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Arega B, Mengistu M, Mersha A, Agunie A. Evaluation of hospital quality of care outcomes in a teaching hospital in Ethiopia: a retrospective database study. BMJ Open 2024; 14:e082908. [PMID: 39266321 PMCID: PMC11407220 DOI: 10.1136/bmjopen-2023-082908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2024] Open
Abstract
OBJECTIVES We aimed to evaluate hospital mortality rates, readmission rates and length of hospital stay (LOS) among adult medical patients admitted to a teaching hospital in Ethiopia. DESIGN We performed a retrospective study using routinely collected electronic data. SETTING Data were collected from Yekatit 12 Hospital Medical College between January 2021 and July 2023. PARTICIPANTS The analysis included 3499 (4111 admissions) adult medical patients with complete data. OUTCOME MEASURES We used mortality rates, readmission rates and LOS to measure the quality of the outcomes for the top 15 admission diagnoses. A multivariable Cox proportional hazard model was used to identify the statistically significant predictors of mortality with p values<0.05 and a 95% CI. The Kaplan-Meier curve was used to estimate the failure rate (mortality) of the admitted patients. RESULTS The median age of patients was 50 years and men accounted for 1827 (52.3%) of all admitted cases. Non-communicable diseases accounted for 2537 (72.5%) admissions. In descending order, stroke, 644 (18.29%); heart failure, 640 (18.41%); and severe pneumonia, 422 (12.06%) were the three most common causes of admission. The readmission rate was 25.67% (1056/411), and 61.9% of them were readmitted within 30 days of index discharge. The overall median LOS was 8 days. The median LOSs in the index admission (11 vs 8 days, p value=0.001) of readmitted patients was significantly higher than not readmitted. The in-hospital mortality rate was 438 (12.5%), with the highest number of deaths occurred between days 30 and 50 of admission. The mortality rate is significantly higher among patients with communicable diseases (adjusted HR, 1.64, 95% CI: 1.34, 2.10) and elderly patients (≥65 years) (adjusted HR, 1.79, 95% CI: 1.44, 2.22). Septicemia, chronic liver diseases with complications and HIV with complications were the three common causes of death with a proportional mortality rate of 55.2%, 27.93% and 22.46%, respectively. CONCLUSIONS Mortality, median LOSs and readmission rate were comparable to other national and international studies. Multicentre compressive research using these three quality patient outcomes is required to establish national standards and evaluate institutional performance.
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Affiliation(s)
- Balew Arega
- Department of Internal Medicine, Yekatit 12 Hospital, Addis Ababa, Ethiopia
| | - Mekoya Mengistu
- Department of Internal Medicine, Yekatit 12 Hospital, Addis Ababa, Ethiopia
- Department of Medical Physiology, College of Health Sciences,Addis Ababa University, Addis Ababa, Ethiopia
| | - Amdemeskel Mersha
- Department of Internal Medicine, Yekatit 12 Hospital, Addis Ababa, Ethiopia
| | - Asnake Agunie
- Department of Health Care Quality, Yekatit 12 Hospital, Addis Ababa, Ethiopia
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Wang DY, Wong ELY, Cheung AWL, Tam ZPY, Tang KS, Yeoh EK. Implementing the information system for older adult patients post-discharge self-management: a qualitative study. Age Ageing 2024; 53:afae136. [PMID: 38970302 PMCID: PMC11225609 DOI: 10.1093/ageing/afae136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/02/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND Discharging older adult patients from the hospital poses risks due to their vulnerable conditions, complex instructions and limited health literacy. Insufficient information about medication side effects adds to patient concerns. To address this, a post-discharge information summary system was developed. While it has shown positive impacts, concerns exist regarding implementation fidelity. OBJECTIVE This study employed a theory-driven approach to understand health providers' perspectives on effective implementation. METHOD Individual semi-structured interviews were conducted via telephone with nurses, doctors and pharmacists from local public hospitals. All interviews were audio-recorded and transcribed verbatim. Theoretical Domains Framework (TDF) was applied for direct content analysis. Belief statements were generated by thematic synthesis under each of the TDF domains. RESULTS A total of 98 participants were interviewed. Out of the 49 belief statements covering eight TDF domains, 19 were determined to be highly relevant to the implementation of the post-discharge information summary system. These TDF domains include knowledge, skills, social/professional role and identity, beliefs about consequences, intentions, memory, attention and decision processes, environmental context and resources and social influences. CONCLUSION Our study contributes to the understanding of determinants in implementing discharge interventions for older adult patients' self-care. Our findings can inform tailored strategies for frontline staff, including aligning programme rationale with stakeholders, promoting staff engagement through co-creation, reinforcing positive programme outcomes and creating default settings. Future research should employ rigorous quantitative designs to examine the actual impact and relationships among these determinants.
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Affiliation(s)
- Dorothy Yingxuan Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Eliza Lai-Yi Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Annie Wai-Ling Cheung
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Zoe Pui-Yee Tam
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kam-Shing Tang
- Kwong Wah Hospital, Hospital Authority, Hong Kong SAR, China
| | - Eng-Kiong Yeoh
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Skjevling L, Goll R, Hanssen HM, Johnsen PH. Faecal microbiota transplantation (FMT) in Norwegian outpatients with mild to severe myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): protocol for a 12-month randomised double-blind placebo-controlled trial. BMJ Open 2024; 14:e073275. [PMID: 38858151 PMCID: PMC11168185 DOI: 10.1136/bmjopen-2023-073275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/11/2024] [Indexed: 06/12/2024] Open
Abstract
INTRODUCTION The observed alteration of the intestinal microbiota in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and the effect of transferring a healthy gut flora from a faecal donor using a faecal microbiota transplantation (FMT) will be explored in this trial. METHODS AND ANALYSIS This is a protocol for a randomised, double-blind, placebo-controlled, parallel-group, single-centre trial, with 12 months follow-up. 80 participants will be included and randomised (1:1:2) to either donor FMT (from two different donors) or placebo (autologous FMT). Participants will be included by the International Clinical Criteria for ME/CFS. The clinical measures of ME/CFS and disease activity include Modified DePaul Questionnaire, Fatigue Severity Scale (FSS), Hospital Anxiety and Depression Scale (HADS), 36-Item Short Form Health Survey (SF-36), ROMA IV criteria, Food Frequency Questionnaire, Repeatable Battery for the Assessment of Neuropsychological Status, heart rate variability testing and reports on the use of antibiotics and food supplements, as well as biobanking of blood, urine and faeces.The primary endpoint is proportion with treatment success in FSS score in donor versus autologous FMT group 3 months after treatment. Treatment success is defined as an FSS improvement of more than 1.2 points from baseline at 3 months after treatment. Adverse events will be registered throughout the study. ETHICS AND DISSEMINATION The Regional Committee for Medical Research Ethics Northern Norway has approved the study. The study has commenced in May 2019. Findings will be disseminated in international peer-reviewed journal(s), submitted to relevant conferences, and trial participants will be informed via phone calls. TRIAL REGISTRATION NUMBER NCT03691987.
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Affiliation(s)
- Linn Skjevling
- UiT The Arctic University of Norway, Tromso, Troms, Norway
- Medical Department, University Hospital of North Norway, Harstad, Troms, Norway
| | - Rasmus Goll
- UiT The Arctic University of Norway, Tromso, Troms, Norway
- Department of Gastroenterology, University Hospital of North Norway, Tromso, Troms, Norway
| | - Hege Marie Hanssen
- UiT The Arctic University of Norway, Tromso, Troms, Norway
- Medical Department, University Hospital of North Norway, Harstad, Troms, Norway
| | - Peter Holger Johnsen
- UiT The Arctic University of Norway, Tromso, Troms, Norway
- Medical Department, University Hospital of North Norway, Harstad, Troms, Norway
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Abrishami R, Golestani K, Farhang Ranjbar M, Ghasemie Abarghouie MH, Ghadami A. A survey on the effects of patient safety training programs based on SBAR and FMEA techniques on the level of self-efficacy and observance of patient safety culture in Iran hospital, Shiraz in 2022-2023. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:66. [PMID: 38559489 PMCID: PMC10979771 DOI: 10.4103/jehp.jehp_194_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 04/24/2023] [Indexed: 04/04/2024]
Abstract
BACKGROUND AND OBJECTIVE Patient safety and medical personnel self-efficacy are among the main factors involved in providing quality health services. Moreover, safety culture in an organization is considered one of the most critical factors regarding patients' safety. Therefore, the present study aimed to determine the effects of patient safety programs based on Situation, Background, Assessment, Recommendation (SBAR) and Failure Model Effects Analysis (FMEA) techniques on self-efficacy and patient safety culture in Iran Hospital of Shiraz in 2022-2023. MATERIALS AND METHODS This two-stage quasi-experimental study was conducted in 2022-2033. Considering inclusion criteria, the present study included 80 nurses working in Iran Hospital. The participants were divided into groups of SBAR (40 participants) and FMEA (40 participants). All the data were collected using a Hospital Survey on Patient Safety Culture questionnaire and Sherer General Self-Efficacy Scale. Then, the collected data were analyzed using SPSS 13, Fisher's exact test, paired t-test, and independent t-test with a significant level of P < 0.05. RESULTS The mean score of total patient safety culture between the two groups was insignificant before the intervention (P = 0.58). However, it was more significant in the FMEA group than the SBAR group after the intervention (P < 0/05). In addition, the mean self-efficacy score between the two groups was insignificant before the intervention (P = 0.80). However, after the intervention, the mean score of the FMEA group was significantly higher than the SBAR group (P < 0.05). CONCLUSION According to the findings of this study, there is a meaningful relationship between patient safety training programs based on SBAR and FMEA techniques on patient safety and self-efficacy of nurses; however, FMEA training has more positive effects on self-efficacy and patient safety compared to other techniques. As a result, these techniques, along with other plans, are recommended to authorities in order to help improve patient safety.
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Affiliation(s)
- Ramin Abrishami
- Research Center for Trauma in Police Operations, Directorate of Health, Rescue and Treatment, Police Headquarter, Tehran, Iran
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Kambiz Golestani
- Research Center for Trauma in Police Operations, Directorate of Health, Rescue and Treatment, Police Headquarter, Tehran, Iran
| | - Mehri Farhang Ranjbar
- Research Center for Trauma in Police Operations, Directorate of Health, Rescue and Treatment, Police Headquarter, Tehran, Iran
| | - Mohammad Hassan Ghasemie Abarghouie
- Research Center for Trauma in Police Operations, Directorate of Health, Rescue and Treatment, Police Headquarter, Tehran, Iran
- Nursing Department, Eghlid Branch, Islamic Azad University, Eghlid, Iran
| | - Ahmad Ghadami
- Department of Operating Room, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery Isfahan University of Medical Sciences, Isfahan, Iran
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Ziarukh S, Sabir A. Burnout and patient safety culture assessment in a secondary care hospital. Pak J Med Sci 2024; 40:S58-S63. [PMID: 38328661 PMCID: PMC10844919 DOI: 10.12669/pjms.40.2(icon).8970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 10/16/2023] [Accepted: 11/14/2023] [Indexed: 02/09/2024] Open
Abstract
Objectives To identify employee burn-out and assess its impact on patient safety culture. Methods This cross-sectional study was carried out amongst healthcare providers (HCP) of Tehsil Head Quarter Manawan Hospital, Lahore from April 1st till 30th, 2023, who had been working for at least one year and directly involved in patient care. Two questionnaires were used; the Maslach Burnout Inventory (MBI) to assess level of burnout, and Agency for Healthcare Research and Quality (AHRQ) patient safety culture survey. After obtaining informed consent, 59 participants were enrolled in this study. Results High degree of occupational exhaustion (OE) 42.9% was seen amongst doctors and 57.1% had low degree of personal accomplishment (PA) compared to all other health care providers. Significant association was observed between two sub-scales of MBI (p<0.05). No significant association was observed in working hours, designated positions and burnout (p>0.05). Statistically weak correlation existed between burnout and patient safety culture (r=0.075, p=0.580). Awareness on incident reporting was in 43.3% of participants; of which 31% had reported at least one event in last 12 months. Overall, 76% employees consider their work unit reliable for providing safe patient care. Conclusions Burnout was observed in employees, particularly high degree in attending physicians. However, team work, high level of personal accomplishment and incident reporting culture, served as protective factors for patient safety and safe working environment and culture.
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Affiliation(s)
- Sharmeen Ziarukh
- Sharmeen Ziarukh, Department of Family Medicine and Nutrition, Managed by IHHN, THQ Manawan Hospital, Lahore, Pakistan
| | - Aamina Sabir
- Aamina Sabir, Department of Family Medicine and Nutrition, Managed by IHHN, THQ Manawan Hospital, Lahore, Pakistan
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George J, Jack S, Gauld R, Colbourn T, Stokes T. Impact of health system governance on healthcare quality in low-income and middle-income countries: a scoping review. BMJ Open 2023; 13:e073669. [PMID: 38081664 PMCID: PMC10729209 DOI: 10.1136/bmjopen-2023-073669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Improving healthcare quality in low-/middle-income countries (LMICs) is a critical step in the pathway to Universal Health Coverage and health-related sustainable development goals. This study aimed to map the available evidence on the impacts of health system governance interventions on the quality of healthcare services in LMICs. METHODS We conducted a scoping review of the literature. The search strategy used a combination of keywords and phrases relevant to health system governance, quality of healthcare and LMICs. Studies published in English until August 2023, with no start date limitation, were searched on PubMed, Cochrane Library, CINAHL, Web of Science, Scopus, Google Scholar and ProQuest. Additional publications were identified by snowballing. The effects reported by the studies on processes of care and quality impacts were reviewed. RESULTS The findings from 201 primary studies were grouped under (1) leadership, (2) system design, (3) accountability and transparency, (4) financing, (5) private sector partnerships, (6) information and monitoring; (7) participation and engagement and (8) regulation. CONCLUSIONS We identified a stronger evidence base linking improved quality of care with health financing, private sector partnerships and community participation and engagement strategies. The evidence related to leadership, system design, information and monitoring, and accountability and transparency is limited.
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Affiliation(s)
- Joby George
- Department of General Practice & Rural Health, University of Otago, Dunedin, New Zealand
| | - Susan Jack
- Te Whatu Ora - Southern, National Public Health Service, Dunedin, New Zealand
- Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand
| | - Robin Gauld
- Department of Preventive & Social Medicine, University of Otago, Dunedin, New Zealand
- Otago Business School, University of Otago, Dunedin, New Zealand
| | | | - Tim Stokes
- Department of General Practice & Rural Health, University of Otago, Dunedin, New Zealand
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Dufour I, Arsenault-Lapierre G, Guillette M, Dame N, Poitras ME, Lussier MT, Fortier A, Brunet J, Martin J, Laverdure M, Brousseau G, Bergman H, Couturier Y, Quesnel-Vallée A, Vedel I. Research protocol of the Laval-ROSA Transilab: a living lab on transitions for people living with dementia. BMC Health Serv Res 2023; 23:1255. [PMID: 37964248 PMCID: PMC10647081 DOI: 10.1186/s12913-023-10248-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/30/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND The Laval-ROSA Transilab is a living lab that aims to support the Laval Integrated Health and Social Services Centres (Quebec, Canada) in consolidating the Quebec Alzheimer Plan. It aims to improve care transitions between different settings (Family Medicine Groups, home care, and community services) and as such improve the care of people living with dementia and their care partners. Four transition-oriented innovations are targeted. Two are already underway and will be co-evaluated: A) training of primary care professionals on dementia and interprofessional collaboration; B) early referral process to community services. Two will be co-developed and co-evaluated: C) developing a structured communication strategy around the dementia diagnosis disclosure; D) designation of a care navigator from the time of dementia diagnosis. The objectives are to: 1) co-develop a dashboard for monitoring transitions; 2) co-develop and 3) co-evaluate the four targeted innovations on transitions. In addition, we will 4) co-evaluate the impact and implementation process of the entire Laval-ROSA Transilab transformation, 5) support its sustainability, and 6) transfer it to other health organizations. METHODS Multi-methods living lab approach based on the principles of a learning health system. Living labs are open innovation systems that integrate research co-creation and knowledge exchange in real-life settings. Learning health systems centers care improvement on developing the organization's capacity to learn from their practices. We will conduct two learning cycles (data to knowledge, knowledge to practice, and practice to data) and involve various partners. We will use multiple data sources, including health administrative databases, electronic health records data, surveys, semi-structured interviews, focus groups, and observations. DISCUSSION Through its structuring actions, the Laval-ROSA Transilab will benefit people living with dementia, their care partners, and healthcare professionals. Its strategies will support sustainability and will thus allow for improvements throughout the care continuum so that people can receive the right services, at the right time, in the right place, and from the right staff.
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Affiliation(s)
- Isabelle Dufour
- School of Nursing, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12E Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada.
| | | | - Maxime Guillette
- School of Social Work, Faculty of Letters and Humanities, Université de Sherbrooke, Sherbrooke, Canada
| | - Nathalie Dame
- School of Social Work, Faculty of Letters and Humanities, Université de Sherbrooke, Sherbrooke, Canada
| | - Marie-Eve Poitras
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Marie-Thérèse Lussier
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Annie Fortier
- Integrated Health and Social Services Centre of Laval, Laval, Canada
| | - Julie Brunet
- Integrated Health and Social Services Centre of Laval, Laval, Canada
| | - Julie Martin
- School of Social Work, Faculty of Letters and Humanities, Université de Sherbrooke, Sherbrooke, Canada
| | | | - Ginette Brousseau
- Integrated Health and Social Services Centre of Laval, Laval, Canada
| | - Howard Bergman
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Yves Couturier
- School of Social Work, Faculty of Letters and Humanities, Université de Sherbrooke, Sherbrooke, Canada
| | | | - Isabelle Vedel
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
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Turcotte M, Etherington C, Rowe J, Duong A, Kaur M, Talbot Z, Mansour F, Mohamed J, Zahrai A, Fournier K, Boet S. Effectiveness of interprofessional teamwork interventions for improving occupational well-being among perioperative healthcare providers: a systematic review. J Interprof Care 2023; 37:904-921. [PMID: 36373205 DOI: 10.1080/13561820.2022.2137116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 08/15/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022]
Abstract
The occupational well-being of healthcare providers is crucial for safe and effective patient care, especially in the complex, high acuity operating room (OR) setting. There has been a recent proliferation of interventions to improve teamwork in the OR setting, but the impact of these interventions on clinician occupational well-being has yet to be systematically assessed. This systematic review aimed to summarize the impact of interprofessional teamwork interventions on occupational well-being among perioperative healthcare providers. We included all qualitative or quantitative peer-reviewed studies assessing a multidisciplinary teamwork intervention including members of at least two professions. We included seven studies which involved checklists (n = 2), simulation-based training (n = 2), and various teamwork development and training programs (n = 3). Five of the seven included studies reported no significant effect on job satisfaction, while one found a significant negative association between the intervention and job satisfaction (p < .0001), and another showed significant decrease in worker stress. Our findings highlight the gaps in our understanding of the impact of interprofessional teamwork interventions on healthcare worker well-being in the perioperative environment and the multi-level factors influencing OR teamwork, intervention implementation, and well-being across the different professions.
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Affiliation(s)
- Michelle Turcotte
- MD Program, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Cole Etherington
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jennifer Rowe
- MD Program, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Ann Duong
- Faculty of Science, University of Ottawa, Ottawa, ON, Canada
- Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, Canada
| | - Manvinder Kaur
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Zoé Talbot
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Fadi Mansour
- MD Program, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Janna Mohamed
- Faculty of Science, University of Ottawa, Ottawa, ON, Canada
| | - Amin Zahrai
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Karine Fournier
- Health Sciences Library, University of Ottawa, Ottawa, Canada
| | - Sylvain Boet
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, Canada
- Translational and Molecular Medicine Program, University of Ottawa, Ottawa, Canada
- Department of Innovation in Medical Education, University of Ottawa Ottawa Canada
- Francophone Affairs, Faculty of Medicine, University of Ottawa Ottawa Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
- Faculty of Education, University of Ottawa, Ottawa, Canada
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Rasmussen LF, Grode L, Barat I, Gregersen M. Prevalence of factors contributing to unplanned hospital readmission of older medical patients when assessed by patients, their significant others and healthcare professionals: a cross-sectional survey. Eur Geriatr Med 2023; 14:823-835. [PMID: 37222865 PMCID: PMC10206346 DOI: 10.1007/s41999-023-00799-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/10/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To describe the prevalence of factors contributing to readmission of older medical patients perceived by patients, significant others and healthcare professionals and to examine the agreement of factors contributing to readmission. METHODS This cross-sectional survey was conducted at Horsens Regional Hospital from September 2020 to June 2021. Patients aged ≥ 65 years and who were readmitted within 30 days were included. The questionnaire covered eight themes: disease; diagnosing, treatment and care; network; organisation; communication; skills and knowledge; resources; and practical arrangements. Response groups were patients, significant others, GPs, district nurses and hospital physicians. Outcomes were the prevalence of factors contributing to 30-day readmission and inter-rater agreement between respondents. RESULTS In total, 165 patients, 147 significant others, 115 GPs, 75 district nurses and 165 hospital physicians were included. The patients' median age was 79 years (IQR 74-85), and 44% were women. The following were the most prevalent contributing factors: (1) relapse of the condition that caused the index admission, (2) the patient could not manage the symptoms or illness, (3) worsening of other illnesses or conditions, (4) the patient was not fully treated at the time of discharge and (5) the patient's situation was too complex for the medical practice to handle. Kappas ranged from 0.0142 to 0.2421 for patient-significant other dyads and 0.0032 to 0.2459 for GP-hospital physician dyads. CONCLUSION From the perspectives of the included respondents, factors associated with the disease and its management were the most prevalent contributors to readmission for older medical patients. Agreement on the contributing factors was generally low. TRIAL REGISTRATION Clinical trial number NCT05116644. Registration date October 27, 2021.
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Affiliation(s)
- Lisa Fønss Rasmussen
- Department of Research, Horsens Regional Hospital, Sundvej 30, 8700, Horsens, Denmark.
| | - Louise Grode
- Department of Medicine, Horsens Regional Hospital, Sundvej 30, 8700, Horsens, Denmark
| | - Ishay Barat
- Department of Medicine, Horsens Regional Hospital, Sundvej 30, 8700, Horsens, Denmark
| | - Merete Gregersen
- Department of Geriatrics, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark
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Renu Kalhari Geethani Nandasena HM, Sajith Prasanga PT, Muditha Piumali Atapattu AM. Are nursing students flourish or languish in their mental health? Heliyon 2023; 9:e18838. [PMID: 37583760 PMCID: PMC10424072 DOI: 10.1016/j.heliyon.2023.e18838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/10/2023] [Accepted: 07/31/2023] [Indexed: 08/17/2023] Open
Abstract
Background Positive mental health (PMH) is the presence of emotional, social, and psychological well-being. Objective To determine the level of positive mental health and associated factors among nursing students in a public university in Sri Lanka. Methods A descriptive cross-sectional study was conducted among 185 nursing students. Data was collected using a self-administered questionnaire. Students were categorized as Flourished, Moderate and Languished. Results Out of 185 students 170 responded. Mean age was 23.5 years (SD = 1.3). Of them 25.3% flourished and 32.7% languished. Students who engaged in leisure activities and social activities were more flourished whereas students who have diagnosed with chronic illness/es, mental illness/es and had any family member/s suffering with a severe illness/es were more languished. Conclusion Involvement in leisure activities, social activities, status of physical and mental health and family member health status were associated with the level of positive mental health.
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Barega B, Seifu L, Melkie A, Abebe S, Taye M. Blood Pressure Control among Adults with Hypertension at a Tertiary Hospital in Ethiopia. Ethiop J Health Sci 2023; 33:563-570. [PMID: 38784211 PMCID: PMC11111181 DOI: 10.4314/ejhs.v33i4.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/13/2023] [Indexed: 05/25/2024] Open
Abstract
Background Uncontrolled hypertension is a leading modifiable risk factor for cardiovascular disease morbidity and mortality. Despite the availability of several effective blood pressure lowering drugs, hypertension control rates remain poor globally. This study aimed to define the level of blood pressure control and to determine the factors associated with poor hypertension control. Methods A hospital-based cross-sectional study was conducted from January to March 2019 at Tikur Anbessa Specialized Hospital among randomly selected 369 patients with hypertension. Data were collected using a pre-tested structured questionnaire. Multivariate binary logistic regression was used to identify determinants of blood pressure control. Results The mean (SD) age of the study participants was 55.5 (13.2) years; 188 (50.9%) were males and 28 (7.6%) were active smokers. More than half of the patients (56.0%) were overweight or obese. The most commonly identified comorbidities were diabetes mellitus (48.0%), dyslipidemia (50.9%), and chronic kidney disease (56.1%). The mean (SD) systolic blood pressure was 140.6 (22) mmHg, and diastolic blood pressure was 85.8 (14) mmHg. About two-thirds of the patients (60.2%) had uncontrolled blood pressure. The factors associated with poor blood pressure control with an AOR (95% CI) were increasing age: 1.05 (1.00-1.11), increasing household income: 1.25 (1.04-1.49), being physically inactive: 7.64 (1.14-51.13), chronic kidney disease: 5.36 (1.14-5.16), and use of home blood pressure monitoring: 0.31 (0.102-0.94). Conclusion The rate of blood pressure control in patients with hypertension was suboptimal. Age, household income, level of physical activity, chronic kidney disease, and use of home blood pressure monitoring were independent predictors of blood pressure control. It is important to optimize the treatment of hypertension in this high-risk group by implementing effective strategies.
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Affiliation(s)
- Binyam Barega
- Department of Internal Medicine, Ras Desta Hospital, Addis Ababa, Ethiopia
| | - Lissane Seifu
- Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Addisu Melkie
- Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sintayehu Abebe
- Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Melaku Taye
- Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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12
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Li X, Zhou Y, Liu Y, Wang X, Yuen KF. Psychological antecedents of telehealth acceptance: A technology readiness perspective. INTERNATIONAL JOURNAL OF DISASTER RISK REDUCTION : IJDRR 2023; 91:103688. [PMID: 37089615 PMCID: PMC10110278 DOI: 10.1016/j.ijdrr.2023.103688] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/11/2023] [Accepted: 04/10/2023] [Indexed: 05/03/2023]
Abstract
The ongoing coronavirus pandemic has been threatening the healthcare system. In this context, telehealth is a potential solution to deliver effective and safe health care to the public. To facilitate the application and acceptance of telehealth, a good understanding of psychological determinants is of great importance. Therefore, this study aims to examine the public's positive and negative mindsets towards telehealth. A theoretical model was established by employing the technology readiness model and perceived value theory. To empirically test the relationships between constructs, a total of 500 responses from residents in Singapore were collected; thereafter, structural equation modeling was performed. The results indicate that discomfort negatively impacts perceived value whereas optimism and innovativeness positively impact users' perceived value. Further, perceived value positively impacts the acceptance of telehealth via attitude. Demographic factors (i.e. internet literacy, age, education) can also influence certain aspects of technology readiness (e.g. innovativeness, optimism). Moreover, social influence is an important moderator between perceived value and the acceptance of telehealth. The empirical findings enhance the understanding of users' psychology concerning telehealth and provide policy recommendations regarding the development of telehealth to improve public health.
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Affiliation(s)
- Xue Li
- School of Civil and Environmental Engineering, Nanyang Technological University, Singapore
| | - Yusheng Zhou
- School of Civil and Environmental Engineering, Nanyang Technological University, Singapore
| | - Yanfeng Liu
- Graduate School of Management of Technology, Pukyong National University, South Korea
| | - Xueqin Wang
- Department of International Logistics, Chung-Ang University, South Korea
| | - Kum Fai Yuen
- School of Civil and Environmental Engineering, Nanyang Technological University, Singapore
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13
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Dzomeku VM, Mensah ABB, Nakua EK, Agbadi P, Okyere J, Kumah A, Munukpa J, Ofosu AA, Lockhart N, Lori JR. Perspectives of healthcare workers on the challenges with obstetric referrals in rural communities in Ghana: a descriptive phenomenology study. BMJ Open 2023; 13:e066910. [PMID: 37055200 PMCID: PMC10106065 DOI: 10.1136/bmjopen-2022-066910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
OBJECTIVE We explored and document healthcare workers' (HCWs') perspectives on the challenges encountered during obstetric referrals. DESIGN The study adopted a qualitative research approach and a descriptive phenomenology design. HCWs permanently working in 16 rural healthcare facilities in the Sene East and West Districts composed of the target population for this study. Using a purposive sampling technique, participants were recruited and enrolled in in-depth individual interviews (n=25) and focused group discussions (n=12). Data were analysed thematically using QSR NVivo V.12. SETTING Sixteen rural healthcare facilities in the Sene East and West Districts, Ghana. PARTICIPANTS Healthcare workers. RESULTS Areas related to patient as well as institutional level issues challenged the referral processes. At the patients' level, financial constraints, fears associated with referral and patients' non-compliance with referrals were identified as challenges that delayed the referral process. With regard to institutional challenges, the following emerged: referral transportation challenges, poor attitudes of service providers, low staff strength and healthcare bureaucracies. CONCLUSION We conclude that in order for obstetric referrals in rural Ghana to be effective and timely, there is the need to raise more awareness about the need for patients to comply with referral directives, through health education messages and campaigns. Given our findings on the delays associated with long deliberations, the study recommends the training of more cadre of healthcare providers to facilitate obstetric referral processes. Such an intervention would help to improve the current low staff strength. Also, there is a need to improve ambulatory services in rural communities to counteract the challenges that poor transportation system poses on obstetric referrals.
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Affiliation(s)
| | | | - Emmanuel Kweku Nakua
- Department of Epidemiology and Biostatistics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Pascal Agbadi
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Sociology and Social Policy, Lingnan University, Hong Kong, Hong Kong
| | - Joshua Okyere
- Department of Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Alex Kumah
- Sene West District Health Directorate, Kwame Danso, Ghana
| | - Jacob Munukpa
- Sene East District Health Directorate, Kajaji, Ghana
| | | | - Nancy Lockhart
- School of Nursing, University of Michigan, Michigan, Ann Abbor, USA
| | - Jody R Lori
- School of Nursing, University of Michigan, Michigan, Ann Abbor, USA
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Coube M, Nikoloski Z, Mrejen M, Mossialos E. Inequalities in unmet need for health care services and medications in Brazil: a decomposition analysis. LANCET REGIONAL HEALTH. AMERICAS 2023; 19:100426. [PMID: 36950032 PMCID: PMC10025415 DOI: 10.1016/j.lana.2022.100426] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/16/2022] [Accepted: 12/21/2022] [Indexed: 06/18/2023]
Abstract
Background Unmet need is a metric used to assess the performance of health care systems throughout the world. One of the primary objectives of the Brazilian health care system is to identify ways to improve the health outcomes of all citizens. To accomplish this challenging goal, the health care system in Brazil will need to identify and eliminate barriers and provide timely and adequate access to health care services to all. Methods This study assessed the performance of the Brazilian health care system by focusing on the unmet need for health care services and medications. We evaluated the Brazilian National Health Survey data collected in 2013 and 2019 to determine the magnitude of socioeconomic-related inequalities associated with unmet health care needs. Primary contributing factors were identified via decomposition analysis of the calculated concentration indices (CInds). Findings Despite the availability of universal health care, 3.8% and 7.5% of the population in Brazil reported unmet needs for health care services and medications, respectively in the 2019 survey. Although the overall unmet need for medications remained unchanged between 2013 and 2019, CInd analysis revealed significant pro-poor inequalities with respect to unmet needs for both health care services and medications. The overall magnitude of these inequalities was higher in the poorer regions of the country. The use of private health insurance as well as individual health and socioeconomic status contributed significantly to the inequalities associated with unmet needs for health care services and medication throughout Brazil. Interpretations Policy interventions should focus on improving access to health care services, extending coverage to include pharmaceuticals, and targeting both financial and non-financial barriers to obtaining care, particularly those experienced by the poor and vulnerable populations in Brazil. Funding None.
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Affiliation(s)
- Maíra Coube
- Fundação Getúlio Vargas, São Paulo, Brazil
- Instituto de Estudos para Políticas de Saúde (IEPS), São Paulo, Brazil
| | - Zlatko Nikoloski
- Department of Health Policy, London School of Economics and Political Science, London, WC2A 2AE, United Kingdom
| | - Matías Mrejen
- Instituto de Estudos para Políticas de Saúde (IEPS), São Paulo, Brazil
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, London, WC2A 2AE, United Kingdom
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15
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Stevelink SAM, Phillips A, Broadbent M, Boyd A, Dorrington S, Jewell A, Leal R, Bakolis I, Madan I, Hotopf M, Fear NT, Downs J. Linking electronic mental healthcare and benefits records in South London: design, procedure and descriptive outcomes. BMJ Open 2023; 13:e067136. [PMID: 36792321 PMCID: PMC9950921 DOI: 10.1136/bmjopen-2022-067136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVES To describe the process and outcomes of a data linkage between electronic secondary mental healthcare records from the South London and Maudsley (SLaM) NHS Foundation Trust with benefits records from the Department for Work and Pensions (DWP). We also describe the mental health and benefit profile of patients who were successfully linked. DESIGN A deterministic linkage of routine records from health and welfare government service providers within a secure environment. SETTING AND PARTICIPANTS Adults aged≥18 years who were referred to or accessed treatment at SLaM services between January 2007 and June 2019, including those who were treated as part of Improving Access to Psychological Therapies (IAPT) services between January 2008 and June 2019 (n=448 404). Benefits data from the DWP from January 2005 to June 2020. OUTCOME MEASURES The linkage rate and associated sociodemographic, diagnostic and treatment factors. Recorded primary psychiatric diagnosis based on International Classification of Diseases (ICD)-10 codes and type of benefit receipt. RESULTS A linkage rate of 92.3% was achieved. Women, younger patients and those from ethnic minority groups were less likely to be successfully linked. Patients who had subsequently died, had a recorded primary psychiatric diagnosis, had also engaged with IAPT and had a higher number of historical postcodes available were more likely to be linked. Overall, 83% of patients received benefits at some point between 2005 and 2020. Benefit receipt across the psychiatric diagnosis spectrum was high, over 80% across most ICD-10 codes. CONCLUSIONS This data linkage is the first of its kind in the UK demonstrating the use of routinely collected mental health and benefits data. Benefit receipt was high among patients accessing SLaM services and varied by psychiatric diagnosis. Future areas of research are discussed, including exploring the effectiveness of interventions for helping people into work and the impact of benefit reforms.
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Affiliation(s)
- Sharon A M Stevelink
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Ava Phillips
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Matthew Broadbent
- South London and Maudsley Mental Health NHS Trust, NIHR Maudsley Biomedical Research Centre, London, UK
| | - Andy Boyd
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Dorrington
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley Mental Health NHS Trust, NIHR Maudsley Biomedical Research Centre, London, UK
| | - Amelia Jewell
- South London and Maudsley Mental Health NHS Trust, NIHR Maudsley Biomedical Research Centre, London, UK
| | - Ray Leal
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Ioannis Bakolis
- Centre for Implementation Science, Health Services and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Department of Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Ira Madan
- Department of Occupational Health, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- King's College London, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley Mental Health NHS Trust, NIHR Maudsley Biomedical Research Centre, London, UK
| | - Nicola T Fear
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Academic Department of Military Mental Health, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Johnny Downs
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley Mental Health NHS Trust, NIHR Maudsley Biomedical Research Centre, London, UK
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Chen C, Yip HT, Leong KH, Yao WC, Hung CL, Su CH, Kuo CF, Tsai SY. Presence of depression and anxiety with distinct patterns of pharmacological treatments before the diagnosis of chronic fatigue syndrome: a population-based study in Taiwan. J Transl Med 2023; 21:98. [PMID: 36755267 PMCID: PMC9907887 DOI: 10.1186/s12967-023-03886-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/11/2023] [Indexed: 02/10/2023] Open
Abstract
OBJECTIVE An increased prevalence of psychiatric comorbidities (including depression and anxiety disorder) has been observed among patients with chronic fatigue syndrome (CFS). However, few studies have examined the presence of depression and anxiety disorder before the diagnosis of CFS. This study aimed to clarify the preexisting comorbidities and treatments associated with patients with subsequent CFS diagnosis in a population-based cohort in Taiwan. METHODS An analysis utilizing the National Health Insurance Research Database of Taiwan was conducted. Participants included were 6303 patients with CFS newly diagnosed between 2000 and 2010 and 6303 age-/sex-matched controls. RESULTS Compared with the control group, the CFS group had a higher prevalence of depression and anxiety disorder before the diagnosis of CFS. Sampled patients who took specific types of antidepressants, namely, selective serotonin reuptake inhibitors (adjusted odds ratio [aOR] = 1.21, 95% confidence interval [CI] 1.04-1.39), serotonin antagonists and reuptake inhibitors (SARI; aOR = 1.87, 95% CI 1.59-2.19), and tricyclic antidepressants (aOR = 1.46, 95% CI 1.09-1.95), had an increased risk of CFS. CFS risk was also higher among participants taking benzodiazepine, muscle relaxants, and analgesic drugs. A sub-group analysis revealed that SARI use was related to an increased risk of CFS in the depression, anxiety disorder, male, and female groups. In the depression and anxiety disorder groups, analgesic drug use was associated with an increased CFS risk. Nonpharmacological treatment administration differed between men and women. CONCLUSION This population-based retrospective cohort study revealed an increased risk of CFS among populations with preexisting depression and anxiety disorder, especially those taking SARI and analgesic drugs.
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Affiliation(s)
- Chi Chen
- grid.412094.a0000 0004 0572 7815Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Hei-Tung Yip
- grid.411508.90000 0004 0572 9415Management Office for Health Data, China Medical University Hospital, Taichung, 404 Taiwan
| | - Kam-Hang Leong
- grid.452449.a0000 0004 1762 5613Department of Medicine, MacKay Medical College, New Taipei City, 252 Taiwan ,grid.413593.90000 0004 0573 007XDepartment of Laboratory Medicine, MacKay Memorial Hospital, Taipei, 104 Taiwan
| | - Wei-Cheng Yao
- grid.415675.40000 0004 0572 8359Department of Anesthesiology and Pain Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Chung-Lieh Hung
- grid.452449.a0000 0004 1762 5613Institute of Biomedical Sciences, MacKay Medical College, New Taipei City, Taiwan
| | - Ching-Huang Su
- grid.413593.90000 0004 0573 007XDepartment of Laboratory Medicine, MacKay Memorial Hospital, Taipei, 104 Taiwan
| | - Chien-Feng Kuo
- grid.452449.a0000 0004 1762 5613Department of Medicine, MacKay Medical College, New Taipei City, 252 Taiwan ,Department of Nursing, Nursing and Management, MacKay Junior College of Medicine, New Taipei City, 25245 Taiwan ,grid.413593.90000 0004 0573 007XDivision of Infectious Diseases, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shin-Yi Tsai
- Department of Medicine, MacKay Medical College, New Taipei City, 252, Taiwan. .,Department of Laboratory Medicine, MacKay Memorial Hospital, Taipei, 104, Taiwan. .,Institute of Biomedical Sciences, MacKay Medical College, New Taipei City, Taiwan. .,Institute of Long-Term Care, MacKay Medical College, New Taipei City, Taiwan. .,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
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Effects of a transitional care intervention on readmission among older medical inpatients: a quasi-experimental study. Eur Geriatr Med 2023; 14:131-144. [PMID: 36564644 PMCID: PMC9902414 DOI: 10.1007/s41999-022-00730-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/07/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the effect of a transitional care intervention (TCI) on readmission among older medical inpatients. METHODS This non-randomised quasi-experimental study was conducted at Horsens Regional Hospital in Denmark from 1 February 2017 to 31 December 2018. Inclusion criteria were patients ≥ 75 years old admitted for at least 48 h. First, patients were screened for eligibility. Then, the allocation to the intervention or control group was performed according to the municipality of residence. Patients living in three municipalities were offered the hospital-based intervention, and patients living in a fourth municipality were allocated to the control group. The intervention components were (1) discharge transportation with a home visit, (2) a post-discharge cross-sectorial video conference and (3) seven-day telephone consultation. The primary outcome was 30-day unplanned readmission. Secondary outcomes were 30- and 90-day mortality and days alive and out of hospital (DAOH). RESULTS The study included 1205 patients (intervention: n = 615; usual care: n = 590). In the intervention group, the median age was 84.3 years and 53.7% were females. In the control group, the median age was 84.9 years and 57.5% were females. The 30-day readmission rates were 20.8% in the intervention group and 20.2% in the control group. Adjusted relative risk was 1.00 (95% confidence interval: 0.80, 1.26; p = 0.99). No significant difference was found between the groups for the secondary outcomes. CONCLUSION The TCI did not impact readmission, mortality or DAOH. Future research should conduct a pilot test, address intervention fidelity and consider real-world challenges. TRIAL REGISTRATION Clinical trial number: NCT04796701. Registration date: 24 February 2021.
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O'Neill A, Baldwin D, Cortese S, Sinclair J. Impact of intrawork rest breaks on doctors' performance and well-being: systematic review. BMJ Open 2022; 12:e062469. [PMID: 36517098 PMCID: PMC9756173 DOI: 10.1136/bmjopen-2022-062469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To summarise evidence on intrawork breaks and their associated effect on doctors' well-being and/or performance at work. DESIGN Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement guidelines DATA SOURCES: Embase, PubMed, Web of Science (Core Collection) and PsychINFO were systematically searched on 6 June 2021. ELIGIBILITY CRITERIA No restrictions were placed on language, study design or date of publication. DATA EXTRACTION AND ANALYSIS Methodological quality was appraised using Cochrane's Risk of Bias (ROB-2), Cochrane's Risk of Bias in Non-randomised Studies (ROBINS-I), and the Johanna Briggs Institute (JBI) checklists for cross-sectional, cohort and qualitative studies. Quantitative synthesis was not undertaken due to substantial heterogeneity of design and outcomes. Results are presented narratively. RESULTS Database searches returned 10 557 results and searches of other sources returned two additional records. Thirty-two papers were included in the systematic review, comprised of 29 unique studies, participants and topics and 3 follow-up studies. A variety of well-being and performance outcome measures were used. Overall, findings indicate that intrawork breaks improved some measures of well-being and/or work performance. However, methodological quality was judged to be low with a high risk of bias in most included studies. DISCUSSION Using existing evidence, it is not possible to conclude with confidence whether intrawork breaks improve well-being and/or work performance in doctors. There is much inconsistency regarding how breaks are defined, measured and the outcomes used to assess effectiveness. Future research should seek to: (a) define and standardise the measurement of breaks, (b) use valid, reliable outcome measures to evaluate their impact on well-being and performance and (c) minimise the risk of bias in studies where possible. PROSPERO REGISTRATION NUMBER CRD42020156924; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=156924.
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Affiliation(s)
- Aimee O'Neill
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - David Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- University Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Samuele Cortese
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
| | - Julia Sinclair
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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Zeinolabedini M, Heidarnia A, Shakerinejad G, Motlagh ME. Perceived job demands: a qualitative study of workplace stress in the Iranian healthcare workers (HCWs). BMJ Open 2022; 12:e061925. [PMID: 36385035 PMCID: PMC9670948 DOI: 10.1136/bmjopen-2022-061925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Work-related stress is a common risk factor among healthcare workers (HCWs). In Iran, the healthcare system has undergone extensive changes to develop services. Organisational change has led to the creation of new working conditions for HCWs. The purpose of this study is to identify job demands that health workers perceive as stressors. DESIGN As a qualitative study, semistructured interviews, a focus group, and related data were analysed both inductively and deductively with reference to the job demand component based on the job demands-resources model and MAXQDA. SETTING This investigation was conducted in 18 primary healthcare centres in Qazvin, Iran. PARTICIPANT Twenty-one female HCWs with at least 6 months of work experience and an average age of 34.4 years. RESULTS The participants identified six key elements as the stressful job demands including organisation's supervisory function, role characteristics, workload, job insecurity, client service challenges and perceived job content. CONCLUSIONS After organisational changes and development, HCWs were faced with role changes and increased workload. In addition, organisational supervision in terms of quantity and quality and lack of job security intensified the pressures. These factors led to the high level of stress among employees who dealt with people and those who perceived their job content as unfavourable. Perhaps teaching stress control skills and organisational support interventions can be useful to reduce and control stress among HCWs.
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Affiliation(s)
- Masoume Zeinolabedini
- Department of Health Education and Health Promotion, Faculty of Medical Sciences, Tarbiat Modares University (TMU), Tehran, Iran (the Islamic Republic of)
| | - Alireza Heidarnia
- Department of Health Education and Health Promotion, Faculty of Medical Sciences, Tarbiat Modares University (TMU), Tehran, Iran (the Islamic Republic of)
| | - Ghodratollah Shakerinejad
- Health Education Research Department, Academic Center for Education, Culture and Research (ACECR)-Khuzestan, Ahvaz, Iran (the Islamic Republic of)
| | - Mohammad Esmaeil Motlagh
- Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran (the Islamic Republic of)
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Specificity of severe AKI aetiology and care in the elderly. The IRACIBLE prospective cohort study. J Nephrol 2022; 35:2097-2108. [PMID: 35503200 DOI: 10.1007/s40620-022-01322-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/26/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Acute Kidney Injury (AKI) is increasingly common in people over 65 years of age, but its causes and management are poorly described. The purpose of this study was to describe the causes, management and prognosis of patients over 65 hospitalised for severe acute kidney injury (AKI) in all departments of a tertiary centre. METHOD The prospective IRACIBLE (IRA: AKI in French; CIBLE: target in French) cohort included 480 patients hospitalised at a university hospital over 18 months for severe AKI or subgroup of AKIN3 (Acute Kidney Injury Network classification) defined by an acute creatinine increase > 354 μmol/L or managed with acute renal replacement therapy (RRT). The history, aetiology of AKI, management, and prognosis were compared in three age groups: < 65, 65-75, and > 75 years. RESULTS The study population included 480 subjects (73% men) with a median body mass index (BMI) of 26.6 kg/m2 [23.3, 30.9], 176 (37%) diabetic patients, 124 (26%) patients < 65 years, 150 (31%) 65-75 years and 206 (43%) > 75 years. Increasing age class was associated with more comorbidities, a significantly lower median estimated glomerular filtration rate (eGFR) 6 months before inclusion (82; 62; 46 ml/min/1.73 m2, p < 0.05) and aetiology of AKI, which was more often obstructive (12%; 15%; 23%, p = 0.03) or part of a cardio-renal syndrome (6%; 9%; /15%, p = 0.04). Older patients were less often managed in the intensive care unit (54%; 47%; 24%, p < 0.0001), were less frequently treated by RRT (52%; 43%; 31%, p < 0.001) and received fewer invasive treatments (6%; 9%; 22%, p < 0.0001). Older survivors returned home less often (80%; 73%; 62%, p = 0.05) in favour of transfers to rehabilitation services (10%; 13%; 22%) with higher mortality at 3 months (35%; 32%; 50%, p < 0.0001). CONCLUSION Older patients hospitalised for severe AKI have a specific profile with more comorbidities, lower baseline renal function, an aetiology of AKI of mainly extra-parenchymal causes and a complex pathway of care with an overall poor prognosis.
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Xu D, Lewis T, Rurka M, Arling G. Approach to systematically examine the usefulness of quality measures in practice: Minnesota's nursing home quality indicators and scoring approach. BMJ Qual Saf 2022; 32:319-329. [PMID: 36192147 DOI: 10.1136/bmjqs-2021-014384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 08/29/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Healthcare quality measurement systems, which use aggregated patient-level quality measures to assess organisational performance, have been introduced widely. Yet, their usefulness in practice has received scant attention. Using Minnesota nursing home quality indicators (QIs) as a case example, we demonstrate an approach for systematically evaluating QIs in practice based on: (a) parsimony and relevance, (b) usability in discriminating between facilities, (c) actionability and (d) construct validity. METHODS We analysed 19 risk-adjusted, facility-level QIs over the 2012-2019 period. Parsimony and relevance of QIs were evaluated using scatter plots, Pearson correlations, literature review and expert opinions. Discrimination between facilities was assessed by examining facility QI distributions and the impact of the distributions on scoring. Actionability of QIs was assessed through QI trends over time. Construct validity was assessed through exploratory factor analysis of domain structure for grouping the QIs. RESULTS Correlation analysis and qualitative assessment led to redefining one QI, adding one improvement-focused QI, and combining two highly correlated QIs to improve parsimony and clinical relevance. Ten of the QIs displayed normal distributions which discriminated well between the best and worst performers. The other nine QIs displayed poor discrimination; they had skewed distributions with ceiling or floor effects. We recommended scoring approaches tailored to these distributions. One QI displaying substantial improvement over time was recommended for retirement (physical restraint use). Based on factor analysis, we grouped the 18 final QIs into four domains: incontinence (4 QIs), physical functioning (4 QIs), psychosocial care (4 QIs) and care for specific conditions (6 QIs). CONCLUSION We demonstrated a systematic approach for evaluating QIs in practice by arriving at parsimonious and relevant QIs, tailored scoring to different QI distributions and a meaningful domain structure. This approach could be applied in evaluating quality measures in other health or long-term care settings.
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Affiliation(s)
- Dongjuan Xu
- School of Nursing, Purdue University, West Lafayette, Indiana, USA
| | - Teresa Lewis
- Nursing Facility Rates and Policy Division, Minnesota Department of Human Services, Saint Paul, Minnesota, USA
| | - Marissa Rurka
- Department of Sociology, Purdue University, West Lafayette, Indiana, USA
| | - Greg Arling
- School of Nursing, Purdue University, West Lafayette, Indiana, USA
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22
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Seidman AJ, Wade NG, Geller J. The effects of group counseling and self-affirmation on stigma and group relationship development: A replication and extension. J Couns Psychol 2022; 69:701-710. [PMID: 35324220 PMCID: PMC10037926 DOI: 10.1037/cou0000614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The stigma of seeking counseling and negative attitudes about counseling are primary barriers to its use. In the only known study examining the utility of attending a group counseling session to ameliorate stigma (no control group), participation was associated with reductions in self-stigma (Wade et al., 2011). Self-affirmation interventions have shown promising results in reducing stigma and promoting positive expectations about counseling, but no research has examined its effects on a counseling session. In the present, two-part study, 172 college students who had previously completed an online screening survey, including measures of stigma, participated in a single session of group counseling at a mental health clinic. Upon arrival, participants completed a self-affirmation intervention before viewing psychoeducation (n = 66; 12 groups) or only viewed psychoeducation (n = 72; 14 groups); both groups then completed a session of group counseling. After, participants completed these same measures along with measures of group relationships. The remaining participants (n = 34; 7 groups) viewed psychoeducation and completed the same stigma measures before being informed of randomization to the wait-list control condition. Our results replicate and extend findings from Wade et al. (2011): Completing a single session of group counseling reduced self-stigma and promoted positive attitudes toward counseling. Further, completing self-affirmation reduced postsession perceptions of public stigma. Self-affirmation had no impact on group relationships. Overall, findings suggest the utility of offering a "try-out" session of group counseling as a stigma-reduction intervention; preceding with a brief self-affirmation intervention provides further benefits by reducing perceptions of public stigma. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | | | - Jason Geller
- Rutgers University, Center for Cognitive Science
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Fute A, Sun B, Oubibi M. Assessing Teaching Compassion, Work Engagement and Compassion Fatigue Among Teachers During the Pandemic. Psychol Res Behav Manag 2022; 15:2561-2571. [PMID: 36124334 PMCID: PMC9482458 DOI: 10.2147/prbm.s383292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/03/2022] [Indexed: 01/28/2023] Open
Abstract
Introduction Teachers' mental health is an imperative aspect in ensuring their appropriate cognition, behaviors and perception. Studies have reported mixed results on work engagement and compassion fatigue among employees in different time and cultures. This study assesses and examines the correlation between Chinese teachers' work engagement and compassion fatigue during the pandemic. Methods An online questionnaire was designed through a Chinese data collection platform (Credamo), and the sample of 3147 teachers in Zhejiang province (China) completed the survey online. The Utrecht Work Engagement Scale (UWES) was used to measure teachers' work engagement (WE), while the Professional Quality of Life Scale version 5 (ProQoL-5) was used to measure teachers' compassion fatigue (CF). SPSS 25, PROCESS Macro of SPSS, and JASP were used to analyze the data. Results The results indicated a negative correlation between teachers' work engagement and compassion fatigue in general, while particularly, vigor, dedication, and absorption negatively correlated with burnout (r = -0.370, r = -0.243, and r = -0.220 respectively), but positively correlating with secondary traumatic stress (r = 0.489, r = 0.343, and r = 0.319). Discussion Teachers' working experience positively correlates with their work engagement but negatively correlates with their compassion fatigue. Conclusion Teachers' work engagement (ie, dedication) is important in reducing compassion fatigue and maintaining compassion satisfaction.
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Affiliation(s)
- Antony Fute
- College of Teacher Education, Zhejiang Normal University, Jinhua, People’s Republic of China
| | - Binghai Sun
- College of Teacher Education, Zhejiang Normal University, Jinhua, People’s Republic of China
| | - Mohamed Oubibi
- College of Teacher Education, Zhejiang Normal University, Jinhua, People’s Republic of China
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Adnan NBB, Dafny HA, Baldwin C, Jakimowitz S, Chalmers D, Aroury AMA, Chamberlain D. What are the solutions for well-being and burn-out for healthcare professionals? An umbrella realist review of learnings of individual-focused interventions for critical care. BMJ Open 2022; 12:e060973. [PMID: 36691206 PMCID: PMC9462087 DOI: 10.1136/bmjopen-2022-060973] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 08/18/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To determine what, how, for whom and under what conditions individual-focused interventions are effective to improve well-being and decrease burn-out among critical care healthcare professionals. DESIGN This study is an umbrella review that used the realist approach, using Realist and Meta-narrative Evidence Synthesis: Evolving Standards guidelines. PsycINFO, Web of Science, CINAHL, MEDLINE, Scopus, ClinicalTrials.gov and ISRCTN databases were searched for published and unpublished systematic reviews and meta-analyses literature between 2016 and 2020. The team appraised and extracted data and identified relationships between content, mechanism and outcomes (CMOs). Theory prepositions were developed using CMOs and were used to refine the existing programme. RESULTS A total of 81 interventions from 17 reviews were mapped, including mindfulness interventions, cognitive-behavioural therapy, self-care and coping strategies. The revised programme theory determined that contextual factors such as ethnicity, workload, and work schedules play a crucial role in determining the effectiveness of interventions. Mechanisms including the interventions' interests, acceptance, and receptivity are also influential in determining engagement and adherence to the intervention. Findings suggest that the solution for burn-out is complex. However, it offers an optimistic view of tailoring and customising one or a combination of interventions, integrating structured education and components of emotional intelligence. Self-care, social support, awareness or mindfulness and self-efficacy are prime components to improve emotional intelligence and resilience for critical care healthcare professionals to improve well-being and decrease burn-out experience. CONCLUSIONS These findings provide realistic and reliable reporting of outcomes to better support implementation within the 'real world'. Future research such as seeking validation using expert opinions can provide further in depth understanding of hidden contextual factors, mechanisms and their interactions to provide a greater depth of knowledge ready for application with the critical care population.
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Affiliation(s)
- Nurul Bahirah Binte Adnan
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Flinders University Caring Futures Institute, Bedford Park, South Australia, Australia
| | - Hila Ariela Dafny
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Flinders University Caring Futures Institute, Bedford Park, South Australia, Australia
| | - Claire Baldwin
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Flinders University Caring Futures Institute, Bedford Park, South Australia, Australia
| | - Samantha Jakimowitz
- School of Nursing and Midwifery, University of Technology Sydney, Sydney, New South Wales, Australia
| | | | - Ammar Moh'd Ahmad Aroury
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Flinders University Caring Futures Institute, Bedford Park, South Australia, Australia
| | - Diane Chamberlain
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Flinders University Caring Futures Institute, Bedford Park, South Australia, Australia
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de Walque D, Kandpal E. Reviewing the evidence on health financing for effective coverage: do financial incentives work? BMJ Glob Health 2022; 7:bmjgh-2022-009932. [PMID: 36130774 PMCID: PMC9490608 DOI: 10.1136/bmjgh-2022-009932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022] Open
Abstract
The widening gap between improving healthcare coverage rates and stagnating health outcomes across low-income and middle-income countries highlights the need for investments in quality of care, in addition to access. New research, presented in a World Bank report, examines one type of relevant policy reform: performance-based financing (PBF), which is a package reform that always includes performance pay to front-line health workers and often also provides facility autonomy, transparency and community engagement. A large body of rigorous studies and new analysis show that in under-resourced, centralised health systems, PBF can result in gains to service utilisation, but only has limited impacts on quality. Even the relative benefits of PBF on service utilisation are less clear when compared with (1) direct facility financing which provides front-line facilities with operating budgets and provider autonomy, but not performance pay and (2) demand-side financial support for health services (ie, conditional cash transfers and vouchers). Thus, the central component of PBF—the performance pay—appears to add little value over flexible payment systems and provider autonomy. The analysis shows that this lack of impact is unsurprising because most of the constraints to improving quality do not lie with the health worker in these settings. While PBF was conceived as a complex package ‘blueprint’, we review the evidence to conclude that only some elements seem to make sense. To improve quality of care, health financing should pivot from performance pay while retaining the elements of direct facility financing, autonomy, transparency and community engagement.
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Affiliation(s)
- Damien de Walque
- Development Research Group, World Bank, Washington, District of Columbia, USA
| | - Eeshani Kandpal
- Development Research Group, World Bank, Washington, District of Columbia, USA
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Carradore M, Guasconi M, Giusti GD, Artioli G, Sarli L. Re-evaluation of the interprofessional collaboration scale validation between nurses towards other health care professionals occupied in Italian emergency medical services. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022287. [PMID: 36043951 PMCID: PMC9534248 DOI: 10.23750/abm.v93i4.13514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIM Interprofessional collaboration (IPC) between health professionals is fundamental for the provision of an efficient and effective medical care service. This is especially so in states of emergency, as highlighted by the ongoing coronavirus disease 2019 pandemic. This study aimed to obtain further evidence regarding the validity and reliability of the Italian language IPC scale -an instrument for measuring interprofessional collaboration- in a setting that has yet to be investigated at an in-depth level: the emergency departments in Italian hospitals. METHODS The survey tool was a structured questionnaire in the Italian language. It comprised the validated Italian version of the IPC scale plus a question concerning the frequency of collaborations between the nurses interviewed and other health professionals. Confirmatory factor analysis was applied to rate the three factors ("communication", "accommodation" and "isolation") that compose the scale. RESULTS Four hundred thirty-six nurses working in an emergency department for at least one year completed the questionnaire, which assessed collaboration with other health professionals working in the same department. The model fit statistics are satisfactory for all the nurse-target group combinations analysed. Regarding the Cronbach's alpha statistic used to compute the reliability of the scale, acceptable values were obtained for all items, except for those related to the isolation factor for each case of interprofessional collaboration considered. CONCLUSIONS The results confirm the validity of the IPC scale as an instrument for the assessment of interprofessional collaboration involving nurses and other workers occupied in the provision of healthcare in Italian emergency departments.
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Affiliation(s)
- Marco Carradore
- University of Verona, Department of Cultures and Civilizations, Verona, Italy.
| | - Massimo Guasconi
- University of Parma, Department of Medicine and Surgery, Parma, Italy; "Azienda Unità Sanitaria Locale" (Local Health Service) di Piacenza, Piacenza, Italy; .
| | - Gian Domenico Giusti
- University of Perugia, Department of Medicine and Surgery, Perugia, Italy; "Azienda Ospedaliera" (Local Health Service) di Perugia, Department of Teaching and Quality, Perugia, Italy.
| | - Giovanna Artioli
- University of Parma, Department of Medicine and Surgery, Parma, Italy.
| | - Leopoldo Sarli
- University of Parma, Department of Medicine and Surgery, Parma, Italy.
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Flannery C, Dennehy R, Riordan F, Cronin F, Moriarty E, Turvey S, O'Connor K, Barry P, Jonsson A, Duggan E, O'Sullivan L, O'Reilly É, Sinnott SJ, McHugh S. Enhancing referral processes within an integrated fall prevention pathway for older people: a mixed-methods study. BMJ Open 2022; 12:e056182. [PMID: 35985777 PMCID: PMC9396121 DOI: 10.1136/bmjopen-2021-056182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Multifactorial interventions, which involve assessing an individual's risk of falling and providing treatment or onward referral, require coordination across settings. Using a mixed-methods design, we aimed to develop a process map to examine onward referral pathways following falls risk assessment in primary care. SETTING Primary care fall risk assessment clinics in the South of Ireland. PARTICIPANTS Focus groups using participatory mapping techniques with primary care staff (public health nurses (PHNs), physiotherapists (PT),and occupational therapists (OT)) were conducted to plot the processes and onward referral pathways at each clinic (n=5). METHODS Focus groups were analysed in NVivo V.12 using inductive thematic analysis. Routine administrative data from January to March 2018 included details of client referrals, assessments and demographics sourced from referral and assessment forms. Data were analysed in Stata V.12 to estimate the number, origin and focus of onward referrals and whether older adults received follow-up interventions. Quantitative and qualitative data were analysed separately and integrated to produce a map of the service. RESULTS Nine staff participated in three focus groups and one interview (PHN n=2; OT n=4; PT n=3). 85 assessments were completed at five clinics (female n=69, 81.2%, average age 77). The average number of risk factors was 5.4 out of a maximum of 10. Following assessment, clients received an average of three onward referrals. Only one-third of referrals (n=135/201, 33%) had data available on intervention receipt. Primary care staff identified variations in how formally onward referrals were managed and barriers, including a lack of client information, inappropriate referral and a lack of data management support. CONCLUSION Challenges to onward referral manifest early in an integrated care pathway, such as clients with multiple risk factors sent for initial assessment and the lack of an integrated IT system to share information across settings.
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Affiliation(s)
- Caragh Flannery
- School of Public Health, University College Cork, Cork, Ireland
| | - Rebecca Dennehy
- School of Public Health, University College Cork, Cork, Ireland
| | - Fiona Riordan
- School of Public Health, University College Cork, Cork, Ireland
| | - Finola Cronin
- Corks Falls Prevention Service, Health Service Executive, Naas, Ireland
| | - Eileen Moriarty
- School of Public Health, University College Cork, Cork, Ireland
- National Services for Older Persons Team, Health Service Executive, Naas, Ireland
| | - Spencer Turvey
- Cork Kerry Community Healthcare, Health Service Executive, Naas, Ireland
| | - Kieran O'Connor
- Geriatric Medicine, Mercy University Hospital, Cork, Ireland
| | - Patrick Barry
- Acute Medicine and Geriatric Medicine, Cork University Hospital Group, Cork, Ireland
| | | | - Eoin Duggan
- Geriatric Medicine, Mercy University Hospital, Cork, Ireland
- Mercers Institute for Successful Ageing, Saint James's Hospital, Dublin, Ireland
| | - Liz O'Sullivan
- Cork Kerry Community Healthcare HSE South, Health Service Executive, Dublin, Ireland
| | - Éilis O'Reilly
- School of Public Health, University College Cork, Cork, Ireland
| | - Sarah-Jo Sinnott
- Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
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McAiney C, Markle-Reid M, Ganann R, Whitmore C, Valaitis R, Urajnik DJ, Fisher K, Ploeg J, Petrie P, McMillan F, McElhaney JE. Implementation of the Community Assets Supporting Transitions (CAST) transitional care intervention for older adults with multimorbidity and depressive symptoms: A qualitative descriptive study. PLoS One 2022; 17:e0271500. [PMID: 35930542 PMCID: PMC9355229 DOI: 10.1371/journal.pone.0271500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/01/2022] [Indexed: 11/24/2022] Open
Abstract
Background Older adults with multimorbidity experience frequent care transitions, particularly from hospital to home, which are often poorly coordinated and fragmented. We conducted a pragmatic randomized controlled trial to test the implementation and effectiveness of Community Assets Supporting Transitions (CAST), an evidence-informed nurse-led intervention to support older adults with multimorbidity and depressive symptoms with the aim of improving health outcomes and enhancing transitions from hospital to home. This trial was conducted in three sites, representing suburban/rural and urban communities, within two health regions in Ontario, Canada. Purpose This paper reports on facilitators and barriers to implementing CAST. Methods Data collection and analysis were guided by the Consolidated Framework for Implementation Research framework. Data were collected through study documents and individual and group interviews conducted with Care Transition Coordinators and members from local Community Advisory Boards. Study documents included minutes of meetings with research team members, study partners, Community Advisory Boards, and Care Transition Coordinators. Data were analyzed using content analysis. Findings Intervention implementation was facilitated by: (a) engaging the community to gain buy-in and adapt CAST to the local community contest; (b) planning, training, and research meetings; (c) facilitating engagement, building relationships, and collaborating with local partners; (d) ensuring availability of support and resources for Care Transition Coordinators; and (e) tailoring of the intervention to individual client (i.e., older adult) needs and preferences. Implementation barriers included: (a) difficulties recruiting and retaining intervention staff; (b) difficulties engaging older adults in the intervention; (c) balancing tailoring the intervention with delivering the core intervention components; and (c) Care Transition Coordinators’ challenges in engaging providers within clients’ circles of care. Conclusion This research enhances our understanding of the importance of considering intervention characteristics, the context within which the intervention is being implemented, and the processes required for implementing transitional care intervention for complex older adults.
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Affiliation(s)
- Carrie McAiney
- School of Public Health Sciences, University of Waterloo and Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
- * E-mail:
| | - Maureen Markle-Reid
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Rebecca Ganann
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Carly Whitmore
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Ruta Valaitis
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Diana J. Urajnik
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, Ontario, Canada
| | - Kathryn Fisher
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Jenny Ploeg
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Penelope Petrie
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Fran McMillan
- Centre for Rural and Northern Health Research, Laurentian University, Sudbury, Ontario, Canada
| | - Janet E. McElhaney
- Northern Ontario School of Medicine and Health Sciences North Research Institute, Sudbury, Ontario, Canada
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Cross-sectional associations of personal efforts and beliefs and depressive symptoms among older adults in India. Sci Rep 2022; 12:13194. [PMID: 35915137 PMCID: PMC9343383 DOI: 10.1038/s41598-022-17578-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/27/2022] [Indexed: 11/21/2022] Open
Abstract
Whilst there is growing evidence on the increased vulnerability of older adults to depression, there is limited research on potentially mitigative factors against symptoms of depression at a population level. This research examined associations of possible protective factors (personal efforts and beliefs) and depressive symptoms among older adults in India. This cross-sectional study used data from the Longitudinal Aging Study in India with 31,464 respondents aged 60 years and above. Depressive symptoms were assessed using the 10-item Centre for Epidemiologic Studies Depression Scale. Multivariable linear regression was used while exploring the associated factors of depressive symptoms. The mean score of depressive symptoms was 2.94 (CI 2.92, 2.96). Older adults who engaged in moderate [aCoef: −0.11, CI −0.18, −0.05], vigorous [aCoef: −0.09, CI −0.16, −0.03], or both types of physical activity [aCoef: −0.10, CI −0.19, −0.02] had lower likelihood of depressive symptoms in comparison to those who were physically inactive. Older adults who participated in social activities were less likely to have depressive symptoms [aCoef: −0.44, CI −0.50, −0.39] compared to their socially inactive counterparts. Further, older adults who perceived religion as very important [aCoef: −0.29, CI −0.41, −0.17], who had high life satisfaction [aCoef: −0.78, CI −0.82, −0.73], who had good self-perceived health [aCoef: −0.29, CI −0.33, −0.25] and those who had high self-perceived social standing [aCoef: −0.39, CI −0.47, −0.31] had lower likelihood of depressive symptoms in comparison to their respective counterparts. Physical activity, social participation, voluntary work and financial contribution to family, religiosity, life satisfaction, self-perceived health and self-perceived social standing are associated with lower likelihood of depressive symptoms among community-dwelling older adults in this study. Future longitudinal studies should explore these factors that can guide interventions against depression in old age.
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Rizvi Jafree S, Mahmood QK, Mujahid S, Asim M, Barlow J. Narrative synthesis systematic review of Pakistani women's health outcomes from primary care interventions. BMJ Open 2022; 12:e061644. [PMID: 35914906 PMCID: PMC9345069 DOI: 10.1136/bmjopen-2022-061644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 07/07/2022] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Women living in Pakistan have complex health problems including infectious and non-communicable diseases, accident and injuries, and mental health problems. While a majority of these women rely on primary healthcare services for all of their healthcare needs, there has to date been no overview of the extent of their effectiveness. The objective of this review was to (1) synthesise the available evidence regarding the effectiveness of primary care based interventions aimed at improving women's mental and physical health and (2) identify the factors that promote effectiveness for women's health outcomes. METHODS Five academic databases were searched, including PubMed, BMC Medicine, Medline, CINAHL and the Cochrane Library. A search was also made of the grey literature. The quality of included studies was assessed using a standardised critical appraisal tool, and the findings summarised using a narrative synthesis. RESULTS In total, 18 studies were included in the review. Eight involved evaluations of counselling interventions, three health education and awareness interventions, two social and psychosocial interventions, and five were evaluations of combination interventions. Twelve of the included studies were randomised controlled trials. Of these 14 reported significant outcomes, and 4 further interventions showed partially favourable results. However, interventions mostly targeted women's mental or reproductive health. CONCLUSIONS While the evidence is limited in terms of quality and what has been evaluated, a number of interventions appear to be effective in improving outcomes for women. The three key approaches include the adoption of an active door-to-door and group-based approach; utilisation of community peers who can deliver care cost-effectively and who are more accepted in the community; and the integration of financial vouchers to support uptake in poor populations. PROSPERO REGISTRATION NUMBER CRD42020203472.
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Affiliation(s)
| | | | - Sohail Mujahid
- Department of Sociology, University of Chakwal, Chakwal, Punjab, Pakistan
| | - Muhammad Asim
- Department of Community Health Sciences, Aga Khan University Hospital Clinical Laboratories, Karachi, Federal Capital Territory, Pakistan
| | - Jane Barlow
- Department of Social Policy, University of Oxford, Oxford, UK
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Khowaja BMH, Shahil Feroz A, Saleem S. Factors influencing utilisation of services provided by community midwives and their non-retention in district Thatta, Pakistan: a qualitative study protocol. BMJ Open 2022; 12:e052323. [PMID: 35863826 PMCID: PMC9310158 DOI: 10.1136/bmjopen-2021-052323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Drawing on the well-acknowledged evidence of community midwives services to address the issue of high maternal mortality, the Government of Pakistan initiated the Community Midwifery (CMW) programme in 2006 to provide skilled birth attendance to pregnant women living in rural areas. Despite a large investment in CMW programme, the availability of community midwives in rural areas following their training is a constant struggle. The concerns related to the training, support and acceptability of community midwives need to be studied in order to identify gaps in the provision of skilled maternal and newborn healthcare. Therefore, this study aims to explore factors influencing the utilisation of services provided by community midwives and their non-retention in district Thatta, Pakistan. METHODS AND ANALYSIS The study will use a qualitative exploratory research design. The data will be collected through semistructured interviews and an approach of purposive sampling for the selection of participants for interviews. The study will be conducted in one of the rural districts Thatta of Province Sindh, Pakistan. The data will be collected through key informant interviews (KIIs) and in-depth interviews (IDIs). The KIIs will be conducted with officials of the health department (Thatta), the provincial maternal and newborn child health programme, and the Midwifery Association of Pakistan. The IDIs will be conducted with midwifery students, community midwives working and not working in the district, and community women of district Thatta. Data will be analysed through qualitative data analysis software NVivo V.10 and the thematic analysis approach. ETHICS AND DISSEMINATION Ethical approval for this study has been obtained from the Aga Khan University Ethical Review Committee (2020-3391-11138). The results of the study will be disseminated to the scientific community, to policy-makers involved in CMW programme training and implementation, and to the research subjects participating in the study.
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Affiliation(s)
| | | | - Sarah Saleem
- Community Health Sciences, Aga Khan University, Karachi, Pakistan
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Sorra J, Zebrak K, Yount N, Famolaro T, Gray L, Franklin M, Smith SA, Streagle S. Development and pilot testing of survey items to assess the culture of value and efficiency in hospitals and medical offices. BMJ Qual Saf 2022; 31:493-502. [PMID: 34417333 PMCID: PMC9234417 DOI: 10.1136/bmjqs-2020-012407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 08/01/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Given rising costs and changing payment models, healthcare organisations are increasingly focused on value and efficiency. The goal of our study was to develop survey items to assess clinician and staff perspectives about the extent to which the organisational culture in hospitals and medical offices supports value and efficiency. METHODS Development began with a literature review and interviews with experts and clinicians and staff from hospitals and medical offices. We identified key areas of value and efficiency culture, drafted survey items and conducted cognitive testing. Using purposive sampling to select sites, the 36-item surveys were pilot tested in 47 hospitals and 96 medical offices. Psychometric analysis was conducted on data from 3951 hospital respondents (42% response) and 1458 medical office respondents (63% response). RESULTS Factor loadings, multilevel confirmatory factor analysis model fit and reliability estimates were acceptable for the 13 items grouped into 4 composite measures: Empowerment to Improve Efficiency (3 items), Efficiency and Waste Reduction (3 items), Patient Centeredness and Efficiency (3 items) and Management Support for Improving Efficiency and Reducing Waste (4 items). All composite measures were significantly intercorrelated and related to the four Overall Ratings of Healthcare Quality, indicating adequate conceptual convergence among the measures. Eight items assessing Experiences With Activities to Improve Efficiency were also included. CONCLUSION We developed psychometrically sound survey items measuring value and efficiency culture. When added to the Agency for Healthcare Research and Quality Surveys on Patient Safety Culture, the item sets extend those surveys by assessing additional dimensions of organisational culture that affect care delivery. Healthcare organisations can use these item sets to assess how well their organisational culture supports value and efficiency and identify areas for improvement.
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Irandoost SF, Yoosefi Lebni J, Safari H, Khorami F, Ahmadi S, Soofizad G, Ebadi Fard Azar F. Explaining the challenges and adaptation strategies of nurses in caring for patients with COVID-19: a qualitative study in Iran. BMC Nurs 2022; 21:170. [PMID: 35765051 PMCID: PMC9238071 DOI: 10.1186/s12912-022-00937-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 06/10/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Nurses, as the primary human resource in the fight against COVID-19, encounter several obstacles and concerns. As a result, the current study used a qualitative method to describe the problems and adaptation techniques of nurses caring for COVID-19 patients. METHODS The current study used a qualitative conventional content analysis technique with 30 nurses working in COVID-19 wards in Tehran hospitals. Purposive sampling, snowball sampling, and semi-structured interviews were used to get access to participants and gather data. The data was examined using conventional qualitative content analysis and the MAXQDA-18 program. To assess the quality of study findings, Guba and Lincoln's trustworthiness criteria were fulfilled. RESULTS The data analysis revealed two main categories and sixteen subcategories: (1) experiences and challenges (lack of protective equipment, high work pressure, marginalized physical health, problems related to the use of protective equipment, being excluded, a lack of a supportive work environment, problems related to patients, psychological problems, fear, marginalized personal and family life, and the challenge of communicating with patients' families); and (2) adaptation strategies for work conditions (performing religious-spiritual activities, creating an empathetic atmosphere in the workplace, spiritualizing their work, trying to convince the family and gaining their support, and strengthening their sense of self-worth and responsibility). CONCLUSION Nurses' working conditions can be improved by providing adequate protective equipment, a suitable work environment, and more social and financial support; paying more attention to nurses' physical and mental health; and considering appropriate communication mechanisms for nurses to communicate with their families and patients' families.
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Affiliation(s)
- Seyed Fahim Irandoost
- Social Determinants of Health Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Javad Yoosefi Lebni
- Health Education and Promotion, Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Hossein Safari
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran
- School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Farhad Khorami
- Clinical Psychology, Islamic Azad University, Kermanshah Branch, Kermanshah, Iran
| | - Sina Ahmadi
- Department of Social Welfare Management, Social Welfare Management Research Centre, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Goli Soofizad
- School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Zeng Y, Xu W, Tao X. What factors are associated with utilisation of health services for the poor elderly? Evidence from a nationally representative longitudinal survey in China. BMJ Open 2022; 12:e059758. [PMID: 35760535 PMCID: PMC9237900 DOI: 10.1136/bmjopen-2021-059758] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate the status and factors of healthcare service utilisation among the poor elderly in China. METHODS We selected the poor elderly from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2015. The main outcome measures include utilisation indicators for the probability and costs of outpatient/inpatient services. Based on modified Andersen behaviour model, a two-part model is designed to analyse the factors of the health service utilisation of the poor elderly. RESULTS The visit rate of outpatient services increased from 15.05% in 2011 to 21.26% in 2015, and the hospitalisation rate increased from 7.26% to 14.32%. The median cost of outpatient and inpatient services in 2015 for the poor elderly were 350 RMB and 10 000 RMB, respectively, and the out-of-pocket ratios were 85.2% and 53.3%, respectively. 78.44% of the people who actually needed healthcare did not use health services, and the main reason was financial difficulties (42.32%). The poor elderly who are higher educated, have children, live in central regions and have social security and a poor health status and who do not smoke or drink are more likely to use health services. The need factor plays a crucial role in determining health service utilisation. CONCLUSIONS The poor elderly tends to have a worse health status and a heavier medical burden but had a lower utilisation of health services. Predisposing, enabling, need and health behaviour variables should be considered to improve the health service utilisation and the health of the poor elderly.
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Affiliation(s)
- Yanbing Zeng
- School of Public Health, Capital Medical University, Beijing, China
| | - Weiqian Xu
- Tsinghua Shenzhen International Graduate School, Tsinghua university, Shenzhen, China
| | - Xiaomeng Tao
- School of Public Health, Capital Medical University, Beijing, China
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Dessureault M, Dallaire C. Recevoir un soutien aux capacités d’autosoins lors de la transition posthospitalisation en résidence pour aînés en perte d’autonomie : un besoin non comblé. Rech Soins Infirm 2022; 146:19-34. [PMID: 35724020 DOI: 10.3917/rsi.146.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Elderly people who receive appropriate transitional care after hospitalization experience fewer complications. CONTEXT However, in Quebec, transitional care for the elderly is limited to case management and targets elderly people who are in need of resources. This often excludes those who remain in homes for the elderly. OBJECTIVES The objective of this study was to identify the unmet needs of elderly people during the posthospitalization transition to intermediate care facilities in Quebec, as well as the strategies they use on a daily basis to cope with these needs. METHODS A descriptive qualitative study was conducted as part of an intervention research process. Eleven elderly participants and health professionals were recruited (n=11). RESULTS The results presented suggest a need to support patients' capacity for self-care, unmet during the post-hospitalization transition to intermediate care facilities. DISCUSSION Supporting the self-care abilities of elderly people can help ensure their safety when living in homes for the elderly. CONCLUSION Supporting the capacity for self-care is an important component of transitional care after hospitalization, including for elderly people with disabilities.
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Affiliation(s)
- Maude Dessureault
- Infirmière, Ph.D, professeure adjointe, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Clémence Dallaire
- Infirmière, Ph.D, professeure titulaire, Université Laval, Québec, Canada
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Enam A, Dreyer HC, De Boer L. Impact of distance monitoring service in managing healthcare demand: a case study through the lens of cocreation. BMC Health Serv Res 2022; 22:802. [PMID: 35729627 PMCID: PMC9209829 DOI: 10.1186/s12913-022-08164-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/08/2022] [Indexed: 12/02/2022] Open
Abstract
Background There is a consensus among healthcare providers, academics, and policy-makers that spiraling demand and diminishing resources are threatening the sustainability of the current healthcare system. Different telemedicine services are seen as potential solutions to the current challenges in healthcare. This paper aims to identify how distance monitoring services rendered for patients with chronic conditions can affect the escalating demand for healthcare. First, we identify how distance monitoring service changes the care delivery process using the lens of service cocreation. Next, we analyze how these changes can impact healthcare demand using the literature on demand and capacity management. Method In this qualitative study, we explore a distance monitoring service in a primary healthcare setting in Norway. We collected primary data from nurses and general physicians using the semi-structured interview technique. We used secondary patient data collected from a study conducted to evaluate the distance monitoring project. The deductive content analysis method was used to analyze the data. Result This study shows that the application of distance monitoring services changes the care delivery process by creating new activities, new channels for interaction, and new roles for patients, general physicians, and nurses. We define patients’ roles as proactive providers of health information, general physicians’ roles as patient selectors, and nurses’ roles as technical coordinators, data workers, and empathetic listeners. Thus, the co-creation aspect of the service becomes more prominent demonstrating potential for better management of healthcare demand. However, these changes also render the management of demand and resources more complex. To reduce the complexities, we propose three mechanisms: foreseeing and managing new roles, developing capabilities, and adopting a system-wide perspective. Conclusion The main contribution of the paper is that it demonstrates that, although distance monitoring services have the potential to have a positive impact on healthcare demand management, in the absence of adequate managerial mechanisms, they can also adversely affect healthcare demand management. This study provides a means for practitioners to reflect upon and refine the decisions that they make regarding telemedicine deployment and resource planning for delivering care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08164-2.
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Affiliation(s)
- Amia Enam
- Department of Industrial Economics and Technology Management, Faculty of Economics and Management, Norwegian University of Science and Technology, Sentralbygg 1, 1365, Gløshaugen, Alfred Getz' vei 3, Trondheim, Norway.
| | - Heidi Carin Dreyer
- Department of Industrial Economics and Technology Management, Faculty of Economics and Management, Norwegian University of Science and Technology, Sentralbygg 1, Gløshaugen, Alfred Getz vei 3, Trondheim, Norway
| | - Luitzen De Boer
- Department of Industrial Economics and Technology Management, Faculty of Economics and Management, Norwegian University of Science and Technology, Sentralbygg 1, Gløshaugen, Alfred Getz vei 3, Trondheim, Norway
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Hayat S, Luben R, Khaw KT, Wareham N, Brayne C. Evaluation of routinely collected records for dementia outcomes in UK: a prospective cohort study. BMJ Open 2022; 12:e060931. [PMID: 35705339 PMCID: PMC9204445 DOI: 10.1136/bmjopen-2022-060931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES To evaluate the characteristics of individuals recorded as having a dementia diagnosis in different routinely collected records and to examine the extent of overlap of dementia coding across data sources. Also, to present comparisons of secondary and primary care records providing value for researchers using routinely collected records for dementia outcome capture. STUDY DESIGN A prospective cohort study. SETTING AND PARTICIPANTS A cohort of 25 639 men and women in Norfolk, aged 40-79 years at recruitment (1993-1997) followed until 2018 linked to routinely collected to identify dementia cases. Data sources include mortality from death certification and National Health Service (NHS) hospital or secondary care records. Primary care records for a subset of the cohort were also reviewed. PRIMARY OUTCOME MEASURE Diagnosis of dementia (any-cause). RESULTS Over 2000 participants (n=2635 individuals) were found to have a dementia diagnosis recorded in one or more of the data sources examined. Limited concordance was observed across the secondary care data sources. We also observed discrepancies with primary care records for the subset and report on potential linkage-related selection bias. CONCLUSIONS Use of different types of record linkage from varying parts of the UK's health system reveals differences in recorded dementia diagnosis, indicating that dementia can be identified to varying extents in different parts of the NHS system. However, there is considerable variation, and limited overlap in those identified. We present potential selection biases that might occur depending on whether cause of death, or primary and secondary care data sources are used. With the expansion of using routinely collected health data, researchers must be aware of these potential biases and inaccuracies, reporting carefully on the likely extent of limitations and challenges of the data sources they use.
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Affiliation(s)
- Shabina Hayat
- Department of Psychiatry, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Robert Luben
- MRC Epidemiology Unit, Cambridge, Cambridgeshire, UK
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, UK
| | - Kay-Tee Khaw
- MRC Epidemiology Unit, Cambridge, Cambridgeshire, UK
| | | | - Carol Brayne
- Department of Psychiatry, University of Cambridge, Cambridge, Cambridgeshire, UK
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Bradfield OM, Bismark M, Scott A, Spittal M. Vocational and psychosocial predictors of medical negligence claims among Australian doctors: a prospective cohort analysis of the MABEL survey. BMJ Open 2022; 12:e055432. [PMID: 35649606 PMCID: PMC9171255 DOI: 10.1136/bmjopen-2021-055432] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To understand the association between medical negligence claims and doctors' sex, age, specialty, working hours, work location, personality, social supports, family circumstances, self-rated health, self-rated life satisfaction and presence of recent injury or illness. DESIGN AND SETTING Prospective cohort study of Australian doctors. PARTICIPANTS 12 134 doctors who completed the Medicine in Australia: Balancing Employment and Life survey between 2013 and 2019. PRIMARY OUTCOME MEASURE Doctors named as a defendant in a medical negligence claim in the preceding 12 months. RESULTS 649 (5.35%) doctors reported being named in a medical negligence claim during the study period. In addition to previously identified demographic factors (sex, age and specialty), we identified the following vocational and psychosocial risk factors for claims: working full time (OR=1.48, 95% CI 1.13 to 1.94) or overtime hours (OR 1.70, 95% CI 1.29 to 2.23), working in a regional centre (OR 1.69, 95% CI 1.37 to 2.08), increasing job demands (OR 1.16, 95% CI 1.04 to 1.30), low self-rated life satisfaction (OR 1.43, 95% CI 1.08 to 1.91) and recent serious personal injury or illness (OR 1.40, 95% CI 1.13 to 1.72). Having an agreeable personality was mildly protective (OR 0.91, 95% CI 0.83 to 1.00). When stratified according to sex, we found that working in a regional area, low self-rated life satisfaction and not achieving work-life balance predicted medical negligence claims in male, but not female, doctors. However, working more than part-time hours and having a recent personal injury or illness predicted medical negligence claims in female, but not male, doctors. Increasing age predicted claims more strongly in male doctors. Personality type predicted claims in both male and female doctors. CONCLUSIONS Modifiable risk factors contribute to an increased risk of medical negligence claims among doctors in Australia. Creating more supportive work environments and targeting interventions that improve doctors' health and well-being could reduce the risk of medical negligence claims and contribute to improved patient safety.
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Affiliation(s)
- Owen M Bradfield
- Law and Public Health Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marie Bismark
- Law and Public Health Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anthony Scott
- Melbourne Institute of Applied Economic and Social Research, The University of Melbourne, Melbourne, Victoria, Australia
| | - Matthew Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Bradfield OM, Bismark M, Scott A, Spittal M. Medical negligence claims and the health and life satisfaction of Australian doctors: a prospective cohort analysis of the MABEL survey. BMJ Open 2022; 12:e059447. [PMID: 35589347 PMCID: PMC9121477 DOI: 10.1136/bmjopen-2021-059447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To assess the association between medical negligence claims and doctors' self-rated health and life satisfaction. DESIGN Prospective cohort study. PARTICIPANTS Registered doctors practising in Australia who participated in waves 4 to 11 of the Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal survey between 2011 and 2018. PRIMARY AND SECONDARY OUTCOME MEASURES Self-rated health and self-rated life satisfaction. RESULTS Of the 15 105 doctors in the study, 885 reported being named in a medical negligence claim. Fixed-effects linear regression analysis showed that both self-rated health and self-rated life satisfaction declined for all doctors over the course of the MABEL survey, with no association between wave and being sued. However, being sued was not associated with any additional declines in self-rated health (coef.=-0.02, 95% CI -0.06 to 0.02, p=0.39) or self-rated life satisfaction (coef.=-0.01, 95% CI -0.08 to 0.07, p=0.91) after controlling for a range of job factors. Instead, we found that working conditions and job satisfaction were the strongest predictors of self-rated health and self-rated life satisfaction in sued doctors. In analyses restricted to doctors who were sued, we observed no changes in self-rated health (p=0.99) or self-rated life satisfaction (p=0.59) in the years immediately following a claim. CONCLUSIONS In contrast to prior overseas cross-sectional survey studies, we show that medical negligence claims do not adversely affect the well-being of doctors in Australia when adjusting for time trends and previously established covariates. This may be because: (1) prior studies failed to adequately address issues of causation and confounding; or (2) legal processes governing medical negligence claims in Australia cause less distress compared with those in other jurisdictions. Our findings suggest that the interaction between medical negligence claims and poor doctors' health is more complex than revealed through previous studies.
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Affiliation(s)
- Owen M Bradfield
- Law and Public Health Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marie Bismark
- Law and Public Health Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anthony Scott
- Melbourne Institute of Applied Economic and Social Research, The University of Melbourne, Melbourne, Victoria, Australia
| | - Matthew Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Ho ISS, Azcoaga-Lorenzo A, Akbari A, Davies J, Hodgins P, Khunti K, Kadam U, Lyons R, McCowan C, Mercer SW, Nirantharakumar K, Guthrie B. Variation in the estimated prevalence of multimorbidity: systematic review and meta-analysis of 193 international studies. BMJ Open 2022; 12:e057017. [PMID: 35487738 PMCID: PMC9058768 DOI: 10.1136/bmjopen-2021-057017] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE (1) To estimate the pooled prevalence of multimorbidity in all age groups, globally. (2) To examine how measurement of multimorbidity impacted the estimated prevalence. METHODS In this systematic review and meta-analysis, we conducted searches in nine bibliographic databases (PsycINFO, Embase, Global Health, Medline, Scopus, Web of Science, Cochrane Library, CINAHL and ProQuest Dissertations and Theses Global) for prevalence studies published between database inception and 21 January 2020. Studies reporting the prevalence of multimorbidity (in all age groups and in community, primary care, care home and hospital settings) were included. Studies with an index condition or those that did not include people with no long-term conditions in the denominator were excluded. Retrieved studies were independently reviewed by two reviewers, and relevant data were extracted using predesigned pro forma. We used meta-analysis to pool the estimated prevalence of multimorbidity across studies, and used random-effects meta-regression and subgroup analysis to examine the association of heterogeneous prevalence estimates with study and measure characteristics. RESULTS 13 807 titles were screened, of which 193 met inclusion criteria for meta-analysis. The pooled prevalence of multimorbidity was 42.4% (95% CI 38.9% to 46.0%) with high heterogeneity (I2 >99%). In adjusted meta-regression models, participant mean age and the number of conditions included in a measure accounted for 47.8% of heterogeneity in effect sizes. The estimated prevalence of multimorbidity was significantly higher in studies with older adults and those that included larger numbers of conditions. There was no significant difference in estimated prevalence between low-income or middle-income countries (36.8%) and high-income countries (44.3%), or between self-report (40.0%) and administrative/clinical databases (52.7%). CONCLUSIONS The pooled prevalence of multimorbidity was significantly higher in older populations and when studies included a larger number of baseline conditions. The findings suggest that, to improve study comparability and quality of reporting, future studies should use a common core conditions set for multimorbidity measurement and report multimorbidity prevalence stratified by sociodemographics.PROSPERO registration numberCRD42020172409.
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Affiliation(s)
- Iris Szu-Szu Ho
- Usher Institute, Medical School, The University of Edinburgh, Edinburgh, Scotland, UK
| | | | - Ashley Akbari
- Medical School, Swansea University, Swansea, Wales, UK
| | - Jim Davies
- Department of Computer Science, University of Oxford, Oxford, England, UK
| | - Peter Hodgins
- Usher Institute, Medical School, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Kamlesh Khunti
- Medical School, University of Leicester, Leicester, England, UK
| | - Umesh Kadam
- Medical School, University of Leicester, Leicester, England, UK
| | - Ronan Lyons
- Medical School, Swansea University, Swansea, Wales, UK
| | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, Scotland, UK
| | - Stewart W Mercer
- Usher Institute, Medical School, The University of Edinburgh, Edinburgh, Scotland, UK
| | | | - Bruce Guthrie
- Usher Institute, Medical School, The University of Edinburgh, Edinburgh, Scotland, UK
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Focused-Attention Meditation Improves Flow, Communication Skills, and Safety Attitudes of Surgeons. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095292. [PMID: 35564687 PMCID: PMC9099589 DOI: 10.3390/ijerph19095292] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/23/2022] [Accepted: 04/24/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Patient safety is a worldwide problem and a focus of academic research. Human factors and ergonomics (HFE) is an approach to improving healthcare work systems and processes. From the perspective of the cognitive ergonomics of HFE, the aim of this study is to improve the flow level, communication skills, and safety attitudes of surgeons through focused-attention meditation (FAM) training, thus helping to reduce adverse clinical events. METHODS In total, 140 surgeons were recruited from three hospitals in China and randomly divided into two groups (FAM group and control group). The FAM group received 8 weeks of FAM training, while the control group was on the waiting list and did not receive any interventions. Three scales (WOLF, LCSAS, and SAQ-C) were used to measure the data of three variables (flow, communication skills, and safety attitude), respectively, at two times, before and after the intervention (pre-test and post-test). The incidence of adverse events during the intervention was also collected for both groups. RESULTS The ANOVA results showed that all three variables had a significant main effect of time and significant interactions between time and group. The independent-sample T-test results showed that the incidence of adverse events during the intervention was significantly lower in the FAM group than in the control group. CONCLUSIONS The intervention of FAM could significantly improve surgeons' flow levels, communication skills, and safety attitudes, potentially helping to reduce adverse clinical events.
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Johns G, Whistance B, Khalil S, Whistance M, Thomas B, Ogonovsky M, Ahuja A. Digital NHS Wales: a coding reliability analysis based on the voices of 22 978 patients and clinicians on the benefits, challenges and sustainability of video consulting. BMJ Open 2022; 12:e057874. [PMID: 35443959 PMCID: PMC9021454 DOI: 10.1136/bmjopen-2021-057874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The use of video consulting (VC) in Wales UK has expanded rapidly. Previous VC evidence has been the subject of small-scale projects and evaluations. Technology Enabled Care Cymru is an all-Wales digital service and rolls out digital interventions and evaluates on large scales, thus capturing representative data sets across Wales, and therefore a wide range of National Health Service (NHS) specialties. OBJECTIVE To extract and analyse narrative feedback from patients and clinicians using the NHS Wales VC Service for 6 months (September 2020 to March 2021). DESIGN A coding reliability approach of a cross-sectional study was conducted. SETTING From all health boards across Wales. PARTICIPANTS NHS patients and clinicians across primary, secondary and community care settings in Wales. RESULTS Data were captured on benefits, challenges and sustainability of VC. A coding reliability analysis was used with six domain summaries materialising to include: 'The Ease of VC'; 'The Personal Touches'; 'The Benefits of VC'; 'The Challenges of VC'; 'Technical Quality'; and 'Recommendations & Future Use'. An additional 17 subdomains are included. Direct quotations from patients and clinicians are provided for context. CONCLUSIONS A total of 22 978 participants were included. These data help demonstrate that NHS remote service delivery, via the method of VC, can be highly satisfactory, well accepted and clinically suitable yielding many benefits. Despite this, the data are not without its challenges surrounding engagement and suitability for VC. The NHS Wales VC Service rolled out and evaluated at scale and demonstrates that VC has potential for long-term sustainability. For the future, use a 'blended approach' for NHS appointments that are clinically judged and centred on patient choice.
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Affiliation(s)
- Gemma Johns
- TEC Cymru Informatics, Aneurin Bevan Health Board, Gwent, UK
| | | | - Sara Khalil
- TEC Cymru Informatics, Aneurin Bevan Health Board, Gwent, UK
| | - Megan Whistance
- TEC Cymru Informatics, Aneurin Bevan Health Board, Gwent, UK
| | - Bronwen Thomas
- TEC Cymru Informatics, Aneurin Bevan Health Board, Gwent, UK
| | - Mike Ogonovsky
- TEC Cymru Informatics, Aneurin Bevan Health Board, Gwent, UK
| | - Alka Ahuja
- TEC Cymru Informatics, Aneurin Bevan Health Board, Gwent, UK
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Witt UF, Nibe SM, Ole H, Lebech CS. A novel approach for predicting acute hospitalizations among elderly recipients of home care? A model development study. Int J Med Inform 2022; 160:104715. [DOI: 10.1016/j.ijmedinf.2022.104715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/25/2022] [Accepted: 02/07/2022] [Indexed: 10/19/2022]
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Lin E, Harris H, Gruszecki S, Costa-Dookhan KA, Rodak T, Sockalingam S, Soklaridis S. Developing an evaluation framework for assessing the impact of recovery colleges: protocol for a participatory stakeholder engagement process and cocreated scoping review. BMJ Open 2022; 12:e055289. [PMID: 35314472 PMCID: PMC8938698 DOI: 10.1136/bmjopen-2021-055289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Recovery colleges (RCs) are mental health centres aimed at equipping people with skills to live a meaningful life despite the presence of mental distress. Unique to them is the aspect of cocreation; RCs are designed collaboratively with people of lived experiences of mental health and addictions and care providers. Despite established benefits, there remains a lack of empirical evidence on how RCs work and on their impact. AIMS We aim to address this gap by designing a cocreated evaluation framework for RCs. This will be accomplished by engaging RC student/facilitators to provide perspectives on RCs/RC evaluation and cocreate a scoping review identifying evaluation gaps in the literature. Themes identified through these processes will form the evaluation framework. METHODS AND ANALYSIS Two methodologies will be used to explore RC evaluation: student/facilitator engagement and a scoping review of current published and grey literature on RC evaluation. Engagement will be achieved using a participatory action research approach consisting of informant interviews of ~25 RC students/facilitators across Canada, which will be thematically analysed. The scoping review will follow methodology described by Arksey and O'Malley modified to support cocreation. Concurrent conducting of the engagement process and scoping review will allow RC students and peer facilitators the opportunity to shape RC evaluations, address gaps in the literature and codesign an evaluation framework focused on recovery-oriented processes and outcomes mattering most to RCs students/facilitators. ETHICS AND DISSEMINATION Ethics approval was received for the RC student/facilitator engagement component from the Centre for Addictions and Mental Health Research Ethics Board (#042-2020) and Ontario Shores Centre for Mental Health Sciences (#20-013-B). Scoping review results will be copresented through national and international medical education conferences and published in open-access peer-reviewed journals. Furthermore, a dissemination strategy on evaluation for the national RC community will be created.
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Affiliation(s)
- Elizabeth Lin
- Department of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Holly Harris
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada
| | - Sam Gruszecki
- Department of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kenya A Costa-Dookhan
- Department of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Terri Rodak
- Department of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sanjeev Sockalingam
- Department of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Sophie Soklaridis
- Department of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
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Viscardi MK, French R, Brom H, Lake E, Ulrich C, McHugh MD. Care Quality, Patient Safety, and Nurse Outcomes at Hospitals Serving Economically Disadvantaged Patients: A Case for Investment in Nursing. Policy Polit Nurs Pract 2022; 23:5-14. [PMID: 34986064 DOI: 10.1177/15271544211069554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We sought to evaluate if better work environments or staffing were associated with improvements in care quality, patient safety, and nurse outcomes across hospitals caring for different proportions of patients who are economically disadvantaged. Few actionable approaches for hospitals with quality and resource deficits exist. One solution may be to invest in the nurse work environment and staffing. This cross-sectional study utilized secondary data from 23,629 registered nurses in 503 hospitals from a four-state survey collected in 2005-2008. Each 10% increase in the proportion of patients who are economically disadvantaged was associated with 27% and 22% decreased odds of rating unit-level care quality as excellent and giving an "A" safety grade, respectively. Each 10% increase was also associated with 9%, 25%, and 11% increased odds of job dissatisfaction, intent to leave, and burnout, respectively. The work environment had the largest association with each outcome. Accounting for the nurse work environment lessened or eliminated the negative outcomes experienced at hospitals serving high proportions of patients who are economically disadvantaged. Leaders at hospitals serving high proportions of patients who are economically disadvantaged, as well as state and federal policymakers, should work to improve quality, safety, and nurse outcomes by strengthening nurse work environments. Improving work environments highlights the role of nursing in the health care system, and policies focused on work environments are needed to improve the experiences of patients and nurses, especially at hospitals that care for many patients who are economically disadvantaged.
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Affiliation(s)
| | - Rachel French
- 16142School of Nursing, University of Pennsylvania, 418 Curie Blvd., Philadelphia, PA 19104
| | - Heather Brom
- College of Nursing, Villanova University, 800 Lancaster Ave., Villanova, PA 19085
| | - Eileen Lake
- 16142School of Nursing, University of Pennsylvania, 418 Curie Blvd., Philadelphia, PA 19104
| | - Connie Ulrich
- 16142School of Nursing, University of Pennsylvania, 418 Curie Blvd., Philadelphia, PA 19104
| | - Matthew D McHugh
- 16142School of Nursing, University of Pennsylvania, 418 Curie Blvd., Philadelphia, PA 19104
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Udod S, Lobchuk M, Avery L, Armah N. Using the Donabedian framework to examine transitional care for cardiac patients and family caregivers. Leadersh Health Serv (Bradf Engl) 2022; ahead-of-print. [DOI: 10.1108/lhs-10-2021-0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This study aims to examine how health-care managers in acute care and post-acute care facilities support and plan to improve transitional care for cardiac patients and their family caregivers, to better manage care in the home.
Design/methodology/approach
A qualitative descriptive approach, guided by appreciative inquiry was used in this study. A purposive sample of 16 participants were engaged in the study. Participants completed a demographic questionnaire, the caregiver policy lens questionnaire and participated in one of four focus group interviews. The semi-structured focus group interviews were audio-recorded and analyzed using thematic analysis.
Findings
Using Donabedian’s framework, six major themes contributed to how health-care managers can improve transitional care: structure included supporting personnel and continuing education; process included enacting approaches of care, coordinating care among the health-care team and calling to work upstream; and outcomes included needing to clarify expectations of home care services and witnessing the impact of the caregiver role.
Originality/value
These findings demonstrate the importance of Donabedian’s core dimensions of structure and processes in influencing caregiver outcomes. These results emphasize the central role of the manager in influencing system change to improve transitional care.
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Arslan G, Yıldırım M, Zangeneh M, Ak İ. Benefits of Positive Psychology-Based Story Reading on Adolescent Mental Health and Well-Being. CHILD INDICATORS RESEARCH 2022; 15:781-793. [PMID: 35013685 PMCID: PMC8731136 DOI: 10.1007/s12187-021-09891-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 06/14/2023]
Abstract
The importance of complete mental health in school context has recently begun to attract a lot of attention. Positive psychology interventions are often associated with improvement in mental health outcomes, but few studies have examined whether story reading is an intervention that is linked with indicators of complete mental health. This study investigated the effects of story reading interventions on both positive and negative indicators of mental health over time for a group of Turkish grade 10 high school students (n = 53). These included 33 students in a story reading group and 20 in a control group for comparison. The results showed that story reading led to improvement in students' mindfulness, optimism, happiness, and positive emotions, and also caused reduction in depression, anxiety, pessimism, and other negative emotions over a 5-week period, with a small to large effect sizes. The obtained results are discussed in the context of their implications for potential psychological interventions in high school settings.
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Affiliation(s)
- Gökmen Arslan
- Mehmet Akif Ersoy University, Burdur, Turkey
- The University of Melbourne, Melbourne, Australia
| | | | | | - İsmail Ak
- Isparta Provincial Directorate of National Education, Isparta, Turkey
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Hadid M, Elomri A, El Mekkawy T, Kerbache L, El Omri A, El Omri H, Taha RY, Hamad AA, Al Thani MHJ. Bibliometric analysis of cancer care operations management: current status, developments, and future directions. Health Care Manag Sci 2022; 25:166-185. [PMID: 34981268 DOI: 10.1007/s10729-021-09585-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 10/05/2021] [Indexed: 01/31/2023]
Abstract
Around the world, cancer care services are facing many operational challenges. Operations management research can provide important solutions to these challenges, from screening and diagnosis to treatment. In recent years, the growth in the number of papers published on cancer care operations management (CCOM) indicates that development has been fast. Within this context, the objective of this research was to understand the evolution of CCOM through a comprehensive study and an up-to-date bibliometric analysis of the literature. To achieve this aim, the Web of Science Core Collection database was used as the source of bibliographic records. The data-mining and quantitative tools in the software Biblioshiny were used to analyze CCOM articles published from 2010 to 2021. First, a historical analysis described CCOM research, the sources, and the subfields. Second, an analysis of keywords highlighted the significant developments in this field. Third, an analysis of research themes identified three main directions for future research in CCOM, which has 11 evolutionary paths. Finally, this paper discussed the gaps in CCOM research and the areas that require further investigation and development.
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Affiliation(s)
- Majed Hadid
- College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
| | - Adel Elomri
- College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar.
| | | | - Laoucine Kerbache
- College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
| | | | - Halima El Omri
- National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
| | - Ruba Y Taha
- National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
| | - Anas Ahmad Hamad
- National Center for Cancer Care and Research (NCCCR), Hamad Medical Corporation, Doha, Qatar
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Kokorelias KM, Nelson MLA, Tang T, Steele Gray C, Ellen M, Plett D, Jarach CM, Xin Nie J, Thavorn K, Singh H. Who is Included in Digital Health Technologies to Support Hospital to Home Transitions for Older Adults?: Secondary analysis of a rapid review and equity-informed recommendations (Preprint). JMIR Aging 2021; 5:e35925. [PMID: 35475971 PMCID: PMC9096639 DOI: 10.2196/35925] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 12/25/2022] Open
Affiliation(s)
- Kristina Marie Kokorelias
- St John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Sinai Health System/University Health Network, Toronto, ON, Canada
| | - Michelle LA Nelson
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- March of Dimes Canada, Toronto, ON, Canada
| | - Terence Tang
- Institute for Better Health, Trillium Health Partners, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Carolyn Steele Gray
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Moriah Ellen
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Health Policy and Management, Ben-Gurion University of the Negev, Eilat, Israel
- Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Eilat, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Eilat, Israel
| | - Donna Plett
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Carlotta Micaela Jarach
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Jason Xin Nie
- Institute for Better Health, Trillium Health Partners, Toronto, ON, Canada
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Hardeep Singh
- March of Dimes Canada, Toronto, ON, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Direct phone communication to primary care physician to plan discharge from hospital: feasibility and benefits. BMC Health Serv Res 2021; 21:1352. [PMID: 34922549 PMCID: PMC8684651 DOI: 10.1186/s12913-021-07398-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The discharge summary is the main vector of communication at the time of hospital discharge, but it is known to be insufficient. Direct phone contact between hospitalist and primary care physician (PCP) at discharge could ensure rapid transmission of information, improve patient safety and promote interprofessional collaboration. The objective of this study was to evaluate the feasibility and benefit of a phone call from hospitalist to PCP to plan discharge. METHODS This study was a prospective, single-center, cross-sectional observational study. It took place in an acute medicine unit of a French university hospital. The hospitalist had to contact the PCP by telephone within 72 h prior discharge, making a maximum of 3 call attempts. The primary endpoint was the proportion of patients whose primary care physician could be reached by telephone at the time of discharge. The other criteria were the physicians' opinions on the benefits of this contact and its effect on readmission rates. RESULTS 275 patients were eligible. 8 hospitalists and 130 PCPs gave their opinion. Calls attempts were made for 71% of eligible patients. Call attempts resulted in successful contact with the PCP 157 times, representing 80% of call attempts and 57% of eligible patients. The average call completion rate was 47%. The telephone contact was perceived by hospitalist as useful and providing security. The PCPs were satisfied and wanted this intervention to become systematic. Telephone contact did not reduce the readmission rate. CONCLUSIONS Despite the implementation of a standardized process, the feasibility of the intervention was modest. The main obstacle was hospitalists lacking time and facing difficulties in reaching the PCPs. However, physicians showed desire to communicate directly by telephone at the time of discharge. TRIAL REGISTRATION French C.N.I.L. registration number 2108852. Registration date October 12, 2017.
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