Improving hand hygiene in community healthcare settings: the impact of research and clinical collaboration

Observation of nursing activities and bacteriological studies undertaken with a sample of nurses employed in a community NHS trust indicated that considerable scope for cross infection existed during domiciliary visits. Poor conditions in patients' homes compromised nurses' ability to perform hand hygiene effectively, increasing risks. A clinical trial indicated that carriage of medically significant bacteria likely to contribute to cross infection could be reduced by applying an antiseptic cream which exhibited residual effectiveness. An audit of hand hygiene throughout the inner city trust indicated the need to pay greater attention to hand hygiene, especially during home nursing visits. The situation was less acute in a rural trust where a second audit was performed for comparative purposes. The motivation of clinical staff to improve hand hygiene precautions was high.     

A method for analyzing resource use in ambulatory care settings

The major objective of this research is to develop a methodological framework to help analyze the use of resources in ambulatory care environments. Emphasis is placed on trying to understand reasons for variation in treatment patterns. Important methodological considerations include: 1) the selection of a set of medical problems appropriate for evaluating the interaction effects of the variables being considered; 2) the development of problem-specific computerized routines for defining episodes of care based on patient visit information; and 3) the selection of appropriate measures of utilization. The Frontier Nursing Service (FNS) was used as a study setting. FNS is a primary health care service and training center located in Leslie County in eastern Kentucky. an area that covers 1,000 square miles with a population of approximately 15,000. The analysis indicates that for common primary care problems, the level of provider training as well as accessibility of services significantly influence patterns of care.     

Vocational services research: recommendations for next stage of work

As the field of vocational services (VS) research matures, it is necessary to review its progress and identify any important gaps in measurement and methodology that may hamper future efforts. To encourage progress, we have identified (1) ways to increase consistency in measuring employment outcomes, (2) emerging patterns and lingering gaps in the range of variables and measures commonly used in VS research, (3) broader methodological patterns and needs in the area of study design and sampling, (4) interventions that warrant additional study, and (5) broad strategies to increase the overall amount and quality of VS research. The goal of this article is to assist the field in achieving clearer coherence in shared expectations and standards for research so that the field can consolidate its gains as it helps people successfully return to rewarding jobs in the community.     

The impact of hypnotic suggestibility in clinical care settings

Hypnotic suggestibility has been described as a powerful predictor of outcomes associated with hypnotic interventions. However, there have been no systematic approaches to quantifying this effect across the literature. This meta-analysis evaluates the magnitude of the effect of hypnotic suggestibility on hypnotic outcomes in clinical settings. PsycINFO and PubMed were searched from their inception through July 2009. Thirty-four effects from 10 studies and 283 participants are reported. Results revealed a statistically significant overall effect size in the small to medium range (r = .24; 95% Confidence Interval = -0.28 to 0.75), indicating that greater hypnotic suggestibility led to greater effects of hypnosis interventions. Hypnotic suggestibility accounted for 6% of the variance in outcomes. Smaller sample size studies, use of the SHCS, and pediatric samples tended to result in larger effect sizes. The authors question the usefulness of assessing hypnotic suggestibility in clinical contexts.     

Societal perceptions of community pharmaceutical services in Malta

Objective: To assess the views of the Maltese general public on services provided by community pharmacies in Malta and their opinions on the proposed extended role for pharmacies Method: An interviewer-administered structured questionnaire was used to interview 912 members of the public (395 males, 517 females) Results: The majority of respondents (70·8%) visited a pharmacy at least once a month, with females visiting more frequently than males ( P< 0·01). Almost 31% stated that the main reason for visiting a pharmacy was to purchase prescribed medication, while 23·3% said that it was to obtain over-the-counter products. Women were more likely than men to be influenced by the pharmacist's advice when selecting an over-the-counter product ( P< 0·05). The majority of respondents (62·8%) said that they usually bought their medicines from the same pharmacy and loyalty to a particular pharmacy increased with age. When treating minor ailments, respondents were more likely to consult their doctor or self-treat rather than seek advice from the pharmacist. The proposed extended role of the community pharmacist found support with the public, e.g. 90·2% felt that the pharmacist should promote health education, with the preferred method suggested being through individual advice; 85·7% were in favour of screening and monitoring services and 85·6% felt that the keeping of patient medication records would be useful. Almost three-quarters (74·6%) of respondents said that they would be willing to participate in pharmaceutical care programmes. When asked to suggest new activities for community pharmacy, respondents were most in favour of the pharmacist offering more advice on the treatment of minor ailments Conclusion: Overall, the results obtained are encouraging and Maltese pharmacists should plan to provide new services to the community in the future     

The intensive care unit work environment: Current challenges and recommendations for the future

The need for critical care services has grown substantially in the last decade in most of the G8 nations. This increasing demand has accentuated an already existing shortage of trained critical care professionals. Recent studies argue that difficulty in recruiting an appropriate workforce relates to a shortage of graduating professionals and unhealthy work environments in which critical care professionals must work.     

The concept, delivery and future of medical ambulatory care

Bed shortages, efficient modern diagnostic services and increasing risks associated with hospital admission, require review of conventional medical practice. Patients referred as emergencies who are walking, talking sense, eating and drinking and have normal sphincter function can usually be managed as outpatients. Widespread adoption of this practice would require more general physicians and nurse practitioners near the front door, rapid access and early review clinics and prompt diagnostic support. Education of the public, changes in medical training and reallocation of resources would reduce the need for inpatient management, providing beds for those in real need.     

The status of complementary therapy services in Canadian palliative care settings

Goal of work Little is known about complementary therapy services (CTs) available in Canadian palliative care settings. Materials and methods An online survey was e-mailed to multiple Canadian palliative care settings to determine the types and frequency of CTs provided and allowed, who are the CT providers, funding of CT services, and barriers to the provision of CTs. Main results The response rate was 54% (74/136). Eleven percent of surveyed palliative care settings provided CTs, and 45% allowed CTs to be brought in or to be used by patients. The three most commonly used CTs were music (57%), massage therapy (57%), and therapeutic touch (48%). Less than 25% of patients received CTs in the settings that provided and/or allowed these therapies. CTs were mostly provided by volunteers, and at most settings, limited or no funding was available. Barriers to the delivery of CTs included lack of funding (67%), insufficient knowledge of CTs by staff (49%), and limited knowledge on how to successfully operate a CT service (44%). For settings that did not provide or allow CTs, 44% felt it was important or very important for their patients to have access to CTs. The most common reasons not to provide or allow CTs were insufficient staff knowledge of CTs (67%) and lack of CT personnel (44%). Conclusions Overall, these findings were similar to those reported in a US-based hospice survey after which this survey was patterned. Possible reasons for these shared findings and important directions regarding the future of CT service provision in Canadian palliative care setting are discussed.     

Spinal cord injury and aging: challenges and recommendations for future research

Population aging, caused by reductions in fertility and increasing longevity, varies by country and is anticipated to continue and to reach global proportions during the 21st century. Although the effects of population aging have been well documented for decades, the impact of aging on people with spinal cord injury (SCI) has not received similar attention. It is reasonable to expect that population aging features such as the increasing mean age of the population, share of the population in the oldest age groups, and life expectancy would be reflected in SCI population demographics. Although the mean age and share of the SCI population older than 65 yrs are increasing, data from the National Spinal Cord Injury Statistical Center suggest that life expectancy increases in the SCI population have not kept the same pace as those without SCI in the last 15 yrs. The reasons for this disparity are likely multifactorial and include the changing demographics of the SCI population with more older people being injured; susceptibility of people with SCI to numerous medical conditions that impart a health hazard; risky behaviors leading to a disproportionate percentage of deaths as a result of preventable causes, including septicemia; changes in the delivery of health services during the first year after injury when the greatest resources are available; and other unknown factors. The purposes of this paper are (1) to define and differentiate general population aging and aging in people with SCI, (2) to briefly present the state of the science on health conditions in those aging with SCI, and finally, (3) to present recommendations for future research in the area of aging with SCI.     

Critical care in resource-poor settings: lessons learned and future directions

CONTEXT: Critical care faces the same challenges as other aspects of healthcare in the developing world. However, critical care faces an additional challenge in that it has often been deemed too costly or complicated for resource-poor settings. This lack of prioritization is not justified. Hospital care for the sickest patients affects overall mortality, and public health interventions depend on community confidence in healthcare to ensure participation and adherence. Some of the most effective critical care interventions, including rapid fluid resuscitation, early antibiotics, and patient monitoring, are relatively inexpensive. Although cost-effectiveness studies on critical care in resource-poor settings have not been done, evidence from the surgical literature suggests that even resource-intensive interventions can be cost effective in comparison to immunizations and human immunodeficiency virus care. In the developing world, where many critically ill patients are younger and have fewer comorbidities, critical care presents a remarkable opportunity to provide significant incremental benefit, arguably much more so than in the developed world. ESSENTIAL CONSIDERATIONS: Key areas of consideration in developing critical care in resource-poor settings include: Personnel and training, equipment and support services, ethics, and research. Strategies for training and retaining skilled labor include tying education to service commitment and developing protocols for even complex processes. Equipment and support services need to focus on technologies that are affordable and sustainable. Ethical decision making must be based on data when possible and on transparent articulated policies always. Research should be performed in resource-poor settings and focus on needs assessment, prognostication, and cost effectiveness. FUTURE DIRECTIONS: The development of critical care in resource-poor settings will rely on the stepwise introduction of service improvements, leveraging human resources through training, a focus on sustainable technology, ongoing analysis of cost effectiveness, and the sharing of context-specific best practices. Although prevention, public health, and disease-specific agendas dominate many current conversations in global health, this is nonetheless a time ripe for the development of critical care. Leaders in global health funding hope to improve quality and length of life. Critical care is an integral part of the continuum of care necessary to make that possible.     

The 'Silver Book' on elderly care in hospitals and community settings

The number of people aged 85 and over is set to increase by two-thirds in the next 20 years, making it imperative that appropriate structures are in place and guidance is available for clinicians in every setting on best practice in caring for older people over the first 24 hours of an urgent care episode. This article discusses the launch of the Silver Book, which recommends ways in which emergency admissions can be reduced and the experience of those admitted improved.     

Reorganizing nursing for the future: nursing commission recommendations and research implications

The department of Health and Human Services Commission on Nursing, along with various nurse advisors, has developed a series of findings and recommendations relevant to the nursing shortage. This article discusses the findings and recommendations and their relevance to practice in the current climate of the nursing shortage and changing work environment, and presents implications for future organizational and clinical research.