Impact of an integrated community-based model of care for older people with complex conditions on hospital emergency presentations and admissions: a step-wedged cluster randomized trial

Background Health systems must reorient towards preventative and co-ordinated care to reduce hospital demand and achieve positive and fiscally responsible outcomes for older persons with complex needs. Integrated care models can improve outcomes by aligning primary practice with the specialist health and social services required to manage complex needs. This paper describes the impact of a community-facing program that integrates care at the primary-secondary interface on the rate of Emergency Department (ED) presentation and hospital admissions among older people with complex needs. Methods The Older Persons Enablement and Rehabilitation for Complex Health Conditions (OPEN ARCH) study is a multicentre randomised controlled trial with a stepped wedge cluster design. General practitioners (GPs; n = 14) in primary practice within the Cairns region are considered ‘clusters’ each comprising a mixed number of participants. 80 community-dwelling persons over 70 years of age if non-Indigenous and over 50 years of age if Indigenous were included at baseline with no new participants added during the study. Clusters were randomly assigned to one of three steps that represent the time at which they would commence the OPEN ARCH intervention, and the subsequent intervention duration (3, 6, or 9 months). Each participant was its own control. GPs and participants were not blinded. The primary outcomes were ED presentations and hospital admissions. Data were collected from Queensland Health Casemix data and analysed with multilevel mixed-effects Poisson regression modelling to estimate the effectiveness of the OPEN ARCH intervention. Data were analysed at the cluster and participant levels. Results Five clusters were randomised to steps 1 and 2, and 4 clusters randomised to step 3. All clusters (n = 14) completed the trial accounting for 80 participants. An effect size of 9% in service use (95% CI) was expected. The OPEN ARCH intervention was found to not make a statistically significant difference to ED presentations or admissions. However, a stabilising of ED presentations and a trend toward lower hospitalisation rates over time was observed. Conclusions While this study detected no statistically significant change in ED presentations or hospital admissions, a plateauing of ED presentation and admission rates is a clinically significant finding for older persons with complex needs. Multi-sectoral integrated programs of care require an adequate preparation period and sufficient duration of intervention for effectiveness to be measured. Trial registration The OPEN ARCH study received ethical approval from the Far North Queensland Human Research Ethics Committee, HREC/17/QCH/104–1174 and is registered on the Australian and New Zealand Trials Registry, ACTRN12617000198325p.

The Culture and Personal Disposal Practices of University Students: A Qualitative Study in Brazil and Germany

This study aimed to investigate the relationship between cultural components and municipal solid waste (MSW) disposal individual practices in the context of Brazilian and German university students. To achieve this goal, we chose to conduct qualitative research with ethnographic inspiration, exploratory and descriptive nature. For one year, the authors collected data through participant and non-participant observations, interviews and photographs from both countries. The results showed that waste disposal is a constant concern in Germany. Waste separation for recycling is cultural and is the primary waste disposal practice in the country. In Brazil, the primary practice is to dispose of all waste in just one bin. Several elements of the cultural components are involved in these practices, revealing a significant sustainable cultural difference between the two countries. One of the limitations of the study is Brazil itself. Brazil is a continental and multi-cultural country. The results present a perceived country general view; but maybe in other cities inside Brazil, some differences could be present. As an empirical contribution, the study presents a lack of public policy and gives suggestions to improve the structure (material culture) and communication (and language) of the practices through actions. These actions can be the implementation of the selective collection in the city, improved enforcement of laws or even new public policies aimed at waste management. The originality of the article consists in investigating and comparing the disposal practices of MSW of Brazilian and German students in the light of culture. This study innovates bringing an empirical analysis of cultural components little studied.

State of Physician and Pharmacist Oncology Workforce in the United States in 2019

PURPOSE: To examine the geographic distribution of physician and pharmacist workforce specialized in oncology in the United States. METHODS: Using the National Provider Identifier data, we identified two types of oncology workforce via the healthcare provider taxonomy codes. Oncologists were physicians self-identified as providing oncologic care to patients. Oncology pharmacists were pharmacists with an oncology subspecialty. We calculated the geographic density of physician and pharmacist oncology workforce and used county-level cancer crude rates to quantify the demand for oncology workforce. We used spatial data to plot the density of oncology workforces relative to county-level cancer rates and compared the county-level density of oncologists and oncology pharmacists. RESULTS: Of the 30,553 members of the oncology workforce in 2019, 28,681 were oncologists and 1,090 were oncology pharmacists. The mean county-level density of oncologists was 2.94 (SD = 7.32) per 100,000 persons. Sixty-four percent of counties had no oncologists with primary practice location in that county and 12% had no oncologists in the local and adjacent counties. Counties in the top quartile of cancer rates had the highest percentage without any oncologists with primary practice location in the county (75%) and with no oncologists in the local as well as adjacent counties (16%). CONCLUSION: Geographically mismatched demand and supply characterized the current oncology workforce. Wide discrepancies in the supply of oncologists across geographic regions highlight the importance of developing core competencies for health professions not specialized in oncology to deliver quality cancer care in areas with unmet need for oncology care.

Behaviour and perception of hand hygiene practice among dental students- A cross-sectional study

Hand hygiene is the act of cleaning one’s hands to remove oil, grease, microorganisms (or) other unwanted substances. Hand hygiene is considered as a primary practice which is used to reduce the risk and spread of infections to some extent. Washing hands with soap and water are considered the best way to remove germs. It helps in preventing diarrhea and uncomfortable intestinal diseases and reduces bacterial content on our hands. Health care professionals use alcohol-based hand disinfectant to prevent healthcare-associated infections and transmission of pathogens. Another widely used standard precautionary measure is wearing protective gloves. The main aim of this study is to assess the knowledge of hand hygiene practice of dental students. The present study is a cross-sectional study conducted among 100 dental students. The questionnaire consisted of 15 questions which were circulated among dental students through an online survey link. The questions were read carefully, and the answers were marked accordingly. The data was then collected and statistically analyzed. 93% of the participants think that hand hygiene is really necessary for day to day life. 88% of the participants think that maintaining proper hand hygiene helps us to be free from infections. The present-day dental students have very good knowledge about hand hygiene practice.