Hortonflowers4887

Continuity and timely access are hallmarks of high-quality primary care and are important considerations for urgent concerns that present both during the day and after-hours. It can be especially difficult to ensure continuity of primary care after-hours in urban settings where walk-in clinics offer patients easy and convenient access. Patients of our large, multisite primary care practice in inner-city Toronto, Canada were reporting that they were not easily able to access after-hours care from their team without having to use outside services. In partnership with patients, we combined the Model for Improvement with Experience-Based Design methodology to address the issue of poor access to after-hours care. We did a root cause analysis to isolate the causes of the local problem, using a variety of capture tools designed to incorporate the patient voice. Then, patients and providers codesigned two Plan-Do-Study-Act (PDSA) cycles aimed to increase the ease of accessing after-hours care. Key actions included a redesign of our after-hours advertisement and communication of the material in multiple formats. Following these PDSA cycles, the team saw a 26%, 23% and 17% increase in awareness of weekday evening clinics, weekend clinics and after-hours phone services, respectively, and a 16% increase in the proportion of patients reporting that it was very or somewhat easy to get care during the evening, on the weekend or on a holiday from their care team. Measures continued to improve and improvements have been sustained 3 years later. Our success highlights the effectiveness of partnering with patients to improve access to primary care. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.BACKGROUND Despite significant attention to safety and quality in healthcare over two decades, patient harm in hospitals remains a challenge. There is now growing emphasis on continuous quality improvement, with approaches that engage front-line staff. Our objective was to determine whether a novel approach to reviewing routine clinical practice through structured conversations-map-enabled experiential review-could improve engagement of front-line staff in quality improvement activities and drive improvements in indicators of patient harm. METHODS Once a week over a 10-month period, front-line staff were engaged in 35 min team-based conversations about routine practices relating to five national safety standards. Structure for the conversations was provided by interactive graphical logic maps representing each standard. Staff awareness of-and attitudes to-quality improvement, as well as their perceptions of the intervention and its impact, were canvassed through surveys. The impact of the intervention on measnd permissions. Published by BMJ.OBJECTIVES To outline which infectious diseases in the pre-covid-19 era persist in children and adolescents in China and to describe recent trends and variations by age, sex, season, and province. DESIGN National surveillance studies, 2008-17. SETTING 31 provinces in mainland China. PARTICIPANTS 4 959 790 Chinese students aged 6 to 22 years with a diagnosis of any of 44 notifiable infectious diseases. The diseases were categorised into seven groups quarantinable; vaccine preventable; gastrointestinal and enteroviral; vectorborne; zoonotic; bacterial; and sexually transmitted and bloodborne. MAIN OUTCOME MEASURES Diagnosis of, and deaths from, 44 notifiable infectious diseases. RESULTS From 2008 to 2017, 44 notifiable infectious diseases were diagnosed in 4 959 790 participants (3 045 905 males, 1 913 885 females) and there were 2532 deaths (1663 males, 869 females). The leading causes of death among infectious diseases shifted from rabies and tuberculosis to HIV/AIDS, particularly in males. Mortality from inf and 2017. Sexually transmitted diseases and bloodborne infections increased significantly, particularly from 2011 to 2017, among which HIV/AIDS increased fivefold, particularly in males. Difference was noticeable between regions, with children and adolescents in western China continuing to carry a disproportionate burden from infectious diseases. CONCLUSIONS China's success in infectious disease control in the pre-covid-19 era was notable, with deaths due to infectious diseases in children and adolescents aged 6-22 years becoming rare. Many challenges remain around reducing regional inequalities, scaling-up of vaccination, prevention of further escalation of HIV/AIDS, renewed efforts for persisting diseases, and undertaking early and effective response to highly transmissible seasonal and unpredictable diseases such as that caused by the novel SARS-CoV-2 virus. © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. read more No commercial re-use. See rights and permissions. Published by BMJ.OBJECTIVE Although national guidelines advocate for earlier diabetes screening in high-risk ethnic groups, little evidence exists to guide clinicians on the age at which screening should commence. The purpose of this study was to determine age equivalency thresholds for diabetes risk across a broad range of ethnic populations. METHODS This population-based, retrospective cohort study used linked administrative health and immigration records for 592,376 individuals in Ontario, Canada. Adjusted incidence rates by ethnicity, sex and age were used to derive ethnic-specific age thresholds for risk. RESULTS Diabetes incidence rates in South Asians reached an equivalent risk as that experienced by a 40-year-old Western European man (3.7 per 1,000 person-years) by 25 years of age. For all other non-European ethnic groups, the equivalent risk was experienced between 30 and 35 years of age. These risk differentials persisted despite controlling for covariates. CONCLUSIONS We found a 15-year difference in age equivalency of risk across ethnic groups. Diabetic foot ulcers (DFUs) incidence is increasing with the rising global prevalence of diabetes. In spite of following best practice standard of care, most DFUs are slow to heal. Photobiomodulation (PBM), previously known as low-level laser therapy, has been shown to accelerate healing of acute or chronic wounds, and specifically DFUs. However, the frequent applications required translates to frequent visits at the clinic, which are difficult for patients with DFU. In the following case series, we present our preliminary experience with a recently approved (Health Canada) consumer home-use PBM device as an adjuvant to standard treatment. Four men presented at the clinic (67 to 84 years of age) with DFUs/diabetic leg ulcers. The PBM treatment (808 nm, 250-mW peak power, 15 KHz, 5 J/min, ray size 4.5×1.0 cm2) was applied by the patients themselves at the clinic or at home. In the cases presented, all wounds closed within 1 to 3 weeks with no reported adverse events. Patients found the routine easy to follow and painless.