Perioperative medicine training resources: U1M1 Social assessment

The intersection of SDOH and surgery is a nascent field of study, but the last decade has added a significant amount of research showing that SDOH have a measurable effect on patient access to surgery and surgical outcomes.

Summary
This article provides a general overview of the special needs of the older surgery patient. The preoperative assessment for the older patient must be multidimensional, encompassing the bio-psycho-social-spheres. Social and economic factors such as income level, education, culture and ethnicity, social support networks, transportation, and access to community services may greatly enhance or impede the likelihood of successful outcomes after surgery. Hence, it is critical that the oral surgeon be aware of the importance of these factors and determine the patient's needs and resources on an individual basis.

Abstract: Social networking for healthcare is used by many of the different participants in the healthcare system. The motivations for using social networking differ depending on the participant. In this paper, the distinct types of social networking for health care and the user groups that are associated with them are defined. There are three distinct emerging user groups in social networking for health care. These three user groups are identified as doctor to doctor (D2D), patient to patient (P2P) and doctor to patient (D2P). Each of these distinct user groups has different objectives for using social networking for healthcare. They also have unique benefits and issues for each type of social networking for healthcare as well as having some in common.

Sometimes you may need to be involved in advance care planning for a family member or friend who is no longer able to make medical decisions. You may have been legally appointed to be their substitute decision-maker.

Abstract
Travel time to hospital is a key measure of health service accessibility, and impacts patients' experiences of care and health outcomes. Methods used to estimate travel time vary across studies. In Australia the smallest geographical areas defined by the Australian Bureau of Statistics for the release of population counts are mesh blocks (MBs) and the smallest geographical areas for the release of health-related statistics are statistical areas level 2 (SA2). SA2s are built up from whole MBs. This project used the Open Source Routing Machine (OSRM) HTTP server to compute estimated travel times between the centroid of each inhabited MB and each hospital in Australia, as well as the shortest travel times between MBs and any hospital. By computing population-weighted averages across MBs, the average travel times to hospitals and the shortest travel time to any hospital were estimated for each SA2. This dataset will promote consistency across studies investigating geographic influences on health care in Australia, and the methods are applicable to generating similar datasets for other countries.

Abstract
This is the second in a series of discussion papers from the WHO Regional Office for Europe. The first covers concepts and principes of equity in relation to health, and should be read in conjunction with this paper (Whitehead 1990). The present paper sets out to develop the discussion further by outlining a strategic approach to promote greater equity in health between different social and occupational groups. This draws on the work of WHO advisory groups and associated litterature listed at the back, together with practical examples from industrialized countries where strategies have been put into action. The first part (section 1-9) of the paper outlines why equity is seen as a priority and distinguishes different policy levels for interventions. Specific equity aspects related to each policy level are then highlighted as well as some case studies. The second part of the paper (section 10-14) deals with putting policy into practice. Special attention is then paid to the need for comprehensive approaches to combat social and occupational inequities in health as illustrated in terms of a strategy matrix. Furthermore the democratice process within which healthy public policies are to be discussed and determined is discussed as well as organizational aspects as regards the implementation of an equity oriented health policy. Finally checklists are presented focusing upon how to make things happen.

Abstract
Surgical outcomes are significantly influenced by patients' overall health, function, and life expectancy. A comprehensive geriatric preoperative assessment of older adults requires expanding beyond an organ-based or disease-based assessment. At a preoperative visit, it is important to establish the patient's goals and preferences, and to determine whether the risks and benefits of surgery match these goals and preferences. These discussions should cover the possibility of resuscitation and ventilator support, prolonged rehabilitation, and loss of independence. The assessment should include evaluation of medical comorbidities, cognitive function, decision-making capacity, functional status, fall risk, frailty, nutritional status, and potentially inappropriate medication use. Problems identified in any of these key areas are associated with an increased risk of postoperative complications, institutionalization, functional decline, and, in some cases, mortality. If a patient elects to proceed with surgery, the risks should be communicated to surgical teams to allow for inpatient interventions that lower the risk of postoperative complications and functional decline, such as early mobilization and limiting medications that can cause delirium. Alcohol abuse and smoking are associated with increased rates of postoperative complications, and physicians should discuss cessation with patients before surgery. Physicians should also assess patients' social support systems because they are a critical component of discharge planning in this population and have been shown to predict 30-day postoperative morbidity.