Acceptability, impact and sustainability of the national pilot quality assurance system for self management programs

Chronic condition self-management education and training interventions such as the Stanford Self Management Programs (SMP) have the capacity to improve health and quality of life of people with chronic conditions whilst reducing the use of health services. This is in line with the outcomes from the recent Council of Australian Governments&rsquo; meeting where it was indicated that self-management will be a centrepiece in forthcoming chronic disease initiatives.Aim: report on a large national pilot quality assurance program involving the implementation and of an evaluation and quality monitoring system for SMPs including the provision of structured feedback to courses course leaders and service providers. During 2005/06 the quality assurance program was implemented at 11 diverse organisations across Australia. The program involved assisting organisations apply the 42-item Health Education Impact Questionnaire (HEIQ), a chronic disease health education outcome measure, and then observe and evaluate the value and impact of the quality program. Interviews with course leaders (n=60) and course participants (n=35) have elicited views about course quality and feedback processes.Results: The evaluation revealed enablers and barriers to effective implementation and sustainability. Important enablers were:- Course Leaders and organisations valued an Australia-wide system that provided feedback on coursequality and the impact on participants.- Course Leaders were strongly personally motivated to respond appropriately to HEI-Q coursereport feedback.- Completing the questionnaire provided participants with the opportunity to reflect on issues thatemerge in the course content and reflect on their progression at the end of the SSMP.Sustainability issues included:- Organisations and course leaders require support, training and flexibility on how to administer andmanage the use of the HEI-Q.- Availability of administrative resources in organisations to support the quality assurance activities.- The requirement that course leaders are trained in interpreting HEI-Q course report data.A quality improvement framework was developed which identified the actions required of key stakeholders tosupport effective implementation.Discussion: With the increasing endorsement of SMP across sectors it is important that course quality is known, is acceptable, and is communicated to stakeholders to inform and engender confidence in the SSMP. To effectively implement and sustain a quality improvement program for SMP, the processes and tools for measuring outcomes need to be responsive, flexible and easily integrated into the organisation and delivery of programs.<br /

To integrate or not to integrate? Future considerations for chronic disease self-management programs in the health care system

Objective: The growing burden of chronic disease and the increasing realisation that the current health system is ill equipped to deal with this trend has resulted in a health policy shift away from the traditional medical model to a more patient centred approach. As such, chronic disease self-management programs (CDSMP) have emerged as a potentially important component within this approach. Policy and program trends at the international level highlight several critical factors that need to be considered by governments and health care providers alike if CDSMP are to be integrated within the broader health system. This study reviewed international and local policy literature and sought perspectives from key stakeholders to determine the value and potential for integrating a generic group-based CDSMP into the care continuum.Method: Prominent self-management policies were identified through a comprehensive literature search. Interviews were conducted with policy makers across Australia (n=20), health practitioners (n=20) and consumers (n=42) purposefully recruited from metropolitan and rural Victoria, representing key demographics of interest including low socioeconomic areas.Results: Whilst CDSMP were viewed as having significant potential to be integrated into the health sector it was identified that the delivery and content of CDSMP needs to be flexible in order to address the needs of people across the disease, age and care continuums. Critical issues to be addressed if CDSMP are to be successfully integrated include increasing the profile of self-management; actively engaging and training health practitioners in self-management and overcoming system barriers such as lack of integrated referral pathways and networks.Discussion: Policy directions at the national level suggest that self-management will be a centrepiece in forthcoming chronic disease initiatives. International evidence has highlighted the requirement for a &lsquo;suite&rsquo; of programs to adequately cater to different stages of the disease continuum, age groups, ethnic backgrounds and sociogeographical areas. Furthermore engagement with key stakeholders (particularly GPs) is identified as critical to ensure the successful integration of CDSMP into the health system.Conclusion: Evidence suggests that CDSMP is an important facet in improving care of people with chronic conditions. Findings from this study suggest that current infrastructure and policy direction, which have been found to be critical factors in facilitating integration of CDSMP into the health sector, are either absent or inadequate in Victoria. CDSMPs are currently lacking a sustainable workforce, referral infrastructure and specific policy. Such factors need to be addressed before the integration of CDSMP can be considered across the healthcare continuum in Victoria.<br /

Chronic disease self-management programs : perspectives on enablers and barriers to GP and patient engagement

Aims &amp; rationale/Objectives : Chronic disease self-management programs (CDSMP) are increasingly being integrated into the health system to improve the care of people with chronic conditions. Despite activity at both policy and program levels, GPs as the \u27gatekeepers\u27 to the health system have generally not been well informed or engaged in this process. This study, in collaboration with 3 Victorian Divisions of General Practice, sought both GP and patient perspectives on enablers and barriers to engagement in self-management programs.Methods : Interviews were conducted with GPs (n=20) and consumers (n=45) purposefully recruited from metropolitan and rural Victoria, representing key demographics of interest including low socioeconomic areas.Principal findings : Lack of education/information and uncertainty about the effectiveness of self-management programs were key barriers for both GP and patient engagement. Programs that were sustainable and utilised existing community resources were viewed as enablers to increase uptake. GP and patient preferences for disease specific or generic CDSMP differed.Discussion : Outcomes from the recent Council of Australian Governments\u27 meeting suggest that self-management will be a centerpiece in forthcoming chronic disease initiatives. International evidence has highlighted the need for GP and patient engagement as critical in ensuring the recruitment of a critical mass of individuals to participate in CDSMP to ensure the sustainability of such initiatives. Insight from this study indicates that GPs and patients are not well informed about self-management, have different preferences to current policy trends and identifies several other barriers which need to be addressed if CDSMP are to be successful.Implications : Identification of barriers and enablers of GP and patient engagement in self-management is essential in shaping current policy initiatives and delivery of future programs. This is supported by international evidence which indicates strongly that GP engagement in particular is crucial to the success of these programs.Presentation type : Paper <br /

Evidence for 24-hour posture management: A scoping review

© The Author(s) 2023. This is an open access article distributed under the Creative Commons Attribution License, to view a copy of the license, see: https://creativecommons.org/licenses/by/4.0/Introduction:: People with complex physical disabilities unable to change their position independently are at risk of developing postural deformities and secondary complications. 24-hour posture management is needed to protect body structure. With inconsistencies in current service provision, this research aimed to scope the evidence for a 24-hour posture management approach. Method:: A scoping review was conducted using four health and social science databases. Inclusion and exclusion criteria were applied; further papers were included through citation chaining. Results:: The evidence for 24-hour posture management was often low quality due to the complications of completing robust research studies in this complex specialty. However, many professionals in the field agree that a 24-hour approach to postural care is essential. Conclusion:: There is a need for clear national policy and guidance relating to postural care and scope for development of dedicated posture management services. Current NHS service provision is variable and inconsistent. Lack of postural care is a safeguarding and human rights issue. Specialist training and research in postural care within the Occupational Therapy profession is required to raise awareness of the role Occupational Therapists can play in preventing postural deformities and other secondary complications through providing good postural care.Peer reviewe

Preoperative bathing or showering with skin antiseptics to prevent surgical site infection (Review)

Surgical site infection is a serious complication of surgery and is usually associated with increased length of hospital stay for the patient, and also higher hospital costs. The use of an antiseptic solution for preoperative bathing or showering is widely practiced in the belief that it will help to prevent surgical site infections from developing. This review identified seven trials, with over 10,000 patients, that tested skin antiseptics (chlorhexidine solution) against normal soap or no presurgical washing. The review of these trials did not show clear evidence that the use of chlorhexidine solution before surgery was better than other wash products at preventing surgical site infections from developing after surgery

The Ursinus Weekly, April 27, 1953

Y to sponsor panel meeting with Albright • Price, Merrifield, Haines, Hartman to head WSGA, WAA, YWCA, YMCA • May Day dancers prepare pageant for gala weekend • Concert presented by Meistersingers • Fraternities plan May dinner dances • Sororities make plans for shore visits, dinner dances • Group plays to be given • Eight win full scholarships • French teachers\u27 conference held at Ursinus, April 25 • Thespians to give Two blind mice • Friedlin crowned queen; Cub & Key honors five • Radomski, Wong elected to pre-med society offices • Class and council petitioning ends Friday • Jones reads from works of Noyes and Lindsay on Tuesday • Editorials: Tradition vs. common sense • I love Spring! • Helfferich named to board • Career offer for grads • Letters to the editor • Are you wasting money? • Alumni news • U.C. co-ed gives inside scoop on life in a boys\u27 dormitory • Ursinus professors are authorities in subject fields • From memoirs of a freshman: A visit to the Supply Store • Bears drop track meet to West Chester, 69-57 • Bryn Mawr tops girls in tennis • Baseball team loses, 8-7; But tops Graterford, 7-3 • East Stroudsburg routs Belles, 5-0 • Men\u27s tennis team loses, 5-4 • Belles, Albright vie in softball opener • Court squad downs Chestnut Hill, 5-0 • Hutch twirls shut-out; Bears beat Pharmacy, 20-0https://digitalcommons.ursinus.edu/weekly/1518/thumbnail.jp

Clinically-indicated replacement versus routine replacement of peripheral venous catheters (Review)

Background: US Centers for Disease Control guidelines recommend replacement of peripheral intravenous (IV) catheters no more frequently than every 72 to 96 hours. Routine replacement is thought to reduce the risk of phlebitis and bloodstream infection. Catheter insertion is an unpleasant experience for patients and replacement may be unnecessary if the catheter remains functional and there are no signs of inflammation. Costs associated with routine replacement may be considerable. This is an update of a review first published in 2010. Objectives: To assess the effects of removing peripheral IV catheters when clinically indicated compared with removing and re-siting the catheter routinely. Search methods: For this update the Cochrane Vascular Trials Search Co-ordinator searched the Cochrane Vascular Specialised Register (March 2015) and CENTRAL (2015, Issue 3). We also searched clinical trials registries (April 2015). Selection criteria: Randomised controlled trials that compared routine removal of peripheral IV catheters with removal only when clinically indicated in hospitalised or community dwelling patients receiving continuous or intermittent infusions. Data collection and analysis: Two review authors independently assessed trial quality and extracted data. Main results: Seven trials with a total of 4895 patients were included in the review. The quality of the evidence was high for most outcomes but was downgraded to moderate for the outcome catheter-related bloodstream infection (CRBSI). The downgrade was due to wide confidence intervals, which created a high level of uncertainty around the effect estimate. CRBSI was assessed in five trials (4806 patients). There was no significant between group difference in the CRBSI rate (clinically-indicated 1/2365; routine change 2/2441). The risk ratio (RR) was 0.61 (95% CI 0.08 to 4.68; P = 0.64). No difference in phlebitis rates was found whether catheters were changed according to clinical indications or routinely (clinically-indicated 186/2365; 3-day change 166/2441; RR 1.14, 95% CI 0.93 to 1.39). This result was unaffected by whether infusion through the catheter was continuous or intermittent. We also analysed the data by number of device days and again no differences between groups were observed (RR 1.03, 95% CI 0.84 to 1.27; P = 0.75). One trial assessed all-cause bloodstream infection. There was no difference in this outcome between the two groups (clinically-indicated 4/1593 (0.02%); routine change 9/1690 (0.05%); P = 0.21). Cannulation costs were lower by approximately AUD 7.00 in the clinically-indicated group (mean difference (MD) -6.96, 95% CI -9.05 to -4.86; P ≤ 0.00001). Authors' conclusions: The review found no evidence to support changing catheters every 72 to 96 hours. Consequently, healthcare organisations may consider changing to a policy whereby catheters are changed only if clinically indicated. This would provide significant cost savings and would spare patients the unnecessary pain of routine re-sites in the absence of clinical indications. To minimise peripheral catheter-related complications, the insertion site should be inspected at each shift change and the catheter removed if signs of inflammation, infiltration, or blockage are present

Clinically-indicated replacement versus routine replacement of peripheral venous catheters [Review]

Background US Centers for Disease Control guidelines recommend replacement of peripheral intravenous (IV) catheters no more frequently than every 72 to 96 hours. Routine replacement is thought to reduce the risk of phlebitis and bloodstream infection. Catheter insertion is an unpleasant experience for patients and replacement may be unnecessary if the catheter remains functional and there are no signs of inflammation. Costs associated with routine replacement may be considerable. This is an update of a review first published in 2010. Objectives To assess the effects of removing peripheral IV catheters when clinically indicated compared with removing and re‐siting the catheter routinely. Search methods For this update the Cochrane Peripheral Vascular Diseases (PVD) Group Trials Search Co‐ordinator searched the PVD Specialised Register (December 2012) and CENTRAL (2012, Issue 11). We also searched MEDLINE (last searched October 2012) and clinical trials registries. Selection criteria Randomised controlled trials that compared routine removal of peripheral IV catheters with removal only when clinically indicated in hospitalised or community dwelling patients receiving continuous or intermittent infusions. Data collection and analysis Two review authors independently assessed trial quality and extracted data. Main results Seven trials with a total of 4895 patients were included in the review. Catheter‐related bloodstream infection (CRBSI) was assessed in five trials (4806 patients). There was no significant between group difference in the CRBSI rate (clinically‐indicated 1/2365; routine change 2/2441). The risk ratio (RR) was 0.61 but the confidence interval (CI) was wide, creating uncertainty around the estimate (95% CI 0.08 to 4.68; P = 0.64). No difference in phlebitis rates was found whether catheters were changed according to clinical indications or routinely (clinically‐indicated 186/2365; 3‐day change 166/2441; RR 1.14, 95% CI 0.93 to 1.39). This result was unaffected by whether infusion through the catheter was continuous or intermittent. We also analysed the data by number of device days and again no differences between groups were observed (RR 1.03, 95% CI 0.84 to 1.27; P = 0.75). One trial assessed all‐cause bloodstream infection. There was no difference in this outcome between the two groups (clinically‐indicated 4/1593 (0.02%); routine change 9/1690 (0.05%); P = 0.21). Cannulation costs were lower by approximately AUD 7.00 in the clinically‐indicated group (mean difference (MD) ‐6.96, 95% CI ‐9.05 to ‐4.86; P ≤ 0.00001). Authors' conclusions The review found no evidence to support changing catheters every 72 to 96 hours. Consequently, healthcare organisations may consider changing to a policy whereby catheters are changed only if clinically indicated. This would provide significant cost savings and would spare patients the unnecessary pain of routine re‐sites in the absence of clinical indications. To minimise peripheral catheter‐related complications, the insertion site should be inspected at each shift change and the catheter removed if signs of inflammation, infiltration, or blockage are present

Duchamp's Erotic Stereoscopic Exercises

This article explores certain links between medicine and art, with regard to their use of stereoscopy. I highlight a work by the artist Marcel Duchamp (the ready-made Stéréoscopie a la Main) and stereoscopic cards used in ophthalmic medicine. Both instances involve the drawing of graphic marks over previously existing stereoscopic cards. This similarity between Stéréoscopie a la Main and stereoscopic cards is echoed in the form of "stereoscopic exercises." Stereoscopic exercises were prescribed by doctors to be performed with the stereoscope as early as 1864. Stereoscopic cards were widely diffused in the 19th century, often promoted as "stay-at-home travel." It was over such kinds of materials that both Marcel Duchamp and doctors of ophthalmic medicine drew their graphic marks. I explore Duchamp's Stéréoscopie a la Main as a hypothetical basis for stereoscopic exercises of different types, proposing that this rectified ready-made is the locus for erotic stereoscopic exercises.Este artigo busca explorar certos elos entre a medicina e a arte por meio da estereoscopia. Destaca-se uma obra do artista Marcel Duchamp (o ready-made Stéréoscopie a la Main) e cartões estereoscópicos usados na oftalmologia. As duas instâncias envolvem o desenho de marcas gráficas sobre cartões estereoscópicos pré-existentes. A similaridade entre Stéréoscopie a la Main e os ditos cartões ecoa também na forma dos exercícios estereoscópicos. O cartão estereoscópico foi amplamente difundido na segunda metade do séc. XIX, frequentemente na forma da "viagem sem sair de casa." Foi sobre esse tipo de material que tanto médicos quanto Marcel Duchamp desenharam suas marcas. Explora-se a obra Stéréoscopie a la Main como um sítio hipotético para uma espécie de exercício, propondo que tal ready-made retificado seja um lugar para exercícios estereoscópicos eróticos