From Ancestral Knowledge to Clinical Practice: The Case of \u3cem\u3eAgonias\u3c/em\u3e and Portuguese Clinicians in America

Cultures have varying notions about symptom expression and the treatment of mental health issues. Consequently, clients and psychotherapists may or may not share a similar worldview. In the psychotherapy literature there has been increased attention to these complex processes. This survey descriptive study aims to understand how therapists working with culturally diverse clients incorporate sensitivity to cultural differences. Fifteen culturally sensitive mental health care providers working with the Portuguese immigrant community were interviewed about their practices. Specifically, we investigated their understanding of the symptoms, causes and cures for agonias, a culture specific phenomenon. It was found that even though the providers are all Portuguese themselves, the meaning that they ascribed to agonias (anxiety and/or depression) was very different than the meaning ascribed to agonias by community members. The community member’s meanings ranged from indigestion to being on the brink of death. A cluster analysis revealed that clinicians who stated that agonias is anxiety, conducted cognitive behavioral therapy or psychopharmacology, and those that stated agonias had a depressive component tended to use family therapy or psychoanalysis

"If we can't measure it, we can't do it". The role of health outcomes in community and allied health service accountability

Health outcomes fulfill a number of roles in the health sector. Economists, clinicians, researchers and managers use health outcomes in a range of different contexts for distinct purposes. New management approaches that use contracts as the basis for health service accountability have attempted to take health outcomes from their clinical role into a management setting. In particular, the purchasers and managers of some health services expect that service providers should demonstrate that they improve the health outcomes of their patients to justify their on-going funding. However, a number of organisations have experienced barriers to the application of the outcomes approach to health service management and there has been no systematic evaluation of the approach. Nor has there been an investigation into why purchasing organisations have difficulty introducing health outcomes into purchasing contracts. The result is that managers and purchasers continue to assign resources to the pursuit of health outcomes as an accountability tool. This thesis addresses two research questions around the use of health outcomes in community and allied health service accountability. The first is the barriers to the application of health outcomes to health services accountability. The second question examines the conditions that must be met before health outcomes can be used as an accountability tool in purchasing contracts for allied health. The research questions are addressed through the analysis of case studies that explore systematically the approach taken by two organisations, the Department of Veterans’ Affairs and ACT Community Care, in their attempts to identify health outcomes that could be used in purchasing contracts for community and allied health services.

Feros Care's My Health Clinic at Home pilot: Final report

This study was one of the first remote monitoring studies in Australia. It enabled me to create, deliver and evaluate the first health literacy patient education program delivered by group videoconferencing, forming part of my PhD studies.\ua0Results of this study is significant because it revealed that patients who were remotely monitored could be taught how to understand their readings and consequently make changes in their health behaviours leading to better self-managementThis study provides rare and unique findings from real-world research with demonstrates remote monitoring empowers older people to better understand and manage their health.\ua0 Additionally it found group education via videoconferencing is acceptable to seniors with little to no experience in using technology

Contested professional role boundaries in health care: a systematic review of the literature

Across the Western world, demographic changes have led to healthcare policy trends in the direction of role flexibility, challenging established role boundaries and professional hierarchies. Population ageing is known to be associated with a rise in prevalence of chronic illnesses which, coupled with a reducing workforce, now places much greater demands on healthcare provision. Role flexibility within the health professions has been identified as one of the key innovative practice developments which may mitigate the effects of these demographic changes and help to ensure a sustainable health provision into the future. However, it is clear that policy drives to encourage and enable greater role flexibility among the health professions may also lead to professional resistance and inter-professional role boundary disputes. In the foot and ankle arena, this has been evident in areas such as podiatric surgery, podiatrist prescribing and extended practice in diabetes care, but it is far from unique to podiatry. MethodsA systematic review of the literature identifying examples of disputed role boundaries in health professions was undertaken, utilising the STARLITE framework and adopting a focus on the specific characteristics and outcomes of boundary disputes. Synthesis of the data was undertaken via template analysis, employing a thematic organisation and structure. ResultsThe review highlights the range of role boundary disputes across the health professions, and a commonality of events preceding each dispute. It was notable that relatively few disputes were resolved through recourse to legal or regulatory mandates. ConclusionsWhilst there are a number of different strategies underpinning boundary disputes, some common characteristics can be identified and related to existing theory. Importantly, horizontal substitution invokes more overt role boundary disputes than other forms, with less resolution, and with clear implications for professions working within the foot and ankle arena. <br/

AI-Driven Personalised Offloading Device Prescriptions: A Cutting-Edge Approach to Preventing Diabetes-Related Plantar Forefoot Ulcers and Complications

Diabetes-related foot ulcers and complications are a significant concern for individuals with diabetes, leading to severe health implications such as lower-limb amputation and reduced quality of life. This chapter discusses applying AI-driven personalised offloading device prescriptions as an advanced solution for preventing such conditions. By harnessing the capabilities of artificial intelligence, this cutting-edge approach enables the prescription of offloading devices tailored to each patient's specific requirements. This includes the patient's preferences on offloading devices such as footwear and foot orthotics and their adaptations that suit the patient's intention of use and lifestyle. Through a series of studies, real-world data analysis and machine learning algorithms, high-risk areas can be identified, facilitating the recommendation of precise offloading strategies, including custom orthotic insoles, shoe adaptations, or specialised footwear. By including patient-specific factors to promote adherence, proactively addressing pressure points and promoting optimal foot mechanics, these personalised offloading devices have the potential to minimise the occurrence of foot ulcers and associated complications. This chapter proposes an AI-powered Clinical Decision Support System (CDSS) to recommend personalised prescriptions of offloading devices (footwear and insoles) for patients with diabetes who are at risk of foot complications. This innovative approach signifies a transformative leap in diabetic foot care, offering promising opportunities for preventive healthcare interventions.Comment: 33 pages, 2 figure

Leadership in interprofessional health and social care teams : a literature review

Purpose: To review evidence on the nature of effective leadership in Interprofessional health and social care teams. Design: A critical review and thematic synthesis of research literature conducted using systematic methods to identify and construct a framework to explain the available evidence about leadership in interprofessional health and social care teams. Findings: Twenty-eight (28) papers were reviewed and contributed to the Framework for Interprofessional Leadership. Twelve themes emerged from the literature, the themes were: Facilitate shared leadership; transformation and change; personal qualities; goal alignment; creativity and innovation; communication; teambuilding; leadership clarity; direction setting; external liaison; skill mix and diversity; clinical and contextual expertise. The discussion includes some comparative analysis with theories and themes in team management and team leadership. Originality/Value: This research identifies some of the characteristics of effective leadership of interprofessional health and social care teams. By capturing and synthesizing the literature, it is clear that effective interprofessional health and social care team leadership requires a unique blend of knowledge and skills that support innovation and improvement. Further research is required to deepen understanding of the degree to which team leadership results in better outcomes for both patients and teams

Factors associated with non-attendance in a general practice super clinic population in regional Australia: a retrospective cohort study

BackgroundNon-attendance at medical appointments is associated with increased patient morbidity and is a significant drain on health service resources. Australian studies have focused on secondary healthcare settings, screening, and interventions to reduce non-attendance.AimsTo explore factors associated with non-attendance in a regional primary care setting.MethodA retrospective cohort of all patients with a scheduled appointment between October 2011 and October 2013 at a regional, primary care clinic providing medical and allied health services in a region of New South Wales (NSW) serving a large Aboriginal population (10.7 per cent). Using multivariate logistic regression, non-attendance was regressed on a range of covariates, including number of appointments per person, gender and ethnicity, and day of the week.  ResultsThe overall proportion of missed appointments was 7.6 per cent. Risk factors for non-attendance were day of the week [Mondays (8.1 per cent), Fridays (8.0 per cent), and Thursdays (7.9 per cent), (χ2(4)= 20.208,

Towards a theoretical framework for integrated team leadership (IgTL)

This study presents a framework for leadership of integrated, interprofessional health and social-care teams (IgT's) based on a previous literature review and a qualitative study. The theoretical framework for Integrated Team Leadership (IgTL) is based on contributions from fifteen professional and non-professional staff, in 8 community teams in the United Kingdom. Participants shared their perceptions of IgT's good-practice in relation to patient outcomes. There were two clear elements, Person-focused and Task-focused leadership behaviours with particular emphasis on the facilitation of shared professional practices. Person-focused leadership skills include: inspiring and motivating; walking the talk; change and innovation; consideration; empowerment, teambuilding and team maintenance; and emotional intelligence. Task-focused leadership behaviours included: setting team direction; managing performance; and managing external relationships. Team members felt that the IgTL should be: a Health or Social Care (HSC) professional; engaged in professional practice; and have worked in an IgT before leading one. Technical and cultural issues were identified that differentiate IgTL from usual leadership practice; in particular the ability to facilitate or create barriers to effective integrated teamworking within the organisational context. In common with other OECD countries, there are policy imperatives in England for further integration of health and social care, needed to improve quality and effectiveness of care for older people with multiple conditions. Further attention is needed to support the development of effective IgT's and leadership will be a pre-requisite to achieve this vision. The research advances the understanding of the need for skilled interprofessional leadership practice