Point-of-Care Testing Practices, Failure Modes, and Risk-Mitigation Strategies in Emergency Medical Services Programs in the Canadian Province of Alberta.

CONTEXT.­: Emergency medical services (EMS) programs have been using point-of-care testing (POCT) for more than 20 years. However, only a handful of reports have been published in all of that time on POCT practices in field settings. OBJECTIVE.­: To provide an overview of POCT practices and failure modes in 3 of Alberta's EMS programs, and to propose risk-mitigation strategies for reducing or eliminating these failure modes. DESIGN.­: Details about POCT practices, failure modes, and risk-mitigation strategies were gathered through (1) conversations with personnel, (2) in-person tours of EMS bases, (3) accompaniment of EMS personnel on missions, (4) internet searches for publicly available information, and (5) a review of laboratory documents. RESULTS.­: Practices were most standardized and robust in the community paramedicine program (single service provider, full laboratory oversight), and least standardized and robust in the air ambulance program (4 service providers, limited laboratory oversight). Common failure modes across all 3 programs included device inoperability due to cold weather, analytical validation procedures that failed to consider the unique challenges of EMS settings, and a lack of real-time electronic transmission of results into the health care record. CONCLUSIONS.­: A provincial framework for POCT in EMS programs is desirable. Such a framework should include appropriate funding models, laboratory oversight of POCT, and relevant expertise on POCT in EMS settings. The framework should also incorporate specific guidance on quality standards that are needed to address the unique challenges of performing POCT in field settings.

Improving access to quality medicines in East Africa: An independent perspective on the East African Community Medicines Regulatory Harmonization initiative.

Alexander Giaquinto and co-authors discuss the East African Community's Medicines Regulatory Harmonization initiative.

Optimizing the East African Community's Medicines Regulatory Harmonization initiative in 2020-2022: A Roadmap for the Future.

Margareth Ndomondo-Sigonda outlines future challenges for the East African Medicines Regulatory Harmonization initiative.

Coming together to improve access to medicines: The genesis of the East African Community's Medicines Regulatory Harmonization initiative.

Hiiti Sillo and colleagues reveal how the East African Community's Medicines Regulatory Harmonization initiative improves access to important medicines in Africa.

Profiling the best-performing community medicine distributors for mass drug administration: a comprehensive, data-driven analysis of treatment for schistosomiasis, lymphatic filariasis, and soil-transmitted helminths in Uganda.

BACKGROUND: The most prevalent neglected tropical diseases are treated through blanket drug distribution that is reliant on lay community medicine distributors (CMDs). Yet, treatment rates achieved by CMDs vary widely and it is not known which CMDs treat the most people. METHODS: In Mayuge District, Uganda, we tracked 6779 individuals (aged 1+ years) in 1238 households across 31 villages. Routine, community-based mass drug administration (MDA) was implemented for schistosomiasis, lymphatic filariasis, and soil-transmitted helminths. For each CMD, the percentage of eligible individuals treated (offered and ingested medicines) with at least one drug of praziquantel, albendazole, or ivermectin was examined. CMD attributes (more than 25) were measured, ranging from altruistic tendencies to socioeconomic characteristics to MDA-specific variables. The predictors of treatment rates achieved by CMDs were selected with least absolute shrinkage and selection operators and then analyzed in ordinary least squares regression with standard errors clustered by village. The influences of participant compliance and the ordering of drugs offered also were examined for the treatment rates achieved by CMDs. RESULTS: Overall, only 44.89% (3043/6779) of eligible individuals were treated with at least one drug. Treatment rates varied amongst CMDs from 0% to 84.25%. Treatment rate increases were associated (p value< 0.05) with CMDs who displayed altruistic biases towards their friends (13.88%), had friends who helped with MDA (8.43%), were male (11.96%), worked as fishermen/fishmongers (14.93%), and used protected drinking water sources (13.43%). Only 0.24% (16/6779) of all eligible individuals were noncompliant by refusing to ingest all offered drugs. Distributing praziquantel first was strongly, positively correlated (p value < 0.0001) with treatment rates for albendazole and ivermectin. CONCLUSIONS: These findings profile CMDs who treat the most people during routine MDA. Criteria currently used to select CMDs-community-wide meetings, educational attainment, age, years as a CMD, etc.-were uninformative. Participant noncompliance and the provision of praziquantel before albendazole and ivermectin did not negatively impact treatment rates achieved by CMDs. Engaging CMD friend groups with MDA, selecting CMDs who practise good preventative health behaviours, and including CMDs with high-risk occupations for endemic infections may improve MDA treatment rates. Evidence-based guidelines are needed to improve the monitoring, selection, and replacement of CMDs during MDA.

Development, validation and use of appropriate assessment tools for certification of entrustable professional activities in community medicine to produce a competent postgraduate: A pilot study.

BACKGROUND: Adoption of competence-based medical education (CBME) is the need of the hour. OBJECTIVES: The objective of the study is to develop and validate appropriate assessment tools for the community medicine entrustable professional activities (EPAs) and to assess the usefulness of the validated tools in the assessment of postgraduate (PG) students. METHODS: An interventional study for 14 months was done in the department of community medicine. After the sensitization of faculty members and PGs, three EPAs were selected through consensus between faculty members and appropriate assessment tools mini-clinical evaluation exercise (Mini-CEX), case-based discussion (CBD), and direct observation of procedural skills (DOPS). Rubrics of milestones were formulated for the selected tools, and the designed tools were validated. These three validated tools were used for the quarterly assessment. RESULTS: The item-content validity index for all three assessment tools was one, while Scale Content Validity Index for Mini-CEX and CBD were 1, and for DOPS, it was 0.87. Three PG students were assessed using the validated tools thrice for the three selected EPAs. The PGs opined that assessment using rubrics made their task-specific, while faculties were quite satisfied with the assessment process as it removed subjectivity. CONCLUSIONS: The developed and selected tools of EPAs were found to have a substantial level of both face validity and content validity. The tools were also found to useful for periodic assessment in workplace settings and acceptable to both PG students and internal/external faculty members.

Integrating social class and privilege in the community medicine curriculum.

Social class and privilege are hidden variables that impact the physician-patient relationship and health outcomes. This article presents a sample of activities from three programs utilized in the community health curriculum to teach resident physicians about patients within context, including how social class and privilege impact physician-patient relationships and patient health. These activities address resident physicians' resistance to discussion of privilege, social class, and race by emphasizing direct experience and active learning rather than traditional didactic sessions. The group format of these activities fosters flexible discussion and personal engagement that provide opportunities for reflection. Each activity affords opportunities to develop a vocabulary for discussing social class and privilege with compassion and to adopt therapeutic approaches that are more likely to meet patients where they are.

Implementación de las Unidades Docentes Multiprofesionales de Atención Familiar y Comunitaria en Cataluña / Implementation of Multiprofessional Teaching Units of Family and Community Care in Catalonia

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Urban general practice and medical education: Academic outcomes from a unique urban, longitudinal integrated community-based program.

BACKGROUND: In 2009, Flinders University established an urban, community-based, longitudinal integrated program providing medical students extended placements that offered continuities of patient care, clinical supervision and peer group. OBJECTIVE: The aim of this research was to analyse academic outcomes of the new placement program. METHODS: The results of all students undertaking Year 3 exams from 2011 to 2014 were collected and analysed. The Years 1 and 2 exam results for students in the new program were also analysed. RESULTS: Students in the new placement program achieved significantly higher grades than those who undertook the traditional rotations program, with aver-age scores of 69.05, compared with 66.45 (P = 0.03). Analysis of average class ranking for students who undertook the new program showed a statistically significant improvement from 59th in class to 48th in class (P = 0.03). DISCUSSION: This evaluation shows that an urban, community-based, longitudinal integrated clerkship centred in general practice provides at least academically equivalent outcomes to traditional rotations-based programs.

Resultados preliminares de un programa comunitario de prevención de caídas: estudio Precari (prevención de caídas en La Ribera) / Preliminary results of a community fall prevention programme: Precan study (falls prevention in La Ribera)

Objetivo. Evaluar la posible reducción en la incidencia de caídas y la ganancia funcional de un programa de prevención de caídas. Material y métodos. Doscientos cuarenta y nueve sujetos no institucionalizados fueron repartidos aleatoriamente en 3 grupos: el grupo intervención mensual (GIM), el cual recibió instrucción teórica sobre prevención de caídas y ejercicios que mejoran la función física y el equilibrio de forma mensual complementado con una clase práctica con la misma periodicidad. El grupo intervención trimestral (GIT), el cual recibió la misma información teórica con periodicidad trimestral. El grupo control (GC), instruido teóricamente al inicio del estudio, sin refuerzos posteriores. La duración del estudio fue de 12 meses. Resultados. Edad media 74,47 (DE: 5,33) años, mujeres: 64%. La incidencia de caídas se redujo del GIM desde el 0,64 por paciente y año en el año previo al 0,39 en el año posterior a la intervención, en el GIT desde 0,49 a 0,47 y en el GC desde se mantuvo en el 0,47, no existiendo diferencias significativas en dicha reducción entre grupos (p = 0,062). También se objetiva un descenso de la puntuación en la escala de Rizzo de 0,72 (IC 95%: 0,57-0,88) puntos, p < 0,001. Conclusión. Una intervención comunitaria interdisciplinar puede contribuir a la reducción de la incidencia de caídas, aunque estos resultados no son concluyentes. Es necesario seguir estudiando el abordaje de la incidencia de caídas en poblaciones ancianas de ámbito comunitario (AU)

Objective. To evaluate the results of a fall prevention programme designed to be applied to the elderly living in the community. Material and methods. The sample consisted of 249 participants ≥70 years of age, who were randomly assigned to one of three groups. The monthly intervention group (GIM): instructions on fall prevention and healthy exercises to improve physical function and balance at beginning of the study, and a monthly theoretical and practical refresher session. The quarterly intervention group (GIT), with the same beginning intervention and a refresher session every three months. The control group (GC), the same beginning intervention but no refresher sessions. Results. The mean age of the sample was 74.47 years (SD 5.33), with 64% women. The incidence of falls was reduced from 0.64 per patient year in the previous year to 0.39 in the post-intervention year in GIM, from 0.49 to 0.47 in GIT, and in the GC it remained at 0.47 before and twelve months after, but with no significant differences in the reduction between groups (P=.062). At the end of the study there was a decrease in Rizzo scale of 0.72 points (95% CI: 0.57-0.88, P<.001). Conclusion. An interdisciplinary community intervention programme can contribute to reducing the incidence of falls. Further studies are required to continue research into the incidence of falls in the elderly living in the community (AU)

Anaphylaxis challenges on the front line: perspectives from community medicine.

This report reflects a discussion from the multidisciplinary Partnership for Anaphylaxis Round Table meeting, held in November 2012, in Dallas, Texas. Community medicine participants included John R. Bennett, MD, an internist who practiced in Cumming, Georgia, and whose patients were adults; Leonard Fromer, MD, a family practitioner in Los Angeles, California, who was the medical director of a network of 600 medical groups, including pediatricians, internists, and family physicians, and who in his previous practice treated children and adults, many of them with severe allergies; and Mary Lou Hayden, MS, RN, FNP-BC, AE-C, a nurse practitioner who treated adults in a university employee health clinic and in an allergy clinic in Charlottesville, Virginia, and whose prior practice focused on allergy and immunology in children and adults. This discussion was moderated by Dr Bennett. Participants provided their perspectives as primary care providers (PCPs) concerning anaphylaxis, which has become a major public health concern. The rising prevalence of severe allergies and incidence of anaphylaxis and other severe allergic reactions among children and adults is shifting more care to PCPs. This discussion provides insights into challenges faced by PCPs in treating patients at risk for anaphylaxis in the community setting and provides potential solutions to those challenges.

The primacy of relationships: a study of public health nursing practice from a critical caring perspective.

Critical caring is a midrange theory proposed as a framework to guide public health nursing practice. This article reports findings of a study that examined the relevance of the theory to the practice of expert public health nurses (PHNs). Twenty-six PHNs participated in this study: 10 in interviews and 16 in 2 focus groups. Findings support the relevance of critical caring to PHN practice, explicated, and further refined the theory through the richness of participants' practice accounts As such, it has potential as a tool of resistance to forces that limit PHNs working to their full scope of practice.

Biospecimens and biorepositories for the community pathologist.

Pathologists have long served as custodians of human biospecimens collected for diagnostic purposes. Rapid advancements in diagnostic technologies require that pathologists change their practices to optimize patient care. The proper handling of biospecimens creates opportunities for pathologists to improve their diagnoses while assessing prognosis and treatment. In addition, the growing need for high-quality biorepositories represents an opportunity for community pathologists to strengthen their role within the health care team, ensuring that clinical care is not compromised while facilitating research. This article provides a resource to community pathologists learning how to create high-quality biorepositories and participating in emerging opportunities in the biorepository field. While a variety of topics are covered to provide breadth of information, the intent is to facilitate a level of understanding that permits community pathologists to make more informed choices in identifying how best their skills and practice may be augmented to address developments in this field.

Control de calidad en la gestión de las reclamaciones de los usuarios del área sanitaria 10 de atención especializada de la comunidad de Madrid (2000-2005) / No disponible

Objetivo: Analizar las causas de las reclamaciones del área sanitarian.º 10 de Madrid, su tendencia de cambio en el tiempo y valorar elcumplimiento del control de calidad en la gestión de las reclamaciones.Material y métodos: Estudio observacional, descriptivo y retrospectivosobre las reclamaciones entre 2000-2005. Se calcularon tasa deincidencia y cambio porcentual anual, se estudió la relación temporalcon las reclamaciones más frecuentes y porcentaje de reclamacionescorrectamente contestadas por escrito.Resultados: La incidencia de reclamaciones se incrementó en esteperíodo de 132,93 a 482,28/100.000 habitantes. El cambio porcentualanual de reclamaciones fue del +15,21. Existió una relaciónentre varios tipos de reclamaciones y el año (disconformidadasistencial, contra la organización y normas, por extravío de documentos,por disconformidad con información clínica, por disconformidadcon la lista de espera no quirúrgica, por disconformidad conla lista de espera quirúrgica y por suspensión de actividad programada).En 2004 se contestaron el 98,7% de reclamaciones y enplazo inferior a 30 días el 24,8%. En 2005, se contestaron el98,8%, y 44% en plazo.Conclusiones: Se observó un incremento de la tasa de incidencia delas reclamaciones en el área sanitaria 10 de Madrid, de 2000 a2005. Los usuarios dieron mayor importancia al aspecto técnico yhumano de la asistencia sanitaria frente a los logísticos y estructurales.Se halló una asociación significativa entre las reclamacionesmás frecuentes y el año, salvo las debidas al trato del personal. Elcontrol de calidad de las reclamaciones contestadas fue pobre (AU)

Objective: To analyse the complaints made by users of the NationalHealth System in the University Hospital of Getafe (Madrid, Spain),to characterise trends in complaint rates over time and to appraisethe quality control in the management of complaints.Material and methods: All complaints made between January 2000and December 2005 were recorded and the incidence rate and annualpercent change were calculated. The relationships betweencomplaints and time were analysed. Finally, the percentage of complaintscorrectly dealt with in less than 30 days was calculated.Results: The number of complaints increased from 132.93 to482.28 per 100,000 inhabitants. The annual percent increase was+15.21. There was a relationship between several types of complaintsand time (disagreement with health care, the organisation,with loss of documents, with clinical information, with delays in surgicaland non-surgical treatment and cancellations. In 2004, only24.8% of complaints were answered in time, but increased to 44%in 2005.Conclusions: There was an increase in the incidence of the complaintsin the University Hospital of Getafe (Madrid) during the periodstudied. The users give greater importance to the technical andhuman aspects of health care compared to organisational and planningaspects. The quality control in the management of the complaintsis poor (AU)

Lo que no hay que hacer para desburocratizar la atención primaria / What has to be done to debureaucratise primary care

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Atención Primaria en el Science Citation Index Expanded / Atención primaria in the science citation index expanded

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[General medicine in the 21st century]. / La Médecine générale du XXIe Siècle.

General medicine is the main pivot of our healthcare system. General practitioners' tasks are numerous: front line responsibility, networking coordination, long-term patient care, community medicine and also primary care research. In the framework of general medicine that has been undergoing profound change for many years, we have chosen to develop three of these facets: general practitioners' knowledge of family, psychological, social or environmental factors and their capacity to coordinate with other health workers will help them in their primary and secondary prevention and also quaternary work by sparing patients unnecessary treatment and examinations. General medicine will increasingly become a discipline, one of which specific expertise will be to manage bio-psycho-societal complexity. Multidisciplinary action will be the rule: general practitioners will no longer be able to claim they can deal with all the curative, preventive and health education tasks. And the research in general medicine is essential because general practitioners can deal with over 80% of the health problems identified by patients and because the symptoms leading to the treatment cannot only be studied by laboratory or hospital research.

Técnicas educativas en el uso de inhaladores para el asma bronquial / Educational techniques in the use of bronchial asthma inhalers

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