A Hitchhiker's Guide to caring for an older person before and during coronavirus‐19

Coronavirus‐19 (COVID‐19) has reconfigured working lives with astonishing velocity. Older people have suffered the worst effects of the pandemic, with governments marginalizing or overlooking their needs. Women perform the majority of care for older people, often compromising their working lives and health. Yet in academic articles their voices are often filtered or aggregated in quantitative studies. Based on a weave of personal experiences and secondary research, the article traces a path through UK forms of care and shows how the inadequate response to COVID‐19 stemmed from existing policies embedded in health and social care. COVID‐19 has severed important informal care work, rendering the vulnerable yet more exposed and carers anxious and bereft. Longitudinal research capturing the trajectory of care from the perspective of older people and their carers would lead to improved support hence gender equality.     

Every Minute Counts: Using Process Improvement and Performance Feedback to Improve Patient Flow in an Emergency Department

Prolonged emergency department (ED) visits are associated with a number of adverse outcomes for patients as well as lower patient satisfaction scores and increased costs. Several factors that influence the length of ED visits are out of the control of hospital employees, but some opportunities exist to improve performance. For this study, the ED department of a 150-bed hospital in the southeastern United States wanted to improve door-to-discharge time. To do so, a subprocess of door-to-discharge time was targeted, door-to-order. After analyzing the process, the team created standard orders for the 10 most common presenting conditions in the ER with preapproval, allowing nurses to submit the orders without the provider first visiting the patient. Following the process change, daily feedback was added to increase utilization of the preapproved orders. Reductions in door-to-order times and door-to-discharge were observed and patient satisfaction remained stable. Implications for future research in this area are discussed.     

Improving patients’ satisfaction in a mobile hospital using Lean Six Sigma – a design-thinking intervention

Abstract

Lean Six Sigma (LSS) that offers a unique integration of Lean and Six Sigma has been accepted globally across services sectors. Previous studies that examined the application of LSS in healthcare were steered in traditional hospital settings. Apparently, there are no studies that highlight the application of LSS in mobile hospitals, an emerging trend in the healthcare sector. The aim of this article is to explore the applicability of LSS in a mobile hospital. The authors present a case study of improving patients’ satisfaction in a mobile hospital, through reducing turnaround time. Design-thinking intervention to LSS helped resolve a real-time problem using Define-Measure-Analyze-Design-Verify roadmap. This article contributes to the ‘healthcare quality” body of knowledge and is novel as it is the first of its kind of LSS application in a mobile hospital underpinning Design thinking. This study is unique as it demonstrates academia–industry collaboration in solving an organizational problem.     

弗洛伦斯·南丁格尔与克里米亚战争

弗洛伦斯·南丁格尔被誉为克里米亚战争（1854-1856）的女英雄和现代护理学的主要奠基人。战地记者无情揭露了克里米亚战争中英国军队存在的诸多弊端，促使英国政府派遣南丁格尔护士团前往克里米亚战争前线医院，而南丁格尔在护理教育、军队医疗和卫生改革等方面的贡献都要追溯到她在克里米亚战争中的经历。     

Propensity score prediction for electronic healthcare databases using super learner and high-dimensional propensity score methods

ABSTRACT

The optimal learner for prediction modeling varies depending on the underlying data-generating distribution. Super Learner (SL) is a generic ensemble learning algorithm that uses cross-validation to select among a ‘library’ of candidate prediction models. While SL has been widely studied in a number of settings, it has not been thoroughly evaluated in large electronic healthcare databases that are common in pharmacoepidemiology and comparative effectiveness research. In this study, we applied and evaluated the performance of SL in its ability to predict the propensity score (PS), the conditional probability of treatment assignment given baseline covariates, using three electronic healthcare databases. We considered a library of algorithms that consisted of both nonparametric and parametric models. We also proposed a novel strategy for prediction modeling that combines SL with the high-dimensional propensity score (hdPS) variable selection algorithm. Predictive performance was assessed using three metrics: the negative log-likelihood, area under the curve (AUC), and time complexity. Results showed that the best individual algorithm, in terms of predictive performance, varied across datasets. The SL was able to adapt to the given dataset and optimize predictive performance relative to any individual learner. Combining the SL with the hdPS was the most consistent prediction method and may be promising for PS estimation and prediction modeling in electronic healthcare databases.     

Collecting feedback as a tool to reduce care paralysis: something for family group conferencing coordinators?

Family group conferencing (FGC) coordinators in public mental healthcare are confronted with clients who have little faith in professionals and organizations, who hold off decisions in their family life, who avoid care and who sometimes behave in a hostile manner. A lack of initiative to deal with their situation is not only reserved for clients – all bystanders, including professionals, can suffer from it. The multiplicity and severity of the client's problems lead to a situation wherein everyone involved waits for the initiative of the other. The independence of the FGC coordinator – a fellow citizen, who is free of organizational loyalties and comes to assist other citizens in establishing a plan – seems to work well with the client group of the public mental healthcare. However, the coordinator cannot always prevent deferral or failure of conferences. Drawing on empirical and theoretical findings, this paper considers the possibility of collecting feedback as a way to contribute positively to the alliance between FGC coordinators and those for whom a conference is deployed. We highlight findings from three case studies that centred on multiproblem families. The findings indicate the importance of feedback theory for FGC coordinators in enhancing trust and engagement.     

加拿大的卫生政策及其对中国卫生改革的借鉴

卫生政策在改善与增进人口健康中发挥了重要作用。文章通过对加拿大卫生系统相关立法进程的系统回顾与分析。发现加拿大医疗系统的特点是公共筹资而非私人运作,而全覆盖、可携带性、综合性、可及性以及公共管理等五项基础性原则保证了加拿大卫生系统的成功运行。文章着重回答了有哪些政策可以借鉴,如何借鉴。以及哪些政策的不良后果可以避免等。     

疾病的宗教性建构：理解农民因病信教的行为和动机——以一个河南乡村基督教会为例

近年来,农村地区的一些村民在身患重病难以得到医疗救治的情况下,会尝试将信仰基督教作为一种替代治疗方案。本文通过对豫东陈村教会农民因病信教现象的深入分析,发现本土化的基督教为农民的疾病医治提供了一套“合理”的解释体系,通过“神医结合”的方式,有些农民疾病的痊愈得以可能。“疾病”和“苦难”被赋予新的意义,被构建为“神拣选之前的考验”,继而导向皈依基督教。农民最初的功利性信仰,会经由宗教仪式的出席和宗教实践的参与而逐渐形成对基督教的理解和体验。农民因病信教成为基督教民间信仰化和本土化实践的重要表现形式。     

县级城市医疗卫生事业建设中的问题研究

在城市化进程加快的今天,县级城市既有城市的特点,又有农村的特征。医疗卫生是公共事业的重要组成部分,县级城市的医疗卫生事业发展水平对于我国医疗卫生事业的整体发展而言关系重大。从医疗卫生服务体系上来说,县级城市既有向城市专科医疗方向发展的特点,又具有巩固与发展三级医疗卫生网络的特点。因而对于县级城市医疗卫生事业发展的研究具有深远意义。