Established evidence-based treatment guidelines help mitigate disparities in quality of emergency care.

BACKGROUND: Evidence-based guidelines are often cited as a means of ensuring high-quality care for all patients. Our objective was to assess whether emergency department (ED) adherence to core evidence-based guidelines differed by patient sex and race/ethnicity and to assess the effect of ED guideline adherence on patient outcomes by sex and race/ethnicity. METHODS: We conducted a preplanned secondary analysis of data from a multicenter retrospective observational study evaluating variation in ED adherence to five core evidence-based treatment guidelines including aspirin for acute coronary syndrome, door-to-balloon time for acute ST-elevation myocardial infarction, systemic thrombolysis for acute ischemic stroke, antibiotic selection for inpatient pneumonia, and early management of severe sepsis/septic shock. This study was performed at six hospitals in Colorado with heterogeneous and diverse practice environments. Hierarchical generalized linear modeling was used to estimate adjusted associations between ED adherence and patient sex and race/ethnicity while controlling for other patient, physician, and environmental factors that could confound this association. RESULTS: A total of 1,880 patients were included in the study with a median (IQR) age of 62 (51-74) years. Males and non-Hispanic whites comprised 59% and 71% of the cohort, respectively. While unadjusted differences were identified, our adjusted analyses found no significant association between ED guideline adherence and sex or race/ethnicity. Patients who did not receive guideline adherent care in the ED were significantly more likely to die while in the hospital (odds ratio = 2.0, 95% confidence interval = 1.3 to 3.2). CONCLUSIONS: Longstanding, nationally reported evidence-based guidelines can help eliminate sex and race/ethnicity disparities in quality of care. When providers know their care is being monitored and reported, their implicit biases may be less likely to impact care.

Perceptions towards lesbian, gay and bisexual people in residential care facilities: a qualitative study.

BACKGROUND: Internationally, increases in the numbers of older people will be reflected in larger numbers of more socioculturally diverse groups of older people requiring care provided by residential care facilities. Covert and overt instances of homophobia are evident within residential care services provided to older lesbian, gay and bisexual people. AIMS: To explore the perceptions of care staff working in residential care homes towards older lesbian, gay and bisexual people. DESIGN: Critical gerontology formed the methodological foundations for focus group discussions with care staff from seven residential care facilities. Hypothetical vignettes were used to stimulate discussion amongst participants. RESULTS: Thematic analysis of the seven focus group interviews illuminated three themes: 'Knowing me knowing you', 'Out of sight out of mind' and 'It's a generational thing'. Subtle as well as not so subtle forms of homophobia were evident in each of the themes. Care staff felt they were largely unprepared to provide care to older lesbian, gay and bisexual people. CONCLUSION: This small-scale New Zealand study identifies that the residential care sector is not always supportive, or prepared, to provide a care service to those people identifying as lesbian, gay and bisexual. IMPLICATIONS FOR PRACTICE: Findings from this study recommend the implementation of principle-based guidelines, opportunities to participate in ongoing education and partnering with non-heterosexual community organisations in order to provide culturally appropriate care to older lesbian, gay and bisexual people.

Feasibility of three electronic instruments in studying the benefits of adaptive seating.

PURPOSE: This pilot study assesses the suitability of three electronic instruments for the potential to objectively and consistently measure the effectiveness of adaptive seating for children with neuromotor disorders such as cerebral palsy and muscular dystrophy. METHOD: A MiniMicroactigraph, an XSens accelerometer and an Xsensor pressure mapping system were assessed for their ability to measure change in five participants' stability, movement and posture when seating in a flat CAPS II chair and a contoured CAPS II chair. RESULTS: The accelerometer and pressure mapping system showed a difference in amount of movement and body/seat interface between two contrasting seated surfaces on all children, demonstrating potential for use in future research. The results of the actigraph were inconclusive, but did highlight the importance of instrument placement for future studies that utilise this technology. CONCLUSION: The three instruments have potential suitability for use in future, more comprehensive studies of adaptive seating. It is recommended that future studies explore the additional features of these instruments for their potential to provide objective data regarding the effects of adaptive seating on children's postural alignment and support, pressure management, stability, functional ability and comfort.