Homelessness is a social condition increasing in frequency and severity across Canada. Interventions to end and prevent homelessness include effective case management in addition to an affordable housing provision. Little standardization exists for service providers to guide their decision making in developing and maintaining effective case management programs. The purpose of this 2-part article is to articulate dimensions of promising practice for case managers working in a "Housing First" context. Part 1 discusses research processes and findings and Part 2 articulates the 6 dimensions of quality.
Practice settings include community-based organizations that employ and support case managers whose primary role is moving people from homelessness into permanent supportive housing.
Six dimensions of promising practice are critically important to reducing barriers, improving sector collaboration, and ensuring that case managers have appropriate and effective training and support. Dimensions of promising practice are (1) collaboration and cooperation-a true team approach; (2) right matching of services-person-centered; (3) contextual case management-culture and flexibility; (4) the right kind of engagement-relationships and advocacy; (5) coordinated and well-managed system-ethics and communication; and (6) evaluation for success-support and training.
Effective, coordinated case management, in addition to permanent affordable housing has the potential to reduce a person's or family's homelessness permanently. Organizations and professionals working in this context have the opportunity to improve processes, reduce burnout, collaborate and standardize, and, most importantly, efficiently and permanently end someone's homelessness with the help of dimensions of quality for case management.
AIM: To re-examine a population after 20 years and evaluate changes in prevalence of endodontic treatment and apical periodontitis, as well as the technical quality of root fillings. METHODOLOGY: One hundred and fifteen out of an original 200 patients living in the northern part of Sweden were re-examined with a full mouth radiographic survey after 20 years. Frequencies of root canal treated teeth, apical periodontitis and quality parameters of root fillings were registered. RESULTS: The frequency of root canal treated teeth increased significantly (P
To provide updated, evidence-based recommendations for the diagnosis and assessment of adults with hypertension.
MEDLINE searches were conducted from November 2008 to October 2009 with the aid of a medical librarian. Reference lists were scanned, experts were contacted, and the personal files of authors and subgroup members were used to identify additional studies. Content and methodological experts assessed studies using prespecified, standardized evidence-based algorithms. Recommendations were based on evidence from peer-reviewed full-text articles only.
Recommendations for blood pressure measurement, criteria for hypertension diagnosis and follow-up, assessment of global cardiovascular risk, diagnostic testing, diagnosis of renovascular and endocrine causes of hypertension, home and ambulatory monitoring, and the use of echocardiography in hypertensive individuals are outlined. Changes to the recommendations for 2010 relate to automated office blood pressure measurements. Automated office blood pressure measurements can be used in the assessment of office blood pressure. When used under proper conditions, an automated office systolic blood pressure of 135 mmHg or higher or diastolic blood pressure of 85 mmHg or higher should be considered analogous to a mean awake ambulatory systolic blood pressure of 135 mmHg or higher and diastolic blood pressure of 85 mmHg or higher, respectively.
All recommendations were graded according to strength of the evidence and voted on by the 63 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. To be approved, all recommendations were required to be supported by at least 70% of task force members. These guidelines will continue to be updated annually.
The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) collects data to support the improvement of care for heart disease.
SWEDEHEART collects on-line data from consecutive patients treated at any coronary care unit n = (74), followed for secondary prevention, undergoing any coronary angiography, percutaneous coronary intervention, percutaneous valve or cardiac surgery. The registry is governed by an independent steering committee, the software is developed by Uppsala Clinical Research Center and it is funded by The Swedish national health care provider independent of industry support. Approximately 80,000 patients per year enter the database which consists of more than 3 million patients.
Base-line, procedural, complications and discharge data consists of several hundred variables. The data quality is secured by monitoring. Outcomes are validated by linkage to other registries such as the National Cause of Death Register, the National Patient Registry, and the National Registry of Drug prescriptions. Thanks to the unique social security number provided to all citizens follow-up is complete. The 2011 outcomes with special emphasis on patients more than 80 years of age are presented.
SWEDEHEART is a unique complete national registry for heart disease.
OBJECTIVE/BACKGROUND: Aboriginals constitute a substantial portion of the population of Northern Alberta. Determinants such as poverty and education can compound health-care accessibility barriers experienced by Aboriginals compared to non-Aboriginals. A diabetes care enhancement study involved the collection of baseline and follow-up data on Aboriginal and non-Aboriginal patients with known type 2 diabetes in two rural communities in Northern Alberta. Analyses were conducted to determine any demographic or clinical differences existing between Aboriginals and non-Aboriginals. METHODS: 394 diabetes patients were recruited from the Peace and Keeweetinok Lakes health regions. 354 self-reported whether or not they were Aboriginal; a total of 94 self-reported being Aboriginal. Baseline and follow-up data were collected through interviews, standardized physical assessments, laboratory testing and self-reporting questionnaires (RAND-12 and HUI3). RESULTS: Aboriginals were younger, with longer duration of diabetes, more likely to be female, and less likely to have completed high school. At baseline, self-reported health status was uniformly worse, but the differences disappeared with adjustments for sociodemographic confounders, except for perceived mental health status. Aboriginals considered their mental health status to be worse than non-Aboriginals at baseline. Some aspects of health utilization were also different. DISCUSSION: While demographics were different and some utilization differences existed, overall this analysis demonstrates that "Aboriginality" does not contribute to diabetes outcomes when adjusted for appropriate variables.
The objective of this study was to evaluate the quality of the clinical pharmacy service in a Swedish hospital according to the Lund Integrated Medicine Management (LIMM) model, in terms of the acceptance and clinical significance of the recommendations made by clinical pharmacists.
The clinical significance of the recommendations made by clinical pharmacists was assessed for a random sample of inpatients receiving the clinical pharmacy service in 2007. Two independent physicians retrospectively ranked the recommendations emerging from errors in the patients' current medication list and actual drug-related problems according to Hatoum, with rankings ranging between 1 (adverse significance) and 6 (extremely significant).
The random sample comprised 132 patients (out of 800 receiving the service). The clinical significance of 197 recommendations was assessed. The physicians accepted and implemented 178 (90%) of the clinical pharmacists' recommendations. Most of these recommendations, 170 (83%), were ranked 3 (somewhat significant) or higher.
This study provides further evidence of the quality of the LIMM model and confirms that the inclusion of clinical pharmacists in a multi-professional team can improve drug therapy for inpatients. The very high level of acceptance by the physicians of the pharmacists' recommendations further demonstrates the effectiveness of the process.