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Trevisan V, De Corso E, Viscogliosi G, Onesimo R, Cina A, Panfili M, Perri L, Agazzi C, Giorgio V, Rigante D, Vento G, Papacci P, Paradiso FV, Silvaroli S, Nanni L, Resta N, Castori M, Galli J, Paludetti G, Zampino G, Leoni C. A multi-step approach to overcome challenges in the management of head and neck lymphatic malformations, and response to treatment. Orphanet J Rare Dis 2024; 19:276. [PMID: 39044220 PMCID: PMC11265367 DOI: 10.1186/s13023-024-03200-2] [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: 11/06/2023] [Accepted: 05/05/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Lymphatic malformations are vascular developmental anomalies varying from local superficial masses to diffuse infiltrating lesions, resulting in disfigurement. Patients' outcomes range from spontaneous regression to severe sequelae notwithstanding appropriate treatment. The current classification guides, in part, clinicians through the decision-making process, prognosis prediction and choice of therapeutic strategies. Even though the understanding of molecular basis of the disease has been recently improved, a standardized management algorithm has not been reached yet. RESULTS Here, we report our experience on five children with different lymphatic anomalies of the head and neck region treated by applying a multidisciplinary approach reaching a consensus among specialists on problem-solving and setting priorities. CONCLUSIONS Although restitutio ad integrum was rarely achieved and the burden of care is challenging for patients, caregivers and healthcare providers, this study demonstrates how the referral to expert centres can significantly improve outcomes by alleviating parental stress and ameliorating patients' quality of life. A flow-chart is proposed to guide the multidisciplinary care of children with LMs and to encourage multidisciplinary collaborative initiatives to implement dedicated patients' pathways.
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Affiliation(s)
- Valentina Trevisan
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, Rome, 00168, RM, Italy
| | - Eugenio De Corso
- Unit of Otorhinolaryngology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, RM, Italy
| | - Germana Viscogliosi
- UOC Radiodiagnostica e Neuroradiologia, Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario A. Gemelli IRCCS, Radioterapia, Rome, Italy
| | - Roberta Onesimo
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, Rome, 00168, RM, Italy
| | - Alessandro Cina
- UOC Radiodiagnostica e Neuroradiologia, Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario A. Gemelli IRCCS, Radioterapia, Rome, Italy
| | - Marco Panfili
- UOC Radiodiagnostica e Neuroradiologia, Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario A. Gemelli IRCCS, Radioterapia, Rome, Italy
| | - Lucrezia Perri
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, Rome, 00168, RM, Italy
| | - Cristiana Agazzi
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, Rome, 00168, RM, Italy
| | - Valentina Giorgio
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, Rome, 00168, RM, Italy
| | - Donato Rigante
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, Rome, 00168, RM, Italy
- Università Cattolica del Sacro Cuore, Rome, RM, Italy
| | - Giovanni Vento
- Università Cattolica del Sacro Cuore, Rome, RM, Italy
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, 00168, Italy
| | - Patrizia Papacci
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, 00168, Italy
| | | | - Sara Silvaroli
- Scuola di Specializzazione in Chirurgia Pediatrica, Università Cattolica Sacro Cuore, Roma, Italy
| | - Lorenzo Nanni
- Università Cattolica del Sacro Cuore, Rome, RM, Italy
- Scuola di Specializzazione in Chirurgia Pediatrica, Università Cattolica Sacro Cuore, Roma, Italy
| | - Nicoletta Resta
- Department of Biomedical Sciences and Human Oncology (DIMO), Medical Genetics, University of Bari "Aldo Moro", Bari, Italy
| | - Marco Castori
- Division of Medical Genetics, Fondazione IRCCS-Casa Sollievo della Sofferenza, Foggia, San Giovanni Rotondo, Italy
| | - Jacopo Galli
- Unit of Otorhinolaryngology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, RM, Italy
- Università Cattolica del Sacro Cuore, Rome, RM, Italy
| | | | - Giuseppe Zampino
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, Rome, 00168, RM, Italy
- Università Cattolica del Sacro Cuore, Rome, RM, Italy
| | - Chiara Leoni
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, Rome, 00168, RM, Italy.
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Bohm-Starke N, Pukall C, Österberg M, Ahlberg M, Jonsson AK, Tranæus S, Kempe S, Hellberg C. Development of a core outcome set for treatment studies for provoked vestibulodynia. J Sex Med 2024; 21:556-565. [PMID: 38515322 DOI: 10.1093/jsxmed/qdae035] [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: 05/11/2023] [Revised: 02/01/2024] [Accepted: 02/09/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND There is an inconsistency in treatment outcomes used in clinical trials for provoked vestibulodynia (PVD), which makes it impossible to compare the effects of different interventions. AIM In this study, we completed the first step in creating a core outcome set (COS), defining what outcomes should be measured in clinical trials for PVD. METHODS Identification of outcomes used in studies was done by extracting data from clinical trials in a recently published systematic review and via review of clinical trials for PVD registered on ClinicalTrials.gov. The COS process consisted of 2 rounds of Delphi surveys and a consensus meeting, during which the final COS was decided through a modified nominal group technique. OUTCOMES Consensus on what outcomes to include in a COS for PVD. RESULTS Forty scientific articles and 92 study protocols were reviewed for outcomes. Of those, 36 articles and 25 protocols were eligible, resulting in 402 outcomes, which were then categorized into 63 unique outcomes. Participants consisted of patients, relatives/partners of patients, health care professionals, and researchers. Out of 463 who registered for participation, 319 and 213 responded to the first and second surveys, respectively. The consensus meeting consisted of 18 members and resulted in 6 outcomes for the COS to be measured in all treatment trials regardless of intervention: insertional pain (nonsexual), insertional pain (sexual), provoked vulvar pain by pressure/contact, pain-related interference on one's life, pain interference on sexual life, and sexual function. CLINICAL IMPLICATIONS Critical outcomes to be measured in clinical trials will allow for accurate comparison of outcomes across treatment interventions and provide solid treatment recommendations. STRENGTHS AND LIMITATIONS The major strengths of the study are the adherence to methodological recommendations and the intentional focus on aspects of diversity of participating stakeholders (eg, status such as patients with lived experience and researchers, inclusiveness with respect to sexual identity), the latter of which will allow for broader application and relevance of the COS. Among the limitations of the study are the low rate of participants outside North America and Europe and the lower response rate (about 50%) for the second Delphi survey. CONCLUSION In this international project, patients, health care professionals, and researchers have decided what critical outcomes are to be used in future clinical trials for PVD. Before the COS can be fully implemented, there is also a need to decide on how and preferably when the outcomes should be measured.
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Affiliation(s)
- Nina Bohm-Starke
- Division of Obstetrics and Gynecology, Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, 171 77 Stockholm, Sweden
| | - Caroline Pukall
- Department of Psychology, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Marie Österberg
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, 102 33, Sweden
| | - Maria Ahlberg
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, 102 33, Sweden
| | - Ann Kristine Jonsson
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, 102 33, Sweden
| | - Sofia Tranæus
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, 102 33, Sweden
- Health Technology Assessment-Odontology, Faculty of Odontology, Malmö University, 214 21 Malmö, Sweden
| | - Susanna Kempe
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, 102 33, Sweden
| | - Christel Hellberg
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, 102 33, Sweden
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Akhavan AR, Kontrick AV, Egan H, Balint SA, Kane BG, House JB, Graffeo CS, Courtney DM, Lu DW. "Cold feet": A qualitative study of medical students who seriously considered emergency medicine but chose another specialty. AEM EDUCATION AND TRAINING 2024; 8:e10967. [PMID: 38525364 PMCID: PMC10955612 DOI: 10.1002/aet2.10967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/08/2024] [Accepted: 02/19/2024] [Indexed: 03/26/2024]
Abstract
Introduction Emergency medicine (EM) has historically been among the most competitive specialties in the United States. However, in 2022 and 2023, 219 of 2921 and 554 of 3010 respective National Resident Matching Program positions were initially unfilled. Medical students' selection of a medical specialty is a complex process. To better understand recent trends in the EM residency match, this qualitative study explored through one-on-one interviews the rationale of senior medical students who seriously considered EM but ultimately pursued another specialty. Methods A convenience sample of senior medical students from across the United States was recruited via multiple mechanisms after the 2023 match. Participant characteristics were collected via an online survey. Qualitative data were generated through a series of one-on-one semistructured interviews and thematic analysis of the data was performed using a constant comparative approach. Results Sixteen senior medical students from 12 different institutions participated in the study. Thematic saturation was reached after 12 interviews but data from all 16 interviews were included for qualitative analyses. Five major themes emerged as important in students' consideration but ultimate rejection of EM as a career: (1) innate features of EM attracted or dissuaded students, (2) widespread awareness of a recent workforce report, (3) burnout in EM, (4) their perception of EM's standing in the health care landscape, and (5) early EM experience and exposure. Conclusions This qualitative study identified five major themes in the career decisions of senior medical students who seriously considered EM but chose another specialty. These findings may help inform the perceptions of students and guide future EM recruitment efforts.
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Affiliation(s)
- Arvin R. Akhavan
- Department of Emergency MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Amy V. Kontrick
- Department of Emergency MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Haley Egan
- Department of Emergency MedicineUniversity of WashingtonSeattleWashingtonUSA
| | | | - Bryan G. Kane
- Emergency MedicineLehigh Valley HospitalBethlehemPennsylvaniaUSA
| | - Joseph B. House
- Department of Emergency MedicineUniversity of MichiganAnn ArborMichiganUSA
| | | | | | - Dave W. Lu
- Department of Emergency MedicineUniversity of WashingtonSeattleWashingtonUSA
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Uwimana P, Mukamana D, Babenko-Mould Y, Adejumo O. A framework for capacity enhancement of Rwandan nurse educators and preceptors facilitating nursing students to learn pediatric pain management. BMC Nurs 2024; 23:127. [PMID: 38368319 PMCID: PMC10874038 DOI: 10.1186/s12912-024-01769-4] [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: 03/23/2023] [Accepted: 01/28/2024] [Indexed: 02/19/2024] Open
Abstract
INTRODUCTION In low- and middle- income countries like Rwanda, children are most likely to suffer from painful and life-limiting conditions due to various factors predominant in these settings. Adequate pre-licensure pain management training can improve pain relief nursing practices. Educators and nurses in practice have a responsibility to teach the soon-to- be nurses for holistic competent nursing care of children, emphasizing the importance of and addressing child's suffering, yet inconsistencies were reported in what was taught regarding pediatric pain management from a theoretical perspective by nurse educators as compared to their counterparts in clinical settings in Rwanda. DESIGN This study applied a qualitative approach using group discussions based on nominal group technique (NGT) to develop and validate a conceptual framework supporting the capacity enhancement of nurse educators and preceptors facilitating students' learning about pediatric pain management in Rwanda. METHODS NGT meetings were conducted with academic nurses (n = 8), nurse clinicians (n = 4), and nursing students (n = 2) during a 2-day workshop to identify strategies, discuss the relevance of each strategy and to agree on key concepts of a framework for improving the ability of nurse educators and preceptors to teach PPM to nursing students. After four weeks another round of NGT meetings were done with nursing faculty (n = 6), academic nurse leaders (n = 3), nurse preceptors (n = 2), clinical nurse leaders (n = 2), a nurse leader from a regulatory body (n = 1), and nursing student (n = 1) to validate the developed framework. FINDINGS Four main strategies corresponding to the key concepts were mapped in a framework. Participants had a consensual agreement on the importance of the developed framework, they confirmed its completeness and practicality. In addition, participants found that the developed framework is logical, and confirmed that it is applicable for its purpose. CONCLUSION The developed framework presents an opportunity to respond to the gaps in nursing pain education in the context of limited resources settings such as Rwanda. It can also be applied in nursing practice and nursing research, aligning with the need of improving the quality of care of suffering children. Furthermore, the framework can be adapted and utilized to meet the needs of healthcare professionals other than nurses. CLINICAL RELEVANCE Strategies are suggested to improve the ability of nurse educators and preceptors in clinical settings to facilitate the acquisition of pediatric pain management competencies by the next generation of nurses. Future Rwandan nurses could then use the competencies acquired to provide optimal health care to children with pain in the best way possible during their practices.
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Affiliation(s)
- Philomene Uwimana
- School of Nursing and Midwifery, University of Rwanda, KG 11 Ave 47 St, 3682, Kigali, Rwanda.
| | - Donatilla Mukamana
- School of Nursing and Midwifery, University of Rwanda, KG 11 Ave 47 St, 3682, Kigali, Rwanda
| | - Yolanda Babenko-Mould
- Arthur Labatt Family School of Nursing, University of Western Ontario, 1151 Richmond St, N6A 3K7, London, ON, Canada
| | - Oluyinka Adejumo
- School of Nursing and Midwifery, University of Rwanda, KG 11 Ave 47 St, 3682, Kigali, Rwanda
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Guanter-Peris L, Alburquerque-Medina E, Solà-Pola M, Pla M. Towards a set of competencies in palliative care nursing in Spain: what's getting in the way of consensus? BMC Palliat Care 2024; 23:41. [PMID: 38350955 PMCID: PMC10865715 DOI: 10.1186/s12904-024-01359-w] [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: 05/12/2023] [Accepted: 01/18/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Spain currently lacks a competency framework for palliative care nursing. Having such a framework would help to advance this field in academic, governmental, and health management contexts. In phase I of a mixed-methods sequential study, we collected quantitative data, proposing 98 competencies to a sample of palliative care nurses. They accepted 62 of them and rejected 36. METHODS Phase II is a qualitative phase in which we used consensus techniques with two modified nominal groups to interpret the quantitative findings with the objective of understanding of why the 36 competencies had been rejected. Twenty nurses from different areas of palliative care (direct care, teaching, management, research) participated. We conducted a thematic analysis using NVivo12 to identify meaning units and group them into larger thematic categories. RESULTS Participants attributed the lack of consensus on the 36 competencies to four main reasons: the rejection of standardised nursing language, the context in which nurses carry out palliative care and other factors that are external to the care itself, the degree of specificity of the proposed competency (too little or too great), and the complexity of nursing care related to the end of life and/or death. CONCLUSIONS Based on the results, we propose reparative actions, such as reformulating the competencies expressed in nursing terminology to describe them as specific behaviours and insisting on the participation of nurses in developing institutional policies and strategies so that competencies related to development, leadership and professional commitment can be implemented. It is essential to promote greater consensus on the definition and levels of nursing intervention according to criteria of complexity and to advocate for adequate training, regulation, and accreditation of palliative care expert practice. Locally, understanding why the 36 competencies were rejected can help Spanish palliative care nurses reach a shared competency framework. More broadly, our consensus methodology and our findings regarding the causes for rejection may be useful to other countries that are in the process of formalising or reviewing their palliative care nursing model.
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Affiliation(s)
- Lourdes Guanter-Peris
- Catalan Institute of Oncology (ICO), Hospital Duran I Reynals, Avinguda de La Gran Via de L'Hospitalet,199-203, 08908, Barcelona, L'Hospitalet de Llobregat, Spain.
| | - Eulàlia Alburquerque-Medina
- Catalan Institute of Oncology (ICO), Hospital Duran I Reynals, Avinguda de La Gran Via de L'Hospitalet,199-203, 08908, Barcelona, L'Hospitalet de Llobregat, Spain
| | - Montserrat Solà-Pola
- Faculty of Nursing, University of Barcelona, S/N Feixa LLarga, Pavelló de Govern 3a Planta, 08907, Barcelona, L'Hospitalet de Llobregat, Spain
| | - Margarida Pla
- Faculty of Nursing, University of Barcelona, S/N Feixa LLarga, Pavelló de Govern 3a Planta, 08907, Barcelona, L'Hospitalet de Llobregat, Spain
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McKenzie BL, Mustapha FI, Battumur BE, Batsaikhan E, Chandran A, Michael V, Webster J, Trieu K. Strengthening national salt reduction strategies using multiple methods process evaluations: case studies from Malaysia and Mongolia. Public Health Nutr 2024; 27:e89. [PMID: 38343162 DOI: 10.1017/s1368980023002781] [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] [Indexed: 03/26/2024]
Abstract
OBJECTIVE To understand the extent to which national salt reduction strategies in Malaysia and Mongolia were implemented and achieving their intended outcomes. DESIGN Multiple methods process evaluations conducted at the mid-point of strategy implementation, guided by theoretical frameworks. SETTING Malaysia (2018-2019) and Mongolia (2020-2021). PARTICIPANTS Desk-based reviews of related documents, interviews with key stakeholders (n 12 Malaysia, n 10 Mongolia), focus group discussions with health professionals in Malaysia (n 43) and health provider surveys in Mongolia (n 12). RESULTS Both countries generated high-quality local evidence about salt intake and levels in foods and culturally specific education resources. In Malaysia, education and reformulation activities were delivered with moderate dose (quantity) but reach among the population was low. Within 5 years, Mongolia implemented education among schools, health professionals and food producers on salt reduction with high reach, but with moderate dose (quantity) and reach among the general population. Both countries faced challenges in implementing legislative interventions (mandatory salt labelling and salt limits in packaged foods) and both could improve the scaling up of their reformulation and education activities. CONCLUSIONS In the first half of Malaysia's and Mongolia's strategies, both countries generated necessary evidence and education materials, mobilised health professionals to deliver salt reduction education and achieved small-scale reformulation in foods. Both subsequently should focus on implementing regulatory policies and achieving population-wide reach and impact. Process evaluations of existing salt reduction strategies can help strengthen intervention delivery, aiding achievement of WHO's 30 % reduction in salt intake by 2025 target.
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Affiliation(s)
- Briar L McKenzie
- The George Institute for Global Health, UNSW, Level 18, International Towers 3, 300 Barangaroo Ave, Barangaroo, NSW2000, Australia
| | | | | | - Enkhtungalag Batsaikhan
- Department of Nutrition Research of the National Center for Public Health, Ulaanbaatar, Mongolia
| | - Arunah Chandran
- Ministry of Health Malaysia, Putrajaya, Wilayah Persekutuan, Malaysia
| | - Viola Michael
- Ministry of Health Malaysia, Putrajaya, Wilayah Persekutuan, Malaysia
| | - Jacqui Webster
- The George Institute for Global Health, UNSW, Level 18, International Towers 3, 300 Barangaroo Ave, Barangaroo, NSW2000, Australia
| | - Kathy Trieu
- The George Institute for Global Health, UNSW, Level 18, International Towers 3, 300 Barangaroo Ave, Barangaroo, NSW2000, Australia
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Rooha A, Shetty S, Bajaj G, Jacob NL, George VM, Bhat JS. Development and validation of educational multimedia to promote public health literacy about healthy cognitive aging. Health Expect 2023; 26:2571-2583. [PMID: 37635370 PMCID: PMC10632613 DOI: 10.1111/hex.13857] [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: 05/25/2023] [Revised: 07/31/2023] [Accepted: 08/16/2023] [Indexed: 08/29/2023] Open
Abstract
OBJECTIVES Health literacy (HL) about healthy cognitive aging is essential in preventing cognitive decline and promoting cognitive well-being. It is important that one such HL module should be scientifically designed, delivered in a technically sound manner to the audience, and specific to the context. The present study thus aimed at developing and validating educational multimedia about cognitive health. METHODS The study followed a methodological framework and was carried out across three phases, that is, identification of themes, development and validation of educational script and design, and validation of educational multimedia. The module was scripted based on the Integrated HL framework and the recommendations made during the modified nominal group technique among the research team. Seven speech-language pathologists (SLPs), with expertise in the field of cognitive sciences, and 15 representatives of the general public validated the module using the Educational Content Validation Instrument in Health and the Patient Education Materials Assessment Tool for Audiovisual Materials questionnaire. RESULTS The scientific content of the educational script received satisfactory agreements among the experts (content validity index [CVI]: 0.93) and representatives of the general public (CVI: 0.86). The technical aspects of the educational multimedia were rated to have high understandability (experts: 92.8%; representatives of general public: 98.8%) and actionability (experts and representatives of general public 100%). CONCLUSION Overall, the developed educational multimedia scored optimally with respect to the objective, structure, relevance of the content, actionability and understandability of the multimedia. The developed module holds the potential to be used at community and national level health educational programs or awareness campaigns to enhance public knowledge and beliefs pertaining to cognitive health. PATIENT OR PUBLIC CONTRIBUTION SLPs with expertise in the field of cognitive science and representatives from the general public were included to validate and obtain feedback on the developed educational multimedia.
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Affiliation(s)
- Aysha Rooha
- Department of Audiology and Speech Language PathologyKasturba Medical College, Mangalore, Manipal Academy of Higher EducationManipalKarnatakaIndia
| | - Shreya Shetty
- Department of Audiology and Speech Language PathologyKasturba Medical College, Mangalore, Manipal Academy of Higher EducationManipalKarnatakaIndia
| | - Gagan Bajaj
- Department of Audiology and Speech Language PathologyKasturba Medical College, Mangalore, Manipal Academy of Higher EducationManipalKarnatakaIndia
| | - Nidhi L. Jacob
- Department of Audiology and Speech Language PathologyKasturba Medical College, Mangalore, Manipal Academy of Higher EducationManipalKarnatakaIndia
| | - Vinitha M. George
- Department of Audiology and Speech Language PathologyNational Institute of Speech and HearingTrivandrumKeralaIndia
| | - Jayashree S. Bhat
- Department of Audiology and Speech Language PathologyNitte Institute of Speech and Hearing, DeralakatteMangaloreKarnatakaIndia
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Gazzin A, Leoni C, Viscogliosi G, Borgini F, Perri L, Iacoviello M, Piglionica M, De Pellegrin M, Ferrero GB, Bartuli A, Zampino G, Buonuomo PS, Resta N, Mussa A. Work-Up and Treatment Strategies for Individuals with PIK3CA-Related Disorders: A Consensus of Experts from the Scientific Committee of the Italian Macrodactyly and PROS Association. Genes (Basel) 2023; 14:2134. [PMID: 38136956 PMCID: PMC10742781 DOI: 10.3390/genes14122134] [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: 11/05/2023] [Revised: 11/23/2023] [Accepted: 11/25/2023] [Indexed: 12/24/2023] Open
Abstract
PIK3CA-related disorders encompass many rare and ultra-rare conditions caused by somatic genetic variants that hyperactivate the PI3K-AKT-mTOR signaling pathway, which is essential for cell cycle control. PIK3CA-related disorders include PIK3CA-related overgrowth spectrum (PROS), PIK3CA-related vascular malformations and PIK3CA-related non-vascular lesions. Phenotypes are extremely heterogeneous and overlapping. Therefore, diagnosis and management frequently involve various health specialists. Given the rarity of these disorders and the limited number of centers offering optimal care, the Scientific Committee of the Italian Macrodactyly and PROS Association has proposed a revision of the most recent recommendations for the diagnosis, molecular testing, clinical management, follow-up, and treatment strategies. These recommendations give insight on molecular diagnosis, eligible samples, preferable sequencing, and validation methods and management of negative results. The purpose of this paper is to promote collaboration between health care centers and clinicians with a joint shared approach. Finally, we suggest the direction of present and future research studies, including new systemic target therapies, which are currently under evaluation in several clinical trials, such as specific inhibitors that can be employed to downregulate the signaling pathway.
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Affiliation(s)
- Andrea Gazzin
- Clinical Pediatric Genetics Unit, Department of Public Health and Pediatrics, University of Torino, Regina Margherita Children’s Hospital, 10126 Torino, Italy; (A.G.); (A.M.)
- Postgraduate School of Pediatrics, University of Torino, 10126 Torino, Italy
| | - Chiara Leoni
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (G.V.); (L.P.); (G.Z.)
| | - Germana Viscogliosi
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (G.V.); (L.P.); (G.Z.)
| | - Federica Borgini
- Italian Macrodactyly and PROS Association, 27010 San Genesio ed Uniti (PV), Italy;
| | - Lucrezia Perri
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (G.V.); (L.P.); (G.Z.)
| | - Matteo Iacoviello
- Medical Genetics Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (M.I.); (M.P.); (N.R.)
| | - Marilidia Piglionica
- Medical Genetics Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (M.I.); (M.P.); (N.R.)
| | - Maurizio De Pellegrin
- Pediatric Orthopedic Unit, Piccole Figlie Hospital, 43125 Parma, Italy
- Department of Orthopedics, ASST Ospedale Papa Giovanni XXIII, 24127 Bergamo, Italy
| | | | - Andrea Bartuli
- Rare Disease and Medical Genetics Unit, Bambino Gesù Children’s Hospital, IRCCS, 00168 Rome, Italy; (A.B.); (P.S.B.)
| | - Giuseppe Zampino
- Center for Rare Diseases and Birth Defects, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (G.V.); (L.P.); (G.Z.)
- Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Paola Sabrina Buonuomo
- Rare Disease and Medical Genetics Unit, Bambino Gesù Children’s Hospital, IRCCS, 00168 Rome, Italy; (A.B.); (P.S.B.)
| | - Nicoletta Resta
- Medical Genetics Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari “Aldo Moro”, 70124 Bari, Italy; (M.I.); (M.P.); (N.R.)
| | - Alessandro Mussa
- Clinical Pediatric Genetics Unit, Department of Public Health and Pediatrics, University of Torino, Regina Margherita Children’s Hospital, 10126 Torino, Italy; (A.G.); (A.M.)
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Lebdai S, Ben Boujema M, Benard A, Barry Delongchamps N, Benchikh A, Bruyere F, Della Negra E, Descazeaud A, Doizi S, Fourmarier M, Mallet R, Misrai V, Pelegrin T, Rouscoff Y, Ruffion A, Villers A, Saillour F, Robert G. Standardized technique for ejaculation preservation during prostatic endoscopic ablative surgery. World J Urol 2023; 41:3041-3049. [PMID: 37715788 DOI: 10.1007/s00345-023-04592-9] [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: 05/06/2023] [Accepted: 08/15/2023] [Indexed: 09/18/2023] Open
Abstract
PURPOSE Ejaculatory dysfunction is the most common side effect of benign prostatic hyperplasia surgery. Modified techniques have emerged with the aim of preserving antegrade ejaculation without compromising obstruction relief. None are standardized or validated. The PARTURP study is a randomized study investigating partial versus complete prostate resection. We conducted an investigator consensus meeting to define the ideal surgical technique to achieve both correct obstruction relief with ejaculation preservation. METHODS An expert consensus meeting involving all investigators of the PARTURP study took place to define a common technique using the nominal group methodology. The objectives were to define the areas to be resected and the areas to be preserved; to define the criteria for proper obstruction relief; to define the criteria for proper ejaculation preservation. RESULTS All investigators (n = 15) attended the consensus meeting, and agreement between all the participants was obtained. The anatomical landmarks to be preserved are located around the verumontanum and along the posterior part of the prostatic urethra. These structures must be preserved up to 2 cm from the verumontanum. The participants agreed on the need to preserve the urethral mucosa in all the areas to be preserved and to reach the enucleation plane in the areas of resection. CONCLUSIONS Anatomical landmarks for ejaculation-sparing surgery have been defined by the investigators of the PARTURP randomized study. These landmarks will be used during the study, and the clinical outcomes of this ejaculation-sparing technique will be compared with complete resection with up to 3 years follow-up.
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Affiliation(s)
- Souhil Lebdai
- Urology Department, University Hospital of Angers, CHU Angers, 4 Rue Larrey, 49933, Angers Cedex 9, France.
| | - Méric Ben Boujema
- Methodology Department, University Hospital of Bordeaux, Bordeaux, France
| | - Antoine Benard
- Methodology Department, University Hospital of Bordeaux, Bordeaux, France
| | | | - Amine Benchikh
- Urology Department, Clinique Des Franciscaines, Versailles, France
| | - Franck Bruyere
- Urology Department, University Hospital of Tours, Tours, France
| | | | | | - Steeve Doizi
- Urology Department, Hôpital Tenon, APHP, Paris, France
| | | | - Richard Mallet
- Urology Department, Hôpital Prive Francheville, Périgueux, France
| | | | | | - Yohan Rouscoff
- Urology Department, Polyclinique Saint Georges, Nice, France
| | - Alain Ruffion
- Urology Department, University Hospital of Lyon, Lyon, France
- EA 3738-CICLY EMR UCBL Lyon 1, Lyon, France
| | - Arnaud Villers
- Urology Department, University Hospital of Lille, Lille, France
| | - Florence Saillour
- Methodology Department, University Hospital of Bordeaux, Bordeaux, France
| | - Grégoire Robert
- Urology Department, University Hospital of Bordeaux, Bordeaux, France
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Søndergaard E, Reventlow S, Siersma V, Nicolaisdottir DR, Jepsen R, Rasmussen K, Møller A. A cross-sectional study of the association between family conflicts and children's health: Lolland-Falster Health Study. Child Care Health Dev 2023; 49:972-984. [PMID: 36805605 DOI: 10.1111/cch.13108] [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: 10/20/2021] [Revised: 11/07/2022] [Accepted: 02/14/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Few family interaction processes are more detrimental to children's health than family conflicts. Conflictual relationships in childhood predict a host of adverse health outcomes across the life course. The current study examines associations between household conflicts and the health of children aged 6-12 years and explores to which extent this may vary by socioeconomic status (SES) and multimorbidity (MM) in the household. METHODS Cross-sectional study using questionnaire data gathered between 2016 and 2020 as part of the Lolland-Falster Health Study (LOFUS) combined with routine register data on health care use and socio-demography from the Danish nationwide administrative databases. The study sample consisted of 1065 children 6-12 years old, who answered LOFUS4 or LOFUS11, from 777 households for which at least one adult answered LOFUS18. Main outcome was children's health complaints, defined as headache, abdominal pain, back pain, and sleep difficulties. Covariates included MM, SES, and conflicts, all three measured at household level. Multivariable logistic regression models were used. RESULTS Conflicts were negatively associated with children's health. This was most pronounced for general conflicts in the household, with increased complaints of abdominal pain, back pain, and sleep difficulties. The associations varied when we stratified the households according to MM and SES. Significant associations were found within households without MM for abdominal pain, and within households with MM and low SES, and without MM and with high SES for sleep difficulties. While the higher level of abdominal pain for the above indicated households were found for both internal and external conflicts in the household, the higher level in sleep difficulties was mostly driven by internal conflicts. CONCLUSION Children reporting frequent health complaints have a higher future health care use compared with children without such complaints. Our results indicate that growing up in a household with a high conflict level might be a predisposing factor.
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Affiliation(s)
- Elisabeth Søndergaard
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Reventlow
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Dagny Ros Nicolaisdottir
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Randi Jepsen
- Lolland-Falster Health Study, Nykøbing F. Hospital, Nykøbing Falster, Denmark
| | | | - Anne Møller
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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11
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Karupaiah T, Mat Daud ZA, Khosla P, Khor BH, Sahathevan S, Kaur D, Tallman DA, Rashid HU, Rahman T, Saxena A, Gulati S, Sengupta P, Susetyowati S. Identifying Challenges and Potential Solutions for Sustainable Kidney Nutrition Care Delivery in Selected Asian Countries. J Ren Nutr 2023; 33:S73-S79. [PMID: 37597574 DOI: 10.1053/j.jrn.2023.08.003] [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: 06/29/2022] [Revised: 07/20/2023] [Accepted: 08/03/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Recent surveys highlight gross workforce shortage of dietitians in global kidney health and significant gaps in renal nutrition care, with disparities greater in low/low-middle income countries. OBJECTIVE This paper narrates ground experiences gained through the Palm Tocotrienols in Chronic Hemodialysis (PaTCH) project on kidney nutrition care scenarios and some Asian low-to-middle-income countries namely Bangladesh, India, and Malaysia. METHOD Core PaTCH investigators from 3 universities (USA and Malaysia) were supported by their postgraduate students (n = 17) with capacity skills in kidney nutrition care methodology and processes. This core team, in turn, built capacity for partnering hospitals as countries differed in their ability to deliver dietitian-related activities for dialysis patients. RESULTS We performed a structural component analyses of PaTCH affiliated and nonaffiliated (Myanmar and Indonesia) countries to identify challenges to kidney nutrition care. Deficits in patient-centered care, empowerment processes and moderating factors to nutrition care optimization characterized country comparisons. Underscoring these factors were some countries lacked trained dietitians whilst for others generalist dietitians or nonclinical nutritionists were providing patient care. Resolution of some challenges in low-to-middle-income countries through coalition networking to facilitate interprofessional collaboration and task sharing is described. CONCLUSIONS We perceive interprofessional collaboration is the way forward to fill gaps in essential dietitian services and regional-based institutional coalitions will facilitate culture-sensitive capacity in building skills. For the long-term an advanced renal nutrition course such as the Global Renal Internet Course for Dietitians is vital to facilitate sustainable kidney nutrition care.
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Affiliation(s)
- Tilakavati Karupaiah
- Food Security and Nutrition Impact Lab, School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia.
| | - Zulfitri Azuan Mat Daud
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Pramod Khosla
- Department of Nutrition and Food Science, Wayne State University, Detroit, Michigan
| | - Ban-Hock Khor
- Faculty of Food Science and Nutrition, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Sharmela Sahathevan
- Department of Allied Health Sciences, Faculty of Science, Universiti Tunku Abdul Rahman, Kampar, Malaysia
| | - Deepinder Kaur
- Department of Nutrition and Food Science, Wayne State University, Detroit, Michigan
| | - Dina A Tallman
- Department of Nutrition and Food Science, Wayne State University, Detroit, Michigan
| | - Harun-Ur Rashid
- Kidney Foundation Hospital and Research Institute Bangladesh, Dhaka, Bangladesh
| | - Tanjina Rahman
- Institute of Food Science and Nutrition, University of Dhaka, Dhaka, Bangladesh
| | - Anita Saxena
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Vu TA, Fenwick E, Doshi K, Gupta P, Quek SY, Chen C, Ting S, Ng ASL, Yap P, Yeo D, Milea D, Lamoureux EL. Content development of the VISION-Cog: a novel tool to assess cognitive impairment in visually impaired older adults in Singapore. BMJ Open 2023; 13:e070850. [PMID: 37816566 PMCID: PMC10565319 DOI: 10.1136/bmjopen-2022-070850] [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: 12/07/2022] [Accepted: 09/25/2023] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVES Current cognitive screening and diagnostic instruments rely on visually dependent tasks and are, therefore, not suitable to assess cognitive impairment (CI) in visually impaired older adults. We describe the content development of the VISually Independent test battery Of NeuroCOGnition (VISION-Cog)-a new diagnostic tool to evaluate CI in visually impaired older Singaporean adults. DESIGN The content development phase consisted of two iterative stages: a neuropsychological consultation and literature review (stage 1) and an expert-panel discussion (stage 2). In stage 1, we investigated currently available neuropsychological test batteries for CI to inform constructions of our preliminary test battery. We then deliberated this battery during a consensus meeting using the Modified Nominal Group technique (stage 2) to decide, via agreement of five experts, the content of a pilot neuropsychological battery for the visually impaired. SETTING Singapore Eye Research Institute. PARTICIPANTS Stakeholders included researchers, psychologists, neurologists, neuro-ophthalmologists, geriatricians and psychiatrists. OUTCOME MEASURE pilot VISION-Cog. RESULTS The two-stage process resulted in a pilot VISION-Cog consisting of nine vision-independent neuropsychological tests, including the modified spatial memory test, list learning, list recall and list recognition, adapted token test, semantic fluency, modified spatial analysis, verbal subtests of the frontal battery assessment, digit symbol, digit span forwards, and digit span backwards. These tests encompassed five cognitive domains-memory and learning, language, executive function, complex attention, and perceptual-motor abilities. The expert panel suggested improvements to the clarity of test instructions and culturally relevant test content. These suggestions were incorporated and iteratively pilot-tested by the study team until no further issues emerged. CONCLUSIONS We have developed a five-domain and nine-test VISION-Cog pilot instrument capable of replacing vision-dependent diagnostic batteries in aiding the clinician-based diagnosis of CI in visually impaired older adults. Subsequent phases will examine the VISION-Cog's feasibility, comprehensibility and acceptability; and evaluate its diagnostic performance.
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Affiliation(s)
- Tai Anh Vu
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Eva Fenwick
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Population Health Research, Singapore Eye Research Institute, Singapore
| | - Kinjal Doshi
- Department of Psychology, National University of Singapore, Singapore
| | - Preeti Gupta
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Population Health Research, Singapore Eye Research Institute, Singapore
| | - Shin Yi Quek
- Department of Psychology, Ng Teng Fong General Hospital, Singapore
| | - Christopher Chen
- Deaprtment of Pharmacology and Psychological Medicine, National University of Singapore, Singapore
| | - Simon Ting
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Adeline S L Ng
- Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore
| | - Philip Yap
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore
| | - Donald Yeo
- KALL Psychological & Counselling Services Pte Ltd, Singapore
| | - Dan Milea
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Population Health Research, Singapore Eye Research Institute, Singapore
- Rothschild Foundation Hospital, Paris, France
| | - Ecosse Luc Lamoureux
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Department of Ophthalmology, The University of Melbourne, Melbourne, Victoria, Australia
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13
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Zhao M, Xiao M, Tan Q, Lyu J, Lu F. The effect of aerobic exercise on oxidative stress in patients with chronic kidney disease: a systematic review and meta-analysis with trial sequential analysis. Ren Fail 2023; 45:2252093. [PMID: 37753870 PMCID: PMC10538458 DOI: 10.1080/0886022x.2023.2252093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/21/2023] [Indexed: 09/28/2023] Open
Abstract
PURPOSE The purpose of this study was to investigate how aerobic exercise affects oxidative stress (OS) in patients with chronic kidney disease (CKD). METHODS Retrieval dates range from the date the database was established to 19 July 2023, without languages being restricted. A meta-analysis and sensitivity analysis were conducted using RevMan 5.3 and Stata 16.0. RESULTS The meta-analysis showed that, compared to usual activity or no exercise, aerobic exercise significantly reduced the oxidative markers malondialdehyde (MDA) (mean differences (MD) - 0.96 (95% CI -1.33, - 0.59); p < 0.00001), advanced oxidation protein product (AOPP) (MD - 3.49 (95% CI - 5.05, - 1.93); p < 0.00001), F2-isoprostanes (F2-iso) (MD - 11.02 (95% CI - 17.79, - 4.25); p = 0.001). Aerobic exercise also increased the antioxidant marker superoxide dismutase (SOD) in CKD patients (standardized mean differences (SMD) 1.30 (95% CI 0.56, 2.04); p = 0.0005). Subgroup analysis showed a significant increase in glutathione peroxidase (GPX) in patients aged ≥60 years (SMD 2.11 (95% CI 1.69, 2.54); p < 0.00001). The change in total antioxidant capacity (TAC) after aerobic exercise was insignificant in patients with CKD. The trial sequential analysis supported aerobic exercise's effectiveness in improving MDA, SOD, AOPP, and F2-iso in patients with CKD. CONCLUSION The results of this review suggest that aerobic exercise improves OS indicators (MDA, SOD, AOPP, and F2-iso) in CKD patients compared to conventional treatment or no exercise and that the effects on GPX and TAC indicators need further confirmation. For better validation of benefits and exploration of the best aerobic exercise regimen to improve OS status with CKD, further studies with high methodological quality and large sample sizes are needed.
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Affiliation(s)
- Mengjie Zhao
- Graduate School of Beijing University of Chinese Medicine, Beijing, P.R. China
- NMPA Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, Xiyuan Hospital, China Academy of Chinese Medicine Sciences, Beijing, P.R. China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medicine Sciences, Beijing, P.R. China
| | - Mengli Xiao
- NMPA Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, Xiyuan Hospital, China Academy of Chinese Medicine Sciences, Beijing, P.R. China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medicine Sciences, Beijing, P.R. China
| | - Qin Tan
- NMPA Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, Xiyuan Hospital, China Academy of Chinese Medicine Sciences, Beijing, P.R. China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medicine Sciences, Beijing, P.R. China
| | - Jian Lyu
- NMPA Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, Xiyuan Hospital, China Academy of Chinese Medicine Sciences, Beijing, P.R. China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medicine Sciences, Beijing, P.R. China
| | - Fang Lu
- NMPA Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, Xiyuan Hospital, China Academy of Chinese Medicine Sciences, Beijing, P.R. China
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medicine Sciences, Beijing, P.R. China
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14
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Shapiro LM, Welch J, Leversedge C, Katarincic JA, Leversedge FJ, Dyer GSM, Kozin SH, Fox PM, McCullough M, Agins B, Kamal RN. Capacity Assessment Tool to Promote Capacity Building in Global Orthopaedic Surgical Outreach. J Bone Joint Surg Am 2023; 105:1295-1300. [PMID: 37319177 DOI: 10.2106/jbjs.23.00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND A growing number of nongovernmental organizations from high-income countries aim to provide surgical outreach for patients in low- and middle-income countries in a manner that builds capacity. There remains, however, a paucity of measurable steps to benchmark and evaluate capacity-building efforts. Based on a framework for capacity building, the present study aimed to develop a Capacity Assessment Tool for orthopaedic surgery (CAT-os) that could be utilized to evaluate and promote capacity building. METHODS To develop the CAT-os tool, we utilized methodological triangulation-an approach that incorporates multiple different types of data. We utilized (1) the results of a systematic review of capacity-building best practices in surgical outreach, (2) the HEALTHQUAL National Organizational Assessment Tool, and (3) 20 semistructured interviews to develop a draft of the CAT-os. We subsequently iteratively used a modified nominal group technique with a consortium of 8 globally experienced surgeons to build consensus, which was followed by validation through member-checking. RESULTS The CAT-os was developed and validated as a formal instrument with actionable steps in each of 7 domains of capacity building. Each domain includes items that are scaled for scoring. For example, in the domain of partnership, items range from no formalized plans for sustainable, bidirectional relationships (no capacity) to local surgeons and other health-care workers independently participating in annual meetings of surgical professional societies and independently creating partnership with third party organizations (optimal capacity). CONCLUSIONS The CAT-os details steps to assess capacity of a local facility, guide capacity-improvement efforts during surgical outreach, and measure the impact of capacity-building efforts. Capacity building is a frequently cited and commendable approach to surgical outreach, and this tool provides objective measurement to aid in improving the capacity in low and middle-income countries through surgical outreach.
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Affiliation(s)
- Lauren M Shapiro
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California
| | - Jessica Welch
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, Redwood City, California
| | - Chelsea Leversedge
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, Redwood City, California
| | | | | | - George S M Dyer
- Department of Orthopaedics, Harvard Combined Orthopaedics Residency Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Scott H Kozin
- Shriners Hospitals for Children-Philadelphia, Philadelphia, Pennsylvania
| | - Paige M Fox
- Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, California
| | | | - Bruce Agins
- Department of Epidemiology & Biostatistics, University of California-San Francisco, San Francisco California
| | - Robin N Kamal
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, Redwood City, California
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15
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Dompmartin A, Baselga E, Boon LM, Diociaiuti A, Dvorakova V, El Hachem M, Gasparella P, Haxhija E, Ghaffarpour N, Kyrklund K, Irvine AD, Kapp FG, Rößler J, Salminen P, van den Bosch C, van der Vleuten C, Schultze Kool L, Vikkula M. The VASCERN-VASCA Working Group Diagnostic and Management Pathways for Venous Malformations. JOURNAL OF VASCULAR ANOMALIES 2023; 4:e064. [PMID: 37332880 PMCID: PMC10275493 DOI: 10.1097/jova.0000000000000064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/04/2023] [Indexed: 06/20/2023]
Abstract
To elaborate expert consensus patient pathways to guide patients and physicians toward efficient diagnostics and management of patients with venous malformations. Methods VASCERN-VASCA (https://vascern.eu/) is a European network of multidisciplinary centers for Vascular Anomalies. The Nominal Group Technique was used to establish the pathways. Two facilitators were identified: one to propose initial discussion points and draw the pathways, and another to chair the discussion. A dermatologist (AD) was chosen as first facilitator due to her specific clinical and research experience. The draft was subsequently discussed within VASCERN-VASCA monthly virtual meetings and annual face-to-face meetings. Results The Pathway starts from the clinical suspicion of a venous type malformation (VM) and lists the clinical characteristics to look for to support this suspicion. Strategies for subsequent imaging and histopathology are suggested. These aim to inform on the diagnosis and to separate the patients into 4 subtypes: (1) sporadic single VMs or (2) multifocal, (3) familial, multifocal, and (4) combined and/or syndromic VMs. The management of each type is detailed in subsequent pages of the pathway, which are color coded to identify sections on (1) clinical evaluations, (2) investigations, (3) treatments, and (4) associated genes. Actions relevant to all types are marked in separate boxes, including when imaging is recommended. When definite diagnoses have been reached, the pathway also points toward disease-specific additional investigations and recommendations for follow up. Options for management are discussed for each subtype, including conservative and invasive treatments, as well as novel molecular therapies. Conclusion The collaborative efforts of VASCERN-VASCA, a network of the 9 Expert Centers, has led to a consensus Diagnostic and Management Pathways for VMs to assist clinicians and patients. It also emphasizes the role of multidisciplinary expert centers in the management of VM patients. This pathway will become available on the VASCERN website (http://vascern.eu/).
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Affiliation(s)
- Anne Dompmartin
- Dermatology Department CHU Caen Université Caen Normandie CHU Caen Côte nacre 14033 Caen Cedex, France
| | - Eulalia Baselga
- Pediatric Dermatology, Hospital Sant Joan de Deu, Barcelona, Spain; VASCERN VASCA European Reference Centre
| | - Laurence M. Boon
- Center for Vascular Anomalies, Division of Plastic Surgery, University Clinics Saint-Luc, University of Louvain, Brussels, Belgium; VASCERN VASCA European Reference Centre
| | - Andrea Diociaiuti
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165, Rome, Italy; VASCERN VASCA European Reference Centre
| | - Veronika Dvorakova
- Paediatric Dermatology, Children’s Health Ireland; Clinical Medicine, Trinity College Dublin, Ireland; VASCERN VASCA European Reference Centre
| | - May El Hachem
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, IRCCS, Piazza Sant’Onofrio 4, 00165, Rome, Italy; VASCERN VASCA European Reference Centre
| | - Paolo Gasparella
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria; VASCERN VASCA European Reference Centre
| | - Emir Haxhija
- Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria; VASCERN VASCA European Reference Centre
| | - Nader Ghaffarpour
- Department of Plastic and Craniofacial Surgery Karolinska University Hospital Stockholm, Stockholm, Sweden; VASCERN VASCA European Reference Centre
| | - Kristiina Kyrklund
- Department of Pediatric Surgery, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; VASCERN VASCA European Reference Centre
| | - Alan D. Irvine
- Paediatric Dermatology, Children’s Health Ireland; Clinical Medicine, Trinity College Dublin, Ireland; VASCERN VASCA European Reference Centre
| | - Friedrich G. Kapp
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; VASCERN VASCA European Reference Centre
| | - Jochen Rößler
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; VASCERN VASCA European Reference Centre
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Päivi Salminen
- Department of Pediatric Surgery, HUSRare Disease Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; VASCERN VASCA European Reference Centre
| | | | - Carine van der Vleuten
- Department of Dermatology, Radboudumc Expertise Center for Haemangiomas and Congenital Vascular Malformations Nijmegen (Hecovan), Radboud University Medical Center, Nijmegen, the Netherlands; VASCERN VASCA European Reference Centre
| | - Leo Schultze Kool
- Department of Radiology, Radboudumc Expertise Center for Haemangiomas and Congenital Vascular Malformations Nijmegen (Hecovan), Radboud University Medical Center, Nijmegen, the Netherlands; VASCERN VASCA European Reference Centre
| | - Miikka Vikkula
- Center for Vascular Anomalies, Division of Plastic Surgery, University Clinics Saint-Luc, University of Louvain, Brussels, Belgium; VASCERN VASCA European Reference Centre
- Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium
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Davies JF, McGain F, Francis JJ. Consensus on Prioritisation of Actions for Reducing the Environmental Impact of a Large Tertiary Hospital: Application of the Nominal Group Technique. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3978. [PMID: 36901002 PMCID: PMC10001469 DOI: 10.3390/ijerph20053978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/20/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
Hospitals are the largest greenhouse gas producers within the Australian healthcare sector due to the large amounts of energy, resource utilization, equipment and pharmaceuticals required to deliver care. In order to reduce healthcare emissions, healthcare services must take multiple actions to address the broad range of emissions produced when delivering patient care. The goal of this study was to seek consensus on the priority actions needed to reduce the environmental impact of a tertiary Australian hospital. A nominal group technique was utilized within a multidisciplinary, executive-led environmental sustainability committee to find consensus on the 62 proposed actions to reduce the environmental impact of a tertiary Australian hospital. Thirteen participants joined an online workshop during which an educational presentation was delivered, 62 potential actions were privately ranked according to two domains of 'amenability to change' and 'scale of climate impact' and a moderated group discussion ensued. The group achieved verbal consensus on 16 actions that span staff education, procurement, pharmaceuticals, waste, transport and advocacy on all-electric capital works upgrades. In addition, the individual ratings of potential actions according to each domain were ranked and shared with the group. Despite a large number of actions and varied perspectives within the group, the nominal group technique can be used to focus a hospital leadership group on priority actions to improve environmental sustainability.
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Affiliation(s)
- Jessica F. Davies
- Anaesthetics Department, Austin Health, Heidelberg, VIC 3084, Australia
- Department of Critical Care, School of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
| | - Forbes McGain
- Department of Critical Care, School of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
- Anaesthetic and Intensive Care Departments, Western Health, St Albans, VIC 3021, Australia
- School of Public Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Jillian J. Francis
- School of Health Sciences, University of Melbourne, Melbourne, VIC 3010, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, 305 Grattan St., Melbourne, VIC 3000, Australia
- Centre for Implementation Research, Ottawa Hospital Research Institute, General Campus, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
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Shapiro LM, Welch JM, Chatterjee M, Katarincic JA, Leversedge FJ, Dyer GSM, Fufa DT, Kozin SH, Chung KC, Fox PM, Chang J, Kamal RN. A Framework and Blueprint for Building Capacity in Global Orthopaedic Surgical Outreach. J Bone Joint Surg Am 2023; 105:e10. [PMID: 35984012 PMCID: PMC10760412 DOI: 10.2106/jbjs.22.00353] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Nongovernmental organizations (NGOs) from high-income countries provide surgical outreach for patients in low and middle-income countries (LMICs); however, these efforts lack a coordinated measurement of their ability to build capacity. While the World Health Organization and others recommend outreach trips that aim to build the capacity of the local health-care system, no guidance exists on how to accomplish this. The objective of this paper is to establish a framework and a blueprint to guide the operations of NGOs that provide outreach to build orthopaedic surgical capacity in LMICs. METHODS We conducted a qualitative analysis of semistructured interviews with 16 orthopaedic surgeons and administrators located in 7 countries (6 LMICs) on the necessary domains for capacity-building; the analysis was guided by a literature review of capacity-building frameworks. We subsequently conducted a modified nominal group technique with a consortium of 10 U.S.-based surgeons with expertise in global surgical outreach, which was member-checked with 8 new stakeholders from 4 LMICs. RESULTS A framework with 7 domains for capacity-building in global surgical outreach was identified. The domains included professional development, finance, partnerships, governance, community impact, culture, and coordination. These domains were tiered in a hierarchical system to stratify the level of capacity for each domain. A blueprint was developed to guide the operations of an organization seeking to build capacity. CONCLUSIONS The developed framework identified 7 domains to address when building capacity during global orthopaedic surgical outreach. The framework and its tiered system can be used to assess capacity and guide capacity-building efforts in LMICs. The developed blueprint can inform the operations of NGOs toward activities that focus on building capacity in order to ensure a measured and sustained impact.
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Affiliation(s)
- Lauren M Shapiro
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California
| | - Jessica M Welch
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Maya Chatterjee
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | | | | | - George S M Dyer
- Department of Orthopaedics, Harvard Combined Orthopaedics Residency Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Duretti T Fufa
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Scott H Kozin
- Shriners Hospitals for Children–Philadelphia, Philadelphia, Pennsylvania
| | - Kevin C Chung
- Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Paige M Fox
- Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, California
| | - James Chang
- Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, California
| | - Robin N Kamal
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, California
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18
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de Voss S, Wilson P, Saxild S, Overbeck G. Increasing the psychosocial focus in child developmental assessments: a qualitative study. BMC Pediatr 2023; 23:44. [PMID: 36698093 PMCID: PMC9875422 DOI: 10.1186/s12887-023-03849-x] [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] [Received: 04/07/2022] [Accepted: 01/16/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Previous studies have indicated a need for increased psychosocial focus on children and their families to improve children's wellbeing and mental health. Child developmental assessments could be a place to implement changes to achieve this. A standardised record might be helpful to clinicians trying to increase psychosocial focus. The aim of this study is to investigate clinical barriers and facilitators when introducing standardised child records with increased focus on psychosocial wellbeing and mental health into child developmental assessments. METHODS This is a qualitative study based on 12 semi-structured interviews with four midwives and nine doctors who carry out child developmental assessments in general practice. Data is analysed in the framework of Normalisation Process Theory. RESULTS General practice-based clinicians were positive towards increasing the psychosocial focus in child developmental assessments. The main barriers when clinicians used the standardised child records were: feeling forced to ask certain questions, in turn making the conversation rigid; leaving less room for parents to bring up other issues; making clinicians feel awkward when addressing problems that they cannot solve; the need for extended consultation time; and medico-legal concerns when registering findings. The experience of positive aspects when using the standardised child records facilitated continuous use of the records. Positive aspects included having a standardised approach to recording important findings, thereby uncovering psychosocial problems that could potentially be overlooked. Additionally, structured observation of parent-child interaction and gaining a new vocabulary to describe the findings were valued by clinicians. Balancing a standardised approach with clinicians' ability to steer the consultation and explore topics in depth while preserving the potential for patients to bring up other issues became an important theme. CONCLUSION Clinicians need to be well-equipped to handle psychosocial problems through coping strategies, referral options and communication techniques in the psychosocial domain. The parent-child-interaction assessment might expose potentially dysfunctional parenting behaviours and could improve communication between health professionals. Implementing standardised child development records with an increased psychosocial focus is feasible but improvements could optimise the use of the records. Parental views on an increased psychosocial focus during child developmental assessments should be investigated prior to further implementation. TRIAL REGISTRATION Trial registry number for the FamilieTrivsel (Family Wellbeing) trial: NCT04129359.
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Affiliation(s)
- Sarah de Voss
- grid.5254.60000 0001 0674 042XDepartment of Public Health, Centre for General Practice, University of Copenhagen, Øster Farimagsgade 5, Opg. Q, CSS, Bg. 24, Postboks 2099, 1353 København K, Denmark
| | - Philip Wilson
- grid.5254.60000 0001 0674 042XDepartment of Public Health, Centre for General Practice, University of Copenhagen, Øster Farimagsgade 5, Opg. Q, CSS, Bg. 24, Postboks 2099, 1353 København K, Denmark ,grid.7107.10000 0004 1936 7291Centre for Rural Health, Institute of Applied Health Sciences, University of Aberdeen, Old Perth Road Inverness, IV2 3JH Aberdeen, Scotland
| | - Sofie Saxild
- grid.5254.60000 0001 0674 042XDepartment of Public Health, Centre for General Practice, University of Copenhagen, Øster Farimagsgade 5, Opg. Q, CSS, Bg. 24, Postboks 2099, 1353 København K, Denmark
| | - Gritt Overbeck
- grid.5254.60000 0001 0674 042XDepartment of Public Health, Centre for General Practice, University of Copenhagen, Øster Farimagsgade 5, Opg. Q, CSS, Bg. 24, Postboks 2099, 1353 København K, Denmark
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Defining avoidable healthcare-associated harm in prisons: A mixed-method development study. PLoS One 2023; 18:e0282021. [PMID: 36920916 PMCID: PMC10016636 DOI: 10.1371/journal.pone.0282021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 02/06/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Reducing avoidable healthcare-associated harm is a global health priority. Progress in evaluating the burden and aetiology of avoidable harm in prisons is limited compared with other healthcare sectors. To address this gap, this study aimed to develop a definition of avoidable harm to facilitate future epidemiological studies in prisons. METHODS Using a sequential mixed methods study design we first characterised and reached consensus on the types and avoidability of patient harm in prison healthcare involving analysis of 151 serious prison incidents reported to the Strategic Executive Information System (StEIS) followed by in-depth nominal group (NG) discussions with four former service users and four prison professionals. Findings of the NG discussions and StEIS analysis were then synthesised and discussed among the research team and study oversight groups to develop an operational definition of avoidable harm in prison healthcare which was subsequently tested and validated using prison patient safety incident report data derived from the National Reporting and Learning System (NRLS). RESULTS Analysis of StEIS incident reports and NG discussions identified important factors influencing avoidable harm which reflected the unique prison setting, including health care delivery issues and constraints associated with the secure environment which limited access to care. These findings informed the development of a new working two-tier definition of avoidable harm using appropriate and timely intervention, which included an additional assessment of harm avoidability taking into the account the prison regime and environment. The definition was compatible with the NRLS incident report narratives and illustrated how the prison environment may influence identification of avoidable harm and judgements of avoidability. CONCLUSIONS We have developed a working definition of avoidable harm in prison health care that enables consideration of caveats associated with prison environments and systems. Our definition enables future studies of the safety of prison healthcare to standardise outcome measurement.
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Maluleke K, Musekiwa A, Mashamba-Thompson TP. Study protocol for developing a novel approach for improving supply chain management for SARS-CoV-2 point of care diagnostic services in resource-limited settings: a case study of Mopani District in Limpopo province, South Africa. BMJ Open 2022; 12:e062509. [PMID: 36424106 PMCID: PMC9693879 DOI: 10.1136/bmjopen-2022-062509] [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: 11/25/2022] Open
Abstract
INTRODUCTION Recent evidence shows that point-of-care (POC) testing is a more feasible alternative for diagnosis of COVID-19 in settings that have poor access to laboratory diagnostic services. Equitable access to POC testing can be optimised through well-established supply chain management (SCM) systems. The proposed study aims to develop a novel approach for improving SCM for COVID-19 POC diagnostic services in resource-limited settings with poor access to laboratory diagnostic services, using Mopani District in Limpopo Province, South Africa as a study setting. METHODS AND ANALYSIS This study was guided by results of the scoping review. Following the scoping review, we propose a mixed-methods study, which will be implemented in three phases. First, we will perform a geospatial analysis to investigate the spatial distribution of COVID-19 testing services. Second, we will perform an audit of POC diagnostic services including its supply chain to evaluate the effect of SCM on accessibility of COVID-19 POC diagnostic services and reveal SCM barriers and enablers of accessibility of COVID-19 POC diagnostic services. Third, we will perform a nominal group technique to collaborate with key stakeholders in co-creation of a novel approach for improving SCM systems for COVID-19 POC diagnostic services. For the geospatial analysis, we will employ the ArcGIS Software. For the analysis of quantitative and qualitative data that will be generated from the audit and nominal group discussion, we will employ Stata software and NVivo software, respectively. ETHICS AND DISSEMINATION This study has been ethically reviewed and approved by two institutional review boards: University of Pretoria Faculty of Health Sciences Research Ethics Committee (approval number 655/2021) and Limpopo Department of Health Research Ethics Committee (approval number LP-2021-12-007). The results of this study will be disseminated through national and international presentations and peer-reviewed publications.
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Affiliation(s)
- Kuhlula Maluleke
- School of Health Systems and Public Health, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa
| | - Alfred Musekiwa
- School of Health Systems and Public Health, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa
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21
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Akhavan AR, Strout TD, Germann CA, Nelson SW, Jauregui J, Lu DW. "Going through the motions": A qualitative exploration of the impact of emergency medicine resident burnout on patient care. AEM EDUCATION AND TRAINING 2022; 6:e10809. [PMID: 36189447 PMCID: PMC9513530 DOI: 10.1002/aet2.10809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/30/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
Objectives Burnout occurs frequently in emergency medicine (EM) residents and has been shown to have a negative impact on patient care. The specific effects of burnout on patient care are less well understood. This study qualitatively explores how burnout may change the way EM residents provide patient care. Methods Qualitative data were obtained from a sample of 29 EM residents in four semistructured focus groups across four institutions in the United States in early 2019. Transcripts were coded and organized into major patient care themes. Results Residents described many ways in which feelings of burnout negatively impacted patient care. These detrimental effects most often fit into one of four main themes: reduced motivation to care for patients, poor communication with patients, difficult interactions with health care colleagues, and impaired decision making. Conclusions According to EM residents, burnout negatively impacts several important aspects of patient care. Resident engagement with clinical care, communication with patients and colleagues, and clinical care may suffer as a result of burnout.
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Affiliation(s)
| | | | | | | | | | - Dave W. Lu
- Department of Emergency MedicineUniversity of WashingtonSeattleWashingtonUSA
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22
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Looman N, de Graaf J, Thoonen B, van Asselt D, de Groot E, Kramer A, Scherpbier N, Fluit C. Designing the learning of intraprofessional collaboration among medical residents. MEDICAL EDUCATION 2022; 56:1017-1031. [PMID: 35791303 PMCID: PMC9543842 DOI: 10.1111/medu.14868] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 05/21/2023]
Abstract
BACKGROUND To preserve quality and continuity of care, collaboration between primary-care and secondary-care physicians is becoming increasingly important. Therefore, learning intraprofessional collaboration (intraPC) requires explicit attention during postgraduate training. Hospital placements provide opportunities for intraPC learning, but these opportunities require interventions to support and enhance such learning. Design-Principles guide the design and development of educational activities when theory-driven Design-Principles are tailored into context-sensitive Design-Principles. The aim of this study was to develop and substantiate a set of theory-driven and context-sensitive Design-Principles for intraPC learning during hospital placements. METHODS Based on our earlier research, we formulated nine theory-driven Design-Principles. To enrich, refine and consolidate these principles, three focus group sessions with stakeholders were conducted using a Modified Nominal Group Technique. Next, two work conferences were conducted to test the feasibility and applicability of the Design-Principles for developing intraPC educational activities and to sharpen the principles into a final set of Design-Principles. RESULTS The theoretical Design-Principles were discussed and modified iteratively. Two new Design-Principles were added during focus group 1, and one more Design-Principle was added during focus group 2. The Design-Principles were categorised into three clusters: (i) Culture: building collaborative relations in a psychologically safe context where patterns or feelings of power dynamics between primary and secondary care physicians can be discussed; (ii) Connecting Contexts: making residents and supervisors mutually understand each other's work contexts and activities; and (iii) Making the Implicit Explicit: having supervising teams act as role models demonstrating intraPC and continuously pursuing improvement in intraPC to make intraPC explicit. Participants were unanimous in their view that the Design-Principles in the Culture cluster were prerequisites to facilitate intraPC learning. CONCLUSION This study led to the development of 12 theory-driven and context-sensitive Design-Principles that may guide the design of educational activities to support intraPC learning during hospital placements.
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Affiliation(s)
- Natasja Looman
- Department of Primary and Community CareRadboudumcNijmegenThe Netherlands
| | | | - Bart Thoonen
- Department of Primary and Community CareRadboudumcNijmegenThe Netherlands
| | | | - Esther de Groot
- Julius Center for Health Sciences and Primary CareUMC UtrechtUtrechtThe Netherlands
| | - Anneke Kramer
- Department of Public health and Primary CareLeiden UMCLeidenThe Netherlands
| | - Nynke Scherpbier
- Department of General Practice and Elderly CareUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Cornelia Fluit
- Department for Research in Learning and EducationRadboudumc Health AcademyNijmegenThe Netherlands
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23
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Maguire T, Garvey L, Ryan J, Olasoji M, Willets G. Using the Nominal Group Technique to determine a nursing framework for a forensic mental health service: A discussion paper. Int J Ment Health Nurs 2022; 31:1030-1038. [PMID: 35591773 PMCID: PMC9321579 DOI: 10.1111/inm.13023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/29/2022]
Abstract
The Nominal Group Technique is a method used to explore issues, generate ideas, and reach consensus on a topic. The Nominal Group Technique includes individual and group work and is designed to ensure participants have the same opportunity to engage and provide their opinions. While the technique has been used for around six decades to assist groups, in industry, and government organizations to examine issues and make decisions, this technique has received limited attention in nursing research, particularly in mental health. This discussion paper describes the use of a modified Nominal Group Technique for a study designed to determine a nursing decision-making framework for a state-wide forensic mental health service. Modifications were made to the traditional technique, to enable participants to make an informed and collective decision about a suitable framework for the novice to expert nurses, across secure inpatient, prison, and community forensic mental health settings. The Nominal Group Technique generated rich data and offered a structured approach to the process. We argue that the Nominal Group Technique offers an exciting and interactive method for nursing research and can increase opportunity for minority group members to participate. This technique also offers a time efficient way to engage busy clinical nurses to participate in research, with the advantage of members knowing the decision on the day of the group. Consideration, however, needs to be given to the duration and effect on participant concentration, and if not actively managed by facilitators, the possible emergence of group dynamics affecting individuals' decisions.
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Affiliation(s)
- Tessa Maguire
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Australia.,The Victorian Institute of Forensic Mental Health (Forensicare), Melbourne, Australia
| | - Loretta Garvey
- Department of Nursing & Allied Health, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Jo Ryan
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Australia.,The Victorian Institute of Forensic Mental Health (Forensicare), Melbourne, Australia
| | - Michael Olasoji
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Georgina Willets
- School of Health, Federation University Australia, Melbourne, Australia
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Under-triage: A New Trigger to Drive Quality Improvement in the Emergency Department. Pediatr Qual Saf 2022; 7:e581. [PMID: 35928021 PMCID: PMC9345634 DOI: 10.1097/pq9.0000000000000581] [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: 01/10/2022] [Accepted: 06/30/2022] [Indexed: 11/26/2022] Open
Abstract
The emergency department (ED) is a care setting with a high risk for medical error. In collaboration with our nursing colleagues, we identified a new trigger, under-triage, and demonstrated how its implementation could detect and reduce medical errors in the ED.
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25
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Lin E, Gobraeil J, Johnston S, Venables MJ, Archibald D. Consensus-Based Development of an Assessment Tool: A Methodology for Patient Engagement in Primary Care and CPD Research. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 42:153-158. [PMID: 35916890 PMCID: PMC9398503 DOI: 10.1097/ceh.0000000000000440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
With cardiovascular disease (CVD) posing a significant disease burden in Canada and more broadly, preventative efforts which incorporate best evidence, patient preference, and physician expertise must continue to take place. Primary care providers play a pivotal role in this effort, and a greater understanding of patient perspectives is needed to guide management and inform training. We used a validated consensus method, the nominal group technique (NGT), to identify patient-reported experience measures (PREM) related to CVD prevention deemed most important by both patients and providers. The NGT was used by using structured discussions between patients and providers to bring ideas about PREM CVD outcomes to a consensus. Four patient partners and four primary care providers were selected to participate in an NGT session. Each participant wrote down items/questions they believed important in CVD preventative care. After discussions, all items underwent anonymous ranking on a 5-point scale. Items were included/excluded based on 75% agreement a priori. The panel produced 10 items from a total of 26 after 2 rounds of ranking. The top two items were as follows: "Is your treatment plan tailored to you" and "Was your physician good at giving information about your risk factors?" These results are significantly different compared with existing quality measures because they highlight aspects of patient experience and therapeutic relationship. A questionnaire consisting of prioritized PREM items is valuable in quality improvement and continuous professional development (CPD).
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26
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Kaur HS, Chen JSC, Doolan BJ, Gupta M. Narrow-band UVB phototherapy-Australian consensus-based recommendations. Australas J Dermatol 2022; 63:387-391. [PMID: 35576122 PMCID: PMC9541837 DOI: 10.1111/ajd.13850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/16/2022] [Accepted: 03/31/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Har Simrat Kaur
- Faculty of Medicine, University of New South Wales, Western Sydney University, Sydney, New South Wales, Australia.,Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Jessica Szu-Chia Chen
- Faculty of Medicine, University of New South Wales, Western Sydney University, Sydney, New South Wales, Australia
| | - Brent J Doolan
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Monisha Gupta
- Faculty of Medicine, University of New South Wales, Western Sydney University, Sydney, New South Wales, Australia.,Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia
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Backhouse MR, Parker DJ, Morison SC, Anderson J, Cockayne S, Adamson JA. Using a modified nominal group technique to develop complex interventions for a randomised controlled trial in children with symptomatic pes planus. Trials 2022; 23:286. [PMID: 35410282 PMCID: PMC8996675 DOI: 10.1186/s13063-022-06251-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Children with symptomatic flat feet (pes planus) frequently present for care but there remains uncertainty about how best to manage their condition. There is considerable variation in practice between and within professions. We intend to conduct a three-arm trial to evaluate three frequently used interventions for pes planus (exercise and advice, exercise and advice plus prefabricated orthoses, and exercise and advice plus custom made orthoses). Each of these interventions are complex and required developing prior to starting the trial. This paper focusses on the development process undertaken to develop the interventions. Methods We used a modified Nominal Group Technique combining an electronic survey with two face-to-face meetings to achieve consensus on the final logic model and menu of options for each intervention. Using the Nominal Group Technique across consecutive meetings in combination with a questionnaire is novel, and enabled us to develop complex interventions that reflect contemporary clinical practice. Results In total 16 healthcare professionals took part in the consensus. These consisted of 11 podiatrists, two orthotists, two physiotherapists, and one orthopaedic surgeon. Both meetings endorsed the logic model with amendments to reflect the wider psychosocial impact of pes planus and its treatment, as well as the increasing use of shared decision making in practice. Short lists of options were agreed for prefabricated and custom made orthoses, structures to target in stretching and strengthening exercises, and elements of health education and advice. Conclusions Our novel modification of the nominal group technique produced a coherent logic model and shortlist of options for each of the interventions that explicitly enable adaptability. We formed a consensus on the range of what is permissible within each intervention so that their integrity is kept intact and they can be adapted and pragmatically applied. The process of combining survey data with face-to-face meetings has ensured the interventions mirror contemporary practice and may provide a template for other trials. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06251-7.
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Thibault LP, Bourque CJ, Luu TM, Huot C, Cardinal G, Carriere B, Dupont-Thibodeau A, Moussa A. Residents as Research Subjects: Balancing Resident Education and Contribution to Advancing Educational Innovations. J Grad Med Educ 2022; 14:191-200. [PMID: 35463172 PMCID: PMC9017267 DOI: 10.4300/jgme-d-21-00530.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/15/2021] [Accepted: 01/03/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Research in education advances knowledge and improves learning, but the literature does not define how to protect residents' rights as subjects in studies or how to limit the impact of their participation on their clinical training. OBJECTIVE We aimed to develop a consensual framework on how to include residents as participants in education research, with the dual goal of protecting their rights and promoting their contributions to research. METHODS A nominal group technique approach was used to structure 3 iterative meetings held with the pre-existing residency training program committee and 7 invited experts between September 2018 and April 2019. Thematic text analysis was conducted to prepare a final report, including recommendations. RESULTS Five themes, each with recommendations, were identified: (1) Freedom of participation: participation, non-participation, or withdrawal from a study should not interfere with teacher-learner relationship (recommendation: improve recruitment and consent forms); (2) Avoidance of over-solicitation (recommendation: limit the number of ongoing studies); (3) Management of time dedicated to participation in research (recommendations: schedule and proportion of time for study participation); (4) Emotional safety (recommendation: requirement for debriefing and confidential counseling); and (5) Educational safety: data collected during a study should not influence clinical assessment of the resident (recommendation: principal investigator should not be involved in the evaluation process of learners in clinical rotation). CONCLUSIONS Our nominal group technique approach resulted in raising 5 specific issues about freedom of participation of residents in research in medical education, over-solicitation, time dedicated to research, emotional safety, and educational safety.
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Affiliation(s)
- Louis-Philippe Thibault
- Louis-Philippe Thibault, MD, BBA, is a Student, Master's in Medical Education Program, Harvard Medical School, and a Pediatrician, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Claude Julie Bourque
- Claude Julie Bourque, PhD, is an Assistant Professor and a Researcher, Department of Pediatrics, Centre for Applied Health Sciences Education, Faculty of Medicine, Université de Montréal, Quebec, Canada
| | - Thuy Mai Luu
- Thuy Mai Luu, MD, MSc, is an Associate Clinical Professor, Department of Pediatrics, and Clinician-Scientist, CHU Sainte-Justine Research Center, Faculty of Medicine, Université de Montréal
| | - Celine Huot
- Celine Huot, MD, MSc, is a Full Clinical Professor and Researcher, Department of Pediatrics and CHU Sainte-Justine Research Center, Faculty of Medicine, Université de Montréal
| | - Genevieve Cardinal
- Genevieve Cardinal, LLM, is Chair of the Research Ethics Board and Manager, Research Ethics Office, CHU Sainte-Justine
| | - Benoit Carriere
- Benoit Carriere, MD, MHPE, is an Associate Professor and the Director of Medical Education, CHU Sainte-Justine, Department of Pediatrics, Faculty of Medicine, Université de Montréal
| | - Amelie Dupont-Thibodeau
- Amelie Dupont-Thibodeau, MD, PhD, is an Assistant Professor and a Researcher, Department of Pediatrics, CHU Sainte-Justine Research Center, Faculty of Medicine, Université de Montréal
| | - Ahmed Moussa
- Ahmed Moussa, MD, MMEd, is an Associate Professor, Department of Pediatrics, a Clinician-Scientist, CHU Sainte-Justine Research Center, and Director, Center for Applied Health Sciences Education, Faculty of Medicine, Université de Montréal
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Montesanti S, Fitzpatrick K, Fayant B, Pritchard C. Identifying priorities, directions and a vision for Indigenous mental health using a collaborative and consensus-based facilitation approach. BMC Health Serv Res 2022; 22:406. [PMID: 35346187 PMCID: PMC8958486 DOI: 10.1186/s12913-022-07682-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/24/2022] [Indexed: 12/19/2022] Open
Abstract
Background Mental health disparities between Indigenous and non-Indigenous people in Canada are related to underlying economic, social, and political inequities that are legacies of colonization and the oppression of Indigenous cultures. It also widely acknowledged that mental health services currently available may not be culturally appropriate in supporting the health needs of Indigenous Canadians. A two-day Indigenous mental health forum examined mental health needs and gaps among Indigenous communities across the Regional Municipality of Wood Buffalo (RMWB) on Treaty 8 territory, in northern Alberta, Canada. This paper outlines the insights generated by stakeholder engagement at the forum to identify and prioritize directions for Indigenous mental health and build a vision and strategy for improving mental health services and programs for the region’s diverse Indigenous population. Methods We applied a modified nominal group technique (NGT) consensus method embedded within Indigenous knowledge to determine key priorities and directions for Indigenous-focused mental health and synthesize information from discussions that occurred at the forum. Following the NGT, a participatory community visioning exercise was conducted with participants to develop a vision, guiding principles, and components of an action plan for an Indigenous mental health strategy for the RMWB. Results Four key themes for setting priorities and directions for Indigenous mental health emerged from roundtable group discussions: 1) understand the realities of mental health experiences for Indigenous peoples, 2) design a holistic and culturally rooted mental health system, 3) foster cross-sectoral engagement and collaboration on mental health service delivery, and 4) focus on children and youth. The community visioning exercise helped stakeholders to visualize a direction or path forward for addressing existing gaps in the mental health system and opportunities for strengthening Indigenous mental health in the region. Conclusions Forum participants described mental health and well-being around holistic concepts of social and emotional well-being. Addressing Indigenous mental health and wellness involves multi-sectoral action in various settings including community and school through programs, policies, and other interventions that promote mental health for all Indigenous peoples, as well as for those at greater risk such as children and youth. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07682-3.
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Ahmad Zamzuri MI, Naserrudin NA, Ali NKM, Aziz SA, Rashid MFA, Dapari R, Ramdzan AR, Hod R, Hassan MR. “Best of Both World”: The Amalgamation of Fuzzy Delphi Method with Nominal Group Technique for Dengue Risk Prioritisation Decision-Making. JOURNAL OF FUNCTION SPACES 2022; 2022:1-8. [DOI: 10.1155/2022/9581367] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Introduction. Dengue remains a public health threat. Clarifying the characteristics of future threats and prioritising intervention towards the highest risk potential can help to control and prevent dengue outbreaks. However, obtaining a consensus from panels of experts is certainly challenging due to the relative subjectivity of experience. Therefore, this article incorporates the fuzzy Delphi method (FDM) within a nominal group technique (NGT) as a multicriteria decision-making tool for (1) describing the characteristics of socioecological attributes (SEAs) with a high risk of causing dengue outbreak and (2) ranking those SEAs as priorities for intervention. Material and Methods. Experts were recruited using a purposive sampling technique. Informed consent was obtained before the start of the study. The NGT process began with an introductory presentation of dengue SEA by the moderator, followed by “silent generation.” Next, each participant provided information in a round-robin fashion. Ideas were collected by the moderator and displayed publicly. All experts were given ample time and space to contribute and justify their ideas without interruption during the discussion step to yield agreeable SEA characteristics. Ultimately, FDM was incorporated in the voting step to ensure rigorous analysis. The study was approved by an ethical committee before its commencement. Results. A total of 10 field experts participated in the study, with a median experience of 7.5 years working on a dengue team. The common characteristics of SEA prone to cause dengue outbreaks were the presence of human-made containers, in high quantities, left unattended, and covered from direct sunlight. Apart from that, all eight SEAs passed the triangulation of fuzzy numbers and defuzzification processes. The average fuzzy numbers ranged between 0.500 and 0.780, and the threshold value (
) ranged from 0.055 to 0.196. Of the potential risk factors identified, experts ranked illegal dumping sites as the most important, followed by old and unused items and construction sites. Conclusion. The NGT process successfully helped to obtain a consensus among the expert panels in describing SEA characteristics. Nevertheless, the integration of FDM offered a robust analysis that validated their ranking in dengue risk prioritisation. Therefore, we strongly recommend the application of FDM to be incorporated in any public health decision-making process.
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Affiliation(s)
- Mohd‘Ammar Ihsan Ahmad Zamzuri
- Department of Community Health, Faculty of Medicine, National University of Malaysia Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia
- Seremban District Health Office, Ministry of Health Malaysia, Jalan Lee Sam, Bandar Seremban, 70590, Seremban, Negeri Sembilan, Malaysia
| | - Nurul Athirah Naserrudin
- Department of Community Health, Faculty of Medicine, National University of Malaysia Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Noor Khalili Mohd Ali
- Seremban District Health Office, Ministry of Health Malaysia, Jalan Lee Sam, Bandar Seremban, 70590, Seremban, Negeri Sembilan, Malaysia
| | - Suriyati Abd Aziz
- General Hospital of Malacca, Ministry of Health Malaysia, Jalan Mufti Haji Khalil, 75400 Melaka, Malaysia
| | - Mohammad Faid Abd. Rashid
- General Hospital of Malacca, Ministry of Health Malaysia, Jalan Mufti Haji Khalil, 75400 Melaka, Malaysia
| | - Rahmat Dapari
- Department of Community Health, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia
| | - Abdul Rahman Ramdzan
- Department of Public Health Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, 88400 Kota Kinabalu, Sabah, Malaysia
| | - Rozita Hod
- Department of Community Health, Faculty of Medicine, National University of Malaysia Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Mohd Rohaizat Hassan
- Department of Community Health, Faculty of Medicine, National University of Malaysia Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia
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Keegan D, Heffernan E, McSharry J, Barry T, Masterson S. Identifying priorities for the collection and use of data related to community first response and out-of-hospital cardiac arrest: protocol for a nominal group technique study. HRB Open Res 2021; 4:81. [PMID: 34909578 PMCID: PMC8637246 DOI: 10.12688/hrbopenres.13347.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: Out-of-hospital cardiac arrest (OHCA) is a devastating health event that affects over 2000 people each year in Ireland. Survival rate is low, but immediate intervention and initiation of cardiopulmonary resuscitation (CPR) and administration of an automated external defibrillator (AED) can increase chances of survival. It is not always possible for the emergency medical services (EMS) to reach OHCA cases quickly. As such, volunteers, including lay and professional responders (e.g. off-duty paramedics and fire-fighters), trained in CPR and AED use, are mobilised by the EMS to respond locally to prehospital medical emergencies (e.g. OHCA and stroke). This is known as community first response (CFR). Data on the impact of CFR interventions are limited. This research aims to identify the most important CFR data to collect and analyse, the most important uses of CFR data, as well as barriers and facilitators to data collection and use. This can inform policies to optimise the practice of CFR in Ireland. Methods: The nominal group technique (NGT) is a structured consensus process where key stakeholders (e.g. CFR volunteers, clinicians, EMS personnel, and patients/relatives) develop a set of prioritised recommendations. This study will employ the NGT, incorporating an online survey and online consensus meeting, to develop a priority list for the collection and use of CFR data in Ireland. Stakeholder responses will also identify barriers and facilitators to data collection and use, as well as indicators that improvements to these processes have been achieved. The maximum sample size for the NGT will be 20 participants to ensure sufficient representation from stakeholder groups. Discussion: This study, employing the NGT, will consult key stakeholders to establish CFR data collection, analysis, and use priorities. Results from this study will inform CFR research, practice, and policy, to improve the national CFR service model and inform international response programs.
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Affiliation(s)
- Dylan Keegan
- Discipline of General Practice, Clinical Science Institute, School of Medicine, National University of Ireland, Galway, Galway, H91 TK33, Ireland
| | - Eithne Heffernan
- Discipline of General Practice, Clinical Science Institute, School of Medicine, National University of Ireland, Galway, Galway, H91 TK33, Ireland
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, H91 TK33, Ireland
| | - Tomás Barry
- School of Medicine, University College Dublin, Dublin 4, D04 V1W8, Ireland
| | - Siobhán Masterson
- Discipline of General Practice, Clinical Science Institute, School of Medicine, National University of Ireland, Galway, Galway, H91 TK33, Ireland
- National Ambulance Service, Health Service Executive, St. Eunan's Hall, St Conal's Hospital, Letterkenny, Donegal, F92 XK84, Ireland
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Shawahna R. Using a mixed method to develop consensus-based aims, contents, intended learning outcomes, teaching, and evaluation methods for a course on epilepsy for postgraduate or continuing education in community health nursing programs. BMC MEDICAL EDUCATION 2021; 21:572. [PMID: 34772401 PMCID: PMC8588674 DOI: 10.1186/s12909-021-03001-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Knowledge deficits with regard to epilepsy have been reported among healthcare professionals. This study was conducted to develop consensus-based aims, contents, intended learning outcomes, teaching, and evaluation methods for a course on epilepsy for postgraduate or continuing education in community health nursing programs. METHODS A mixed method which combined a thorough search of literature, the nominal group technique, the Delphi technique, and survey of students' agreement was used. The databases MEDLINE/PUBMED, EMBASE, COCHRANE, CInAHL/EBESCO, SCOPUS, Google Scholar, Google Books, and Amazon were searched to identify potential aims, topics/contents, intended learning outcomes, teaching, and evaluation methods. Discussions and deliberations in serial meetings based on the nominal group technique were attended by educators/academicians (n = 12), neurologists (n = 2), practicing nurses (n = 5), pharmacists (n = 2), patients with epilepsy (n = 2), and students in postgraduate and continuing education programs (n = 7) to supplement and refine the data collected from the literature. The qualitative data were analyzed using RQDA tool for R. The Delphi technique was used among educators/academicians (n = 15), neurologists (n = 2), practicing nurses (n = 5), pharmacists (n = 2), patients with epilepsy (n = 3), and students in postgraduate and continuing education programs (n = 8) to achieve formal consensus. RESULTS Consensus was achieved on 6 aims, 16 intended learning outcomes, and 27 topics in the course. Of the topics, 13 were relevant to nature of epilepsy and seizures, 2 were relevant to the impact of epilepsy and seizures on different life aspects of patients with epilepsy, 4 were relevant to advocating for the patients and supporting their choices, 5 were relevant to educating patients and their caregivers, and 3 were relevant to assessments and services. CONCLUSION Consensus-based aims, topics/contents, intended learning outcomes, teaching, and evaluation methods of a course on epilepsy for postgraduate or continuing education in community health nursing programs were developed. Consensus-based courses could bridge knowledge gaps and improve educating community health nursing programs on epilepsy. Further studies are needed to determine if such consensus-based courses could promote care of patients with epilepsy.
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Affiliation(s)
- Ramzi Shawahna
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, New Campus, Building: 19, Office: 1340, P.O. Box 7, Nablus, Palestine.
- An-Najah BioSciences Unit, Centre for Poisons Control, Chemical and Biological Analyses, An-Najah National University, Nablus, Palestine.
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Chen TT, Hsiao CC, Chu TP, Chen SH, Liao MN, Hung CC. Exploring core competencies of clinical nurse preceptors: A nominal group technique study. Nurse Educ Pract 2021; 56:103200. [PMID: 34555785 DOI: 10.1016/j.nepr.2021.103200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/16/2021] [Accepted: 09/03/2021] [Indexed: 12/12/2022]
Abstract
AIM The aim of this study was to explore core competencies of nurse preceptors based on the perspectives of postgraduate-year nurses, nurse preceptors and head nurses. BACKGROUND Perspectives of core competencies of nurse preceptors are varied among postgraduate-year nurses, nurse preceptors and head nurses, which makes it difficult to establish preceptor training programs and develop evaluation instruments. DESIGN A nominal group technique study. METHODS A nominal group technique procedure was applied to small-group and large-group discussion. The participants were recruited from the inpatient units at five nonprofit hospitals, each having over 1000 patient beds, in Taiwan. A total of 101 participants were involved in this study: 32 postgraduate-year nurses, 42 nurse preceptors and 27 head nurses, who were respectively sorted into five, six and four small groups with six to eight members in each group. After applying nominal group technique procedure, the core competencies were scored and ranked. Based on the final scores and ranking, the core competencies that the participants felt to be most important for nurse preceptors were identified. The expert panel then integrated these core competencies and derived a consensus. RESULTS Seven core competencies of nurse preceptors were derived, in order of declining importance: teaching traits, clinical nursing profession, communication and collaboration, teaching pedagogy, reaction of contingency, critical thinking and reflection and consultation on academic writing. All participants perceived that teaching traits (198 points) and clinical nursing profession (161 points) were the most important. Consultation of academic writing is unique, which may be due to the clinical ladder system still being implemented in Taiwan. CONCLUSIONS The nominal group technique is an efficient and proper method to conduct a consensus for specific issues or values among individuals and groups. The results of this study can facilitate the development of evaluation indicators or instruments as well as provide a direction of continuing education program for preceptor training.
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Affiliation(s)
- Tzu-Ting Chen
- Department of Nursing, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
| | - Chia-Chi Hsiao
- Department of Nursing, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
| | - Tsui-Ping Chu
- Department of Nursing, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
| | - Sue-Hsien Chen
- Department of Nursing Management, Chang Gung Medical Foundation Administration Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Mei-Nan Liao
- Chang Gung Medical Foundation Administration Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Chang-Chiao Hung
- School of Nursing & Nursing Department, Chang Gung University of Science and Technology & Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
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Keegan D, Heffernan E, McSharry J, Barry T, Masterson S. Identifying priorities for the collection and use of data related to community first response and out-of-hospital cardiac arrest: protocol for a nominal group technique study. HRB Open Res 2021; 4:81. [PMID: 34909578 PMCID: PMC8637246 DOI: 10.12688/hrbopenres.13347.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 04/05/2024] Open
Abstract
Introduction: Out-of-hospital cardiac arrest (OHCA) is a devastating health event that affects over 2000 people each year in Ireland. Survival rate is low, but immediate intervention and initiation of cardiopulmonary resuscitation (CPR) and administration of an automated external defibrillator (AED) can increase chances of survival. It is not always possible for the emergency medical services (EMS) to reach OHCA cases quickly. As such, volunteers, including lay and professional responders (e.g. off-duty paramedics and fire-fighters), trained in CPR and AED use, are mobilised by the EMS to respond locally to prehospital medical emergencies (e.g. OHCA and stroke). This is known as community first response (CFR). Data on the impact of CFR interventions are limited. This research aims to identify the most important CFR data to collect and analyse, the most important uses of CFR data, as well as barriers and facilitators to data collection and use. This can inform policies to optimise the practice of CFR in Ireland. Methods: The nominal group technique (NGT) is a structured consensus process where key stakeholders (e.g. CFR volunteers, clinicians, EMS personnel, and patients/relatives) develop a set of prioritised recommendations. This study will employ the NGT, incorporating an online survey and online consensus meeting, to develop a priority list for the collection and use of CFR data in Ireland. Stakeholder responses will also identify barriers and facilitators to data collection and use, as well as indicators that improvements to these processes have been achieved. The maximum sample size for the NGT will be 20 participants to ensure sufficient representation from stakeholder groups. Discussion: This study, employing the NGT, will consult key stakeholders to establish CFR data collection, analysis, and use priorities. Results from this study will inform CFR research, practice, and policy, to improve the national CFR service model and inform international response programs.
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Affiliation(s)
- Dylan Keegan
- Discipline of General Practice, Clinical Science Institute, School of Medicine, National University of Ireland, Galway, Galway, H91 TK33, Ireland
| | - Eithne Heffernan
- Discipline of General Practice, Clinical Science Institute, School of Medicine, National University of Ireland, Galway, Galway, H91 TK33, Ireland
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, H91 TK33, Ireland
| | - Tomás Barry
- School of Medicine, University College Dublin, Dublin 4, D04 V1W8, Ireland
| | - Siobhán Masterson
- Discipline of General Practice, Clinical Science Institute, School of Medicine, National University of Ireland, Galway, Galway, H91 TK33, Ireland
- National Ambulance Service, Health Service Executive, St. Eunan's Hall, St Conal's Hospital, Letterkenny, Donegal, F92 XK84, Ireland
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Valiquette CR, Forrest CR, Kasrai L, Wanzel KR, Martou G, Beber BA, Semple JL, Constantine T, Ho ES, Somogyi RB. Can We Reach a Consensus on the Appropriate Use of Before and After Photos in Breast Surgery? PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3682. [PMID: 34285856 PMCID: PMC8284704 DOI: 10.1097/gox.0000000000003682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/05/2021] [Indexed: 11/25/2022]
Abstract
Breast surgery is an area of practice where patients value before and after photographs (BAPs). Consensus is needed to develop guidelines to address the deficit in the literature regarding appropriate use of BAPs, as these may ultimately play a significant role in the breast surgery consent process.
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Affiliation(s)
- Chantal R Valiquette
- Division of Plastic and Reconstructive Surgery, University of Toronto; Toronto, Ontario, Canada
| | - Christopher R Forrest
- Division of Plastic and Reconstructive Surgery, University of Toronto; Toronto, Ontario, Canada
| | - Leila Kasrai
- Division of Plastic and Reconstructive Surgery, University of Toronto; Toronto, Ontario, Canada
| | - Kyle R Wanzel
- Division of Plastic and Reconstructive Surgery, University of Toronto; Toronto, Ontario, Canada
| | - Glykeria Martou
- Division of Plastic Surgery, Queen's University, Kingston, Ontario, Canada
| | - Brett A Beber
- Division of Plastic and Reconstructive Surgery, University of Toronto; Toronto, Ontario, Canada
| | - John L Semple
- Division of Plastic and Reconstructive Surgery, University of Toronto; Toronto, Ontario, Canada
| | - Thomas Constantine
- Division of Plastic Surgery, Humber River Hospital; Toronto, Ontario, Canada
| | - Emily S Ho
- Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Ron B Somogyi
- Division of Plastic and Reconstructive Surgery, University of Toronto; Toronto, Ontario, Canada
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Lu DW, Germann CA, Nelson SW, Jauregui J, Strout TD. "Pulling the Parachute": A Qualitative Study of Burnout's Influence on Emergency Medicine Resident Career Choices. AEM EDUCATION AND TRAINING 2021; 5:e10535. [PMID: 34099988 PMCID: PMC8166306 DOI: 10.1002/aet2.10535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/30/2020] [Accepted: 09/11/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES About half of all resident physicians report symptoms of burnout. Burnout negatively influences multiple aspects of their education and training. How burnout may impact residents' career choices remains unclear. The authors explored the role burnout played in residents' career decisions. METHODS This was a qualitative study among a sample of 29 emergency medicine residents from four institutions. Qualitative data were generated through four semistructured focus groups. The authors employed a constructivist approach to thematic analysis. Transcripts were coded and organized into major themes. RESULTS Five major themes connecting burnout with residents' career choices emerged: 1) residents' current burnout and the prevention of future burnout figured prominently in their career considerations, 2) residents aimed to mitigate sources of burnout through their career choices, 3) residents' view of clinical work as a burden and a burnout contributor spurred the pursuit of other interests, 4) faculty advice and role modeling in relation to burnout shaped residents' career perspectives, and 5) residents weighed long-term burnout concerns with short-term financial needs. CONCLUSION Burnout played an important role in multiple aspects of residents' career considerations. Educators, program directors, and organization leaders can focus on identified target areas to address burnout's influence on residents' career decisions.
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Affiliation(s)
- Dave W. Lu
- From theDepartment of Emergency MedicineUniversity of Washington School of MedicineSeattleWAUSA
- and theDepartment of Emergency MedicineTufts University School of Medicine–Maine Medical CenterPortlandMEUSA
| | - Carl A. Germann
- and theDepartment of Emergency MedicineTufts University School of Medicine–Maine Medical CenterPortlandMEUSA
| | - Sara W. Nelson
- and theDepartment of Emergency MedicineTufts University School of Medicine–Maine Medical CenterPortlandMEUSA
| | - Joshua Jauregui
- From theDepartment of Emergency MedicineUniversity of Washington School of MedicineSeattleWAUSA
| | - Tania D. Strout
- and theDepartment of Emergency MedicineTufts University School of Medicine–Maine Medical CenterPortlandMEUSA
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Lu DW, Germann CA, Nelson SW, Jauregui J, Strout TD. "Necessary Compromises": A Qualitative Exploration of the Influence of Burnout on Resident Education. AEM EDUCATION AND TRAINING 2021; 5:e10500. [PMID: 33842813 PMCID: PMC8019220 DOI: 10.1002/aet2.10500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/23/2020] [Accepted: 07/01/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Burnout is prevalent among resident physicians and has a negative impact on their well-being and effectiveness at work. How burnout shapes residents' educational experiences, attitudes, habits, and practices is not well understood. There is also a lack of research regarding self-identified mitigation strategies for residents. The authors qualitatively explored burnout's role in the educational experiences of resident physicians. METHODS Qualitative data were generated from a sample of 29 emergency medicine residents through four semistructured focus groups across four institutions in January and February 2019. The authors employed a constructivist approach to thematic analysis. Transcripts were coded and organized into major and minor themes. RESULTS Residents reported that a misalignment of their individual versus institutional priorities and a lack of agency were significant contributors to their burnout. Residents described how burnout affected multiple aspects of their education, including their motivation and curiosity to learn, engagement in scholarly activity, and teaching of others. Residents identified several ways of building a sense of community that they explained was most useful in mitigating their experiences with burnout. CONCLUSION Burnout had a negative influence on many facets of residents' educational experiences during training. Program directors and educators can take resident-identified steps to moderate its detrimental role on trainee education.
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Affiliation(s)
- Dave W. Lu
- From theDepartment of Emergency MedicineUniversity of Washington School of MedicineSeattleWAUSA
- Department of Emergency MedicineTufts University School of Medicine – Maine Medical CenterPortlandMEUSA
| | - Carl A. Germann
- From theDepartment of Emergency MedicineUniversity of Washington School of MedicineSeattleWAUSA
| | - Sara W. Nelson
- From theDepartment of Emergency MedicineUniversity of Washington School of MedicineSeattleWAUSA
| | - Joshua Jauregui
- Department of Emergency MedicineTufts University School of Medicine – Maine Medical CenterPortlandMEUSA
| | - Tania D. Strout
- From theDepartment of Emergency MedicineUniversity of Washington School of MedicineSeattleWAUSA
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Cole R, Young J, Kearney L, Thompson JM. Priority setting: Consensus for Australia's infant safe sleeping public health promotion programme. J Paediatr Child Health 2021; 57:219-226. [PMID: 32918511 DOI: 10.1111/jpc.15178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/10/2020] [Accepted: 08/23/2020] [Indexed: 12/22/2022]
Abstract
AIM To develop focused priorities to inform the revision of Australia's Sudden Unexpected Death in Infancy (SUDI) risk reduction public health programme. METHODS A content expert consensus research activity was designed using two consensus techniques. The two-phase study employed a Delphi process (phase 1) and a Nominal Group workshop technique (phase 2). The Delphi invited 56 national and international content experts. The Nominal Group comprised 17 Australasian experts and stakeholders to ensure priority setting was relevant to the Australian context. RESULTS Phase 1 established a ranked thematic list of 10 key SUDI risk reduction themes. Phase 2 addressed three nominal questions producing prioritised lists for: key-message wording; contextual information and strategies to support caregiver implementation of key messages; and considerations in redesigning and dissemination of a safe sleep campaign. The top four priority themes were: sleep position, sleep space, smoking and surface-sharing. CONCLUSION This two-phase priority setting was successful in establishing clearly defined infant safe sleep priorities. International content expert participation in phase 1 strengthened priority setting outcomes while phase 2 ensured final outcomes provided a strong national focus reflective of identified needs of Australian families. Findings provide a foundation from which important components can be considered when revising and developing future SUDI risk reduction programmes.
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Affiliation(s)
- Roni Cole
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia.,Women's and Families Service Group, Sunshine Coast Hospital and Health Service, Sunshine Coast, Queensland, Australia
| | - Jeanine Young
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Lauren Kearney
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - John Md Thompson
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia.,Paediatrics, Child and Youth Health, School of Medicine, University of Auckland, Auckland, New Zealand
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Ezeanolue EE, Iheanacho T, Adedeji IA, Itanyi IU, Olakunde B, Patel D, Dakum P, Okonkwo P, Akinmurele T, Obiefune M, Khamofu H, Oyeledun B, Aina M, Eyo A, Oleribe O, Oko J, Olutola A, Gobir I, Aliyu MH, Aliyu G, Woelk G, Aarons G, Siberry G, Sturke R. Opportunities and challenges to integrating mental health into HIV programs in a low- and middle-income country: insights from the Nigeria implementation science Alliance. BMC Health Serv Res 2020; 20:904. [PMID: 32993621 PMCID: PMC7526407 DOI: 10.1186/s12913-020-05750-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background In Nigeria, there is an estimated 1.9 million people living with HIV (PLHIV), 53% of whom utilize HIV care and services. With decreasing HIV-related deaths and increasing new infections, HIV with its associated comorbidities continue to be a key public health challenge in Nigeria. Untreated, comorbid mental disorders are a critical but potentially modifiable determinant of optimal HIV treatment outcomes. This study aimed to identify the challenges and opportunities related to integrating mental health care into existing HIV programs in Nigeria. Method Attendees at the Nigeria Implementation Science Alliance (NISA)‘s 2019 conference participated in nominal group technique (NGT) exercise informed by the “Exploration, Preparation, Implementation, and Sustainment (EPIS)” framework. The NGT process was conducted among the nominal groups in two major sessions of 30-min phases followed by a 30-min plenary session. Data analysis proceeded in four steps: transcription, collation, theming and content analysis. Results The two major theoretical themes from the study were – opportunities and challenges of integrating mental health treatment into HIV services. Three sub-themes emerged on opportunities: building on health care facilities for HIV services (screening, counseling, task-sharing monitoring and evaluation frameworks), utilizing existing human resources or workforce in HIV programs (in-service training and including mental health in education curriculum) and the role of social and cultural structures (leveraging existing community, traditional and faith-based infrastructures). Four sub-themes emerged for challenges: double burden of stigma and the problems of early detection (HIV and mental health stigma, lack of awareness), existing policy gaps and structural challenges (fragmented health system), limited human resources for mental health care in Nigeria (knowledge gap and burnout) and dearth of data/evidence for planning and action (research gaps). Conclusions Potential for integrating treatments for mental disorders into HIV programs and services exist in Nigeria. These include opportunities for clinicians’ training and capacity building as well as community partnerships. Multiple barriers and challenges such as stigma, policy and research gaps would need to be addressed to leverage these opportunities. Our findings serve as a useful guide for government agencies, policy makers and research organizations to address co-morbid mental disorders among PLHIV in Nigeria.
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Affiliation(s)
- Echezona E Ezeanolue
- Center for Translation and Implementation Research, Institute of Maternal and Child health, University of Nigeria Nsukka, Enugu Campus, Enugu, Nigeria.,Healthy Sunrise Foundation, Las Vegas, NV, USA
| | - Theddeus Iheanacho
- Department of Psychiatry, Yale University School of Medicine, Yale University, 300 George Street, New Haven, CT, 06511, USA.
| | | | - Ijeoma Uchenna Itanyi
- Center for Translation and Implementation Research, Institute of Maternal and Child health, University of Nigeria Nsukka, Enugu Campus, Enugu, Nigeria.,Department of Community Medicine, University of Nigeria, Enugu, Nigeria
| | - Babayemi Olakunde
- Center for Translation and Implementation Research, Institute of Maternal and Child health, University of Nigeria Nsukka, Enugu Campus, Enugu, Nigeria.,National Agency for Control of AIDS, Abuja, Nigeria
| | - Dina Patel
- Healthy Sunrise Foundation, Las Vegas, NV, USA
| | - Patrick Dakum
- Institute of Human Virology, University of Maryland, Baltimore, MD, USA.,Institute of Human Virology, Abuja, Nigeria
| | | | | | | | | | | | | | - Andy Eyo
- Excellence Community Education Welfare Scheme, Abuja, Nigeria
| | - Obinna Oleribe
- Excellence and Friends Management Consult, Abuja, Nigeria
| | - John Oko
- Catholic Caritas Foundation Nigeria, Abuja, Nigeria
| | | | - Ibrahim Gobir
- Center for Global Health Practice and Impact, Georgetown University, Washington, USA
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gambo Aliyu
- National Agency for Control of AIDS, Abuja, Nigeria
| | - Godfrey Woelk
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, USA
| | | | - George Siberry
- United States Agency for International Development, Washington, USA
| | - Rachel Sturke
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
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Critical Success Factors of the Reliability-Centred Maintenance Implementation in the Oil and Gas Industry. Symmetry (Basel) 2020. [DOI: 10.3390/sym12101585] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Reliability-Centred Maintenance (RCM) is a strategic process to improve the maintenance planning of companies which contributes to sustainable production. This method has been applied by numerous industries to achieve an efficient maintenance process, but many have not fully completed their goals. The reason for this failure is that RCM implementation is complex, and organisations need to have adequate preparations before they implement it. In the pre-implementation phase, it is necessary to know the number of Critical Success Factors (CSFs) as a critical measure for implementing the RCM method successfully. Therefore, it is important for practitioners to apply a symmetric mechanism involving fuzzy systems to achieve the desired RCM implementation. There are a limited number of studies that have observed these factors regarding the characteristics of oil and gas companies, especially in the pre-implementation phase. Addressing RCM pre-implementation issues is of high importance from the economic perspective of sustainability for oil and gas organisations. The objective of this study is to investigate significant items in RCM pre-implementation through a combination of quantitative and qualitative analyses. The Nominal Group Technique (NGT) method is applied by gaining the opinion of experts to determine the factors and prioritising them using mathematical modelling. A group of related experts from the oil and gas industry were initially interviewed and surveyed to determine the critical success factors. These identified factors were then analysed using quantitative analysis to identify the important degrees and scored using Fuzzy Analytic Network Process (FANP). Fifteen major factors affecting the criticality of successful RCM implementation have been identified and prioritised, based on their weights. The model proposed in this study could be used as a guideline for assessing CSFs in other countries. To apply the proposed model in different contexts, it needs to be modified according to the needs, policies, and perspectives of each country.
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Potok OA, Rifkin DE. Applying a Geriatrics Framework to Older Dialysis Patients’ Needs: Getting There Is Half the Battle. Kidney Med 2020; 2:514-516. [PMID: 33095846 PMCID: PMC7568080 DOI: 10.1016/j.xkme.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Padhye K, El-Hawary R, Price V, Stevens S, Branchford B, Kulkarni K. Development of a perioperative venous thromboembolism prophylaxis algorithm for pediatric orthopedic surgical patients. Pediatr Hematol Oncol 2020; 37:109-118. [PMID: 31868065 DOI: 10.1080/08880018.2019.1695030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Venous thromboembolism (VTE) has been recognized as a rare but potentially serious complication in pediatric orthopedic patients. However, standardized guidelines for screening and management of at-risk patients do not exist. The aim of the study was to develop a VTE prophylaxis screening tool for postoperative orthopedic patients after conducting an institutional needs assessment survey. A needs assessment survey was conducted after institutional ethics board approval. Development of perioperative VTE prophylaxis algorithm for pediatric orthopedic surgical patients was planned after thorough literature review, consultation with national and international experts as well as using a modified nominal and consensus development conference (serial meetings) method for reaching a consensus. NAS as well as discussion with stakeholders indicated support for development of perioperative VTE prophylaxis algorithm for orthopedic patients. Using above methods, a VTE prophylaxis algorithm was developed and implemented at IWK Health Center. The present study involved development of a perioperative VTE prophylaxis algorithm for pediatric orthopedic surgical patients that could be easily and rapidly administered as a point of care assessment tool.
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Affiliation(s)
- Kedar Padhye
- Division of Orthopaedics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Ron El-Hawary
- Division of Orthopaedics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Victoria Price
- Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Sarah Stevens
- Department of Anesthesiology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Brian Branchford
- Department of Pediatrics, University of Colorado, Denver, Colorado, USA
| | - Ketan Kulkarni
- Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
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Facilitating ethical, legal, and professional deliberations to resolve dilemmas in daily healthcare practice: A case of driver with breakthrough seizures. Epilepsy Behav 2020; 102:106703. [PMID: 31786471 DOI: 10.1016/j.yebeh.2019.106703] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The present study was conducted among pharmacy students to use an 8-step systematic approach to facilitate discussions, deliberations, and decision-making on what to do when facing a dilemma of a patient with epilepsy who drives while having breakthrough seizures. METHODS A hypothetical case was developed using the 12-tips for developing dilemma case-based assessments in health education. A mixed method was used in this study. A serial group discussions based on the nominal group technique (NGT) method were applied. A thorough review of the literature and interviews with key experts in the domain (n = 12) were conducted to obtain pertinent data to inform discussions, deliberations, and decision-making. The analytic hierarchy process (AHP) was used to pairwise compare countervailing arguments and alternative courses of action. RESULTS In this study, 3 nominal groups were held, and for each 3, discussion rounds were conducted. A total of 27 panelists took part in the nominal groups. Compared with other alternative courses of action, significantly higher weight scores (p-value < 0.001) were given to the course action, "the pharmacist could counsel/educate the patient on the dangers/risks of driving while experiencing breakthrough seizures, inform the patient to refrain from driving in this period, and make a shared decision with the patient to refrain from driving in this period and inform the state authorities". CONCLUSION This study demonstrates that the 8-step approach when combined with the AHP can be a handy method in facilitating decision-making while addressing and resolving ethical/legal/professional dilemmas in daily healthcare practice.
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Terregino CA, Copeland HL, Sarfaty SC, Lantz-Gefroh V, Hoffmann-Longtin K. Development of an empathy and clarity rating scale to measure the effect of medical improv on end-of-first-year OCSE performance: a pilot study. MEDICAL EDUCATION ONLINE 2019; 24:1666537. [PMID: 31532330 PMCID: PMC6758630 DOI: 10.1080/10872981.2019.1666537] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 07/17/2019] [Accepted: 07/30/2019] [Indexed: 05/25/2023]
Abstract
Patients want empathetic physicians who listen and understand. How do you teach and measure empathy? Medical educators, including those inspired by Alan Alda, have turned to theater to teach skills in empathetic communication. Improvisation-informedcurriculum (medical improv) draws upon foundational actors training: deep listening, emotional understanding, connections, authenticity. Arating scale to measure the impact of medical improv on empathetic and clear communication does not exist. Objective: To develop aframework and instrument, the Empathy and Clarity Rating Scale (ECRS), for measuring communication elements used by actors and physicians, and pilot ECRS to test effectiveness of medical improv on first-yearstudents' communication skills. Design: Four medical schools collaborated. USMLE Step 2 Communication and Interpersonal Skills (CIS) domains were used as framework for discussion among three focus groups, each with clinicians, actors, communication experts, and community members with patient experience. Audiotaped discussions were transcribed; open coding procedures located emerging themes. The initial coding scheme was compared with the Consultation and Relational Empathy (CARE) measure. ECRS content was aligned with CARE, CIS and focus group themes. Modified nominal processes were conducted to finalize the scale. We implemented procedures to establish content validity and interrater reliability. Final ECRS was used to study student performance across three levels of experience with medical improv. Results: The final ECRS was comprised of seven five-pointscale items. Narrative comments precede behaviorally anchored ratings: 5=desired, 1=ineffective, 2-4=developing based upon adjustment needed. Rater agreement across all items was 84%. There was asmall correlation between the ECRS and another measure interviewing (r=0.262, p=0.003). Students with advanced medical improv training outperformed those without (F=3.51, p=.042). Conclusion: Acommunication scale enlightened by experiences of actors, clinicians, scholars and patients has been developed. The ECRS has potential to detect the impact of medical improv on development of empathetic and clear communication.
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Affiliation(s)
- Carol A. Terregino
- Office of Education and Academic Affairs, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - H. Liesel Copeland
- Office of Education, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Suzanne C. Sarfaty
- Office of Academic Affairs, Boston University School of Medicine, Boston, MA, USA
| | - Valeri Lantz-Gefroh
- School of Journalism, Stony Brook University School of Medicine (now at TCU and UNTHSV Medical School, Fort Worth, TX, USA), Stony Brook, NY, USA
| | - Krista Hoffmann-Longtin
- Office of Faculty Affairs and Professional Development, Indiana University School of Medicine, Indianapolis, IN, USA
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The Development of a Digital Dysphagia Guide with Care Homes: Co-Production and Evaluation of a Nutrition Support Tool. Geriatrics (Basel) 2019; 4:geriatrics4030048. [PMID: 31443170 PMCID: PMC6787745 DOI: 10.3390/geriatrics4030048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 07/25/2019] [Accepted: 08/09/2019] [Indexed: 12/03/2022] Open
Abstract
Good nutrition is a recognised outcome in the health and well-being of older care home residents and dysphagia is a known risk factor associated with under nutrition and poor outcomes. The study co-produced a digital Dysphagia Guide with Care Homes using a consensus method with interviews and focus groups to prioritise the need for information and explore acceptability of an educational tool for care home workers. Evaluation of use, acceptability of design, and content of the guide were completed via remote monitoring. The workforce prioritised the need for training as well as the knowledge and skills in relation to planning resident-centred care and advice on textured diets. The technology was a means of offering ‘bite-size’ learning to enhance planning for nutrition across the whole organisation including managers, kitchen staff, and care workers. The Guide to Dysphagia was produced on a tablet and piloted in four care homes over 12 weeks, by 57 staff. Integrated analytics allowed user activity to be monitored. Findings showed that 73% of respondents reported the guide helped them in their job. Additionally, 88% of respondents stated they would recommend the guide to other staff, with 90% reporting it was easy to use. Engagement with staff and managers in four homes resulted in a co-designed, dysphagia guide.
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Purkey E, Htoo SN, Whelan R, Mhote NPP, Davison CM. Creating a locally driven research agenda for the ethnic minorities of Eastern Myanmar. Health Res Policy Syst 2019; 17:64. [PMID: 31242918 PMCID: PMC6595672 DOI: 10.1186/s12961-019-0465-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research funding and production is inequitably distributed internationally, with emphasis placed on the priorities of funders and international partners. Research capacity development, along with agenda-setting for research priorities can create agency and self-sufficiency and should be inclusive of all relevant stakeholders. Myanmar is a fragile state, where decades of conflict have created a weakened healthcare system and health research sector. The population of Eastern Myanmar have long had their healthcare needs met by community-based organisations and ethnic health organisations operating within Eastern Myanmar and the adjoining Thai-Myanmar border. Despite a transition to civilian rule, the current context does not allow for a truly participatory health research capacity development and agenda-setting exercise between the health leaders of Eastern Myanmar and the government in Yangon. In this context, and with a desire to enhance the capacity, legitimacy and agency of their organisations, the health leaders of Eastern Myanmar are seeking to develop their own health research capacity and to take control of their own research agenda. METHODS Approximately 60 participants from 15 organisations attended a 3-day forum with the goals of (1) developing research capacity and interest through a research conference and methods workshop; (2) using a nominal group technique (NGT) to develop a locally driven research agenda; and (3) supporting the development of local research projects through ongoing funding and mentorship. RESULTS Participants were actively engaged in the workshops and NGT. Participants identified a broad range of health issues as priorities and were able to develop consensus around a list of 15 top priorities for the populations they serve. Despite availability of ongoing support, participants did not pursue the opportunity to engage in their own research projects emerging from this forum. CONCLUSIONS The NGT was an effective way to achieve engagement and consensus around research priorities between a group of healthcare providers, researchers and policy-makers from a variety of ethnic groups. More active involvement of senior leadership must happen before the energy harnessed at such a forum can be implemented in ongoing research capacity development.
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Affiliation(s)
- Eva Purkey
- Department of Family Medicine, Queen's University, 220 Bagot street, Kingston, Ontario, K7L 3G2, Canada.
| | - Saw Nay Htoo
- Burma Medical Association, PO Box 156, Mae Sot, Tak, 63110, Thailand
| | - Rachel Whelan
- Community Partners International, 81 University Avenue Road, Shwe Taung Gyar Ward (1), Bahan Township, Yangon, Myanmar
| | - Naw Pue Pue Mhote
- Burma Medical Association, PO Box 156, Mae Sot, Tak, 63110, Thailand
| | - Colleen M Davison
- Department of Public Health Sciences, Faculty of Health Sciences, Queen's University, Carruthers Hall, 62 Fifth Field Company Lane, Kingston, Ontario, K7L 3N6, Canada
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Banerjee Y, Tambi R, Gholami M, Alsheikh-Ali A, Bayoumi R, Lansberg P. Augmenting Flexnerism Via Twitterism: Need for Integrating Social Media Application in Blueprinting Pedagogical Strategies for Undergraduate Medical Education. JMIR MEDICAL EDUCATION 2019; 5:e12403. [PMID: 30907736 PMCID: PMC6452274 DOI: 10.2196/12403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/29/2018] [Accepted: 01/03/2019] [Indexed: 05/10/2023]
Abstract
BACKGROUND Flexnerism, or "competency-based medical education," advocates that formal analytic reasoning, the kind of rational thinking fundamental to the basic sciences, especially the natural sciences, should be the foundation of physicians' intellectual training. The complexity of 21st century health care requires rethinking of current (medical) educational paradigms. In this "Millennial Era," promulgation of the tenets of Flexnerism in undergraduate medical education requires a design and blueprint of innovative pedagogical strategies, as the targeted learners are millennials (designated as generation-Y medical students). OBJECTIVE The aim of this proof-of-concept study was to identify the specific social media app platforms that are selectively preferred by generation-Y medical students in undergraduate medical education. In addition, we aimed to explore if these preferred social media apps can be used to design an effective pedagogical strategy in order to disseminate course learning objectives in the preclinical phase of a spiral curriculum. METHODS A cross-sectional survey was conducted by distributing a 17-item questionnaire among the first- and second-year medical students in the preclinical phase at the Mohammed Bin Rashid University of Medicine and Health Science. RESULTS The study identified YouTube and WhatsApp as the social media app platforms preferred by generation-Y medical students in undergraduate medical education. This study also identified the differences between female and male generation-Y medical students in terms of the use of social media apps in medical education, which we believe will assist instructors in designing pedagogical strategies to integrate social media apps. In addition, we determined the perceptions of generation-Y medical students on the implementation of social media apps in medical education. The pedagogical strategy designed using social media apps and implemented in the Biochemistry course was well accepted by generation-Y medical students and can be translated to any course in the preclinical phase of the medical curriculum. Moreover, the identified limitations of this study provide an understanding of the gaps in research in the integration of social media apps in a medical curriculum catering to generation-Y medical students. CONCLUSIONS 21st century medical education requires effective use of social media app platforms to augment competency-based medical education: Augmentation of Flexnerism in the current scenario is possible only by the adaptation of Twitterism.
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Affiliation(s)
- Yajnavalka Banerjee
- Department of Basic Medical Sciences, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- Centre for Medical Education, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Richa Tambi
- Academic Medical Center, Dubai Healthcare City, Department of Basic Medical Sciences, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- Laboratory for Computational Molecular Design, RIKEN Center for Biosystems Dynamics Research, Osaka, Japan
| | - Mandana Gholami
- Academic Medical Center, Dubai Healthcare City, Bachelor of Medicine & Bachelor of Surgery Program, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Alawi Alsheikh-Ali
- Academic Medical Center, Dubai Healthcare City, Department of Basic Medical Sciences, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Riad Bayoumi
- Department of Basic Medical Sciences, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Peter Lansberg
- Molecular Genetics Section, Department of Pediatrics, University Medical Center Groningen, Groningen, Netherlands
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