Achieving integrated care for older people: shuffling the deckchairs or making the system watertight for the future?

ePublished: 3 January 2018Integrated care has been recognised as a key initiative to resolve the issues surrounding care for older people living with multi-morbidity. Multiple strategies and policies have been implemented to increase coordination of care globally however, evidence of effectiveness remains mixed. The reasons for this are complex and multi-factorial, yet many strategies deal with parts of the problem rather than taking a whole systems view with the older person clearly at the centre. This approach of fixing parts of the system may be akin to shuffling the deckchairs on the Titanic, rather than dealing with the fundamental reasons why the ship is sinking. Attempts to make the ship more watertight need to be firmly centred on the older person, pay close attention to implementation and embrace approaches that promote collaborative working between all the stakeholders involved.Gill Harvey, Joanne Dollard, Amy Marshall, Manasi Murthy Mittint

Scattering into Cones and Flux across Surfaces in Quantum Mechanics: a Pathwise Probabilistic Approach

We show how the scattering-into-cones and flux-across-surfaces theorems in Quantum Mechanics have very intuitive pathwise probabilistic versions based on some results by Carlen about large time behaviour of paths of Nelson diffusions. The quantum mechanical results can be then recovered by taking expectations in our pathwise statements.Comment: To appear in Journal of Mathematical Physic

Fermi-Walker gauge in 2+1 dimensional gravity.

It is shown that the Fermi-Walker gauge allows the general solution of determining the metric given the sources, in terms of simple quadratures. We treat the general stationary problem providing explicit solving formulas for the metric and explicit support conditions for the energy momentum tensor. The same type of solution is obtained for the time dependent problem with circular symmetry. In both cases the solutions are classified in terms of the invariants of the Wilson loops outside the sources. The Fermi-Walker gauge, due to its physical nature, allows to exploit the weak energy condition and in this connection it is proved that, both for open and closed universes with rotational invariance, the energy condition imply the total absence of closed time like curves. The extension of this theorem to the general stationary problem, in absence of rotational symmetry is considered. At present such extension is subject to some assumptions on the behavior of the determinant of the dreibein in this gauge. PACS number: 0420Comment: 28 pages, RevTex, no figure

Scattering theory for arbitrary potentials

The fundamental quantities of potential scattering theory are generalized to accommodate long-range interactions. New definitions for the scattering amplitude and wave operators valid for arbitrary interactions including potentials with a Coulomb tail are presented. It is shown that for the Coulomb potential the generalized amplitude gives the physical on-shell amplitude without recourse to a renormalization procedure.Comment: To be published in Phys Rev

Tunneling times with covariant measurements

We consider the time delay of massive, non-relativistic, one-dimensional particles due to a tunneling potential. In this setting the well-known Hartman effect asserts that often the sub-ensemble of particles going through the tunnel seems to cross the tunnel region instantaneously. An obstacle to the utilization of this effect for getting faster signals is the exponential damping by the tunnel, so there seems to be a trade-off between speedup and intensity. In this paper we prove that this trade-off is never in favor of faster signals: the probability for a signal to reach its destination before some deadline is always reduced by the tunnel, for arbitrary incoming states, arbitrary positive and compactly supported tunnel potentials, and arbitrary detectors. More specifically, we show this for several different ways to define ``the same incoming state'' and ''the same detector'' when comparing the settings with and without tunnel potential. The arrival time measurements are expressed in the time-covariant approach, but we also allow the detection to be a localization measurement at a later time.Comment: 12 pages, 2 figure

Stakeholders' perspectives of mobile x-ray services in support of healthcare-in-place in residential aged care facilities: a qualitative study

Background: There is interest in reducing avoidable emergency department presentations from residential aged care facilities (RACF). Mobile x-ray services may enable the delivery of healthcare in residential aged care facilities. Accordingly, the Australian Government in November 2019 introduced a Medicare Benefit Schedule rebate providing for a ‘call-out’ fee payable to radiology service providers. This study aims to understand stakeholder perspectives on the benefits of mobile x-ray services and the factors influencing their adoption by RACFs. Design, setting, participants: Twenty-two semi-structured interviews were conducted between October 2020 and February 2021 with a range of stakeholders involved in healthcare delivery to residents: a) general practitioners; b) emergency department clinicians; c) paramedic clinicians; d) a hospital avoidance clinician; e) radiology clinicians and managers; and f ) aged care clinicians and managers. Thematic analysis was conducted. Results: Mobile x-ray services were considered valuable for RACF residents. Lack of timely general practitioner in person assessment and referral, as well as staffing deficits in residential aged care facilities, reduces optimal use of mobile x-ray services and results in potentially unnecessary hospital transfers. Conclusions: The use of mobile x-ray services, as a hospital avoidance strategy, depends on the capacity of RACFs to provide more complex healthcare-in-place. However, this requires greater access to general practitioners for in-person assessment and referral, adequate staffing numbers and appropriately skilled nursing staff within residential aged care facilities.Joanne Dollard, Jane Edwards, Lalit Yadav, Virginie Gaget, David Tivey, Maria Inacio, Guy Maddern, and Renuka Visvanatha

A powerful intervention: general practitioners' use of sickness certification in depression

<b>Background</b> Depression is frequently cited as the reason for sickness absence, and it is estimated that sickness certificates are issued in one third of consultations for depression. Previous research has considered GP views of sickness certification but not specifically in relation to depression. This study aimed to explore GPs views of sickness certification in relation to depression.<p></p> <b>Methods</b> A purposive sample of GP practices across Scotland was selected to reflect variations in levels of incapacity claimants and antidepressant prescribing. Qualitative interviews were carried out between 2008 and 2009.<p></p> <b>Results</b> A total of 30 GPs were interviewed. A number of common themes emerged including the perceived importance of GP advocacy on behalf of their patients, the tensions between stakeholders involved in the sickness certification system, the need to respond flexibly to patients who present with depression and the therapeutic nature of time away from work as well as the benefits of work. GPs reported that most patients with depression returned to work after a short period of absence and that it was often difficult to predict which patients would struggle to return to work.<p></p> <b>Conclusions</b> GPs reported that dealing with sickness certification and depression presents distinct challenges. Sickness certificates are often viewed as powerful interventions, the effectiveness of time away from work for those with depression should be subject to robust enquiry

On some aspects of the definition of scattering states in quantum field theory

The problem of extending quantum-mechanical formal scattering theory to a more general class of models that also includes quantum field theories is discussed, with the aim of clarifying certain aspects of the definition of scattering states. As the strong limit is not suitable for the definition of scattering states in quantum field theory, some other limiting procedure is needed. Two possibilities are considered, the abelian limit and adiabatic switching. Formulas for the scattering states based on both methods are discussed, and it is found that generally there are significant differences between the two approaches. As an illustration of the application and the features of these formulas, S-matrix elements and energy corrections in two quantum field theoretical models are calculated using (generalized) old-fashioned perturbation theory. The two methods are found to give equivalent results.Comment: 20 page

We are all one together : peer educators\u27 views about falls prevention education for community-dwelling older adults - a qualitative study

Background: Falls are common in older people. Despite strong evidence for effective falls prevention strategies, there appears to be limited translation of these strategies from research to clinical practice. Use of peers in delivering falls prevention education messages has been proposed to improve uptake of falls prevention strategies and facilitate translation to practice. Volunteer peer educators often deliver educational presentations on falls prevention to community-dwelling older adults. However, research evaluating the effectiveness of peer-led education approaches in falls prevention has been limited and no known study has evaluated such a program from the perspective of peer educators involved in delivering the message. The purpose of this study was to explore peer educators’ perspective about their role in delivering peer-led falls prevention education for community-dwelling older adults. Methods: A two-stage qualitative inductive constant comparative design was used.In stage one (core component) focus group interviews involving a total of eleven participants were conducted. During stage two (supplementary component) semi-structured interviews with two participants were conducted. Data were analysed thematically by two researchers independently. Key themes were identified and findings were displayed in a conceptual framework. Results: Peer educators were motivated to deliver educational presentations and importantly, to reach an optimal peer connection with their audience. Key themes identified included both personal and organisational factors that impact on educators’ capacity to facilitate their peers’ engagement with the message. Personal factors that facilitated message delivery and engagement included peer-to-peer connection and perceived credibility, while barriers included a reluctance to accept the message that they were at risk of falling by some members in the audience. Organisational factors, including ongoing training for peer educators and formative feedback following presentations, were perceived as essential because they affect successful message delivery. Conclusions: Peer educators have the potential to effectively deliver falls prevention education to older adults and influence acceptance of the message as they possess the peer-to-peer connection that facilitates optimal engagement. There is a need to consider incorporating learnings from this research into a formal large scale evaluation of the effectiveness of the peer education approach in reducing falls in older adults