In this review, we discuss considerations and successful models for providing decentralized diagnosis, treatment, and prevention services for children and adolescents. Key approaches to building decentralized capacity for childhood TB diagnosis in primary care facilities include provider training and increased access to child-focused diagnostic tools and techniques. Treatment of TB disease should be managed close to where patients live; pediatric formulations of both first-and second-line drugs should be widely available; and any hospitalization should be for as brief a period as medically indicated. TB preventive treatment for child and adolescent contacts must be greatly expanded, which will require home visits to identify contacts, building capacity to rule out TB, and adoption of shorter preventive regimens. Decentralization of TB services should involve the private sector, with collaborations outside the TB program in order to reach children and adolescents where they first enter the health care system. The impact of decentralization will be maximized if programs are family-centered and designed around responding to the needs of children and adolescents affected by TB, as well as their families. / Revisión por pares

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Most physical rehabilitation services are not person-centered. Occupational therapy practitioners (OTPs) are vested in person-centered approaches, thereby they are optimally positioned to take leading roles in these quality improvement (QI) activities. Yet, there is a lack of OTPs-led QI activities on person-centered rehabilitation, and seminally, a lack of a QI guide informing these activities. To shape the evidence- and theory-based QI guide, we engaged a small international sample (n= 8) of potential end-users, i.e., OTPs in practice or management roles. The process involved three rounds of mixed-methods surveys, which helped in the design, refinement, and preliminary evaluation of the QI guide. Informed by theory, evidence and participants’ feedback, the final guide followed a “why, what, and how” structure. Six out of the eight participants rated the QI guide as one they are “very likely” to use. Also, the median rated value of the guide was “9” in a “0-10” scale. The QI was also well appraised by being an all-in-one resource to enable OTPs close the gap in person-centered rehabilitation practices and its improvement. The final version of the QI guide is ready to use and freely available in the Open Science Framework platform: http://osf.io/xzgpe/.

Bakgrund: Ett personcentrerat arbetssätt är en grund inom arbetsterapeutiska verksamheter, där varje person har ett unikt utgångsläge inom sina sociodemografiska faktorer och personliga preferenser, vilket kan påverka personers utförande av aktiviteter och delaktighet i det vardagliga livet. Syfte: Att granska och sammanställa hur personer som har deltagit i arbetsterapeutiska interventioner samt arbetsterapeuter upplever ett personcentrerat arbetssätt, för att få förståelse för svårigheter och möjligheter med detta arbetssätt. Metod: En kvalitativ litteraturöversikt av tidigare forskning. Resultat: Resultatet presenteras under rubrikerna och underrubrikerna: Hur personer som har deltagit i arbetsterapeutiska interventioner upplever ett personcentrerat arbetssätt; Svårigheter och möjligheter i samarbetet, Arbetsterapeuters upplevelser av ett personcentrerat arbetssätt; Svårigheter och möjligheter i samarbetet samt:Organisatoriska svårigheter och möjligheter med ett personcentrerat arbetssätt. Slutsats: En ökad förståelse för begreppet personcentrering behövs genom ytterligare studier, detta skulle bidra till mer kunskap om begreppets innebörd och hur det bör implementeras i svenska arbetsterapeutiska verksamheter. / Background: A person-centered approach is a foundation in occupational therapy activities, where each person has a unique starting point within their sociodemographic factors and personal preferences, which can affect people's performance of activities and participation in everyday life. Aim: To examine and compile how people who have participated in occupational therapy interventions and occupational therapists experience a person-centered approach, to gain an understanding of difficulties and opportunities with this approach. Method: A qualitative literature review of previous research. Results: The result are presented under the headings and subheadings: How people who have participated in occupational therapy interventions experience a person-centered approach; Difficulties and opportunities in the collaboration, Occupational therapists' experiences of a person-centered approach; Difficulties and opportunities in the collaboration and: Organizational difficulties and opportunities with a person-centered approach. Conclusion: An increased understanding of the concept of a person-centered approach is needed through further studies, this would contribute to more knowledge about the meaning of the concept and how it should be implemented in Swedish occupational therapy.

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Background & Purpose: Sustaining an acquired brain injury (ABI) can often lead to admission to an inpatient rehabilitation program. The purpose of inpatient rehabilitation is to provide individualized, patient-centered therapy in order to facilitate community re-integration. Considering the patient perspective is beneficial for informing patient-centered care because clinicians and program administrators may develop greater awareness and understanding of patient needs and preferences. There is a lack of qualitative research investigating patient experiences and perspectives of ABI inpatient rehabilitation, and the majority of existing research was conducted in non-Canadian contexts. The present study was thus designed to describe and interpret patient experiences of an ABI inpatient rehabilitation program in urban Ontario. The purpose was to contribute to a patient lens that inpatient rehabilitation staff could consider in their work. Methods: An interpretive description approach was adopted for this qualitative study. Twelve participants were purposively sampled from a regional ABI rehabilitation program. They completed semi-structured interviews about their experiences. Interviews were transcribed, coded, and analyzed to identify major themes. Results: Three major themes were identified from the analysis and arranged around three time points. At the time point prior to admission to inpatient rehabilitation, the theme was “Life Rerouted,” where participants described their lives being diverted from what was “normal” after sustaining an ABI. Inpatient rehabilitation was seen as a way to return to their pre-injury life. The second theme described experiences within inpatient rehabilitation and was entitled, “Autonomy within Rehab.” Under this theme, participants emphasized the importance of personal autonomy over their choices and abilities while in rehabilitation, with three related sub-themes: interactions with clinicians, perceptions of institutional policy, and the involvement of family members. Under a minor theme, not directly related to aspects of autonomy, entitled “social comparisons,” participants also made comparisons of their recovery progress to other patients. The third and final theme reflected participants experiences just after discharge and was entitled, “Life (and Recovery) Go On.” Under this theme, participants described an ongoing recovery process leading to sentiments of both frustration and hope for the future. Discussion: An overarching key message was developed from these themes: “re-establishing personal identity is important to the recovery process.” Two theories (biographical disruption and relational autonomy) are used to interpret this message and describe the strategies and perspectives adopted by patients during inpatient rehabilitation as they attempted to cope with the psychosocial impacts of ABI on their lives. Conclusions: The findings of this study provide knowledge and a theoretical lens in which program staff can view and understand patients’ experiences, needs and preferences. These findings may enhance patient-centered care within the context of ABI inpatient rehabilitation. / Thesis / Master of Science (MSc)

Family-Centered Care has been recognized as the best current model for delivering care to all patients, particularly pediatric patients and their families. Although the concepts of family-centered care are accepted in theory, studies show barriers in implementing the model in clinical practice. The major problems reported during pediatric hospitalizations include lack of communication, lack of information and guidance, lack of clearly defined roles and expectations, lack of support for parents' psychosocial needs, disregard for parents' prior experience and concerns, stereotyping of parents by nurses, unfair expectations placed on parents, and the use of parents as unpaid caregivers. This thesis provides a comprehensive review of research literature regarding the barriers associated with implementing family-centered care. Studies included perspectives of parents, nurses, and health care professionals and the themes identified were used to make recommendations for clinical practice, nursing education, and future research

Yes / The notion of person-centered care has been important in investigating relationships between people with dementia and paid carers, and measures are available to assess this. It has been suggested that person-centered care may be a useful construct to apply to understand family-care relationships. However, no measures of person-centered care in this context exist. The study aimed to develop an observational measure of person-centered care for this purpose. Method: First, a coding system incorporating a range of behaviors that could be considered person-centered or non-person-centered was constructed. Examples included a code relating to whether the person with dementia was involved in planning a task, and a code relating to how the spouse responded to confusion/distress. Second, 11 couples, where one partner had a dementia, were recruited and videotaped cooperating on an everyday task. The system was applied to the care-giving spouse's behaviors, labeling examples of behavior as person-centered or non-person-centered. The final step involved assessing the inter-rater reliability of the system. Results: The system captured nine categories of behavior, which were each divided into person-centered and non-person-centered types. The system had good reliability (Cohen's κ coefficients were: 0.65 for category and whether behaviors needed to be placed in a category; 0.81 for category excluding the decision about whether behaviors needed to be placed in a category; and 0.79 in relation to whether behaviors were person-centered or non-person-centered.) Conclusions: Although the small sample size limits the implications of the results, the system is a promising quantitative measure of spousal person-centered care.