Can a smartphone app help manage wounds in primary care?

BACKGROUND AND PURPOSE: Although wound care guidelines are available for primary care providers, barriers to assessment and treatment remain. This article examines current evidence supporting wound management, wound guidelines, and provider comfort with wound management in primary care and discusses the need for improved training, education, and the development of a simplified approach to wound management in primary care. METHODS: This review of evidence examines knowledge of wound care, wound curriculum, and the current availability of guidelines for health care providers at the frontlines. CONCLUSION: Few primary care curriculums and institutions require wound care education. Access to guidelines, pathways, and educational resources is limited, which negatively effects primary care provider's knowledge and comfort level in treating wounds in current clinical practice. IMPLICATION FOR PRACTICE: Educating the general practitioner on evidence-based wound management and providing adequate resources remain a priority. Increasing awareness of available electronic wound care applications (apps) can improve a timely wound care assessment, diagnosis, and initiation of treatment.

Advanced care planning in health service users.

AIMS AND OBJECTIVES: To examine the use of advanced directives (ADs) in patients actively using health services in the USA. BACKGROUND: Since 1991, USA law (PSDA 1991) has required hospitals, skilled nursing facilities (SNFs) and home health services to inquire, at admission, if patients have in place ADs, to provide patients with a written summary of their rights in regard to health-related decision-making and to provide education to staff and the community about ADs. DESIGN: Via chart review and observation, the AD status of patients residing in three SNFs during a six-week period was ascertained (n = 272). Those with ADs were further evaluated to examine the timing of the directive in regards to their health status. METHODS: Patients residing at SNFs were selected for study because SNF patients are admitted from the hospital; therefore, there are at least two opportunities - at hospital admission and at SNF admission - to inquire and educate about advance directives. RESULTS: Residents ranged in age from 35 to 100 years and included patients admitted for short-term rehabilitaion after hospitalisation, as well as residents who were initially admitted after a hospitalisation but required long-term care. A full 90·44% (n = 246) entered skilled care without an AD, and 69·11% (n = 188) remained without an AD. The most likely reason for the development of an AD was lengthy decline in health status associated with multiple hospitalisations. CONCLUSIONS: Current law appears ineffective. A more appropriate approach is to encourage open dialogue about treatment options and quality of life. RELEVANCE TO CLINICAL PRACTICE: Given the rapidity with which populations are ageing in countries worldwide, ADs would appear to be a phenomenon that should be embraced. However, experience in the USA has called into question their usefulness.

Health practices of older adults in good health.

Using an interpretive, descriptive method, this study investigated the beliefs, values, lifestyles, and health status of adults age 75 and older who identified themselves as healthy, as well as the interactions with and observations of health care personnel who work with them. Staff participants were drawn from medical offices, a skilled nursing facility, and an assisted living site. Older adults who self-identified themselves as healthy (n = 14), as well as those who self-identified themselves as being in fair or poor health but were included per staff recommendation (n = 4), were recruited from the sites in which these staff worked. They were interviewed about health, health promotion, health care, and lifestyle. Social engagement appeared to be a strong mediating factor against chronic illness.