Quality care outcomes following transitional care interventions for older people from hospital to home: a systematic review

 Background
Provision of high quality transitional care is a challenge for health care providers in many western countries. This systematic review was conducted to (1) identify and synthesise research, using randomised control trial designs, on the quality of transitional care interventions compared with standard hospital discharge for older people with chronic illnesses, and (2) make recommendations for research and practice.

Methods
Eight databases were searched; CINAHL, Psychinfo, Medline, Proquest, Academic Search Complete, Masterfile Premier, SocIndex, Humanities and Social Sciences Collection, in addition to the Cochrane Collaboration, Joanna Briggs Institute and Google Scholar. Results were screened to identify peer reviewed journal articles reporting analysis of quality indicator outcomes in relation to a transitional care intervention involving discharge care in hospital and follow-up support in the home. Studies were limited to those published between January 1990 and May 2013. Study participants included people 60 years of age or older living in their own homes who were undergoing care transitions from hospital to home. Data relating to study characteristics and research findings were extracted from the included articles. Two reviewers independently assessed studies for risk of bias.

Results
Twelve articles met the inclusion criteria. Transitional care interventions reported in most studies reduced re-hospitalizations, with the exception of general practitioner and primary care nurse models. All 12 studies included outcome measures of re-hospitalization and length of stay indicating a quality focus on effectiveness, efficiency, and safety/risk. Patient satisfaction was assessed in six of the 12 studies and was mostly found to be high. Other outcomes reflecting person and family centred care were limited including those pertaining to the patient and carer experience, carer burden and support, and emotional support for older people and their carers. Limited outcome measures were reported reflecting timeliness, equity, efficiencies for community providers, and symptom management.

Conclusions
Gaps in the evidence base were apparent in the quality domains of timeliness, equity, efficiencies for community providers, effectiveness/symptom management, and domains of person and family centred care. Further research that involves the person and their family/caregiver in transitional care interventions is needed.

Understanding neighborhood environment related to Hong Kong children's physical activity: a qualitative study using nominal group technique

Relationships between the neighborhood environment and children's physical activity have been well documented in Western countries but are less investigated in ultra-dense Asian cities. The aim of this study was to identify the environmental facilitators and barriers of physical activity behaviors among Hong Kong Chinese children using nominal group technique.

The impetus for the development of hospital in the home (HITH) programs: a literature review

Alternative health care delivery models such as Hospital in the Home (HITH) are proliferating in Australia and in most Western countries. Such models facilitate patients who would otherwise be hospitalised to be cared for in their own homes. This paper reports a review of the literature related to the development of HITH programs. It reveals that the driving force behind the implementation of acute care programs comes from political and managerial aims to reduce health care spending. Home is clearly an appropriate care option for certain acute patients however, there is no strong evidence to suggest that it suits everyone. Very little attention has been given to the patient's experience of home care and the ethical and social consequences are largely ignored.

Gender blind? Australian immigration policy and practice, 1901-1930

This paper seeks to explore the nature of Australian immigration policies and practices, particularly their impact on women, from federation in 1901 to the cessation of large-scale assisted immigration to Australia brought about by the 1930s depression. The characteristics that influenced and affected female immigrants may have differentiated their experiences from those of male immigrants in the same period. Differential treatment of men and women has often been an unstated given in the formulation and implementation of immigration policies. It was as common to non-government organisations (of which there were, and still are, a great many associated with immigration and settlement), as to governments, both federal and state. Several inequities can be identified in the making and implementation of immigration and settlement policies, and in the access to government grants, concessions and services, not only in terms of race, ethnicity, class or occupation (which is well trodden ground in this field) but also in terms of gender.[1] Such differentiation is part of the broader framework of changing conceptions about the place and roles of women in Australian society and their expected contribution to the nation, but it has remained largely unexplicated in this period and field.

The theory and practice of coastal area planning: linking strategic planning to local communities

Integrated coastal management (ICM) has been slowly accepted over the last decade as a unifying approach for coastal planning and management throughout the world. Coastal planning aimed at achieving the objectives of ICM can be implemented by varying processes and faces many challenges. One major challenge for coastal planning is to adapt the well-developed theoretical principles of ICM to practical and understandable outcomes in local areas. Associated with this challenge is the need to balance coastal planning objectives for conservation and economic development of a nation or state/province with the objectives of the local community. This article describes a three-tiered approach to coastal planning in Victoria, Australia, which will be of value to other countries, particularly those with subnational coastal planning jurisdictions. This approach not only has the aim of balancing subnational (e.g., state government) and local objectives, but also of applying the theoretical concept of ICM in practice on the ground. In addition, the approach sets out to achieve a sense of ownership of the planning process by local communities by maximizing their involvement at all levels of planning and also by making the state strategy as easy to understand and follow as possible.

Selection, exclusion and assimilation: the project lambert of 1931 on the reform of French immigration policy

The unemployment crisis of 1926-7 focused attention onto the question of immigration. Historians of this period have generally focused on the crisis of public policy and popular antipathies towards foreigners; more recently historians have become attuned to voices of racism. Less attention has been paid to attempts to redress the policy weaknesses through a new legislative regime on immigration. This paper reviews one such proposal, made by Charles Lambert, a deputy from the Rhone, in 1931. Instrumental in a revision of the naturalization law in 1927 to encourage the assimilation of foreigners through the acquisition of French citizenship, Lambert proposed a comprehensive statute on immigration to select “desirable” foreigners and exclude the “undesirables” to promote the assimilation of the “better” elements. The paper argues that his rationale betrays a profound fear of mounting French weakness in the face of economic and demographic decline, and grave anxieties for the future health of the French nation.

Overcoming the adversity of diversity : an Australian story

The low participation rate of women in computing education and the computing industry is a phenomenon that has been recognised by many western countries. While much has been written on the underlying reasons for the low participation in such a growing and dynamic industry, the situation only seems to be worsening. This paper examines briefly a number of approaches taken by researchers in Australia to try and address the problem. One tertiary institution, Victoria University, has undertaken over a ten year period a sequence of projects, aimed at encouraging and supportingfemale students to study information technology and then make a successful transition from university to the workplace. The strategies and outcomes of the most recent project is the focus of this paper. This project concentrated on equipping graduatingfemale students with skills and knowledge to enable them to participate on equal terms with their male counterparts in workgroups and project teams. An outcome from this work was the preparation and distribution of a resource book to graduating female students during 2002.

Corporate governance developments in commonwealth countries

Corporate failures, fraud and rising salaries have directed attention towards the corporate governance mechanisms of companies. A review of governance developments in selected Commonwealth countries is undertaken in order to inform the governance debate and provide an opportunity to discuss governance relating to some countries which may not receive much attention in the debate. The countries covered in this review are the United Kingdom, South Africa, India and Australia. Brief coverage of the respective countries' progressions in the corporate governance debate is provided.

The TRIPS agreement and developing countries: a discussion of the paragraph 6 of the Doha declaration on public health

The Paragraph 6 solution arrived on 30th August 2003 to facilitate export of drugs to the countries which were not able to manufacture said drugs shows the total marginalization of developing countries in international treaty negotiations. A simple proposal by developing counties to use Article 30 of the TRIPS Agreement for such manufacture and export to non-manufacturing countries in order to avoid expensive litigations with the pharmaceutical multinationals took an ugly turn where not only the said proposal was totally rejected but export was added as one of the patenting rights in the TRIPS Agreement with payment of remuneration to patent holders. This introduction of export as one of the patenting rights was surrounded by a thicket of rules on the plea that such products would be diverted to ensure that the needing countries never acquire the requisite drugs. This article analyses the events leading to the establishment of the TRIPS Agreement, the elimination of developing countries from such negotiations through the use of suitably placed officials in the negotiating forums, the role of CEOs of the multinationals and the business NGOs such as International Intellectual Property Alliance and IPC (Intellectual Property Committee), epistemic community consisting of individuals such as Jacques Gorlin and Eric Smith and the subsequent development leading to the finalization of Para 6 Solution, which was an exact replication of events during the TRIPS negotiations. The analysis suggests that developing countries do not have any say in international negotiations and their agreements to such negotiations are essentially to legitimize their colonized existence.

Arts marketing challenges in multicultural societies

With an increasingly diverse, multicultural society in many countries, it is timely to look more closely at the current literature on arts marketing, ethnic identity and segmentation issues. The growth of diverse, multicultural societies in many countries warrants a closer examination of arts marketing and the use of ethnicity as a basis for segmentation, as these issues have implications for attracting and retaining arts audiences and other consumers of arts related activities. Researchers in the arts industry have stressed the importance of understanding the fundamentals of audience development and the ability to focus on satisfying the needs and wants of their audiences. The focus on marketing activities comes at a time when there is greater pressure on arts organisations to move beyond their traditional role as subsidized non-profit organisations in order to become more self-supporting. Internationally, audience development in the arts industry has focused on segmentation dimensions such as youth, mature aged individuals, geographic location (rural), individuals with disabilities, low income earners, and individuals with culturally diverse backgrounds. Most of these potential segments are under represented in the population of arts consumers in Australia, the United Kingdom, Singapore, and North America. Of those dimensions, segmentation of arts markets by cultural differences such as ethnic identity appears to be a somewhat under researched area. Hofstede's (1980) model of national cultural differences continues to be widely used as a basis for strategic and marketing decisions in international business. However, the cultural characteristics attributed to individuals in their country of birth are likely to change through immigration to another country. In this situation, the ability to predict the consumption behaviour of various ethnic groups is complicated by acculturation processes in which arrivals attempt to adapt to their new environment. Over time, this process has resulted in the emergence of bicultural individuals who are able to switch, at will, between their ethnic identity and an identity aligned with their host country, or a combination of both at any time. Ethnic identity and affiliation with ethnic groups can also change over time, suggesting challenges for arts marketing approaches, and the application of market segmentation theory in particular.

Continuity of care and general wellbeing of patients with comorbidities requiring joint replacement

Aim. The aim of this paper is to examine the continuity of care and general wellbeing of patients with comorbidities undergoing elective total hip or knee joint replacement.
Background. Advances in medical science and improved lifestyles have reduced mortality rates in most Western countries. As a result, there is an ageing population with a concomitant growth in the number of people who are living with multiple chronic illnesses, commonly referred to as comorbidities. These patients often require acute care services, creating a blend of acute and chronic illness needs. For example, joint replacement surgery is frequently performed to improve impaired mobility associated with osteoarthritis.
Method. A purposive sample of twenty participants with multiple comorbidities who required joint replacement surgery was recruited to obtain survey, interview and medical record audit data. Data were collected during 2004 and 2005.
Findings. Comorbidity care was poorly co-ordinated prior to having surgery, during the acute care stay and following surgery and primarily entailed prescribed medicines. The main focus in acute care was patient throughput following joint replacement surgery according to a prescribed clinical pathway. General wellbeing was less than optimal: participants reported pain, fatigue, insomnia and alterations in urinary elimination as the chief sources of discomfort during the course of the study.
Conclusion. Continuity of care of comorbidities was lacking. Comorbidities affected patient general wellbeing and delayed recovery from surgery. Acute care, clinical pathways and the specialisation of medicine and nursing subordinated the general problem of patients with comorbidities. Systems designed to integrate and co-ordinate chronic illness care had limited application in the acute care setting. A multidisciplinary, holistic approach is required. Recommendations for further research conclude this paper.

Issues concerning the on-going care of patients with comorbidities in acute care and post-discharge in Australia: a literature review

Issues concerning the on-going care of patients with comorbidities in acute care and post-discharge in Australia: a literature review

Background. Advances in medical science and improved lifestyles have reduced mortality rates in Australia and most western countries. This has resulted in an ageing population with a concomitant growth in the number of people who are living with chronic illnesses. Indeed a significant number of younger people experience more than one chronic illness. Large numbers of these may require repeated admissions to hospital for acute or episodic care that is superimposed upon the needs of their chronic conditions.

Aim. To explore the issues that circumscribe the complexities of caring for people with concurrent chronic illnesses, or comorbidities, in the acute care setting and postdischarge.

Methods. A literature review to examine the issues that impact upon the provision of comprehensive care to patients with comorbidities in the acute care setting and postdischarge.

Findings. Few studies have investigated this subject. From an Australian perspective, it is evident that the structure of the current health care environment has made it difficult to meet the needs of patients with comorbidities in the acute care setting and postdischarge. This is of major concern for nurses attempting to provide comprehensive care to an increasingly prevalent group of chronically ill people.

Conclusion. Further research is necessary to explore how episodic care is integrated into the on-going management of patients with comorbidities and how nurse clinicians can better use an episode of acute illness as an opportunity to review their overall management.

A review of school drug policies and their impact on youth substance use

Youth substance use is an important social and health problem in the United States, Australia and other Western nations. Schools are recognized as important sites for prevention efforts and school substance use policies are a key component of health promotion in schools. The first part of this paper reviews the known status of school policies on tobacco, alcohol and other illicit drugs in a number of Western countries and the existing evidence for the effectiveness of school drug policy in preventing drug use. The review shows that most schools in developed countries have substance use policies but that there is substantial variation in the comprehensiveness of these policies (i.e. the breadth of people, places and times of day that are explicitly subject to policy prohibitions), and the orientation of their enforcement (e.g. punitive versus remedial), both across and within schools. The few studies of policy impact focus solely on tobacco policy and provide preliminary evidence that more comprehensive and strictly enforced school policies are associated with less smoking. The second part of the paper introduces the International Youth Development Study, a new longitudinal research project aimed at comparing school policies and the developmental course of youth drug use in the United States, where drug policies are abstinence-based, with Australia, which has adopted a harm minimization approach to drug policy

The development impact of remittances to Nicaragua

Workers' remittances represent a resource flow from rich to poor countries. The global value of remittances has risen sharply to over US$100 billion a year. This represents the second largest external income source for developing countries behind foreign direct investment (FDI), and far outstrips official development assistance (ODA) (Orozco 2003a). Remittances to developing countries are becoming increasingly important as other sources of external income decline. The impact of remittances on development, however, is inadequately reflected in the literature. Latin America and the Caribbean (LAC) is the world's largest remittance-receiving region. With 9 per cent of the world's population, the region receives approximately 32 per cent of the world's remittances. It is appreciably greater than tourist revenues in many countries, and in five countries in this region, remittances account for over 10 per cent of GNP (World Bank 2003). Within LAC, Nicaragua stands out from other countries. While the US dollar value of remittances to Nicaragua, estimated at US$610 million in 2001, is quite modest compared with the US$10 billion flowing into Mexico, for example, the relative volume of this resource compared with other income flows, and the potential for the country's development, makes Nicaragua's case exceptional. Representing almost 24 per cent of its GNP, remittances to Nicaragua have a significant social and economic impact. The value of known remittances is greater than total export earnings, on a par with the country's ODA, and almost five times that of FDI. As such, remittances currently represent the second largest single resource flow into the country. This is a recent phenomenon.

The impact of consumer ethnocentrism and country of origin sub-components for high involvement products on young Chinese consumers' product assessments

Purpose – The purpose of this paper is to examine the effect of country of origin (COO) sub-components (i.e. design, assembly and parts), as well as the extent to which consumer ethnocentrism tendencies interact with these COO sub-components for young Chinese consumers with regards to product quality assessments and purchase intentions.

Design/methodology/approach – A 2?×?2?×?2 factorial experimental design was used to examine the effects of the three sub-components of COO with two levels of sourcing location – Home (China) and Foreign (Germany), for two high involvement products (an automobile and a digital camera). Chinese students in China represented the sample of 272 respondents. MANOVA was used to examine the direct effects and interactions of the three COO components, as well as ethnocentrism, measured using the CETSCALE.

Findings – It was found that the three COO sub-components did not influence young Chinese consumers’ evaluation of product quality or purchase intentions. In addition, consumers’ level of ethnocentrism also did not have a direct effect on perceived product quality or purchase intentions. There was only one statistically significant interaction effect between ethnocentrism and country of parts for one of the two products. As such, COO dimensions and young Chinese consumers’ ethnocentrism appears to have limited influence on their assessments of product quality or purchase intentions. This may occur because young Chinese consumers perceive that hybrid products are the norm for high involvement products in China as these products are all these consumers have experienced.

Originality/value – The findings of this research dispute the commonly held belief and evidence that sub-components of COO have an impact on the perceptions of product quality and purchase intentions. Young Chinese consumers may be different to consumers from western countries because they have been extensively exposed to hybrid products. Given the size and growth potential of China, young Chinese are an important, under-researched segment within the Chinese market.