Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 3 de 3
Archives of Disease in Childhood ; 106(Suppl 1):A442-A443, 2021.
Article in English | ProQuest Central | ID: covidwho-1443551


BackgroundWe aim to provide high value care through optimum patient outcomes with limited resource. As our service has grown rapidly, we identified need for managing complex cases in a different way. To avoid admissions yet allow our team to consider each case in depth and carefully monitor patients remotely over time. We undertook a service redesign project to optimise management of our complex high risk patients through a weekly virtual ward round. This was chaired by the Rheumatology CNS with attendance from Clinical Fellows and Consultants. Consequently, we were able to avoid loss to follow up and potential undesirable events including admissions to local hospitals, loss of schooling or parental work absence. Here we describe the process and value of the virtual ward round.ObjectivesActive monitoring of high risk, high need complex patientsReduce admission ratesRemotely manage/avoid unnecessary appointmentsReduce unnecessary GP contactsMethodsRetrospective reviews of the weekly minutes with both qualitative and quantitative data collected. The CNS team generated a list of patients with clinical or social concerns, complex disease, frequent contact, upcoming transition, regular infusions and inpatients. Patients were divided into three categories;red, amber and green to highlight the concern level. Patients moved between groups as required and were taken off the list once concerns were dealt with.ResultsAn average of 58 patients were listed each week from a database of 791 and 16 decisions made on average. Discussions focussed on areas of concern therefore not all patients were discussed at each meeting. These decisions included new requests for day unit treatment/assessment, medication changes, changing appointments, referral to other specialties and whether patients can be removed from the list. There were no unexpected outpatients admitted. Patient conditions included Juvenile Idiopathic Arthritis, Systemic Lupus Erythematosus, Juvenile Dermatomyositis, Vasculitis, Scleroderma and Mixed Connective Tissue Disease with decisions leading to involvement from our colleagues in the dermatology and renal departments for many. A significant proportion of patients were added to the list due to social concerns or poor engagement.ConclusionsThis project identified the high level of productivity possible by continuing a weekly virtual ward round during a very difficult year. It is a reliable and resilient method for the team to keep track of a complex patient cohort. Data collection also highlighted the valuable learning for individuals and the team as a whole by sharing knowledge, discussing treatment plans and problem solving difficult cases. Limitations to this project include limited prospective data collection for contemporaneous analysis and the use of very basic computer systems to record outcomes. Going forward we plan to develop this meeting with the potential to upscale and use similar formats for other patient groups. It would also be important to assess technology options available to assist more detailed documentation and analysis of the outcomes. Through this low cost implementation there has been highly valuable output with overall improvement of patient care quality and consistency.

Med J Aust ; 214 Suppl 8: S5-S40, 2021 05.
Article in English | MEDLINE | ID: covidwho-1256945


CHAPTER 1: HOW AUSTRALIA IMPROVED HEALTH EQUITY THROUGH ACTION ON THE SOCIAL DETERMINANTS OF HEALTH: Do not think that the social determinants of health equity are old hat. In reality, Australia is very far away from addressing the societal level drivers of health inequity. There is little progressive policy that touches on the conditions of daily life that matter for health, and action to redress inequities in power, money and resources is almost non-existent. In this chapter we ask you to pause this reality and come on a fantastic journey where we envisage how COVID-19 was a great disruptor and accelerator of positive progressive action. We offer glimmers of what life could be like if there was committed and real policy action on the social determinants of health equity. It is vital that the health sector assists in convening the multisectoral stakeholders necessary to turn this fantasy into reality. CHAPTER 2: ABORIGINAL AND TORRES STRAIT ISLANDER CONNECTION TO CULTURE: BUILDING STRONGER INDIVIDUAL AND COLLECTIVE WELLBEING: Aboriginal and Torres Strait Islander peoples have long maintained that culture (ie, practising, maintaining and reclaiming it) is vital to good health and wellbeing. However, this knowledge and understanding has been dismissed or described as anecdotal or intangible by Western research methods and science. As a result, Aboriginal and Torres Strait Islander culture is a poorly acknowledged determinant of health and wellbeing, despite its significant role in shaping individuals, communities and societies. By extension, the cultural determinants of health have been poorly defined until recently. However, an increasing amount of scientific evidence supports what Aboriginal and Torres Strait Islander people have always said - that strong culture plays a significant and positive role in improved health and wellbeing. Owing to known gaps in knowledge, we aim to define the cultural determinants of health and describe their relationship with the social determinants of health, to provide a full understanding of Aboriginal and Torres Strait Islander wellbeing. We provide examples of evidence on cultural determinants of health and links to improved Aboriginal and Torres Strait Islander health and wellbeing. We also discuss future research directions that will enable a deeper understanding of the cultural determinants of health for Aboriginal and Torres Strait Islander people. CHAPTER 3: PHYSICAL DETERMINANTS OF HEALTH: HEALTHY, LIVEABLE AND SUSTAINABLE COMMUNITIES: Good city planning is essential for protecting and improving human and planetary health. Until recently, however, collaboration between city planners and the public health sector has languished. We review the evidence on the health benefits of good city planning and propose an agenda for public health advocacy relating to health-promoting city planning for all by 2030. Over the next 10 years, there is an urgent need for public health leaders to collaborate with city planners - to advocate for evidence-informed policy, and to evaluate the health effects of city planning efforts. Importantly, we need integrated planning across and between all levels of government and sectors, to create healthy, liveable and sustainable cities for all. CHAPTER 4: HEALTH PROMOTION IN THE ANTHROPOCENE: THE ECOLOGICAL DETERMINANTS OF HEALTH: Human health is inextricably linked to the health of the natural environment. In this chapter, we focus on ecological determinants of health, including the urgent and critical threats to the natural environment, and opportunities for health promotion arising from the human health co-benefits of actions to protect the health of the planet. We characterise ecological determinants in the Anthropocene and provide a sobering snapshot of planetary health science, particularly the momentous climate change health impacts in Australia. We highlight Australia's position as a major fossil fuel producer and exporter, and a country lacking cohesive and timely emissions reduction policy. We offer a roadmap for action, with four priority directions, and point to a scaffold of guiding approaches - planetary health, Indigenous people's knowledge systems, ecological economics, health co-benefits and climate-resilient development. Our situation requires a paradigm shift, and this demands a recalibration of health promotion education, research and practice in Australia over the coming decade. CHAPTER 5: DISRUPTING THE COMMERCIAL DETERMINANTS OF HEALTH: Our vision for 2030 is an Australian economy that promotes optimal human and planetary health for current and future generations. To achieve this, current patterns of corporate practice and consumption of harmful commodities and services need to change. In this chapter, we suggest ways forward for Australia, focusing on pragmatic actions that can be taken now to redress the power imbalances between corporations and Australian governments and citizens. We begin by exploring how the terms of health policy making must change to protect it from conflicted commercial interests. We also examine how marketing unhealthy products and services can be more effectively regulated, and how healthier business practices can be incentivised. Finally, we make recommendations on how various public health stakeholders can hold corporations to account, to ensure that people come before profits in a healthy and prosperous future Australia. CHAPTER 6: DIGITAL DETERMINANTS OF HEALTH: THE DIGITAL TRANSFORMATION: We live in an age of rapid and exponential technological change. Extraordinary digital advancements and the fusion of technologies, such as artificial intelligence, robotics, the Internet of Things and quantum computing constitute what is often referred to as the digital revolution or the Fourth Industrial Revolution (Industry 4.0). Reflections on the future of public health and health promotion require thorough consideration of the role of digital technologies and the systems they influence. Just how the digital revolution will unfold is unknown, but it is clear that advancements and integrations of technologies will fundamentally influence our health and wellbeing in the future. The public health response must be proactive, involving many stakeholders, and thoughtfully considered to ensure equitable and ethical applications and use. CHAPTER 7: GOVERNANCE FOR HEALTH AND EQUITY: A VISION FOR OUR FUTURE: Coronavirus disease 2019 has caused many people and communities to take stock on Australia's direction in relation to health, community, jobs, environmental sustainability, income and wealth. A desire for change is in the air. This chapter imagines how changes in the way we govern our lives and what we value as a society could solve many of the issues Australia is facing - most pressingly, the climate crisis and growing economic and health inequities. We present an imagined future for 2030 where governance structures are designed to ensure transparent and fair behaviour from those in power and to increase the involvement of citizens in these decisions, including a constitutional voice for Indigenous peoples. We imagine that these changes were made by measuring social progress in new ways, ensuring taxation for public good, enshrining human rights (including to health) in legislation, and protecting and encouraging an independent media. Measures to overcome the climate crisis were adopted and democratic processes introduced in the provision of housing, education and community development.

Health Equity/trends , Health Promotion/trends , Australia , Commerce , Community Health Planning/trends , Digital Technology/trends , Environmental Health/trends , Forecasting , Health Services, Indigenous/trends , Humans , Social Determinants of Health/trends
American Antiquity ; 86(2):224-243, 2021.
Article in English | ProQuest Central | ID: covidwho-1196787


This forum builds on the discussion stimulated during an online salon in which the authors participated on June 25, 2020, entitled “Archaeology in the Time of Black Lives Matter,” and which was cosponsored by the Society of Black Archaeologists (SBA), the North American Theoretical Archaeology Group (TAG), and the Columbia Center for Archaeology. The online salon reflected on the social unrest that gripped the United States in the spring of 2020, gauged the history and conditions leading up to it, and considered its rippling throughout the disciplines of archaeology and heritage preservation. Within the forum, the authors go beyond reporting the generative conversation that took place in June by presenting a road map for an antiracist archaeology in which antiblackness is dismantled.