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Upstream healthcare

J Patel, A Durey, L Hearn, L M Slack-Smith
BACKGROUND: Aboriginal Australians experience significant disparities in oral health with even poorer outcomes reported in rural and remote areas. The high rates of preventable dental disease in Aboriginal communities are a serious concern from a social standpoint and in terms of service provision and healthcare expenditure. METHODS: Primary research literature was comprehensively reviewed. Papers were selected if they reported designing or implementing an intervention or oral health program specific to the needs of Aboriginal communities...
December 20, 2016: Australian Dental Journal
Francesco Giannini, Andrea Aurelio, Alaide Chieffo
Refractory angina is a chronic condition characterized by the presence of disabling symptoms due to severe obstructive coronary artery disease not improved by either optimal medical therapy and/or percutaneous or surgical revascularization. Mortality rates associated with this condition are quite low in clinically stable patients on optimal medical therapy. However, rehospitalization rates are high. In this subgroup of patients there is thus a clinical need for new therapies targeting an improvement of symptoms but taking into account the potential impact in terms of healthcare and costs...
October 2016: Giornale Italiano di Cardiologia
Vanessa Cristine Kobs, Jéssica Augustini Ferreira, Thaís Alexandra Bobrowicz, Leslie Ecker Ferreira, Roseneide Campos Deglmann, Glauco Adrieno Westphal, Paulo Henrique Condeixa de França
INTRODUCTION: Members of the Acinetobacter genus are key pathogens that cause healthcare-associated infections, and they tend to spread and develop new antibiotic resistance mechanisms. Oxacillinases are primarily responsible for resistance to carbapenem antibiotics. Higher rates of carbapenem hydrolysis might be ascribed to insertion sequences, such as the ISAba1 sequence, near bla OXA genes. The present study examined the occurrence of the genetic elements bla OXA and ISAba1 and their relationship with susceptibility to carbapenems in clinical isolates of the Acinetobacter calcoaceticus-Acinetobacter baumannii complex...
July 2016: Revista da Sociedade Brasileira de Medicina Tropical
Jessie Y Huang, David S Followill, Rebecca M Howell, Xinming Liu, Dragan Mirkovic, Francesco C Stingo, Stephen F Kry
PURPOSE: Dose calculation errors near metal implants are caused by limitations of the dose calculation algorithm in modeling tissue/metal interface effects as well as density assignment errors caused by imaging artifacts. The purpose of this study was to investigate two strategies for reducing dose calculation errors near metal implants: implementation of metal-based energy deposition kernels in the convolution/superposition (C/S) dose calculation method and use of metal artifact reduction methods for computed tomography (CT) imaging...
September 2016: Medical Physics
Kim Manley, Anne Martin, Carolyn Jackson, Toni Wright
BACKGROUND: Overcrowding in emergency departments is a global issue, which places pressure on the shrinking workforce and threatens the future of high quality, safe and effective care. Healthcare reforms aimed at tackling this crisis have focused primarily on structural changes, which alone do not deliver anticipated improvements in quality and performance. The purpose of this study was to identify workforce enablers for achieving whole systems urgent and emergency care delivery. METHODS: A multiple case study design framed around systems thinking was conducted in South East England across one Trust consisting of five hospitals, one community healthcare trust and one ambulance trust...
2016: BMC Health Services Research
H Chihi, R A Bonnin, A Bourouis, S Mahrouki, S Besbes, M Ben Moussa, O Belhadj, T Naas
Acinetobacter baumannii is an emerging threat in healthcare facilities owing to its ability to be multidrug-resistant (MDR) and to be involved in outbreaks. GES-type extended-spectrum β-lactamases (ESBLs) have been increasingly identified in A. baumannii. In this study, clinical A. baumannii isolates were characterised using standard biochemical methods and antibiotic susceptibility testing. Antibiotic resistance genes were sought by PCR and sequencing. Genetic support was characterised using S1 nuclease pulsed-field gel electrophoresis (PFGE) mapping, conjugation and electroporation assays...
June 2016: Journal of Global Antimicrobial Resistance
Mélanie Van Hollebeke, Sarah Talavera-Pons, Aurélien Mulliez, Valérie Sautou, Gilles Bommelaer, Armand Abergel, Anne Boyer
Background Care transitions from hospital to community have been identified as risk points for the continuity of patient care. Without upstream information, the community pharmacist (CP) cannot ensure error-free drug dispensing. A hospital-to-community records transmission process would enable CPs to guarantee that all prescription drugs are ready to pick up at hospital discharge, and to improve their responses to patient health inquiries. Objective To evaluate the impact of a hospital-to-CP medication records scheme on post-discharge continuity of patient treatment...
October 2016: International Journal of Clinical Pharmacy
Sally Dalton-Brown
Upstream engagement is commonly regarded as necessary for the smooth implementation of new technologies, particularly when there is an impact on health. Is the healthcare context in Australia geared toward such public engagement? There are established engagement practices for issues of healthcare resourcing, for example; however, the situation becomes more complex with the introduction of a new technology such as nanomedicine.
July 2016: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
Alan Currie, Allan Johnston
Athletes experience a range of mental health problems with at least an equivalent prevalence to the general population. This chapter explores the psychiatrist's role in sport, along a pathway of mental healthcare from 'upstream' prevention, screening, and early detection of mental stress to 'downstream' assessment, treatment, rehabilitation, and recovery from mental illness. At each stage on this pathway the psychiatrist has a broad spectrum of bio-psycho-social strategies to employ in clinical practice. Upstream, the importance of psychological resilience is described along with the concept of mental 'pre-habilitation' (a term usually associated with the prevention of physical injury)...
June 27, 2016: International Review of Psychiatry
Sheryl Reimer-Kirkham, Richard Sawatzky, Della Roberts, Marie Cochrane, Kelli Stajduhar
AIMS AND OBJECTIVES: The purpose of the study was to examine nurses' and nursing assistants' perspectives of a palliative approach in a variety of nursing care settings that do not specialise in palliative care. BACKGROUND: Ageing populations worldwide are drawing increasing attention to palliative care. In particular, people with advancing chronic life-limiting conditions often have unmet needs and may die in acute medical, residential care and home health settings without access to palliative care...
August 2016: Journal of Clinical Nursing
Stephanie M Topp, Clement N Moonga, Nkandu Luo, Michael Kaingu, Chisela Chileshe, George Magwende, S Jody Heymann, German Henostroza
BACKGROUND: Prison populations in sub-Saharan Africa (SSA) experience a high burden of disease and poor access to health care. Although it is generally understood that environmental conditions are dire and contribute to disease spread, evidence of how environmental conditions interact with facility-level social and institutional factors is lacking. This study aimed to unpack the nature of interactions and their influence on health and healthcare access in the Zambian prison setting. METHODS: We conducted in-depth interviews of a clustered random sample of 79 male prisoners across four prisons, as well as 32 prison officers, policy makers and health care workers...
November 2016: Health Policy and Planning
Taghrid S El-Mahdy, Mohamed H Al-Agamy, Ahmed A Al-Qahtani, Atef M Shibl
Acinetobacter baumannii is currently considered as one of the most common successful pathogens in the healthcare system due to its ability to quickly develop resistance. Ten carbapenem-resistant A. calcoaceticus-baumannii complex were isolated from the eastern region, Saudi Arabia in 2014. All isolates were resistant to ciprofloxacin, however, 8 of 10 isolates were tigecycline resistant. Susceptibility test was also carried out for three aminoglycosides, resistance to gentamicin was 80%, amikacin was 90%, and tobramycin was 50%...
January 2017: Microbial Drug Resistance: MDR: Mechanisms, Epidemiology, and Disease
Hamed Zandian, Alireza Olyaeemanesh, Amirhossein Takian, Mostafa Hosseini
INTRODUCTION: The Targeted Subsidies Law (TSL) was implemented in 2010 with a platform of improving equity in the Iran's society. One of the objectives of the TSL was improving equity in Healthcare Financing (HCF), but a significant change has not occurred since then. The aim of this study was to analyze the challenges of the TSL to equity in the HCF in Iran. METHODS: In this interpretive qualitative study, 31 policy makers and health system experts were interviewed face to face from September 2014 to June 2015...
February 2016: Electronic Physician
Bernadette Ann-Marie O'Hare, Delan Devakumar, Stephen Allen
BACKGROUND: The Committee on Economic, Social and Cultural Rights states that the right to health is closely related to, and dependent upon, the realization of other human rights, including the right to food, water, education and shelter which are important determinants of health. Children's healthcare workers in low income settings may spend the majority of their professional lives trying to mitigate deficiencies of these rights but have little influence over them. In order to advocate successfully at a local level, we should be aware of the proportion of children living in our catchment population who do not have access to their basic rights...
2016: BMC International Health and Human Rights
Raoudha Dziri, Naouel Klibi, Carla Andrea Alonso, Ahlem Jouini, Leila Ben Said, Sarra Chairat, Ridha Bellaaj, Abdellatif Boudabous, Karim Ben Slama, Carmen Torres
To investigate the possible role of the hospital environment in the dissemination of extended-spectrum-beta-lactamase (ESBL)-producing Escherichia coli isolates, 300 samples were taken during 2013 from abiotic surfaces (n = 250), healthcare worker hands (n = 27), and hands of patients (n = 23) in a Tunisian Hospital. ESBL-producing E. coli isolates were recovered in 3.7% of analyzed samples (4% abiotic surfaces; 4.3% hands of patients; 0% in healthcare worker hands), and one isolate/sample was further studied...
July 2016: Microbial Drug Resistance: MDR: Mechanisms, Epidemiology, and Disease
Julio Frenk, Octavio Gómez-Dantés
In this essay we discuss the need to reestablish the balance between health enhancing activities and care for the sick in order to meet the challenges of the 21st century. We first briefly review the historical evolution of personal and public hygiene. We then discuss the increasing emphasis on curative care that has characterized the modern world. We conclude that, in order to meet the emerging challenges, contemporary health systems need to adopt a comprehensive scope which include upstream interventions to address the determinants of health; public health interventions to deal with major risk factors; personal health services to manage common infections, reproductive problems, non-communicable diseases, injuries, and mental health problems; and palliative care to deal with old age and the final phases of the human life cycle...
January 2016: Salud Pública de México
Richard Sawatzky, Pat Porterfield, Joyce Lee, Duncan Dixon, Kathleen Lounsbury, Barbara Pesut, Della Roberts, Carolyn Tayler, James Voth, Kelli Stajduhar
BACKGROUND: Much of what we understand about the design of healthcare systems to support care of the dying comes from our experiences with providing palliative care for dying cancer patients. It is increasingly recognized that in addition to cancer, high quality end of life care should be an integral part of care that is provided for those with other advancing chronic life-limiting conditions. A "palliative approach" has been articulated as one way of conceptualizing this care. However, there is a lack of conceptual clarity regarding the essential characteristics of a palliative approach to care...
2016: BMC Palliative Care
William Hsu, Simon X Han, Corey W Arnold, Alex At Bui, Dieter R Enzmann
Given the increasing emphasis on delivering high-quality, cost-efficient healthcare, improved methodologies are needed to measure the accuracy and utility of ordered diagnostic examinations in achieving the appropriate diagnosis. Here, we present a data-driven approach for performing automated quality assessment of radiologic interpretations using other clinical information (e.g., pathology) as a reference standard for individual radiologists, subspecialty sections, imaging modalities, and entire departments...
April 2016: Journal of the American Medical Informatics Association: JAMIA
Daniela Benedetto, Masieh Abawi, Pieter R Stella, Freek Nijhoff, Pierfrancesco Agostoni
Refractory angina is a chronic condition characterized by the presence of disabling symptoms due to severe obstructive coronary artery disease that is not improved by a combination of medical therapy and percutaneous or surgical revascularization. Mortality rates associated with this condition are quite low in clinically stable patients on optimal medical therapy, but rehospitalization rates remain high. This mandates the need for new therapies targeting an improvement of symptoms in this population, taking into account also the potential impact in terms of healthcare and costs...
November 2015: Giornale Italiano di Cardiologia
Lareen Newman, Fran Baum, Sara Javanparast, Kerryn O'Rourke, Leanne Carlon
Changing settings to be more supportive of health and healthy choices is an optimum way to improve population health and health equity. This article uses the World Health Organisation's (1998) (WHO Health Promotion Glossary. WHO Collaborating Centre for Health Promotion, Department of Public Health and Community Medicine, University of Sydney, NSW) definition of settings approaches to health promotion as those focused on modifying settings' structure and nature. A rapid literature review was undertaken in the period June-August 2014, combining a systematically conducted search of two major databases with targeted searches...
September 2015: Health Promotion International
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