The Gold Coast Integrated Care Programme: The Perspectives of Patients, Carers, General Practitioners and Healthcare Staff

Introduction: The Australian Gold Coast Integrated Care programme trialled an innovative model of care to proactively manage high risk patients with complex and chronic conditions in collaboration with general practitioners. The objective was to enhance coordination and continuity of care across primary and secondary health services from a single point-of-entry multidisciplinary coordination centre. This case study, embedded in the broader trial, analysed the perceptions of patients, healthcare staff and general practitioners on the adequacy, comprehensiveness, timeliness and acceptability of the new model of care to help inform the decision by the health service whether to adopt it beyond the trial. Methods: This mixed method embedded, explanatory case study design included surveys of general practice staff and focus groups with patients, carers and coordination centre staff. Qualitative data were thematically analysed and findings merged with survey data in a narrative explanatory case report. Discussion: Staff, patients, general practitioners and practice nurses were generally satisfied with services, coordination of care and information sharing but general practice staff satisfaction ratings declined over time. Conclusion: The programme enhanced care and coordination of services and was valued by patients and healthcare providers. Study results provide a rationale for adopting the model for those with chronic and complex conditions

Eyes, ears and technology : an evaluation of the use of video-conferencing in BPR workshops

Purpose: The purpose of this paper is to evaluate the effectiveness of video-conferencing as a suitable technology for business process reengineering (BPR) training of 12 health sector participants located in Prince Edward Island, Canada. Design/methodology/approach: An action research was adopted. The participants received training from a remote BPR consultant located in Northern Ireland (UK), with the assistance of local moderators. The focus of the study is concerned with the quality of the learning experience and the important role played by local moderators. Findings: Overall, the use of video-conferencing technology provided a valuable learning experience. It was also cost effective and an efficient use of both the consultants' and the participants' time. A key part of the success of the exercise was the role of one of the local moderators who acted as the eyes and ears of the consultant. Originality/value: A general contribution to knowledge is the positioning of the argument developed within the technology diffusion literature. The paper offers important insights into the effective use of video-conferencing technology for BPR training purposes; and Knipe and Lee's evaluation of a video-conferencing experiment in terms of the relationship between the human actors at the remote and local sites is discussed and extended

Recruitment and Retention Strategies for a Community-Based Weight Management Study for Multi-Ethnic Elementary School Children and Their Parents

This paper describes successful recruitment and retention strategies for a community-based weight management study in two school districts in North Carolina. Recruitment and retention on both district and school levels and child and parent levels are discussed

How to implement person-centred care and support for dementia in outpatient and home/community settings: Scoping review

From Springer Nature via Jisc Publications RouterBackground: Little prior research focused on person-centred care and support (PCCS) for dementia in home, community or outpatient care. We aimed to describe what constitutes PCCS, how to implement it, and considerations for women who comprise the majority of affected persons (with dementia, carers). Methods: We conducted a scoping review by searching multiple databases from 2000 inclusive to June 7, 2020. We extracted data on study characteristics and PCCS approaches, evaluation, determinants or the impact of strategies to implement PCCS. We used summary statistics to report data and interpreted findings with an existing person-centred care framework. Results: We included 22 studies with qualitative (55%) or quantitative/multiple methods design (45%) involving affected persons (50%), or healthcare workers (50%). Studies varied in how PCCS was conceptualized; 59% cited a PCC definition or framework. Affected persons and healthcare workers largely agreed on what constitutes PCCS (e.g. foster partnership, promote autonomy, support carers). In 4 studies that evaluated care, barriers of PCCS were reported at the affected person (e.g. family conflict), healthcare worker (e.g. lack of knowledge) and organizational (e.g. resource constraints) levels. Studies that evaluated strategies to implement PCCS approaches were largely targeted to healthcare workers, and showed that in-person inter-professional educational meetings yielded both perceived (e.g. improved engagement of affected persons) and observed (e.g. use of PCCS approaches) beneficial outcomes. Few studies reported results by gender or other intersectional factors, and none revealed if or how to tailor PCCS for women. This synthesis confirmed and elaborated the PCC framework, resulting in a Framework of PCCS for Dementia. Conclusion: Despite the paucity of research on PCCS for dementia, synthesis of knowledge from diverse studies into a Framework provides interim guidance for those planning or evaluating dementia services in outpatient, home or community settings. Further research is needed to elaborate the Framework, evaluate PCCS for dementia, explore determinants, and develop strategies to implement and scale-up PCCS approaches. Such studies should explore how to tailor PCCS needs and preferences based on input from persons with dementia, and by sex/gender and other intersectional factors such as ethnicity or culture.22pubpu

Barriers and facilitators to person-centred infection prevention and control: results of a survey about the Dementia Isolation Toolkit

Objectives: People working in long-term care homes (LTCH) face difficult decisions balancing the risk of spread of infection with the hardship that infection control and prevention (ICP) measures put on residents. The Dementia Isolation Toolkit (DIT) was developed to address the gap in ethical guidance on how to safely and effectively isolate people living with dementia while supporting their personhood. In this study, we report the results of a survey of LTCH staff on barriers and facilitators regarding isolating residents, and on the use and impact of the DIT. Design: Online survey. Setting and Participants: Participants (n=208) were staff working on-site in LTCH in Ontario, Canada since March 1, 2020, with direct or indirect experience with the isolation of LTCH resi-dents. Methods: LTCH staff were recruited through provincial LTCH organizations, social media, and the DIT website. Survey results were summarized, and three groups compared, those: 1) unfamiliar with, 2) familiar with, and 3) users of the DIT. Results: 61% of respondents identified distress of LTCH staff about the harmful effects of isola-tion on residents as a major barrier to effective isolation. Facilitators for isolation included delivery of 1:1 activity in the resident’s room (81%) and designating essential caregivers to provide support (67%). Almost all respondents (84%) reported an increase in moral distress. DIT users were less likely to report an impact of moral distress on job satisfaction (OR 0.41, 95% CI 0.19-0.87) with 48% of users reporting it was helpful in reducing their level of distress. Conclusions and Implications: Isolation as an ICP measure in LTCH environments creates mor-al distress in staff which is a barrier to its effectiveness. ICP guidance to LTCH would be strength-ened with the inclusion of a dementia-specific ethical framework that addresses how to minimize the harms of isolation on both residents and staff

Three-year follow-up of physical activity in Norwegian youth from two ethnic groups: associations with socio-demographic factors

<p>Abstract</p> <p>Background</p> <p>More research on factors associated with physical activity and the decline in participation during adolescence is needed. In this paper, we investigate the levels, change, and stability of physical activity during the late teens among ethnic Norwegians and ethnic minorities, and we examine the associations between physical activity and socio-demographic factors.</p> <p>Methods</p> <p>The baseline (T1) of this longitudinal study included 10^thgraders who participated in the youth part of the Oslo Health Study, which was carried out in schools in 2000–2001. The follow-up (T2) in 2003–2004 was conducted partly at school and partly by mail. A total of 2489 (1112 boys and 1377 girls) participated both at baseline and at follow-up. Physical activity level was measured by a question on weekly hours of physical activity outside of school. Socio-demographic variables were collected by questionnaire and from data obtained from Statistics Norway. Analysis of variance was used to study the level of and changes (T1 to T2) in physical activity, and the associations between physical activity and socio-demographic factors. Stability in physical activity was defined as the percentage of students reporting the same physical activity both times.</p> <p>Results</p> <p>Boys were more active than girls at age 15 and 18 years, independent of ethnic background. Among girls, ethnic Norwegians were more active than ethnic minorities. Hours per week spent on physical activity declined in all groups during the follow-up period. Few associations were found between physical activity and socio-demographic factors in both cross-sectional and longitudinal data. Among the ethnic minority girls, 65% reported being physically active 0–2 hours per week at baseline, and 82% of these girls reported the same level at follow up.</p> <p>Conclusion</p> <p>The association between physical activity and ethnicity at age 15 years remained the same during the follow-up. Few associations were found between physical activity and socio-demographic variables. A large proportion of ethnic minority girls reported a persistently low physical activity level, and this low participation rate may need special attention.</p

Multiple M. tuberculosis Phenotypes in Mouse and Guinea Pig Lung Tissue Revealed by a Dual-Staining Approach

A unique hallmark of tuberculosis is the granulomatous lesions formed in the lung. Granulomas can be heterogeneous in nature and can develop a necrotic, hypoxic core which is surrounded by an acellular, fibrotic rim. Studying bacilli in this in vivo microenvironment is problematic as Mycobacterium tuberculosis can change its phenotype and also become acid-fast negative. Under in vitro models of differing environments, M. tuberculosis alters its metabolism, transcriptional profile and rate of replication. In this study, we investigated whether these phenotypic adaptations of M. tuberculosis are unique for certain environmental conditions and if they could therefore be used as differential markers. Bacilli were studied using fluorescent acid-fast auramine-rhodamine targeting the mycolic acid containing cell wall, and immunofluorescence targeting bacterial proteins using an anti-M. tuberculosis whole cell lysate polyclonal antibody. These techniques were combined and simultaneously applied to M. tuberculosis in vitro culture samples and to lung sections of M. tuberculosis infected mice and guinea pigs. Two phenotypically different subpopulations of M. tuberculosis were found in stationary culture whilst three subpopulations were found in hypoxic culture and in lung sections. Bacilli were either exclusively acid-fast positive, exclusively immunofluorescent positive or acid-fast and immunofluorescent positive. These results suggest that M. tuberculosis exists as multiple populations in most conditions, even within seemingly a single microenvironment. This is relevant information for approaches that study bacillary characteristics in pooled samples (using lipidomics and proteomics) as well as in M. tuberculosis drug development

Rationale, design, methodology and sample characteristics for the family partners for health study: a cluster randomized controlled study

<p>Abstract</p> <p>Background</p> <p>Young children who are overweight are at increased risk of becoming obese and developing type 2 diabetes and cardiovascular disease later in life. Therefore, early intervention is critical. This paper describes the rationale, design, methodology, and sample characteristics of a 5-year cluster randomized controlled trial being conducted in eight elementary schools in rural North Carolina, United States.</p> <p>Methods/Design</p> <p>The first aim of the trial is to examine the effects of a two-phased intervention on weight status, adiposity, nutrition and exercise health behaviors, and self-efficacy in overweight or obese 2nd, 3 rd, and 4th grade children and their overweight or obese parents. The primary outcome in children is stabilization of BMI percentile trajectory from baseline to 18 months. The primary outcome in parents is a decrease in BMI from baseline to 18 months. Secondary outcomes for both children and parents include adiposity, nutrition and exercise health behaviors, and self-efficacy from baseline to 18 months. A secondary aim of the trial is to examine in the experimental group, the relationships between parents and children's changes in weight status, adiposity, nutrition and exercise health behaviors, and self-efficacy. An exploratory aim is to determine whether African American, Hispanic, and non-Hispanic white children and parents in the experimental group benefit differently from the intervention in weight status, adiposity, health behaviors, and self-efficacy.</p> <p>A total of 358 African American, non-Hispanic white, and bilingual Hispanic children with a BMI ≥ 85th percentile and 358 parents with a BMI ≥ 25 kg/m²have been inducted over 3 1/2 years and randomized by cohort to either an experimental or a wait-listed control group. The experimental group receives a 12-week intensive intervention of nutrition and exercise education, coping skills training and exercise (Phase I), 9 months of continued monthly contact (Phase II) and then 6 months (follow-up) on their own. Safety endpoints include adverse event reporting. Intention-to-treat analysis will be applied to all data.</p> <p>Discussion</p> <p>Findings from this trial may lead to an effective intervention to assist children and parents to work together to improve nutrition and exercise patterns by making small lifestyle pattern changes.</p> <p>Trial registration</p> <p><a href="http://www.clinicaltrials.gov/ct2/show/NCT01378806">NCT01378806</a>.</p