groups are an effective method for providing mutual aid to patients and families experiencing crisis in acute care/emergency settings. This toolkit provides health care professionals with practical guidance in establishing, recruiting for, and facilitating single-session groups in hospital settings. A two-step literature search was conducted to identify all relevant articles. The literature was retrieved and reviewed for inclusion. The results of this review form the basis of the toolkit. A framework for establishing this type of group is explored. Challenges and strategies concerning recruitment are discussed. The practice skills relevant to facilitating time-limited groups are outlined.
Beck, Esther-Ruth; McIlfatrick, Sonja; Hasson, Felicity; Leavey, Gerry
This paper provides an overview of the evidence on the perspective of health care professionals (HCPs) in relation to advance care planning (ACP) for people with dementia, residing in long-term care settings. A narrative approach was adopted to provide a comprehensive synthesis of previously published literature in the area. A systematic literature search identified 14 papers for inclusion. Following review of the studies four themes were identified for discussion; Early integration and planning for palliative care in dementia; HCPs ethical and moral concerns regarding ACP; Communication challenges when interacting with the person with dementia and their families and HCPs need for education and training. Despite evidence, that HCPs recognise the potential benefits of ACP, they struggle with its implementation in this setting. Greater understanding of dementia and the concept of ACP is required to improve consistency in practice. Synthesising the existing evidence will allow for further understanding of the key issues, potentially resulting in improved implementation in practice.
Background In Switzerland the extent to which patients with chronic illnesses receive care congruent with the Chronic Care Model (CCM) is unknown. Methods According to guidelines we translated the Assessment of Chronic Illness Care (ACIC) into German (G-ACIC). We tested the instrument in different primary care settings and compared subscales with the original testing. Results Difficulties encountered during the translation process consisted in the difference of health care settings in Switzerland and USA. However initial testing showed the G-ACIC to be a suitable instrument. The average ACIC subscale scores in Swiss managed care (MC)-, group (GP)- and single handed practices (SP) were higher for MC practices than for group- and single handed practices: Organization of the healthcare delivery system: MC mean (m) = 6.80 (SD 1.55), GP m = 5.42 (SD 0.99), SP m = 4.60 (SD 2.07); community linkages: MC m = 4.19 (SD 1.47), GP m = 4.83 (SD 1.81), SP m = 3.10 (SD 2.12); self-management support: MC m = 4.96 (SD 1.13), GP m = 4.73 (SD 1.40), SP m = 4.43 (SD 1.34); decision support: MC m = 4.75 (SD 1.06); GP m = 4.20 (SD 0.87), SP m = 3.25 (SD 1.59); delivery system design: MC m = 5.98 (SD 1.61), GP m = 5.05 (SD 2.05), SP m = 3.86 (SD 1.51) and clinical information systems: MC m = 4.34 (SD = 2.49), GP m = 2.06 (SD 1.35), SP m = 3.20 (SD 1.57). Conclusions The G-ACIC is applicable and useful for comparing different health care settings in German speaking countries. Managed care organizations seem to implement the different components of the CCM in a greater extend than group and single handed practices. However, much room exists for further improvement. PMID:20979632
Akbar, Umer; Eilers, Amanda; Thompson-Avila, Amanda; Malaty, Irene A.; Okun, Michael S.
Objective. (1) To evaluate the feasibility of implementing and evaluating a home visit program for persons with Parkinson's disease (PD) in a rural setting. (2) To have movement disorders fellows coordinate and manage health care delivery. Background. The University of Florida, Center for Movement Disorders and Neurorestoration established Operation House Call to serve patients with PD who could not otherwise afford to travel to an expert center or to pay for medical care. PD is known to lead to significant disability, frequent hospitalization, early nursing home placement, and morbidity. Methods. This was designed as a quality improvement project. Movement disorders fellows travelled to the home(s) of underserved PD patients and coordinated their clinical care. The diagnosis of Parkinson's disease was confirmed using standardized criteria, and the Unified Parkinson's Disease Rating Scale was performed and best treatment practices were delivered. Results. All seven patients have been followed up longitudinally every 3 to 6 months in the home setting, and they remain functional and independent. None of the patients have been hospitalized for PD related complications. Each patient has a new updatable electronic medical record. All Operation House Call cases are presented during video rounds for the interdisciplinary PD team to make recommendations for care (neurology, neurosurgery, neuropsychology, psychiatry, physical therapy, occupational therapy, speech therapy, and social work). One Operation House Call patient has successfully received deep brain stimulation (DBS). Conclusion. This program is a pilot program that has demonstrated that it is possible to provide person-centered care in the home setting for PD patients. This program could provide a proof of concept for the construction of a larger visiting physician or nurse program. PMID:26078912
Hack, Nawaz; Akbar, Umer; Monari, Erin H; Eilers, Amanda; Thompson-Avila, Amanda; Hwynn, Nelson H; Sriram, Ashok; Haq, Ihtsham; Hardwick, Angela; Malaty, Irene A; Okun, Michael S
Objective. (1) To evaluate the feasibility of implementing and evaluating a home visit program for persons with Parkinson's disease (PD) in a rural setting. (2) To have movement disorders fellows coordinate and manage health care delivery. Background. The University of Florida, Center for Movement Disorders and Neurorestoration established Operation House Call to serve patients with PD who could not otherwise afford to travel to an expert center or to pay for medical care. PD is known to lead to significant disability, frequent hospitalization, early nursing home placement, and morbidity. Methods. This was designed as a quality improvement project. Movement disorders fellows travelled to the home(s) of underserved PD patients and coordinated their clinical care. The diagnosis of Parkinson's disease was confirmed using standardized criteria, and the Unified Parkinson's Disease Rating Scale was performed and best treatment practices were delivered. Results. All seven patients have been followed up longitudinally every 3 to 6 months in the home setting, and they remain functional and independent. None of the patients have been hospitalized for PD related complications. Each patient has a new updatable electronic medical record. All Operation House Call cases are presented during video rounds for the interdisciplinary PD team to make recommendations for care (neurology, neurosurgery, neuropsychology, psychiatry, physical therapy, occupational therapy, speech therapy, and social work). One Operation House Call patient has successfully received deep brain stimulation (DBS). Conclusion. This program is a pilot program that has demonstrated that it is possible to provide person-centered care in the home setting for PD patients. This program could provide a proof of concept for the construction of a larger visiting physician or nurse program.
Miller, Elizabeth B.
Data from the Head Start Impact Study (N = 1,141) and the Head Start Family and Child Experiences Survey, 2009 Cohort (N = 825) were used to describe child care enrollment decisions among Spanish-speaking Dual Language Learner (DLL) families. In particular, logistic regression models tested which child, family, and institutional characteristics predicted enrollment in early care and education (ECE) settings that used Spanish for instruction versus enrollment in settings that did not use Spanish. Results showed that whether the child’s first language was exclusively Spanish and whether other DLL families previously attended the ECE arrangement strongly predicted whether that child enrolled. Policy implications for Head Start-eligible Spanish-speaking DLLs are discussed. PMID:26900255
Hajek, André; Lehnert, Thomas; Wegener, Annemarie; Riedel-Heller, Steffi G; König, Hans-Helmut
The need for long-term care is expected to increase markedly in the next decades as a result of demographic ageing. Consequently, it is important to know the long-term care preferences. This study investigated the long-term care preferences among older individuals in Germany. Based on a systematic review and expert interviews, a questionnaire was designed to assess long-term care preferences. Data were gathered from a representative telephone survey of the German population (n=1,006; 65 years and above) in 2015. The mean age was 75.2 years (±6.6 years, ranging from 65 to 96 years). While nearly 90% of the individuals preferred home care, other care settings such as nursing care abroad were mostly undesired. In case of home care, most of the individuals preferred care provided by friends/family or formal caregivers, whereas the idea of all-day care services (such as employed private caregivers) was less popular. With respect to home care, additional services such as household assistance, transportation services, and emergency call systems were highly valued by the study participants, whereas continual supervision throughout the day was seen as less important. In case of inpatient care, more than 90% of the individuals preferred a private room, with the inpatient facility located near home or close to relatives' homes. A wide range of activities was appreciated. Given these preferences, it is assumed that there is a gap between expectations (preferences) and reality (utilization) regarding long-term care in Germany. Interventions aimed at minimizing this gap are urgently needed. For example, strategies to raise the awareness of private long-term care provision might be fruitful.
Williams, S J; Calnan, M
This paper describes the results of the first-stage of a study carried out in the spring of 1988 in the South East of England. The study looked at general and specific aspects of consumer satisfaction with general practitioner services, general dental care services and hospital in-patients care. It also examined which specific consumer criteria were the key predictors of overall satisfaction within each of these particular medical care settings. A related aim was to assess the degree of congruence or divergence of consumer criteria across these differing medical care settings. The evidence suggests that whilst general levels of consumer satisfaction are high (i.e. 83-97%), questions of a more detailed and specific nature revealed greater levels of expressed dissatisfaction (e.g. 38% of the sample felt that they could not discuss personal problems with their GP, 51% felt their dentist was not easy to reach at weekends/holidays, whilst 35% felt hospital doctors did not give sufficient information). Whilst different areas of dissatisfaction were found in each specific medical care setting examined, what was particularly striking was the degree of convergence of the key predictors of overall consumer satisfaction across the medical care settings. That is to say, our findings clearly suggest that issues concerning 'professional competence', together with the nature and quality of the patient-professional relationship, are the key predictors of overall consumer satisfaction with general practice, dental and hospital care [e.g. GP giving sufficient information correlated 0.64 (P less than 0.001) with overall GP satisfaction scores; competent dentist 0.52 (P less than 0.001) with overall dental satisfaction scores; and full confidence in hospital doctors 0.49 (P less than 0.001) with overall hospital satisfaction scores]. The theoretical importance and policy implications of these findings, particularly in the light of the recent NHS reforms, are discussed.
Pain, Tilley; Stainkey, Lesley; Chapman, Sue
This paper describes a medical model to provide in-house GP services to residents of aged-care facilities. Access to GP services for aged-care residents is decreasing, partially due to the changing demographic of the Australian GP workforce. The model we have developed is an in-house GP (AgedCare+GP) trialled in a publicly funded residential aged-care facility (RACF). The service model was based on the GP cooperative used in our after-hours general practice (AfterHours+GP). Briefly, the service model involves rostering a core group of GPs to provide weekly sessional clinics at the RACF. Financial contributions from appropriate Medicare Benefits Schedule (MBS) items for aged-care planning (including chronic conditions) provided adequate funds to operate the clinic for RACF residents. Evaluation of the service model used the number of resident transfers to the local emergency department as the primary outcome measure. There were 37 transfers of residents in the 3 months before the commencement of the AgedCare+GP and 11 transfers over a 3-month period at the end of the first year of operation; a reduction of almost 70%. This project demonstrates that AgedCare+GP is a successful model for GP service provision to RACF residents, and it also reduces the number of emergency department transfers.
Hageman, Jeffrey C; Hazim, Carmen; Wilson, Katie; Malpiedi, Paul; Gupta, Neil; Bennett, Sarah; Kolwaite, Amy; Tumpey, Abbigail; Brinsley-Rainisch, Kristin; Christensen, Bryan; Gould, Carolyn; Fisher, Angela; Jhung, Michael; Hamilton, Douglas; Moran, Kerri; Delaney, Lisa; Dowell, Chad; Bell, Michael; Srinivasan, Arjun; Schaefer, Melissa; Fagan, Ryan; Adrien, Nedghie; Chea, Nora; Park, Benjamin J
The 2014-2016 Ebola virus disease (Ebola) epidemic in West Africa underscores the need for health care infection prevention and control (IPC) practices to be implemented properly and consistently to interrupt transmission of pathogens in health care settings to patients and health care workers. Training and assessing IPC practices in general health care facilities not designated as Ebola treatment units or centers became a priority for CDC as the number of Ebola virus transmissions among health care workers in West Africa began to affect the West African health care system and increasingly more persons became infected. CDC and partners developed policies, procedures, and training materials tailored to the affected countries. Safety training courses were also provided to U.S. health care workers intending to work with Ebola patients in West Africa. As the Ebola epidemic continued in West Africa, the possibility that patients with Ebola could be identified and treated in the United States became more realistic. In response, CDC, other federal components (e.g., Office of the Assistant Secretary for Preparedness and Response) and public health partners focused on health care worker training and preparedness for U.S. health care facilities. CDC used the input from these partners to develop guidelines on IPC for hospitalized patients with known or suspected Ebola, which was updated based on feedback from partners who provided care for Ebola patients in the United States. Strengthening and sustaining IPC helps health care systems be better prepared to prevent and respond to current and future infectious disease threats.The activities summarized in this report would not have been possible without collaboration with many U.S. and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html).
Saravanakumar, Padmapriya; Higgins, Isabel Johanna; van der Riet, Pamela Jane; Marquez, Jodie; Sibbritt, David
Abstract Falls amongst older people is a global public health concern. Whilst falling is not a typical feature of ageing, older people are more likely to fall. Fall injuries amongst older people are a leading cause of death and disability. Many older people do not do regular exercise so that they lose muscle tone, strength, and flexibility which affect balance and predispose them to falls. The management of falls in residential care settings is a major concern with strategies for prevention and monitoring a focus in this setting. Yoga and tai chi have shown potential to improve balance and prevent falls in older adults. They also have potential to improve pain and quality of life. The aim of this study was to determine the feasibility of conducting a three-arm randomised controlled trial (RCT) with frail older people in a residential care setting to test the hypothesis that a 14-week modified tai chi or yoga programme is more effective than usual care activity in improving balance function, quality of life, pain experience and in reducing number of falls. There were no statistically significant differences between the three groups in the occurrence of falls. Yoga demonstrated a slight decrease in fall incidence; quality of life improved for the tai chi group. Only the yoga group experienced a reduction in average pain scores though not statistically significant. The findings of the study suggest it is possible to safely implement modified yoga and tai chi in a residential care setting and evaluate this using RCT design. They show positive changes to balance, pain and quality of life and a high level of interest through attendance amongst the older participants. The results support offering tai chi and yoga to older people who are frail and dependent with physical and cognitive limitations.
Saravanakumar, Padmapriya; Higgins, Isabel Johanna; Van Der Riet, Pamela Jane; Marquez, Jodie; Sibbritt, David
Abstract Falls amongst older people is a global public health concern. Whilst falling is not a typical feature of ageing, older people are more likely to fall. Fall injuries amongst older people are a leading cause of death and disability. Many older people do not do regular exercise so that they lose muscle tone, strength, and flexibility which affect balance and predispose them to falls. The management of falls in residential care settings is a major concern with strategies for prevention and monitoring a focus in this setting. Yoga and tai chi have shown potential to improve balance and prevent falls in older adults. They also have potential to improve pain and quality of life. The aim of this study was to determine the feasibility of conducting a 3-arm RCT with frail older people in a residential care setting to test the hypothesis that a 14 week modified tai chi or yoga program is more effective than usual care activity in improving balance function, quality of life, pain experience and in reducing number of falls. There were no statistically significant differences between the three groups in the occurrence of falls. Yoga demonstrated a slight decrease in fall incidence; quality of life improved for the tai chi group. Only the yoga group experienced a reduction in average pain scores though not statistically significant. The findings of the study suggest it is possible to safely implement modified yoga and tai chi in a residential care setting and evaluate this using RCT design. They show positive changes to balance, pain and quality of life and a high level of interest through attendance amongst the older participants. The results support offering tai chi and yoga to older people who are frail and dependent with physical and cognitive limitations.
Ollhoff, Jim; Ollhoff, Laurie
This document presents 17 philosophical statements regarding school-age care programs, staff, and challenges. The essence of school-age care is to understand childhood and to facilitate positive development. Because these programs provide a place where children have significant contact with adults within a multi-age peer group, they can teach…
Nair, Shoba; Tarey, SD; Barathi, B; Mary, Thiophin Regina; Mathew, Lovely; Daniel, Sudha Pauline
Background: Palliative care in low and middle-income countries is a new discipline, responding to a greater patient need, than in high-income countries. By its very nature, palliative as a specialty has to network with other specialties to provide quality care to patients. For any medical discipline to grow as a specialty, it should be well established in the teaching medical institutions of that country. Data show that palliative care is more likely to establish and grow in an academic health care institution. It is a necessity that multiple networking strategies are adopted to reach this goal. Objectives: (1) To describe a strategic approach to palliative care service development and integration into clinical academic setting. (2) To present the change in metrics to evaluate progress. Design and Setting: This is a descriptive study wherein, the different strategies that are adopted by the Department of Palliative Medicine for networking in an academic health care institution and outside the institution are scrutinized. Measurement: The impact of this networking was assessed, one, at the level of academics and the other, at the level of service. The number of people who attended various training programs conducted by the department and the number of patients who availed palliative care service over the years were assessed. Results: Ten different strategies were identified that helped with networking of palliative care in the institution. During this time, the referrals to the department increased both for malignant diseases (52–395) and nonmalignant diseases (5–353) from 2000 to 2013. The academic sessions conducted by the department for undergraduates also saw an increase in the number of hours from 6 to 12, apart from the increase in a number of courses conducted by the department for doctors and nurses. Conclusion: Networking is an essential strategy for the establishment of a relatively new medical discipline like palliative care in a developing and
Murray, Ann D.; Fees, Bronwyn S.; Crowe, Linda K.; Murphy, Molly E.; Henriksen, Amanda L.
Children's language development is significantly affected by the quantity and quality of language input, particularly during infancy and toddlerhood. The purpose of this study was to compare the language environment in an accredited child care program with data collected by Hart and Risley (1995). Fourteen toddlers (mean age 24.4 months) were…
... April 18, 2012 Characteristics and Use of Home Health Care by Men and Women Aged 65 and Over ... and Roberto Valverde, M.P.H., Division of Health Care Statistics Abstract Objective —This report presents national estimates ...
Bar-Sela, Gil; Bentur, Netta; Schultz, Michael; Corn, Benjamin W
Faced with a serious, incurable illness, disability, and other symptoms, both physical and mental, some patients find themselves wondering about the meaning of their Lives. They need the help of a professional who can perceive their mental turmoil and identify their spiritual needs, and who knows how to help them find meaning in their uncertain state. Spiritual care providers are professionals whose role it is to provide patients with support in their hour of need, to help them preserve their identity in life-threatening situations, and to help them re-endow their world with meaning, employing a special language and set of tools that enable patients to get in touch with their spiritual resources and internal powers of healing. Spiritual care providers serve on the medical staff in Western countries. In the United States, some 2,600 are employed in general hospitals, psychiatric hospitals, long-term care facilities, and palliative care units. Approximately ten years ago, the profession began developing in Israel. Today, dozens of spiritual care providers are now working in the healthcare system. There is a spiritual care network with 21 member organizations. Although the profession is laying down roots in the healthcare system in this country, it is still in its infancy and has to contend with substantial barriers and challenges, including professional recognition, creating positions, and identifying sources of funding for positions. The profession still has much room to grow as it is further incorporated into the healthcare system and continues undergoing adaptation to the Israeli cultural setting.
Goh, A; Mok, Q
AIMS—To determine the extent of futile care provided to critically ill children admitted to a paediatric intensive care setting. METHODS—Prospective evaluation of consecutive admissions to a 20 bedded multidisciplinary paediatric intensive care unit of a North London teaching hospital over a nine month period. Three previously defined criteria for futility were used: (1) imminent demise futility (those with a mortality risk greater than 90% using the Paediatric Risk of Mortality (PRISM II) score); (2) lethal condition futility (those with conditions incompatible with long term survival); and (3) qualitative futility (those with unacceptable quality of life and high morbidity). RESULTS—A total of 662 children accounting for 3409 patient bed days were studied. Thirty four patients fulfilled at least one of the criteria for futility, and used a total of 104 bed days (3%). Only 33 (0.9%) bed days were used by patients with mortality risk greater than 90%, 60 (1.8%) by patients with poor long term prognosis, and 16 (0.5%) by those with poor quality of life. Nineteen of 34 patients died; withdrawal of treatment was the mode of death in 15 (79%). CONCLUSIONS—Cost containment initiatives focusing on futility in the paediatric intensive care unit setting are unlikely to be successful as only relatively small amounts of resources were used in providing futile care. Paediatricians are recognising futility early and may have taken ethically appropriate measures to limit care that is futile. PMID:11207181
Schnelle, John F.; Bates-Jensen, Barbara M.; Levy-Storms, Lene; Grbic, Valena; Yoshii, June; Cadogan, Mary; Simmons, Sandra F.
Purpose: This study investigated whether the use of restraining devices and related measures of care quality are different in nursing homes that score in the upper and lower quartiles on the Minimum Data Set (MDS) "prevalence of restraint" quality indicator, which assesses daily use of restraining devices when residents are out of bed. Design and…
Simmons, S.F.; Cadogan, M.P.; Cabrera, G.R.; Al-Samarrai, N.R.; Jorge, J.S.; Levy-Storms, L.; Osterweil, D.; Schnelle, J.F.
Purpose. The objective of this work was to determine if nursing homes that score differently on prevalence of depression, according to the Minimum Data Set (MDS) quality indicator, also provide different processes of care related to depression. Design and Methods. A cross-sectional study with 396 long-term residents in 14 skilled nursing…
Viele, Elizabeth; Hertel, Victoria
This manual presents detailed instructions for delivering health care services to students with special health needs within the school setting. Individual chapters address the following areas: dressing; vital signs; height and weight; fluids/nourishment; medications; oxygen and use of the respirator/ventilator; suctioning; respiratory therapy;…
Oelke, Nelly; Wilhelm, Amanda; Jackson, Karen
The role of nurses in primary care is poorly understood and many are not working to their full scope of practice. Building on previous research, this knowledge translation (KT) project's aim was to facilitate nurses' capacity to optimise their practice in these settings. A Summit engaging Alberta stakeholders in a deliberative discussion was the…
Kampfe, Charlene M.
This paper describes the types of attitudes and behaviors that might be destructive to an individual's sense of self-worth, and suggests that counselors in long-term care settings face the challenge of changing these. One strategy for counteracting potential dehumanization, offering in-service training to all levels of staff and administrators, is…
Registered nurses (RNs) who make the move from a patient-care service setting to an academic teaching environment often go through a transition phase in their first semesters of teaching that is difficult and traumatic. RNs that go on to higher academic degrees often do so in order to teach in schools of nursing. However, graduate work in nursing…
Schryer, Catherine; McDougall, Allan; Tait, Glendon R.; Lingard, Lorelei
This article investigates an emerging practice in palliative care: dignity therapy. Dignity therapy is a psychotherapeutic intervention that its proponents assert has clinically significant positive impacts on dying patients. Dignity therapy consists of a physician asking a patient a set of questions about his or her life and returning to the…
Kemper, Peter; Heier, Brigitt; Barry, Teta; Brannon, Diane; Angelelli, Joe; Vasey, Joe; Anderson-Knott, Mindy
Purpose: The study's goals were to understand what changes in management practices would most improve the jobs of frontline workers from the perspective of workers themselves and to analyze differences across settings. Design and Methods: The baseline survey of direct care workers (N = 3,468) conducted as part of the National Study of the Better…
Gear, Sabra; Bobzien, Jonna; Judge, Sharon; Raver, Sharon A.
Adults with intellectual disabilities face difficulty seeking employment in the community workforce. Using a single-subject design, this study examined the utility of role playing and self-management strategies to enhance work performance by promoting the social skills of a young woman with Down syndrome working in a community child care setting.…
Wu, Shinyi; Duan, Naihua; Wisdom, Jennifer P; Kravitz, Richard L; Owen, Richard R; Sullivan, J Greer; Wu, Albert W; Di Capua, Paul; Hoagwood, Kimberly Eaton
Integrating two distinct and complementary paradigms, science and engineering, may produce more effective outcomes for the implementation of evidence-based practices in health care settings. Science formalizes and tests innovations, whereas engineering customizes and optimizes how the innovation is applied tailoring to accommodate local conditions. Together they may accelerate the creation of an evidence-based healthcare system that works effectively in specific health care settings. We give examples of applying engineering methods for better quality, more efficient, and safer implementation of clinical practices, medical devices, and health services systems. A specific example was applying systems engineering design that orchestrated people, process, data, decision-making, and communication through a technology application to implement evidence-based depression care among low-income patients with diabetes. We recommend that leading journals recognize the fundamental role of engineering in implementation research, to improve understanding of design elements that create a better fit between program elements and local context.
Blackstone, Sarah W; Pressman, Harvey
Delivering quality health care requires effective communication between health care providers and their patients. In this article, we call on augmentative and alternative communication (AAC) practitioners to offer their knowledge and skills in support of a broader range of patients who confront communication challenges in health care settings. We also provide ideas and examples about ways to prepare people with complex communication needs for the inevitable medical encounters that they will face. We argue that AAC practitioners, educators, and researchers have a unique role to play, important expertise to share, and an extraordinary opportunity to advance the profession, while positively affecting patient outcomes across the health care continuum for a large number of people.
Snell, Anita J; Briscoe, Don; Dickson, Graham
Health care delivery must be transformed to manage spiraling costs and preserve quality care. Transforming complex health systems will require the engagement of physicians as leaders in their health care settings, in both formal and informal roles. In this article we explore the experience of physician leader engagement and identify factors operating at the individual, team, and organizational levels related to increased or decreased physician leader engagement. Using an inductive approach, our analysis of the transcribed interviews yielded a rich understanding of what motivates physicians to be engaged as leaders, how they experience engagement, the role of the physician leader, how physicians understand other physicians' engagement, what encourages and discourages their engagement efforts, and the role that education and training has in physician engagement. We conclude by offering strategies that physicians, health care organizations, and educational institutions can implement to increase the engagement of physician leaders.
Peters, Clark; Bell, Katie S. Claussen; Zinn, Andrew; Goerge, Robert M.; Courtney, Mark E.
Research has found that foster youth who remain in care beyond age 18 are more likely to participate in services and tend to have better outcomes than those who do not. However, not all youth eligible to remain in care beyond age 18 do so. This study examines Illinois, one of the few states that extends care up to age 21, to identify the major…
Abbott, P A; Quirolgico, S; Candidate, D; Manchand, R; Canfield, K; Adya, M
This paper is intended to give an overview of Knowledge Discovery in Large Datasets (KDD) and data mining applications in healthcare particularly as related to the Minimum Data Set, a resident assessment tool which is used in US long-term care facilities. The US Health Care Finance Administration, which mandates the use of this tool, has accumulated massive warehouses of MDS data. The pressure in healthcare to increase efficiency and effectiveness while improving patient outcomes requires that we find new ways to harness these vast resources. The intent of this preliminary study design paper is to discuss the development of an approach which utilizes the MDS, in conjunction with KDD and classification algorithms, in an attempt to predict admission from a long-term care facility to an acute care facility. The use of acute care services by long term care residents is a negative outcome, potentially avoidable, and expensive. The value of the MDS warehouse can be realized by the use of the stored data in ways that can improve patient outcomes and avoid the use of expensive acute care services. This study, when completed, will test whether the MDS warehouse can be used to describe patient outcomes and possibly be of predictive value.
Ewing, Gail; Farquhar, Morag; Booth, Sara
There has been a steady expansion of hospital-based palliative care in the United Kingdom but limited published research on health professionals' views of hospital multidisciplinary specialist palliative care services (SPCS). The aim of the study was to describe referrer (SPCS user) and provider (SPCS staff) perspectives on delivery of specialist palliative care in hospital. Interviews were conducted with referrers, including five junior doctors, 13 consultants, and six clinical nurse specialists, to investigate the reasons for referral, beneficial aspects, and barriers to use. Focus groups were conducted with providers, six medical and five nursing, to identify their perspective on delivering the specialist service in hospital. Discussions were tape recorded and transcribed verbatim. Data were analyzed thematically using a framework analysis approach. The study found large areas of agreement between referrers and providers on what hospital palliative care teams should be providing for patients, that is, expertise in managing difficult symptoms and complex psychosocial problems, and this was being achieved locally. Access to the specialist team was also important: visibility on the wards, informal routes of access to advice and a timely response by specialists. However, discordance in views of providing palliative care was also identified; in particular, whether specialists should be providing generalist palliative care (such as basic psychological support) neglected by ward teams and implementation of specialist advice by referrers. Such perspectives on the interface of generalist and specialist provision provide insights into improving care for palliative patients in the acute hospital setting.
Hodgkinson, Stacy; Godoy, Leandra; Beers, Lee Savio; Lewin, Amy
Poverty is a common experience for many children and families in the United States. Children <18 years old are disproportionately affected by poverty, making up 33% of all people in poverty. Living in a poor or low-income household has been linked to poor health and increased risk for mental health problems in both children and adults that can persist across the life span. Despite their high need for mental health services, children and families living in poverty are least likely to be connected with high-quality mental health care. Pediatric primary care providers are in a unique position to take a leading role in addressing disparities in access to mental health care, because many low-income families come to them first to address mental health concerns. In this report, we discuss the impact of poverty on mental health, barriers to care, and integrated behavioral health care models that show promise in improving access and outcomes for children and families residing in the contexts of poverty. We also offer practice recommendations, relevant to providers in the primary care setting, that can help improve access to mental health care in this population.
Lee, Sook Y; Chaudhury, Habib; Hung, Lillian
This study explored staff perceptions of the role of physical environment in dementia care facilities in affecting resident's behaviors and staff care practice. We conducted focus groups with staff (n = 15) in two purposely selected care facilities in Vancouver, Canada. Focus group participants included nurses, care aides, recreation staff, administrative staff, and family. Data analysis revealed two themes: (a) a supportive physical environment contributes positively to both quality of staff care interaction and residents' quality of life and (b) an unsupportive physical environment contributes negatively to residents' quality of life and thereby makes the work of staff more challenging. The staff participants collectively viewed that comfort, familiarity, and an organized space were important therapeutic resources for supporting the well-being of residents. Certain behaviors of residents were influenced by poor environmental factors, including stimulation overload, safety risks, wayfinding challenge, and rushed care This study demonstrates the complex interrelationships among the dementia care setting's physical environment, staff experiences, and residents' quality of life.
Tomonaga, Yuki; Risch, Lorenz; Szucs, Thomas D.; Ambuehl, Patrice M.
Chronic kidney disease (CKD) often remains clinically silent and therefore undiagnosed until a progressed stage is reached. Our aim was to estimate the prevalence of CKD in a primary care setting in Switzerland. A multicenter, cross-sectional study with randomly selected general practitioners was performed. Adults visiting their general physician’s cabinet during defined periods were asked to participate. Baseline information was reported on a questionnaire, urine and blood samples were analyzed in a central laboratory. Renal status was assessed using the Kidney Disease: Improving Global Outcomes (KDIGO) classification. Extrapolation of results to national level was adjusted for age and gender. One thousand individuals (57% females) with a mean age of 57±17 years were included. Overall, 41% of the patients had normal estimated glomerular filtration rate (eGFR) and albumin creatinine ratio (ACR), whereas 36% of the subjects had slightly reduced excretory renal function with physiological albuminuria based on normal ACR. Almost one fourth of the subjects (23%) had either a substantially reduced eGFR or high levels of ACR. About 10% of the patients had a substantially reduced eGFR of <60 ml/min/1.73 m2, and 17% showed relevant proteinuria (ACR >30 mg/g creatinine). Extrapolation to national level suggests that about 18% of primary care patients may suffer from CKD. CKD prevalence in a primary care population is therefore high, and preventive interventions may be advisable, in particular as CKD prevalence is likely to rise over the next decades. PMID:23844110
Nace, David A; Archbald-Pannone, Laurie R; Ashraf, Muhammad S; Drinka, Paul J; Frentzel, Elizabeth; Gaur, Swati; Mahajan, Dheeraj; Mehr, David R; Mercer, William C; Sloane, Philip D; Jump, Robin L P
Efforts at preventing pneumococcal disease are a national health priority, particularly in older adults and especially in post-acute and long-term care settings The Advisory Committee on Immunization Practices recommends that all adults ≥65 years of age, as well as adults 18-64 years of age with specific risk factors, receive both the recently introduced polysaccharide-protein conjugate vaccine against 13 pneumococcal serotypes as well as the polysaccharide vaccine against 23 pneumococcal serotypes. Nursing facility licensure regulations require facilities to assess the pneumococcal vaccination status of each resident, provide education regarding pneumococcal vaccination, and administer the appropriate pneumococcal vaccine when indicated. Sorting out the indications and timing for 13 pneumococcal serotypes and 23 pneumococcal serotypes administration is complex and presents a significant challenge to healthcare providers. Here, we discuss the importance of pneumococcal vaccination for older adults, detail AMDA-The Society for Post-Acute and Long-Term Care Medicine (The Society)'s recommendations for pneumococcal vaccination practice and procedures, and offer guidance to postacute and long-term care providers supporting the development and effective implementation of pneumococcal vaccine policies.
Seaman, Karla; Saunders, Rosemary; Williams, Elly; Harrup-Gregory, Jane; Loffler, Helen; Lake, Fiona
It is essential that health professionals are trained to provide optimal care for our ageing population. Key to this is a positive attitude to older adults along with the ability to work in teams and provide interprofessional care. There is limited evidence on the impact an interprofessional education (IPE) placement in a residential aged care facility (RACF) has on students. In 2015 in Western Australia, 51 students (30% male, median age 23 years), from seven professions, undertook a placement between 2 and 13 weeks in length at 1 RACF. Pre- and post-placement measurements of attitudes to the elderly were collected using the Ageing Semantic Differential (ASD) questionnaire and level of readiness for interprofessional learning with the Readiness for Interprofessional Learning Scale (RIPLS). A total of 47 students completed matched ASD and RIPLS surveys. The mean total score on the ASD survey decreased significantly from pre- to post-placement from 116.0 to 108.9 (p = 0.033), indicating attitudes became increasingly positive towards older adults. Significant differences post-placement were seen indicating better readiness for interprofessional learning, for two out of four subscales on the RIPLS, namely "teamwork & collaboration" (42.1-44.0; (p = 0.000)) and "positive professional identity" (18.2-19.3 (p = 0.001)). The degree of change is similar to findings from other settings. The results support IPE-focussed student placements within RACF positively influence student's attitudes towards the older adult as well as increase student's readiness for interprofessional learning, confirming RACF are valuable places for training health professionals.
Lo, Raymond S K; Kwan, Bonnie H F; Lau, Kay P K; Kwan, Cecilia W M; Lam, L M; Woo, Jean
This study aims to explore in depth the needs, current knowledge, and attitudes of all ranks of old age home staff. A large-scale qualitative study with 13 semistructured focus groups was conducted in Hong Kong. Key themes were extracted by framework analysis. Three major themes were extracted, including role as a service provider, current knowledge, and attitude toward palliative care. There was a marked difference in familiarity with the concept of ''palliative care'' between different groups of staff, yet both shared the motivation for enhancement. The biggest concerns for the staff were elderly residents' readiness to accept palliative care, manpower, and resources. Care staff, regardless of rank, seemed to welcome and be ready to adopt a palliative care approach in caring for old age home residents, though not without worries and concerns.
Trauma-informed care is an emerging value that is seen as fundamental to effective and contemporary mental health nursing practice. Trauma-informed care, like recovery, leaves mental health nurses struggling to translate these values into day-to-day nursing practice. Many are confused about what individual actions they can take to support these values. To date, the most clearly articulated policy to emerge from the trauma-informed care movement in Australia has been the agreement to reduce, and wherever possible, eliminate the use of seclusion and restraint. Confronted with the constant churn of admissions and readmissions of clients with challenging behaviours, and seemingly intractable mental illness, the elimination of seclusion and restraint is seen to be utopian by many mental health nurses in inpatient settings. Is trauma-informed care solely about eliminating seclusion and restraint, or are there other tangible practices nurses could utilize to effect better health outcomes for mental health clients, especially those with significant abuse histories? This article summarizes the findings from the literature from 2000-2011 in identifying those practices and clinical activities that have been implemented to effect trauma-informed care in inpatient mental health settings.
Ajay, Vamadevan S; Prabhakaran, Dorairaj
Diabetes has emerged as a major public health concern in developing nations. Health systems in most developing countries are yet to integrate effective prevention and control programs for diabetes into routine health care services. Given the inadequate human resources and underfunctioning health systems, we need novel and innovative approaches to combat diabetes in developing-country settings. In this regard, the tremendous advances in telecommunication technology, particularly cell phones, can be harnessed to improve diabetes care. Cell phones could serve as a tool for collecting information on surveillance, service delivery, evidence-based care, management, and supply systems pertaining to diabetes from primary care settings in addition to providing health messages as part of diabetes education. As a screening/diagnostic tool for diabetes, cell phones can aid the health workers in undertaking screening and diagnostic and follow-up care for diabetes in the community. Cell phones are also capable of acting as a vehicle for continuing medical education; a decision support system for evidence-based management; and a tool for patient education, self-management, and compliance. However, for widespread use, we need robust evaluations of cell phone applications in existing practices and appropriate interventions in diabetes.
Santa Maria, Diane; Guilamo-Ramos, Vincent; Jemmott, Loretta Sweet; Derouin, Anne; Villarruel, Antonia
: Nurses care for adolescents in a variety of settings, including communities, schools, and public health and acute care clinics, which affords them many opportunities to improve adolescents' sexual and reproductive health and reduce the rates of unplanned pregnancy and sexually transmitted infections. To ensure that adolescents have access to sexual and reproductive health care (which includes both preventive counseling and treatment) in all nursing practice sites, nurses need to gain the knowledge and hone the skills required to deliver evidence-based counseling and services to adolescents and parents. Collectively, nurses can use their unique combination of knowledge and skills to make a positive impact on adolescent sexual and reproductive outcomes. Nurses have the capacity and opportunity to disseminate information about sexual and reproductive health to adolescents and their parents in communities, schools, public health clinics, and acute care settings. This article discusses the Society for Adolescent Health and Medicine's goals and recommendations, which address adolescent sexual and reproductive health as both a health care and a human rights issue.
Holst, Lone; Lundgren, Maren; Olsen, Lutte; Ishøy, Torben
Working in a hospice and being able to focus on individualized, specialized end-of-life care is a privilege for the hospice staff member. However, it also presents the hospice staff with unique challenges. This descriptive study is based upon two cases from an end-of-life care setting in Denmark, where dysfunctional family dynamics presented added challenges to the staff members in their efforts to provide optimal palliative care. The hospice triad--the patient, the staff member and the family member--forms the basis for communication and intervention in a hospice. Higher expectations and demands of younger, more well-informed patients and family members challenge hospice staff in terms of information and communication when planning for care. The inherent risk factors of working with patients in the terminal phase of life become a focal point in the prevention of the development of compassion fatigue among staff members. A series of coping strategies to more optimally manage dysfunctional families in a setting where time is of the essence are then presented in an effort to empower the hospice team, to prevent splitting among staff members, and to improve quality of care.
Konstantinov, Konstantin N; Tzamaloukas, Antonios; Rubin, Robert L
Autoimmune rheumatic diseases are common and confront society with serious medical, social, and financial burdens imposed by their debilitating nature. Many autoimmune diseases are associated with a particular set of autoantibodies, which have emerged as highly useful to define and classify disease, predict flares, or monitor efficacy of therapy. However, current practice for monitoring autoantibodies is protracted, labor-intensive, and expensive. This review provides an overview on the value of point-of-care (POC) biosensor technology in the diagnosis and management of patients with autoimmune rheumatic diseases. Real-time measurement of autoantibodies will clearly benefit the rheumatology practice in emergency and urgent care settings, where definitive diagnosis is essential for initiation of correct critical care therapy. Immediate serological information in clinic will provide considerable value for long-term patient care and an opportunity for an instant, result-deduced therapeutic action, avoiding delays and improving compliance, especially in field-based and remote areas. We describe the particular autoantibodies that are useful disease and activity markers and would, therefore, be attractive to POC applications. Already existing biosensors and platforms that show promise for autoantibody testing are summarized and comparatively evaluated. As POC assessment is gaining momentum in several areas of patient care, we propose that rheumatology is poised to benefit from this innovative and affordable technology.
Istiono, Wahyudi; Claramita, Mora; Ekawati, Fitriana Murriya; Gayatri, Aghnaa; Sutomo, Adi Heru; Kusnanto, Hari; Graber, Mark Alan
Background: Southeast Asian countries with better-skilled primary care physicians have been shown to have better health outcomes. However, in Indonesia, there has been a large number of inappropriate referrals, leading to suboptimal health outcomes. This study aimed to examine the reasons underlying the unnecessary referrals as related to Indonesian physicians’ standard of abilities. Materials and Methods: This was a multiple-case study that explored physicians’ self-evaluation of their abilities. Self-evaluation questionnaires were constructed from the Indonesian Standards of Physicians Competences of 2006-2012 (ISPC), which is a list of 155 diseases. This study was undertaken in three cities, three towns, and one “border-less developed” area during 2011-2014. The study involved 184 physicians in those seven districts. Data were collected using one-on-one, in-depth interviews, focus group discussions (FGDs), and clinical observations. Results: This study found that primary care physicians in Indonesia felt that they were competent to handle less than one-third of “typical” primary care cases. The reasons were limited understanding of person-centered care principles and limited patient care services to diagnosis and treatment of common biomedical problems. Additionally, physical facilities in primary care settings are lacking. Discussions and Conclusions: Strengthening primary health care in Indonesia requires upscaling doctors’ abilities in managing health problems through more structured graduate education in family medicine, which emphasizes the bio-psycho-socio-cultural background of persons; secondly, standardizing primary care facilities to support physicians’ performance is critical. Finally, a strong national health policy that recognizes the essential role of primary care physicians in health outcomes is an urgent need. PMID:26985415
Larson, Nicole; Ward, Dianne S; Neelon, Sara Benjamin; Story, Mary
Given the widespread use of out-of-home child care and an all-time high prevalence of obesity among US preschool-aged children, it is imperative to consider the opportunities that child-care facilities may provide to reduce childhood obesity. This review examines the scientific literature on state regulations, practices and policies, and interventions for promoting healthy eating and physical activity, and for preventing obesity in preschool-aged children attending child care. Research published between January 2000 and July 2010 was identified by searching PubMed and MEDLINE databases, and by examining the bibliographies of relevant studies. Although the review focused on US child-care settings, interventions implemented in international settings were also included. In total, 42 studies were identified for inclusion in this review: four reviews of state regulations, 18 studies of child-care practices and policies that may influence eating or physical activity behaviors, two studies of parental perceptions and practices relevant to obesity prevention, and 18 evaluated interventions. Findings from this review reveal that most states lack strong regulations for child-care settings related to healthy eating and physical activity. Recent assessments of child-care settings suggest opportunities for improving the nutritional quality of food provided to children, the time children are engaged in physical activity, and caregivers' promotion of children's health behaviors and use of health education resources. A limited number of interventions have been designed to address these concerns, and only two interventions have successfully demonstrated an effect on child weight status. Recommendations are provided for future research addressing opportunities to prevent obesity in child-care settings.
Hariharan, Vishnupriya; Manivel, Rajajeyakumar; Trakroo, Madanmohan
Introduction Health care economics restricts many health centers from using hi-tech diagnostics equipment. Mercury manometers are used for calibration of pressure transducers. If standardized it would be a cost effective, simple alternative to transducers in low economic settings. Aim To analyse the feasibility of mercury manometer usage in respiratory pressure measurement. Materials and Methods The experimental study was conducted with 30 healthy volunteers of age group 17–19 yrs. They were recruited by using simple random sampling method. The volunteers were made familiarized to lab environment, instrument and techniques of maximum inspiratory (Pimax) and expiratory pressures (Pemax). Then parameters were recorded using mercury manometer connected to different syringes as mouth piece (2.5 ml, 10 ml, and 20 ml) and with sphygmomanometer. Statistical analysis was done by using IBM SPSS statistics version 21. Results The Pimax was 111.07 ± 6.53 with a 2.5 ml syringe as mouth piece. With 20 ml syringe it was 61.47 ± 9.98. PEmax with 2.5 ml syringe was 70.33 ± 8.19 with a confidence limit of 2.93 and with sphygmomanometer was 99.33 ± 8.16 with a confidence limit of 2.92. There was a change in recorded pressure and the correlation analysis result showed a significant difference from both above and below 10 ml mouth piece range. Conclusion Mercury manometers could be used for recording respiratory pressures in low economic facilities once standardized. Size of syringe to be used as mouth piece needs further more works although this study finds 10 ml syringe as suitable. PMID:26894061
Satheeshkumar, PS; Mohan, Minu P; Saji, Sweta; Sadanandan, Sudheesh; George, Giju
Background: Dental pulp calcifications are unique and represent the dental pulp regenerative process. Dental pulp calcifications are sometimes routine findings in oral radiographs and may later serve as an important diagnostic criterion for a hidden aspect of systemic illness. Objective: The purpose of this study was to assess the patterns and prevalence of idiopathic dental pulp calcifications in a tertiary care setting in South India. Materials and Methods: A total of 227 patients were included in the study fulfilling the inclusion criteria. Age range of the study population was from 15 to 70 years. Teeth were examined under digital panoramic radiograph. The presence or absence of pulp stones was recorded. The presence of pulp stone were categorized according to the types classified as Type I, Type IA, Type II, Type IIA, Type II B, and Type III. The frequency of occurrence of pulp stones with sex, tooth type, dental arches, and types were compared with the types of calcification. Results: Total no. of patients with pulpal calcification were 227 [females 133 (58.59%) and males 94 (41.40%)]. The most common type between both sexes was Type I (48%). Total no. of teeth with calcification was 697; maxilla (48%), mandible (52%). The prevalence of pulp stone was found to be higher in the molars in both the arches. Most no. of pulp stones are reported at the third and fourth decade of life. Conclusion: Idiopathic dental pulp calcifications are incidental radiographic findings of the pulp tissue and also may be an indicator of underlying disease. PMID:23349577
Bohannon, Richard W
A hand-grip dynamometer was used to assess the magnitude and prevalence of grip strength impairments among 41 home-care patients with diverse diagnoses (e.g., stroke, cancer, fracture, osteoarthritis). Based on published reference values, patients (as a whole) were weaker than normal for age and sex. The prevalence of weakness was 85.4% on one or the other side and 70.7% on both sides. Considering the prognostic importance of grip strength, this study emphasized the potential value of its measurement in a home-care population.
Maluka, Stephen; Kamuzora, Peter; San Sebastiån, Miguel; Byskov, Jens; Olsen, Øystein E; Shayo, Elizabeth; Ndawi, Benedict; Hurtig, Anna-Karin
Priority-setting has become one of the biggest challenges faced by health decision-makers worldwide. Fairness is a key goal of priority-setting and Accountability for Reasonableness has emerged as a guiding framework for fair priority-setting. This paper describes the processes of setting health care priorities in Mbarali district, Tanzania, and evaluates the descriptions against Accountability for Reasonableness. Key informant interviews were conducted with district health managers, local government officials and other stakeholders using a semi-structured interview guide. Relevant documents were also gathered and group priority-setting in the district was observed. The results indicate that, while Tanzania has a decentralized public health care system, the reality of the district level priority-setting process was that it was not nearly as participatory as the official guidelines suggest it should have been. Priority-setting usually occurred in the context of budget cycles and the process was driven by historical allocation. Stakeholders' involvement in the process was minimal. Decisions (but not the reasoning behind them) were publicized through circulars and notice boards, but there were no formal mechanisms in place to ensure that this information reached the public. There were neither formal mechanisms for challenging decisions nor an adequate enforcement mechanism to ensure that decisions were made in a fair and equitable manner. Therefore, priority-setting in Mbarali district did not satisfy all four conditions of Accountability for Reasonableness; namely relevance, publicity, appeals and revision, and enforcement. This paper aims to make two important contributions to this problematic situation. First, it provides empirical analysis of priority-setting at the district level in the contexts of low-income countries. Second, it provides guidance to decision-makers on how to improve fairness, legitimacy, and sustainability of the priority-setting process.
Oduncu, Fuat S
Germany has just started a public debate on priority-setting, rationing and cost-effectiveness due to the cost explosion within the German health care system. To date, the costs for German health care run at 11,6% of its Gross Domestic Product (GDP, 278,3 billion €) that represents a significant increase from the 5,9 % levels present in 1970. In response, the German Parliament has enacted several major and minor legal reforms over the last three decades for the sake of cost containment and maintaining stability of the health care system. The Statutory Health Insurance--SHI (Gesetzliche Krankenversicherung--GKV) is based on the fundamental principle of solidarity and provides an ethical and legal framework for implementing equity, comprehensiveness and setting the principles and rules for financing and providing health care services and benefits. Within the SHI system, several major actors can be identified: the Federal Ministry of Health, the 16 state ministries of health, the Federal Joint Committee (G-BA), the physicians (with their associations) and the hospitals (with their organizations) on the provider side, and the sickness funds with their associations on the purchasers' side. This article reviews the structure and complexities of the German health care system with its major players and participants. The focus will be put on relevant ethical, legal and economic aspects for prioritization, rationalization, rationing and cost-effectiveness of medical benefits and services. In conclusion, this article pleads for open discussion on the challenging subject of priority-setting instead of accepting the implicit and non-transparent rationing of medical services that currently occurs at many different levels within the health care system, as it stands today.
Kimura, Takuma; Imanaga, Teruhiko; Matsuzaki, Makoto
Promotion of home medical care is absolutely necessary in Japan where is a rapidly aging society. In home medical care settings, triadic communications among the doctor, patient and the family are common. And "communications just between the doctor and the patient without the family" (doctor-patient communication without family, "DPC without family") is considered important for the patient to frankly communicate with the doctor without consideration for the family. However, the circumstances associated with DPC without family are unclear. Therefore, to identify the factors of the occurrence of DPC without family, we conducted a cross-sectional mail-in survey targeting 271 families of Japanese patients who had previously received home medical care. Among 227 respondents (83.8%), we eventually analyzed data from 143, excluding families of patients with severe hearing or cognitive impairment and severe verbal communication dysfunction. DPC without family occurred in 26.6% (n = 38) of the families analyzed. A multivariable logistic regression analysis was performed using a model including Primary disease, Daily activity, Duration of home medical care, Interval between doctor visits, Duration of doctor's stay, Existence of another room, and Spouse as primary caregiver. As a result, DPC without family was significantly associated with malignant tumor as primary disease (OR, 3.165; 95% CI, 1.180-8.486; P = 0.022). In conclusion, the visiting doctors should bear in mind that the background factor of the occurrence of DPC without family is patient's malignant tumors.
Hogan, Pamela; Moxham, Lorna; Dwyer, Trudy
It is paramount that there is an adequate nursing workforce supply for now and in the future, to achieve equitable and quality health outcomes and consumer access to healthcare, regardless of geographic location. Nursing forms the largest body of employees in the health care system, spanning all segments of care. A shortage of nurses, particularly in the acute care settings in hospitals, jeopardizes the provision of quality health care to consumers. This article provides a literature review of Australian State and Federal Government reports into nurse retention. All reports discuss staff turnover rates; the average age of nurses; enrolment numbers in nursing courses; workloads; nursing workforce shortfalls and the effect on the work environment; leadership and management styles; organizational culture; change management; the mobility of nursing qualifications both locally and internationally and the critical need to value nurses. Then why has the situation of nurse retention not improved? Possible reasons for the continued nurse shortage and the promise of strategic HRM in addressing nurse retention are discussed.
Wilson, Donna M.; Thomas, Roger; Burns, Katharina Kovacs; Hewitt, Jessica A.; Jane, Osei-Waree; Sandra, Robertson
Few studies have focused on the care setting transitions that occur in the last year of life. A three part mixed-methods study was conducted to gain an understanding of the number and implications or impact of care setting transitions in the last year of life for rural Canadians. Provincial health services utilization data, national online survey data, and local qualitative interview data were analyzed to gain general and specific information for consideration. Rural Albertans had significantly more healthcare setting transitions than urbanites in the last year of life (M=4.2 vs 3.3). Online family respondents reported 8 moves on average occurred for family members in the last year of life. These moves were most often identified (65%) on a likert-type scale as “very difficult,” with the free text information revealing these trips were often emotionally painful for themselves and physically painful for their ill family member. Eleven informants were then interviewed until data saturation, with constant-comparative data analysis conducted for a more in-depth understanding of rural transitions. Moving from place to place for needed care in the last year of life was identified as common and concerning for rural people and their families, with three data themes developing: (a) needed care in the last year of life is scattered across many places, (b) travelling is very difficult for terminally-ill persons and their caregivers, and (c) local rural services are minimal. These findings indicate planning is needed to avoid unnecessary end-of-life care setting transitions and to make needed moves for essential services in the last year of life less costly, stressful, and socially disruptive for rural people and their families. PMID:22980372
Faxelid, E; Ahlberg, B M; Maimbolwa, M; Krantz, I
The aim of this paper is to analyse obstacles to optimal STD care in an urban setting in Zambia. Eight-two health professionals answered a questionnaire with closed and open-ended questions. More than 50% were not satisfied with their working conditions, due to heavy workload, lack of equipment/drugs, poor salary, and lack of continuing education. Negative opinions about STD patients were common. Treatment and preventive activities were considered important but most respondents found patient compliance poor--especially for partner notification. To improve the quality of STD care, training in STD management should be combined with improved working conditions.
Hall, Daleasha; Shirey, Mary A; Waggoner, David C
Hospice of Sacred Heart, an agency of PeaceHealth Oregon, experienced a dramatic increase in its census beginning in 2007. The spiritual care team noticed the number of referrals was decreasing while the census was increasing. A quality improvement initiative was conducted, including a staff survey, an education program about spirituality and the role of chaplains on interdisciplinary teams in the hospice setting, and an audit of the chaplain's daily allocation of time. These actions resulted in an increase in the use of spiritual care services by patients and staff and the addition of two full-time, benefited chaplain positions.
Wilkins, Linda; Laragy, Carmel; Zadeh, Hossein S.
The growing challenge and diversity of ageing populations is a key global issue for struggling health systems. Consumer Directed Care (CDC), an innovative service delivery system, opens up possibilities for re-defining consumer expectations, prompting change in how health service providers operate. As a service delivery model, CDC offers improved responsiveness to individual requirements; and increased transparency in the use of allocated funding. Where implemented, CDC has established new relationships and interactions between key stakeholders, co-creating value for older citizens. This chapter reviews some drivers for the development of service innovation, surveys various in-country approaches, highlights current trends in CDC delivery and describes an EU policy impact assessment instrument to aid funding bodies. The chapter concludes by speculating on organizational outcomes from CDC and the likelihood that the introduction of this innovative service delivery model will require closer collaborative relationships between service providers and information technology specialists.
Conway, T; Hu, T C; Mason, E; Mueller, C
A 1991 study of 115 internal medicine and 28 family practice residents at a large inner-city public hospital finds that both groups would perform poorly in providing preconception counseling to women of reproductive age. More than 40% of residents failed to indicate that they would provide a healthy woman with information on rubella immunization and family planning or counseling on sexually transmitted diseases and safer sex. When counseling a diabetic woman seeking pregnancy, 74% would not have discussed congenital anomalies with her and 45% would not have considered discontinuing oral hypoglycemics if she became pregnant. Furthermore, 58% would have neglected to review or change hypertension medications in a newly diagnosed pregnant woman. Although both internal medicine and family practice residents had positive attitudes toward offering preconception care, family practice residents had significantly higher attitude scores. No clear improvement was found in patient management, attitude or knowledge scores as residents progressed from their first to their third year of training.
Scott, N Ann; Moga, Carmen; Harstall, Christa
OBJECTIVE: To ascertain knowledge gaps in the diagnosis and treatment of acute and chronic low back pain (LBP) in the primary care setting to prepare a scoping survey for identifying knowledge gaps in LBP management among Alberta’s primary care practitioners, and to identify potential barriers to implementing a multidisciplinary LBP guideline. METHODS: English language studies, published from 1996 to 2008, comparing the clinical practice patterns of primary care practitioners with guideline recommendations were identified by systematically searching literature databases, the websites of various health technology assessment agencies and libraries, and the Internet. Data were synthesized qualitatively. RESULTS: The literature search identified 14 relevant studies. Knowledge gaps were reported among various primary care practitioner groups in the assessment of red flags, use of diagnostic imaging, provision of advice regarding sick leave and continuing activity, administration of some medications (muscle relaxants, oral steroids and opioids) and recommendation of particular treatments (acupuncture, physiotherapy, spinal manipulation, traction, ultrasound, transcutaneous electrical nerve stimulation and spinal mobilization). CONCLUSIONS: A know-do gap clearly exists among primary care practitioners with respect to the diagnosis and treatment of LBP. The information on know-do gaps will be used to construct a survey tool for unearthing the local knowledge gaps extant among Alberta’s primary care practitioners, and to develop a dissemination strategy for a locally produced multidisciplinary LBP guideline, with the aim of ensuring that the know-do gaps inherent within each primary practice discipline are specifically targeted. PMID:21165374
Gibson, Jennifer L; Martin, Douglas K; Singer, Peter A
Background Hospitals and regional health authorities must set priorities in the face of resource constraints. Decision-makers seek practical ways to set priorities fairly in strategic planning, but find limited guidance from the literature. Very little has been reported from the perspective of Board members and senior managers about what criteria, processes and parameters of success they would use to set priorities fairly. Discussion We facilitated workshops for board members and senior leadership at three health care organizations to assist them in developing a strategy for fair priority setting. Workshop participants identified 8 priority setting criteria, 10 key priority setting process elements, and 6 parameters of success that they would use to set priorities in their organizations. Decision-makers in other organizations can draw lessons from these findings to enhance the fairness of their priority setting decision-making. Summary Lessons learned in three workshops fill an important gap in the literature about what criteria, processes, and parameters of success Board members and senior managers would use to set priorities fairly. PMID:15355544
El-Menyar, Ayman; Asim, Mohammad; Latifi, Rifat; Al-Thani, Hassan
Research is an integral part of evidence-based practice in the emergency department and critical care unit that improves patient management. It is important to understand the need and major obstacles for conducting research in emergency settings. Herein, we review the literature for the obligations, ethics and major implications of emergency research and the associated limiting factors influencing research activities in critical care and emergency settings. We reviewed research engines such as PubMed, MEDLINE, and EMBASE for the last two decades using the key words "emergency department", "critical care", "research", "consent", and "ethics" as the search terms. Research within emergency settings is slow or non-existent due to time and financial constraints as well as the lack of a research tradition. There are several barriers to conducting research studies in emergency situations such as who, what, when, and how to obtain patient consent. The emergency environment is highly pressurized, emotional, and overburdened. The time taken for research is a particular risk that could delay the desired immediate interventions. Ethical issues abound, particularly relating to informed consent. Research in emergency settings is still in its infancy. Thus, there is a strong need for extensive research in the emergency setting through community awareness, resource management, ethics, collaborations, capacity building, and the development of a research interest for the improvement of patient care and outcomes. We need to establish a well-structured plan to assess and track the decision-making capacity, consider a multistep enrolment and consent strategy, and develop an integrated approach for recruitment into studies.
Background Many studies on diabetes have demonstrated that an intensive control of glycaemia and the main associated risk factors (hypertension, dislipidaemia, obesity and smoking) reduce cardiovascular morbi-mortality. Different scientific societies have proposed a multifactorial approach to type 2 diabetes. The objective of this study was to identify the degree of control of glycosylated haemoglobin (HbA1c) and of cardiovascular risk factors in type 2 diabetic patients, using the GedapS 2004 guidelines, and to analyse the type and intensity of drug treatment. Methods This cross-sectional, multicentre, epidemiological study was conducted in a primary care setting in Vallès Occidental South, Catalonia. Data were collected of 393 patients aged 18 and above who were diagnosed with diabetes mellitus type 2. Biodemographic and clinical data, cardiovascular risk factors, associated cardiovascular disease, and treatment were assessed. Descriptive and multivariable analysis with logistic regression was realized. Results A total of 392 patients with a mean age of 66.8 years (SD = 10.6) (45.4% male patients) were analyzed. The duration of diabetes was 8.4 years (SD = 7.6). The degree of multifactorial control of risk factors was only 2.6%, although in more than 50% individual cardiovascular risk factor was controlled, except for LDL cholesterol (40.6%) and systolic blood pressure (29.6%). Furthermore, only 13.0% of subjects had an optimal BMI, 27.5% an optimal waist circumference. Treatment for diabetes was prescribed in 82.7% of patients, for hypertension 70.7%, for dyslipidaemia 47.2% and 40.1% were taking antiplatelets. Conclusion Over 50% of type 2 diabetic patients presented optimal control of the majority of individual cardiovascular risk factors, although the degree of multifactorial control of diabetes was insufficient (2.6%) and should be improved. Drug treatment can be intensified using a larger number of combinations, particularly in patients with target organ
Takahashi, Ikuko; Turale, Sue
Internationally, it has been found that regular and timely hand washing is part of hand-hygiene practices that can reduce rates of infection in health-care facilities, but research has shown that there is a low level of compliance with hand washing in hospitals worldwide, including Japan. The number of aged-care facilities is growing throughout the world as our populations age, but hand-washing compliance appears even lower in such settings where there are vulnerable and frail elderly persons. This study used a correlational, cross-sectional design to clarify, for the first time, individual and facility factors related to the hand-washing behaviors of care staff at Japanese aged-care facilities. In 56 facilities (31 special nursing homes and 25 health-service facilities) in Yamaguchi Prefecture, data were gathered through survey questionnaires from care staff and facility managers. A total of 1323 (79.6%) questionnaires were returned and 1016 (61.1%) were analyzed. Using logistical regression analysis, two individual factors were investigated ("willingness to practice standard precautions" and "attendance at seminars") and two facility factors were investigated ("implementation of hand-washing evaluation" and "hand-washing environment"). These factors were found to promote hand washing, but no single factor was particularly related to its promotion in aged-care settings. If the health of elderly residents is to be better protected and infection rates lowered, especially in an era of increasing pandemics and epidemics, the compliance rate of health-care workers needs to be increased. We conclude that diverse approaches to both individual and facility factors are necessary to improve compliance with hand washing.
Teichert, Martina; Schoenmakers, Tim; Kylstra, Nico; Mosk, Berend; Bouvy, Marcel L; van de Vaart, Frans; De Smet, Peter A G M; Wensing, Michel
Background The quality of pharmaceutical care in community pharmacies in the Netherlands has been assessed annually since 2008. The initial set has been further developed with pharmacists and patient organizations, the healthcare inspectorate, the government and health insurance companies. The set over 2012 was the first set of quality indicators for community pharmacies which was validated and supported by all major stakeholders. The aims of this study were to describe the validated set of quality indicators for community pharmacies and to report their scores over 2012. In subanalyses the score development over 5 years was described for those indicators, that have been surveyed before and remained unchanged. Methods Community pharmacists in the Netherlands were invited in 2013 to provide information for the set of 2012. Quality indicators were mapped by categories relevant for pharmaceutical care and defined for structures, processes and dispensing outcomes. Scores for categorically-measured quality indicators were presented as the percentage of pharmacies reporting the presence of a quality aspect. For numerical quality indicators, the mean of all reported scores was expressed. In subanalyses for those indicators that had been questioned previously, scores were collected from earlier measurements for pharmacies providing their scores in 2012. Multilevel analysis was used to assess the consistency of scores within one pharmacy over time by the intra-class correlation coefficient (ICC). Results For the set in 2012, 1739 Dutch community pharmacies (88 % of the total) provided information for 66 quality indicators in 10 categories. Indicator scores on the presence of quality structures showed relatively high quality levels. Scores for processes and dispensing outcomes were lower. Subanalyses showed that overall indicators scores improved within pharmacies, but this development differed between pharmacies. Conclusions A set of validated quality indicators provided
Schafer, Katherine Montag; Reidt, Shannon
Advancing age is associated with an increased risk of herpes zoster (shingles) infection and latent effects such as postherpetic neuralgia. The herpes zoster vaccine is recommended in those 60 years of age and older and has been shown to prevent both the primary disease and associated complications. While this recommendation applies to those living in long-term care facilities, there is little clinical evidence to support use in this population. Additionally, there are logistical barriers that may complicate the use of the vaccine. The article examines the evidence for vaccinating residents in long-term care facilities and discusses logistical barriers to vaccination. Pharmacists and providers may consider life expectancy and other factors when evaluating which patients should receive the vaccination.
Wygant, Carmella; Hui, David; Bruera, Eduardo
Childhood sexual abuse (CSA) is a common, distressing, yet rarely discussed topic in palliative care. The long-term effects of CSA can have a significant impact on patients' quality of life, particularly at the end of life. In this article, we aim to initiate a discussion regarding the need to address CSA in the palliative care setting, using the example of an advanced cancer patient and her caregiver sister who revealed their common past. Specifically, we will be discussing 1) the comorbidities, psychological distress, and family distress associated with CSA, 2) its impact on health care delivery, 3) an approach to initiating conversations regarding CSA, and 4) various management strategies. Successful management of CSA necessitates an interprofessional team approach and may help to improve the quality of life of patients and their families.
Televisitation is the virtual transportation of a patient's family to the bedside, regardless of the patient's location within an acute care setting. This innovation in the Telemedicine Program at Thunder Bay Regional Health Sciences Centre (TBRHSC) in Ontario, Canada, embraces the concept of patient- and family-centered care and has been identified as a leading practice by Accreditation Canada. The need to find creative ways to link patients to their family and friend supports hundreds of miles away was identified more than ten years ago. The important relationship between health outcomes and the psychosocial needs of patients and families has been recognized more recently. TBRHSC's patient- and family-centered model of care focuses on connecting patients with their families. First Nations renal patients with family in remote communities were some of the earliest users of videoconferencing technology for this purpose.
Cioffi, R N Jane
Communication with culturally and linguistically diverse (CLD) patients has been shown to be difficult. This study describes nurses' experiences of communicating with CLD patients in an acute care setting. A purposive sample of registered nurses and certified midwives (n=23) were interviewed. Main findings were: interpreters, bilingual health workers and combinations of different strategies were used to communicate with CLD patients; some nurses showed empathy, respect and a willingness to make an effort in the communication process with others showing an ethnocentric orientation. Main recommendations were: prioritising access to appropriate linguistic services, providing nurses with support from health care workers, e.g., bilingual health care workers who are able to provide more in-depth information, increasing nurses' understanding of legal issues within patient encounters, supporting nurses to translate their awareness of cultural diversity into acceptance of, appreciation for and commitment to CLD patients and their families.
Ajja, Rahma; Beets, Michael W.; Chandler, Jessica; Kaczynski, Andrew T.; Ward, Dianne S.
Background There is a growing interest in evaluating the physical activity (PA) and healthy eating (HE) policy and practice environment characteristics in settings frequented by youth (≤18 years). Objective This review evaluates the measurement properties of audit tools designed to assess PA and HE policy and practice environmental characteristics in settings that care for youth (e.g., childcare, school, afterschool, summer camp). Method Three electronic databases, reference lists, educational department and national health organizations’ web pages were searched between January 1980 and February 2014 to identify tools assessing PA and/or HE policy and practice environments in settings that care for youth (≤18 years). Results Sixty-five audit tools were identified of which 53 individual tools met the inclusion criteria. Thirty-three tools assessed both the PA and HE domains, 6 assessed PA domain and 14 assessed HE domain solely. The majority of the tools were self-assessment tools (n=40), and were developed to assess the PA and/or HE environment in school settings (n=33), childcare (n=12), and afterschool programs (n=4). Four tools assessed the community at-large and had sections for assessing preschool, school and/or afterschool settings within the tool. The majority of audit tools lacked validity and/or reliability data (n=42). Inter-rater reliability and construct validity were the most frequently reported reliability (n= 7) and validity types (n=5). Conclusions Limited attention has been given to establishing the reliability and validity of audit tools for settings that care for youth. Future efforts should be directed towards establishing a strong measurement foundation for these important environmental audit tools. PMID:25964078
Munro, Michelle L.
Research indicates that only a small fraction of sexual assault survivors seek comprehensive care afterward, including physical and mental health care, forensic evidence collection, victim services, and legal support. This integrative review was conducted to identify barriers that may be keeping sexual assault survivors of childbearing age from receiving such comprehensive care. PMID:25664329
Kosberg, Jordan I.
This paper addresses issues related to the care of the aged by informal caregivers, government support of such care, and policy changes that might result in improved care of the elderly population. In its treatment of family responsibility for the elderly, it calls attention to several trends: (1) family members will be increasingly unavailable to…
Landwehr, Claudia; Klinnert, Dorothea
Most developed democracies have faced the challenge of priority setting in health care by setting up specialized agencies to take decisions on which medical services to include in public health baskets. Under the influence of Daniels and Sabin's seminal work on the topic, agencies increasingly aim to fulfil criteria of procedural justice, such as accountability and transparency. We assume, however, that the institutional design of agencies also and necessarily reflects substantial value judgments on the respective weight of distributive principles such as efficiency, need and equality. The public acceptance of prioritization decisions, and eventually of the health care system at large, will ultimately depend not only on considerations of procedural fairness, but also on the congruence between a society's values and its institutions. We study social values, institutions and decisions in three countries (France, Germany and the United Kingdom) in order to assess such congruence and formulate expectations on its effects.
Wang, ShuQi; Lifson, Mark A; Inci, Fatih; Liang, Li-Guo; Sheng, Ye-Feng; Demirci, Utkan
The striking prevalence of HIV, TB and malaria, as well as outbreaks of emerging infectious diseases, such as influenza A (H7N9), Ebola and MERS, poses great challenges for patient care in resource-limited settings (RLS). However, advanced diagnostic technologies cannot be implemented in RLS largely due to economic constraints. Simple and inexpensive point-of-care (POC) diagnostics, which rely less on environmental context and operator training, have thus been extensively studied to achieve early diagnosis and treatment monitoring in non-laboratory settings. Despite great input from material science, biomedical engineering and nanotechnology for developing POC diagnostics, significant technical challenges are yet to be overcome. Summarized here are the technical challenges associated with POC diagnostics from a RLS perspective and the latest advances in addressing these challenges are reviewed.
Wang, ShuQi; Lifson, Mark A.; Inci, Fatih; Liang, Li-Guo; Sheng, Ye-Feng; Demirci, Utkan
The striking prevalence of HIV, TB and malaria, as well as outbreaks of emerging infectious diseases, such as influenza A (H7N9), Ebola and MERS, poses great challenges for patient care in resource-limited settings (RLS). However, advanced diagnostic technologies cannot be implemented in RLS largely due to economic constraints. Simple and inexpensive point-of-care (POC) diagnostics, which rely less on environmental context and operator training, have thus been extensively studied to achieve early diagnosis and treatment monitoring in non-laboratory settings. Despite great input from material science, biomedical engineering and nanotechnology for developing POC diagnostics, significant technical challenges are yet to be overcome. Summarized here are the technical challenges associated with POC diagnostics from a RLS perspective and the latest advances in addressing these challenges are reviewed. PMID:26777725
Painter, J; Akroyd, D; Wilson, S; Figuers, C
Using a perceived reward model of overall job satisfaction, this study utilized a correlational research design with multiple regression analysis to determine the predictive power of extrinsic rewards and intrinsic rewards, collectively and individually, as determinants of overall job satisfaction among registered occupational therapists (OTR) working full-time in ambulatory care settings. The intrinsic rewards (task involvement and task autonomy), collectively and individually, were perceived to be significant overall job satisfaction determinants. General working conditions was the only significant extrinsic reward. Given the demand for OTRs in ambulatory care settings, a better understanding of factors that influence overall job satisfaction among OTRs could prove beneficial in developing appropriate recruitment and retention job design strategies.
Mintzer, Janet L.
The Delaware Valley Child Care Council (DVCCC) developed this booklet to help Philadelphia school principals plan and develop privately run after-school centers in their schools. First, an executive summary documents the need for school-age day care nationwide and in the Philadelphia area. Section I offers guidance on planning a school-age child…
Wellesley Coll., MA. Center for Research on Women.
Collected are seven technical assistance papers concerning the development and implementation of community school age day care programs. The first paper provides a step-by-step guide to organizing a school-age child care program and the second paper focuses on developing a high quality program. Paper 3 explores administrative, policy, and legal…
In 2001, Arizona's Children's Action Alliance (CCA) developed a resource for community groups interested in exploring the need for care for school-age children. Titled "School-Age Care Tool Kit: A Guide for Measuring Needs in Your Community," the resource provided step-by-step advice to community organizations on how to identify the need…
Noting that the population of foster children who "age out" of the foster care system may be even more at risk than other foster children, this research brief summarizes a longer report examining trends in foster care in the United States, the number and needs of those aging out of the system, and public policy implications. The brief indicates…
Barnes, Sarah; Wasielewska, Anna; Raiswell, Christine; Drummond, Barbara
Improving the mealtime experience in residential care can be a major facilitator in improving care, well-being and QoL. Evidence suggests that, despite guidance on the subject of food, nutrition and hydration, there are still concerns. Although there is a range of methods to research and assess the quality of food provision, there is a challenge in capturing the experiences of those residents who are unable or unwilling to describe their feelings and experiences because of frailty, impaired communication or other vulnerability. The aim of this exploratory study was to capture and describe individual residents' mealtime experience. In spring 2011, a small-scale, observational study was carried out in seven dining settings in four residential care homes in Manchester. An adapted dementia care mapping tool was used alongside field notes. Observations showed two major differences in the way the mealtimes were organised: 'pre-plated' and 'family-style' (where either bowls of food are placed in the centre of the table or food is served directly from a hotplate by a chef). These two styles of service are discussed in relation to the emerging themes of 'task versus resident-centred mealtimes', 'fostering resident independence' and 'levels of interaction'. Although improving mealtimes alone is not enough to improve quality of life in care homes, findings showed that relatively small changes to mealtime delivery can potentially have an impact on resident well-being in these homes. Observation is a useful method of engaging residents in care settings for older people who may not otherwise be able to take part in research.
Sabik, Lindsay M; Lie, Reidar K
All health care systems face problems of justice and efficiency related to setting priorities for allocating a limited pool of resources to a population. Because many of the central issues are the same in all systems, the United States and other countries can learn from the successes and failures of countries that have explicitly addressed the question of health care priorities. We review explicit priority setting efforts in Norway, Sweden, Israel, the Netherlands, Denmark, New Zealand, the United Kingdom and the state of Oregon in the US. The approaches used can be divided into those centered on outlining principles versus those that define practices. In order to establish the main lessons from their experiences we consider (1) the process each country used, (2) criteria to judge the success of these efforts, (3) which approaches seem to have met these criteria, and (4) using their successes and failures as a guide, how to proceed in setting priorities. We demonstrate that there is little evidence that establishment of a values framework for priority setting has had any effect on health policy, nor is there evidence that priority setting exercises have led to the envisaged ideal of an open and participatory public involvement in decision making. PMID:18208617
Muckaden, MA; Pandya, Sachi Sanjay
Background: Volunteers are an integral part of the palliative care services in the Tata Memorial Hospital, Mumbai, Maharashtra, India. These volunteers are an important resource for the department. Thus, it is necessary for the department to determine what motivates these volunteers to continue to work in the setting, acknowledge them and direct efforts toward retaining them and giving them opportunities to serve to the best of their desire and abilities. Aims: The current study aimed at understanding the motivation of volunteers to work in palliative care, to identify the challenges they face and also the effect of their work on their self and relationships. Methodology: In-depth interviews were conducted using semistructured interview guide to study above mentioned aspects. Themes were identified and coding was used to analyze the data. Results: The results suggested that the basic motivation for all the volunteers to work in a palliative care setting is an inherent urge, a feeling of need to give back to the society by serving the sick and the suffering. Other motivating factors identified were team spirit, comfort shared, warm and respectful treatment by the team, satisfying nature of work, experience of cancer in the family, and aligned values and beliefs. Some intrinsic rewards mentioned by volunteers were joy of giving, personal growth, enriching experiences, and meaningful nature of work. Conclusion: The study attempted to improve opportunities of working for these volunteers. Although limited in scope, it offers insight for future research in the area of volunteerism in palliative care setup. PMID:27559267
Adams, Rose; White, Barb; Beckett, Cynthia
Background Pain management remains a critical issue for hospitals and is receiving the attention of hospital accreditation organizations. The acute care setting of the hospital provides an excellent opportunity for the integration of massage therapy for pain management into the team-centered approach of patient care. Purpose and Setting This preliminary study evaluated the effect of the use of massage therapy on inpatient pain levels in the acute care setting. The study was conducted at Flagstaff Medical Center in Flagstaff, Arizona—a nonprofit community hospital serving a large rural area of northern Arizona. Method A convenience sample was used to identify research participants. Pain levels before and after massage therapy were recorded using a 0 – 10 visual analog scale. Quantitative and qualitative methods were used for analysis of this descriptive study. Participants Hospital inpatients (n = 53) from medical, surgical, and obstetrics units participated in the current research by each receiving one or more massage therapy sessions averaging 30 minutes each. The number of sessions received depended on the length of the hospital stay. Result Before massage, the mean pain level recorded by the patients was 5.18 [standard deviation (SD): 2.01]. After massage, the mean pain level was 2.33 (SD: 2.10). The observed reduction in pain was statistically significant: paired samples t52 = 12.43, r = .67, d = 1.38, p < .001. Qualitative data illustrated improvement in all areas, with the most significant areas of impact reported being overall pain level, emotional well-being, relaxation, and ability to sleep. Conclusions This study shows that integration of massage therapy into the acute care setting creates overall positive results in the patient’s ability to deal with the challenging physical and psychological aspects of their health condition. The study demonstrated not only significant reduction in pain levels, but also the interrelatedness of pain, relaxation
Marten, Marie Lucille
Proposes a series of university nursing education programs developed to increase knowledge and skills relevant to nursing care of elderly and chronically ill persons who reside in nursing homes. Briefly describes five programs intended for persons engaged in long-term care or in preparation for such roles. (EM)
Mazerolle, Stephanie M.; Eason, Christianne M.; Goodman, Ashley
Context: Over the last few decades, the National Collegiate Athletics Association (NCAA) has made changes related to the increase in sanctioned team activities during summer athletics. These changes may affect how athletic training services are provided. Objective: To investigate the methods by which athletic training departments of NCAA institutions manage expectations regarding athletic training services during the summer. Design: Mixed-methods qualitative and quantitative study. Setting: The NCAA Division I. Patients or Other Participants: Twenty-two athletic trainers (13 men, 9 women) participated. All were employed full time within the NCAA Division I setting. Participants were 35 ± 8 years of age (range, 26−52 years), with 12 ± 7 years (range, 3−29 years) of athletic training experience. Data Collection and Analysis: All participants completed a series of questions online that consisted of closed- (demographic and Likert-scale 5-point) and open-ended items that addressed the research questions. Descriptive statistics, frequency distributions, and phenomenologic analyses were completed with the data. Peer review and multiple-analyst triangulation established credibility. Results: Summer athletic training services included 3 primary mechanisms: individual medical care, shared medical care, or a combination of the 2. Participants reported working 40 ± 10 hours during the summer. Likert-item analysis showed that participants were moderately satisfied with their summer medical care structure (3.3 ± 1.0) and with the flexibility of summer schedules (3.0 ± 1.2). Yet the qualitative analysis revealed that perceptions of summer medical care were more positive for shared-care participants than for individual- or combination-care participants. The perceived effect on the athletic trainer included increased workload and expectations and a negative influence on work-life balance, particularly in terms of decreased schedule flexibility and
Morton, Katie; Beauchamp, Mark; Prothero, Anna; Joyce, Lauren; Saunders, Laura; Spencer-Bowdage, Sarah; Dancy, Bernadette; Pedlar, Charles
Motivational interviewing (MI) is a patient-centred approach to behaviour change that was originally developed in the addiction field but has increasingly been applied to public health settings with a focus on health promotion. The purpose of this review was to examine the evidence base for MI interventions in primary care settings with non-clinical populations to achieve behaviour change for physical activity, dietary behaviours and/or alcohol intake. We also sought to explore the specific behaviour change techniques included in MI interventions within primary care. Electronic databases were searched for relevant articles and 33 papers met inclusion criteria and were included. Approximately 50% of the included studies (n = 18) demonstrated positive effects in relation to health behaviour change. The efficacy of MI approaches is unclear given the inconsistency of MI descriptions and intervention components. Furthermore, research designs that do not isolate the effects of MI make it difficult to determine the effectiveness of such approaches. We offer a number of recommendations for researchers and practitioners seeking to include MI within behaviour change interventions to help improve the quality of the research and the effectiveness of MI-based interventions within primary care settings.
Wong, Albert; Wouterse, Bram; Slobbe, Laurentius C J; Boshuizen, Hendriek C; Polder, Johan J
Health care utilization is expected to rise in the coming decades. Not only will the aggregate need for health care grow by changing demographics, so too will per capita utilization. It has been suggested that trends in health care utilization may be age-specific. In this paper, age-specific trends in health care utilization are presented for different health care sectors in the Netherlands, for the period 1981-2009. For the hospital sector we also explore the link between these trends and the state of medical technology. Using aggregated data from a Dutch health survey and a nationwide hospital register, regression analysis was used to examine age-specific trends in the probability of utilizing health care. To determine the influence of medical technology, the growth in age-specific probabilities of hospital care was regressed on the number of medical patents while adjusting for confounders related to demographics, health status, supply and institutional factors. The findings suggest that for most health care sectors, the trend in the probability of health care utilization is highest for ages 65 and up. Larger advances in medical technology are found to be significantly associated with a higher growth of hospitalization probability, particularly for the higher ages. Age-specific trends will raise questions on the sustainability of intergenerational solidarity in health care, as solidarity will not only be strained by the ageing population, but also might find itself under additional pressure as the gap in health care utilization between elderly and non-elderly grows over time. For hospital care utilization, this process might well be accelerated by advances in medical technology.
Vvedenskaia, E S; Kobzeva, L F; Vvedenskaia, I I
The article presents a detailed analysis of health care provision to both general and retirement age population (RAP) in the Nizhny Novgorod region. For the past 10 years, the organization and use of different types of health care for RAP have not changed. The availability of inpatient health care for RAP is high whereas the availability of nursing and outpatient health care is low and palliative care service is not available. In order to enhance availability and ensure quality of medical services it is necessary to implement restructuring of health care for RAP at the municipal level herewith a key attention will be paid to out-patient types of health care expansion and palliative care development. The authors formulate some proposals aimed at improving the organization of medical and social care for RAP which should be included in the health care restructuring program at the municipal level.
Larson, Nicole; Ward, Dianne; Neelon, Sara Benjamin; Story, Mary
Child-care settings provide numerous opportunities to promote healthy eating and physical activity behaviors among preschool children. The majority of U.S. children are placed in some form of non-parental care during their preschool years. While approximately 15 percent of preschool children are primarily cared for by their relatives, most…
Lehrer, Joanne S.; Lemay, Lise; Bigras, Nathalie
The current study examined how parental perceptions of child care quality were related to external quality ratings and considered how parental perceptions of quality varied according to child care context (home-based or centre-based settings). Parents of 179 4-year-old children who attended child care centres (n = 141) and home-based settings…
Klaczynski, Paul A.
To examine age trends in precedent-setting decisions and the effects of these decisions on perceptions of authorities, preadolescents and adolescents were presented with deontic rule infractions that occurred in the absence or presence of mitigating circumstances. In Study 1, in the absence of mitigating circumstances, adolescents recommended…
Campbell, Alaina H; Meritt, Donald W; Franklin, Rima B; Boone, Edward L; Nicely, Carol T; Brown, Bonnie L
Lack of success in restoring the native Eastern oyster, Crassostrea virginica, to Chesapeake Bay has been linked to the low occurrence of oyster larval setting in tributaries to the Bay. Among the many potential factors that could affect efforts to produce oysters through aquaculture or supplementation of shell beds is substratum condition. The present study examined larval setting on field-produced biofilms from Little Wicomico River (Virginia, USA) to assess whether bacterial community structure (examined by terminal restriction fragment length polymorphism, T-RFLP) or other characteristics of contemporary biofilms in this tributary (biofilm age and mass, algal abundance, and percentage organic matter) inhibited setting of larval oysters. The structure of the natural and heterogenous bacterial community in the biofilms and the success of oyster set were correlated, suggesting that specific microbial species may play a role in oyster setting. Larval set increased with biofilm age and mass, suggesting that established field-produced biofilms have no inhibitory effect. In contrast, the percentage of organic matter was negatively correlated with oyster set, whereas chlorophyll a concentration had no observed effect. The study expands prior knowledge by providing a more realistic timeframe for biofilm development (weeks as opposed to days), recounting effects of biofilms that are more representative of the natural dynamic and disturbance processes that would be expected to occur on submerged structures, and by incorporating seasonal and spatial variation. An important negative effect observed during the study period was heavy predation by Stylochus ellipticus on newly set oysters. Overall, the results of this study, which is the first assessment of the effects of biofilms produced naturally within a Chesapeake Bay tributary, suggest that the absence of large numbers of oysters in Little Wicomico River is not related to microbes or other specific characteristics of
Bodak, Marie; Barlas, Joanna; Harwood, June; Pether, Mary
Robots, including robotic seals, have been used as an alternative to therapies such as animal assisted therapy in the promotion of health and social wellbeing of older people in aged care facilities. There is limited research available that evaluates the effectiveness of robot therapies in these settings. The aim of this study was to identify, explore, and describe the impact of the use of Paro robotic seals in an aged care facility in a regional Australian city. A qualitative, descriptive, exploratory design was employed. Data were gathered through interviews with the three recreational therapists employed at the facility who were also asked to maintain logs of their interactions with the Paro and residents. Data were transcribed and thematically analysed. Three major themes were identified from the analyses of these data: “a therapeutic tool that's not for everybody,” “every interaction is powerful,” and “keeping the momentum.” Findings support the use of Paro as a therapeutic tool, revealing improvement in emotional state, reduction of challenging behaviours, and improvement in social interactions of residents. The potential benefits justify the investment in Paro, with clear evidence that these tools can have a positive impact that warrants further exploration. PMID:27990301
Background The need for palliative care in sub-Saharan Africa is staggering: this region shoulders over 67% of the global burden of HIV/AIDS and cancer. However, provisions for these essential services remain limited and poorly integrated with national health systems in most nations. Moreover, the evidence base for palliative care in the region remains scarce. This study chronicles the development and evaluation of DataPall, an open-source electronic medical records system that can be used to track patients, manage data, and generate reports for palliative care providers in these settings. DataPall was developed using design criteria encompassing both functional and technical objectives articulated by hospital leaders and palliative care staff at a leading palliative care center in Malawi. The database can be used with computers that run Windows XP SP 2 or newer, and does not require an internet connection for use. Subsequent to its development and implementation in two hospitals, DataPall was tested among both trained and untrained hospital staff populations on the basis of its usability with comparison to existing paper records systems as well as on the speed at which users could perform basic database functions. Additionally, all participants evaluated this program on a standard system usability scale. Results In a study of health professionals in a Malawian hospital, DataPall enabled palliative care providers to find patients’ appointments, on average, in less than half the time required to locate the same record in current paper records. Moreover, participants generated customizable reports documenting patient records and comprehensive reports on providers’ activities with little training necessary. Participants affirmed this ease of use on the system usability scale. Conclusions DataPall is a simple, effective electronic medical records system that can assist in developing an evidence base of clinical data for palliative care in low resource settings. The
You, Emily Chuanmei; Dunt, David; Doyle, Colleen
This study aimed to explore the perceptions of case managers about their roles in providing community aged care in Australia. Purposeful sampling was used and 33 qualitative semi-structured interviews with 47 participants were conducted. Participants were drawn from a list of all case managers working in aged care organisations that provided publicly funded case-managed community aged care programmes in the State of Victoria, Australia. Participant selection criteria included age, gender, job titles, professional backgrounds, practice locations, organisational attributes and organisational size. Data collection was implemented between September 2012 and March 2013. Thematic analysis was performed. Participants believed that case managers performed diverse roles based on clients' needs. They also articulated 16 important roles of case managers, including advisors, advocates, carers, communicators, co-ordinators, educators, empowering clients, engaging clients and families, liaising with people, managing budgets, navigators, negotiators, networking with people, facilitators, problem solvers and supporters. However, they were concerned about brokers, mediators and counsellors in terms of the terminology or case managers' willingness to perform these roles. Moreover, they perceived that neither gatekeepers nor direct service provision was case managers' role. The findings of this study suggest that case managers working in community aged care sectors may be more effective if they practised the 16 roles aforementioned. With the value of helping rather than obstructing clients to access services, they may not act as gatekeepers. In addition, they may not provide services directly as opposed to their peers working in medical care settings. The findings will also assist organisations to design job descriptions specifying case managers' roles and associated job responsibilities. Clear job descriptions will further benefit the organisations in staff recruitment, orientation
Sharma, Shikha; Zapatero-Rodríguez, Julia; Estrela, Pedro; O’Kennedy, Richard
The inability to diagnose numerous diseases rapidly is a significant cause of the disparity of deaths resulting from both communicable and non-communicable diseases in the developing world in comparison to the developed world. Existing diagnostic instrumentation usually requires sophisticated infrastructure, stable electrical power, expensive reagents, long assay times, and highly trained personnel which is not often available in limited resource settings. This review will critically survey and analyse the current lateral flow-based point-of-care (POC) technologies, which have made a major impact on diagnostic testing in developing countries over the last 50 years. The future of POC technologies including the applications of microfluidics, which allows miniaturisation and integration of complex functions that facilitate their usage in limited resource settings, is discussed The advantages offered by such systems, including low cost, ruggedness and the capacity to generate accurate and reliable results rapidly, are well suited to the clinical and social settings of the developing world. PMID:26287254
Sharma, Shikha; Zapatero-Rodríguez, Julia; Estrela, Pedro; O'Kennedy, Richard
The inability to diagnose numerous diseases rapidly is a significant cause of the disparity of deaths resulting from both communicable and non-communicable diseases in the developing world in comparison to the developed world. Existing diagnostic instrumentation usually requires sophisticated infrastructure, stable electrical power, expensive reagents, long assay times, and highly trained personnel which is not often available in limited resource settings. This review will critically survey and analyse the current lateral flow-based point-of-care (POC) technologies, which have made a major impact on diagnostic testing in developing countries over the last 50 years. The future of POC technologies including the applications of microfluidics, which allows miniaturisation and integration of complex functions that facilitate their usage in limited resource settings, is discussed The advantages offered by such systems, including low cost, ruggedness and the capacity to generate accurate and reliable results rapidly, are well suited to the clinical and social settings of the developing world.
Wendsche, Johannes; Hacker, Winfried; Wegge, Jürgen; Rudolf, Matthias
We investigated how two types of care setting (home care and nursing home) and type of ownership (for-profit vs. public/non-profit) of geriatric care services interacted in influencing registered nurses' intention to give up their profession. In prior research, employment in for-profit-organizations, high job demands, and low job control were important antecedents of nurses' intent to leave. However, the impact of care setting on these associations was inconclusive. Therefore, we tested a mediated moderation model predicting that adverse work characteristics would drive professional leaving intentions, particularly in for-profit services and in nursing homes. A representative German sample of 304 registered nurses working in 78 different teams participated in our cross-sectional study. As predicted, lower job control and higher job demands were associated with higher professional leaving intentions, and nurses reported higher job demands in public/non-profit care than in for-profit care, and in nursing homes compared to home care. Overall, RNs in nursing homes and home care reported similar intent to leave, but in for-profit settings only, nurses working in nursing homes reported higher professional leaving intentions than did nurses in home care, which was linked to lower job control in the for-profit nursing home setting, supporting mediated moderation. Taken together, our results indicate that the interplay of care setting and type of ownership is important when explaining nurses' intentions to give up their profession. © 2016 Wiley Periodicals, Inc.
Field, Craig A.; Caetano, Raul; Harris, T. Robert; Frankowski, Ralph; Roudsari, Bahman
Background Evidence suggests that brief interventions in the trauma care setting reduce drinking, subsequent injury and DUI arrest. However, evidence on the effectiveness of these interventions in ethnic minority groups is lacking. The current study evaluates the efficacy of brief intervention among Whites, Blacks and Hispanics in the U.S. Methods We conducted a two-group parallel randomized trial comparing Brief Motivational Intervention (BMI) and Treatment as Usual with assessment (TAU+) to evaluate treatment differences in drinking patterns by ethnicity. Patients were recruited from a Level 1 urban trauma center over a two year period. The study included 1493 trauma patients including 668 Whites, 288 Blacks, and 537 Hispanics. Hierarchical linear modeling was used to evaluate ethnic differences in drinking outcomes including volume per week, maximum amount consumed in one day, percent days abstinent and percent days heavy drinking at 6 and 12 month follow up. Analyses controlled for age, gender, employment status, marital status, prior alcohol treatment, type of injury and injury severity. Special emphasis was given to potential ethnic differences by testing the interaction between ethnicity and BMI. Results At 6 and 12 month follow up, BMI significantly reduced maximum amount consumed in one day (p<.001; p<.001, respectively) and percent days heavy drinking (p<.05; p<.05, respectively) among Hispanics. Hispanics in the BMI group also reduced average volume per week at 12 month follow up (X2=6.8, df=1, p<.01). In addition, Hispanics in TAU+ reduced maximum amount consumed at 6 and 12 month follow up (p<.001; p<.001) and volume per week at 12 month follow up (p<.001). Whites and Blacks in both BMI and TAU+ reduced volume per week and percent days heavy drinking at 12 month follow up (p<.001; p<.01, respectively) and decreased maximum amount at 6 (p<.001) and 12 month follow up (p<.001). All three ethnic groups In both BMI and TAU+ reduced volume per week at 6
Background It is important that healthcare provided in crisis settings is based on the best available research evidence. We reviewed guidelines for child and perinatal health care in crisis situations to determine whether they were based on research evidence, whether Cochrane systematic reviews were available in the clinical areas addressed by these guidelines and whether summaries of these reviews were provided in Evidence Aid. Methods Broad internet searches were undertaken to identify relevant guidelines. Guidelines were appraised using AGREE and the clinical areas that were relevant to perinatal or child health were extracted. We searched The Cochrane Database of Systematic Reviews to identify potentially relevant reviews. For each review we determined how many trials were included, and how many were conducted in resource-limited settings. Results Six guidelines met selection criteria. None of the included guidelines were clearly based on research evidence. 198 Cochrane reviews were potentially relevant to the guidelines. These reviews predominantly addressed nutrient supplementation, breastfeeding, malaria, maternal hypertension, premature labour and prevention of HIV transmission. Most reviews included studies from developing settings. However for large portions of the guidelines, particularly health services delivery, there were no relevant reviews. Only 18 (9.1%) reviews have summaries in Evidence Aid. Conclusions We did not identify any evidence-based guidelines for perinatal and child health care in disaster settings. We found many Cochrane reviews that could contribute to the evidence-base supporting future guidelines. However there are important issues to be addressed in terms of the relevance of the available reviews and increasing the number of reviews addressing health care delivery. PMID:20350326
Jung, Martin; Brearley, Francis Q.; Ribbons, Relena R.; Lines, Emily R.; Jacob, Aerin L.
Globally, mature forests appear to be increasing in biomass density (BD). There is disagreement whether these increases are the result of increases in atmospheric CO2 concentrations or a legacy effect of previous land-use. Recently, it was suggested that a threshold of 450 years should be used to define mature forests and that many forests increasing in BD may be younger than this. However, the study making these suggestions failed to account for the interactions between forest age and climate. Here we revisit the issue to identify: (1) how climate and forest age control global forest BD and (2) whether we can set a threshold age for mature forests. Using data from previously published studies we modelled the impacts of forest age and climate on BD using linear mixed effects models. We examined the potential biases in the dataset by comparing how representative it was of global mature forests in terms of its distribution, the climate space it occupied, and the ages of the forests used. BD increased with forest age, mean annual temperature and annual precipitation. Importantly, the effect of forest age increased with increasing temperature, but the effect of precipitation decreased with increasing temperatures. The dataset was biased towards northern hemisphere forests in relatively dry, cold climates. The dataset was also clearly biased towards forests <250 years of age. Our analysis suggests that there is not a single threshold age for forest maturity. Since climate interacts with forest age to determine BD, a threshold age at which they reach equilibrium can only be determined locally. We caution against using BD as the only determinant of forest maturity since this ignores forest biodiversity and tree size structure which may take longer to recover. Future research should address the utility and cost-effectiveness of different methods for determining whether forests should be classified as mature. PMID:26870607
Montes de Oca, Maria; Aguirre, Carlos; Lopez Varela, Maria Victorina; Laucho-Contreras, Maria E; Casas, Alejandro; Surmont, Filip
Background COPD, asthma, and asthma–COPD overlap increase health care resource consumption, predominantly because of hospitalization for exacerbations and also increased visits to general practitioners (GPs) or specialists. Little information is available regarding this in the primary care setting. Objectives To describe the prevalence and number of GP and specialist visits for any cause or due to exacerbations in patients with COPD, asthma, and asthma–COPD overlap. Methods COPD was defined as post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio <0.70; asthma was defined as prior medical diagnosis, wheezing in the last 12 months, or wheezing plus reversibility (post-bronchodilator FEV1 or FVC increase ≥200 mL and ≥12%); asthma–COPD overlap was defined as post-bronchodilator FEV1/FVC <0.70 plus prior asthma diagnosis. Health care utilization was evaluated as GP and/or specialist visits in the previous year. Results Among the 1,743 individuals who completed the questionnaire, 1,540 performed acceptable spirometry. COPD patients had a higher prevalence of any medical visits to any physician versus those without COPD (37.2% vs 21.8%, respectively) and exacerbations doubled the number of visits. The prevalence of any medical visits to any physician was also higher in asthma patients versus those without asthma (wheezing: 47.2% vs 22.7%; medical diagnosis: 54.6% vs 21.6%; wheezing plus reversibility: 46.2% vs 23.8%, respectively). Asthma patients with exacerbations had twice the number of visits versus those without an exacerbation. The number of visits was higher (2.8 times) in asthma–COPD overlap, asthma (1.9 times), or COPD (1.4 times) patients versus those without these respiratory diseases; the number of visits due to exacerbation was also higher (4.9 times) in asthma–COPD overlap, asthma (3.5 times), and COPD (3.8 times) patients. Conclusion COPD, asthma, and asthma–COPD overlap increase the prevalence of
Angus, Jocelyn; Nay, Rhonda
This paper examines the marginalisation of nursing discourse, which followed the enactment of the Aged Care Act 1997. This neo-reform period in aged care, dominated by theories of economic rationalism, enshrined legislation based upon market principles and by implication, the provision of care at the cheapest possible price. This paper exposes some of the gaps in the neo-reform period and challenges the assertion that the amalgamation of nursing homes and hostels in such an environment can provide better quality of care and life for residents. It argues that this amalgamation entails a transformation towards a social model of care and fails to address the professional healthcare needs of the acutely sick and complex extreme old person and makes evident new gaps in the provision of aged care services. The paper proceeds to present strategies where the future for nursing practice in aged care necessarily involves a judicious balancing of individual cases alongside economic prescriptions of care and ever-changing public policy initiatives. It concludes that this can be achieved through a more interactive public, professional and advocacy discourse. The methodology involves extensive analysis of public documents including media, academic journals, government reports and interviews with recognised leaders in the field of aged care. The study utilises a critical interpretative framework consistent with the logic of Michel Foucault.
Brenes-Camacho, Gilbert; Rosero-Bixby, Luis
Background Costa Rica, like other developing countries, is experiencing an increasing burden of chronic conditions such as diabetes mellitus (DM), especially among its elderly population. This article has two goals: (1) to assess the level of metabolic control among the diabetic population age ≥ 60 years old in Costa Rica, and (2) to test whether diabetic elderly patients of community health centers differ from patients in other health care settings in terms of the level of metabolic control. Methods Data come from the project CRELES, a nationally representative study of people aged 60 and over in Costa Rica. This article analyzes a subsample of 542 participants in CRELES with self-reported diagnosis of diabetes mellitus. Odds ratios of poor levels of metabolic control at different health care settings are computed using logistic regressions. Results Lack of metabolic control among elderly diabetic population in Costa Rica is described as follows: 37% have glycated hemoglobin ≥ 7%; 78% have systolic blood pressure ≥ 130 mmHg; 66% have diastolic blood pressure ≥ 80 mmHg; 48% have triglycerides ≥ 150 mg/dl; 78% have LDL ≥ 100 mg/dl; 70% have HDL ≤ 40 mg/dl. Elevated levels of triglycerides and LDL were higher in patients of community health centers than in patients of other clinical settings. There were no statistical differences in the other metabolic control indicators across health care settings. Conclusion Levels of metabolic control among elderly population with DM in Costa Rica are not that different from those observed in industrialized countries. Elevated levels of triglycerides and LDL at community health centers may indicate problems of dyslipidemia treatment among diabetic patients; these problems are not observed in other health care settings. The Costa Rican health care system should address this problem, given that community health centers constitute a means of democratizing access to primary health care to underserved and poor areas. PMID
Morris, Heather L; Dumenci, Levent; Lafata, Jennifer E
Objective Despite known benefits of patient-perceived collaborative goal setting, we have a limited ability to monitor this process in practice. We developed the Patient Measure of Collaborative Goal Setting (PM-CGS) to evaluate the use of collaborative goal setting from the patient's perspective. Research design and methods A random sample of 400 patients aged 40 years or older, receiving diabetes care from the Virginia Commonwealth University Health System between 8/2012 and 8/2013, were mailed a survey containing potential PM-CGS items (n=44) as well as measures of patient demographics, perceived self-management competence, trust in their physician, and self-management behaviors. Confirmatory factor analysis was used to evaluate construct validity. External validity was evaluated via a structural equation model (SEM) that tested the association of the PM-CGS with self-management behaviors. The direct and two mediated (via trust and self-efficacy) pathways were tested. Results A total of 259 patients responded to the survey (64% response rate), of which 192 were eligible for inclusion. Results from the factor analysis supported a 37-item measure of patient-perceived CGS spanning five domains: listen and learn; share ideas; caring relationship; measurable objective; and goal achievement support (χ=4366.13, p<0.001; RMSEA=0.08). Results from the SEM supported the external validity of the PM-CGS. The relationship between CGS and self-management was partially mediated by perceived competence (p<0.05). The direct effect between the PM-CGS and self-management was significant (p<0.001). Conclusions CGS can be validly measured by the 37-item PM-CGS. Use of the PM-CGS can help illustrate actionable deficits in goal-setting discussions. PMID:28316793
Paudyal, Priyamvada; Flohr, Francesca D; Llewellyn, Carrie D
This systematic review summarised the literature on patient acceptability of screening for oral cancer outside dental care settings. A comprehensive search of relevant literature was performed in EMBASE, MEDLINE, Cochrane Database of Systematic Reviews, CINAHAL, psycINFO, CANCERLIT and BNI to identify relevant articles published between 1975 and Dec 2013. Studies reporting acceptability of oral cancer screening to undiagnosed individuals attending non-dental settings were eligible for inclusion. A total of 2935 references were initially identified from the computerised search but 2217 were excluded after screening the titles. From the abstracts of the remaining 178 articles, 47 full text articles were retrieved for further scrutiny, and 12 studies were found to be eligible for inclusion. In these studies, knowledge about oral cancer, anxiety related to the screening process, preference for care provision, and financial cost were influencing factors for the acceptance of screening. Written information provided to patients in primary care was reported to boost immediate knowledge levels of oral cancer, lessen anxiety, and increase intentions for screening. The majority of screening methods were entirely acceptable to patients; lack of acceptability from the patients' viewpoint was not a significant barrier to carrying out opportunistic screening of high-risk populations. In conclusion, the available evidence suggests that acceptance of, and satisfaction with oral cancer screening is high, particularly where patients have previously been educated about oral cancer. Further research focusing on patient's preferences would enable streamlining of the approach to oral cancer screening taken by any national programme.
Ghoshal, Arunangshu; Damani, Anuja; Salins, Naveen; Deodhar, Jayita; Muckaden, Mary Ann
Levofloxacin is a commonly prescribed antibiotic for managing chest and urinary tract infections in a palliative care setting. Incidence of Levofloxacin-associated anaphylaxis is rare and delirium secondary to Levofloxacin is a seldom occurrence with only few published case reports. It is an extremely rare occurrence to see this phenomenon in combination. Early identification and prompt intervention reduces both mortality and morbidity. A 17-year-old male with synovial sarcoma of right thigh with chest wall and lung metastasis and with no prior psychiatric morbidity presented to palliative medicine outpatient department with community-acquired pneumonia. He was initiated on intravenous (IV) Ceftriaxone and IV Levofloxacin. Post IV Levofloxacin patient developed anaphylaxis and acute delirium necessitating IV Hydrocortisone, IV Chlorpheneramine, Oxygen and IV Haloperidol. Early detection and prompt intervention helped in complete recovery. Patient was discharged to hospice for respite after 2 days of hospitalization and then discharged home. Acute palliative care approach facilitated management of two life-threatening medical complications in a palliative care setting improving both quality and length of life. PMID:25709191
Madueño, Antonio; Martín, Antonio; Péculo, Juan-Antonio; Antón, Esther; Paravisini, Alejandra; León, Antonio
Objective: To determine if inspiratory capacity (IC) assessment could be useful for chronic obstructive pulmonary disease (COPD) patient management in the primary care setting. Methods: A descriptive cross-sectional study was conducted in 93 patients diagnosed with COPD according to Spanish Thoracic Society (SEPAR) criteria. Patients were recruited in eight primary care centers in Andalusia, Spain. Anthropometric, sociodemographic, resting lung function (forced expiratory volume in one second [FEV1], forced vital capacity, synchronized vital capacity, IC), and quality of life data based on the Spanish version of Saint George’s Respiratory Questionnaire (SGRQ) were obtained. Results: Lung function results expressed as percentages of the predicted values were as follows: FEV1, 49.04 (standard deviation [SD]: 16.23); IC, 61.73 (SD: 15.42). The SGRQ mean total score was 47.5 (SD 17.98). The Spearman’s Rho correlation between FEV1 and SGRQ was r = −0.36 (95% confidence interval [CI]: −0.529 to −0.166), between IC and SGRQ was r = −0.329 (95% CI −0.502 to −0.131), and between FEV1 and IC was r = −0.561. Conclusions: Measurement of IC at rest could be used as a complementary functional exploration to forced spirometry in the monitorization of patients with COPD in the primary care setting. We found a poor correlation between IC and quality of life at the same level as in FEV1. PMID:20360907
Gold, Melanie A.; Borrero, Sonya; Santucci, Aimee; Schwarz, Eleanor B.
Abstract Background Although three quarters of reproductive-age women see a health provider annually, less than half receive recommended contraceptive counseling services. We sought to explore providers' perspectives on the challenges to contraceptive counseling in primary care clinics to develop strategies to improve counseling services. Methods A qualitative, focus group (n = 8) study was conducted in November and December 2007; 48 of 90 providers practicing in four primary care clinics at the University of Pittsburgh Medical Center participated. Providers included physicians, nurses, and pharmacists working in these clinics' multidisciplinary teams. Discussions explored perceived barriers to the provision of counseling services. All groups were audiorecorded, transcribed, and entered into Atlas.Ti, a qualitative data management software. The data were analyzed using a grounded theory approach to content analysis. Results Perceived patient, provider, and health system barriers to contraceptive counseling were identified. Perceived patient barriers included infrequent sexual activity, familiarity with a limited number of methods, desire for pregnancy despite medical contraindications, and religious beliefs. Provider barriers included lack of knowledge, training, and comfort; assumptions about patient pregnancy risk; negative beliefs about contraceptive methods; reliance on patients to initiate discussions; and limited communication between primary care providers (PCPs) and subspecialists. Health system barriers included limited time and competing medical priorities. Conclusions PCPs vary widely in their knowledge, perceived competence, and comfort in providing contraceptive counseling. General efforts to improve integration of contraceptive counseling into primary care services in addition to electronic reminders and efficient delivery of contraceptive information are needed. PMID:20420508
Karner, T X
Understanding the impact of cohort values is important in trying to project future aging service needs. The cultural characteristics of cohorts yet to reach the age of 65 are compared with those already "old," with specific focus on the Baby Boomers. Aging policies (and available services) reflect the cultural notions of age and aging held as normative during the historical era in which they are enacted. Previous research into lifestyle preferences, consumer practices, and key characteristics is drawn upon to investigate the values of Baby Boomers in light of their projected needs for eldercare services. Cohort research and generational marketing practices offer a promising foundation for exploring how best to develop, target, and deliver aging services that most effectively utilize our social resources.
Spitzer, William J; Davidson, Kay W
Major economic, political, demographic, social, and operational system factors are prompting evolutionary changes in health care delivery. Of particular significance, the "graying of America" promises new challenges and opportunities for health care social work. At the same time, the Patient Protection and Affordable Care Act of 2010, evolution of Accountable Care Organizations, and an emphasis on integrated, transdisciplinary, person-centered care represent fundamental shifts in service delivery with implications for social work practice and education. This article identifies the aging shift in American demography, its impact on health policy legislation, factors influencing fundamentally new service delivery paradigms, and opportunities of the profession to address the health disparities and care needs of an aging population. It underscores the importance of social work inclusion in integrated health care delivery and offers recommendations for practice education.
Molyneux, Elizabeth; Ahmad, Shafique; Robertson, Ann
PROBLEM: Early assessment, prioritization for treatment and management of sick children attending a health service are critical to achieving good outcomes. Many hospitals in developing countries see large numbers of patients and have few staff, so patients often have to wait before being assessed and treated. APPROACH: We present the example of a busy Under-Fives Clinic that provided outpatient services, immunizations and treatment for medical emergencies. The clinic was providing an inadequate service resulting in some inappropriate admissions and a high case-fatality rate. We assessed the deficiencies and sought resources to improve services. LOCAL SETTING: A busy paediatric outpatient clinic in a public tertiary care hospital in Blantyre, Malawi. RELEVANT CHANGES: The main changes we made were to train staff in emergency care and triage, improve patient flow through the department and to develop close cooperation between inpatient and outpatient services. Training coincided with a restructuring of the physical layout of the department. The changes were put in place when the department reopened in January 2001. LESSONS LEARNED: Improvements in the process and delivery of care and the ability to prioritize clinical management are essential to good practice. Making the changes described above has streamlined the delivery of care and led to a reduction in inpatient mortality from 10-18% before the changes were made (before 2001) to 6-8% after. PMID:16628305
Kallen, Alexander J; Patel, Priti R; O'Grady, Naomi P
With the growing recognition of the preventability of catheter-related bloodstream infections (CRBSIs), reducing the number of CRBSIs acquired in health care facilities has become an important patient safety goal. To date, most prevention efforts have been conducted in intensive care units (ICUs); however, many central venous catheters (CVCs) are found outside the ICU, and rates of catheter-associated bloodstream infections in these settings appear to be similar to rates of these infections in ICUs. CVCs are also used in patients who primarily receive their care as outpatients, including those requiring hemodialysis, undergoing treatment for malignancies, and receiving parenteral nutrition. In some of these patients, CVCs might be used for extended periods, prolonging the patient's time at risk for CRBSIs and highlighting the potential need to look beyond insertion-based interventions to prevent infections. To meet the goal of reducing the number of all CRBSIs associated with health care, further attention on CRBSIs occurring outside the ICU is needed; however, this effort will require a better understanding of the epidemiology and prevention of these infections.
Torres-Ricarte, Marc; Crusat-Abelló, Ernest; Peñuelas-Rodríguez, Silvia; Zabaleta-del-Olmo, Edurne
At present, the severe economic crisis along with the increasing prevalence of chronic diseases is leading to different countries to consider updating their Primary Health Care (PHC) services in order to make them more efficient and reduce health inequalities. To that end, various initiatives are being carried out, such as the provision of Nurse-led services and interventions. The purpose of this article is to present the available knowledge, controversies and opportunities for Nurse-led initiatives in the setting of PHC. Nurse- led interventions or health services in PHC have proven to be equal or more effective than usual care in disease prevention, the routine follow-up of patients with chronic conditions, and first contact care for people with minor illness. However, as there are only a few health economic evaluation studies published their efficiency is still potential. In conclusion, the Nurse-led care could be an innovative organizational initiative with the potential to provide an adequate response to the contemporary health needs of the population, as well as an opportunity for the nursing profession and for PHC and health systems in general.
Age estimation from DNA methylation markers has seen an exponential growth of interest, not in the least from forensic scientists. The current published assays, however, can still be improved by lowering the number of markers in the assay and by providing more accurate models to predict chronological age. From the published literature we selected 4 age-associated genes (ASPA, PDE4C, ELOVL2, and EDARADD) and determined CpG methylation levels from 206 blood samples of both deceased and living individuals (age range: 0–91 years). This data was subsequently used to compare prediction accuracy with both linear and non-linear regression models. A quadratic regression model in which the methylation levels of ELOVL2 were squared showed the highest accuracy with a Mean Absolute Deviation (MAD) between chronological age and predicted age of 3.75 years and an adjusted R2 of 0.95. No difference in accuracy was observed for samples obtained either from living and deceased individuals or between the 2 genders. In addition, 29 teeth from different individuals (age range: 19–70 years) were analyzed using the same set of markers resulting in a MAD of 4.86 years and an adjusted R2 of 0.74. Cross validation of the results obtained from blood samples demonstrated the robustness and reproducibility of the assay. In conclusion, the set of 4 CpG DNA methylation markers is capable of producing highly accurate age predictions for blood samples from deceased and living individuals PMID:26280308
Datta, Hema Sharma; Paramesh, Rangesh
The association between Ayurveda, anti-aging and cosmeceuticals is gaining importance in the beauty, health and wellness sector. Ayurvedic cosmeceuticals date back to the Indus Valley Civilization. Modern research trends mainly revolve around principles of anti-aging activity described in Ayurveda: Vayasthapana (age defying), Varnya (brighten skin-glow), Sandhaniya (cell regeneration), Vranaropana (healing), Tvachya (nurturing), Shothahara (anti-inflammatory), Tvachagnivardhani (strengthening skin metabolism) and Tvagrasayana (retarding aging). Many rasayana plants such as Emblica officinalis (Amla) and Centella asiatica (Gotukola) are extensively used. PMID:21836797
Devine, Emily Beth; Hollingworth, William; Hansen, Ryan N; Lawless, Nathan M; Wilson-Norton, Jennifer L; Martin, Diane P; Blough, David K; Sullivan, Sean D
Objective To evaluate the impact of an ambulatory computerized provider order entry (CPOE) system on the time efficiency of prescribers. Two primary aims were to compare prescribing time between (1) handwritten and electronic (e-) prescriptions and (2) e-prescriptions using differing hardware configurations. Data Sources/Study Setting Primary data on prescribers/staff were collected (2005–2007) at three primary care clinics in a community based, multispecialty health system. Study Design This was a quasi-experimental, direct observation, time–motion study conducted in two phases. In phase 1 (n=69 subjects), each site used a unique combination of CPOE software/hardware (paper-based, desktops in prescriber offices or hallway workstations, or laptops). In phase 2 (n=77), all sites used CPOE software on desktops in examination rooms (at point of care). Data Collection Methods Data were collected using TimerPro software on a Palm device. Principal Findings Average time to e-prescribe using CPOE in the examination room was 69 seconds/prescription-event (new/renewed combined)—25 seconds longer than to handwrite (99.5 percent confidence interval [CI] 12.38), and 24 seconds longer than to e-prescribe at offices/workstations (99.5 percent CI 8.39). Each calculates to 20 seconds longer per patient. Conclusions E-prescribing takes longer than handwriting. E-prescribing at the point of care takes longer than e-prescribing in offices/workstations. Improvements in safety and quality may be worth the investment of time. PMID:19929963
Bigby, C.; Webber, R.; Bowers, B.; McKenzie-Green, B.
Background: Australia's national ageing policy recognises that people ageing with intellectual disability (ID) require particular attention, yet there is no policy framework concerning this population. This study describes the distribution and characteristics of people with ID in residential aged care in Victoria, provides insights into the…
Ibrahim, Joseph Elias; Bugeja, Lyndal; Ranson, David
The care of older people in residential aged care services could be improved by optimising the use of existing information gathered for medico-legal death investigations. The authors address three myths contributing to underuse of this information: deaths are not preventable; public health gains are too small; and it is someone else's charter or responsibility A significant proportion of deaths are preventable, specifically those occurring prematurely from natural causes or due to injury and trauma. By addressing these preventable deaths, significant public health cost savings and better health outcomes for our growing ageing population can be achieved. Despite substantive monitoring of the provision of aged care, no single entity is explicitly responsible for systematically analysing medico-legal death information. The data and skills for using information from medico-legal death investigations currently exist. Dispelling the myths removes one impediment to investing in this area of public health.
Majumdar, Anindo; Sahoo, Jayaprakash; Roy, Gautam; Kamalanathan, Sadishkumar
In the recent years, outbreaks of blood-borne infections have been reported from assisted living facilities, which were traced back to improper blood glucose monitoring practices. Needle-stick injuries have been implicated in many such cases. This directly raises concerns over sharp disposal practices of diabetic patients self-managing their condition in home care settings. With India being home to a huge diabetic population, this issue, if neglected, can cause substantial damage to the health of the population and a marked economic loss. This article discusses the sharp disposal practices prevalent among diabetes patients, the importance of proper sharp disposal, barriers to safe disposal of sharps, and the options available for doing the same. For adopting an environmentally safe wholesome approach, disposal of plastics generated as a result of diabetes self-care at home is important as well. The article also looks at the possible long-term solutions to these issues that are sustainable in an Indian context.
Ottiger, Cornelia; Gygli, Nicole; Huber, Andreas R.; Fernandez-Tresguerres, Beatriz; Pardo, Scott; Petruschke, Thorsten
This study assesses and demonstrates that CONTOUR® XT-BGMS (CXT-BGMS) complies with the requirements of the German (RiliBÄK) and Swiss (QUALAB) quality control guidelines for point-of-care testing (POCT) and fulfills the ISO15197:2013 accuracy limits criteria under the routine conditions of a hospital point-of care setting. This single-center study was conducted in Switzerland using 105 venous blood samples from hospitalized patients. Each sample was tested in comparison to the hexokinase reference method. Compliance with POCT guidelines was assessed by daily BGMS measurements using control solutions. Accuracy of CXT-BGMS according to ISO limits was 98.41%. All control measurements were within the limits defined by RiliBÄK (within ± 11% of target values and root mean square error [RMSE] within RMSE limits), and QUALAB (within ± 10% of target values). PMID:26989068
Yount, Brian; McNamara, Timothy
Effective standardization of clinical processes, which is a growing priority for healthcare provider organizations and networks, requires effective teamwork among clinicians and staff from multidisciplinary backgrounds--often from geographically dispersed facilities--to reach consensus on care practices. Yet, most healthcare provider organizations have no precedence or tools for managing large-scale, sustained, collaborative activities. This presentation explores the human and social implications of technology. It specifically addresses healthcare collaboration and describes how innovative collaboration management technologies can be used in the healthcare industry to accelerate care standardization, order set standardization and other initiatives necessary for successful computerized provider order entry and electronic health record deployments. These topics are explored through presentation of a survey of healthcare executives and a case study of an advanced collaboration application that was adapted and deployed in a partnership between a large healthcare provider organization and a commercial developer of document management and collaboration management technologies.
Miller, Christine E
Oral Health in America: A Report of the Surgeon General released in 2000 was the first-ever surgeon general's report on the status of oral health in the United States. It clearly outlined a growing set of challenges in such areas as reducing oral health disparities, improving access to oral and dental care, and prevention of common dental diseases. Findings revealed that 75 percent of dental disease is found in 25 percent of the population. California's children have twice as much untreated decay as their national counterparts. For children with special health care needs seeing a dentist, the data is sparse but a survey of general dentists conducted in 2001 showed that only 10 percent see these children often or very often.
Hendrickson, J M; Gardner, N; Kaiser, A; Riley, A
We used a multiple baseline design across teachers (with a reversal phase for 1 teacher) to evaluate the direct and indirect effects of a structured coaching procedure on the teaching behaviors of 3 day-care teachers. Structured coaching preceding daily caregiver routines resulted in (a) substantial increases in adult delivery of behavioral support of social interaction during group activities with 2- and 4-year-old children and (b) marked collateral increases in positive interactions of socially withdrawn children. Long-term maintenance effects were demonstrated by both the teachers and target children, and social validity measures indicated that the teachers rated coaching very positively on several dimensions. The results are discussed in relation to in-service training of day-care staff, the concept of coaching as a setting event, and the dissemination of teaching technology related to social interaction of young children. PMID:8331018
Peeling, Rosanna W; McNerney, Ruth
Emerging molecular technologies to diagnose infectious diseases at the point at which care is delivered have the potential to save many lives in developing countries where access to laboratories is poor. Molecular tests are needed to improve the specificity of syndromic management, monitor progress towards disease elimination and screen for asymptomatic infections with the goal of interrupting disease transmission and preventing long-term sequelae. In simplifying laboratory-based molecular assays for use at point-of-care, there are inevitable compromises between cost, ease of use and test performance. Despite significant technological advances, many challenges remain for the development of molecular diagnostics for resource-limited settings. There needs to be more advocacy for these technologies to be applied to infectious diseases, increased efforts to lower the barriers to market entry through streamlined and harmonized regulatory approaches, faster policy development for adoption of new technologies and novel financing mechanisms to enable countries to scale up implementation.
Liesching, Florian; Meyer, Thorsten; Raspe, Heiner
Germany's Central Ethics Committee of the Federal Chamber of Physicians (FCP) and other relevant national actors called for a public discourse on priority setting in health care. Politicians, members of a Federal Joint Committee and health insurance representatives, however, refused to promote or participate in the establishment of a public discussion. A change to that attitude only became apparent after former FCP President Hoppe's opening speech at the annual FCP assembly in Mainz in 2009. The present paper applies the Sociology of Knowledge Approach to Discourse, implemented through Qualitative Content Analysis and elements of Grounded Theory, to examine the development of the national public discourse in leading German print media. It creates a matrix that represents the discourse development between May 2009 and May 2010 and reflects central actors, their "communicative phenomena" and their interactions. Additionally, the matrix has been extended to cover the period until December 2011. Hoppe's arguments for priority setting in health care are faced with a wide opposition assuming opposing prerequisites and thus demanding alternative remedies. The lack of interaction between the different parties prevents any development of the speakers' positions. Incorrect accounts, reductions and left-outs in the media representation add to this effect. Consequently, the public discussion on priority setting is far from being an evolving rational discourse. Instead, it constitutes an exchange of preformed opposing positions.
Liu, Tao; Sun, Li
According to the National Bureau of Statistics of China, by 2010 the number of people aged 60 or over had reached 178 million in China or 13% of its population. With the largest elderly population in the world in absolute numbers, China faces a challenge of providing care for the elderly both in the present and the future. Unlike old age pensions and health protection for the elderly, in Chinese society elderly care had never been considered to be a social problem but rather the individual family's responsibility. After the turn of the millennium, as the repercussions of increasingly ageing demographics, the results of the One-Child Policy and drastic changes in traditional family structures gradually became more apparent, this issue of elderly care has increasingly become one of the most pressing concerns for the ageing society. As there is little existing research on this particular topic, this article aims to shed light on elderly care in China, focusing on the care of elderly needing assistance with activities of daily living, since this group of elderly are most in need of care, their numbers having risen to 33 million in 2010. This article argues it is urgent for China to switch from informal family-based elderly care to the state's formal long-term care, illustrates that a model of social insurance (e.g. as in Germany) is advocated by many Chinese scholars and points out the ways in which it is different from both the commercialized models (e.g. as in the USA) and state organized "Beveridge" models (e.g. as in Sweden).
Teachy, Cindy L.; And Others
This workshop section includes four essays: (1) "Building Lifelong Relationships: School Age Programs at Work" (Cindy L. Teachey); (2) "Building Friendships in School Age Programs" (Joan M. Bergstrom); (3) "On the Rocky Road to Friendship: Emerging Peer Relationships" (Kay Albrecht); (4) "Helping Teachers Understand Their Role in Supporting Peer…
Betz, Marian E.; Jones, Jacqueline; Carr, David B.
Background Primary care physicians play a leading role in counseling older drivers, but discussions often do not occur until safety concerns arise. Prior work suggests that routine questioning about driving might facilitate these difficult conversations. Objective To explore system-level factors affecting driving discussions in primary care settings, in order to inform the design and implementation of a program supporting routine conversations. Methods This qualitative descriptive study used iterative interviews with providers (physicians, nurses, medical assistants, social workers, and administrative staff) working at two clinics (one geriatric, one general internal medicine) at a tertiary-care teaching hospital. General inductive techniques in transcript analysis were used to identify stakeholder-perceived system-level barriers and facilitators to routine conversations with older drivers. Results From fifteen interviews, four themes emerged: (1) complexity of defined provider roles within primary care setting (which can both support team work and hamper efficiency); (2) inadequate resources to support providers (including clinical prompts, local guides, and access to social workers and driving specialists); (3) gaps in education of providers and patients about discussing driving; and (4) suggested models to enhance provider conversations with older drivers (including following successful examples and using defined pathways integrated into the electronic medical record). A fifth theme was that participants characterized their experiences in terms of current and ideal states. Conclusions Physicians have been tasked with assessing older driver safety and guiding older patients through the process of “driving retirement.” Attention to system-level factors such as provider roles, resources, and training can support them in this process. PMID:25617342
Keijser, W; de Manuel-Keenoy, E; d'Angelantonio, M; Stafylas, P; Hobson, P; Apuzzo, G; Hurtado, M; Oates, J; Bousquet, J; Senn, A
Information and communication technologies (ICT) are promising for the long-term care of older and frequently frail people. These innovations can improve health outcomes, quality of life and efficiency of care processes, while supporting independent living. However, they may be disruptive innovations. As all European member states are facing an increasing complexity of health and social care, good practices in ICT should be identified and evaluated. Three projects funded by DG CNECT are related to Active and Healthy Ageing (AHA) and frailty: (i) BeyondSilos, dealing with independent living and integrated services, (ii) CareWell, providing integrated care coordination, patient empowerment and home support and (iii) SmartCare, proposing a common set of standard functional specifications for an ICT platform enabling the delivery of integrated care to older patients. The three projects described in this paper provide a unique pan-European research field to further study implementation efforts and outcomes of new technologies. Below, based on a description of the projects, the authors display four domains that are in their views fundamental for in-depth exploration of heterogeneity in the European context: 1. Definition of easily transferable, high level pathways with solid evidence-base; 2. Change management in implementing ICT enabled integrated care; 3. Evaluation and data collection methodologies based on existing experience with MAST and MEDAL methodologies; and 4. Construction of new models for delivery of health and social care. Understanding complementarity, synergies and differences between the three unique projects can help to identify a more effective roll out of best practices within a varying European context.
Daugaard, Morten; Nielsen, Lars Hedemann
In Denmark, early rehabilitation of acquired head injuries is centralised in two centres, each covering half the country as uptake area. The Regional Hospital Hammel Neurocenter (HN), which covers the western half of Denmark, traditionally receives patients for rehabilitation after discharge from the intensive care unit (ICU). In collaboration with the Regional Hospital in Silkeborg HN now offers early rehabilitation in Silkeborg's ICU setting to patients with acquired brain injury. This preliminary study discusses whether the collaboration facilitates rehabilitation at an earlier state than previously.
Preventing or delaying type 2 diabetes and cardiovascular disease is a key public health issue. Large, randomized, clinical trials have shown that intensive lifestyle interventions can be used to prevent or delay type 2 diabetes and to improve cardiovascular disease risk factors, but the key question that remains is how to best translate the results from these large, clinical trials into interventions that can be effectively delivered in primary care and community-based settings. Several effective approaches have been identified and tested. New research examining specific physical activity or dietary behaviors also has identified new behavioral targets for interventions.
Ramklass, Serela S.; Butau, Anne; Ntinga, Nomusa; Cele, Nozipho
In view of South African policy developments related to the care of older persons, it was necessary to examine the nature of the geriatrics content within physiotherapy curricula. A survey was conducted amongst final-year student physiotherapists at South African universities, together with content analysis of physiotherapy curricula. Very little…
At its heart "Every Child Matters: change for children" endeavours to engender an ethic of "care for" the client group. However, although its raison d'etre might well espouse such orientations, it has a certain level of internal ambiguity which if not considered might lead education to position subsequent operationalization in…
Hinkley, Nancy E.
With increasing emphasis on treating the whole person, on the maintenance of an individual's former life style, and on patients' rights, long-term care personnel need to become aware that many nursing home residents experience needs related to their sexuality. A model two-day workshop is presented wlth a focus on the following topics: (1) a broad…
Analysis of research on the Australian elder care industry used the categories of gender equity, gender differences, and gender deconstruction. Findings revealed the gender segregation of the industry, devaluing of women's work, and persistence of body/mind, male/female dualism. (Contains 16 references.) (SK)
Brownie, Sonya; Nancarrow, Susan
Background Several residential aged-care facilities have replaced the institutional model of care to one that accepts person-centered care as the guiding standard of practice. This culture change is impacting the provision of aged-care services around the world. This systematic review evaluates the evidence for an impact of person-centered interventions on aged-care residents and nursing staff. Methods We searched Medline, Cinahl, Academic Search Premier, Scopus, Proquest, and Expanded Academic ASAP databases for studies published between January 1995 and October 2012, using subject headings and free-text search terms (in UK and US English spelling) including person-centered care, patient-centered care, resident-oriented care, Eden Alternative, Green House model, Wellspring model, long-term care, and nursing homes. Results The search identified 323 potentially relevant articles. Once duplicates were removed, 146 were screened for inclusion in this review; 21 were assessed for methodological quality, resulting in nine articles (seven studies) that met our inclusion criteria. There was only one randomized, controlled trial. The majority of studies were quasi-experimental pre-post test designs, with a control group (n = 4). The studies in this review incorporated a range of different outcome measures (ie, dependent variables) to evaluate the impact of person-centered interventions on aged-care residents and staff. One person-centered intervention, ie, the Eden Alternative, was associated with significant improvements in residents’ levels of boredom and helplessness. In contrast, facility-specific person-centered interventions were found to impact nurses’ sense of job satisfaction and their capacity to meet the individual needs of residents in a positive way. Two studies found that person-centered care was actually associated with an increased risk of falls. The findings from this review need to be interpreted cautiously due to limitations in study designs and the
Pfaff, A B
The current type of distribution of tasks between the generations leads to a system of income maintenance programs for the aged, which is based on their own past (largely statutory) provision for their old age income via public institutions. On the whole, the aged are to a very limited degree in the labor force. Most of them receive public transfer payments. On the average, the diverse income maintenance systems dependent on own past performance provide a fairly substantial income level when compared with wages and salaries. The transfer level is largely dependent on the type of old age security institution, on the extent of past labor force participation or contribution and past income; consequently it is quite diverse. Sex largely correlates with income differentials. While some groups end up with retirement incomes higher than their last wage income, others are definitely needy. Especially women constitute a substantial part of the poor. Besides low income, the danger of becoming a nursing case makes the aged dependent on other persons' or institutions' aid. The forthcoming reform of the public pension system shows little hope of eliminating the pockets of poverty among the aged by assuring a redistribution also among the aged.
Hamel, Johanna; De Beukelaer, Sophie; Kraft, Antje; Ohl, Sven; Audebert, Heinrich J; Brandt, Stephan A
Diverse cognitive functions decline with increasing age, including the ability to process central and peripheral visual information in a laboratory testing situation (useful visual field of view). To investigate whether and how this influences activities of daily life, we studied age-related changes in visual exploratory behavior in a natural scene setting: a driving simulator paradigm of variable complexity was tested in subjects of varying ages with simultaneous eye- and head-movement recordings via a head-mounted camera. Detection and reaction times were also measured by visual fixation and manual reaction. We considered video computer game experience as a possible influence on performance. Data of 73 participants of varying ages were analyzed, driving two different courses. We analyzed the influence of route difficulty level, age, and eccentricity of test stimuli on oculomotor and driving behavior parameters. No significant age effects were found regarding saccadic parameters. In the older subjects head-movements increasingly contributed to gaze amplitude. More demanding courses and more peripheral stimuli locations induced longer reaction times in all age groups. Deterioration of the functionally useful visual field of view with increasing age was not suggested in our study group. However, video game-experienced subjects revealed larger saccade amplitudes and a broader distribution of fixations on the screen. They reacted faster to peripheral objects suggesting the notion of a general detection task rather than perceiving driving as a central task. As the video game-experienced population consisted of younger subjects, our study indicates that effects due to video game experience can easily be misinterpreted as age effects if not accounted for. We therefore view it as essential to consider video game experience in all testing methods using virtual media.
Wang, Jing; Xiao, Lily Dongxia; Li, Xiaomei; De Bellis, Anita; Ullah, Shahid
The aim of this study was to investigate caregiver distress in reacting to the care recipient's behavioral and psychological symptoms of dementia (BPSD) and factors contributing to caregiver distress in the community setting in China. One hundred and fifty-two family caregivers of people with dementia in community settings were assessed using the Chinese version of the Neuropsychiatric Inventory-Questionnaire and the Social Support Rating Scale. The prevalence of BPSD and caregiver distress in reacting to BPSD was higher in China than those reported in high income countries. The most common individual BPSD were apathy/indifference, depression/dysphoria and night-time behaviors. Delusions, hallucinations and apathy/indifference were rated as the most distressing to caregivers. BPSD contributed most to caregiver distress. The high level of caregiver distress identified in this study suggests that dementia services and caregiver support should be established in the public healthcare system to target the needs of people with dementia and their caregivers.
Hackenberg, Berit; Ramos, Margarita S; Campbell, Alexander; Resch, Stephen; Finlayson, Samuel R G; Sarma, Hiteswar; Howaldt, Hans-Peter; Caterson, E J
Cleft lip and palate (CLP) care is the longest sustained global effort in humanitarian surgical care. However, the relative cost-effectiveness of surgical delivery approaches remains largely unknown. We assessed the cost-effectiveness of two strategies of CLP surgical care delivery in low resource settings: medical mission and comprehensive care center. We evaluated the medical records and costs for 17 India-based medical missions and a Comprehensive Cleft Care Center in Guwahati, India, from Operation Smile, a humanitarian nongovernmental organization. Age, sex, diagnosis, and procedures were extracted and cost/Disability-Adjusted Life Year (DALY) averted was calculated using a provider's perspective. The disability weights for CLP from the Global Burden of Disease (GBD) 2010 update were used as the reference case. Sensitivity analysis was performed using various disability weights, age-weighting, discounting, and cost perspective. The medical missions treated 3503 patients for first-time cleft procedures and averted 6.00 DALYs per intervention with a cost-effectiveness of $247.42/DALY. The care center cohort included 2778 patients with first-time operations for CLP and averted a mean of 5.96 DALYs per intervention with a cost-effectiveness of $189.81/DALY. The Incremental Cost-Effectiveness Ratio (ICER) of choosing medical mission over care center is $462.55. The care center provides cleft care with a higher cost-effectiveness, although both models are highly cost-effective in India, in accordance with WHO guidelines. Compared to other global health interventions, cleft care is very cost-effective and investment in cleft surgery might be realistic and achievable in similar resource-constrained environments.
O'Connell, Bev; Gardner, Anne; Takase, Miyuki; Hawkins, Mary T; Ostaszkiewicz, Joan; Ski, Chantal; Josipovic, Patricia
Reality Orientation (RO) was developed as a strategy to assist people with dementia to improve their orientation and everyday function. Although its efficacy has been extensively studied in long-term care facilities, its effectiveness has rarely been examined in acute care settings. The aim of this review was to examine the studies cited in systematic reviews of RO to determine the potential clinical usefulness and the feasibility of using RO in acute care settings. Based on this information, the authors make recommendations for future research in this area. The feasibility of implementing RO in acute care poses challenges because of the short time a patient is in hospital and their ability to participate given their acute medical condition. Although the efficacy and feasibility of using RO in acute care settings have not been sufficiently examined, its potential to improve care should not be ignored. A comprehensive and rigorous study is necessary to investigate the usefulness of RO in the acute care setting and to help establish clinical guidelines for dementia care in the context of acute care nursing.
Jo, D. S.; Park, R. J.; Kim, M. J.; Spracklen, D. V.
A global 3-D chemical transport model (GEOS-Chem) is used with the volatility basis set (VBS) approach to examine the effects of chemical aging on global secondary organic aerosol (SOA) concentrations and budgets. We present full-year simulations and their comparisons with the global aerosol mass spectrometer (AMS) dataset, the Interagency Monitoring of Protected Visual Environments (IMPROVE) dataset from the United States, the European Monitoring and Evaluation Programme (EMEP) dataset from Europe, and water-soluble organic carbon observation data collected over East Asia. Using different chemical aging constants, we find that the model results with 4 × 10-11 cm3 molecule-1 s-1 are in better agreement with all observations relative to the model results with other aging constants, without aging, and with the two-product approach. The model simulations are improved when chemical aging is considered, especially for rural regions. However, the simulations still underestimate observed oxygenated organic aerosol (OOA) in urban areas. Two sensitivity simulations including semi-volatile primary organic aerosol (POA) were conducted. We find that including semi-volatile POA improves the model in terms of the hydrogen-like organic aerosol (HOA) to OOA ratio. However, the total OA concentrations are not improved. The total SOA production is considerably increased by 53%, from 26.0 to 39.9 Tg yr-1, after considering chemical aging, remaining lower than top-down estimates of SOA production. Direct radiative forcing (DRF) increases by -0.07 W m-2 due to the chemical aging of SOA, which is comparable to the mean DRF (-0.13 W m-2) of OA from the AeroCom multi-model study. This result indicates considerable global and, more importantly, regional climate implications. For example, the regional DRF change due to chemical aging of SOA in the eastern US is -0.29 W m-2, which is 4 times greater in magnitude than the global mean value.
Kotecha, Aachal; Baldwin, Alex; Brookes, John; Foster, Paul J
Background This article describes the development of a virtual glaucoma clinic, whereby technicians collect information for remote review by a consultant specialist. Design and Methods This was a hospital-based service evaluation study. Patients suitable for the stable monitoring service (SMS) were low-risk patients with “suspect”, “early”-to-“moderate” glaucoma who were deemed stable by their consultant care team. Three technicians and one health care assistant ran the service. Patients underwent tests in a streamlined manner in a dedicated clinical facility, with virtual review of data by a consultant specialist through an electronic patient record. Main outcome measure Feasibility of developing a novel service within a UK National Health Service setting and improvement of patient journey time within the service were studied. Results Challenges to implementation of virtual clinic include staffing issues and use of information technology. Patient journey time within the SMS averaged 51 minutes, compared with 92 minutes in the glaucoma outpatient department. Patient satisfaction with the new service was high. Conclusion Implementing innovation into existing services of the National Health Service is challenging. However, the virtual clinic showed an improved patient journey time compared with that experienced within the general glaucoma outpatient department. There exists a discrepancy between patient management decisions of reviewers, suggesting that some may be more risk averse than others when managing patients seen within this model. Future work will assess the ability to detect progression of disease in this model compared with the general outpatient model of care. PMID:26508830
Wilbur, Kerry; Al-Okka, Maha; Jumaat, Ebaa; Eissa, Nesma; Elbashir, Merwa; Al-Yafei, Sumaya M Al Saadi
Purpose Cancer treatments are frequently associated with adverse effects, but there may be a cultural reluctance by care providers to be forthcoming with patients regarding these risks for fear of promoting nonadherence. Conversely, research in a number of countries indicates high levels of patient desire for this information. We sought to explore cancer patient experiences, satisfaction, and preferences for medication risk communication in a Middle East care setting. Methods We developed and administered a ten-item questionnaire (Arabic and English) to a convenience sample of consenting adult patients receiving treatment at the National Center for Cancer Care and Research in Qatar. Results One hundred and forty-three patients were interviewed. Most (88%) stated that the level of side effect information they received was sufficient, with physicians (86%) followed by pharmacists (39%) as the preferred sources. The majority (97%) agreed that knowing about possible side effects would help them recognize and manage the reaction, and 92% agreed that it would help them understand how to minimize or prevent the risks. Eighteen percent indicated that this information would make them not want to take treatment. Two-thirds (65%) had previously experienced intolerance to their cancer treatment regimen. Conclusion Most patients surveyed expressed preference for the details of possible side effects they may encounter in their treatment. However, one in five considered such information a factor for nonadherence, indicating the need for patient-specific approaches when communicating medication risks. PMID:27175061
Stevens, Wendy; Gous, Natasha; Ford, Nathan; Scott, Lesley E
Improved access to anti-retroviral therapy increases the need for affordable monitoring using assays such as CD4 and/or viral load in resource-limited settings. Barriers to accessing treatment, high rates of loss to initiation and poor retention in care are prompting the need to find alternatives to conventional centralized laboratory testing in certain countries. Strong advocacy has led to a rapidly expanding repertoire of point-of-care tests for HIV. point-of-care testing is not without its challenges: poor regulatory control, lack of guidelines, absence of quality monitoring and lack of industry standards for connectivity, to name a few. The management of HIV increasingly requires a multidisciplinary testing approach involving hematology, chemistry, and tests associated with the management of non-communicable diseases, thus added expertise is needed. This is further complicated by additional human resource requirements and the need for continuous training, a sustainable supply chain, and reimbursement strategies. It is clear that to ensure appropriate national implementation either in a tiered laboratory model or a total decentralized model, clear country-specific assessments need to be conducted.
Cowin, Leanne S
Poor collegial relations can cause communication breakdown, staff attrition and difficulties attracting new nursing staff. Underestimating the potential power of nursing team relationships means that opportunities to create better working environments and increase the quality of nursing care can be missed. Previous research on improving collegiality indicates that professionalism and work satisfaction increases and that staff attrition decreases. This study explores challenges, strengths and strategies used in nursing team communication in order to build collegial relationships. A qualitative approach was employed to gather nurses experiences and discussion of communication within their nursing teams and a constant comparison method was utilised for data analysis. A convenience sampling technique was employed to access both Registered Nurses and Enrolled Nurses to partake in six focus groups. Thirty mostly female nurses (ratio of 5:1) participated in the study. Inclusion criteria consisted of being a nurse currently working in acute care settings and the exclusion criteria included nursing staff currently working in closed specialty units (i.e. intensive care units). Results revealed three main themes: (1) externalisation and internalisation of nursing team communication breakdown, (2) the importance of collegiality for retention of nurses and (3) loss of respect, and civility across the healthcare workplace. A clear division between hierarchies of nurses was apparent in how nursing team communication was delivered and managed. Open, respectful and collegial communication is essential in today's dynamic and complex health environments. The nurses in this study highlighted how important nursing communication can be to work motivation and how leadership fosters teamwork.
Naylor, Patti-Jean; Temple, Viviene A
Healthy Opportunities for Preschoolers (HOP) is a physical activity and movement skill intervention that was developed to address the unique needs of home-based child care providers. The authors used a train-the-trainer approach to enhance local uptake and implementation of HOP and examined the impact on the trainers' (workshop leaders') perceived knowledge, confidence, and intention to implement community workshops and subsequently on the knowledge, confidence, and intentions of workshop participants. This study also assessed feasibility: reach, satisfaction, and facilitators and barriers to workshop implementation. Overall, 92% and 89.5% of the leaders were very or extremely satisfied with the workshop content and delivery, respectively. Training significantly increased their self-reported knowledge (p < .001) and confidence (p < .001). Subsequently, 73% of workshop participants (48 workshops, n = 321) took part in the evaluation; intention to use what they learned after the workshop was high (86%) and perceived knowledge, confidence, and attitude all increased significantly (p < .001). The HOP train-the-trainer approach was feasible and enhanced knowledge, confidence, and readiness to change among home-based child care providers. This approach should be considered as a component of an overall strategy to enhance the promotion of physical activity and movement skills in home-based child care settings.
It is well established that health care workers (HCWs) have a considerably higher risk of occupationally acquired tuberculosis (TB). To reduce the transmission of TB to HCWs and patients, TB infection control programs should be implemented in health care settings. The first and most important level of all protection and control programs is administrative control. Its goals are to prevent HCWs, other staff, and patients from being exposed to TB, and to reduce the transmission of infection by ensuring rapid diagnosis and treatment of affected individuals. Administrative control measures recommended by the United States Centers for Disease Control and Prevention and the World Health Organization include prompt identification of people with TB symptoms, isolation of infectious patients, control of the spread of the pathogen, and minimization of time spent in health care facilities. Another key component of measures undertaken is the baseline and serial screening for latent TB infection in HCWs who are at risk of exposure to TB. Although the interferon-gamma release assay has some advantages over the tuberculin skin test, the former has serious limitations, mostly due to its high conversion rate. PMID:28119743
Lazcano-Ponce, Eduardo; Katz, Gregorio; Allen-Leigh, Betania; Magaña Valladares, Laura; Rangel-Eudave, Guillermina; Minoletti, Alberto; Wahlberg, Ernesto; Vásquez, Armando; Salvador-Carulla, Luis
Intellectual development disorders (IDDs) are a set of development disorders characterized by significantly limited cognitive functioning, learning disorders, and disorders related to adaptive skills and behavior. Previously grouped under the term "intellectual disability," this problem has not been widely studied or quantified in Latin America. Those affected are absent from public policy and do not benefit from government social development and poverty reduction strategies. This article offers a critical look at IDDs and describes a new taxonomy; it also proposes recognizing IDDs as a public health issue and promoting the professionalization of care, and suggests an agenda for research and regional action. In Latin America there is no consensus on the diagnostic criteria for IDDs. A small number of rehabilitation programs cover a significant proportion of the people who suffer from IDDs, evidence-based services are not offered, and health care guidelines have not been evaluated. Manuals on psychiatric diagnosis focus heavily on identifying serious IDDs and contribute to underreporting and erroneous classification. The study of these disorders has not been a legal, social science, or public health priority, resulting in a dearth of scientific evidence on them. Specific competencies and professionalization of care for these persons are needed, and interventions must be carried out with a view to prevention, rehabilitation, community integration, and inclusion in the work force.
van Alfen, Nens; van Eijk, Jeroen J. J.; Ennik, Tessa; Flynn, Sean O.; Nobacht, Inge E. G.; Groothuis, Jan T.; Pillen, Sigrid; van de Laar, Floris A.
Objective Neuralgic amyotrophy is considered a rare peripheral nervous system disorder but in practice seems grossly under recognized, which negatively affects care for these patients. In this study we prospectively counted the one-year incidence rate of classic neuralgic amyotrophy in a primary care setting. Methods In a prospective cohort study during the year 2012 we registered all new cases of neck, shoulder or arm complaints from two large primary care centers serving a population of 14,118. Prior to study, general practitioners received a short training on how to diagnose classic neuralgic amyotrophy. Neuralgic amyotrophy was defined according to published criteria irrespective of family history. Only patients with a classic phenotype were counted as definite cases. After inclusion, patients with suspected neuralgic amyotrophy who had not yet seen a neurologist were offered neurologic evaluation for diagnostic confirmation. Results Of the 492 patients identified with new onset neck, shoulder or arm complaints, 34 were suspected of having neuralgic amyotrophy. After neurologic evaluation the diagnosis was confirmed in 14 patients. This amounts to a one-year incidence rate for classic neuralgic amyotrophy of 1 per 1000. Conclusions Our findings suggest that neuralgic amyotrophy is 30-50 times more common than previously thought. Unawareness of the disorder and its clinical presentation seems the most likely explanation for this difference. An incidence rate of 1 per 1000 and the long-term sequelae many patients suffer warrant more vigilance in diagnosing the disorder, to pave the way for timely treatment and prevent complications. PMID:26016482
Ogenchuk, Marcella; Spurr, Shelley; Bally, Jill
Across North America, educators are challenged with finding learning opportunities for students in the health professions. Faculty members with a pediatric specialization in nursing recognized that schools were an ideal setting to provide children with care from the health continuum including health promotion, assessment and treatment, and chronic disease management. The faculty of nursing at a Western Canadian University established a unique educational approach by creating an interprofessional pediatric clinical learning experience titled, Caring For Kids Where They Live. This practicum brings together students in the health professions (nurses, dentists, and kinesiologists) and students and their families from three urban schools; one elementary school and two high schools. The primary goals of this partnership were to create an interprofessional clinical learning experience and to promote health and wellness of children and youth. This initiative far exceeded the initial goals. This descriptive article with the use of reflective elements from student journals, identifies learning that occurred in an environment whereby students from the health professions had the opportunity to meet and interact, to collaborate, and to gain experience in caring for children and youth.
Annear, Michael; Walker, Kim; Lucas, Peter; Lo, Amanda; Robinson, Andrew
This article examines the reflective discourses of medical, nursing, and paramedic students participating in interprofessional education (IPE) activities in the context of aged-care clinical placements. The intent of the research is to explore how students engage with their interprofessional colleagues in an IPE assessment and care planning activity and elucidate how students configure their role as learners within the context of a non-traditional aged-care training environment. Research participants included cohorts of volunteer medical (n = 61), nursing (n = 46), and paramedic (n = 20) students who were on clinical placements at two large teaching aged-care facilities in Tasmania, Australia, over a period of 18 months. A total of 39 facilitated focus group discussions were undertaken with cohorts of undergraduate student volunteers from three health professions between February 2013 and October 2014. Thematic analysis of focus group transcripts was assisted by NVIVO software and verified through secondary coding and member checking procedures. With an acceptable level of agreement across two independent coders, four themes were identified from student focus group transcripts that described the IPE relations and perceptions of the aged-care environment. Emergent themes included reinforcement of professional hierarchies, IPE in aged care perceived as mundane and extraneous, opportunities for reciprocal teaching and learning, and understanding interprofessional roles. While not all students can be engaged with IPE activities in aged care, our evidence suggests that within 1 week of clinical placements there is a possibility to develop reciprocal professional relations, affirm a positive identity within a collaborative healthcare team, and support the health of vulnerable older adults with complex care needs. These important clinical learnings support aged-care-based IPE as a potentially powerful context for undergraduate learning in the 21st Century.
Krause, S K; Meyers, J L; Friedlander, E
This paper describes an emergency obstetric care (EmOC) project implemented by the Reproductive Health Response in Conflict (RHRC) Consortium in 12 conflict-affected settings in nine countries from 2000-2005 with funding and technical support from Columbia University's Mailman School of Public Health Averting Maternal Death and Disability (AMDD) programme. The overall goal of the project was to reduce maternal morbidity and mortality in select conflict-affected settings by improving the availability of EmOC. Another aim of the project was to institutionalize EmOC within RHRC Consortium agencies by modelling how to improve the availability of basic and comprehensive EmOC at clinics and hospitals. The specific project purpose was to increase the availability of EmOC in select conflict-affected settings. The project demonstrated that a great deal more can and should be done by humanitarian workers to improve the availability of basic and comprehensive emergency obstetric services in conflict-affected settings.
Harrison, Andrew M.; Thongprayoon, Charat; Aakre, Christopher A.; Jeng, Jack Y.; Dziadzko, Mikhail A.; Gajic, Ognjen; Pickering, Brian W.
Background Electronic Health Record (EHR)-based sepsis alert systems have failed to demonstrate improvements in clinically meaningful endpoints. However, the effect of implementation barriers on the success of new sepsis alert systems is rarely explored. Objective To test the hypothesis time to severe sepsis alert acknowledgement by critical care clinicians in the ICU setting would be reduced using an EHR-based alert acknowledgement system compared to a text paging-based system. Study Design In one arm of this simulation study, real alerts for patients in the medical ICU were delivered to critical care clinicians through the EHR. In the other arm, simulated alerts were delivered through text paging. The primary outcome was time to alert acknowledgement. The secondary outcomes were a structured, mixed quantitative/qualitative survey and informal group interview. Results The alert acknowledgement rate from the severe sepsis alert system was 3% (N = 148) and 51% (N = 156) from simulated severe sepsis alerts through traditional text paging. Time to alert acknowledgement from the severe sepsis alert system was median 274 min (N = 5) and median 2 min (N = 80) from text paging. The response rate from the EHR-based alert system was insufficient to compare primary measures. However, secondary measures revealed important barriers. Conclusion Alert fatigue, interruption, human error, and information overload are barriers to alert and simulation studies in the ICU setting. PMID:28316887
Jangam, Sujit R; Agarwal, Abhishek K; Sur, Kunal; Kelso, David M
A low-cost, fully integrated sample-to-answer, quantitative PCR (qPCR) system that can be used for detection of HIV-1 proviral DNA in infants at the point-of-care in resource-limited settings has been developed and tested. The system is based on a novel DNA extraction method, which uses a glass fiber membrane, a disposable assay card that includes on-board reagent storage, provisions for thermal cycling and fluorescence detection, and a battery-operated portable analyzer. The system is capable of automated PCR mix assembly using a novel reagent delivery system and performing qPCR. HIV-1 and internal control targets are detected using two spectrally separated fluorophores, FAM and Quasar 670. In this report, a proof-of-concept of the platform is demonstrated. Initial results with whole blood demonstrate that the test is capable of detecting HIV-1 in blood samples containing greater than 5000 copies of HIV-1. In resource-limited settings, a point-of-care HIV-1 qPCR test would greatly increase the number of test results that reach the infants caregivers, allowing them to pursue anti-retroviral therapy.
Woo, Kevin Y; Sears, Kim; Almost, Joan; Wilson, Rosemary; Whitehead, Marlo; VanDenKerkhof, Elizabeth G
This is a prospective cohort study using population-level administrative data to describe the scope of pressure ulcers in terms of its prevalence, incidence risk, associating factors and the extent to which best practices were applied across a spectrum of health care settings. The data for this study includes the information of Ontario residents who were admitted to acute care, home care, long term care or continuing care and whose health care data is contained in the resident assessment instrument-minimum data set (RAI-MDS) and the health outcomes for better information and care (HOBIC) database from 2010 to 2013. The analysis included 203 035 unique patients. The overall prevalence of pressure ulcers was approximately 13% and highest in the complex continuing care setting. Over 25% of pressure ulcers in long-term care developed one week after discharge from acute care hospitalisation. Individuals with cardiovascular disease, dementia, bed mobility problems, bowel incontinence, end-stage diseases, daily pain, weight loss and shortness of breath were more likely to develop pressure ulcers. While there were a number of evidence-based interventions implemented to treat pressure ulcers, only half of the patients received nutritional interventions.
Salas, C; Raftery, J P
A recent study by Zweifel et al. (Zweifel P, Felder S, Meiers M. Ageing of the population and health care expenditure: a red herring? Health Economics 1999; 8: 485-496) suggests that age is not related to health care expenditure among the elderly once 'closeness to death' is controlled for. If correct, this finding has major policy implications, but flaws in the econometric analysis undermine its credibility. We highlight two in particular, and propose methods to deal with them.
LaMantia, Michael A; Perkins, Anthony J; Gao, Sujuan; Austrom, Mary G; Alder, Cathy A; French, Dustin D; Litzelman, Debra K; Cottingham, Ann H; Boustani, Malaz A
Objective To evaluate the effect of the Aging Brain Care (ABC) Medical Home program’s depression module on patients’ depression severity measurement over time. Design Retrospective chart review. Setting Public hospital system. Participants Patients enrolled in the ABC Medical Home program between October 1, 2012 and March 31, 2014. Methods The response of 773 enrolled patients who had multiple patient health questionnaire-9 (PHQ-9) scores recorded in the ABC Medical Home program’s depression care protocol was evaluated. Repeatedly measured PHQ-9 change scores were the dependent variables in the mixed effects models, and demographic and comorbid medical conditions were tested as potential independent variables while including random effects for time and intercept. Results Among those patients with baseline PHQ-9 scores >10, there was a significant decrease in PHQ-9 scores over time (P<0.001); however, the effect differed by gender (P=0.015). On average, women’s scores (4.5 point drop at 1 month) improved faster than men’s scores (1 point drop at 1 month). Moreover, both men and women had a predicted drop of 7 points (>50% decline from baseline) on the PHQ-9 at 6 months. Conclusion These analyses demonstrate evidence for the sustained effectiveness of the ABC Medical Home program at inducing depression remission outcomes while employing clinical staff who required less formal training than earlier clinical trials. PMID:27826188
In this article, the author presents two emerging state-level public policy trends in the United States, one toward universalizing pre-school services, and one toward systems for delivering early education and care. At this point, it is not clear whether the effect of the two trends will be to unite or divide the field of early education and care.…
Blank, Helen; Behr, Andrea; Schulman, Karen
This report provides highlights and updates regarding state actions on child care and early education issues during 2000. The information in the report was collected by means of written and telephone surveys with advocates or state child care administrators in each state. The final draft was reviewed for verification by advocates or a state child…
Herron, Rachel V; Skinner, Mark W
Qualitative research offers important insights into the subjectivity, complexity, and relationality of care. In this article, we examine the particular processes and relationships involved in doing qualitative research about care with older people in rural places. We draw on our experience completing two related qualitative studies of rural care in Canada to extend discussions about responsible research practice in relation to participant recruitment, interviews, and focus groups. By applying Hankivsky's principles of care ethics in our reflection on research practices, we make explicit the role of emotions in connecting with research participants, collecting and participating in narrative-based research, and negotiating identity. We conclude with a discussion of the distinct ways in which applying care ethics throughout the research process can augment reflexive practice and enhance the integrity and theoretical contributions of qualitative health research while developing more inclusive understandings of vulnerability in older rural populations.
Bigby, C.; Bowers, B.; Webber, R.
Background: Planning for future care after the death of parental caregivers and adapting disability support systems to achieve the best possible quality of life for people with intellectual disability as they age have been important issues for more than two decades. This study examined perceptions held by family members, group home staff and…
Mullen, P D; Mullen, L R
Asthma self-management education has the potential to improve the health and quality of life for children and to reduce use of acute care services. The preparation of parents and children to prevent asthma attacks and to ameliorate acute episodes when they do occur can best be accomplished with the support of medical care providers. This analysis addresses policy issues relevant to that acceptance: the degree of integration into medical practice that is desirable; the most hospitable clinical settings; and the incentives for providers, consumers, and payers that would result in appropriate supply and use of ASME:. The analysis commences with a discussion of the costs and benefits of making ASME a part of medical care. It then turns to a description of the trends that led to the current array of institutions, services, and incentives within the health care sector. Future changes in family context, financing, and other determinants of the use of medical services by children and youth are forecast. The framework for the analysis of incentives is diffusion of innovation. ASME is analyzed according to the attributes that generally facilitate the acceptance of a new procedure. In its current form and with current incentives, ASME is fairly complex and difficult to communicate, has little relative advantage, and is not necessarily compatible with the usual provider goals. The motivating factors for three interrelated groups-providers, consumers, and third-party payers-and leverage points for the application of incentives are identified. The latter include reimbursement, standards of practice, information generation and flow, insurance regulation, institutional development, and research funding. Important information to potential adopters includes the definition of the service, its optimal intensity and mix of providers, and its effects on net costs and quality of life.
McElroy, Susan L.
Objective: The objective of this article is to present practical strategies for detecting and diagnosing bipolar disorder in the primary care setting and to review the evidence for the efficacy and safety of aripiprazole treatment for bipolar disorder. Data Sources: A review of the literature from 1980 to 2007 was conducted from November 2006 through February 2007 using a MEDLINE search and the key words bipolar disorder, primary care, detection, diagnosis, and aripiprazole. Study Selection: A total of 100 articles that focused on the accurate detection and diagnosis of bipolar disorder and the evidence of the efficacy and safety of aripiprazole in the treatment of bipolar disorder were selected. Data Synthesis: Patients with bipolar disorder often present to primary care physicians with depressive or mixed symptoms as opposed to purely hypomanic or manic symptoms. Accurate diagnosis of bipolar disorder is essential in order to provide timely and appropriate treatment. One treatment option available is aripiprazole, a partial agonist of dopamine (D)2 and D3 and serotonin (5-HT)1A receptors and an antagonist of the 5-HT2A receptor. Clinical trial data have shown aripiprazole to be effective in treating manic and mixed episodes associated with bipolar I disorder, both in the acute phase and over an extended period of treatment lasting from 6 months to 2 years. Conclusions: Accurate diagnosis and treatment of bipolar disorder are challenges increasingly faced by primary care physicians. Strategies geared toward detection, diagnosis, and management of bipolar I disorder and other bipolar spectrum disorders may improve the treatment outcome for patients. Aripiprazole may be considered as another first-line choice for the treatment of bipolar I disorder; however, its utility in patients with bipolar spectrum disorders is yet to be determined. PMID:19956463
Alvarez, Bernardo; Cuetos, Fernando
Age of acquisition is one of the most important variables in picture naming. For this reason, a large number of findings concerning age-of-acquisition data have been published in recent years in a number of different languages. In this article, objective age-of-acquisition data in Spanish for 328 pictures were collected from a pool of 760 children, half of whom were boys and the other half girls. A total of 246 pictures were selected from the Snodgrass and Vanderwart (1980) set, and 82 were new pictures. Like the results of other studies, we found that objective age of acquisition correlates less than rated age of acquisition with familiarity and frequency, which indicates that the objective measure is less contaminated by other variables than are rated estimates. A very high correlation was obtained between the norms from this study and those published in English, French, Icelandic, and Italian. These norms will be very useful to Spanish psycholinguists and clinicians. Related materials may be downloaded from the Psychonomic Society Web archive at www.psychonomic.org/archive/.
Rodriguez-Roca, Gustavo C; Llisterri, Jose L; Prieto-Diaz, Miguel A; Alonso-Moreno, Francisco J; Escobar-Cervantes, Carlos; Pallares-Carratala, Vicente; Valls-Roca, Francisco; Barrios, Vivencio; Banegas, Jose R; Alsina, Diegogonzalez-Segura
This study aimed to determine the clinical profile, blood pressure (BP) control rates, therapeutic management and physicians' therapeutic behavior regarding very elderly hypertensive patients. A total of 1540 hypertensive patients 80 years old on antihypertensive therapy and receiving care in primary care settings in Spain were included in this cross-sectional study. The mean patient age was 83.4±3.1 years, 61.9% of patients were women and 49.3% of patients had cardiovascular disease. Of the patients, 27.7% were on monotherapy and 72.3% were on combined therapy (47.4% on two antihypertensive agents and 24.9% on three or more antihypertensive agents). A total of 40.8% (95% confidence interval (CI): 38.4-43.3%) of patients achieved BP goals (<140/90 mm Hg; <130/80 in patients with diabetes, chronic renal disease or cardiovascular disease). Patients with uncontrolled BP were more likely to have metabolic syndrome, diabetes, obesity, a history of cardiovascular disease, ischemic heart disease, renal disease and stroke and were more frequently smokers. Physicians modified the antihypertensive regimens for 27.4% (95% CI: 23.9-30.8%) of the patients with uncontrolled BP, and the addition of another antihypertensive agent was the most frequent modification. With regard to the physicians' perception of patients' BP control, the BPs of 44.1% of the patients with uncontrolled BP were considered well controlled by the physicians.
Adserias-Garriga, Joe; Nogué-Navarro, Laia; Zapico, Sara C; Ubelaker, Douglas H
Age-at-death estimation is one of the main goals in forensic identification, being an essential parameter to determine the biological profile, narrowing the possibility of identification in cases involving missing persons and unidentified bodies. The study of dental tissues has been long considered as a proper tool for age estimation with several age estimation methods based on them. Dental age estimation methods can be divided into three categories: tooth formation and development, post-formation changes, and histological changes. While tooth formation and growth changes are important for fetal and infant consideration, when the end of dental and skeletal growth is achieved, post-formation or biochemical changes can be applied. Lamendin et al. in J Forensic Sci 37:1373-1379, (1992) developed an adult age estimation method based on root transparency and periodontal recession. The regression formula demonstrated its accuracy of use for 40 to 70-year-old individuals. Later on, Prince and Ubelaker in J Forensic Sci 47(1):107-116, (2002) evaluated the effects of ancestry and sex and incorporated root height into the equation, developing four new regression formulas for males and females of African and European ancestry. Even though root transparency is a key element in the method, the conditions for measuring this element have not been established. The aim of the present study is to set the light conditions measured in lumens that offer greater accuracy when applying the Lamendin et al. method modified by Prince and Ubelaker. The results must be also taken into account in the application of other age estimation methodologies using root transparency to estimate age-at-death.
Background Human immunodeficiency virus continues to challenge health care professionals even after the rollout of antiretroviral therapy. South Africa, among the worst affected countries in the world by the pandemic, has seen the effect of people living longer but facing disabling effects of both the virus and the associated impairments of the antiretroviral therapy. Rehabilitation within the evolving context of the disease has changed its focus from the impairment of the individual to the participation restriction within a person’s daily life. Offering a continuum of coordinated, multilevel, multidiscipline, evidence-based rehabilitation within health care will promote its prominence in health care structures. Objective This study aims to develop a model of care within a health care structure using a semi-rural African setting as an example. Methods The study will employ mixed methods using a Learning in Action Approach into the rehabilitation of people living with HIV (PLHIV) at the study setting. The Delphi technique, a multistage consensus method, will be used to obtain feedback from a number of local experts relevant for the field of rehabilitation of people living with HIV. The study will also involve various stakeholders such as the multidisciplinary health care team (doctors, physiotherapists, occupational therapists, dieticians, speech and language therapists, social workers, midlevel workers, community health care workers); department of health representative(s); site affiliated nongovernmental organization representative(s); and service users at the study setting. Results Once a proposed model of care is derived, the model will be assessed for rigour and piloted at the study setting. Conclusions The development of a model of care in rehabilitation for PLHIV in a health care setting is aimed to provide an example of a continuum of coordinated service throughout the disease trajectory. The assumption is that the burden on the health care system will be
Background Evidence-based care should improve acute stroke outcomes with the same magnitude of effect for stroke patients of all ages. However, there is evidence to suggest that, in some instances, older stroke patients may receive poorer quality care than younger patients. Our aim was to systematically review evidence of the quality of care provided to patients with acute stroke related to their age. Quality of care was determined by compliance with recommended care processes. Methods We systematically searched MEDLINE, CINAHL, ISI Web of Knowledge, Ageline and the Cochrane Library databases to identify publications (1995-2009) that reported data on acute stroke care process indicators by patient age. Data extracted included patient demographics and process indicator compliance. Included publications were critically appraised by two independent reviewers using the Critical Appraisal Skills Programme tool, and a comparison was made of the risk of bias according to studies' findings. The evidence base for reported process indicators was determined, and meta-analysis was undertaken for studies with sufficient similarity. Results Nine from 163 potential studies met the inclusion criteria. Of the 56 process indicators reported, eleven indicators were evidence-based. Seven of these indicators (64%) showed significantly poorer care for older patients compared to younger ones, while younger patients received comparatively inferior care for only antihypertensive therapy at discharge. Our findings are limited by the variable methodological quality of included studies. Conclusion Patients' age may be a factor in the care they receive after an acute stroke. However, the possible influence of patients' age on clinicians' decision-making must be considered in terms of the many complex issues that surround the provision of optimal care for older patients with acute stroke. PMID:21729329
Andersen, Rikke Sand; Vedsted, Peter
This article explores the mutually constituting relationship between healthcare seeking practices and the socio-political context of clinical encounters. On the basis of ethnographic fieldwork carried out in the context of Danish primary care (general practice) and inspired by recent writings on institutional logics, we illustrate how a logic of efficiency organise and give shape to healthcare seeking practices as they manifest in local clinical settings. Overall, patient concerns are reconfigured to fit the local clinical setting and healthcare professionals and patients are required to juggle efficiency in order to deal with uncertainties and meet more complex or unpredictable needs. Lastly, building on the empirical case of cancer diagnostics, we discuss the implications of the pervasiveness of the logic of efficiency in the clinical setting and argue that provision of medical care in today's primary care settings requires careful balancing of increasing demands of efficiency, greater complexity of biomedical knowledge and consideration for individual patient needs.
Turner, Erin L.; Nielsen, Katie R.; Jamal, Shelina M.; von Saint André-von Arnim, Amelie; Musa, Ndidiamaka L.
Fifteen years ago, United Nations world leaders defined millenium development goal 4 (MDG 4): to reduce under-5-year mortality rates by two-thirds by the year 2015. Unfortunately, only 27 of 138 developing countries are expected to achieve MDG 4. The majority of childhood deaths in these settings result from reversible causes, and developing effective pediatric emergency and critical care services could substantially reduce this mortality. The Ebola outbreak highlighted the fragility of health care systems in resource-limited settings and emphasized the urgent need for a paradigm shift in the global approach to healthcare delivery related to critical illness. This review provides an overview of pediatric critical care in resource-limited settings and outlines strategies to address challenges specific to these areas. Implementation of these tools has the potential to move us toward delivery of an adequate standard of critical care for all children globally, and ultimately decrease global child mortality in resource-limited settings. PMID:26925393
Moreno, Amanda J.; Green, Sheridan; Koehn, Jo
Research Findings: This study evaluated the effectiveness of 2 professional development interventions aimed at improving the quality of care provided by caregivers in ordinary infant-toddler child care settings, both center- and home-based. In all, 183 participants in a community college course on infant-toddler theory and practice, an in-service…
Carlson, K R
Based on patient condition, intravenous therapies, caregiver support, and organizational policy, correct device selection plays an integral part in the overall care and management of the alternate care setting i.v. therapy patient. This paper will identify the various aspects of appropriate device selection for i.v. therapy prescriptions.
Gillham, Jane E.; Hamilton, John; Freres, Derek R.; Patton, Ken; Gallop, Robert
This study evaluated the Penn Resiliency Program's effectiveness in preventing depression when delivered by therapists in a primary care setting. Two-hundred and seventy-one 11- and 12-year-olds, with elevated depressive symptoms, were randomized to PRP or usual care. Over the 2-year follow-up, PRP improved explanatory style for positive events.…
Council for Exceptional Children, Reston, VA.
These guidelines were developed by a joint task force of members and staff of four national associations, to be of assistance to persons concerned with the safe delivery of specialized health care in educational settings. The guidelines delineate the roles and responsibilities of personnel involved in the provision of specialized health care. They…
Godwin, Annabelle; Schrag, Lorraine
With increasing numbers of infants in need of child care, the demand for infant care programs has grown. This handbook was designed to meet the need for technical assistance regarding program components and workable practices geared specifically to infant and toddler care. Part 1 of the handbook, "Considerations in Infant and Toddler…
Lee, S M; LoGiudice, D
Aged care health professionals in Australia are increasingly referred patients whose standard of cleanliness and self-care has deteriorated to levels resulting in public health concern. This paper describes three illustrative case studies of people referred to an Australian Aged Care Assessment Service who present with 'Diogenes Syndrome'. The diversity and complexity of these cases reflect variable underlying diagnoses. Symptoms of self-neglect, hoarding and domestic squalor and combinations thereof may provide a more useful classification system of the older person who presents in such circumstances than the frequently used term Diogenes syndrome. Practical guidelines are required for appropriate assessment and management of these conditions.
Haesler, Emily; Bauer, Michael; Nay, Rhonda
Background Modern healthcare philosophy espouses the virtues of holistic care and acknowledges that family involvement is appropriate and something to be encouraged due to the role it plays in physical and emotional healing. In the aged care sector, the involvement of families is a strong guarantee of a resident's well-being. The important role family plays in the support and care of the older adult in the residential aged care environment has been enshrined in the Australian Commonwealth Charter of Residents' Rights and Responsibilities and the Aged Care Standards of Practice. Despite wide acknowledgement of the importance of family involvement in the healthcare of the older adult, many barriers to the implementation of participatory family care have been identified in past research. For older adults in the healthcare environment to benefit from the involvement of their family members, healthcare professionals need an understanding of the issues surrounding family presence in the healthcare environment and the strategies to best support it. Objectives The objectives of the systematic review were to present the best available evidence on the strategies, practices and organisational characteristics that promote constructive staff-family relationships in the care of older adults in the healthcare setting. Specifically this review sought to investigate how staff and family members perceive their relationships with each other; staff characteristics that promote constructive relationships with the family; and interventions that support staff-family relationships. Search strategy A literature search was performed using the following databases for the years 1990-2005: Ageline, APAIS Health, Australian Family and Society Abstracts (FAMILY), CINAHL, Cochrane Library, Dare, Dissertation Abstracts, Embase, MEDLINE, PsycINFO and Social Science Index. Personal communication from expert panel members was also used to identify studies for inclusion. A second search stage
da Motta, Luciana Branco; Caldas, Célia Pereira; de Assis, Mônica
The training of professionals in the field of healthcare for the aged is one of the priorities of the national policy for the aged in Brazil due to the accelerated aging of the population. The Núcleo de Atenção ao Idoso (NAI), a unit of the Open University of the Third Age/UERJ (UNATI/UERJ) develops an educational program in this field, based on practical care delivery with emphasis to inter-disciplinarity and teamwork. The program includes different training levels and modalities: Residency, Specialization, Professional Practice and Graduation. The program includes an introductory course in gerontology and geriatrics common to all areas, and specific theoretical-practical qualification coordinated by the professional staff from the respective areas. The practical activities occur in different sceneries: long term care institutions, health promotion educational settings, outpatient facilities and the university hospital. Interdisciplinary thinking and acting is a continuous exercise, and the team should be open to innovative strategies. The experience is a contribution to the increasing social demand for qualified professionals committed with the principles of the Unified Health System and integrated health care.
Duque, Gustavo; Close, Jacqueline J; de Jager, Julien P; Ebeling, Peter R; Inderjeeth, Charles; Lord, Stephen; McLachlan, Andrew J; Reid, Ian R; Troen, Bruce R; Sambrook, Philip N
Older people living in residential aged care facilities (RACFs) are at considerably higher risk of suffering fractures than older people living in the community. When admitted to RACFs, patients should be assessed for fracture risk to ensure early implementation of effective fracture prevention measures. Routine or regular determination of calcium and phosphate serum levels in institutionalised older people is not indicated. Opinion is divided about the value of routine measurements of serum concentrations of 25-hydroxyvitamin D, parathyroid hormone and bone turnover markers. The non-pharmacological approach to fracture prevention includes multifactorial programs of falls prevention and the use of hip protectors. Vitamin D supplementation is recommended for all patients in RACFs. Dietary calcium intake should be optimised (1200-1500 mg per day is recommended) and supplementation offered to those with inadequate intake. The decision to prescribe calcium supplements should be guided by patients' tolerance, whether or not they have a history of kidney stones, and emerging data about its cardiovascular safety. Bisphosphonates are the first-choice pharmacological agents for fracture prevention in older persons at high risk. Intravenous administration is as efficient as oral and has the significant advantage of better adherence. Use of strontium ranelate has not been tested on people in RACFs, but evidence in the "old-old" (those aged 75 years and older) suggests it could be a therapeutic option for fracture prevention in this setting. In general, teriparatide should not be considered as a first-line treatment for fracture prevention, particularly for people in RACFs.
Yeh, Vivian M.; Schnur, Julie B.; Montgomery, Guy H.
Hypnosis is a brief intervention ready for wider dissemination in medical contexts. Overall, hypnosis remains underused despite evidence supporting its beneficial clinical impact. This review will evaluate the evidence supporting hypnosis for dissemination using guidelines formulated by Glasgow and colleagues (1999). Five dissemination dimensions will be considered: Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM). Reach In medical settings, hypnosis is capable of helping a diverse range of individuals with a wide variety of problems. Efficacy There is evidence supporting the use of hypnosis for chronic pain, acute pain and emotional distress arising from medical procedures and conditions, cancer treatment-related side-effects and irritable bowel syndrome. Adoption Although hypnosis is currently not a part of mainstream clinical practices, evidence suggests that patients and healthcare providers are open to trying hypnosis, and may become more so when educated about what hypnosis can do. Implementation Hypnosis is a brief intervention capable of being administered effectively by healthcare providers. Maintenance Given the low resource needs of hypnosis, opportunities for reimbursement, and the ability of the intervention to potentially help medical settings reduce costs, the intervention has the qualities necessary to be integrated into routine care in a self-sustaining way in medical settings. In sum, hypnosis is a promising candidate for further dissemination. PMID:25267941
Murphy, C; Sweeney, M A
This demonstration will present the key modules from an innovative videodisc-based program that was designed as an educational tool for health care professionals. It provides a resource for learning to deal with patients and families regarding the increasing problematic area of end-of-life-decisions. Tough Choices: Ethics, the Elderly, and Life-Sustaining Technologies is an interactive program that combines abstract ethical approaches with the realistic drama of a critical care setting. The format integrates scientific facts about the patient with value questions regarding the utilization of life-sustaining technologies. The unique program provides health care personnel with strategies on how to guide family decision-making as well as examples of the various interventions. This interactive multimedia program opens up an opportunity for health care providers to participate in a clinical case in which life and death decisions are made. Learners can explore various perspectives and treatment options within the framework of the dramatic case presentation without the usual time constraints or worries about causing harm to patients. The program involves learners in a variety of ethical and legal dilemmas that centers around a patient, her family, and a variety of health care professionals. Dramatic advances in the development of life-sustaining medical technologies have given hope to many people whose conditions would have meant certain death only a few years ago. As access to the technologies has expanded, concern for their appropriate utilization has become an issue worthy of increasing attention. Questions about the benefits of life-sustaining treatments are being raised in many quarters, particularly when the technology is viewed as a modern means of postponing death and prolonging suffering. Tough Choices brings to life the story of Irene Sullivan, an elderly widow who has an unexpected heart attack. Suddenly, her very existence depends on the life-support provided
Avery, Rosemary J.; Freundlich, Madelyn
This article considers the repercussions of discharging youth from foster care at age 18 based on recent research demonstrating that youth at this age are not developmentally prepared to live independently and have a continued need for strong social scaffolding during emerging adulthood. Drawing upon recent research findings, we make…
McKenzie, Ellen L.; Brown, Patricia M.
Given a projected threefold increase in people living with dementia globally by 2050 (World Health Organization, 2012), attracting nurses to work in this area will be critical to meet demand. This study examined the role of age, positive ageism, negative ageism, and aged-care placement completion in predicting nursing students' intentions to work…
Norton, J. C.
First, second, and third grade pupils served as subjects in an experiment designed to show the effect of age, mode of stimulus presentation, and information value on recognition time. Stimuli were presented in picture and printed word form and in groups of 2, 4, and 8. The results of the study indicate that first graders are slower than second and third graders who are nearly equal. There is a gross shift in reaction time as a function of mode of stimulus presentation with increase in age. The first graders take much longer to identify words than pictures, while the reverse is true of the older groups. With regard to set size, a slope appears in the pictures condition in the older groups, while for first graders, a large slope occurs in the words condition and only a much smaller one for pictures.
Huang, Allen R.; Larente, Nadine; Morais, Jose A.
Introduction Care of the older adult in the acute care hospital is becoming more challenging. Patients 65 years and older account for 35% of hospital discharges and 45% of hospital days. Up to one-third of the hospitalized frail elderly loses independent functioning in one or more activities of daily living as a result of the ‘hostile environment’ that is present in the acute hospitals. A critical deficit of health care workers with expertise and experience in the care of the elderly also jeopardizes successful care delivery in the acute hospital setting. Methods We propose a paradigm shift in the culture and practice of event-driven acute hospital-based care of the elderly which we call the Age-friendly Hospital concept. Guiding principles include: a favourable physical environment; zero tolerance for ageism throughout the organization; an integrated process to develop comprehensive services using the geriatric approach; assistance with appropriateness decision-making and fostering links between the hospital and the community. Our current proposed strategy is to focus on delirium management as a hospital-wide condition that both requires and highlights the Geriatric Medicine specialist as an expert of content, for program development and of evaluation. Conclusion The Age-friendly Hospital concept we propose may lead the way to enable hospitals in the fast-moving health care system to deliver high-quality care without jeopardizing risk-benefit, function, and quality of life balances for the frail elderly. Recruitment and retention of skilled health care professionals would benefit from this positive ‘branding’ of an institution. Convincing hospital management and managing change are significant challenges, especially with competing priorities in a fiscal environment with limited funding. The implementation of a hospital-wide delirium management program is an example of an intervention that embodies many of the principles in the Age-friendly Hospital concept
Hsiao, Peng-Ching; Chu, Chi-Ming; Sung, Pei-Yi; Perng, Wann-Cherng; Wang, Kwua-Yun
Background Because Taiwan has the fastest aging rate among developed countries, care for the elderly is becoming more prominent in the country. Primary family caregivers play an important role in patient health and health promotion behavior. Chronic obstructive pulmonary disease (COPD), an age-related disease, is a major public health problem with high morbidity and mortality and can be a long-term burden for family members; however, little attention has been given to the differences in COPD care between elder caregivers and other caregivers. This study aimed to investigate the differences between elder family caregivers and non-elder family caregivers caring for COPD patients in Taiwan, including caring behavior, caregiver response, and caring knowledge. Methods This cross-sectional study was conducted between March 2007 and January 2008; 406 primary family caregivers of COPD patients from the thoracic outpatient departments of 6 hospitals in north-central Taiwan were recruited to answer questionnaires measuring COPD characteristics, care behavior, caregiver response, and COPD knowledge. All questionnaires, which addressed caregiver knowledge, care behaviors, and care reactions, were shown to have acceptable validity and reliability, and the data were analyzed using univariate and generalized linear model techniques. Results The elder caregivers group had 79 participants, and the non-elder caregivers comprised 327 participants. The COPD-related knowledge scale results were positively correlated with the family caregiver caring behavior scale, suggesting that better COPD-related knowledge among family caregivers may result in improved caring behavior. After adjusting for all possible confounding factors, the elder caregivers had significantly lower COPD-related knowledge than the non-elder caregivers (P<0.001). However, there were no significant differences in the family caregiver caring behavior scale or the caregiver reaction assessment scale between the two
research on child care environmental health issues, identify key state and regional healthy child care organizations for partnerships, and see how other states are addressing child care environmental health issues.
Couch, Fergus J.; Nathanson, Katherine L.; Offit, Kenneth
The cloning of the breast cancer susceptibility genes BRCA1 and BRCA2 nearly two decades ago helped set in motion an avalanche of research exploring how genomic information can be optimally applied to identify and clinically care for individuals with a high risk of developing cancer. Genetic testing for mutations in BRCA1, BRCA2, and other breast cancer susceptibility genes has since proved to be a valuable tool for determining eligibility for enhanced screening and prevention strategies, as well as for identifying patients most likely to benefit from a targeted therapy. Here, we discuss the landscape of inherited mutations and sequence variants in BRCA1 and BRCA2, the complexities of determining disease risk when the pathogenicity of sequence variants is uncertain, and current strategies for clinical management of women who carry BRCA1/2 mutations. PMID:24675953
Patel, Anisha I; Hampton, Karla E
Children and adolescents are not consuming enough water, instead opting for sugar-sweetened beverages (sodas, sports and energy drinks, milks, coffees, and fruit-flavored drinks with added sugars), 100% fruit juice, and other beverages. Drinking sufficient amounts of water can lead to improved weight status, reduced dental caries, and improved cognition among children and adolescents. Because children spend most of their day at school and in child care, ensuring that safe, potable drinking water is available in these settings is a fundamental public health measure. We sought to identify challenges that limit access to drinking water; opportunities, including promising practices, to increase drinking water availability and consumption; and future research, policy efforts, and funding needed in this area.
Addae-Mensah, Kweku A; Cheung, Yuk Kee; Fekete, Veronika; Rendely, Matthew S; Sia, Samuel K
Although advanced fluid handling using elastomeric valves is useful for a variety of lab-on-a-chip procedures, their operation has traditionally relied on external laboratory infrastructure (such as gas tanks, computers, and ground electricity). This dependence has held back the use of elastomeric microvalves for point-of-care settings. Here, we demonstrate that microfabricated microvalves, via liquid-filled control channels, can be actuated using only a handheld instrument powered by a 9 V battery. This setup can achieve on-off fluid control with fast response times, coordinated switching of multiple valves, and operation of a biological assay. In the future, this technique may enable the widely used elastomeric microvalves (made by multilayer soft lithography) to be increasingly adopted for portable sensors and lab-on-a-chip systems.
Ubesie, Ac; Ibeziakor, Ns
There is still a high burden of protein-energy malnutrition in Nigeria. The severe forms of the disease are usually associated with high level of mortality even in the tertiary health facilities. To review the cost-effective health promotional strategies at community levels that could aid prevention, early detection, and prompt treatment of protein-energy malnutrition. The strategy used for locating articles used for this review was to search databases like Google, Google scholar, relevant electronic journals from the universities' libraries, including PubMed and Scirus, Medline, Cochrane library and WHO's Hinari. We believe that strategies beyond the health care setting have potential of significantly reducing the morbidity and mortality associated with protein-energy malnutrition in Nigeria.
Hampton, Karla E.
Children and adolescents are not consuming enough water, instead opting for sugar-sweetened beverages (sodas, sports and energy drinks, milks, coffees, and fruit-flavored drinks with added sugars), 100% fruit juice, and other beverages. Drinking sufficient amounts of water can lead to improved weight status, reduced dental caries, and improved cognition among children and adolescents. Because children spend most of their day at school and in child care, ensuring that safe, potable drinking water is available in these settings is a fundamental public health measure. We sought to identify challenges that limit access to drinking water; opportunities, including promising practices, to increase drinking water availability and consumption; and future research, policy efforts, and funding needed in this area. PMID:21680941
Albina, Julie K
Incidents of verbal and physical patient abuse in health care settings continue to occur, with some making headline news. Nurses have a professional and ethical responsibility to advocate for their patients when incidents of abuse occur. Tolerating or ignoring inappropriate behaviors occurs for multiple reasons, including ignorance, fear of retaliation, the need for peer acceptance, and concerns for personal advancement. Nurses need to reflect on their biases before they can truly respect patients' autonomy. Through the examination of reported cases of patient abuse, the need for a change in hospital culture becomes evident. The primary steps in eliminating patient abuse are opening communication, providing education, establishing competency, eliminating tolerance of unacceptable behavior, and creating a code of mutual respect. A change in culture to one of mutual respect and dignity for staff members and patients will lead to the best outcomes for all involved.
The purpose of this descriptive pilot study was to describe sleep characteristics of hospitalized older adults and the nighttime environmental noise and light they encountered. Study participants included patients in an acute care setting; actigraphy and light and sound meters were used to measure the variables. Mean sleep time was 215 minutes, and the average sleep efficiency was 44.72%. Nighttime sleep was fragmented into 5 to 38 intervals of 15 to 24 minutes, with frequent awakenings. Mean light levels were 6.14 lux, with peak intensities of 59.68 lux lasting 95 minutes each night. Mean sound levels were 52.87 dB(A). Sleep was markedly impaired in an environment of elevated light and sound levels. Understanding the role of noise and light in the sleep efficiency of ill older adults can help nurses identify sources of noise and light and initiate sleep improvement protocols.
Lyles, Courtney R; Aulakh, Veenu; Jameson, Wendy; Schillinger, Dean; Yee, Hal; Sarkar, Urmimala
Health reform requires safety net settings to transform care delivery, but how they will innovate in order to achieve this transformation is unknown. Two series of key informant interviews (N = 28) were conducted in 2012 with leadership from both California's public hospital systems and community health centers. Interviews focused on how innovation was conceptualized and solicited examples of successful innovations. In contrast to disruptive innovation, interviewees often defined innovation as improving implementation, making incremental changes, and promoting integration. Many leaders gave examples of existing innovative practices to meeting their diverse patient needs, such as patient-centered approaches. Participants expressed challenges to adapting quickly, but a desire to partner together. Safety net systems have already begun implementing innovative practices supporting their key priority areas. However, more support is needed, specifically to accelerate the change needed to succeed under health reform.
McDonald, L. C.; Kuehnert, M. J.; Tenover, F. C.; Jarvis, W. R.
Although nosocomial acquisition and subsequent colonization of vancomycin-resistant enterococci (VRE), an emerging international threat to public health, has been emphasized in the United States, colonization among nonhospitalized persons has been infrequently documented. In contrast, in Europe, colonization appears to occur frequently in persons outside the health-care setting. An important factor associated with VRE in the community in Europe has been avoparcin, a glycopeptide antimicrobial drug used for years in many European nations at subtherapeutic doses as a growth promoter in food-producing animals. In Europe, evidence suggests that foodborne VRE may cause human colonization. Although avoparcin has never been approved for use in the United States, undetected community VRE transmission may be occurring at low levels. Further studies of community transmission of VRE in the United States are urgently needed. If transmission with VRE from unrecognized community sources can be identified and controlled, increased incidence of colonization and infection among hospitalized patients may be prevented. PMID:9284375
McMaster, Victoria; Nichols, Sally; Machin, David
A study was designed to determine the effectiveness of breast self-examination teaching materials in a primary care setting. The Women's National Cancer Control Campaign tape/slide programme and leaflets were displayed in a health centre, both independently and in combination. Women leaving the health centre were interviewed about breast cancer and the information on breast self-examination contained in the educational material. Both the leaflet and tape/slide programme, independently, increased knowledge about breast cancer and self-examination, but only to a small extent. They were more effective in combination, mainly in increasing knowledge of breast self-examination, rather than knowledge of breast cancer or breast abnormalities. PMID:4093902
White, Elizabeth Jayne; Redder, Bridgette; Peter, Mira
This paper examines the significance of a "look" in infant-teacher dialogues in an early education and care centre in New Zealand. Drawing on Bakhtin's principle of "visual surplus" video recordings of two infants', aged under 1 year of age, interactions with their teacher and teacher interpretations of these interactions were…
Hann, C E; Chase, J G; Desaive, T; Froissart, C B; Revie, J; Stevenson, D; Lambermont, B; Ghuysen, A; Kolh, P; Shaw, G M
Lumped parameter approaches for modelling the cardiovascular system typically have many parameters of which a significant percentage are often not identifiable from limited data sets. Hence, significant parts of the model are required to be simulated with little overall effect on the accuracy of data fitting, as well as dramatically increasing the complexity of parameter identification. This separates sub-structures of more complex cardiovascular system models to create uniquely identifiable simplified models that are one to one with the measurements. In addition, a new concept of parameter identification is presented where the changes in the parameters are treated as an actuation force into a feed back control system, and the reference output is taken to be steady state values of measured volume and pressure. The major advantage of the method is that when it converges, it must be at the global minimum so that the solution that best fits the data is always found. By utilizing continuous information from the arterial/pulmonary pressure waveforms and the end-diastolic time, it is shown that potentially, the ventricle volume is not required in the data set, which was a requirement in earlier published work. The simplified models can also act as a bridge to identifying more sophisticated cardiac models, by providing an initial set of patient specific parameters that can reveal trends and interactions in the data over time. The goal is to apply the simplified models to retrospective data on groups of patients to help characterize population trends or un-modelled dynamics within known bounds. These trends can assist in improved prediction of patient responses to cardiac disturbance and therapy intervention with potentially smaller and less invasive data sets. In this way a more complex model that takes into account individual patient variation can be developed, and applied to the improvement of cardiovascular management in critical care.
Silberstein, Stephen D
Migraine is a common disabling brain disorder that affects one in seven US citizens annually. The burden of migraine is substantial, both in economic terms and for individual patients and their close family members. Initial medical consultations for migraine are usually with a primary care physician (PCP), and it is predominantly managed in a primary care setting; therefore, PCPs need a thorough understanding of migraine and the treatment options. This review provides an overview of the prevalence, symptoms, burden, and diagnosis of migraine with a focus on adults. Important aspects of migraine management, such as medication overuse and chronic migraine, are highlighted and insight is provided into factors for consideration when prescribing acute/abortive treatment for migraine to ensure that individual patients receive optimal pharmaceutical management. The effects of associated symptoms, e.g. nausea/vomiting, on treatment efficacy are pertinent in migraine; however, many therapy options, including alternative delivery systems, are available, thus facilitating the selection of optimal treatment for an individual patient.
Holtkamp, Martin; Meierkord, Hartmut
Nonconvulsive status epilepticus (NCSE) comprises a group of syndromes that display a great diversity regarding response to anticonvulsants ranging from virtually self-limiting variants to entirely refractory forms. Therefore, treatment on intensive care units (ICUs) is required only for a selection of cases. The aetiology and clinical form of NCSE are strong predictors for the overall prognosis. Absence status epilepticus is commonly seen in patients with idiopathic generalized epilepsy and is rapidly terminated by low-dose of benzodiazepines. The management of complex partial status epilepticus is straightforward in patients with pre-existing epilepsy, but poses major problems if occurring in the context of acute brain lesions. Subtle status epilepticus represents the late stage of undertreated previous overt generalized convulsive status epilepticus and always requires aggressive ICU treatment. Within the intensive care setting, the diagnostic challenge may be seen in the difficulty in delineating nonepileptic conditions such as posthypoxic, metabolic or septic encephalopathies from NCSE. Although all important forms are considered, the focus of this review lies on clinical presentations and electroencephalogram features of comatose patients treated on ICUs and possible diagnostic pitfalls. PMID:21694817
Sarikaya, Ozlem; Civaner, Murat; Vatansever, Kevser
It is known that interaction between pharmaceutical companies and medical professionals may lead to corruption of professional values, irrational use of medicine, and negative effects on the patient-physician relationship. Medical students frequently interact with pharmaceutical company representatives and increasingly accept their gifts. Considering the move toward early clinical encounters and community-based education, which expose students early to pharmaceutical representatives, the influence of those gifts is becoming a matter of concern. This study examines the frequency and influence of student exposure to drug marketing in primary care settings, as well as student perceptions of physician-pharmaceutical company relationships. This was a two-phase study consisting of qualitative research followed by a cross-sectional survey. Clinical experience logbooks of 280 second-year students in one school were analysed, and the themes that emerged were used to develop a survey that was administered to 308 third-year students from two medical schools. Survey results showed a 91.2% exposure to any type of marketing, and 56.8% of students were exposed to all classes of marketing methods studied. Deliberate targeting of students by pharmaceutical representatives, in particular, was correlated with being less sensitive to the negative effects of and having positive opinions about interactions with pharmaceutical companies. The vast majority of students are exposed to drug marketing in primary care settings, and may become more vulnerable to that strategy. Considering that medical students are vulnerable and are targeted deliberately by pharmaceutical companies, interventions aimed at developing skills in the rational use of medicines and in strategies for coping with drug marketing should be devised.
Matsuzawa, Toshioki; Sakurai, Takashi; Kuranaga, Masako; Endo, Hidetoshi; Yokono, Koichi
To identify predictive factors for hospitalized and institutionalized care-giving among a group of aged patients with diabetes mellitus in Japan, retrospective chart review was performed in 288 diabetic subjects aged 65 years or older. Independent variables, based on the chart review, were age, sex, diagnosis, diabetic control and complications. Comprehensive geriatric assessment was performed to obtain information on the functional capacity and demographic variables, including physical and mental function, and socioeconomic status. 131 diabetic patients were considered as frail elderly and characterized for their higher age, longer duration of diabetes, higher frequency of insulin use, lower cognitive function, and lower QOL, in comparison with those of non-frail patients. All non-frail diabetic patients were independently treated at their homes, while 38 subjects out of 131 frail diabetic patients were hospitalized or institutionalized. Apparent clinical features of hospitalized/institutionalized patients were higher age, higher serum creatinine, and higher prevalence of stroke episodes, advanced cognitive decline and absence of key caregiver in the family members, in comparison with those of in-home frail diabetic patients. The predicted probabilities from the multivariate logistic regression analysis in predicting hospitalized and institutionalized care-giving were as follows: Log p/(1 - p) = -19.801x1 - 54.269x2 + 721.405; where x1 = cognitive function (score), x2 = social support (score). Receiver operating characteristic curve analysis revealed a satisfactory discrimination for hospitalized and institutionalized care-giving in frail diabetic elderly with 92.9% of sensitivity and 91.4% of specificity, when the cutoff point of the model was set at 0.992. We concluded that cognitive decline and low social support are the predictive for hospital and institutional care-giving, and that demographic and mental information as well as diagnostic data should be
Lawlis, Tanya; Wicks, Alison; Jamieson, Maggie; Haughey, Amy; Grealish, Laurie
Health professional clinical education is commonly conducted in single discipline modes, thus limiting student collaboration skills. Aged care residential facilities, due to the chronic and complex health care needs of residents, provide an ideal placement to provide a collaborative experience. Interprofessional education is widely acknowledged as the pedagogical framework through which to facilitate collaboration. The aim of the evaluation was to assess student attitudes towards collaboration after active involvement in an interprofessional education program. Students studying nursing, occupational therapy, and aged care were invited to complete a version of the Readiness for Interprofessional Learning Scale before and after participating in a three-week pilot interprofessional program. A positive change in student attitudes towards other health professionals and the importance of working in interprofessional teams was reported with significant differences between two statements indicated: Learning with health-care students before qualifications would improve relationships after qualifications; and I learned a lot from the students from the other disciplines. The innovative pilot project was found to enhance student learning in interprofessional teams and the aged care environment. Further development of this and similar interprofessional programs is required to develop sustainable student projects that have health benefits for residents in aged care residential facilities.
Semeraro, V; Zantedeschi, E; Pasquarella, A; Guerrera, C; Guasticchi, G
Waiting lists are one of the main Public Health issues within developed countries. To promote appropriateness about General Practitioners' (GPs) prescriptions, during 2009 the project "Priority setting in outpatient prescriptions" in Latium Region has been approved. Regional referees, Latium Public Health Agency managers and advisors, managers and advisors of three Local Public Health Units (LPHUs) within the Latium region and some voluntarily recruited General Practitioners (each one with more than 800 patients enrolled) were included in a team work with the duty to develop the project. During two selected months of 2010, 46 GPs have forwarded overall 2.229 medical prescriptions. The six most numerous prescriptions were picked out and analyzed by the team work. 42% of these prescriptions were identified as belonging to category D of the priority level--"standard", while 42% and 41% of prescriptions bore the expressions of "control" and "diagnostic purpose" respectively. Among these ones, 75% were represented by bilateral mammography, prescribed to women aged between 50 and 69 years: but for those people bilateral mammography is already provided free of charge within the regional program of breast cancer screening, making the routine prescription by their physician a useless duplication, unacceptable in a healthcare system of good quality. Therefore at the conclusion of the project, the team work suggests proper standards be applied by healthcare professionals and GPs to achieve a significant objective: mammography appropriateness prescriptions.
Shen, Sijun; Neyens, David M
There are many studies that evaluate the effects of age, gender, and crash types on crash related injury severity. However, few studies investigate the effects of those crash factors on the crash related health care costs for drivers that are transported to hospital. The purpose of this study is to examine the relationships between drivers' age, gender, and the crash types, as well as other crash characteristics (e.g., not wearing a seatbelt, weather condition, and fatigued driving), on the crash related health care costs. The South Carolina Crash Outcome Data Evaluation System (SC CODES) from 2005 to 2007 was used to construct six separate hierarchical linear regression models based on drivers' age and gender. The results suggest that older drivers have higher health care costs than younger drivers and male drivers tend to have higher health care costs than female drivers in the same age group. Overall, single vehicle crashes had the highest health care costs for all drivers. For males older than 64-years old sideswipe crashes are as costly as single vehicle crashes. In general, not wearing a seatbelt, airbag deployment, and speeding were found to be associated with higher health care costs. Distraction-related crashes are more likely to be associated with lower health care costs in most cases. Furthermore this study highlights the value of considering drivers in subgroups, as some factors have different effects on health care costs in different driver groups. Developing an understanding of longer term outcomes of crashes and their characteristics can lead to improvements in vehicle technology, educational materials, and interventions to reduce crash-related health care costs.
Dionigi, Alberto; Canestrari, Carla
Within the past decade, there has been a surge of interest in investigating the effects of clown intervention in a large variety of clinical settings. Many studies have focused on the effects of clown intervention on children. However, few studies have investigated clowning effects on adults. This paper presents an overview of the concept of medical clowning followed by a literature review conducted on the empirical studies drawn from three data bases (PubMed, PsycINFO, and Google Scholar), with the aim of mapping and discussing the evidence of clowning effects on non-children, namely adults. The following areas were investigated: Adult and elderly patients (mainly those with dementia), observers of clowning, namely non-hospitalized adults who are at the hospital as relatives of patients or health-care staff, and finally clowns themselves. The main results are that 1) clown intervention induces positive emotions, thereby enhancing the patient's well-being, reduces psychological symptoms and emotional reactivity, and prompts a decrease in negative emotions, such as anxiety and stress; 2) clown doctors are also well-perceived by relatives and healthcare staff and their presence appears to be useful in creating a lighter atmosphere in the health setting; 3) few pilot studies have been conducted on clown doctors and this lacuna represents a subject for future research.
Dionigi, Alberto; Canestrari, Carla
Within the past decade, there has been a surge of interest in investigating the effects of clown intervention in a large variety of clinical settings. Many studies have focused on the effects of clown intervention on children. However, few studies have investigated clowning effects on adults. This paper presents an overview of the concept of medical clowning followed by a literature review conducted on the empirical studies drawn from three data bases (PubMed, PsycINFO, and Google Scholar), with the aim of mapping and discussing the evidence of clowning effects on non-children, namely adults. The following areas were investigated: Adult and elderly patients (mainly those with dementia), observers of clowning, namely non-hospitalized adults who are at the hospital as relatives of patients or health-care staff, and finally clowns themselves. The main results are that 1) clown intervention induces positive emotions, thereby enhancing the patient’s well-being, reduces psychological symptoms and emotional reactivity, and prompts a decrease in negative emotions, such as anxiety and stress; 2) clown doctors are also well-perceived by relatives and healthcare staff and their presence appears to be useful in creating a lighter atmosphere in the health setting; 3) few pilot studies have been conducted on clown doctors and this lacuna represents a subject for future research. PMID:27547261
Selim, Heba Sayed; Abaza, Amani Farouk
Aim: This study aimed at investigating the microbial contamination of mobile phones in a hospital setting. Methods: Swab samples were collected from 40 mobile phones of patients and health care workers at the Alexandria University Students’ Hospital. They were tested for their bacterial contamination at the microbiology laboratory of the High Institute of Public Health. Quantification of bacteria was performed using both surface spread and pour plate methods. Isolated bacterial agents were identified using standard microbiological methods. Methicillin-resistant Staphylococcus aureus was identified by disk diffusion method described by Bauer and Kirby. Isolated Gram-negative bacilli were tested for being extended spectrum beta lactamase producers using the double disk diffusion method according to the Clinical and Laboratory Standards Institute recommendations. Results: All of the tested mobile phones (100%) were contaminated with either single or mixed bacterial agents. The most prevalent bacterial contaminants were methicillin-resistant S. aureus and coagulase-negative staphylococci representing 53% and 50%, respectively. The mean bacterial count was 357 CFU/ml, while the median was 13 CFU/ml using the pour plate method. The corresponding figures were 2,192 and 1,720 organisms/phone using the surface spread method. Conclusions: Mobile phones usage in hospital settings poses a risk of transmission of a variety of bacterial agents including multidrug-resistant pathogens as methicillin-resistant S. aureus. The surface spread method is an easy and useful tool for detection and estimation of bacterial contamination of mobile phones. PMID:25699226
Drain, Paul K; Hyle, Emily P; Noubary, Farzad; Freedberg, Kenneth A; Wilson, Douglas; Bishai, William; Rodriguez, William; Bassett, Ingrid V
Diagnostic point-of-care (POC) testing is intended to minimize the time to obtain a test result, thereby allowing clinicians and patients to make an expeditious clinical decision. As POC tests expand into resource-limited settings (RLS), the benefits must outweigh the costs. To optimize POC testing in RLS, diagnostic POC tests need rigorous evaluations focused on relevant clinical outcomes and operational costs, which differ from evaluations of conventional diagnostic tests. Here, we reviewed published studies on POC testing in RLS, and found no clearly defined metric for the clinical utility of POC testing. Therefore, we propose a framework for evaluating POC tests, and suggest and define the term “test efficacy” to describe a diagnostic test’s capacity to support a clinical decision within its operational context. We also proposed revised criteria for an ideal diagnostic POC test in resource-limited settings. Through systematic evaluations, comparisons between centralized diagnostic testing and novel POC technologies can be more formalized, and health officials can better determine which POC technologies represent valuable additions to their clinical programs. PMID:24332389
Neuman, P H; Rice, D P; Hussey, P S
The aging of the U.S. population presents challenges in financing care and meeting the health and long-term care needs of older Americans. Women, who constitute a majority of the older adult population and a disproportionate share of those with low incomes, chronic conditions and long-term care needs, have much at stake in the future direction of health programs for aging Americans. This paper examines the status of older women in 12 industrialized nations to assess how the U.S. compares to other countries in terms of its aging female population. We find that women across the 12 industrialized countries have a longer life expectancy than men at ages 65 and 80, underscoring the universality of aging as a "women's issue". With respect to age composition, the U.S. lags behind many industrialized nations in the share of its elderly female population; by 2030, the proportion of women aged 65 and older, and 80 and older, will be lower in the U.S. than in any of the industrialized nations compared in this paper. Against this backdrop, the paper examines the characteristics of older adult women in the U.S., considers the role of Medicare in meeting the needs of aging women, and identifies gaps in coverage, primarily prescription drug and long-term care, that disproportionately affect older women. The paper concludes by considering how other nations provide and finance prescription drug and long-term care services for older adults, suggesting useful models for the U.S. to consider as it struggles to meet the demands of its aging population.
Jacomet, Christine; Berland, Pauline; Guiguet, Marguerite; Simon, Anne; Rey, David; Arvieux, Cédric; Pugliese, Pascal; Gerbaud, Laurent
The aging population of people living with human immunodeficiency virus (HIV) (PLWH) is exposed to a widening spectrum of non-AIDS-defining diseases. Thus, our objective was to compare the health care offered to PLWH according to age. We conducted a multicenter cross-sectional study on PLWH who consulted at one of 59 French HIV reference centers from 15th to 19th October 2012. Using our survey questionnaires, PLWH self-reported the medical care they received, whether or not tied to HIV infection monitoring, during the previous year. A total of 650 PLWH participated in the survey (median age 48 years, Interquartile range (IQR) 40-54), of which 95 were aged 60 years or over (14.5%). Compared to younger PLWH, 60-and-over PLWH were more often under complementary health insurance cover and less socially deprived based on the French EPICES (Evaluation of Precarity and Inequalities in Health Examination Centers) score. The elderly PLWH presented more comorbidities and less coinfections with hepatitis viruses. During health care, therapeutic education was less often offered to older PLWH (14% vs. 26%, p = .01), but this difference was mainly explained by sociodemographic factors and clinical status. Over the previous 6 months, 74% of PLWH who were followed up in hospital had also consulted another doctor, with a mean of 3.75 consultations (±4.18) without difference between age groups. After adjustment for sociodemographic factors and comorbidities, PLWH over 60 years were more likely to have consulted medical specialists as outpatients in the last 6 months (odds ratio [OR] = 2.63 [1.11-6.20]). Whatever their age, 13% of PLWH had been refused care on disclosure of their HIV status, and 27% of PLWH still did not disclose their HIV status to some caregivers. Coordinated health care throughout patients' lives is crucial, as health-care pathways evolve toward outpatient care as the patients get older.
Xiao, Lily D; Kelton, Moira; Paterson, Jan
The aim of this study was to develop quality clinical placements in residential aged care facilities for undergraduate nursing students undertaking their nursing practicum topics. The proportion of people aged over 65 years is expected to increase steadily from 13% in 2006 to 26% of the total population in Australia in 2051. However, when demand is increasing for a nursing workforce competent in the care of older people, studies have shown that nursing students generally lack interest in working with older people. The lack of exposure of nursing students to quality clinical placements is one of the key factors contributing to this situation. Critical action research built on a partnership between an Australian university and five aged care organisations was utilised. A theoretical framework informed by Habermas' communicative action theory was utilised to guide the action research. Multiple research activities were used to support collaborative critical reflection and inform actions throughout the action research. Clinical placements in eight residential aged care facilities were developed to support 179 nursing students across three year-levels to complete their practicum topics. Findings were presented in three categories described as structures developed to govern clinical placement, learning and teaching in residential aged care facilities.
Porru, S; Cannatelli, P; Cerioli, Beloyanna; Flor, L; Gramegna, Maria; Polato, R; Rodriguez, D
Fitness for work (FFW) in health care workers poses multidisciplinary challenges because of management problems scientific and ethical implications and the implementation of preventive interventions in health care settings. All the relevant stakeholders, including the General Manager, Medical Director, worker's representative, the person responsible for prevention and protection, forensic medicine expert, the person responsible for prevention and health safety at public administration level, commented on: danger to third parties; FFW formulation; human resource management; stress; professional independence; role of the person responsible for prevention and protection and of the person responsible for prevention at public administration level; professional responsibilities. Opinions are reported regarding the main problems related to the role of the Occupational Physician in FFW formulation, such as the difficult balance between autonomy and independence, limited turnover and aging of workforce, need of confidentiality and respect for professional status of the HCW prevalence of susceptibility conditions, rights and duties of stakeholders. The most significant result was the request by the Lombardy Region for more quality in risk assessment and health surveillance; to maintain uniform conduct over all the local health authorities, to allow the board in charge of examining appeals against FFW to fully cooperate with the occupational physician; due attention to the person/worker; the opportunity to convene referral boards for complex FFW management; the challenge of stress management and the need for an observatory for psychological discomforts; the importance of the ICOH Code of Ethics and avoidance of conflicts of interests; the need for individual risk assessment and risk management; the concept of sharing responsibilities and of a real multidisciplinary approach.
KIETZMAN, KATHRYN G.; TROY, LISA M.; GREEN, CARMEN R.; WALLACE, STEVEN P.
Policy-level changes have a significant influence on the health and well-being of aging populations. Yet there is often a gap between scientific knowledge and policy action. Although previous research has identified barriers and facilitators to effective knowledge translation, little attention has been given to the role of academic institutions in knowledge generation. This exploratory focus group study examines barriers and pathways to developing and maintaining an aging policy-relevant research agenda in academic settings, and additional challenges associated with minority group membership in this pursuit. Participants were personally committed to conducting policy-relevant research despite institutional barriers such as fewer funding opportunities and less value attributed to their research, particularly in the context of tenure and promotion. Although many viewed their research as an opportunity to make a difference, especially for underserved older adult populations, a number of minority group participants expressed that their policy research interests were marginalized. Participants offer individual and institutional-level strategies for addressing barriers, including collaborating with community members and colleagues and engaging mentors within and outside of their academic institutions. Reframing the valuation of policy research through the diversification of funding and publishing opportunities can better support scholars engaged in aging policy-relevant research. PMID:26849290
Kietzman, Kathryn G; Troy, Lisa M; Green, Carmen R; Wallace, Steven P
Policy-level changes have a significant influence on the health and well-being of aging populations. Yet there is often a gap between scientific knowledge and policy action. Although previous research has identified barriers and facilitators to effective knowledge translation, little attention has been given to the role of academic institutions in knowledge generation. This exploratory focus group study examines barriers and pathways to developing and maintaining an aging policy-relevant research agenda in academic settings, and additional challenges associated with minority group membership in this pursuit. Participants were personally committed to conducting policy-relevant research despite institutional barriers such as fewer funding opportunities and less value attributed to their research, particularly in the context of tenure and promotion. Although many viewed their research as an opportunity to make a difference, especially for underserved older adult populations, a number of minority group participants expressed that their policy research interests were marginalized. Participants offer individual and institutional-level strategies for addressing barriers, including collaborating with community members and colleagues and engaging mentors within and outside of their academic institutions. Reframing the valuation of policy research through the diversification of funding and publishing opportunities can better support scholars engaged in aging policy-relevant research.
Bartlett, H P; Phillips, D R
"Although the U.K.'s population is not predicted to grow very much in the future, the population structure is changing and there is a shift towards a much older age distribution. The characteristics of demographic aging in the U.K. include a marked reduction in fertility rates, increasing rates of life expectation at birth..., increasing dependency ratios and variations in mortality and social class in old age. The U.K.'s demographic context has important implications for aged care policy and planning. This paper documents the demographic trends, reviews recent major policy changes and their impact on care provision, and discusses some of the emerging implementation issues that challenge the potential of such policies to meet the needs of an aging population."
Vandell, Deborah Lowe; Belsky, Jay; Burchinal, Margaret; Steinberg, Laurence; Vandergrift, Nathan
Relations between nonrelative child care (birth to 4(1/2) years) and functioning at age 15 were examined (N = 1,364). Both quality and quantity of child care were linked to adolescent functioning. Effects were similar in size as those observed at younger ages. Higher quality care predicted higher cognitive-academic achievement at age 15, with escalating positive effects at higher levels of quality. The association between quality and achievement was mediated, in part, by earlier child-care effects on achievement. High-quality early child care also predicted youth reports of less externalizing behavior. More hours of nonrelative care predicted greater risk taking and impulsivity at age 15, relations that were partially mediated by earlier child-care effects on externalizing behaviors.
Lui, Kai Yan Grace; Holyoke, Paul
The benefits of Person- and Family-Centred Care (PFCC) are well documented, and many healthcare organizations have expressed their commitment to take this approach. Yet, it can be a difficult endeavour, with common barriers identified at the point-of-care, organizational and system levels. We implemented a PFCC education program with healthcare leaders, providers, and support staff working in home, community, and long-term care organizations across Canada. Focus groups were then conducted with almost 200 workshop participants and 20 long-term care home residents and family members. Five key opportunities for healthcare leaders to better support the provision of PFCC were revealed. In this article, specific recommendations from focus group participants for addressing each of these five opportunities are provided. These findings can assist healthcare leaders to proactively ensure the supports and processes are in place to enable staff to provide care in a more person- and family-centred way.
Badawi, Dalia; Saleh, Shadi; Natafgi, Nabil; Mourad, Yara; Behbehani, Kazem
Diabetes Mellitus is one of the major public health challenges, affecting more than 347 million adults worldwide. The impact of diabetes necessitates assessing the quality of care received by people with diabetes, especially in countries with a significant diabetes burden such as Kuwait. This paper aimed at piloting an approach for measuring Type II diabetes care performance through the use of a diabetes quality indicator set (DQIS) in primary health care. The DQIS for Kuwait was adapted from that developed by the National Diabetes Quality Improvement Alliance and the International Diabetes Federation. Five key care domains/measures were employed: (1) Blood glucose level measurement, (2) Cholesterol level measurement, (3) Blood pressure measurement, (4) Kidney function testing and (5) Smoking status check. The sample included the four major primary health care centers with the highest case load in Kuwait City, 4,241 patients in 2012 and 3,211 in 2010. Findings revealed the applicability and utility of employing performance indicators for diabetes care in Kuwait. Furthermore, findings revealed that many of the primary health care centers have achieved noteworthy improvement in diabetes care between 2010 and 2012, with the exception of smoking status check. The DQIS can help policymakers identify performance gaps and investigate key system roadblocks related to diabetes care in Kuwait. PMID:26176691
Badawi, Dalia; Saleh, Shadi; Natafgi, Nabil; Mourad, Yara; Behbehani, Kazem
Diabetes Mellitus is one of the major public health challenges, affecting more than 347 million adults worldwide. The impact of diabetes necessitates assessing the quality of care received by people with diabetes, especially in countries with a significant diabetes burden such as Kuwait. This paper aimed at piloting an approach for measuring Type II diabetes care performance through the use of a diabetes quality indicator set (DQIS) in primary health care. The DQIS for Kuwait was adapted from that developed by the National Diabetes Quality Improvement Alliance and the International Diabetes Federation. Five key care domains/measures were employed: (1) Blood glucose level measurement, (2) Cholesterol level measurement, (3) Blood pressure measurement, (4) Kidney function testing and (5) Smoking status check. The sample included the four major primary health care centers with the highest case load in Kuwait City, 4,241 patients in 2012 and 3,211 in 2010. Findings revealed the applicability and utility of employing performance indicators for diabetes care in Kuwait. Furthermore, findings revealed that many of the primary health care centers have achieved noteworthy improvement in diabetes care between 2010 and 2012, with the exception of smoking status check. The DQIS can help policymakers identify performance gaps and investigate key system roadblocks related to diabetes care in Kuwait.
Background The subject site (Ian George Court) caters for clients from a socially disadvantaged background. All clients have been homeless or at risk of homelessness and have a history of alcohol and substance abuse often linked to mental health issues. This project was developed to examine if the site provided best practice in the promotion of smoking cessation. Objectives The first objective of this project was to improve client knowledge to make informed choice about smoking cessation, ensuring that client advice was given in line with best available evidence and assist the client in accessing community programs. The second objective was to fully review the current assessment tool used in relation to gathering baseline data about smoking habits and act on the information provided. Search strategy The search strategy sought to find published studies and papers. An initial limited search of MEDLINE and CINAHL was undertaken followed by an analysis of the text words contained in the title and abstract. A second extensive search was then undertaken using all identified keywords. Conclusion A smoking assessment tool was developed and is now in use across all Anglicare sites in South Australia. This provides staff with consistent baseline information and offers evidence-based health care in a package format to aid clients in smoking cessation.
Mohd Suki, Norazah; Chwee Lian, Jennifer Chiam; Suki, Norbayah Mohd
In today's highly competitive health care environment, many private health care settings are now looking into customer service indicators to learn customers' perceptions and determine whether they are meeting customers' expectations in order to ensure that their customers are satisfied with the services. This research paper aims to investigate whether the human elements were more important than the nonhuman elements in private health care settings. We used the internationally renowned SERVQUAL five-dimension model plus three additional dimensions-courtesy, communication, and understanding of customers of the human element-when evaluating health care services. A total of 191 respondents from three private health care settings in the Klang Valley region of Malaysia were investigated. Descriptive statistics were calculated by the Statistical Package for Social Sciences (SPSS) computer program, version 15. Interestingly, the results suggested that customers nowadays have very high expectations especially when it comes to the treatment they are receiving. Overall, the research indicated that the human elements were more important than the nonhuman element in private health care settings. Hospital management should look further to improve on areas that have been highlighted. Implications for management practice and directions for future research are discussed.