A qualitative analysis of the barriers and enablers faced by Australian rural general practitioners in the non-pharmacological management of congestive heart failure in community dwelling patients.

BACKGROUND: Congestive heart failure (CHF) is a significant health problem in Australia, and disproportionately affects rural Australians. Management of CHF in Australia is heavily centred around the general practitioner (GP). Australian and international literature indicates there is a gap between current and best practice in CHF management. There is little known about the non-pharmacological aspects of management, or CHF management in a rural Australian context. This study aimed to identify what Australian GPs practicing in the Northern Rivers Region of New South Wales, Australia, perceived were the barriers and enablers in the non-pharmacological management of CHF amongst community dwelling patients, to inform healthcare access, resourcing and delivery in Australian rural environments. METHODS: Qualitative study involving a realist thematic analysis of data collected from semi-structured face-to-face interviews. RESULTS: Fifteen GPs and GP trainees participated. Four interlinked key themes underpinning GPs' experiences with non-pharmacological management of CHF were interpreted from the interview data: (1) resources, (2) complexity of heart failure, (3) relationships, and (4) patient demographics, priorities and views affect how patients engage with non-pharmacological management of CHF. CONCLUSION: Rural Australian GPs face considerable barriers to non-pharmacological management of CHF. The data suggests that increased rural Australian health services and community transportation, multidisciplinary management, and stronger professional networks have the potential to be invaluable enablers of CHF management. Further research exploring non-pharmacological management of CHF in other rural contexts may provide additional insights to better inform rural healthcare access and resourcing.

Design of a 1-Bit MEMS Gyroscope Using the Model Predictive Control Approach.

In this paper, a bi-level Delta-Sigma modulator-based MEMS gyroscope design is presented based on a Model Predictive Control (MPC) approach. The MPC is popular because of its capability of handling hard constraints. In this work, we propose to combine the 1-bit nature of the bi-level Delta-Sigma modulator output with the MPC to develop a 1-bit processing-based MPC (OBMPC). This paper will focus on the affine relationship between the 1-bit feedback and the in-loop MPC controller, as this can potentially remove the multipliers from the controller. In doing so, the computational requirement of the MPC control is significantly alleviated, which makes the 1-bit MEMS Gyroscope feasible for implementation. In addition, a stable constrained MPC is designed, so that the input will not overload the quantizer while maintaining a higher Signal-to-Noise Ratio (SNR).