The efficacy of the seamless transfer of care model to apply for the patients with cerebral apoplexy in China

Purpose:To evaluate the efficacy of the Seamless Transfer of Care Model(STCM)to improve readmission occurrence of patients withstroke.Methods:The sample was comprised of fifty-nine subjects with stroke who were hospitalized in the geriatric and neurology departments of a large university hospital in China.Subjects were allocated to an STCM group(n=30)or a routine care(control)group(n=29).Results:Compared with the control group,the STCM group had a higher quality of life(p<0.05),higher compliance(p<0.05)and a lower readmission rate(p<0.05).Conclusion:Based on our results,the application of the STCM in Chinese stroke patients can improve quality of life and compliance,and reduce readmission rate.

Outcomes and Cost Effectiveness of a Respiratory Coordinated Care Program in Patients with Severe or Very Severe COPD

Multidisciplinary community coordinated care programs are widely adopted to optimise care of chronic disease patients, but there is a need for further evaluation in the setting of COPD. This observational study evaluated 147 patients with severe or very severe COPD who were enrolled in a multidisciplinary community respiratory coordinated care program (RCCP) from 2007 to 2012. Comparison was made of hospitalisation rates and length of stay for 12 months prior to joining the program, and the first 12 months after joining the program. This data was used to inform a cost analysis. Enrolment into RCCP halved the annual hospital admission rate from 1.18 to 0.57 admissions per year (relative risk reduction 51.4%, p < 0.001), and annual total length of stay was reduced from 8.06 to 3.59 days per patient per year (p < 0.001). Hospital admissions were reduced from 5.05 days to 2.00 days (p < 0.001). Accounting for the program’s costs, these changes resulted in a $US 906.94 ($AUD 972.80) cost saving per patient per year. A RCCP program can reduce patient hospitalisation and overall costs in the COPD setting.

Study Protocol on Stroke Management: Role of Nurses and Physiotherapists at the Adult University Teaching Hospital, Lusaka Zambia

Background: Management of stroke patients requires a multidisciplinary approach. Literature presents unequivocal evidence of improved outcomes when patients are treated in a stroke unit by multi-disciplinary teams made up of medical doctors, nurses, physiotherapists and occupational therapists. Among the multidisciplinary team members, physiotherapists and nurses are the largest professional workforce working with both stroke patients and survivors. This study, therefore, aims at investigating the role of nurses and physiotherapists in the management of stroke patients at the Adult University Teaching Hospital. Methodology: This study shall utilize a convergent parallel mixed method design where both quantitative and qualitative data will be collected at the same time resulting in two data sets which will eventually be merged at the point of discussion. The quantitative component shall utilize an analytical cross-sectional approach while the qualitative component shall use a qualitative case study approach. The study will be conducted at the Adult University Teaching Hospital in Lusaka. Data will be collected from all the 287 nurses and 37 physiotherapists working in the Emergency Department, Medical Wards, Adult Intensive Care Unit and the Department of Physiotherapy. Quantitative data will be analyzed using Statistical Package for social sciences. Descriptive statistics shall be computed on the role of nurses and physiotherapists in stroke care. In addition, chi-square and fisher’s exact tests will be used in the test for associations between variables while binary logistic regression will be used in identifying predictors of the various roles played by nurses and physiotherapists in the management of stroke patients. Qualitative data will be analyzed using thematic analysis in order to generate new concepts and a substantive model of care for stroke patients. Conclusion: Despite research evidence of improved outcomes when stroke patients are managed by a multi-disciplinary team, data on the role of different members of the multidisciplinary care team in stroke management is almost non-existent from the Zambia context. It is therefore hoped that information obtained from this study will be used as a basis for recommending the streamlined role of the nurse and physiotherapist in both acute care and rehabilitation.

Outcome of treatment seeking rural gamblers attending a nurse-led cognitive-behaviour therapy service:A pilot study

Objectives:Little is known about the differences between urban and rural gamblers in Australia,in terms of comorbidity and treatment outcome.Health disparities exist between urban and rural areas in terms of accessibility,availability,and acceptability of treatment programs for problem gamblers.However,evidence supporting cognitivebehaviour therapy as the main treatment for problem gamblers is strong.This pilot study aimed to assess the outcome of a Cognitive-Behavioural Therapy(CBT)treatment program offered to urban and rural treatment-seeking gamblers.Methods:People who presented for treatment at a nurse-led Cognitive-Behavioural Therapy(CBT)gambling treatment service were invited to take part in this study.A standardised clinical assessment and treatment service was provided to all participants.A series of validated questionnaires were given to all participants at(a)assessment,(b)discharge,(c)at a one-month,and(d)at a 3-month follow-up visit.Results:Differences emerged between urban and rural treatment-seeking gamblers.While overall treatment outcomes were much the same at three months after treatment,rural gamblers appeared to respond more rapidly and to have sustained improvements over time.Conclusion:This study suggests that rural problem gamblers experience different levels of co-morbid anxiety and depression from their urban counterparts,but once in treatment appear to respond quicker.ACBT approach was found to be effective in treating rural gamblers and outcomes were maintained.Ensuring better availability and access to such treatment in rural areas is important.Nurses are in a position as the majority health professional in rural areas to provide such help.

Participatory approach to design social accountability interventions to improve maternal health services:a case study from the Democratic Republic of the Congo

Background:Social accountability(SA)comprises a set of mechanisms aiming to,on the one hand,enable users to raise their concerns about the health services provided to them(voice),and to hold health providers(HPs)accountable for actions and decisions related to the health service provision.On the other hand,they aim to facilitate HPs to take into account users’needs and expectations in providing care.This article describes the development of a SA intervention that aims to improve health services responsiveness in two health zones in the Democratic Republic of the Congo.Methods:Beneficiaries including men,women,community health workers(CHWs),representatives of the health sector and local authorities were purposively selected and involved in an advisory process using the Dialogue Model in the two health zones:(1)Eight focus group discussions(FGDs)were organized separately during consultation aimed at sharing and discussing results from the situation analysis,and collecting suggestions for improvement,(2)Representatives of participants in previous FGDs were involved in dialogue meetings for prioritizing and integrating suggestions from FGDs,and(3)the integrated suggestions were discussed by research partners and set as intervention components.All the processes were audio-taped,transcribed and analysed using inductive content analysis.Results:Overall there were 121 participants involved in the process,51 were female.They provided 48 suggestions.Their suggestions were integrated into six intervention components during dialogue meetings:(1)use CHWs and a health committee for collecting and transmitting community concerns about health services,(2)build the capacity of the community in terms of knowledge and information,(3)involve community leaders through dialogue meetings,(4)improve the attitude of HPs towards voice and the management of voice at health facility level,(5)involve the health service supervisors in community participation and;(6)use other existing interventions.These components were then articulated into three intervention components during programming to:create a formal voice system,introduce dialogue meetings improving enforceability and answerability,and enhance the health providers’responsiveness.Conclusions:The use of the Dialogue Model,a participatory process,allowed beneficiaries to be involved with other community stakeholders having different perspectives and types of knowledge in an advisory process and to articulate their suggestions on a combination of SA intervention components,specific for the two health zones contexts.