Multidisciplinary residential home intervention to improve outcomes for frail residents

Background Residential homes provide accommodation and assistance with personal care only and are not required to have registered nurses on site. However, their residents often have a combination of comorbidity, polypharmacy, frailty and mental-health conditions with poor access to healthcare to meet these needs. Integrated healthcare for older people is a key NHS priority in the Long-Term Plan and the Five-Year Forward View. We describe development and implementation of multi-disciplinary intervention to integrate healthcare and promote interprofessional education. Methods A multi-disciplinary residential home quality improvement project in two cycles by a team comprising senior and trainee general practitioners, trainees in geriatrics, psychiatry, pharmacist and residential home senior staff. The intervention was underpinned by the framework for enhanced health in care homes including Comprehensive Geriatric Assessment (CGA) and mental-health review. Each intervention session included an educational presentation by a team member consideration of each resident in a pre-evaluation multi-disciplinary discussion followed by a structured clinical assessment and discussion of proposed management. Results Three residential homes participated with a total 34 residents receiving intervention. In one residential home, there was a 75% reduction in admissions for those reviewed and a reduction in overall admission costs. Polypharmacy was reduced by an average of 2 medications per resident across the three sites. There was a 63% increase in cardio-pulmonary resuscitation decisions and 76% increase in advance care planning discussions. Conclusion This was an effective model for multi-disciplinary trainees working with a perceived impact on physical and mental health, and valuable opportunities for sharing learning.

Audiobooks: Improving Access to and Use of Learning and Teaching Materials for the Print-Disabled

Equal access to books and other educational materials presents equal opportunities for all to acquire education, develop skills, and realise their full potential. Drawing on data gathered through focus group discussions and interviews, our study discusses access and use of books in braille by the print-disabled in special schools/education in Ghana. The study found the supply and access to books in braille by students and teachers inadequate to support teaching and learning, mainly due to the challenges with production. Given the poor access teachers and students have to publications in braille, we argue that audiobooks be adopted as a supplementary reading format for the print-disabled in Ghana so they can have access to equal educational opportunities as their non-disabled colleagues.

Family-Centered Telehealth Supporting Motor Skills and Activity in Individuals With Rett Syndrome

Rett syndrome is a rare genetically caused condition associated with severe disability and impaired motor functions. Local therapists typically see small numbers of affected individuals, and this limits their capacity to gain experience. Telehealth is being used increasingly to counter poor access to rehabilitation services. Moreover, there is a need to develop management plans that support individuals with Rett syndrome over their lifespan. Three projects in which telehealth support was provided by therapists experienced in Rett syndrome and supported by available local resources are presented in this chapter. The three projects responded to locally identified needs in a cost-efficient way and empowered those working with people with Rett syndrome to maintain and improve their clients' physical function and activity. This chapter will discuss the conceptual underpinnings of delivering a service using a telehealth approach and describe the results and the strategies implemented in the projects mentioned above.

Sexually Transmitted Infections in Pediatrics

Sexually transmitted diseases (STDs) disproportionately affect young people, with more than half of the infections occurring in 15- to 25-year-olds, although as an age group they constitute only 25% of the sexually active population. Adolescents have been considered as a key and vulnerable population; adolescents are considered as marginalized populations (i.e., poor access to adequate health services, social and parental acceptance, stigmatization, among others. Every year, 87 million new cases of gonorrhea are reported worldwide in the population from 15 to 49 years old. In 2016, the estimated global prevalence of CT in 15-to 49-year-old women was 3.8% and in men 2.7%, with regional values ranging from 1.5 to 7.0% in women and 1.2 to 4.0% in men. The worldwide prevalence of HSV-2 among 15–49-year old is 11.3% and for HSV-1 among 0–49-year-old is 67%. These numbers alert us about the increase in the frequency of these diseases among young populations; more open sexual behavior could be an important factor for this increase; the treatment of these diseases is challenging due to the difficulties with detection and treatment; in the case of gonorrhea, it could become a major public health problem due to the emerging antimicrobial resistance; in the case of Chlamydia, despite the effective treatment, reinfection is still a possibility and for genital herpes, the disease can be controlled but not cured. This chapter will describe the most important aspects of these three diseases for supporting the clinicians and researchers about the management of sexually transmitted diseases in the adolescent population.

Precision Medicine—A Demand Signal for Genomics Education

ABSTRACT Pressed by the accumulating knowledge in genomics and the proven success of the translation of cancer genomics to clinical practice in oncology, the Obama administration unveiled a $215 million commitment for the Precision Medicine Initiative (PMI) in 2016, a pioneering research effort to improve health and treat disease using a new model of patient-powered research. The objectives of the initiative include more effective treatments for cancer and other diseases, creation of a voluntary national research cohort, adherence to privacy protections for maintaining data sharing and use, modernization of the regulatory framework, and forging public–private partnerships to facilitate these objectives. Specifically, the DoD Military Health System joined other agencies to execute a comprehensive effort for PMI. Of the many challenges to consider that may contribute to the implementation of genomics—lack of familiarity and understanding, poor access to genomic medicine expertise, needs for extensive informatics and infrastructure to integrate genomic results, privacy and security, and policy development to address the unique requirements of military medical practice—we will focus on the need to establish education in genomics appropriate to the provider’s responsibilities. Our hypothesis is that there is a growing urgency for the development of educational experiences, formal and informal, to enable clinicians to acquire competency in genomics commensurate with their level of practice. Several educational approaches, both in practice and in development, are presented to inform decision-makers and empower military providers to pursue courses of action that respond to this need.

Exploring Key Components of Successful Distance Learning Programs: A Case Study in Palau

Introduction: The Pacific faces multiple healthcare crises, including high rates of noncommunicable diseases, infectious disease outbreaks, and susceptibility to natural disasters. These issues are expected to worsen in the coming decades, increasing the burden on an already understaffed healthcare system. Improvements in technology and accessibility have increased telehealth’s utility and have already proven to reduce costs and increase access to care in remote areas. Telehealth includes distance learning; a form of education that can help alleviate many healthcare issues by providing education to healthcare professionals and upskilling staff, which can promote workforce retention and decrease patient mortality. Distance learning programs at the Ministry of Health in the Pacific nation of Palau were examined and key elements to their success were identified. Methods: Thirty-four people, mostly health professionals at the Belau National Hospital in Palau were interviewed. Standardized questions and surveys were conducted in person throughout the month of July 2019. Findings: Two examples of successful distance learning programs were identified. Consulting with staff and analyzing each program, four factors for a successful distance learning program were identified: having a cohort, having a facilitator, dedicated study time off from work, and motivation. Conclusions: In countries as geographically isolated as the Pacific, with poor access to specialists and resources, telehealth has the potential to radically change how healthcare is delivered. Palau shares similar resources and issues as other countries in the Pacific and the lessons learned from their successful programs can be adapted to help other Pacific nations develop their own distance learning programs.

Use of Simple Mobile Technology to Create an Electronic Vaccination Registry in Kenya

Vaccination is one of the high-impact public health interventions against the spread of disease. Over time, developed countries have been able to reduce the burden of disease through improving access to vaccination and achieving high vaccine coverage. In low-income countries, the situation is different as most countries still report low coverages of less than 90%, which is the global target recommended by the World Health Organization. The main reasons for this low coverage include poor access to vaccination, stock-outs, and poor documentation and targeting for vaccination services. To address these problems, we developed an electronic vaccine registry using Unstructured Supplementary Service Data (USSD) technology that registered births, vaccines administered and sent short message reminders to mothers about their clinic dates. The study was conducted in Nyandarua County, Kenya, between June 2018 to March 2019. To participate in the study, mothers had to reside within the jurisdiction of the study site. Mothers who moved into the study site also had their children registered and previous vaccines updated. A total of 4,823 births and 20,515 vaccines administered were captured into the system. The system sent 12,554 short message reminders to mothers; 3 days before the due day and on the due day. Additionally, it generated a birth register, vaccination register, defaulter list, dropout rate report, vaccine coverage, and timeliness reports. The intervention improved vaccination coverage and timeliness of vaccination by up to 8.7%.

Prevalence and Exposure to Ergonomic Risk Factors among Crop Farmers in Nigeria

This study examined the prevalence and exposure to ergonomic risks factors among crop farmers in selected states in Nigeria. We used cross-sectional data to provide this evidence. Data were collected with the aid of a standardized questionnaire administered to farmers. A total of 480 smallholder cassava farmers selected across 24 farming communities in Kogi and Kwara states, Nigeria, were engaged in the study. Descriptive statistics and binary regression were used for analysis. About 96% of the respondents reported shoulder pain, 85% reported lower back pain, 82% reported upper back pain, 64% reported neck pain, and 53% reported elbow pain during farming operations. We found that the age of farmers (OR = 2.01) and daily duration of daily chemical spray (OR = 1.17) were risk factors, while previous training on the safe use and application of farm chemicals was found to be a protective factor (α = 0.05). The study identified affordability of farm safety measures and poor access to relevant safety information as top constraints to farmers’ adoption of safe farm practices. We concluded there is a high prevalence of ergonomic risks during cassava operations among respondents. A crop-specific co-designed ergonomic intervention targeted at Nigerian farmers to reduce exposure to ergonomic risks is recommended.

Hepatitis C Vaccination: Where We Are and Where We Need to Be

The hepatitis C virus (HCV) is a common cause of chronic liver disease and liver cancer worldwide. Despite advances in curative therapies for HCV, the incidence of new infections is not decreasing at the expected rate to hit the World Health Organization (WHO) target for the elimination of HCV by 2030. In fact, there are still more new cases of infection in the United States and worldwide than are being cured. The reasons for the rise in new cases include poor access to care and the opioid epidemic. The clinical burden of HCV requires a multimodal approach to eradicating the infection. Vaccination would be an excellent tool to prevent incidence of new infections; however, the genetic diversity of HCV and its ability to generate quasispecies within an infected host make creating a broadly reactive vaccine difficult. Multiple vaccine candidates have been identified, but to date, there has not been a target that has led to a broadly reactive vaccine, though several of the candidates are promising. Additionally, the virus is very difficult to culture and testing candidates in humans or chimpanzees is ethically challenging. Despite the multiple barriers to creating a vaccine, vaccination still represents an important tool in the fight against HCV.

Born or Grown: Enablers and Barriers to Circular Business in Europe

Circular economy goals have made their way towards the very heart of EU policy, promising the delivery of both economic and environmental goals, but key to their achievement is the active involvement and participation of businesses. Scholarly literature has made considerable headway in describing the diverse CE business model archetypes and the enablers and barriers that can nurture the transition toward them. However, little work has been done to assess a more profound distinction—that between enterprises that are born circular in contrast with incumbent businesses that grow into circularity. We review 18 case studies of businesses in Europe, which shed light on this distinction. A systematic analysis of their internal, contextual, and policy issues results in the identification of ten key enablers (including business targets, cost reduction potential, loyal customers, demographic aspects, growing waste flows, environmentalism, EU policy, circular policy, and dis/incentives as well as sectoral considerations) and ten key barriers (including bottom line concerns, problematic consumer preferences, lack of infrastructure, technological barriers, poor access to finance, competition, lack of EU harmonisation, uncertainty and lack of internalisation of externalities, and the presence of obstructive policy). We observe that businesses which are born circular seem to face fewer barriers than those seeking to grow into circularity, a finding which offers hope for the transition to a circular economy. Our analysis also suggests that while some enablers and barriers cut across different types of businesses, others tend to be more prevalent among enterprises of a certain size or sector.