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AJNR. American Journal of Neuroradiology Jul 2018Timely administration of thrombolytic therapy is critical to maximizing the likelihood of favorable outcomes in patients with acute ischemic stroke. Although emergency...
Timely administration of thrombolytic therapy is critical to maximizing the likelihood of favorable outcomes in patients with acute ischemic stroke. Although emergency medical service activation overall improves the timeliness of acute stroke treatment, the time from emergency medical service dispatch to hospital arrival unavoidably decreases the timeliness of thrombolytic administration. Our mobile stroke unit, a new-generation ambulance with on-board CT scanning capability, reduces key imaging time metrics and facilitates in-the-field delivery of IV thrombolytic therapy.
Topics: Aged; Female; Humans; Male; Mobile Health Units; Stroke; Thrombolytic Therapy; Time-to-Treatment; Tomography, X-Ray Computed
PubMed: 29773569
DOI: 10.3174/ajnr.A5673 -
Rural and Remote Health 2011The majority of Malawians are impoverished and primarily dependant on subsistence farming, with 85% of the population living in a rural area. The country is highly...
CONTEXT
The majority of Malawians are impoverished and primarily dependant on subsistence farming, with 85% of the population living in a rural area. The country is highly affected by HIV and under-resourced rural health centers struggle to meet the government's goal of expanding HIV testing, antiretroviral treatment, and other basic services.
ISSUE
This report describes the work of two four-wheel drive mobile clinics launched in 2008 to fill an identified service gap in the remote areas of Mulanje District, Malawi. The program was developed by an international non-governmental organization, Global AIDS Interfaith Alliance (GAIA), and the Mulanje District Health Office, with funding from the Elizabeth Taylor HIV/AIDS Foundation. The clinics provide: (1) rapid HIV testing and treatment referral; (2) diagnosis and treatment of malaria; (3) sputum collection for TB screening; (4) diagnosis and treatment of sexually transmitted and opportunistic infections; and (5) pre-natal care. The clinic vehicles provide medical supplies and personnel (a clinical officer, nurse, and nurse aide) to set up clinics in community buildings such as churches or schools.
LESSONS LEARNED
In such a project, the implementation process and schedule can be affected by medication, supply chain and infrastructural issues, as well as governmental and non-governmental requirements. Timelines should be sufficiently flexible to accommodate unexpected delays. Once established, service scheduling should be flexible and responsive; for instance, malaria treatment rather than HIV testing was most urgently needed in the season when these services were launched. Assessing the impact of healthcare delivery in Malawi is challenging. Although mobile clinic and the government Health Management Information System (HMIS) data were matched, inconsistent variables and gaps in data made direct comparisons difficult. Data collection was compromised by the competing demand of high patient volume; however, rather than reducing the burden on existing health centers, the data suggest that the mobile clinics provided services for people who otherwise may not have attended a health center. The GAIA mobile clinics were integrated into a catchment area through a community participation model, allowing point-of-care primary health services to be provided to thousands of people in remote rural villagers. Strong relationships have been forged with local community leaders and with Malawi Ministry of Health officers as the foundation for long-term sustainable engagement and eventual integration of services into Health Ministry programs.
Topics: Adult; Child; Child, Preschool; Data Collection; Delivery of Health Care; Female; HIV; HIV Infections; Health Education; Humans; Malawi; Male; Mobile Health Units; Pregnancy; Prenatal Care; Rural Health Services; Rural Population
PubMed: 21787108
DOI: No ID Found -
PloS One 2024Uganda has a high demand for neurosurgical and neurological care. 78% of the over 50 million population reside in rural and remote communities where access to...
INTRODUCTION
Uganda has a high demand for neurosurgical and neurological care. 78% of the over 50 million population reside in rural and remote communities where access to neurosurgical and neurological services is lacking. This study aimed to determine the feasibility, appropriateness, and usability of mobile neuro clinics (MNCs) in providing neurological care to rural and remote Ugandan populations.
METHODS
Neurosurgery, neurology, and mobile health clinic providers participated in an education and interview session to assess the feasibility, appropriateness, and usability of the MNC intervention. A qualitative analysis of the interview responses using the constructs in the updated Consolidated Framework for Implementation Research was performed. Providers' opinions were weighted using average sentiment scores on a novel sentiment-weighted scale adapted from the CFIR. A stakeholder analysis was also performed to assess the power and interest of the actors described by the participants.
RESULTS
Twenty-one healthcare providers completed the study. Participants discussed the potential benefits and concerns of MNCs as well as potential barriers and critical incidents that could jeopardize the intervention. Of the five CFIR domains evaluated, variables in the implementation process domain showed the highest average sentiment scores, followed by the implementation climate constructs, inner setting, innovation, and outer setting domains. Furthermore, many interested stakeholders were identified with diverse roles and responsibilities for implementing MNCs. These findings demonstrate that MNC innovation is feasible, appropriate, and usable.
CONCLUSION
The findings of this study support the feasibility, appropriateness, and usability of MNCs in Uganda. However, integration of this innovation requires careful planning and stakeholder engagement at all levels to ensure the best possible outcomes.
Topics: Humans; Uganda; Feasibility Studies; Mobile Health Units; Female; Male; Health Personnel; Neurosurgery; Neurology; Adult; Rural Population; Health Services Needs and Demand; Health Services Accessibility; Neurosurgical Procedures
PubMed: 38913633
DOI: 10.1371/journal.pone.0305382 -
Translational Behavioral Medicine Mar 2021This position statement provides researchers, practitioners, and policymakers an overview of pre-existing and COVID-related rural health inequities in the United States...
This position statement provides researchers, practitioners, and policymakers an overview of pre-existing and COVID-related rural health inequities in the United States (U.S.) and how they have been exacerbated by the COVID-19 pandemic. "Health deserts," defined as "large areas with inadequate or nonexistent medical and trauma facilities," are common in rural regions of the U.S. While telehealth could address some of these health-related inequities, significant gaps in broadband Internet availability are also common in these more remote areas. The Society of Behavioral Medicine urges Congress to authorize increased funding to rural healthcare facilities and staffing, along with the development of enhanced broadband Internet infrastructure. In addition, incentivizing rural healthcare systems to deliver value-based care could enhance their capacity to implement population health and behavioral health strategies. To stem the spread of COVID-19 in higher-risk rural-based industries (e.g., food processing plants), SBM urges Congress to require the Occupational Safety and Health Administration (OSHA) to routinely inspect for and enforce COVID-19 mitigation procedures, such as provision of effective Personal Protective Equipment (PPE) to all front-line workers and consistent implementation of standardized testing and social distancing advisories. The context of rural communities underscores the importance of tailored approaches to mitigate rural health inequities and promote the well-being of rural residents.
Topics: Behavioral Medicine; COVID-19; Health Policy; Healthcare Disparities; Humans; Mobile Health Units; Pandemics; Rural Health; Rural Population; SARS-CoV-2; Societies, Medical; Telemedicine; United States
PubMed: 33289790
DOI: 10.1093/tbm/ibaa114 -
Stroke Mar 2020Background and Purpose- Mobile stroke units (MSUs) are increasingly used worldwide to provide prehospital triage and treatment. The benefits of MSUs in giving earlier... (Comparative Study)
Comparative Study
Background and Purpose- Mobile stroke units (MSUs) are increasingly used worldwide to provide prehospital triage and treatment. The benefits of MSUs in giving earlier thrombolysis have been well established, but the impacts of MSUs on endovascular thrombectomy (EVT) and effect on disability avoidance are largely unknown. We aimed to determine the clinical impact and disability reduction for reperfusion therapies in the first operational year of the Melbourne MSU. Methods- Treatment time metrics for MSU patients receiving reperfusion therapy were compared with control patients presenting to metropolitan Melbourne stroke units via standard ambulance within MSU operating hours. The primary outcome was median time difference in first ambulance dispatch to treatment modeled using quantile regression analysis. Time savings were subsequently converted to disability-adjusted life years avoided using published estimates. Results- In the first 365-day operation of the Melbourne MSU, prehospital thrombolysis was administered to 100 patients (mean age, 73.8 years; 62% men). The median time savings per MSU patient, compared with the control cohort, was 26 minutes (<0.001) for dispatch to hospital arrival and 15 minutes (<0.001) for hospital arrival to thrombolysis. The calculated overall time saving from dispatch to thrombolysis was 42.5 minutes (95% CI, 36.0-49.0). In the same period, 41 MSU patients received EVT (mean age, 76 years; 61% men) with median dispatch-to-treatment time saving of 51 minutes ([95% CI, 30.1-71.9], <0.001). This included a median time saving of 17 minutes ([95% CI, 7.6-26.4], =0.001) for EVT hospital arrival to arterial puncture for MSU patients. Estimated median disability-adjusted life years saved through earlier provision of reperfusion therapies were 20.9 for thrombolysis and 24.6 for EVT. Conclusions- The Melbourne MSU substantially reduced time to reperfusion therapies, with the greatest estimated disability avoidance driven by the more powerful impact of earlier EVT. These findings highlight the benefits of prehospital notification and direct triage to EVT centers with facilitated workflow on arrival by the MSU.
Topics: Aged; Aged, 80 and over; Ambulances; Computed Tomography Angiography; Emergency Medical Services; Female; Humans; Male; Middle Aged; Mobile Health Units; Reperfusion; Stroke; Thrombectomy; Thrombolytic Therapy; Time Factors; Victoria
PubMed: 32078483
DOI: 10.1161/STROKEAHA.119.027843 -
Lancet (London, England) Apr 2020Fangcang shelter hospitals are a novel public health concept. They were implemented for the first time in China in February, 2020, to tackle the coronavirus disease 2019... (Review)
Review
Fangcang shelter hospitals are a novel public health concept. They were implemented for the first time in China in February, 2020, to tackle the coronavirus disease 2019 (COVID-19) outbreak. The Fangcang shelter hospitals in China were large-scale, temporary hospitals, rapidly built by converting existing public venues, such as stadiums and exhibition centres, into health-care facilities. They served to isolate patients with mild to moderate COVID-19 from their families and communities, while providing medical care, disease monitoring, food, shelter, and social activities. We document the development of Fangcang shelter hospitals during the COVID-19 outbreak in China and explain their three key characteristics (rapid construction, massive scale, and low cost) and five essential functions (isolation, triage, basic medical care, frequent monitoring and rapid referral, and essential living and social engagement). Fangcang shelter hospitals could be powerful components of national responses to the COVID-19 pandemic, as well as future epidemics and public health emergencies.
Topics: Betacoronavirus; COVID-19; China; Coronavirus Infections; Cost Control; Disease Outbreaks; Emergencies; Facility Design and Construction; Hospitals, Special; Humans; Infection Control; Mobile Health Units; Pandemics; Patient Isolation; Pneumonia, Viral; SARS-CoV-2
PubMed: 32247320
DOI: 10.1016/S0140-6736(20)30744-3 -
International Journal For Equity in... Nov 2017There are approximately 2000 mobile health clinics operating in the United States. While researchers have established that mobile health clinics can be cost effective...
BACKGROUND
There are approximately 2000 mobile health clinics operating in the United States. While researchers have established that mobile health clinics can be cost effective and improve outcomes, there is scant research examining the healthcare experience on a mobile health clinic from patients' perspectives.
METHODS
Data were gathered from interviews with 25 clients receiving care on a Boston-based mobile health clinic and analyzed using grounded theory methodology.
RESULTS
Emerging patterns in the data revealed three relational and three structural factors most significant to participants' experience of care on The Family Van. Relational factors include providers who 1) Communicate understandably, 2) Create a culture of respect and inclusivity, and 3) Are diverse with knowledge of the community. Structural factors include 1) A focus on preventative health and managing chronic disease, 2) Expeditious, free, and multiple services, and 3) Location.
CONCLUSIONS
The participant accounts in this report serve to expand on prior research exploring mobile health clinics' role in patients' healthcare, to more clearly define the most salient aspects of the mobile health clinic model for the patients they serve, and to give voice to patients too seldom heard in the academic literature.
Topics: Aged; Ambulatory Care; Attitude to Health; Boston; Cultural Diversity; Female; Humans; Male; Middle Aged; Mobile Health Units; Patients; Physician-Patient Relations; Preventive Health Services; Qualitative Research
PubMed: 29100517
DOI: 10.1186/s12939-017-0688-6 -
The American Journal of Medicine Oct 2020
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Delivery of Health Care; Gulf War; History, 20th Century; History, 21st Century; Hospitals; Hospitals, Military; Humans; Influenza, Human; Iraq War, 2003-2011; Korean War; Military Medicine; Mobile Health Units; Pandemics; Pneumonia, Viral; SARS-CoV-2; United States; Vietnam Conflict; World War II
PubMed: 32442513
DOI: 10.1016/j.amjmed.2020.04.022 -
European Review For Medical and... Apr 2021Demographic changes in the Western world linked to the increase in the elderly population, life expectancy and above all cancer patients and chronically ill patients,...
Demographic changes in the Western world linked to the increase in the elderly population, life expectancy and above all cancer patients and chronically ill patients, often entrusted to home care or in healthcare residences, highlight an exponential increase in requests for diagnostic tests at home. Conventional radiographic examinations, such as thoracic, musculoskeletal and abdominal images are the most requested and are important first level diagnostic tests. To date and, in particular, in times of COVID-19 emergency, these patients need to be transferred to the hospital to perform radiological examinations which involve an increase in costs for the health system and an increased risk for the health of these patients, already often debilitated and immunocompromised. This article discussed the benefits of taking conventional chest x-rays directly at the patient's home.
Topics: COVID-19; Delivery of Health Care; Home Care Services; Humans; Mobile Health Units; Radiography; SARS-CoV-2
PubMed: 33928621
DOI: 10.26355/eurrev_202104_25745 -
Journal of the American College of... Jan 2018Mobile mammographic services have been proposed as a way to reduce Latinas' disproportionate late-stage presentation compared with white women by increasing their access... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
Mobile mammographic services have been proposed as a way to reduce Latinas' disproportionate late-stage presentation compared with white women by increasing their access to mammography. The aims of this study were to assess why Latinas may not use mobile mammographic services and to explore their preferences after using these services.
METHODS
Using a mixed-methods approach, a secondary analysis was conducted of baseline survey data (n = 538) from a randomized controlled trial to improve screening mammography rates among Latinas in Washington. Descriptive statistics and bivariate regression were used to characterize mammography location preferences and to test for associations with sociodemographic indices, health care access, and perceived breast cancer risk and beliefs. On the basis of these findings, a qualitative study (n = 18) was used to explore changes in perceptions after using mobile mammographic services.
RESULTS
More Latinas preferred obtaining a mammogram at a fixed facility (52.3% [n = 276]) compared with having no preference (46.3% [n = 249]) and preferring mobile mammographic services (1.7% [n = 9]). Concerns about privacy and comfort (15.6% [n = 84]) and about general quality (10.6% [n = 57]) were common reasons for preferring a fixed facility. Those with no history of mammography preferred a fixed facility (P < .05). In the qualitative study, Latinas expressed similar initial concerns but became positive toward the mobile mammographic services after obtaining a mammogram.
CONCLUSIONS
Although most Latinas preferred obtaining a mammogram at a fixed facility, positive experiences with mobile mammography services changed their attitudes toward them. These findings highlight the need to include community education when using mobile mammographic service to increase screening mammography rates in underserved communities.
Topics: Adult; Aged; Breast Neoplasms; Early Detection of Cancer; Female; Hispanic or Latino; Humans; Mammography; Middle Aged; Mobile Health Units; Patient Preference; Washington
PubMed: 29055611
DOI: 10.1016/j.jacr.2017.08.030