Knowledge Brokers, Companions, And Navigators: A Qualitative Examination Of Informal Caregivers\u27 Roles In Medical Tourism

Introduction Many studies examining the phenomena of medical tourism have identified health equity issues associated with this global health services practice. However, there is a notable lack of attention in this existing research to the informal care provided by the friends and family members who typically accompany medical tourists abroad. To date, researchers have not examined the care roles filled by informal caregivers travelling with medical tourists. In this article, we fill this gap by examining these informal caregivers and the roles they take on towards supporting medical tourists’ health and wellbeing. Methods We conducted 21 interviews with International Patient Coordinators (IPCs) working at medical tourism hospitals across ten countries. IPCs work closely with informal caregivers as providers of non-medical personal assistance, and can therefore offer broad insight on caregiver roles. The interviews were coded and analyzed thematically. Results Three roles emerged: knowledge broker, companion, and navigator. As knowledge brokers, caregivers facilitate the transfer of information between the medical tourist and formal health care providers as well as other staff members at medical tourism facilities. The companion role involves providing medical tourists with physical and emotional care. Meanwhile, responsibilities associated with handling documents and coordinating often complex journeys are part of the navigation role. Conclusions This is the first study to examine informal caregiving roles in medical tourism. Many of the roles identified are similar to those of conventional informal caregivers while others are specific to the transnational context. We conclude that these roles make informal caregivers an integral part of the larger phenomenon of medical tourism. We further contend that examining the roles taken on by a heretofore-unconsidered medical tourism stakeholder group sheds valuable insight into how this industry operates and that such knowledge is necessary in order to respond to the health equity debates that surround this particular global health services practice

A mentalistic account of teleology in biology

The thesis titled ‘A Mentalistic Account of Teleology in Biology’ is a philosophical account of teleological concepts within the context of biology. It explains the usefulness of teleological reasoning and the success of teleological predictions about organisms without positing the existence of mind-independent teleological properties or facts

Working as Civic and Patriotic Duty for Consumption: A Critical Discourse Analysis of American Presidential Inaugural Speeches Since World War II

Presidential speeches recycle and reify power to construct notions of citizenship, civic duty, and patriotism (Bostdorff 2003, Bostdorff and O’Rourke 1997, Loseke 2009, Murphy 2003). Previous research shows that Presidents use patriotism and civic duty to promote particular policies (Bostdorff and O’Rourke 1997, Coe et al. 2004) and war (Altheide 2004, Ivie 2005, Bostdorff 2003, Loseke 2009, Murphy 2003). Research also looks at how post-World War II (WWII) political culture and campaigning reflect a consumer society, either through how Presidents use consumption to promote a specific value (Altheide 2004, Bostdorff 2003) or how Presidents themselves symbolize branded commodities (Miller and Stiles 1986, Scammell 2007, Simonds 1989, Uricchio 2009 van Ham 2001, Vidich 1990, Zavattaro 2010). However, there is not much research examining how Presidential rhetoric connects consumption and economic values to civic duty and patriotism over time. Using Critical Discourse Analysis, I reviewed twenty inaugural speeches twelve Presidents delivered while in office since WWII to examine how they connect consumption and economic values to civic duty and patriotism. Presidential inaugural speeches from the 1930s-1950s emphasize collectivism and construct civic duty as working together to build a better America; expressing patriotism required citizens fulfill their civic duty and maintain strong work ethics. Presidential inaugural speeches from 1960s and 1970s emphasize collectivism and individualism and construct civic duty as an individual’s obligation to pursue an American Dream and as working together to help stabilize America’s economic system; expressing patriotism required citizens fulfill their civic duty and maintain independence from government assistance. Presidential inaugural speeches from the 1980s-mid 2000s emphasize individualism and construct civic duty as an individual’s obligation to work for the resources needed to consume and to develop community resources; expressing patriotism required citizens fulfill their civic duty by spending and serving their communities

Ethical and Legal Implications of the Risks of Medical Tourism for Patients: A Qualitative Study of Canadian Health and Safety Representatives’ Perspectives

Objectives Medical tourism involves patients’ intentional travel to privately obtain medical care in another country. Empirical evidence regarding health and safety risks facing medical tourists is limited. Consideration of this issue is dominated by speculation and lacks meaningful input from people with specific expertise in patient health and safety. We consulted with patient health and safety experts in the Canadian province of British Columbia to explore their views concerning risks that medical tourists may be exposed to. Herein, we report on the findings, linking them to existing ethical and legal issues associated with medical tourism. Design We held a focus group in September 2011 in Vancouver, British Columbia with professionals representing different domains of patient health and safety expertise. The focus group was transcribed verbatim and analysed thematically. Participants Seven professionals representing the domains of tissue banking, blood safety, health records, organ transplantation, dental care, clinical ethics and infection control participated. Results Five dominant health and safety risks for outbound medical tourists were identified by participants: (1) complications; (2) specific concerns regarding organ transplantation; (3) transmission of antibiotic-resistant organisms; (4) (dis)continuity of medical documentation and (5) (un)informed decision-making. Conclusions Concern was expressed that medical tourism might have unintended and undesired effects upon patients’ home healthcare systems. The individual choices of medical tourists could have significant public consequences if healthcare facilities in their home countries must expend resources treating postoperative complications. Participants also expressed concern that medical tourists returning home with infections, particularly antibiotic-resistant infections, could place others at risk of exposure to infections that are refractory to standard treatment regimens and thereby pose significant public health risks

Reliability of recommended non-invasive chairside screening tests for diabetes-related peripheral neuropathy : a systematic review with meta-analyses

The objective is to determine, by systematic review, the reliability of testing methods for diagnosis of diabetes-related peripheral neuropathy (DPN) as recommended by the most recent guidelines from the International Diabetes Foundation, International Working Group on the Diabetic Foot and American Diabetes Association. Electronic searches of Cochrane Library, EBSCO Megafile Ultimate and EMBASE were performed to May 2021. Articles were included if they reported on the reliability of recommended chairside tests in diabetes cohorts. Quality appraisal was performed using a Quality Appraisal of Reliability Studies checklist and where possible, meta-analyses, with reliability reported as estimated Cohen's kappa (95% CI). Seventeen studies were eligible for inclusion. Pooled analysis found acceptable inter-rater reliability of vibration perception threshold (VPT) (κ=0.61 (0.50 to 0.73)) and ankle reflex testing (κ=0.60 (0.55 to 0.64)), but weak inter-rater reliability for pinprick (κ=0.45 (0.22 to 0.69)) and 128 Hz tuning fork (κ=0.42 (0.15 to 0.70)), though intra-rater reliability of the 128 Hz tuning fork was moderate (κ=0.54 (0.37 to 0.73)). Inter-rater reliability of the four-site monofilament was acceptable (κ=0.61 (0.45 to 0.77)). These results support the clinical use of VPT, ankle reflexes and four-site monofilament for screening and ongoing monitoring of DPN as recommended by the latest guidelines. The reliability of temperature perception, pinprick, proprioception, three-site monofilament and Ipswich touch test when performed in people with diabetes remains unclear

Evaluating outcomes of medication-related interventions from the “Seniors At risk for Falls after Emergency Room visit” (SAFER) pilot project

Primary Author: Ling J. Zhan, PharmD Co-Authors: Sharon Leigh, PharmD BCPS, Mary Beth Kuebrich, MS, AGPCNP-BC, Clara Mikhaeil, PharmD, BCPS, Colleen M. Casey, PhD, ANP-BC Location: Providence Health & Services, Portland, Oregon Title: Evaluating outcomes of medication-related interventions from the “Seniors At risk for Falls after Emergency Room visit” (SAFER) pilot project Purpose: Falls are the leading cause of injury in older adults, resulting in decreased mobility, loss of independence, and increased health care costs. Even a single fall puts an older adult at higher risk for future falls. Despite numerous studies showing evidence that multifactorial fall risk interventions are effective in decreasing fall risk, even older adults who have an injurious fall often do not receive meaningful interventions to mitigate their fall risk. This study evaluated the impact of medication-related interventions for older adults who had a fall-related ED visit, as part of a larger study of multifactorial fall-risk interventions in the primary care setting. Methods: This study was approved by the Providence-Oregon Institutional Review Board. This retrospective chart review studied a subset of patients enrolled in the SAFER pilot project who presented to an ED following a fall. Included patients were 75 years or older and taking at least one high-risk medication (HRM) that is associated with increased risk for falls. Patients were enrolled in the SAFER pilot from December 2018 to June 2019. Eligible patients received a comprehensive medication review by a clinical pharmacist; some also received a Geriatric consult that included medication recommendations. Medication recommendations were then forwarded to the clinic’s Primary Care Provider (PCP) and Registered Nurse for follow up. The parent study used a matched control design to compare SAFER interventions with usual care; this study did not include a comparison to the control group. Study outcomes included: overall burden of high-risk medications, number of high-risk medications discontinued or tapered, initiation of osteoporosis treatment or prevention measures, changes in blood pressure (BP) or hemoglobin A1c goals, and overall reduction in polypharmacy. The study also evaluated to what degree medication-related recommendations were adopted by the PCP over a minimum follow-up period of 7 months. Results: Overall, 50 patients underwent chart review with 4 patients not meeting inclusion criteria; 46 patients were on HRM (average 4.3 HRM/person) and included in the final analysis. Of those patients, 25 (54%) received a PharmD consult. For these 25 patients, 117 medication-related recommendations were made by the Geriatric and Clinical Pharmacy teams. Of those, a total of 52 (44%) changes were implemented by the PCP: 17 HRMs were discontinued, 9 taper/cross-tapered, and 17 osteoporosis-related initiated. BP and A1c goals on patient’s problem list were not clearly defined for 69% and 50% of patients, respectively. Conclusion: Medication optimization and reduction of HRM was effective in patients receiving a PharmD consult. The most accepted recommendations included ordering DEXA, orthostatic BP testing, adding Vitamin D, and discontinuing opioids. Not every patient who qualified received a PharmD consult, suggesting that more medication changes could have been implemented had PharmDs been involved. The process of referring to a PharmD for a consult will need to be reviewed. Given that these patients are at high risk to fall, BP and A1c goals should be clarified and perhaps more lenient goals may be indicated. In addition, these results should be compared with the matched-control group of the parent study to determine the value of reducing HRM use in older patients at high risk of falls.https://digitalcommons.psjhealth.org/pharmacy_PGY1/1007/thumbnail.jp

Knowledge brokers, companions, and navigators: a qualitative examination of informal caregivers’ roles in medical tourism

IntroductionMany studies examining the phenomena of medical tourism have identified health equity issues associated with this global health services practice. However, there is a notable lack of attention in this existing research to the informal care provided by the friends and family members who typically accompany medical tourists abroad. To date, researchers have not examined the care roles filled by informal caregivers travelling with medical tourists. In this article, we fill this gap by examining these informal caregivers and the roles they take on towards supporting medical tourists' health and wellbeing.MethodsWe conducted 21 interviews with International Patient Coordinators (IPCs) working at medical tourism hospitals across ten countries. IPCs work closely with informal caregivers as providers of non-medical personal assistance, and can therefore offer broad insight on caregiver roles. The interviews were coded and analyzed thematically.ResultsThree roles emerged: knowledge broker, companion, and navigator. As knowledge brokers, caregivers facilitate the transfer of information between the medical tourist and formal health care providers as well as other staff members at medical tourism facilities. The companion role involves providing medical tourists with physical and emotional care. Meanwhile, responsibilities associated with handling documents and coordinating often complex journeys are part of the navigation role.ConclusionsThis is the first study to examine informal caregiving roles in medical tourism. Many of the roles identified are similar to those of conventional informal caregivers while others are specific to the transnational context. We conclude that these roles make informal caregivers an integral part of the larger phenomenon of medical tourism. We further contend that examining the roles taken on by a heretofore-unconsidered medical tourism stakeholder group sheds valuable insight into how this industry operates and that such knowledge is necessary in order to respond to the health equity debates that surround this particular global health services practice