Monday, 14 August 2017

Emergency services specific to the elderly








Elderly care is best resolved at the primary care level, with a geriatric orientation and in a community setting. However, sometimes older people need to go to the emergency room for a variety of reasons, such as a fracture, fibrillation, retention, sudden choking or blockage, to name just a few reasons. What happens then is easy to imagine, the geriatric patient is subjected to a triage that leads to a box full of devices, with many people asking the same things repeatedly, some of them with very little tact and almost always with little respect for intimacy, not to mention the discomfort caused by the racking in the corridor, bells and alarms, noise from machines and monitors, and a long etcetera, that easily produces the disorientation of the elderly patient, or delirium in the worst cases.

Towards a new design of emergency services specific for the elderly

In the blog of the British Geriatrics Society, Dr. Rosa McNamara advocates for the creation of specific emergency services for the elderly, points out the similarity to what happened a few years ago with the creation of paediatric emergency services. Children, she says, have different psychological, physical, and social characteristics than adults, and need care by nurses and specialized doctors to ensure appropriate treatment. Today it would be unthinkable to have to treat a child in a general emergency room environment and, worse, by nurses and doctors with no experience in paediatrics.

How should a geriatric emergency department be?

American Geriatrics Society and three other scientific societies, also North American, related to emergency services, have together published the document, "Geriatric Emergency Department Guidelines," which provides guidelines for the creation of geriatric emergency services. This is a document that talks about the structural characteristics that the space should feature: the least noisy possible, the cubicles should preserve privacy, the lighting should adapt to circadian cycles (day/night), there should be large and visible analogue clocks on the walls, the floors should be non-slip, anti-decay mattresses, comfortable chairs, there should be handholds in key locations, etc. it’s a matter of defining a space, usually next to the general emergency service, adapted to the geriatric needs. But the structure is obviously not everything, and that is why the document defines criteria for triage, professional functions and protocols to avoid the most common geriatric complications and, above all, what should be the basic training of the assigned professionals (nurses, social workers and doctors).

The first geriatric emergency room opened its doors to Holy Cross Hospital of Silver Spring in the US in 2008, and nine years later there are already hundreds of US hospitals offering this service. That is why it has seemed relevant to me that the British Geriatrics Society has opened the debate on the opportunity to boost geriatric emergency services within the framework of European public services.


Jordi Varela
Editor

Monday, 7 August 2017

Improving by playing


David Font




Volkswagen launched a campaign, The Fun Theory, aiming to improve habits by introducing game techniques. Let's look at an example.


Anna Sort, a nurse, a professor at several universities and an expert in gamification (a new word) in health, in her blog Lost Nurse in the Digital Era defines gamification as "the use of playing techniques in activities that initially contained no play" with the objective of involving people and solving problems. She argues that we are all potential players and that video games have introduced the game into many aspects of our lives. Mechanics such as collecting, awarding points, providing feedback, promoting exchanges or personalizing, favour motivation and involvement. The challenge is to transform any activity into fun and to make the game difficult enough for people to be enthusiastic about solving it, without finding it impossible.

Monday, 31 July 2017

Evidence in the care continuum - one of the keys to the telemedicine’s success or failure?

Josep M. Picas



It’s notorious that there are a great number of experiments, publications and studies on the application of telemedicine. Over the last few years, this phenomenon that we could label as the "apps revolution" has given telemedicine a great boost. However, the results, in many cases, have not reached the expectations. 

Many studies have tried to identify the causes of this unsuccessful outcome. In a brief reference, we could mention the professionals’ inertia and resistance to change in their work processes, errors of design, i.e. not being focused on patients, regulatory aspects, lack of resources and patient adherence problems caused by, to name just two, little health literacy or the digital gap issue.

Monday, 24 July 2017

Justice and equity in the health system

Xavier Bayona



Should we review the principle of justice from an ethical perspective? If so, we’ll notice that it’s a principle of minimums (of coexistence) faced with the principle of happiness – a principle of maximums ("individual justice") and, unfortunately, we’re often erring by thinking we speak of justice when in fact we speak of happiness (or individual convenience). Similarly, from the bioethical standpoint, justice can be defined as the fact of treating each one appropriately, in order to reduce situations of inequality (ideological, social, cultural, economic, etc.). On the other hand, equity is defined as giving each individual no more and no less of what they need. Following these definitions, when we speak of justice and equity, deep down, we are doing a reiteration, because they are synonymous.

Monday, 17 July 2017

Dying in the hospital: some considerations

Gloria Gálvez


Health inequalities are related to individual and social factors. The way people live, work and grow old as well as the political, social or economic factors that accompany them, vary greatly according to the place where they live. Death, which could be "the great equalizer", doesn’t appear to be equal at all, as Dr. Puri states in his article "Unequal Lives, Unequal Deaths," in which she argues that social and health differences during life, are also present at the time of death. As a group of Danish authors suggest in BMJ Supportive & Palliative Care: "Socioeconomic position and place of death of cancer patients” for people with fewer resources it’s more difficult to benefit from a worthy death in their own home.

When a patient chooses to die in a health institution he does it for different reasons. Higginson et al., In "Dying at home - is it better: A narrative appraisal of the state of the science" identified, besides the socioeconomic level, other determinant elements as the preferences of the patients, the access to the home attendance or the support of the family. Let's look at each one separately.

Monday, 10 July 2017

Cancer committees - a brake on shared clinical decisions?








Cancer committees are instruments for the coordination of cancer practice that have existed for many years. Now, however, a joint German-US research group (with the collaboration of Glyn Elwyn) wanted to know not only the quality of the work of these committees but also how they address the demand for greater involvement of patients in clinical decisions, and an observational study has been carried out on 15 cancer committees of the University Cancer Center Hamburg-Eppendorf. From the publication of this paper, I would like to highlight two key aspects: a) the reality of the organizational quality of cancer committees, and b) how these committees contemplate patients' preferences.

a) Organizational quality of cancer committees

The first observation is that the majority of the tumour committees’ members are doctors in senior positions and, on the other hand, the presence of young doctors is scarce. The participation of other professionals, also important for cancer patients, such as nurses or psycho-oncologists has not been observed in any of the cases. Researchers believe that the hierarchical influence of key members of the committees and the need to close many cases in a short time are limiting factors for productive and quality multidisciplinary work. In summary, the observation notes that guidelines and recommendations are generally applied with margins too scarce for other considerations.

Monday, 3 July 2017

Buurtzorg, a nurse work project with blue ocean strategy








10 years ago, the home care scenario for people with complex social and health needs in the Netherlands followed a bureaucratic scheme based on nursing work on one hand, social work on the other, in addition to the home support actions offered by companies, many of them from the cleaning service world. Jos de Blok, a community nurse, dissatisfied with this fragmented model, put an entrepreneur hat on, assembled a small group of nurses with whom he shared vision and discussed as much at large about a new model of care based on real needs of people. In an interview, Jos de Blok says, "What I wanted to show was that if you are a good nurse, you should know how to focus on the relationship and to build trust with patients in order to make them live with the maximum of independence possible. "