Models of care

Background: Patient retention in care for HIV/AIDS is a critical challenge for antiretroviral treatment programs. Community-based adherence programs (CBAPs) as compared to health care facility-based adherence programs have been considered as one of the options to provide treatment maintenance support for groups of patients on antiretroviral therapy. Such an approach provides a way of enhancing self-management of the patient’s condition. In addition, CBAPs have been implemented to support antiretroviral treatment expansion in resource-limited settings. CBAPs involve 30 patients that are allocated to a group and meet at either a facility or a community venue for less than an hour every 2 or 3 months depending on the supply of medication. Our study aimed to establish perceived challenges in moving adherence clubs from health facilities to communities.
Methods: A qualitative study was conducted in 39 clinics in Mpumalanga and Gauteng Provinces in South Africa between December 2015 and January 2016. Purposive sampling methods was used to identify nurses, club managers, data capturers, pharmacists and pharmacy assistants who had been involved in facility-based treatment adherence clubs. Key-informant interviews were conducted. Also, semi-structured interviews were used and thematic content analysis was done.
Results: A total of 53 health care workers, 12 (22.6%) males and 41 (77.4%) females, participated in the study. Most of them 49 (92.5%) indicated that participating in community adherence clubs were a good idea. Reduction in waiting time at the health facilities, in defaulter rate, improvement in adherence to treatment as well as reduction in stigma were some of the perceived benefits. However, security of medication, storage conditions and transportation of the prepacked medication to the distribution sites were the areas of concern.
Conclusion: Health care workers were agreeable to idea of the moving adherence clubs from health facilities to communities. Although some challenges were identified, these could be addressed by the key stakeholders. However, government and nongovernmental organizations need to exercise caution when transitioning to community-based adherence clubs.

This evaluation was undertaken 2011-14. SWPwAs can be defined as organisations independent of local authorities that are contracted to carry out functions that were previously the duty of local authorities in supporting community dwelling adults potentially or actually defined as in need of social care and support, especially in regards to assessment, care planning and reviews. The Evaluation collected data about the policy impetus that led to the creation of SWPwAs and presents a discussion about the policy announcements, debate and commentary on the pilots as they moved from idea to practice. There are commonalities but also differences between the Social Work Practices pilots with Adults and with the earlier Social Work Practices with Children pilots. Over time, the indicators of success as perceived by government changed and the lessons learned from SWPwA pilots should be seen as supporting the implementation of policy rather than providing evidence for policy formulation. The decision to pilot SWPwAs was made in 2010 and a series of steps followed - namely seeking volunteer local authorities to take part in the pilots as commissioners, deciding on the pilot remits and funding, drawing up contracts and making arrangements for staffing, the chosen areas of practice and methods of engaging with other local stakeholders. These are analysed in the full report.

The paper reflects on a study which explored the role of spirituality in the lives of women during the first year after being diagnosed with breast cancer. The study utilised a qualitative method (hermeneutic phenomenology) designed to provide rich and thick understanding of women’s experiences of breast cancer and to explore possible ways in which spirituality may, or may not, be beneficial in enabling coping and enhancing quality of life. The paper draws on the thinking of David Hay and Viktor Frankl to develop a model of spirituality that includes, but is not defined by, religion and that has the possibility to facilitate effective empirical enquiry. It outlines a threefold movement inwards, outwards and upwards – that emerged from in-depth interviews withwomen who have breast cancer. This framework captures something of the spiritual movement that women went through on their cancer journeys and offers some pointers and possibilities for better and more personcentred caring approaches that include recognition of the spiritual dimension of women’s experiences for the management of those with breast cancer.

In this article I analyze both generalized propriety as a boundary marker of Sudanese identity in Cairo, and gendered attitudes toward morality and female genital cutting (FGC) as a fundamental aspect of that boundary. Sudanese have been profoundly affected by the ongoing political crisis in their home country, by the displacement triggered by political and economic collapse, and by their deteriorating legal and social status in Egypt. The dramatic changes in the circumstances of Sudanese residence in Cairo have challenged the cultural norm of gender complementarity as men |[lsquo]|stay at home|[rsquo]| for want of work while women seek and find new opportunities for themselves. This unstable situation has led Sudanese to place more emphasis on |[lsquo]|proper|[rsquo]| ways of behaving and being, an assertion that helps define the ethnic boundaries of the Sudanese community in Cairo. I demonstrate the inconsistencies between discourse and reality through ethnographic data while analyzing how Sudanese have found new ways of asserting their identity and resisting the practice of FGC.

Growing population of vehicles is one the biggest global concern and it led to traffic problems and creates congestion. People are not getting place to park their vehicles. Travel by car for shorter distance also stressful and time consuming because they have to face road traffic and usually cars are big at size so, to travel by car on road need more spacious and traffic free roads. that's why some manufacturers start designing & manufacturing One seater vehicle which can easily transportable and create less congestion. If a single person wants to ride somewhere then he doesn't have to take large car for one person, He can use single seater vehicle. In this assignment I have Designed and Tested a single seater electric vehicle which can easily transportable, compact and personal commuter vehicle (PMV).

My struggle and fascination with the subject of embodiment began at a young age. Perhaps my first sense of the nuances of being an embodied being began with the realization that my younger brother was considered “different” as a result of being born microcephalic (having an abnormally small head and brain) and therefore having lifelong developmental delay. I remember wondering: How is it that the body can work so perfectly sometimes and yet have so many complications other times? What had happened to make his development so starkly contrast my own? And why can’t it fix itself?

As a high school student, my struggle manifested in the forms of anorexia and bulimia. The anorexia came first, and began almost as if a switch had been thrown. I dieted severely and dropped 60 pounds in a little under 3 months, in the end making it a goal to lose a pound a day. My cheeks sunk in. I slept through lunch. I found little occasion to laugh. And still I could not see an ounce of beauty or satisfaction when I looked at my body. I poked at the jutting bones of my pelvis and wished my bones were smaller. I saw my body as a devious enemy. During my junior year, I became bulimic as a means of coping with increasing pressures by family and friends to eat.

Finally during my senior year in high school, everything came to a head. After beginning to consistently throw up blood, I secretly arranged a meeting with my pediatrician. She made me give her my word that I would put an end to my bulimia…and just as abruptly as I began, I stopped, true to my word.

In my freshman year of college I was sexually assaulted by a member of our social group. I told few people and silently cursed my femininity. College was a time when I neither loved nor hated my body; rather, I simply disconnected from it.

Continue reading: http://feminismandreligion.com/2012/01/10/a-personal-journey-of-embodiment-by-stacia-guzzo/#more-2112

Objectives. To create a preliminary taxonomy and related toolkit of health-related habits (HrH) following a person-centered approach with a focus on primary care.Methods. From 2003–2009, a working group (n=6physicians) defined the knowledge base, created a framing document, and selected evaluation tools using an iterative process. Multidisciplinary focus groups (n=29health professionals) revised the document and evaluation protocol and participated in a feasibility study and review of the model based on a demonstration study with 11 adult volunteers in Antequera, Spain.Results. The preliminary taxonomy contains 6 domains of HrH and 1 domain of additional health descriptors, 3 subdomains, 43 dimensions, and 141 subdimensions. The evaluation tool was completed by the 11 volunteers. The eVITAL toolkit contains history and examination items for 4 levels of engagement: self-assessment, basic primary care, extended primary care, and specialty care. There was positive feedback from the vol...

Background: Approximately one-third of rapid response team consultations involve issues of end-of-life care. We postulate a greater occurrence in patients with a life-limiting illness, in whom the opportunity for advance care planning and palliative care involvement should be offered. Aims: We aim to review the characteristics and compare outcomes of rapid response team consultations on patients with and without a life-limiting illness. Design/Setting: A 3-month retrospective cohort study of all rapid response team consultations was conducted. The sample population included all adult inpatients in a major teaching hospital network. Results: We identified 351 patients – including 139 with a life-limiting illness – receiving a total of 456 rapid response team consultations. The median time from admission to the first rapid response team consultation was 3 days. Patients with a life-limiting illness had a significantly higher mortality rate (41.7% vs 13.2%), were older (72.6 vs 63.5 ye...

El objetivo del estudio citado fue mostrar una experiencia de atención por neurólogos en un servicio de urgencia (SU) de un hospital público regional. Principalmente en lo que respecta al grado de cumplimiento
de la recomendación de evaluación por neurólogo(a) dentro de la primera hora desde el inicio de los síntomas. Idealmente, en urgencias neurológicas de riesgo vital (status epilepticus, hemorragia subaracnoidea), la evaluación debiera realizarse dentro de 15 min desde el ingreso. En nuestro estudio, solo 27,1% de los pacientes fue evaluado en menos de una hora desde su llegada al SU, con una diferencia significativa entre Urgencias Vasculares y No Vasculares (22,6 versus 36%)1. No sólo las urgencias neurovasculares son tiempo-dependientes,
lo son también el status epilepticus y la meningoencefalitis
infecciosas. La evaluación rápida ligada a un manejo certero y precoz se asocia a mejores desenlaces funcionales.

Timely and appropriate pain management is an important quality indicator of ED performance. Emergency health care workers are well positioned to become active leaders and innovatively responsive in reducing human suffering. A pain management audit was conducted to determine Australia practice patterns.
METHODS:
A 12-month retrospective descriptive cohort audit was undertaken. Through the randomization process a medical record audit tool was completed for each record identified. Ethical approval for the study was obtained.
RESULTS:
Seventy-four hospitals agreed to conduct the audit, 36 (48%) provided data. The total number of patient notes reviewed was 2,066. Ninety-five percent (1,966) of patients arrived by ambulance. Of the patients (n=547; 56.4%) with a documented triage pain score the majority arrived in severe pain (n=300; 41.3%). Of the total number of patients (1,966) documented arriving in pain 1,473 (74.9%) received an analgesic. Six hundred and forty-four (32.7%) patients received an opioid. From time of emergency department arrival, the median time for analgesic administration was 70 minutes (IQR 58 minutes to 92 minutes). Twenty-five emergency departments (69.4%) had pain management policies that enabled nurses to initiate a pharmacological analgesia without medical consultation.
DISCUSSION:
The Australian pain management audit highlighted current practices and potential areas for further research. While the audit demonstrated that nurse initiated pain management interventions promoted better analgesic response, greater consistency of triage pain assessment, code allocation, and documentation of pain scores may go some way to improving the timeliness of analgesia.

Observations of prenatal movement patterns of mouth and lips essential for feeding could have the potential for an assessment of
the readiness to feed after birth. Although there is some research on sucking per se, we know very little about prenatal preparatory
movements for sucking, namely, the ability to co-ordinate opening the mouth widely and then pursing the lips as if around a
teat or nipple in utero. The purpose of the present study was to test two hypotheses using an adapted version of the Facial Action
Coding Scheme: first that mouth stretch (AU 27) will be followed by lip pucker (AU 18), and second that these coordinated
movement patterns will increase as a function of gestational age. Fifteen healthy fetuses were scanned four times between 24 and
36 weeks gestation using 4D ultrasound visualization. Results showed a decreased number of mouth stretches with increasing fetal
age. Contrary to our expectations, we did not find an increase in movement patterns of mouth stretch followed by lip pucker
in preparation for feeding ex utero. The results are discussed in terms of sensory triggers in utero required to elicit preparatory
movements for feeding ex utero.

Midwives and other healthcare providers are grappling with the issue of rising intervention rates in childbirth and trying to identify ways to reverse the trend. It is increasingly accepted that intervention in childbirth has long-term consequences for women and their children. Birth Territory provides practical, evidence-based ideas for restructuring the birth territory to facilitate normal birth.

* Links new research findings to birth environments and outcomes.
* Describes the elements of an ideal birthing environment.
* Suggests how to modify existing maternity services to achieve optimal results.
* Investigates the links between the experiences of women and babies, and outcomes.
* Explores the effects of legal and socio-political factors.