Uncovering treatment burden as a key concept for stroke care: a systematic review of qualitative research

<b>Background</b> Patients with chronic disease may experience complicated management plans requiring significant personal investment. This has been termed ‘treatment burden’ and has been associated with unfavourable outcomes. The aim of this systematic review is to examine the qualitative literature on treatment burden in stroke from the patient perspective.<p></p> <b>Methods and findings</b> The search strategy centred on: stroke, treatment burden, patient experience, and qualitative methods. We searched: Scopus, CINAHL, Embase, Medline, and PsycINFO. We tracked references, footnotes, and citations. Restrictions included: English language, date of publication January 2000 until February 2013. Two reviewers independently carried out the following: paper screening, data extraction, and data analysis. Data were analysed using framework synthesis, as informed by Normalization Process Theory. Sixty-nine papers were included. Treatment burden includes: (1) making sense of stroke management and planning care, (2) interacting with others, (3) enacting management strategies, and (4) reflecting on management. Health care is fragmented, with poor communication between patient and health care providers. Patients report inadequate information provision. Inpatient care is unsatisfactory, with a perceived lack of empathy from professionals and a shortage of stimulating activities on the ward. Discharge services are poorly coordinated, and accessing health and social care in the community is difficult. The study has potential limitations because it was restricted to studies published in English only and data from low-income countries were scarce.<p></p> <b>Conclusions</b> Stroke management is extremely demanding for patients, and treatment burden is influenced by micro and macro organisation of health services. Knowledge deficits mean patients are ill equipped to organise their care and develop coping strategies, making adherence less likely. There is a need to transform the approach to care provision so that services are configured to prioritise patient needs rather than those of health care systems

Information systems and healthcare XXIV: Factors affecting the EAI adoption in the healthcare sector

Recent developments in the field of integration technologies like Enterprise Application Integration (EAI) have emerged to support organizations towards improving the quality of services and reducing integration costs. Despite the importance of EAI, there is limited empirical research reported on its adoption in the healthcare sector. Khoumbati et al. [2006] developed a model for the evaluation of EAI in healthcare organizations. In doing so, the causal interrelationship of EAI adoption factors was identified by using fuzzy cognitive mapping. This paper is a progression of previous work in the area and seeks to contribute by validating the model through a different case environment. Thus, this paper contributes by deriving and proposing the MAESTRO model for EAI adoption. MAESTRO identifies a set of factors that influence EAI adoption and it is evaluated through a real-life case study. It provides an understanding of the EAI adoption process through its grounding on empirical data. In doing so, the MAESTRO model supports the management of healthcare organizations during the decision-making process for EAI adoption

Controlling nosocomial infection based on structure of hospital social networks

Nosocomial infection raises a serious public health problem, as implied by the existence of pathogens characteristic to healthcare and hospital-mediated outbreaks of influenza and SARS. We simulate stochastic SIR dynamics on social networks, which are based on observations in a hospital in Tokyo, to explore effective containment strategies against nosocomial infection. The observed networks have hierarchical and modular structure. We show that healthcare workers, particularly medical doctors, are main vectors of diseases on these networks. Intervention methods that restrict interaction between medical doctors and their visits to different wards shrink the final epidemic size more than intervention methods that directly protect patients, such as isolating patients in single rooms. By the same token, vaccinating doctors with priority rather than patients or nurses is more effective. Finally, vaccinating individuals with large betweenness centrality is superior to vaccinating ones with large connectedness to others or randomly chosen individuals, as suggested by previous model studies. [The abstract of the manuscript has more information.]Comment: 12 figures, 2 table

Taking what we have and making what we need: Utilizing Natural Helping Support Networks to decrease self directed violence among Adolescents of Color.

Previous research has linked family and community connectedness with decreased risk of self-directed violence among adolescents. Despite the strong correlation between social connectedness and lowered risk of self-directed violence, very few interventions use social connections as mediators. This article identifies the risk and protective factors associated with self-directed violence among adolescents of color. In alignment with Healthy People 2020, this paper highlights the social determinants of self-directed violence including factors associated with individual’s social and physical environments. The authors provide an interdisciplinary review of current trends and historical data on self-directed violence in adolescents of color. The researchers suggest, the lack of culturally appropriate interventions, mental illness and the complex nature of social constructs in communities of color, makes solving the problem of self-directed violence difficult. This article examines how informal helpers can be utilized as an intervention to decrease health disparities experienced by adolescents of Color in the area of self-directed violence. The authors conclude that adolescents of Color are more likely to attempt to access support for mental/emotional concerns from members of their informal helping network before interacting with formal services. This paper offers a theoretical framework for creating culturally tailored strategies that utilizes informal helping networks. The proposed framework focuses on empowering and increasing education and knowledge about self-directed violence within the informal helping network while providing social and emotional support to adolescents of color

An evaluation of a nurse led unit: an action research study

This study is an exemplar of working in a participatory way with members of the public and health and social care practitioners as co-researchers. A Nurse Consultant Older People working in a nurse-led bed, intermediate care facility in a community hospital acted as joint project lead with an academic researcher. From the outset, members of the public were part of a team of 16 individuals who agreed an evaluation focus and were involved in all stages of the research process from design through to dissemination. An extensive evaluation reflecting all these stakeholders’ preferences was undertaken. Methods included research and audit including: patient and carer satisfaction questionnaire surveys, individual interviews with patients, carers and staff, staff surveys, graffiti board, suggestion box, first impressions questionnaire, patient tracking and a bed census. A key aim of the study has been capacity building of the research team members which has also been evaluated. In terms of impact, the co-researchers have developed research skills and knowledge, grown in confidence, developed in ways that have impacted elsewhere in their lives, developed posters, presented at conferences and gained a better understanding of the NHS. The evaluation itself has provided useful information on the processes and outcomes of intermediate care on the ward which was used to further improve the service

Banning open carry of unloaded handguns decreases firearm-related fatalities and hospital utilization.

BackgroundSince 1967, in California it has been illegal to openly carry a loaded firearm in public except when engaged in hunting or law enforcement. However, beginning January 1, 2012, public open carry of unloaded handguns also became illegal. Fatal and non-fatal (NF) firearm injuries were examined before and after adoption of the 2012 ban to quantify the effect of the new law on public health.MethodsState-level data were obtained directly from California and nine other US state inpatient and emergency department (ED) discharge databases, and the Centers for Disease Control Web-Based Injury Statistics Query and Reporting System. Case numbers of firearm fatalities, NF hospitalizations, NF ED visits, and state-level population estimates were extracted. Each incident was classified as unintentional, self-inflicted, or assault. Crude incidence rates were calculated. The strength of gun laws was quantified using the Brady grade. There were no changes to open carry in these nine states during the study. Using a difference-in-difference technique, the rate trends 3 years preban and postban were compared.ResultsThe 2012 open carry ban resulted in a significantly lower incident rate of both firearm-related fatalities and NF hospitalizations (p<0.001). The effect of the law remained significant when controlling for baseline state gun laws (p<0.001). Firearm incident rate drops in California were significant for male homicide (p=0.023), hospitalization for NF assault (p=0.021  male; p=0.025 female), and ED NF assault visits (p=0.04). No significant decreases were observed by sex for suicides or unintentional injury. Changing the law saved an estimated 337 lives (3.6% fewer deaths) and 1285 NF visits in California during the postban period.DiscussionOpen carry ban decreases fatalities and healthcare utilization even in a state with baseline strict gun laws. The most significant impact is from decreasing firearm-related fatal and NF assaults.Level of evidenceIII, epidemiology

Ears of the Armadillo: Global Health Research and Neglected Diseases in Texas

Neglected tropical diseases (NTDs) have\ud been recently identified as significant public\ud health problems in Texas and elsewhere in\ud the American South. A one-day forum on the\ud landscape of research and development and\ud the hidden burden of NTDs in Texas\ud explored the next steps to coordinate advocacy,\ud public health, and research into a\ud cogent health policy framework for the\ud American NTDs. It also highlighted how\ud U.S.-funded global health research can serve\ud to combat these health disparities in the\ud United States, in addition to benefiting\ud communities abroad

Explicating the role of partnerships in changing the health and well-being of local communities: a profile of neighbourhood renewal activity focused on promoting health and well-being in Salford and the north west region and the north east of England

This scoping and mapping report is one of three outputs from a project: Explicating the role of partnerships in changing the health and well-being of local communities, one of a number of projects in a larger Higher Education Funding Council Strategic Development Fund project ( HEFCE ) entitled: Urban Regeneration: Making a Difference. This was a collaborative venture between Manchester Metropolitan University, Northumbria University, University of Salford and University of Central Lancashire. Bradford University was an affiliated partner