72 research outputs found
Evaluating the Implementation and Feasibility of a WebBased Tool to Support Timely Identification and Care for the Frail Population in Primary Healthcare Settings
Background: Understanding and addressing the needs of frail persons is an emerging health priority for Nova Scotia
and internationally. Primary healthcare (PHC) providers regularly encounter frail persons in their daily clinical work.
However, routine identification and measurement of frailty is not standard practice and, in general, there is a lack
of awareness about how to identify and respond to frailty. A web-based tool called the Frailty Portal was developed
to aid in identifying, screening, and providing care for frail patients in PHC settings. In this study, we will assess
the implementation feasibility and impact of the Frailty Portal to: (1) support increased awareness of frailty among
providers and patients, (2) identify the degree of frailty within individual patients, and (3) develop and deliver actions
to respond to frailtyl in community PHC practice.
Methods: This study will be approached using a convergent mixed method design where quantitative and qualitative
data are collected concurrently, in this case, over a 9-month period, analyzed separately, and then merged to summarize,
interpret and produce a more comprehensive understanding of the initiativeâs feasibility and scalability. Methods will
be informed by the âImplementing the Frailty Portal in Community Primary Care Practiceâ logic model and questions
will be guided by domains and constructs from an implementation science framework, the Consolidated Framework
for Implementation Research (CFIR).
Discussion: The âFrailty Portalâ aims to improve access to, and coordination of, primary care services for persons
experiencing frailty. It also aims to increase primary care providersâ ability to care for patients in the context of their
frailty. Our goal is to help optimize care in the community by helping community providers gain the knowledge they
may lack about frailty both in general and in their practice, support improved identification of frailty with the use of
screening tools, offer evidence based severity-specific care goals and connect providers with local available community
supports
How does Canada stack up? A bibliometric analysis of the primary healthcare electronic medical record literature
Background Major initiatives are underway in Canada which are designed to increase electronic medical record (EMR) implementation and maximise its use in primary health care. These developments need to be supported by sufficient evidence from the literature, particularly relevant research conducted in the Canadian context.Objectives This study sought to quantify this lack of research by: (1) identifying and describing the primary health care EMR literature; and (2) comparing the Canadian and international primary healthcare EMR literature on the basis of content and publication levels.Methods Seven bibliographic databases were searched using primary health care and EMR keywords. Publication abstracts were reviewed and categorised. First author affiliation was used to identify country of origin. Proportions of Canadian- and non-Canadian-authored publications were compared using Fisherâs exact test. For countries having 10 or more primary healthcare EMR publications, publications per 10 000 researchers were calculated.Results After exclusions, 750 publications were identified. More than one-third used primary healthcare EMRs as a study data source. Twenty-two (3%) were Canadian-authored. There were significantly different publication levels in three categories between Canadian- and non-Canadian-authored publications. Based on publications per researchers, the Netherlands ranked first, while Canada ranked eighth of nine countries with 10 or more publications.Conclusions A relatively small body of literature focused on EMRs in primary health care exists; publications by Canadian authors were low. This study highlights the need to develop a strong evidence base to support the effective implementatio
Improving Care for the Frail in Nova Scotia: An Implementation Evaluation of a Frailty Portal in Primary Care Practice
Abstract
Background: Understanding and addressing the needs of frail patients has been identified as an important strategy by
the Nova Scotia Health Authority (NSHA). Primary care (PC) providers are in a key position to aid in the identification
of, and response to frailty as part of routine care. Unlike singular chronic conditions such as diabetes and hypertension
which garner a disease-based approach and identification as part of standard practice, frailty is only just emerging as a
concept for PC. The web-based Frailty Portal was developed to aid in the identification of, assessment and care planning
for frail patients in PC practice. In this study we assess the implementation feasibility and impact of the Frailty Portal
by: (1) identifying factors influencing the Frailty Portalâs use in community PC practice, and (2) examination of the
immediate impact of the âFrailty Portalâ on frail patients, their caregivers and PC providers.
Methods: A convergent mixed method approach was implemented among PC providers in community-based practice in
the NSHA, Central Zone. Quantitative and qualitative data were collected concurrently over a 9-month period. A sample
of patients who underwent assessment and/or their caregiver were approached for survey participation.
Results: Fourteen community PC providers (10 family physicians, 4 nurse practitioners) completed 48 patient assessments
and completed or begun 41 care plans; semi-structured interviews were conducted among 9 providers. Nine patients
and 5 caregivers participated in the survey. PC providers viewed frailty as an important concept but implementation
challenges were met, primarily with respect to the time required for use and lack of fit with traditional practice routines.
Additional barriers included tool usability and accessibility, training and care planning steps, and privacy. Impacts of the
tools use with respect to confidence and knowledge showed early promise.
Conclusion: This feasibility study highlights the need for added health system supports, resources and financial incentives
for successful implementation of the Frailty Portal in community PC practice. We suggest future implementation
integrate the Frailty Portal to practice electronic medical records (EMRs) and target providers with largely geriatric
practice populations and those practicing within interdisciplinary, collaborative primary healthcare (PHC) teams
Modelling interactions of acidâbase balance and respiratory status in the toxicity of metal mixtures in the American oyster Crassostrea virginica
Author Posting. © The Author(s), 2009. This is the author's version of the work. It is posted here by permission of Elsevier B.V. for personal use, not for redistribution. The definitive version was published in Comparative Biochemistry and Physiology - Part A: Molecular & Integrative Physiology 155 (2010): 341-349, doi:10.1016/j.cbpa.2009.11.019.Heavy metals, such as copper, zinc and cadmium, represent some of the most common and
serious pollutants in coastal estuaries. In the present study, we used a combination of linear and
artificial neural network (ANN) modelling to detect and explore interactions among low-dose
mixtures of these heavy metals and their impacts on fundamental physiological processes in
tissues of the Eastern oyster, Crassostrea virginica. Animals were exposed to Cd (0.001 â 0.400
ÎŒM), Zn (0.001 â 3.059 ÎŒM) or Cu (0.002 â 0.787 ÎŒM), either alone or in combination for 1 to
27 days. We measured indicators of acid-base balance (hemolymph pH and total CO2), gas
exchange (Po2), immunocompetence (total hemocyte counts, numbers of invasive bacteria),
antioxidant status (glutathione, GSH), oxidative damage (lipid peroxidation; LPx), and metal
accumulation in the gill and the hepatopancreas. Linear analysis showed that oxidative
membrane damage from tissue accumulation of environmental metals was correlated with
impaired acid-base balance in oysters. ANN analysis revealed interactions of metals with
hemolymph acid-base chemistry in predicting oxidative damage that were not evident from
linear analyses. These results highlight the usefulness of machine learning approaches, such as
ANNs, for improving our ability to recognize and understand the effects of sub-acute exposure to
contaminant mixtures.This study was supported by NOAAâs Center of Excellence in Oceans and Human Health at HML and the National Science Foundation
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