Older Adults’ Expectations and Experiences With Health care Professionals in Ghana

By the year 2050, over 6 million of Ghana’s population will be people aged 60 years and above. Because of increased health challenges that accompany aging, older Ghanaians have health needs to address communicable and chronic non-communicable diseases. This suggests that now into the future, older adults in Ghana will have increased contact with health care professionals. The aim of this qualitative study was to explore older adults’ expectations and experiences with health care professionals to generate information that will shape health care policy and service delivery. Interviews were conducted with a purposive sample of 23 persons aged 60 years and above from the North and South of Ghana. The transcribed data were imported to NVivo software to aid with analysis of the data. An inductive approach ta data analysis was used, drawing from thematic analyses procedures. Three key findings emerged from the study. These include (a) noncompassionate care—health professionals were neglectful, inattentive, discriminatory, and stigmatizing toward participants; (b) disrespectful attitude—professionals showed disrespect by shouting or yelling, making participants feel invisible, or not distinguishing participants from younger patients; and (c) a better way to treat us—participants called for compassion, patience, respect, honesty, and priority attention from health care professionals. The study contributes to literature on older adults’ experiences with health care professionals and suggests to health policy makers and health care professionals to consider older adults’ care expectations to make health care services elder-friendly.

Make No Little Plans: The Lucian Leape Institute

Despite encouraging progress in the early years of the patient safety movement, it soon became evident that there were deeper issues that needed to be addressed. We realized that we were not going to make health care safe by making process changes one by one, even powerful changes such as eliminating CLABSI or implementing the surgical checklist.

Severe hypocalcemia and seizures after normalization of pCO2 in a patient with severe bronchopulmonary dysplasia and permissive hypercapnia

Objectives To describe the association between the rapid normalization of pCO2 after intubation in a patient with severe bronchopulmonary dysplasia managed with permissive hypercapnia, with the risk of developing hypocalcemia and seizures, and to make health care providers aware of this risk in similar cases. Case presentation An extreme premature infant, born at 25 weeks of gestational age (GA), developed a severe bronchopulmonary dysplasia (BPD) and, after several extubation failures could be managed with non-invasive ventilation and permissive hypercapnia, with capillary pCO2 of up to 80 mmHg and pH >7.20. At 46 postmenstrual age (PMA) he was intubated because of severe hypercapnia and compensating metabolic alkalosis. About 20 h after intubation, after normalization of pH and pCO2, he developed hypocalcemia and seizures, that remitted after iCa normalization. A comparison between arterial and capillary blood gases showed a significantly greater correlation between pH and iCa in arterial than in capillary samples. Conclusions Our findings emphasize the importance of avoiding the abrupt reduction of pCO2 and the close monitoring of acute metabolic changes after its correction in chronic patients with permissive hypercapnia, as well as the potential superiority of arterial samples over capillaries to improve the precision of this control.

When the Aims and the Ends of Health Care Misalign

In health care, a high-emotion service, unintended consequences can be especially problematic. People’s physical, psychological, and financial well-being—even their lives—are at stake. As scientific, technological, and demographic changes make health care a much more complex service to deliver, efforts to anticipate, avoid, and correct unintended consequences become more crucial. Using narrative examples and an extensive review of the data and the literature, we explore these efforts in four domains of U.S. health care: (1) the increasingly widespread, often challenging use of electronic health records; (2) the threat to the patient-clinician relationship from a greater, sometimes narrow emphasis on productivity metrics; (3) the culture of medicine’s frequently misguided prioritizing of treatment over true healing; and (4) the overreliance on family caregivers who are often poorly prepared to care for the seriously ill. We then apply lessons from health care’s unintended consequences to non-health-care services and suggest opportunities for service researchers to contribute to improving health care delivery, a service that all of us need.

The Three CCCs of Dysphagia Management: Culturally Competent Care

Purpose Patient-centered care is a healthcare approach that values an individual's right to make health care choices. For patients with dysphagia, honoring choices that carry significant health risks is challenging. This article presents strategies adapted from the multicultural literature to enhance patient engagement and help balance choices for quality of life while mitigating potential negative health consequences. The goal is to provide clinicians with knowledge gleaned from multicultural resources to deliver optimal care that considers both cultural and ethical factors. Method The authors use a hypothetical case of an older adult woman with dysphagia whose family is disagreeing with diet recommendations to introduce the concepts of culture, cultural humility, cultural competence, and ethical considerations. The authors present strategies for working with culturally diverse patients to show that these strategies can be adapted for use with any patient, regardless of cultural background. Conclusion Adopting a perspective that every patient presents with many cultural variables that can influence dysphagia management encourages the speech-language pathologist to approach each patient through a multicultural lens. Strategies and approaches for working with culturally and linguistically diverse patients can be adapted and inform the speech-language pathologist on ways to establish a dynamic of shared decision making for successful outcomes.

“Thanks, But No Thanks!” Patient Refusal of ED Diagnosis and Treatment

Patient refusal of medical treatment that appears to be in the patient’s best interest is a common challenge for emergency physicians. In the United States, adults have the right to refuse treatment, including life-sustaining medical treatment. The patient must both possess the capacity to make the decision and be offered an opportunity to understand the potential consequences of refusal. The determination of capacity is necessary in deciding when to honor a patient’s refusal. Parents and guardians generally have the right to make health care decisions for their children, but those decisions need to align with the best interests of the child. Documentation of the patient’s refusal of treatment against medical advice may be of some evidentiary value but does not ensure legal protection from liability. Patients who have the capacity to refuse medical treatment should be offered the opportunity to learn and consider the potential consequences before physicians respect their autonomous refusal.

Health training – preparing an organism for coping with COVID-19

Coexistence of organisms in the world is a dynamic state, requiring complying with certain rules in order to sustain biological balance. Huge human expansion into the Earth ecosystem results in numerous crises. One of them is a problem of pandemic concerning COVID-19. The dynamics of epidemic development is changing. More and more statistical analyses regarding clinical course of this disease are appearing. Prophylactic actions, specific for each country, are taken aimed at reduction of quantity and intensity of infections in the society in such a way as to make health care systems efficient at the time of pandemic. Great hopes are put in natural defence mechanisms of human body, the effectiveness of which, to a large extent, depends on ourselves. As part of prophylactic actions, heath trainings, that is regular physical exercises together with proper management of rest, nutrition and sleep, can improve physical performance of an organism, strengthen its immuno-logical defence, adapting it to greater burdens. Such a relative load, that impairs functioning of respiratory system and as a consequence limits the ability to obtain energy necessary for independent maintenance of vital functions, may be a clinic course of COVID-19. Development of the Internet and social media considerably facilitates search for those kinds of physical activities that can be performed in the home. That is why, despite the isolation and movement restrictions, everyone can find own way to actively spend free time, which will positively influence his/her organism, and consequently, increase chances in potential encounter with the virus.