Consumer and citizen participation in health care: where are the principles for ethical conduct?

Many health services strive to actively involve consumers and citizens in improving service provision and the safety and quality of health care. However, some health professionals and consumer and citizen participants have raised concerns about ethical issues that have emerged as a consequence of how some of these participation processes are implemented. Issues raised by both health professionals and consumer and citizen participants relate primarily to tokenism and social control practices. It is of paramount importance that the health sector develops ethical principles to underpin ethical conduct for consumer and citizen participation, and define accountability mechanisms to support ethical conduct. This not only protects consumer and citizen participants, but also health professionals

What is translational research? Background, concepts, and a definition

Author version made available here in accordance with publisher copyright policy.This discussion paper aims to offer an overview and working definition of translational research, appropriate to health. Methods: Using scholarly and applied literature, the paper first identifies key challenges in achieving evidence-based policy and practice. It highlights international policy interest in new approaches to evidence translation and the barriers to achieving sound evidence translation. The paper offers an explicit definition of translational research and explains why it is important to have such a definition. It then elaborates on this definition by identifying and exploring seven distinctive research practices that could be associated with translational research. Findings and conclusions: Translational research is research with a sense of place. Its defining feature is excellence in evidence for a specific context or sphere of action, whether that is health policy for the World Health Organisation or service design for a local non-government organisation. If research is to be translated at all, it needs to be meaningful to many specific contexts, including small and regional contexts. The best promise that translational research offers is of exciting new techniques to achieve rigour and systemacy for such localised ‘real world’ policy, service and practice contexts

Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P < 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

Recruiting and Retaining Allied Health Professionals in Rural Australia: Why is it so Difficult?

Rural communities in Australia have particular health needs, and the recruitment and retention of Allied Health Professionals (AHPs) is a significant concern. Despite the increasing number of AHPs being trained, vacancy and attrition rates in rural areas continue to rise. Professional and social isolation combined with rapidly changing health service delivery structures are identified as major deterrents to long-term rural practice. While strategies are now being implemented, endeavours to resolve the issues lag well behind initiates offered to Medical and Nursing staff. Given the wealth of political, professional and health related issues underlying the recruitment and retention of AHPs to rural areas, total resolution of this issue may not be possible. A unified approach by AHPs combined with concerted effort and collaboration on the part of all the stakeholders may, however, allow management at a level required to sustain a viable rural AHP workforce

Considering Physical Inactivity in Relation to Obesity

Physical inactivity and obesity contribute enormously to the current burden of disease in Australia, as in all Western Countries. Although diet and exercise have been linked to health since antiquity, the connection has recently experienced a revival of interest. There is mounting evidence that the current prevalence of obesity is more closely related to decreases in energy expenditure than to the traditionally accepted imbalance between consumption and expenditure, and that physical activity is therefore crucial in maintaining weight loss. With overweight[1] and obesity[2] now the norm in Australia, physical inactivity is a major issue within and beyond the health sector, and should be a concern of all health practitioners. This paper provides an overview of the relationship between obesity and physical inactivity and reflects on some strategies for increasing physical activity in the obese. More research on effective strategies to promote physical activity in all its forms (eg. exercise, transportation and incidental activity) is needed. [1] Body Mass Index (BMI) \u3e25. (BMI = weight(kg)/height2(m)) [2] Body Mass Index \u3e 30

Physiotherapy in Australia - Where to Now?

The physiotherapy profession in Australia appears to have been caught unawares by the rapidly changing demography of health services and now seems to lack a clear identity and vision. Despite being a highly competitive profession to enter, attrition rates are high. This paper reflects on the history of physiotherapy in Australia and the dichotomy of paradigms it now faces, and suggests a possible option for the future, given that existing physiotherapy roles appear difficult to sustain in our current health care climate

An Introduction to Telemedicine and Email Consultations

E-health, telehealth and telemedicine all describe the use of telecommunication and electronic information technology for the provision of health care at a distance. Interest in telemedicine has been heightened recently due to technological advances making equipment more effective and accessible, and increasing healthcare costs and client expectations creating pressures to find alternative modes of healthcare delivery. Although telemedicine suffers from a lack of conclusive evidence regarding its clinical effectiveness, primarily because it has not been adequately evaluated, its popularity and acceptance, particularly amongst lay persons, continues to increase. With the rapid increase in internet use, email, an electronic communication medium, has the potential to radically alter the culture of health-care. Despite a number of logistical issues related to its use, there is high consumer demand for email consultations, yet only 2% of clinicians currently offer them. As issues surrounding security, workflow, liability and workflow are resolved, email will impact increasingly of clinical service delivery

Intraoperative ventilator settings and their association with postoperative pulmonary complications in neurosurgical patients: post-hoc analysis of LAS VEGAS study

Background: Limited information is available regarding intraoperative ventilator settings and the incidence of postoperative pulmonary complications (PPCs) in patients undergoing neurosurgical procedures. The aim of this post-hoc analysis of the 'Multicentre Local ASsessment of VEntilatory management during General Anaesthesia for Surgery' (LAS VEGAS) study was to examine the ventilator settings of patients undergoing neurosurgical procedures, and to explore the association between perioperative variables and the development of PPCs in neurosurgical patients. Methods: Post-hoc analysis of LAS VEGAS study, restricted to patients undergoing neurosurgery. Patients were stratified into groups based on the type of surgery (brain and spine), the occurrence of PPCs and the assess respiratory risk in surgical patients in Catalonia (ARISCAT) score risk for PPCs. Results: Seven hundred eighty-four patients were included in the analysis; 408 patients (52%) underwent spine surgery and 376 patients (48%) brain surgery. Median tidal volume (VT) was 8 ml [Interquartile Range, IQR = 7.3-9] per predicted body weight; median positive end-expiratory pressure (PEEP) was 5 [3 to 5] cmH20. Planned recruitment manoeuvres were used in the 6.9% of patients. No differences in ventilator settings were found among the sub-groups. PPCs occurred in 81 patients (10.3%). Duration of anaesthesia (odds ratio, 1.295 [95% confidence interval 1.067 to 1.572]; p = 0.009) and higher age for the brain group (odds ratio, 0.000 [0.000 to 0.189]; p = 0.031), but not intraoperative ventilator settings were independently associated with development of PPCs. Conclusions: Neurosurgical patients are ventilated with low VT and low PEEP, while recruitment manoeuvres are seldom applied. Intraoperative ventilator settings are not associated with PPCs