A Computer-Based, Automated, Telephonic System to Monitor Patient Progress in the Home Setting

In this report we describe an automated, telephonic system to monitor the progress of patients convalescing at home. The system includes a computerized central station that is capable of automated voice communication over the telephone, using voice reproduction, and touch-tone recognition. Peripheral hardware in multiple monitored homes need include only a touch-tone telephone, but may also be augmented by inexpensive, rudimentary diagnostic aids, such as a scale for body weight, a thermometer, or a blood pressure cuff and manometer. Current central hardware includes a NeXT computer, a fax modem, and a specialized telecommunications modem developed specifically for voice telecommunication using the NeXT. The central station acts like a robotic nurse in that it asks patients a series of questions and records the responses. The subjective questions to be asked are patient individualized and pre-selected by the physician from a question menu including items targeted specifically for the patient\u27s disease or condition. In addition, clinical data such as body weight, blood pressure, and body temperature obtained from in-home diagnostic aids may be transmitted to the central station over the telephone using touch tones. The time-of-day and frequency of calling are pre-selectable, according to the patient\u27s preference and clinical status. Data obtained by the central station can be easily accessed by the duty nurse via menu driven software. Reports depicting significant responses as a function of time are generated in graphical format to facilitate rapid identification of adverse trends. Hard copy reports can be dispersed directly by fax. Results from a pilot study show patients with cardiac disease readily use the system without difficulty or complaints. In one patient a five pound increase in body weight was detected, which prompted the patient\u27s cardiologist to adjust his medication. In this way automated telephone follow-up can provide early detection of complications before they become severe, making the home environment safer and more secure for convalescence and contributing to reduced health-care costs

The rapid response system: an integrative review

© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. Background: Clinical deterioration and adverse events in hospitals is an increasing cause for concern. Rapid response systems have been widely implemented to identify deteriorating patients. Aim: We aimed to examine the literature highlighting major historical trends leading to the widespread adoption of rapid response systems, focussing on Australian issues and identifying future focus areas. Method: Integrative literature review including published and grey literature. Results: Seventy-eight sources including journal articles and Australian government matierlas resulted. Pertinent themes were the increasing acuity and aging of the population, importance of hospital cultures, the emerging role of the consumer, and proliferation, evolution and standardisation of rapid response systems. Discussion: Translating evidence to usual care practice is challenging and strongly driven by local factors and political imperatives. Conclusion: Rapid response systems are complex interventions requiring consideration of contextual factors at all levels. Appropriate resources, a skilled workforce and positive workplace cultures are needed for these systems to reach their full potential

An exploration of nursing professionals’ understanding of Autism Spectrum Disorder

Includes bibliographical references.The number of children diagnosed with autism spectrum disorder is increasing at an alarming rate. Research indicates that early identification and diagnosis is key in terms of children receiving early intervention. However, many children are not being identified as early as possible by their primary health care providers. This research investigated nursing professional’s experiences of working with autism spectrum disorder in a clinic setting. Using phenomenology theory as the epistemological framework, thematic analysis was conducted on ten in-depth interviews with nursing professionals working in the public sector. Three main groupings for the findings emerged from the interpretative analysis: 1) nursing professionals’ knowledge, understanding and awareness of autism spectrum disorder, 2) screening practices of nursing professionals; and 3) identified challenges in screening for autism spectrum disorder. Although the majority of the nursing professionals showed a good understanding of some aspects of the condition, there was some confusion about some key facts concerning the disorder, the characteristics of ASD and scientific terminology, and an inaccurate understanding of early intervention treatments. Nursing professionals’ screening efforts remain poor despite the diagnostic value of routine screening for early childhood developmental delays. Limited services and resources, a lack of communication between primary and secondary systems, time restrictions, work pressure and inadequate training are all barriers that prevent nursing professionals from conducting routine screening during child wellness visits, resulting in missed opportunities for detecting autism spectrum disorders in the early months or years. This research highlights the urgent need to look into strategies that would improve and support efforts for conducting early screening in primary health care clinics. Implications for future research in this area are also addressed

CLIAC

Publication date from document properties.cliac0905_summary.pdf20051134

Can cash transfer programs work in resource-poor countries?

Cash transfer programs are rare in Sub-Saharan Africa. This paper describes the evolution of a cash transfer program in major urban centers of Mozambique, from its inception in 1990 through two major reorganizations until October 1998. Appropriate design, strong multisectoral political support and adequate administrative capacity are critical factors determining the success of such programs. Key lessons applicable to other resource-poor countries designing social assistance programs are drawn, recommending adequate targeted support to truly destitute persons incapable of physical labor in urban areas where administrative costs are more manageable than in more isolated rural sites.Poverty. ,Rural population. ,Social service Mozambique. ,Subsidies. ,

Self-neglect and adult safeguarding: findings from research

This report was commissioned by the Department of Health (DH) and examines the concept of self-neglect. The relationship between self-neglect and safeguarding in the UK is a difficult one, partly because the current definition of abuse specifies harmful actions by someone other than the individual at risk. Safeguarding Adults Boards’ policies and procedures commonly contain no reference to self-neglect; occasionally they explicitly exclude it or set criteria for its inclusion The perceptions of people who neglect themselves have not been extensively researched, but where they have, emerging themes are pride in self-sufficiency, connectedness to place and possessions and behaviour that attempts to preserve continuity of identity and control. Traumatic histories and life-changing effects are also present in individuals’ own accounts of their situation. Self-neglect is reported mainly as occurring in older people, although it is also associated with mental ill health. Differentiation between inability and unwillingness to care for oneself, and capacity to understand the consequences of one’s actions, are crucial determinants of response. Professional tolerance of self-neglect as lifestyle choice is higher than when it accompanies physical/mental impairment. Professionals express uncertainty about causation and intervention