Jonathan Cinnamon

A method to determine spatial access to specialized palliative care services using GIS

BackgroundProviding palliative care is a growing priority for health service administrators worldwide as the populations of many nations continue to age rapidly. In many countries, palliative care services are presently inadequate and this problem will be exacerbated in the coming years. The provision of palliative care, moreover, has been piecemeal in many jurisdictions and there is little distinction made at present between levels of service provision. There is a pressing need to determine which populations do not enjoy access to specialized palliative care services in particular.MethodsCatchments around existing specialized palliative care services in the Canadian province of British Columbia were calculated based on real road travel time. Census block face population counts were linked to postal codes associated with road segments in order to determine the percentage of the total population more than one hour road travel time from specialized palliative care.ResultsWhilst 81% of the provinces population resides within one hour from at least one specialized palliative care service, spatial access varies greatly by regional health authority. Based on the definition of specialized palliative care adopted for the study, the Northern Health Authority has, for instance, just two such service locations, and well over half of its population do not have reasonable spatial access to such care.ConclusionStrategic location analysis methods must be developed and used to accurately locate future palliative services in order to provide spatial access to the greatest number of people, and to ensure that limited health resources are allocated wisely. Improved spatial access has the potential to reduce travel-times for patients, for palliative care workers making home visits, and for travelling practitioners. These methods are particularly useful for health service planners – and provide a means to rationalize their decision-making. Moreover, they are extendable to a number of health service allocation problems.

The electronic Trauma Health Record: design and usability of a novel tablet-based tool for trauma care and injury surveillance in low resource settings.

BACKGROUND Ninety percent of global trauma deaths occur in under-resourced or remote environments, with little or no capacity for injury surveillance. We hypothesized that emerging electronic and web-based technologies could enable design of a tablet-based application, the electronic Trauma Health Record (eTHR), used by front-line clinicians to inform trauma care and acquire injury surveillance data for injury control and health policy development. STUDY DESIGN The study was conducted in 3 phases: 1. Design of an electronic application capable of supporting clinical care and injury surveillance; 2. Preliminary feasibility testing of eTHR in a low-resource, high-volume trauma center; and 3. Qualitative usability testing with 22 trauma clinicians from a spectrum of high- and low-resource and urban and remote settings including Vancouver General Hospital, Whitehorse General Hospital, British Columbia Mobile Medical Unit, and Groote Schuur Hospital in Cape Town, South Africa. RESULTS The eTHR was designed with 3 key sections (admission note, operative note, discharge summary), and 3 key capabilities (clinical checklist creation, injury severity scoring, wireless data transfer to electronic registries). Clinician-driven registry data collection proved to be feasible, with some limitations, in a busy South African trauma center. In pilot testing at a level I trauma center in Cape Town, use of eTHR as a clinical tool allowed for creation of a real-time, self-populating trauma database. Usability assessments with traumatologists in various settings revealed the need for unique eTHR adaptations according to environments of intended use. In all settings, eTHR was found to be user-friendly and have ready appeal for frontline clinicians. CONCLUSIONS The eTHR has potential to be used as an electronic medical record, guiding clinical care while providing data for injury surveillance, without significantly hindering hospital workflow in various health-care settings.

Collecting injury surveillance data in low- and middle-income countries: The Cape Town Trauma Registry pilot

Abstract Injury is a major public health issue, responsible for 5 million deaths each year, equivalent to the total mortality caused by HIV, malaria and tuberculosis combined. The World Health Organisation estimates that of the total worldwide deaths due to injury, more than 90% occur in low- and middle-income countries (LMIC). Despite the burden of injury sustained by LMIC, there are few continuing injury surveillance systems for collection and analysis of injury data. We describe a hospital-based trauma surveillance instrument for collection of a minimum data-set for calculating common injury scoring metrics including the Abbreviated Injury Scale and the Injury Severity Score. The Cape Town Trauma Registry (CTTR) is designed for injury surveillance in low-resource settings. A pilot at Groote Schuur Hospital in Cape Town was conducted for one month to demonstrate the feasibility of systematic data collection and analysis, and to explore challenges of implementing a trauma registry in a LMIC. Key characteristics of the CTTR include: ability to calculate injury severity, key minimal data elements, expansion to include quality indicators and minimal drain on human resources based on few fields. The CTTR provides a strategy to describe the distribution and consequences of injury in a high trauma volume, low-resource environment.

Injury surveillance in low-resource settings using Geospatial and Social Web technologies

BackgroundExtensive public health gains have benefited high-income countries in recent decades, however, citizens of low and middle-income countries (LMIC) have largely not enjoyed the same advancements. This is in part due to the fact that public health data - the foundation for public health advances - are rarely collected in many LMIC. Injury data are particularly scarce in many low-resource settings, despite the huge associated burden of morbidity and mortality. Advances in freely-accessible and easy-to-use information and communication (ICT) technology may provide the impetus for increased public health data collection in settings with limited financial and personnel resources.Methods and ResultsA pilot study was conducted at a hospital in Cape Town, South Africa to assess the utility and feasibility of using free (non-licensed), and easy-to-use Social Web and GeoWeb tools for injury surveillance in low-resource settings. Data entry, geocoding, data exploration, and data visualization were successfully conducted using these technologies, including Google Spreadsheet, Mapalist, BatchGeocode, and Google Earth.ConclusionThis study examined the potential for Social Web and GeoWeb technologies to contribute to public health data collection and analysis in low-resource settings through an injury surveillance pilot study conducted in Cape Town, South Africa. The success of this study illustrates the great potential for these technologies to be leveraged for public health surveillance in resource-constrained environments, given their ease-of-use and low-cost, and the sharing and collaboration capabilities they afford. The possibilities and potential limitations of these technologies are discussed in relation to the study, and to the field of public health in general.

Pedestrian injury and human behaviour: observing road-rule violations at high-incident intersections.

BACKGROUND Human behaviour is an obvious, yet under-studied factor in pedestrian injury. Behavioural interventions that address rule violations by pedestrians and motorists could potentially reduce the frequency of pedestrian injury. In this study, a method was developed to examine road-rule non-compliance by pedestrians and motorists. The purpose of the study was to examine the potential association between violations made by pedestrians and motorists at signalized intersections, and collisions between pedestrians and motor-vehicles. The underlying hypothesis is that high-incident pedestrian intersections are likely to vary with respect to their aetiology, and thus are likely to require individualized interventions--based on the type and rate of pedestrian and motorist violation. METHODS High-incident pedestrian injury intersections in Vancouver, Canada were identified using geographic information systems. Road-rule violations by pedestrians and motorists were documented at each incident hotspot by a team of observers at several different time periods during the day. RESULTS Approximately 9,000 pedestrians and 18,000 vehicles were observed in total. In total for all observed intersections, over 2000 (21%) pedestrians committed one of the observed pedestrian road-crossing violations, while approximately 1000 (5.9%) drivers committed one of the observed motorist violations. Great variability in road-rule violations was observed between intersections, and also within intersections at different observation periods. CONCLUSIONS Both motorists and pedestrians were frequently observed committing road-rule violations at signalized intersections, suggesting a potential human behavioural contribution to pedestrian injury at the study sites. These results suggest that each intersection may have unique mechanisms that contribute to pedestrian injury, and may require targeted behavioural interventions. The method described in this study provides the basis for understanding the relationship between violations and pedestrian injury risk at urban intersections. Findings could be applied to targeted prevention campaigns designed to reduce the number of pedestrian injuries at signalized intersections.

Assessing the suitability of host communities for secondary palliative care hubs: A location analysis model

An increased need for palliative care has been acknowledged world-wide. However, recent Canadian end-of-life care frameworks have largely failed to consider the unique challenges of delivery in rural and remote regions. In the Canadian province of British Columbia (BC), urban areas are well-served for specialized palliative care; however, rural and remote regions are not. This study presents a location analysis model designed to determine appropriate locations to allocate palliative care services. Secondary palliative care hubs (PCH) are introduced as an option for delivering these services in rural and remote regions. Results suggest that several BC communities may be appropriate locations for secondary PCHs. This model could be applied to the allocation of palliative care resources in other jurisdictions with similar rural and remote regions.

Refining a Location Analysis Model Using a Mixed Methods Approach: Community Readiness as a Key Factor in Siting Rural Palliative Care Services:

Drawing on recent debates pointing to the value of mixed methods research in human geography, the authors revisit a quantitative location analysis model previously created to site palliative care services in rural British Columbia, Canada. The original quantitative model posited that population (i.e., number of residents in the community), isolation (i.e., travel time to existing specialized palliative care), and vulnerability (i.e., number of residents older than 65 years in the community) are three factors that must be accounted for when siting palliative care services in rural areas. Using qualitative interview data, the authors refine this model to include a newly identified factor: community readiness. They conclude with a discussion of the benefits of adopting a mixed methods approach to location analysis model development.

Revisiting critical GIS

Even as the meeting ‘revisited’ critical GIS, it offered neither recapitulation nor reification of a fixed field, but repetition with difference. Neither at the meeting nor here do we aspire to write histories of critical GIS, which have been taken up elsewhere.1 In the strictest sense, one might define GIS as a set of tools and technologies through which spatial data are encoded, analyzed, and communicated. Yet any strict definition of GIS, critical or otherwise, is necessarily delimiting, carving out ontologically privileged status that necessarily silences one set of voices in favor of another.

Evidence and future potential of mobile phone data for disease disaster management

Abstract Global health threats such as the recent Ebola and Zika virus outbreaks require rapid and robust responses to prevent, reduce and recover from disease dispersion. As part of broader big data and digital humanitarianism discourses, there is an emerging interest in data produced through mobile phone communications for enhancing the data environment in such circumstances. This paper assembles user perspectives and critically examines existing evidence and future potential of mobile phone data derived from call detail records (CDRs) and two-way short message service (SMS) platforms, for managing and responding to humanitarian disasters caused by communicable disease outbreaks. We undertake a scoping review of relevant literature and in-depth interviews with key informants to ascertain the: (i) information that can be gathered from CDRs or SMS data; (ii) phase(s) in the disease disaster management cycle when mobile data may be useful; (iii) value added over conventional approaches to data collection and transfer; (iv) barriers and enablers to use of mobile data in disaster contexts; and (v) the social and ethical challenges. Based on this evidence we develop a typology of mobile phone data sources, types, and end-uses, and a decision-tree for mobile data use, designed to enable effective use of mobile data for disease disaster management. We show that mobile data holds great potential for improving the quality, quantity and timing of selected information required for disaster management, but that testing and evaluation of the benefits, constraints and limitations of mobile data use in a wider range of mobile-user and disaster contexts is needed to fully understand its utility, validity, and limitations.

Intentional injury and violence in Cape Town, South Africa: an epidemiological analysis of trauma admissions data

Background Injury is a truly global health issue that has enormous societal and economic consequences in all countries. Interpersonal violence is now widely recognized as important global public health issues that can be addressed through evidence-based interventions. In South Africa, as in many low- and middle-income countries (LMIC), a lack of ongoing, systematic injury surveillance has limited the ability to characterize the burden of violence-related injury and to develop prevention programmes. Objective To describe the profile of trauma presenting to the trauma centre of Groote Schuur Hospital in Cape Town, South Africa – relating to interpersonal violence, using data collected from a newly implemented surveillance system. Particular emphasis was placed on temporal aspects of injury epidemiology, as well as age and sex differentiation. Design Data were collected prospectively using a standardized trauma admissions form for all patients presenting to the trauma centre. An epidemiological analysis was conducted on 16 months of data collected from June 2010 to October 2011. Results A total of 8445 patients were included in the analysis, in which the majority were violence-related. Specifically, 35% of records included violent trauma and, of those, 75% of victims were male. There was a clear temporal pattern: a greater proportion of intentional injuries occur during the night, while unintentional injury peaks late in the afternoon. In total, two-third of all intentional trauma is inflicted on the weekends, as is 60% of unintentional trauma. Where alcohol was recorded in the record, 72% of cases involved intentional injury. Sex was again a key factor as over 80% of all records involving alcohol or substance abuse were associated with males. The findings highlighted the association between violence, young males, substance use, and weekends. Conclusions This study provides the basis for evidence-based interventions to reduce the burden of intentional injury. Furthermore, it demonstrates the value of locally appropriate, ongoing, systematic public health surveillance in LMIC.