Canadian Journal of Health Technologies最新文献

{"title":"Emergency Department Overcrowding: An Environmental Scan of Contributing Factors and a Summary of Systematic Review Evidence on Interventions","authors":"Robyn Haas, Francesca Brundisini, Angela Barbara, Nazia Darvesh, Lindsay Ritchie, Danielle MacDougall, Carolyn Spry, Jeff Mason, Justin Hall, Warren Ma, Ivy Cheng","doi":"10.51731/cjht.2023.786","DOIUrl":"https://doi.org/10.51731/cjht.2023.786","url":null,"abstract":"Emergency department (ED) overcrowding occurs when the demand for health services in the ED exceeds the capacity of the ED, hospital, or community to deliver quality care in a reasonable amount of time. Overcrowding is worsening in jurisdictions across Canada and there is a need to address its many causes and identify potential solutions. This report uses a modified version of a conceptual model developed by Asplin et al. (2003) that organizes the emergency care system into 3 interdependent parts: input (arrival to the ED), throughput (flowing through the ED), and output (leaving the ED). We also examined an additional fourth part related to contextual factors and systems that affect overcrowding but lay outside of input, throughout, and output. Examples of factors include, but are not limited to, increased complexity of needs (input), diagnostic testing and procedures (throughput), boarding (output), and limited resources for mental health and substance use (outside the ED). Examples of interventions that were effective in some settings include, but are not limited to, prehospital decision-making by first responders, which reduced ED visits (input); short stay crisis units for people experiencing mental health challenges, which improved emergency department length of stay, wait times, boarding, and patient safety (throughput); ED-based discharge planning, which reduced ED return visits (output); and time-based policy reforms, which reduced ED length of stay (outside the ED). Most of the factors we identified in the published literature existed either outside of the ED or at the interface of the ED and other health care services (input and output), whereas most of the interventions we identified existed within the ED (throughput). We heard from participants (during multistakeholder dialogue sessions) and content experts that ED overcrowding is a complex health system issue for which the causes, impacts, and solutions extend beyond the ED. Specifically, the novel insights we heard included: ED overcrowding is better viewed as a problem of hospital overcrowding and strained resources in the broader social and health care systems. Contributing factors both within and outside the ED influence and interact with each other and are affected by economic, cultural, and institutional realities. Solving the issue requires addressing accountability and implementing multifaceted solutions in which several systems and voices work collaboratively. Existing technologies and data use and collection are not being used to their full potential; they can be better leveraged to alleviate this issue. In the identified literature, there was a lack of explicit reporting around equity and ethical considerations for factors contributing to, and interventions to alleviate, ED overcrowding. Future work should strive to deliberately and explicitly include ethical considerations inherent in research, planning, and policy-making; considerations of equity-de","PeriodicalId":505661,"journal":{"name":"Canadian Journal of Health Technologies","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139259285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient and Care Provider Perspectives on the Management of Fecal Incontinence: A Qualitative Rapid Review","authors":"Umair Majid, Carolyn Spry","doi":"10.51731/cjht.2023.783","DOIUrl":"https://doi.org/10.51731/cjht.2023.783","url":null,"abstract":"This rapid qualitative review included 13 studies aimed at collating evidence on the experiences and perspectives of people with fecal incontinence (FI) and their care providers on their care and management, with a particular focus on sacral nerve stimulation (SNS). Only 1 study focused on the perspectives and experiences of people living with FI specific to SNS. Living with FI is an emotionally taxing experience, deeply affecting individuals' self-perception and daily activities. The symptoms vary, with some facing constant and others occasional leakage episodes, making daily life unpredictable and challenging. Emotional responses included anger, frustration, and despair, with some attributing FI to aging or genetics, while others were in denial. The societal stigma around FI, reinforced by popular culture, led to self-blame and isolation. The unpredictability of FI symptoms altered the daily lives and routines of those affected, making home a refuge. People with FI reported reduced participation in various activities, from travelling to physical exercises, and even affected intimacy for some. Yet, the experiences varied, with some feeling minimal impact on their relationships. For some, however, worsening symptoms made them dependent on others, especially when combined with other health issues. Additionally, FI led to other physical symptoms like urinary tract infections and sore skin. FI is a challenging condition that necessitates practical and emotional coping strategies. Individuals with FI employed self-initiated lifestyle modifications, including dietary changes, pharmaceutical and practical measures to manage their symptoms, and treatments assessed and managed by a continence specialist or clinic, including provider-guided or surgical options. Diet was crucial for FI management, with individuals self-identifying and avoiding specific trigger foods, adjusting meal sizes and timings, or preparing their own meals to control ingredients. Lifestyle strategies included frequent toilet visits, using protective wear like diapers and maintaining genital hygiene. People with FI reported high acceptability and satisfaction with surgical treatments like sacral nerve stimulation (SNS) and percutaneous tibial nerve stimulation (PTNS). Benefits included, symptom relief, improved ability to defer defecation, heightened self-confidence, and better hygiene. They also reported disruptions to daily life, concerns of postoperative recovery after receiving SNS or PTNS, and side effects after PTNS. Providers’ recommendations around non-invasive treatments included increasing fibre intake, pelvic floor exercises, and maintaining a food diary to identify triggers. They also advocated for laxatives, antidiarrheal medications, enemas, and biofeedback, believing that most individuals with FI can benefit from these interventions. No studies discussed providers’ perspective on surgical treatments for FI. The urgency to seek care grew as FI symptoms intensified and","PeriodicalId":505661,"journal":{"name":"Canadian Journal of Health Technologies","volume":"76 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139270288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}