Abstract: The role of place has emerged as an important factor in determining people’s health experiences. Rural populations experience an excess in mortality and morbidity compared to those in urban settings. One of the factors thought to contribute to this rural-urban health disparity is access to healthcare. The objective of this analysis was to examine access to specialized medical care services and several possible determinants of access to services in a distinctly rural population in Canada. In winter 2010, we conducted a baseline mail survey of 11,982 households located in rural Saskatchewan, Canada. We obtained 4620 completed household surveys. A key informant for each household responded to questions about access to medical specialists and the exact distance traveled to these services. Correlates of interest included the location of the residence within the province and within each household, socioeconomic status, household smoking status, median age of household residents, number of non-respiratory chronic conditions and number of current respiratory conditions. Analyses were conducted using log binomial regression for the outcome of interest. The overall response rate was 52%. Of households who required a visit to a medical specialist in the past 12 months, 23% reported having difficulty accessing specialist care. The magnitude of risk for encountering difficulty accessing medical specialist care services increased with the greatest distance categories. Accessing specialist care professionals by rural residents was particularly difficult for persons with current respiratory conditions.
Abstract: Objective: There is still little evidence regarding the type of mattress that is the best for preventing pressure ulcers (PUs). In a Dutch nursing home, a new type of overlay mattress (air inflated visco-elastic foam) was tested to analyze the opportunity for replacement of the normally used static air overlay mattress in its three-step PU prevention protocol In this small pilot the outcome measures were: healing of a category one pressure ulcer, new development or deterioration of a category one PU and need for repositioning. Methods: We included 20 nursing home residents with a new category one pressure ulcer, existing for no longer than 48 h following a consecutive sampling technic. All residents were staying for more than 30 days in the nursing home and were lying on a visco-elastic foam mattress without repositioning (step one of the 3-step protocol) at the start of the pilot study. They had not suffered from a PU in the month before. The intervention involved use of an air inflated foam overlay instead of a static air overlay (normally step 2 of the 3-step protocol). At the start; the following data were registered: age; gender; main diagnosis and presence of incontinence. Thereafter; all participating residents were checked weekly for PU healing tendency; deterioration of PUs; new PUs and need of repositioning. Only when residents showed still a category one PU after 48 h or deterioration of an existing pressure ulcer or if there was development of a new pressure ulcer, repositioning was put into practice (step 3 of the PU protocol). All residents participated during 8 weeks. Results: Seven residents developed a new pressure ulcer category one and still had a category one pressure ulcer at the end of the study period. One resident developed a pressure ulcer category 2. Fifteen residents needed repositioning from one week after start of the study until the end of the study. Conclusions: Overall 40% of the residents developed a pressure ulcer. Seventy five percent of the residents started with repositioning because there was no healing tendency of their category one PU diagnosed at the start of the pilot. Because this new type of overlay mattress resulted in an increased PU incidence, and almost standard need of repositioning with accompanied high costs, this type of overlay mattress gives no benefit above the traditional visco-elastic foam mattresses in combination with the originally used static air overlay.
Abstract: Long term health conditions either wholly or partly diet-related continue to increase. Although pharmacists and allied health professionals (AHPs) have a role in the management of patients with long term conditions, there is limited research exploring whether pharmacists and AHPs other than dietitians have a role in the delivery of dietary advice. This research aimed to explore their views regarding the provision of dietary advice to patients. The research involved a qualitative methodology utilising five uni-professional focus groups with a total of 23 participants. All groups considered the provision of dietary advice in the context of their own professional roles, discussed issues relating to referral to the dietitian for specialist advice and most discussed the need for written information. Interprofessional and collaborative working is needed to maximise the role in the delivery of dietary advice, access to evidence based nutritional information and utlisation of referral pathways across pharmacists and AHPs to ensure the timely provision of nutritional advice to patients. There is a potential role for dietitians to take the lead and further research should focus on this area.
Abstract: An increasing proportion of healthcare resources in the United States are directed toward an expanding group of complex and multimorbid patients. Federal stakeholders have called for new models of care to meet the needs of these patients. Minimally Disruptive Medicine (MDM) is a theory-based, patient-centered, and context-sensitive approach to care that focuses on achieving patient goals for life and health while imposing the smallest possible treatment burden on patients’ lives. The MDM Care Model is designed to be pragmatically comprehensive, meaning that it aims to address any and all factors that impact the implementation and effectiveness of care for patients with multiple chronic conditions. It comprises core activities that map to an underlying and testable theoretical framework. This encourages refinement and future study. Here, we present the conceptual rationale for and a practical approach to minimally disruptive care for patients with multiple chronic conditions. We introduce some of the specific tools and strategies that can be used to identify the right care for these patients and to put it into practice.
Abstract: The outbreak of an emerging infectious disease of zoonotic origin has exposed the weaknesses in the health systems of the nations affected. The purpose of this paper was to explore the political economy of the existing outcome of the management strategies. In addition, it proposed a new strategy in the management of the current Ebola virus disease (EVD) outbreak. This paper admits that the current management strategy which is a top to bottom approach has not worked in reducing the spread of the disease. Instead of waiting for the disease before treatment is commenced, this paper suggests aggressively preventing infection from the EVD. It presents a bottom to top approach where there is individual ownership and community ownership in the prevention and control of the EVD outbreak. In addition, the paper presents the socio-economic situation of the three most affected countries including the ecology and stigmatization of EVD. It highlights the need for cross border surveillance across the West African nations to prevent importation of the disease as occurred in Nigeria and Senegal. It points out the need for aggressive international cooperation, an aggressive prevention and a sustainable control strategy.
Abstract: Evidence of technological performance, medical improvements and economic effectiveness is generally considered sufficient for judging advances in healthcare. In this paper, I aim to add knowledge about the ways human emotions and professional relations play roles in the processes of accommodating new technologies for quality improvements. A newly-implemented, web-based ulcer record service for patients with chronic skin ulcers constitutes the case. After one year, only a few home care nurses were using the service, interacting with a specialist team. The result was disappointing, but the few users were enthusiastic. An explorative, qualitative study was initiated to understand the users, the processes that accounted for use and how improvements were enacted. In the paper, I expose the emotional aspects of the record accommodation by analyzing the ways emotions were translated in the process and how they influenced the improvements. I contend that use came about through a heterogeneous assemblage of ethical engagement and compassionate emotions stemming from frustration, combined with technological affordances and relations between different professionals. Certain aspects of the improvements are exposed. These are discussed as: (1) reconciliations between the medical facts and rational judgments, on one side, and the emotional and subjective values for judging quality, on the other; and (2) mediation between standardized and personalized care. The healing of ulcers was combined with a sense of purpose and wellbeing to validate improvements. Emotions were strongly involved, and the power of evaluative emotions and professional relations should be further explored to add to the understanding of innovation processes and to validate quality improvements.