BACKGROUND: People experiencing homelessness often encounter progressive incurable somatic diseases in combination with psychiatric and psychosocial problems, and many need palliative care at the end of their lives. Little is known about how palliative care for this group can be started in good time and provided optimally. The objective of this paper is to give insight into the extent people experiencing homelessness have access to good palliative care.
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The realization of human rights standards depends in part on the commitment of local actors. It can be argued that local public service professionals such as social workers can also be regarded as key players. The possible role of social workers becomes imperative if these professionals are working in a policy context that is not congruent with human rights. If existing laws or policies cause or maintain disrespect for human rights, social workers are in a position to observe that this is having an adverse impact on clients. When social workers are regarded as human rights actors, the question arises how they can or should respond to law and policy that impedes them in carrying out their work with respect for human rights. This article adds to existing theories on social workers as human rights actors by examining the practices of social professionals working in such a challenging policy context. The research took place among professionals in social district teams in the city of Utrecht, the Netherlands. Following a series of decentralizations and austerity measures the social care landscape in the Netherlands has changed drastically over the last few years. As a result, social workers may find themselves on the one hand trying to realize the best possible care for their clients while on the other hand dealing with new laws and policy expectations focused on self-reliance and diminished access to specialist care. The article explores how social professionals’ responses to barriers in access to care affect human rights requirements. In doing so, this socio-legal study provides insight into the ways in which everyday social work relates to the realization of human rights at the local level.
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1 Maternity services across Europe during the pandemic has undergone changes to limit virus transmission; however, many changes are not evidence-based. 2 Although these changes were introduced to keep women, babies and healthcare staff safe, the exclusion of companions and the separation of mothers and babies is particularly antithetical to a human rights-based approach to quality care. 3 A poll of COST Action 18211 network members showed that inconsistency in the application of restrictions was high, and there were significant deviations from the recommendations of authoritative bodies. 4 Concerns have emerged that restrictions in practice may have longer term negative impacts on mothers and their families and, in particular, may impact on the long-term health of babies. 5 When practice changes deviate from evidence-based frameworks that underpin quality care, they must be monitored, appraised and evaluated to minimise unintended iatrogenic effects.
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Objectives: Direct access is a term that describes the ability of patients to seek healthcare from midlevel dental providers (MLDPs) without first seeing a dentist. Theobjective of this study was to synthesize the evidence for the effects and costs ofdirect access to MLDPs in a primary dental care environment and assess the attitudesof various stakeholders to this method of care delivery.Methods:The literature was examined for descriptive, observational, and experi-mental study designs to examine the evidence for direct access in dentistry. Elec-tronic searches were undertaken of the Database of Abstracts of Reviews ofEffectiveness, bibliographic subscription databases, open access databases, and thegray literature.Results:The search identified 371 records, although the extent of experimental evi-dence was limited. The majority of included studies were descriptive and recordedthe subjective views of different stakeholders, following the introduction of thepolicy.Conclusions:The limited extent of experimental evidence regarding direct access toMLDPs contrasts with their widespread use across Europe, the United States, andthe southern hemisphere. Suggestions are made for a research program to improvethe evidence base for direct access
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It is quite concerning that in a wealthy country, famous for having one of the most equitable health-care systems in the world with free access to care services for everyone, such an unmet need and such sex and socioeconomic inequities are found. Given England's health-care system, we wonder what the situation is like in other countries—and fear that it is probably not any better. Taking the WHO and UNICEF global report into consideration, it would be necessary to develop international guidelines for assistive technology provision, as proposed by Layton and colleagues.4 Such guidelines could have an important role in ensuring high-quality and equitable assistive technology provision across countries.
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Intravenous vascular access (VA) is essential in neonatal intensive care units (NICUs). Short peripheral intravenous catheters (PIVCs) are the most frequently used short-term device.1 Many unmodifiable and potentially modifiable factors affect the incidence of complications, contributing to the success or failure of therapy.2 Numerous interventions such as evidence-based care bundles, innovations in device design and manufacturer are targeted at reducing the incidence and severity of complications.3 Internationally, specialist multiprofessional teams for central venous access are widely established4 but evidence about the impacts of teams for managing peripheral intravenous access is less evident.
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When it comes to hard to solve problems, the significance of situational knowledge construction and network coordination must not be underrated. Professional deliberation is directed toward understanding, acting and analysis. We need smart and flexible ways to direct systems information from practice to network reflection, and to guide results from network consultation to practice. This article presents a case study proposal, as follow-up to a recent dissertation about online simulation gaming for youth care network exchange (Van Haaster, 2014).
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A case study and method development research of online simulation gaming to enhance youth care knowlegde exchange. Youth care professionals affirm that the application used has enough relevance as an additional tool for knowledge construction about complex cases. They state that the usability of the application is suitable, however some remarks are given to adapt the virtual environment to the special needs of youth care knowledge exchange. The method of online simulation gaming appears to be useful to improve network competences and to explore the hidden professional capacities of the participant as to the construction of situational cognition, discourse participation and the accountability of intervention choices.
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This study investigates patients' access to surgical care for burns in a low- and middle-income setting by studying timeliness, surgical capacity, and affordability. A survey was conducted in a regional referral hospital in Manyara, Tanzania. In total, 67 patients were included. To obtain information on burn victims in need of surgical care, irrespective of time lapsed from the burn injury, both patients with burn wounds and patients with contractures were included. Information provided by patients and/or caregivers was supplemented with data from patient files and interviews with hospital administration and physicians. In the burn wound group, 50% reached a facility within 24 hours after the injury. Referrals from other health facilities to the regional referral hospital were made within 3 weeks for 74% in this group. Of contracture patients, 74% had sought healthcare after the acute burn injury. Of the same group, only 4% had been treated with skin grafts beforehand, and 70% never received surgical care or a referral. Together, both groups indicated that lack of trust, surgical capacity, and referral timeliness were important factors negatively affecting patient access to surgical care. Accounting for hospital fees indicated patients routinely exceeded the catastrophic expenditure threshold. It was determined that healthcare for burn victims is without financial risk protection. We recommend strengthening burn care and reconstructive surgical programs in similar settings, using a more comprehensive health systems approach to identify and address both medical and socioeconomic factors that determine patient mortality and disability.
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Background: The substitution of healthcare is a way to control rising healthcare costs. The Primary Care Plus (PC+) intervention of the Dutch ‘Blue Care’ pioneer site aims to achieve this feat by facilitating consultations with medical specialists in the primary care setting. One of the specialties involved is dermatology. This study explores referral decisions following dermatology care in PC+ and the influence of predictive patient and consultation characteristics on this decision. Methods: This retrospective study used clinical data of patients who received dermatology care in PC+ between January 2015 and March 2017. The referral decision following PC+, (i.e., referral back to the general practitioner (GP) or referral to outpatient hospital care) was the primary outcome. Stepwise logistic regression modelling was used to describe variations in the referral decisions following PC+, with patient age and gender, number of PC+ consultations, patient diagnosis and treatment specialist as the predicting factors. Results: A total of 2952 patients visited PC+ for dermatology care. Of those patients with a registered referral, 80.2% (N = 2254) were referred back to the GP, and 19.8% (N = 558) were referred to outpatient hospital care. In the multivariable model, only the treating specialist and patient’s diagnosis independently influenced the referral decisions following PC+. Conclusion: The aim of PC+ is to reduce the number of referrals to outpatient hospital care. According to the results, the treating specialist and patient diagnosis influence referral decisions. Therefore, the results of this study can be used to discuss and improve specialist and patient profiles for PC+ to further optimise the effectiveness of the initiative.
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