Levels Of Health Care Providers Research Articles

Die "Präzisionspsychiatrie" muss Teil der "personalisierten Psychiatrie" werden.

'Precision medicine' is defined as 'an emerging approach for treatment and prevention that takes into account each person's variability in genes, environment, and lifestyle'. Sometimes the term 'personalized medicine' is also used, either as a synonym or in a broader sense. In psychiatry, the term 'personalized' applies to different levels of health-care provision, such as the service organization and the choice of treatment plans based on the characterization of the individual patient. This approach is already feasible but, currently, it is often hampered by the shortage of human and financial resources. Recently, the terminology of 'precision medicine' has been extended to psychiatry: the term 'precision psychiatry' refers to the full exploitation of recent scientific and technological advances to achieve a close match between individual biosignature and prevention / treatment strategies. This article provides an overview of recent advances in neuroimaging, multi-omics and computational neuroscience, which have contributed to foster our understanding of the neurobiology of major mental disorders, and led to the implementation of a precision medicine-oriented approach in psychiatry.We argue that, while 'precision psychiatry' represents an important step to further advance the effectiveness of the 'personalized psychiatry', the distinction between the two terms is important to avoid dangerous neglect of the current potential of personalized care in psychiatry and to underscore the need for disseminating good existing practices aimed at organizing mental health services and providing care according to person's psychopathological characteristics, illness trajectory, needs, environment and preferences.In conclusion, 'precision psychiatry' will contribute to advance 'personalized psychiatry', but for the time being keeping the distinction between the two terms will contribute to fully exploit the current potential of personalized care.

<p>Factors Associated with Timely Antenatal Care Booking Among Pregnant Women in Remote Area of Bule Hora District, Southern Ethiopia</p>

BackgroundAntenatal care (ANC) is one of the most cost-effective and crucial components of maternal health care services. In developing countries where access to care, empowerment, and decision making power of women is low, ANC service is vital. The time at which first ANC visit was done has the utmost importance to ensure optimal health effects for both women and children. This study aimed to assess the proportion and factors associated with early antenatal care booking among pregnant women who were attending public health institutions in a remote area of Bule Hora district, Southern Ethiopia, from May to July, 2019.MethodsInstitutional-based cross-sectional study design was conducted at Bule Hora district public health facilities. Data were collected on systematically selected 377 pregnant women from 1st May to 30th July 2019. The sample size was determined by single population proportion formula and data were collected by using a standardized and pretested questionnaire and entered into Epidata 3.1 version, and then exported to Statistical Package for Social Science (SPSS) version 25 for analysis. The strength of association was measured by odds ratios with 95% confidence interval (CI) at a p-value of <0.05 and finally obtained results were presented by using simple frequency tables, bar graph, and texts.ResultsThe proportion of early antenatal care booking among pregnant women attending antenatal care in the study area was 57.8%. Factors contributing to early antenatal care booking were husband’s education (Adjusted odds ratio (AOR), 2.5; 95% CI: 1.2, 4.9), knowledge on antenatal care service (AOR,1.99; 95% CI:1.2,3.3), means of approving current pregnancy (AOR,1.8; 95% CI:1.1,2.8), and being advised before starting antenatal care visit (AOR,2.1; 95% CI:1.2,3.6).ConclusionGenerally, the timely initiation of ANC among pregnant mothers is not ideal. Modifiable factors like husband’s education, knowledge on antenatal care service, means of recognizing current pregnancy, and access to pre-ANC advice were found determinants for the timely initiation of ANC. Thus, it is advisable to provide proper information about antenatal care services by health care providers and enhancement of health extension program to increase community awareness before and during pregnancy at all levels of health care provision is very important.

Malaria Test, Treat and Track policy implementation in Angola: a retrospective study to assess the progress achieved after 4\xa0years of programme implementation

BackgroundMalaria is one of the main causes of death in Angola, particularly among children under 5 years of age. An essential means to improve the situation is with strong malaria case management; this includes diagnosing suspected patients with a confirmatory test, either with a rapid diagnostic test (RDT) or microscopy, prompt and correct treatment with artemisinin-based combination therapy (ACT), and proper case registration (track). In 2011, the United States President’s Malaria Initiative (PMI) launched a country-wide programme to improve malaria case management through the provision of regular training and supervision at different levels of health care provision. An evaluation of malaria testing, treatment and registration practices in eight provinces, and at health facilities of various capacities, across Angola was conducted to assess progress of the national programme implementation.MethodsA retrospective assessment analysed data collected during supervision visits to health facilities conducted between 2012 and 2016 in 8 provinces in Angola. The supervision tool used data collected for malaria knowledge, testing, treatment and case registration practices among health workers as well as health facilities stock outs from different levels of health care delivery. Contingency tables with Pearson chi-squared (χ2) tests were used to identify factors associated with “knowledge”, “test”, “treat” and “track.” Multivariable logistic regression models were used to assess factors associated with the defined outcomes.ResultsA total of 7156 supervisions were conducted between September 2012 and July 2016. The overall knowledge, testing, treatment and tracking practices among health care workers (HCWs) increased significantly from 2013 to 2016. Health care workers in 2016 were 3.3 times (95% CI: 2.7–3.9) as likely to have a higher knowledge about malaria case management as in 2013 (p < 0.01), 7.4 (95% CI: 6.1–9.0) times as likely to test more suspected cases (p < 0.01), 10.9 (95% CI: 8.6–13.6) times as likely to treat more confirmed cases (p < 0.01) and 3.7 (95% CI: 3.2–4.4) times as likely to report more accurately in the same period (p < 0.01).DiscussionImprovements demonstrated in knowledge about malaria case management, testing with RDT and treatment with artemisinin-based combinations among HCWs is likely associated with malaria case management trainings and supportive supervisions. Gaps in testing and treatment practices are associated with RDT and ACT medicines stock outs in health facilities. Tracking of malaria cases still poses a major challenge, despite training and supervision. Hospitals consistently performed better compared to other health facilities against all parameters assessed; likely due to a better profile of HCWs.ConclusionSignificant progress in malaria case management in eight provinces Angola was achieved in the period of 2013–2016. Continued training and supportive supervision is essential to sustain gains and close existing gaps in malaria case management and reporting in Angola.

Management Algorithm for Subclinical Hypoxemia in Coronavirus Disease-2019 Patients: Intercepting the "Silent Killer".

In the early stages of COVID-19 clinical illness, the ability to oxygenate is impaired However, the patient does not necessarily display the conventionally expected signs or symptoms of respiratory failure, including shortness of breath Given the above, HCP's must remain vigilant and proactively look for 'red flags' described herein, such as the appearance of =3%-5% drop in SpO2 after approximately 60 s of mild activity/ambulation, SpO2/FiO2 ratio <300, SpO2 <93% on room air, and the presence of hypoxemia without tachypnea [Figure 1] [4,11,12] In summary, this expert group views AH as the proverbial "canary in the coalmine" and the first harbinger of future respiratory deterioration in COVID-19 patients

Examining Coronary Revascularization Practice Patterns for Diabetics: Perceived Barriers, Facilitators, and Implications for Knowledge Translation

BackgroundThe FREEDOM trial provided robust evidence that coronary artery bypass grafting (CABG) was superior to percutaneous coronary intervention (PCI) for coronary revascularization in patients with diabetes mellitus (DM) and multivessel coronary artery disease (MV-CAD). The present study examined practice pattern changes and perceived barriers and facilitators to implementing FREEDOM trial evidence in British Columbia (BC). MethodsUsing a population-based database of cardiac procedures in BC, PCI:CABG ratios from 2007-2014 were compared before and after publication of the FREEDOM trial in the 4 tertiary cardiac centres that provided both CABG and PCI. Surveys of barriers and facilitators to implementation of evidence in practice were completed by 57 health care providers (HCPs) attending educational outreach sessions conducted in 2016-17 at 5 tertiary cardiac centres in BC. ResultsThe overall PCI:CABG ratio declined from 1.59 (95% confidence interval [CI] 1.48-1.70, range 1.16-1.86) before publication to 0.88 (95% CI 0.75-1.01, range 0.56-0.82) after publication (P < 0.01). This decline from before to after publication was significant in 3 centres, but not in the fourth centre (from 1.62 to 1.49; P = 0.61). Barriers were identified at the levels of evidence (applicability, credibility), HCP (awareness/knowledge, practice behaviours), patient (knowledge/misconceptions, preferences), and systems (siloing of care, financial disincentives, resource limitations, geography). Facilitators were additional studies/guidelines, education/dissemination, shared decision making, a heart team approach, changes to remuneration models, and increased resources. ConclusionsFollowing publication of the FREEDOM trial, the proportion of patients with DM and MV-CAD undergoing CABG increased in BC; however, practice patterns varied across cardiac centres. HCPs attributed these practice variations to multilevel barriers and facilitators. Future knowledge translation strategies should be multifaceted and tailored to identified determinants.

Sustainability of 'mHealth' interventions in sub- Saharan Africa: a stakeholder analysis of an electronic community case management project in Malawi.

The global health community and funding agencies are currently engaged in ensuring that worthwhile research-based programmes are sustainable. Despite its importance, few studies have analysed the sustainability of global health interventions. In this paper, we aim to explore barriers and facilitators for the wider implementation and sustainability of a mobile health (mHealth) intervention (Supporting LIFE Community Case Management programme) in Malawi, Africa. Between January and March 2017, a qualitative approach was used to carry out and analyse 13 in-depth semi-structured interviews with key stakeholders across all levels of healthcare provision in Malawi to explore their perceptions with regards to the implementation and sustainability of the mHealth programme. Data were analysed thematically by two reviewers. Overall, our analysis found that the programme was successful in achieving its goals. However, there are many challenges to the wider implementation and sustainability of this programme, including the absence of monetary resources, limited visibility outside the healthcare sector, the lack of integration with community-based and nationwide programmes, services and information and communication technologies, and the limited local capacity in relation to the maintenance, further development, and management. Future developments should be aligned with the strategic goals and interests of the Ministry of Health and engage with national and international stakeholders to develop shared goals and strategies for nationwide scale-up. These developments should also focus on building local capacity by educating trainers and ensuring that training methods and guidelines are appropriately accredited based on national policies. Our findings provide a framework for a variety of stakeholders who are engaged in sustaining mHealth programmes in resource-poor settings and can be used to develop an evidence-based policy for the utilization of technology for healthcare delivery across developing countries.

Expert Interviews on Multilevel Barriers in Implementing Expedited Partner Therapy for Chlamydia

Expedited partner therapy (EPT) is an evidence-based practice in which partners of patients with chlamydia are given antibiotics or a prescription for antibiotics without prior medical evaluation. This practice facilitates partner treatment and prevents reinfection of the patient. EPT remains underutilized due to multilevel implementation barriers. Barriers may exist at the level of legislation, policy, health care system, health care provider (HCP), pharmacist, patient, or partner. Qualitative interviews were performed with 11 EPT experts across the United States to uncover barriers in implementation. Thirty-four barriers were identified and grouped into 1 of 15 themes. The themes that surfaced most frequently were liability and adverse events (policy and HCP level), funding (policy level), electronic medical records (health care system level), and awareness (HCP and pharmacy level). Tailored implementation strategies are needed to increase awareness among HCPs and pharmacists, to establish funding and to streamline processes in health care systems.

Barriers and Opportunities in Recalls Management at the Health Care Provider level

One of the operational risks to which a Health Care Provider (HCP) is exposed is the receiving and use of products such as pharmaceuticals and medical devices that could become subject to a health alert. This patient safety issue has to be managed in order to prevent and mitigate adverse events at the last echelon of the supply chain. This article aims to expose a characterization of the alerts response process at the HCP level based on a review of the literature. Additionally, local regulations, strengths and weaknesses were identified. Finally, the study allowed for the identification of the principal opportunities and barriers that should be addressed in order to integrate the recall management process within and outside the HCP. Among these opportunities is traceability along the supply chain, and among the barriers is the high investment in the technology required to facilitate supply chain integration.

Validation of Ultrasound Guidance Targeting Tasks: Relationship of Performance and Clinical Experience.

To assess whether health care provider performance on a novel task trainer and a set of newly created ultrasound guidance targeting tasks relates with their level of clinical experience. In a prospective cohort study, two assessment sessions were carried out in which inexperienced (n=21 and n=15) and experienced (n=14 and n=10) health care providers completed five previously described ultrasound guidance targeting tasks. Raw completion time, number of targeting errors, and error-adjusted completion time for each task were compared between groups with a t test for independent measures. Receiver operating characteristic analyses were performed to estimate whether error-adjusted completion time or number of errors could accurately differentiate between groups. Raw completion time was similar between groups. The number of errors and error-adjusted completion time were significantly lower in the experienced health care providers in all but the out-of-plane dowel task. The receiver operating characteristic analyses of number of errors demonstrated very high areas under the curve (0.93-0.98), sensitivities (100%), specificities (76-86%), positive likelihood ratios (4.2-7.0), and negative likelihood ratios (<0.001) indicating excellent differentiation between experienced and inexperienced health care providers. These values were notably lower in the receiver operating characteristic analyses of error-adjusted completion times. Task performance related well with a health care provider's level of clinical experience providing evidence of construct validity. For each task, we were able to determine a cutoff for number of errors that categorized experienced and inexperienced health care providers with very favorable sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios. Our findings suggest it may be possible to use these cutoffs to objectively classify trainees as competent or not competent.

Cancer Training for Frontline Healthcare Providers in Tanzania.

Cervical and breast cancer are responsible for the highest cancer-related mortality in Tanzania, although both are preventable or curable if diagnosed at an early stage. Limited knowledge of cervical cancer by clinic and dispensary level healthcare providers in Tanzania is a barrier for prevention and control strategies. The purpose of the study was to provide basic oncology training to frontline healthcare workers with a focus on cervical and breast cancer in order to increase knowledge. A 1-day cancer training symposium was conducted in Arusha, Tanzania, with 43 clinicians. Pre- and post-intervention surveys assessed cancer knowledge and confidence of clinicians in risk assessment. Sixty-nine percent of the participants reported never receiving any cervical cancer training in the past. A significant difference was found between the pre- and post-test in a majority of knowledge questions and in reported confidence recognizing signs and symptoms of breast and cervical cancer (p<0.05). The 1-day community oncology training symposium was effective in delivering and increasing basic knowledge about cervical and breast cancers to these healthcare providers. The low level of baseline cancer knowledge among frontline medical providers in Tanzania illustrates the need for increased training around the country.

Towards Reforming Health Provider Payment Methods: Evidence from Iran

Background: Equity of access to health and provider payment mechanism in healthcare is a worldwide debated. Healthcare reforms are primarily designed to improve productivity, economic efficiency and quality of care; however, an appropriate reimbursement of healthcare providers for services offered to patients and marinating a robust payment mechanism are not elucidated yet. Objectives: The current study aimed to develop a potential model of provider payment mechanism within and across different levels of healthcare delivery system in Iran. Methods: A three-stage, qualitative approach was carried out in 2013 to complete the study. In the first stage, a range of databases were used to extract evidence-informed literature pertinent to provider payment methods from 1990 to 2015, and to develop an interview guide. A purposive sample of 15 key healthcare executives was then selected to explore the provider payment mechanism in the Iranian healthcare system through semi-structured interviews and focused group discussions. A preliminary model of provider payment was developed, which subsequently scrutinized by using experts’ opinions through Delphi technique. Narrative analysis was used to analyze the data. Results: A hybrid model of provider payment was developed for various levels of healthcare provision. The model suggested the adjusted capitation payment method as the best possible payment method for the first level of healthcare delivery. A combination of diagnosis-related group (DRG) and pay-for-performance methods was proposed for the secondary and tertiary services across the country especially for in-patient care. Fee-for-service (FFS) payment method suited for out-patient services than other methods. Conclusions: No single payment method was emerged as the best predictor to accurately and fairly determine the providers’ payment, and to serve patients’ needs in all situations. A range of payment methods are required to be in place to tackle challenges faced by patients, providers, insurance companies and policy-makers.

It's All About People and Relationships: Scotland's person-centred health and care collaborative

Objectives: Raise the profile of person centred approaches to care Explain concept and approaches to person centred care in simplified terms and identify high impact interventions Focus on what we can do now Design reliable processes of care to ensure every person has the opportunity to personalise care Measurement framework to support and track improvment Promote the sharing of ideas and approaches Methods: Modified Breakthrough Series Improvement Collaborative. 90 day R&D process. Systematic national approach to improving care experience focusing on what really matters to the Scottish people as described by NHS Scotland's “7Cs”: 1. Caring and compassionate staff and services 2. Clear communication and explanation about conditions and treatments 3. Effective collaboration between clinicians patients and others 4. Clean and safe care environment 5. Continuity of care 6. Clinical excellence This Collaborative is unique in that, as far as we are aware, it is the first to take a national approach to using Improvement Science to develop person-centred approaches to care at scale. It will run initially until December 2015. Collaborative focus: 1. Comprehensive systematic approach to hearing the voice of the people who use services through a multi method, mutli trait methodology. 15th International Conference on Integrated Care, Edinburgh, UK, March 25-27, 2015 1 International Journal of Integrated Care – Volume 15, 27 May – URN:NBN:NL:UI:10-1-116982 – http://www.ijic.org/ 2. Specific focus on five core aspects of care experience called the5 Must do With Meelements (listed below). 1. What matters to you? Personal outcomes / goals focus 2. Who matters to you? Family/carer involvement 3. What information do you need? Clear and full information / health literacy interventions 4. Nothing about me without me. Relationship based care and support where involvement and collaboration is supported and encouraged 5. Service Flexibility. Method and timing of contact flexes according to need. Results: Prototyping and testing under way. Short-term indicators of engagement outputs/outcomes: Change package and measurement framework developed 100% of Scottish territorial health boards participating 4 Learning Sessions held reaching 2250 staff 50+ test teams identified across 14 boards Board re-alignment of governance to profile person-centredness Conclusion: Person centred approaches to care make the difference between good and great. This is the glue that holds everything together, the boosters that have the potential to take us to the next level of healthcare provision and performance. The patient experience is inextricably intertwined with safety and effectiveness4 This is a “must do” not a “nice to do” Take care to explicitly define scope of work This agenda aligns strongly with staff values of staff Disclosure of Interest: None Declared

The patient experience of patient-centered communication with nurses in the hospital setting: a qualitative systematic review protocol.

Review question/objective The objective of this systematic review is to synthesize the eligible evidence of patients’ experience of engaging and interacting with nurses, in the medical-surgical ward setting. This review will consider the following questions: What are the expressed experiences of patients engaging and interacting in patient-centred communication with nurses? What are the beliefs, opinions and desires of patients, when engaging and interacting with nursing staff in terms of communicating in ways that meet the patients’ needs and wants? What factors do patients perceive influence (facilitate or prevent) patient-centred communication and their engagement and interaction with nursing staff? What are the experiences of patients of nurses listening to and responding to them within patient-centred communication with respect to their safety and experience of care? Inclusion criteria Types of participants The review will consider studies that include adult patients who are 18 years of age and older who have been admitted as inpatients to a medical-surgical ward. Studies and texts presenting adult inpatients to all other hospital wards settings will be excluded. Maternity, emergency department, operating room, palliative and psychiatric ward settings will be excluded. Emergency department settings are excluded as they may not include patients that are admitted to hospital. Operating room settings are excluded because of the variations in the level of consciousness that may occur to patients. Maternity, palliative care and psychiatric patients because of unique needs of care required by these patients. Studies that include patients with cognitive disorders will also be excluded. Phenomena of interest This review will consider studies that investigate patient experience of engaging and interacting with nurses at the bedside in the hospital setting and the meaningfulness of that experience.

Health care determinants in comparative perspective: The role of partisan politics for health care provision

Health care differs substantially across countries in terms of service provision relevant for social citizenship. Whereas driving forces for the expansion and subsequent decline of cash benefits have received major scholarly interest in comparative research, determinants of developments in public services are less explored. In this article we assess the role of partisan politics for health care provision measured in terms of health employment, hospital beds, and medical technology. Regression analyses based on Organization for Economic Co-operation and Development Health data for 18 countries covering the period 1980–2005 show that partisan politics influences levels of health care provision. Left government strength is positively related to health care provision and the association is driven by developments in health employment. Confessional parties are also associated with high levels of health employment, particularly when they are in close electoral competition with left parties. Both left and confessional government strength is negatively associated with the provision of hospital beds, but these effects are mitigated when parties are in intense electoral competition. In terms of medical technology, we find no partisan political effects.

If quality is the answer ... what is the question?

In Douglas Adams' iconic works, a supercomputer takes 7 1/2 million years to compute and check that the ultimate answer to life, the universe and everything is 42 [1]. A more powerful supercomputer subsequently takes 10 million years to discover the ultimate question: ‘What do you get if you multiply six by nine?’ [1, 2] Input errors due to a series of unexpected occurrences are later discovered in the system [2]. Quality improvement (QI) efforts in health care can be rather like this. Quality assessment tools offer a set of answers, but if the ‘answers’ are to be at all meaningful, it is important to first identify the questions. Improving the quality of health-care provision is advocated as the answer to better health outcomes for all: to rectify health-care inequities; address human error; and bring the health-care safety record up to par with other industries, where human life can be placed at risk [3, 4]. Providers facing endless drivers to greater efficiency, accountability and service delivery scramble for initiatives to assure and improve health-care quality in the face of fiscal constraints. Indicator implementation has been embraced internationally at all levels of health-care provision, on the rationale that measurement is essential to demonstrate improvement [5] and that indicators can help monitor the efficacy of improvement initiatives [6]. Consequently, a large number of indicators have been introduced to assess performance of individuals and organizations, signal service outcome expectations, …

Growing old before growing rich: inequality in health service utilization among the mid-aged and elderly in Gansu and Zhejiang Provinces, China

BackgroundChina’s recent growth in income has been unequally distributed, resulting in an unusually rapid retreat from relative income equality, which has impacted negatively on health services access. There exists a significant gap between health care utilization in rural and urban areas and inequality in health care access due to differences in socioeconomic status is increasing. We investigate inequality in service utilization among the mid-aged and elderly, with a special attention of health insurance.MethodsThis paper measures the income-related inequality and horizontal inequity in inpatient and outpatient health care utilization among the mid-aged and elderly in two provinces of China. The data for this study come from the pilot survey of the China Health and Retirement Longitudinal Study in Gansu and Zhejiang. Concentration Index (CI) and its decomposition approach were deployed to reflect inequality degree and explore the source of these inequalities.ResultsThere is a pro-rich inequality in the probability of receiving health service utilization in Gansu (CI outpatient = 0.067; CI inpatient = 0.011) and outpatient for Zhejiang (CI = 0.016), but a pro-poor inequality in inpatient utilization in Zhejiang (CI = −0.090). All the Horizontal Inequity Indices (HI) are positive. Income was the dominant factor in health care utilization for out-patient in Gansu (40.3 percent) and Zhejiang (55.5 percent). The non-need factors’ contribution to inequity in Gansu and Zhejiang outpatient care had the same pattern across the two provinces, with the factors evenly split between pro-rich and pro-poor biases. The insurance schemes were strongly pro-rich, except New Cooperative Medical Scheme (NCMS) in Zhejiang.ConclusionsFor the middle-aged and elderly, there is a strong pro-rich inequality of health care utilization in both provinces. Income was the most important factor in outpatient care in both provinces, but access to inpatient care was driven by a mix of income, need and non-need factors that significantly differed across and within the two provinces. These differences were the result of different levels of health care provision, different out-of-pocket expenses for health care and different access to and coverage of health insurance for rural and urban families. To address health care utilization inequality, China will need to reduce the unequal distribution of income and expand the coverage of its health insurance schemes.

Audit of the quality of consent form completion and improvement of practice

To achieve excellence in clinical practice and a high level of health care provision, consent processes need to be clear and precise. In particular, patients who are to undergo elective operations must be fully informed before consenting to treatment. The aim of this study is to assess the quality of consent form completion by different health professionals in our department and to identify areas for potential improvement. We audited 35 elective laparoscopic cholecystectomy consent forms, using a set proforma to produce a final score for each form, in order to assess the quality of consent completion and to recommend changes. We then implemented these changes in our current clinical practice and subsequently re-audited our performance. Our results suggest that targeted, specific, and low cost interventions could significantly improve consent processes. This will considerably improve the quality of health

Private health insurance: a role model for European health systems

European health care systems will face major challenges in the near future. Demographic change and technological progress induce rising costs. In order to deal with these developments and to preserve the current level of health care provision, health care systems need to be highly efficient. Yet existing health care systems show a lot of inefficiencies that result in waste of scarce resources. Therefore, improvements in performance are necessary. In this article, we argue that a change in financing health care accompanied by the liberalisation of the market for health care service providers offers a promising solution. We develop a market-based model for financing health care and show how it can be put into practice without generating additional costs for society while meeting social equity criteria.

Evidence Based Physiotherapy-A Shot in the Foot?

The search for an excellent level of health care provision, coupled with the need for the rational use of treatment and prevention methods for kinetic-functional disorders has resulted in physiotherapists making decisions within their routine practice based on scientific evidence. The term “evidence-based medicine” emerged in the 1980’s to describe the problem-based learning used by McMaster University Medicine School. Evidence-based practice (EBP) and evidence-based health care comprise the same concepts and principles of evidencebased medicine; such terms are used by different professionals and in different health care contexts. EBP has been sustained by a tripod that takes into account the synthesis of the best external evidence or research, the professional experience of the health care provider and the values and preferences of the patient, i.e. focusing on the patient and family. Research undertaken judiciously provides certainty to assist in clinical decision making.

Description and evaluation of a serious game intervention to engage low secure service users with serious mental illness in the design and refurbishment of their environment

Service user involvement in all levels of healthcare provision is the expectation of UK government policy. Involvement should not only include participation in the planning and delivery of health care but also the exercise of choice and opinions about that care. In practice, however, service user engagement is most often tokenistic, involving post hoc consultation over plans already committed to by services. This paper explores an Occupational Therapy-led initiative to use the Serious Game format to engage low secure service users with serious mental illness in the design, layout and refurbishment of their unit. Among other things how medication was to be dispensed on the new unit was explored by this game and led to significant replanning in response to service user involvement. The game format was found to be a useful tool in facilitating communication between professionals and a traditionally marginalized and powerless client group. It enabled service users to have a voice, it provided a format for that voice to be heard and made possible service-led change in the planning process.