1
|
Wathne H, May C, Morken IM, Storm M, Husebø AML. Acceptability and usability of a nurse-assisted remote patient monitoring intervention for the post-hospital follow-up of patients with long-term illness: A qualitative study. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2024; 7:100229. [PMID: 39166216 PMCID: PMC11334779 DOI: 10.1016/j.ijnsa.2024.100229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 07/22/2024] [Accepted: 07/26/2024] [Indexed: 08/22/2024] Open
Abstract
Background Patients living with long-term chronic illnesses often need ongoing medical attention, lifestyle adjustments, and psychosocial support beyond the initial diagnosis and treatment phases. Many experience illness deterioration and subsequently require hospitalisation, especially in the transition period after hospital discharge. A promising strategy for managing long-term conditions is promoting self-management. eHealth interventions involving remote patient monitoring have the potential to promote self-management and offer a more seamless bridge between the hospital and the patient´s home environment. However, such interventions can only significantly impact health and health care if they are effective, accepted and adopted by users, normalised into routine practice and everyday life, and able to be widely implemented. Feasibility studies are used to determine whether an intervention is suitable for the target population and effective in achieving its intended goal. They may also provide critical information about an intervention´s acceptability and usability. Objectives We aimed to evaluate the acceptability and usability of a nurse-assisted remote patient monitoring intervention for the post-hospital follow-up of patients with long-term illnesses by use of the core constructs of normalisation process theory. Design A descriptive and explanatory qualitative approach was used, with patients observed during training and semi-structured interviews conducted with patients and nurses after study completion. Settings Participants were recruited from two university hospitals in Norway between December 2021 and February 2023. Participants Ten patients were observed during training, and 27 patients and eight nurses were interviewed after study completion. Methods Structured and overt observations were made while the patients received training to operate the remote patient monitoring service, guided by an observation guide. Semi-structured interviews were conducted with patients and nurse navigators about their experiences of remote follow-up care, guided by open ended questions. Data analysis followed a stepwise deductive inductive method. Results `Achieving acceptance and usability through digital social interaction´ emerged as a unifying theme that bridged the experiences of patients with long-term illnesses and the nurse navigators. This overarching theme was illustrated by four sub-themes, which all reflected the usability and acceptability of the nurse-assisted remote patient monitoring service in various ways. Conclusion Acceptability and usability are critical factors to consider when evaluating remote patient monitoring interventions. In this study, the most important feature for promoting acceptability and usability was the interaction between patients and nurse navigators. Therefore, the intervention´s feasibility and implementation potential rested upon the relationship between its deliverer and receiver.
Collapse
Affiliation(s)
- Hege Wathne
- Department of Public Health, University of Stavanger, Faculty of Health Science, Stavanger, Norway
| | - Carl May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ingvild Margreta Morken
- Department of Quality and Health Technologies, University of Stavanger, Faculty of Health Science, Stavanger, Norway
- Research Group for Health and Nursing Sciences, Stavanger University Hospital, Stavanger, Norway
| | - Marianne Storm
- Department of Public Health, University of Stavanger, Faculty of Health Science, Stavanger, Norway
- Research Group for Health and Nursing Sciences, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
| | - Anne Marie Lunde Husebø
- Department of Public Health, University of Stavanger, Faculty of Health Science, Stavanger, Norway
- Research Group for Health and Nursing Sciences, Stavanger University Hospital, Stavanger, Norway
| |
Collapse
|
2
|
Guo W, Nazari N, Sadeghi M. Cognitive-behavioral treatment for insomnia and mindfulness-based stress reduction in nurses with insomnia: a non-inferiority internet delivered randomized controlled trial. PeerJ 2024; 12:e17491. [PMID: 39071123 PMCID: PMC11283175 DOI: 10.7717/peerj.17491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/09/2024] [Indexed: 07/30/2024] Open
Abstract
Background Insomnia is a highly prevalent sleep disorder frequently comorbid with mental health conditions in nurses. Despite the effectiveness of evidence-based cognitive behavioral therapy for insomnia (CBT-I), there is a critical need for alternative approaches. This study investigated whether internet-delivered mindfulness-based stress reduction (IMBSR) for insomnia could be an alternative to internet-delivered CBT-I (ICBT-I). Objective The hypothesis was that the IMBSR would be noninferior to the ICBT-I in reducing the severity of insomnia among nurses with insomnia. Additionally, it was expected that ICBT-I would produce a greater reduction in the severity of insomnia and depression than IMBSR. Method Among 240 screened nurses, 134 with insomnia were randomly allocated (IMBSR, n = 67; ICBT-I, n = 67). The assessment protocol comprised clinical interviews and self-reported outcome measures, including the Insomnia Severity Index (ISI), Patient Health Questionnaire-9 (PHQ-9), the 15-item Five Facet Mindfulness Questionnaire (FFMQ), and the Client Satisfaction Questionnaire (CSQ-I). Results The retention rate was 55% with 77.6% (n = 104) of participants completing the study. At post-intervention, the noninferiority analysis of the ISI score showed that the upper limit of the 95% confidence interval was 4.88 (P = 0.46), surpassing the pre-specified noninferiority margin of 4 points. Analysis of covariance revealed that the ICBT-I group had significantly lower ISI (Cohen's d = 1.37) and PHQ-9 (Cohen's d = 0.71) scores than did the IMBSR group. In contrast, the IMBSR group showed a statistically significant increase in the FFMQ-15 score (Cohen's d = 0.67). Within-group differences showed that both the IMBSR and ICBT-I were effective at reducing insomnia severity and depression severity and improving mindfulness. Conclusion Overall, nurses demonstrated high levels of satisfaction and adherence to both interventions. The IMBSR significantly reduced insomnia severity and depression, but the findings of this study do not provide strong evidence that the IMBSR is at least as effective as the ICBT-I in reducing insomnia symptoms among nurses with insomnia. The ICBT-I was found to be significantly superior to the IMBSR in reducing insomnia severity, making it a recommended treatment option for nurses with insomnia.
Collapse
Affiliation(s)
- Wanran Guo
- School of Public Policy and Administration, Nanchang University, Nanchang, Nanchang, China
| | - Nabi Nazari
- Department of Psychology, Faculty of Human Sciences, University of Lorestan, Khorramabad, Lorestan, Iran
| | - Masoud Sadeghi
- Department of Psychology, Faculty of Human Sciences, University of Lorestan, Khorramabad, Lorestan, Iran
| |
Collapse
|
3
|
Morin CM, Buysse DJ. Management of Insomnia. N Engl J Med 2024; 391:247-258. [PMID: 39018534 DOI: 10.1056/nejmcp2305655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Affiliation(s)
- Charles M Morin
- From the School of Psychology and Centre de Recherche CERVO-BRAIN Research Center, Université Laval, Quebec, QC, Canada (C.M.M.); and the Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh (D.J.B.)
| | - Daniel J Buysse
- From the School of Psychology and Centre de Recherche CERVO-BRAIN Research Center, Université Laval, Quebec, QC, Canada (C.M.M.); and the Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh (D.J.B.)
| |
Collapse
|
4
|
Ares-Blanco S, López-Rodríguez JA, Polentinos-Castro E, Del Cura-González I. Effect of GP visits in the compliance of preventive services: a cross-sectional study in Europe. BMC PRIMARY CARE 2024; 25:165. [PMID: 38750446 PMCID: PMC11094967 DOI: 10.1186/s12875-024-02400-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/23/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Performing cardiovascular and cancer screenings in target populations can reduce mortality. Visiting a General Practitioner (GP) once a year is related to an increased likelihood of preventive care. The aim of this study was to analyse the influence of visiting a GP in the last year on the delivery of preventive services based on sex and household income. METHODS Cross-sectional study using data collected from the European Health Interview Survey 2013-2015 of individuals aged 40-74 years from 29 European countries. The variables included: sociodemographic factors (age, sex, and household income (HHI) quintiles [HHI 1: lowest income, HHI 5: more affluent]), lifestyle factors, comorbidities, and preventive care services (cardiometabolic, influenza vaccination, and cancer screening). Descriptive statistics, bivariate analyses and multilevel models (level 1: citizen, level 2: country) were performed. RESULTS 242,212 subjects were included, 53.7% were female. The proportion of subjects who received any cardiometabolic screening (92.4%) was greater than cancer screening (colorectal cancer: 44.1%, gynaecologic cancer: 40.0%) and influenza vaccination. Individuals who visited a GP in the last year were more prone to receive preventive care services (cardiometabolic screening: adjusted OR (aOR): 7.78, 95% CI: 7.43-8.15; colorectal screening aOR: 1.87, 95% CI: 1.80-1.95; mammography aOR: 1.76, 95% CI: 1.69-1.83 and Pap smear test: aOR: 1.89, 95% CI:1.85-1.94). Among those who visited a GP in the last year, the highest ratios of cardiometabolic screening and cancer screening benefited those who were more affluent. Women underwent more blood pressure measurements than men regardless of the HHI. Men were more likely to undergo influenza vaccination than women regardless of the HHI. The highest differences between countries were observed for influenza vaccination, with a median odds ratio (MOR) of 6.36 (under 65 years with comorbidities) and 4.30 (over 65 years with comorbidities), followed by colorectal cancer screening with an MOR of 2.26. CONCLUSIONS Greater adherence to preventive services was linked to individuals who had visited a GP at least once in the past year. Disparities were evident among those with lower household incomes who visited a GP. The most significant variability among countries was observed in influenza vaccination and colorectal cancer screening.
Collapse
Affiliation(s)
- Sara Ares-Blanco
- Federica Montseny Health Centre, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain.
- Medical Specialties and Public Health, School of Health Sciences, Rey Juan Carlos University, Alcorcón, Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
- Chronicity, Primary Care, and Health Promotion Networks (RICAPPS), ISCIII, Madrid, Spain.
| | - Juan A López-Rodríguez
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- General Ricardos Health Centre, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Primary Care Research Unit, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Chronicity, Primary Care, and Health Promotion Networks (RICAPPS), ISCIII, Madrid, Spain
- Medical Specialties and Public Health Department, School of Health Sciences, Rey Juan Carlos, University, Alcorcón, Madrid, Spain
| | - Elena Polentinos-Castro
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Primary Care Research Unit, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Chronicity, Primary Care, and Health Promotion Networks (RICAPPS), ISCIII, Madrid, Spain
- Medical Specialties and Public Health Department, School of Health Sciences, Rey Juan Carlos, University, Alcorcón, Madrid, Spain
| | - Isabel Del Cura-González
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Primary Care Research Unit, Gerencia de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Chronicity, Primary Care, and Health Promotion Networks (RICAPPS), ISCIII, Madrid, Spain
- Medical Specialties and Public Health Department, School of Health Sciences, Rey Juan Carlos, University, Alcorcón, Madrid, Spain
- Aging Research Center, Karolinksa Instituted, Stockholm, Sweden
| |
Collapse
|
5
|
Rahman KMT, Rayna SE, Khan FA, Khan MMH, Rahman F, Ether ST, Islam MZ, Sarkar S, Islam SS, Khalequzzaman M. Challenges faced by medical officers in providing healthcare services at upazila health complexes and district hospitals in Bangladesh - a qualitative study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 24:100398. [PMID: 38665890 PMCID: PMC11043881 DOI: 10.1016/j.lansea.2024.100398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 12/03/2023] [Accepted: 03/23/2024] [Indexed: 04/28/2024]
Abstract
Background Upazila Health Complexes (UHCs) and District Hospitals (DHs) play a crucial role in the healthcare delivery system of Bangladesh. But very few research has been conducted to find out the prevailing challenges of the medical officers working in these tiers. The objective of the study was to identify the challenges faced by medical officers in providing healthcare services at UHCs and DHs. Methods In-depth interviews of 51 medical officers from 17 UHCs and nine DHs were done between March and April 2021. All participants were purposively sampled. Data were transcribed verbatim and analysed using thematic analysis. Findings Inadequate service rooms, unavailability of proper medical equipment, poor housing conditions, lack of public amenities, shortage of health workforce, lack of laboratory services, and excessive workload were the common challenges mentioned by the medical officers in providing healthcare services in UHCs and DHs. Lack of workplace safety, security, and undue pressure from local political leaders and journalists made the work environment fearful. The absence of proper implementation of policy related to higher education, posting, transfer, and promotion was also stated as challenge for the medical officers. Interpretation Infrastructural improvements along with increased safety and security of the doctors at their workplace and transparent implementation of reformed policies are essential to reduce the workplace challenges of medical officers in UHCs and DHs of Bangladesh. Funding The study was funded by Hospital Services Management, Directorate General Of Health Services (DGHS), Mohakhali, Dhaka, and Bangabandhu Sheikh Mujib Medical University.
Collapse
Affiliation(s)
- Khan Mohammad Thouhidur Rahman
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh
| | - Shahrin Emdad Rayna
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh
| | - Fahmida Afroz Khan
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh
| | - Md. Maruf Haque Khan
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh
| | | | | | - Md. Zahidul Islam
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh
| | - Supriya Sarkar
- Hospital Services Management, Directorate General of Health Services, Mohakhali, Dhaka, 1212, Bangladesh
| | - Syed Shariful Islam
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh
| | - Md. Khalequzzaman
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, 1000, Bangladesh
| |
Collapse
|
6
|
Selsick H, Heidbreder A, Ellis J, Ferini-Strambi L, García-Borreguero D, Leontiou C, Mak MSB, O'Regan D, Parrino L. Assessment and management of chronic insomnia disorder: an algorithm for primary care physicians. BMC PRIMARY CARE 2024; 25:138. [PMID: 38671358 PMCID: PMC11055373 DOI: 10.1186/s12875-024-02381-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/10/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Primary care physicians often lack resources and training to correctly diagnose and manage chronic insomnia disorder. Tools supporting chronic insomnia diagnosis and management could fill this critical gap. A survey was conducted to understand insomnia disorder diagnosis and treatment practices among primary care physicians, and to evaluate a diagnosis and treatment algorithm on its use, to identify ways to optimize it specifically for these providers. METHODS A panel of experts developed an algorithm for diagnosing and treating chronic insomnia disorder, based on current guidelines and experience in clinical practice. An online survey was conducted with primary care physicians from France, Germany, Italy, Spain, and the United Kingdom, who treat chronic insomnia patients, between January and February 2023. A sub-sample of participants provided open-ended feedback on the algorithm and gave suggestions for improvements. RESULTS Overall, 106 primary care physicians completed the survey. Half (52%, 55/106) reported they did not regularly screen for insomnia and half (51%, 54/106) felt they did not have enough time to address patients' needs in relation to insomnia or trouble sleeping. The majority (87%,92/106) agreed the algorithm would help diagnose chronic insomnia patients and 82% (87/106) agreed the algorithm would help improve their clinical practice in relation to managing chronic insomnia. Suggestions for improvements were making the algorithm easier to read and use. CONCLUSION The algorithm developed for, and tested by, primary care physicians to diagnose and treat chronic insomnia disorder may offer significant benefits to providers and their patients through ensuring standardization of insomnia diagnosis and management.
Collapse
Affiliation(s)
- Hugh Selsick
- Insomnia and Behavioural Sleep Medicine Clinic, University College London Hospitals, London, NW1 2PG, UK
| | - Anna Heidbreder
- Department of Neurology, Johannes Kepler University Linz, Linz, 4020, Austria
| | - Jason Ellis
- Department of Psychology, Northumbria University, Newcastle, NE1 8ST, UK
| | - Luigi Ferini-Strambi
- Department of Neurological Sciences, Università Vita-Salute San Raffaele, Milan, 20132, Italy
| | | | | | - Michael S B Mak
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - David O'Regan
- Faculty of Life Sciences and Medicine, King's College, London, WC2R 2LS, UK
- Sleep Disorders Centre, Guy's Hospital, London, SE1 9RT, UK
| | - Liborio Parrino
- Sleep Medicine Center, University of Parma, Parma, 43126, Italy.
- Neurology Unit, Parma University Hospital, Parma, 43126, Italy.
| |
Collapse
|
7
|
Carvalho-Silva L, Jiménez-Correa U, Santana-Miranda R, Heyerdahl-Viau I, Benitez-Morales J, García-Casas M, Martínez-Núñez JM. Irrational Use of Medications among Adults with Insomnia: An Observational Study at a Sleep Clinic in Mexico. PHARMACY 2024; 12:56. [PMID: 38668082 PMCID: PMC11054186 DOI: 10.3390/pharmacy12020056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/16/2024] [Accepted: 03/25/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND To determine the patterns of irrational use of medications among a sample of adult patients with insomnia. METHODS We included 89 adult patients diagnosed with chronic insomnia who had consumed medications for this disorder during the 12 months prior to admission to a specialized Sleep Disorders Clinic (SDC) in Mexico City. With a 13-item survey, information was gathered on patterns of medication use and irrational use, considering therapeutic indications, dose, route of administration, and duration of treatment. RESULTS The participants had taken hypnotics (65%), antidepressants (21%), anticonvulsants (8%), and antipsychotics (6%), and 92% had irrational use of their medication. Irrational use was greatest with benzodiazepines and antipsychotics. There were two main types of irrational use: (1) 47% of participants had consumed a drug unsuitable for their condition, although it was almost always prescribed by a doctor, and (2) 43% had consumed a drug for longer than the maximum time recommended. CONCLUSION It is worrisome to find that the irrational use of medications to treat insomnia, especially benzodiazepines and antipsychotics is widespread. Although most participants had acquired their medication by prescription, for many the drug was inappropriate to treat their condition. It should be mandatory that patients with insomnia receive specialized medical attention in primary clinical care.
Collapse
Affiliation(s)
- Lucelya Carvalho-Silva
- Department of Biological Systems, Universidad Autónoma Metropolitana, Campus Xochimilco, Mexico City 04960, Mexico; (L.C.-S.); (I.H.-V.)
| | - Ulises Jiménez-Correa
- Clinic of Sleep Disorders, School of Medicine, Universidad Nacional Autónoma de México (UNAM), Mexico City 06720, Mexico (R.S.-M.)
| | - Rafael Santana-Miranda
- Clinic of Sleep Disorders, School of Medicine, Universidad Nacional Autónoma de México (UNAM), Mexico City 06720, Mexico (R.S.-M.)
| | - Ivo Heyerdahl-Viau
- Department of Biological Systems, Universidad Autónoma Metropolitana, Campus Xochimilco, Mexico City 04960, Mexico; (L.C.-S.); (I.H.-V.)
| | - Jonatan Benitez-Morales
- Department of Hospital Pharmacy, Instituto Nacional de Enfermedades Respiratorias (INER), Mexico City 14080, Mexico
| | - Mireya García-Casas
- Department of Clinical Pharmacy, Facultad de Estudios Superiores, Campus Zaragoza, Universidad Nacional Autónoma de México (UNAM), Mexico City 09230, Mexico
| | - Juan Manuel Martínez-Núñez
- Department of Biological Systems, Universidad Autónoma Metropolitana, Campus Xochimilco, Mexico City 04960, Mexico; (L.C.-S.); (I.H.-V.)
| |
Collapse
|
8
|
Thursby S, Dismore L, Swainston K. Clinical skills development for healthcare practitioners working with patients with persistent physical symptoms (PPS) in healthcare settings: a systematic review and narrative synthesis. BMC MEDICAL EDUCATION 2024; 24:328. [PMID: 38519955 PMCID: PMC10960475 DOI: 10.1186/s12909-024-05306-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND The complexity and uncertainty around Persistent Physical Symptoms (PPS) make it difficult to diagnose and treat, particularly under time-constrained consultations and limited knowledge. Brief interventions that can be utilised in day-to-day practice are necessary to improve ways of managing PPS. This review aimed to establish (i) what training primary and secondary healthcare practitioners have undertaken to develop their clinical skills when working with PPS, (ii) what training techniques or theoretical models have been used within these interventions, and (iii) how effective was the training. METHOD A systematic literature search was undertaken on eight databases to identify professional development interventions for healthcare practitioners working with PPS, were of any study design, and at a minimum were single measure studies (i.e., training outcome alone). Studies were assessed using the Mixed Methods Appraisal Tool (MMAT) and narratively synthesised. RESULTS Despite high methodological heterogeneity across the six included studies, they all aimed to improve healthcare practitioners' communication skills through educational (theory, awareness, attitudes, assessment, treatment, and management of PPS) and experiential (role play) learning. CONCLUSIONS The review findings demonstrate that developing healthcare practitioners' communicative behaviours led to increased confidence and self-efficacy when working with PPS, which facilitated improved consultations and improvements on some patient outcomes. Barriers to the uptake of training programmes and implementation into daily clinical practice are discussed, including the need for PPS to be formally implemented into undergraduate teaching and post-qualification continuous professional development. TRIAL REGISTRATION This review was registered at PROSPERO [CRD42022315631] prior to the review starting.
Collapse
Affiliation(s)
- Stacie Thursby
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, NE29 8NH, United Kingdom
| | - Lorelle Dismore
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, NE29 8NH, United Kingdom
| | - Katherine Swainston
- Faculty of Medical Sciences, School of Psychology, Newcastle University, 4 Floor Dame Margaret Barbour Building, Wallace Street, Newcastle Upon Tyne, NE1 7RU, England.
| |
Collapse
|
9
|
Chong F, Jianping Z, Zhenjie L, Wenxing L, Li Y. Does competition support integrated care to improve quality? Heliyon 2024; 10:e24836. [PMID: 38333801 PMCID: PMC10850910 DOI: 10.1016/j.heliyon.2024.e24836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 01/01/2024] [Accepted: 01/15/2024] [Indexed: 02/10/2024] Open
Abstract
Introduction This work investigates the compatibility of integrated care and competition in China and analyses the impact of integrated care on regional care quality (DeptQ) within a competitive framework. Method The study was built on multivariate correspondence analysis and a two-way fixed-effects model. The data were collected from Xiamen's Big Data Application Open Platform and represent nine specialised departments that regularly performed inter-institutional referrals between 2016 and 2019. Results First, care quality for referred patients (ReferQ) and the relative scale of referred patients (ReferScale) and competition have an antagonistic but not completely mutually exclusive relationship. Second, ReferQ and competition both have a significant effect on DeptQ, but only when competition is weak can ReferQ and competition act synergistically on DeptQ. When competition is fierce, competition will weaken the impact of ReferQ on DeptQ. Conclusion Changes in the intensity of integrated care and competition ultimately affect care quality.
Collapse
Affiliation(s)
- Feng Chong
- School of Mathematics and Statistics, Xiamen University of Technology, Fujian, Xiamen, China
- Data Mining Research Center, Xiamen University, Fujian, Xiamen, China
| | - Zhu Jianping
- School of Management, Xiamen University, Fujian, Xiamen, China
- Data Mining Research Center, Xiamen University, Fujian, Xiamen, China
- National Institute for Data Science in Health and Medicine, Xiamen University, Fujian, Xiamen, China
| | - Liang Zhenjie
- Data Mining Research Center, Xiamen University, Fujian, Xiamen, China
- College of Economics and Management, Minjiang University, Fujian, Fuzhou, China
| | - Lin Wenxing
- Xiamen Health and Medical Big Data Center, Fujian, Xiamen, China
| | - Yumin Li
- School of Economics and Management, Nanjing University of Science and Technology, Jiangsu, Nanjing, China
| |
Collapse
|
10
|
Dergaa I, Fekih-Romdhane F, Hallit S, Loch AA, Glenn JM, Fessi MS, Ben Aissa M, Souissi N, Guelmami N, Swed S, El Omri A, Bragazzi NL, Ben Saad H. ChatGPT is not ready yet for use in providing mental health assessment and interventions. Front Psychiatry 2024; 14:1277756. [PMID: 38239905 PMCID: PMC10794665 DOI: 10.3389/fpsyt.2023.1277756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/17/2023] [Indexed: 01/22/2024] Open
Abstract
Background Psychiatry is a specialized field of medicine that focuses on the diagnosis, treatment, and prevention of mental health disorders. With advancements in technology and the rise of artificial intelligence (AI), there has been a growing interest in exploring the potential of AI language models systems, such as Chat Generative Pre-training Transformer (ChatGPT), to assist in the field of psychiatry. Objective Our study aimed to evaluates the effectiveness, reliability and safeness of ChatGPT in assisting patients with mental health problems, and to assess its potential as a collaborative tool for mental health professionals through a simulated interaction with three distinct imaginary patients. Methods Three imaginary patient scenarios (cases A, B, and C) were created, representing different mental health problems. All three patients present with, and seek to eliminate, the same chief complaint (i.e., difficulty falling asleep and waking up frequently during the night in the last 2°weeks). ChatGPT was engaged as a virtual psychiatric assistant to provide responses and treatment recommendations. Results In case A, the recommendations were relatively appropriate (albeit non-specific), and could potentially be beneficial for both users and clinicians. However, as complexity of clinical cases increased (cases B and C), the information and recommendations generated by ChatGPT became inappropriate, even dangerous; and the limitations of the program became more glaring. The main strengths of ChatGPT lie in its ability to provide quick responses to user queries and to simulate empathy. One notable limitation is ChatGPT inability to interact with users to collect further information relevant to the diagnosis and management of a patient's clinical condition. Another serious limitation is ChatGPT inability to use critical thinking and clinical judgment to drive patient's management. Conclusion As for July 2023, ChatGPT failed to give the simple medical advice given certain clinical scenarios. This supports that the quality of ChatGPT-generated content is still far from being a guide for users and professionals to provide accurate mental health information. It remains, therefore, premature to conclude on the usefulness and safety of ChatGPT in mental health practice.
Collapse
Affiliation(s)
- Ismail Dergaa
- Primary Health Care Corporation (PHCC), Doha, Qatar
- Research Unit Physical Activity, Sport, and Health, UR18JS01, National Observatory of Sport, Tunis, Tunisia
- High Institute of Sport and Physical Education, University of Sfax, Sfax, Tunisia
| | - Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry “Ibn Omrane”, Razi Hospital, Manouba, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Psychology Department, College of Humanities, Effat University, Jeddah, Saudi Arabia
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
| | - Alexandre Andrade Loch
- Laboratorio de Neurociencias (LIM 27), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Instituto de Psiquiatria, Universidade de Sao Paulo, São Paulo, Brazil
- Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Científico e Tecnológico, São Paulo, Brazil
| | | | | | - Mohamed Ben Aissa
- Department of Human and Social Sciences, Higher Institute of Sport and Physical Education of Kef, University of Jendouba, Jendouba, Tunisia
| | - Nizar Souissi
- Research Unit Physical Activity, Sport, and Health, UR18JS01, National Observatory of Sport, Tunis, Tunisia
| | - Noomen Guelmami
- Department of Health Sciences (DISSAL), Postgraduate School of Public Health, University of Genoa, Genoa, Italy
| | - Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | - Abdelfatteh El Omri
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - Helmi Ben Saad
- Service of Physiology and Functional Explorations, Farhat HACHED Hospital, University of Sousse, Sousse, Tunisia
- Heart Failure (LR12SP09) Research Laboratory, Farhat HACHED Hospital, University of Sousse, Sousse, Tunisia
| |
Collapse
|
11
|
Ho CN, Fu PH, Hung KC, Wang LK, Lin YT, Yang AC, Ho CH, Chang JH, Chen JY. Prediction of early postoperative pain using sleep quality and heart rate variability. Pain Pract 2024; 24:82-90. [PMID: 37615236 DOI: 10.1111/papr.13288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
PURPOSE Accurate predictions of postoperative pain intensity are necessary for customizing analgesia plans. Insomnia is a risk factor for severe postoperative pain. Moreover, heart rate variability (HRV) can provide information on the sympathetic-parasympathetic balance in response to noxious stimuli. We developed a prediction model that uses the insomnia severity index (ISI), HRV, and other demographic factors to predict the odds of higher postoperative pain. METHODS We recruited gynecological surgery patients classified as American Society of Anesthesiologists class 1-3. An ISI questionnaire was completed 1 day before surgery. HRV was calculated offline using intraoperative electrocardiogram data. Pain severity at the postanesthesia care unit (PACU) was assessed with the 0-10 numerical rating scale (NRS). The primary outcome was the model's predictive ability for moderate-to-severe postoperative pain. The secondary outcome was the relationship between individual risk factors and opioid consumption in the PACU. RESULTS Our study enrolled 169 women. Higher ISI scores (p = 0.001), higher parasympathetic activity (rMSSD, pNN50, HF; p < 0.001, p < 0.001, p < 0.001), loss of fractal dynamics (SD2, alpha 1; p = 0.012, p = 0.039) in HRV analysis before the end of surgery were associated with higher NRS scores, while laparoscopic surgery (p = 0.031) was associated with lower NRS scores. We constructed a multiple logistic model (area under the curve = 0.852) to predict higher NRS scores at PACU arrival. The five selected predictors were age (OR: 0.94; p = 0.020), ISI score (OR: 1.14; p = 0.002), surgery type (laparoscopic or open; OR: 0.12; p < 0.001), total power (OR: 2.02; p < 0.001), and alpha 1 (OR: 0.03; p < 0.001). CONCLUSION We employed a multiple logistic regression model to determine the likelihood of moderate-to-severe postoperative pain upon arrival at the PACU. Physicians could personalize analgesic regimens based on a deeper comprehension of the factors that contribute to postoperative pain.
Collapse
Affiliation(s)
- Chun-Ning Ho
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
- Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
- Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Pei-Han Fu
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Kuo-Chuan Hung
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
- Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Li-Kai Wang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
- Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Yao-Tsung Lin
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
- Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Albert C Yang
- Institute of Brain Science/Digital Medicine Center, National Yang Ming Chial Tung University, Taipei, Taiwan
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chung-Han Ho
- Department of Medicine Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Jia-Hui Chang
- Department of Medicine Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Jen-Yin Chen
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| |
Collapse
|
12
|
Bjertnæs ØA, Norman RM, Eide TB, Holmboe O, Iversen HH, Telle K, Valderas JM. Feedback reports to the general practitioner (GP) on the patients' experiences: are GPs interested, and is this interest associated with GP factors and patient experience scores? Fam Pract 2023; 40:682-688. [PMID: 36856813 PMCID: PMC10745253 DOI: 10.1093/fampra/cmad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Patient experience feedback is key in patient centred health systems, but empirical evidence of general practitioner (GP) interest in it is sparse. We aimed to: (i) quantitatively estimate the level of GP interest for feedback reports on patient experience; (ii) explore determinants of such interest; and (iii) examine potential association between a priori interest and patient experience. METHODS The patient experience survey included maximum 300 randomly selected patients for each of 50 randomly selected GPs (response rate 41.4%, n = 5,623). GPs were sent a postal letter offering feedback reports and were grouped according to their replies: (i) interested in the report; (ii) not interested. Associations between interest and GP variables were assessed with Chi-square tests and multivariate logistic regression, while associations between interest and scores for 5 patient experiences scales were assessed with multilevel regression models. RESULTS About half (n = 21; 45.7%) of the GPs showed interest in the report by asking to receive the report. The only GP variable associated with a priori interest was being a specialist in general practice (58.6% vs. 23.5% for those without) (P = 0.021). Interest was significantly associated with the practice patient experience scale (4.1 higher score compared with those not interested, P = 0.048). Interest in the report had small and nonsignificant associations with the remaining patient experience scales. CONCLUSIONS Almost half of the GPs, and almost 3 in 5 of specialists in general practice, were interested in receiving a GP-specific feedback report on patient experiences. Interest in the report was generally not related to patient experience scores.
Collapse
Affiliation(s)
- Øyvind A Bjertnæs
- Department of Health Services Research, Division for Health Services, Norwegian Institute of Public Health, Oslo 0473, Norway
| | - Rebecka M Norman
- Department of Health Services Research, Division for Health Services, Norwegian Institute of Public Health, Oslo 0473, Norway
| | - Torunn B Eide
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Olaf Holmboe
- Department of Health Services Research, Division for Health Services, Norwegian Institute of Public Health, Oslo 0473, Norway
| | - Hilde H Iversen
- Department of Health Services Research, Division for Health Services, Norwegian Institute of Public Health, Oslo 0473, Norway
| | - Kjetil Telle
- Department of Health Services Research, Division for Health Services, Norwegian Institute of Public Health, Oslo 0473, Norway
| | - Jose M Valderas
- Department of Family Medicine, National University Health System, Level 9, Singapore, Singapore
| |
Collapse
|
13
|
Litchfield I, Gale N, Burrows M, Greenfield S. " You're only a receptionist, what do you want to know for?": Street-level bureaucracy on the front line of primary care in the United Kingdom. Heliyon 2023; 9:e21298. [PMID: 38053872 PMCID: PMC10694055 DOI: 10.1016/j.heliyon.2023.e21298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/09/2023] [Accepted: 10/19/2023] [Indexed: 12/07/2023] Open
Abstract
Introduction In care settings across the globe non-clinical staff are involved in filtering patients to the most appropriate source of care. This includes primary care where general practice receptionists are key in facilitating access to individual surgeries and the wider National Health Service. Despite the complexity and significance of their role little is known of how the decision-making behaviors of receptionists impact policy implementation and service delivery. By combining the agent-based implementation theory of street-level bureaucracy with a tri-level analytical framework this work acknowledges the impact of the decisions made by receptionists as street-level bureaucrats and demonstrates the benefits of using the novel framework to provide practical insight of the factors influencing those decisions. Methods A secondary analysis of qualitative data gathered from a series of semi-structured interviews conducted with 19 receptionists in the United Kingdom in 2019 was used to populate a tri-level framework: the micro-level relates to influences on decision making acting at an individual level, the meso-level influences at group and organizational levels, and the macro-level influences at a societal or policy level. Results At the micro-level we determined how receptionists are influenced by the level of rapport developed with patients and would use common sense to interpret urgency. At the meso-level, influences included their position at the forefront of premises, the culture of the workplace, and the processes and protocols used by their practice. At the macro-level, participants described the impact of limited health service capacity, the lack of mandatory training, and the growth in the use of digital technologies. Conclusions Street-level bureaucracy, complemented with a tri-level contextual analysis, is a useful theoretical framework to understand how health workers, such as receptionists, attempt to provide universality without sufficient resource, and could potentially be applied to other kinds of public service workers in this way. This theoretical framework also benefits from being an accessible foundation on which to base practice and policy changes.
Collapse
Affiliation(s)
- Ian Litchfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Nicola Gale
- Health Services Management Centre, School of Social Policy, University of Birmingham, UK
| | - Michael Burrows
- Department of Forensic Psychology, School for Health and Life Sciences, Coventry University, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
14
|
van Straten A, van Trigt S, Lancee J. How to boost implementation for insomnia treatment in primary care? Lancet 2023; 402:940-941. [PMID: 37573860 DOI: 10.1016/s0140-6736(23)01040-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 05/11/2023] [Indexed: 08/15/2023]
Affiliation(s)
- Annemieke van Straten
- Department of Clinical, Neuro, and Developmental psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
| | - Shanna van Trigt
- Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, Netherlands
| | - Jaap Lancee
- Department of Psychiatry and Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
15
|
O’Regan D, Garcia-Borreguero D, Gloggner F, Wild I, Leontiou C, Ferini-Strambi L. Mapping the insomnia patient journey in Europe and Canada. Front Public Health 2023; 11:1233201. [PMID: 37711247 PMCID: PMC10497771 DOI: 10.3389/fpubh.2023.1233201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/11/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction Insomnia affects daily functioning and overall health, and is thus associated with significant individual, societal, and economic burden. The experience of patients living with insomnia, their perception of the condition, and its impact on their quality of life is not well documented. The objective of this study was to map the patient journey in insomnia and identify unmet needs. Methods Participants were individuals with insomnia, and healthcare professionals (HCPs) who treat insomnia, in the United Kingdom, France, Germany, Italy, and Canada. Qualitative interviews (50 patients, 70 HCPs) and a quantitative survey (700 patients, 723 HCPs) were conducted to inform the patient-journey mapping and obtain information on the emotions, perceptions, and experiences of patients and HCPs. Results The patient journey comprises seven phases. The first defines the onset of insomnia symptoms. Phase 2 represents self-initiated behavior change to improve sleep (e.g., sleep hygiene, reducing caffeine, exercise). The next phase is characterized by use of over-the-counter (OTC) treatments, which generally fail to provide lasting relief. Phase 4 describes the first HCP consultation (occurring several months to several years after onset) and typically occurs at a crisis point for the patient; patients may be looking for an immediate solution (e.g., medication), which may not align with their HCP's recommendation. The following stage comprises sleep hygiene/behavioral changes (±OTC treatment) under HCP guidance for many patients, although offering prescription treatments without a sleep hygiene stage under supervision is more common in some countries. Phase 6 describes prescription medication initiation, where patients fluctuate between relief/hopefulness and a sense of failure, while HCPs try to balance the need to provide relief for the patient while maintaining best medical practice and minimizing adverse effects. The final phase (living with long-term insomnia) represents an indefinite period during which sleep issues remain unresolved for many patients, with most of them continuing to use prescription treatments for longer than indicated and creating their own variable, self-managed regimens combining multiple modalities. Conclusion This patient journey analysis for insomnia revealed seven distinct phases, highlighting different touchpoints where insomnia management could be optimized.
Collapse
Affiliation(s)
- David O’Regan
- Sleep Disorders Centre, Guy’s Hospital, London, United Kingdom
- Faculty of Life Sciences and Medicine, King’s College, London, United Kingdom
| | | | | | - Imane Wild
- Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
| | | | | |
Collapse
|
16
|
Khatiwada R, Lyu S, Wang H, Bhandari SD, Liu Y. The knowledge and attitude of Nepalese nursing students towards dementia. Heliyon 2023; 9:e19247. [PMID: 37664746 PMCID: PMC10469564 DOI: 10.1016/j.heliyon.2023.e19247] [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: 03/25/2023] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 09/05/2023] Open
Abstract
Background As aging is a significant risk factor for dementia, the number of persons with dementia is growing annually as a result of the aging population, which implies the need for better geriatric care services in terms of both quantity and quality. Methods The knowledge and attitudes of Nepalese nursing students (n = 177) concerning dementia were examined using a descriptive correlational research approach. Alzheimer's Disease Knowledge Scale (ADKS) and Dementia Attitude Scale (DAS) were used to measure students' knowledge and attitude of dementia. Results and discussion The overall mean score of the ADKS was found to be 19.64 (SD = 3.363) out of 30, while the total mean score on dementia attitude of the DAS was 93.82 (SD = 10.09) out of 140. A positive relationship was established between the knowledge and the attitude scores (r = 0.148, P = 0.050), demonstrating limited knowledge and positive attitude towards people with dementia in nursing students.
Collapse
Affiliation(s)
- Ranjana Khatiwada
- School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, 110122, China
| | - Siman Lyu
- Beijing Chaoyang Hospital of Capital Medical University, Beijing, China
| | | | - Sushila Devi Bhandari
- Nepalese Army Institute of Health Sciences, College of Nursing, Bhandarkhal, Kathmandu, Nepal
| | - Yu Liu
- School of Nursing, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, 110122, China
| |
Collapse
|
17
|
Adarkwah MA, Huang R. Blended Learning for the "Multi-Track" Undergraduate Students in Ghana in an Adverse Era. SCIENTIFIC AFRICAN 2023:e01772. [PMID: 37363048 PMCID: PMC10281694 DOI: 10.1016/j.sciaf.2023.e01772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
The sudden emergence of the COVID-19 pandemic led to a paradigm shift in the status quo of education. Institutions globally migrated from traditional face-to-face (F2F) learning to online learning to achieve the objectives of Sustainable Development Goal Four (SDG 4). However, Ghana and its peer countries experienced unique challenges which hinder smooth online instruction delivery. Since 2017, Ghana has subscribed to a multi-track year-round education (MT-YRE) for its students at the Senior High School level because of limited physical capacity. In the wake of COVID-19 with its social distancing norms, the failure of online learning compelled some universities in Ghana to adopt the multi-track system temporarily for its undergraduates. In this phenomenological qualitative study, a snowball sampling technique was used to solicit interview data from undergraduate students (n = 20) in some selected universities on their perceptions of the MT-YRE and future education delivery. Thematic analysis suggests that blended learning is a way to mitigate the "challenge-ridden" online learning and as a solution to the MT-YRE. In the MT-YRE, learners experienced academic anxiety and complained about its intensive nature although there was a positive teacher-student relationship and peer-to-peer relations. They perceived their online experience in 2020 as ineffective and called for a blended modality of instruction for better social interactions. The rapid use of mobile technologies and social media was considered an enabler of blended learning. It is recommended that policymakers, school authorities, and educators implement a blended learning model tailored to the needs of learners post-pandemic.
Collapse
Affiliation(s)
- Michael Agyemang Adarkwah
- Smart Learning Institute of Beijing Normal University, 12F, Block A, Jingshi Technology Building, No. 12 Xueyuan South Road, Haidian District, Beijing, 100082, China
| | - Ronghuai Huang
- Smart Learning Institute of Beijing Normal University, 12F, Block A, Jingshi Technology Building, No. 12 Xueyuan South Road, Haidian District, Beijing, 100082, China
| |
Collapse
|
18
|
Ibrahim AI, Sodipo OO, Oduniyi OA. Risk factors for osteoporosis among postmenopausal women in a Nigerian teaching hospital. J Family Med Prim Care 2023; 12:1145-1149. [PMID: 37636158 PMCID: PMC10451596 DOI: 10.4103/jfmpc.jfmpc_2193_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/10/2022] [Accepted: 01/31/2023] [Indexed: 08/29/2023] Open
Abstract
Background Osteoporosis is a progressive bone disease characterized by a reduction in bone mass and density, leading to bone fragility and an increased risk of sustaining fractures. Several studies have shown that the risk for osteoporosis increases with age and after menopause. Methods A cross-sectional study was undertaken of 422 postmenopausal women at the Family Medicine Clinic of the Lagos State University Teaching Hospital (LASUTH). Variables such as socio-demographic characteristics, anthropometric indices, and lifestyle habits of participants were assessed. In addition, bone mineral density was measured using a validated portable dual-energy X-ray absorptiometry scanner. The results of the bone mineral density were analyzed based on T-scores. Results The mean age of the study subjects was 59.8± ±6.4 years, while the mean age at menopause was 50.15 ± 4.1 years. The majority of the subjects were obese (41.5%), while the prevalence of osteoporosis and osteopenia was 15.1% and 30.6%, respectively. The use of oral steroids was associated with osteoporosis (P < 0.05). Conclusion We recommend regular bone mineral density screening of postmenopausal women at the primary care level for early diagnosis and treatment of osteoporosis to prevent fragility fractures.
Collapse
Affiliation(s)
- Adekunle Ismail Ibrahim
- Department of Family Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | | | - Oludaisi A. Oduniyi
- Department of Family Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| |
Collapse
|
19
|
Marco-Franco JE, Reis-Santos M, Barrachina-Martinez I, Jurewicz A, Camaño-Puig R. Telenursing: The view of care professionals in selected EU countries. A pilot study. Heliyon 2023; 9:e16760. [PMID: 37313150 PMCID: PMC10258424 DOI: 10.1016/j.heliyon.2023.e16760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/15/2023] Open
Abstract
Background With the growth of digital nursing, several studies have focused on recording patients' views on remote care, or specialised nurse staffing aspects. This is the first international survey on telenursing focused exclusively on clinical nurses that analyses the dimensions of usefulness, acceptability, and appropriateness of telenursing from the staff point of view. Methods A previously validated structured questionnaire including demographic variables, 18 responses with a Likert-5 scale, three dichotomous questions, and one overall percentual estimation of holistic nursing care susceptible to being undertaken by telenursing, was administered (from 1 September to 30 November 2022) to 225 clinical and community nurses from three selected EU countries. Data analysis: descriptive data, classical and Rasch testing. Results The results show adequacy of the model for measurement of the domains of usefulness, acceptability, and appropriateness of telenursing (overall Cronbach's alpha 0.945, Kaiser-Meyer-Olkin 0.952 and Bartlett's p < 0.001). Answers in favour of telenursing ranked 4 out of 5 in Likert scale, both globally and by the three domains. Rasch: reliability coefficient 0.94, Warm's main weighted likelihood estimate reliability 0.95. In the ANOVA analysis, the results for Portugal were significantly higher than those for Spain and Poland, both overall and for each of the dimensions. Respondents with bachelor's, master's and doctoral degrees score significantly higher than those with certificates or diplomas. Multiple regression did not yield additional data of interest. Conclusions The tested model proved to be valid, but although the majority of nurses are in favour of telenursing, given the nature of the care, which is mainly face-to-face, according to the respondents, the chances of carrying out their activities by telenursing is only 35.3%. The survey provides useful information on what can be expected from the implementation of telenursing and the questionnaire proves to be a useful tool to be applied in other countries.
Collapse
Affiliation(s)
- Julio Emilio Marco-Franco
- Faculty of Nursing and Podiatry, Valencia University, Spain
- Centre of Economic Engineering (INECO), Unit of Investigation in Economy and Healthcare Management (CIEGS), Department of Economy and Social Sciences, Faculty of Business Administration and Management, Polytechnic University of Valencia, Spain
| | - Margarida Reis-Santos
- Center for Health Technology and Services Research, Higher School of Nursing Porto, Portugal
- Abel Salazar Biomedical Sciences Institute - University of Porto, Portugal
| | - Isabel Barrachina-Martinez
- Centre of Economic Engineering (INECO), Unit of Investigation in Economy and Healthcare Management (CIEGS), Department of Economy and Social Sciences, Faculty of Business Administration and Management, Polytechnic University of Valencia, Spain
| | - Alina Jurewicz
- Department of Specialized Nursing, Faculty of Health Sciences, Pomeranian Medical University of Szczecin, Poland
| | | |
Collapse
|
20
|
Correa-Muñoz E, Retana-Ugalde R, Mendoza-Núñez VM. Detection of Insomnia and Its Relationship with Cognitive Impairment, Depression, and Quality of Life in Older Community-Dwelling Mexicans. Diagnostics (Basel) 2023; 13:diagnostics13111889. [PMID: 37296740 DOI: 10.3390/diagnostics13111889] [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: 02/23/2023] [Revised: 05/18/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
Sleep disturbances are one of the most frequent health problems in old age, among which insomnia stands out. It is characterized by difficulty falling asleep, staying asleep, frequent awakenings, or waking up too early and not having restful sleep, which may be a risk factor for cognitive impairment and depression, affecting functionality and quality of life. Insomnia is a very complex multifactorial problem that requires a multi- and interdisciplinary approach. However, it is frequently not diagnosed in older community-dwelling people, increasing the risk of psychological, cognitive, and quality of life alterations. The aim was to detect insomnia and its relationship with cognitive impairment, depression, and quality of life in older community-dwelling Mexicans. An analytical cross-sectional study was carried out in 107 older adults from Mexico City. The following screening instruments were applied: Athens Insomnia Scale, Mini-Mental State Examination, Geriatric Depression Scale, WHO Quality of Life Questionnaire WHOQoL-Bref, Pittsburgh Sleep Quality Inventory. The frequency of insomnia detected was 57% and its relationship with cognitive impairment, depression, and low quality of life was 31% (OR = 2.5, 95% CI, 1.1-6.6. p < 0.05), 41% (OR = 7.3, 95% CI, 2.3-22.9, p < 0.001), and 59% (OR = 2.5, 95% CI, 1.1-5.4, p < 0.05), respectively. Our findings suggest that insomnia is a frequent clinical disorder that is not diagnosed and a significant risk factor for cognitive decline, depression, and poor quality of life.
Collapse
Affiliation(s)
- Elsa Correa-Muñoz
- Unidad Investigación en Gerontología, Facultad de Estudios Superiores Zaragoza, Universidad Nacional Autónoma de México, Mexico City 09230, Mexico
- Facultad de Humanidades, Ciencias Sociales y Empresariales, Universidad Maimónides, Hidalgo 775-CABA, Buenos Aires B1686IGC, Argentina
| | - Raquel Retana-Ugalde
- Unidad Investigación en Gerontología, Facultad de Estudios Superiores Zaragoza, Universidad Nacional Autónoma de México, Mexico City 09230, Mexico
| | - Víctor Manuel Mendoza-Núñez
- Unidad Investigación en Gerontología, Facultad de Estudios Superiores Zaragoza, Universidad Nacional Autónoma de México, Mexico City 09230, Mexico
| |
Collapse
|
21
|
Olatunde K, Patton S. Association Between Insomnia and Healthcare Utilization: A Scoping Review of the Literature. Am J Lifestyle Med 2023. [DOI: 10.1177/15598276231164953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Insomnia is a sleep disorder that affects significant portion of the population. It can result in adverse health outcomes and increased healthcare utilization. The purpose of this review was to identify existing research on the association between insomnia and healthcare utilization. A five-stage scoping review process was conducted guided by the Joanna Briggs Institute process. Data sources searched through 2022 were PubMed, HINARI, Google Scholar and Cochrane, with additional studies identified through hand searching. Descriptive and exploratory analyses were conducted from the findings of the selected studies. After reviewing 124 references, 23 studies were selected. A strong and positive association between insomnia and healthcare utilization and healthcare costs was identified. We also found that insomnia was associated with absenteeism from work, lower work performance ratings, disability, difficulties in daily activities, and life dissatisfaction. An unexpected theme that emerged from the included studies is that there is a large population with persistent insomnia who do not seek help that could benefit from improved management. Findings suggest that identifying and managing insomnia could result in a decrease in healthcare utilization and costs. Further research is needed to determine the most effective methods of identifying and managing insomnia.
Collapse
Affiliation(s)
- Kolade Olatunde
- Department of Public Policy/Health Policy, University of Arkansas, Fayetteville, AR, USA
| | - Susan Patton
- Department of Nursing, University of Arkansas, Fayetteville, AR, USA
| |
Collapse
|
22
|
Benca RM, Bertisch SM, Ahuja A, Mandelbaum R, Krystal AD. Wake Up America: National Survey of Patients’ and Physicians’ Views and Attitudes on Insomnia Care. J Clin Med 2023; 12:jcm12072498. [PMID: 37048582 PMCID: PMC10094753 DOI: 10.3390/jcm12072498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/14/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
While both patients and physicians consider sleep to be important, sleep health may not receive appropriate consideration during patient visits with health care professionals (HCPs). We completed the first large-scale survey of people with trouble sleeping (PWTS) and physicians who treat insomnia to understand their perspectives and potential discrepancies between them. The Harris Poll conducted online surveys of adult PWTS and HCPs (primary care physicians [PCPs] and psychiatrists) in the United States from September to October 2021. Respondents included 1001 PWTS, 300 PCPs, and 152 psychiatrists. Most HCPs agreed that sleep is critical to good health, yet very few reported routinely conducting full sleep histories on their patients. Approximately 30% of PWTS reported that their PCP never asks about sleep; zero HCPs in this survey reported “never” inquiring. Few HCPs reported being “very satisfied” with current treatment options; 50% of PCPs reported their patients being satisfied. Two-thirds of PWTS did not believe current treatment options adequately improved their sleep. This survey provides evidence that both PWTS and physicians agreed on the importance of sleep, but that treatment is often perceived as ineffective. This survey identifies a need for HCPs to address insomnia management and treatment gaps.
Collapse
|
23
|
Forthun I, Eliassen KER, Emberland KE, Bjorvatn B. The association between self-reported sleep problems, infection, and antibiotic use in patients in general practice. Front Psychiatry 2023; 14:1033034. [PMID: 36937728 PMCID: PMC10017838 DOI: 10.3389/fpsyt.2023.1033034] [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: 10/03/2022] [Accepted: 01/30/2023] [Indexed: 03/06/2023] Open
Abstract
Objectives There is emerging evidence that sleep problems and short sleep duration increase the risk of infection. We aimed to assess whether chronic insomnia disorder, chronic sleep problems, sleep duration and circadian preference based on self-report were associated with risk of infections and antibiotic use among patients visiting their general practitioner (GP). Methods We conducted a cross-sectional study of 1,848 unselected patients in Norway visiting their GP during 2020.The patients completed a one-page questionnaire while waiting for the consultation, that included the validated Bergen Insomnia Scale (BIS), questions on self-assessed sleep problem, sleep duration and circadian preference and whether they have had any infections or used antibiotics in the last 3 months. Relative risks (RR) were estimated using modified Poisson regression models. Results The risk of infection was 27% (95% CI RR 1.11-1.46) and 44% higher (95% CI 1.12-1.84) in patients sleeping < 6 h and >9 h, respectively, compared to those sleeping 7-8 h. The risk was also increased in patients with chronic insomnia disorder or a chronic sleep problem. For antibiotic use, the risk was higher for patients sleeping < 6 h, and for those with chronic insomnia disorder or a chronic sleep problem. Conclusions Among patients visiting their GP, short sleep duration, chronic insomnia and chronic sleep problem based on self-report were associated with higher prevalence of infection and antibiotic use. These findings support the notion of a strong association between sleep and infection.
Collapse
Affiliation(s)
- Ingeborg Forthun
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
| | | | - Knut Erik Emberland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
24
|
Robins G, Lusher D, Broccatelli C, Bright D, Gallagher C, Karkavandi MA, Matous P, Coutinho J, Wang P, Koskinen J, Roden B, Sadewo GRP. Multilevel network interventions: Goals, actions, and outcomes. SOCIAL NETWORKS 2023; 72:108-120. [PMID: 36188126 PMCID: PMC9504355 DOI: 10.1016/j.socnet.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/01/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
COVID-19 has resulted in dramatic and widespread social network interventions across the globe, with public health measures such as distancing and isolation key epidemiological responses to minimize transmission. Because these measures affect social interactions between people, the networked structure of daily lives is changed. Such largescale changes to social structures, present simultaneously across many different societies and touching many different people, give renewed significance to the conceptualization of social network interventions. As social network researchers, we need a framework for understanding and describing network interventions consistent with the COVID-19 experience, one that builds on past work but able to cast interventions across a broad societal framework. In this theoretical paper, we extend the conceptualization of social network interventions in these directions. We follow Valente (2012) with a tripartite categorization of interventions but add a multilevel dimension to capture hierarchical aspects that are a key feature of any society and implicit in any network. This multilevel dimension distinguishes goals, actions, and outcomes at different levels, from individuals to the whole of the society. We illustrate this extended taxonomy with a range of COVID-19 public health measures of different types and at multiple levels, and then show how past network intervention research in other domains can also be framed in this way. We discuss what counts as an effective network, an effective intervention, plausible causality, and careful selection and evaluation, as central to a full theory of network interventions.
Collapse
Affiliation(s)
- Garry Robins
- Swinburne University of Technology, Australia
- University of Melbourne, Australia
| | - Dean Lusher
- Swinburne University of Technology, Australia
| | | | | | | | | | | | | | - Peng Wang
- Swinburne University of Technology, Australia
| | | | - Bopha Roden
- Swinburne University of Technology, Australia
| | | |
Collapse
|
25
|
Bifulco L, Guidotti O, Velez I, Grzejszczak L, Angelocci T, Okunade L, Anderson D. Impact of eConsults on Clinical Care in Primary Care: A Cross-Sectional Analysis of Primary Care Provider Behavior. J Prim Care Community Health 2023; 14:21501319231202201. [PMID: 37753619 PMCID: PMC10524039 DOI: 10.1177/21501319231202201] [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: 08/01/2023] [Revised: 08/29/2023] [Accepted: 09/01/2023] [Indexed: 09/28/2023] Open
Abstract
INTRODUCTION/OBJECTIVES Asynchronous electronic consultations (eConsults) support primary care providers (PCPs) by providing rapid specialist feedback and improve medically underserved patients' access to care. METHODS This cross-sectional study assessed all eConsults requested over a one-year period at a multi-site federally qualified health center in Texas. We analyzed eConsult content and quality and conducted chart reviews for a randomly selected subsample (n = 100) to determine whether PCPs implemented specialists' recommendations within 90 days. Semi-structured interviews with PCPs assessed their ability and willingness to follow recommendations. RESULTS There were 367 eConsults submitted by 25 PCPs across 15 adult medical and surgical specialties. Of the 100 charts reviewed n = 77 (77.0%) contained documentation indicating that the PCP had followed at least 1 of the specialist's recommendations within 90 days. In two-thirds of the cases (n = 66, 66%) the reviewing specialist indicated that a face-to-face referral was not needed. PCPs were most likely to follow recommendations for new medications and least likely to document that they had obtained additional patient history. PCPs noted that they were sometimes unable to follow recommendations when patients could not afford or access treatment or did not return for follow up care, or when they felt that the specialist did not address their specific question. CONCLUSIONS eConsults delivered to medically underserved patients in primary care help PCPs provide timely care for their patients. PCPs utilized a broad range of eConsult specialties and generally implemented eConsult specialists' recommendations within 90 days.
Collapse
|
26
|
Torres-Granados GI, Santana-Miranda R, Barrera-Medina A, Cruz-Cruz C, Jiménez-Correa U, Rosenthal L, López-Naranjo F, Martínez-Núñez JM. The economic costs of insomnia comorbid with depression and anxiety disorders: an observational study at a sleep clinic in Mexico. Sleep Biol Rhythms 2023; 21:23-31. [PMID: 35975183 PMCID: PMC9372938 DOI: 10.1007/s41105-022-00412-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/28/2022] [Indexed: 01/07/2023]
Abstract
Significant advances documenting the costs associated with insomnia have been achieved. However, those related to insomnia associated with mood disorders remain understudied, even though insomnia is more severe in the presence of comorbid conditions such as depression and anxiety. The aim of this study was to determine the direct and indirect costs of insomnia associated with depression and anxiety disorders (DAD) from the perspective of the patient in a private healthcare system. This was an observational study of chronic insomnia associated with DAD at a private Sleep Disorders Clinic in Mexico City between 2019 and 2020. Patients were followed for up to one year. Healthcare resource utilization data were collected through clinical records. Direct and indirect costs associated with insomnia treatment were estimated through micro-costing. The estimated economic burden was projected to 5 years adjusting for inflation and discounting future costs. A deterministic sensitivity analysis was performed. The median cost of the first year of insomnia treatment associated with DAD was US$3537.57 per patient. The work productivity loss represented the highest economic burden (63.84%) followed by direct medical costs (28.32%), and the direct non-medical costs (7.85%). The estimated annual economic burden for patients treated in the private healthcare system in Mexico was US$293 million. The costs of insomnia associated with DAD at a private clinic in México were found to be high. The burden of the costs faced by these patients is substantial relative to the median income of the population. The economic costs at an individual and societal levels are substantial. Supplementary Information The online version contains supplementary material available at 10.1007/s41105-022-00412-6.
Collapse
Affiliation(s)
- Gustavo Ivan Torres-Granados
- Department of Biological Systems, Universidad Autónoma Metropolitana, Campus Xochimilco, Calzada del Hueso 1100, Col. Villa Quietud, 04960 Coyoacán, Mexico City, Mexico
| | - Rafael Santana-Miranda
- Clinic of Sleep Disorders, Research Division, School of Medicine, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Andrés Barrera-Medina
- Clinic of Sleep Disorders, Research Division, School of Medicine, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Copytzy Cruz-Cruz
- Department of Biological Systems, Universidad Autónoma Metropolitana, Campus Xochimilco, Calzada del Hueso 1100, Col. Villa Quietud, 04960 Coyoacán, Mexico City, Mexico
| | - Ulises Jiménez-Correa
- Clinic of Sleep Disorders, Research Division, School of Medicine, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico ,Postgraduate Program in Behavioral Neuroscience, Psychology Faculty, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | | | - Francisco López-Naranjo
- Department of Biological Systems, Universidad Autónoma Metropolitana, Campus Xochimilco, Calzada del Hueso 1100, Col. Villa Quietud, 04960 Coyoacán, Mexico City, Mexico
| | - Juan Manuel Martínez-Núñez
- Department of Biological Systems, Universidad Autónoma Metropolitana, Campus Xochimilco, Calzada del Hueso 1100, Col. Villa Quietud, 04960 Coyoacán, Mexico City, Mexico
| |
Collapse
|
27
|
Phelan A, Broughan J, McCombe G, Collins C, Fawsitt R, O’Callaghan M, Quinlan D, Stanley F, Cullen W. Impact of enhancing GP access to diagnostic imaging: A scoping review. PLoS One 2023; 18:e0281461. [PMID: 36897853 PMCID: PMC10004541 DOI: 10.1371/journal.pone.0281461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/24/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Direct access to diagnostic imaging in General Practice provides an avenue to reduce referrals to hospital-based specialities and emergency departments, and to ensure timely diagnosis. Enhanced GP access to radiology imaging could potentially reduce hospital referrals, hospital admissions, enhance patient care, and improve disease outcomes. This scoping review aims to demonstrate the value of direct access to diagnostic imaging in General Practice and how it has impacted on healthcare delivery and patient care. METHODS A search was conducted of 'PubMed', 'Cochrane Library', 'Embase' and 'Google Scholar' for papers published between 2012-2022 using Arksey and O'Malley's scoping review framework. The search process was guided by the PRISMA extension for Scoping Reviews checklist (PRISMA-ScR). RESULTS Twenty-three papers were included. The studies spanned numerous geographical locations (most commonly UK, Denmark, and Netherlands), encompassing several study designs (most commonly cohort studies, randomised controlled trials and observational studies), and a range of populations and sample sizes. Key outcomes reported included the level of access to imaging serves, the feasibility and cost effectiveness of direct access interventions, GP and patient satisfaction with direct access initiatives, and intervention related scan waiting times and referral process. CONCLUSION Direct access to imaging for GPs can have many benefits for healthcare service delivery, patient care, and the wider healthcare ecosystem. GP focused direct access initiatives should therefore be considered as a desirable and viable health policy directive. Further research is needed to more closely examine the impacts that access to imaging studies have on health system operations, especially those in General Practice. Research examining the impacts of access to multiple imaging modalities is also warranted.
Collapse
Affiliation(s)
- Amy Phelan
- School of Medicine, University College Dublin, Dublin, Ireland
| | - John Broughan
- Clinical Research Centre, School of Medicine, University College Dublin, Dublin, Ireland
- * E-mail:
| | - Geoff McCombe
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Claire Collins
- Research, Policy and Information, Irish College of General Practitioners, Dublin, Ireland
| | - Ronan Fawsitt
- General Practice, Castle Gardens Medical Centre, Kilkenny, Ireland
- Primary Care Advisor, Ireland East Hospital Group, Dublin, Ireland
| | - Mike O’Callaghan
- Irish College of General Practitioners, ICGP, Dublin, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
| | | | - Fintan Stanley
- Irish College of General Practitioners, ICGP, Dublin, Ireland
| | - Walter Cullen
- School of Medicine, University College Dublin, Dublin, Ireland
| |
Collapse
|
28
|
Harada Y, Prajapati D, Poudel P, Karmacharya B, Sugishita T, Rawal L. Effectiveness of oral health promotion interventions for people with type 2 diabetes delivered by non-dental health care professionals: a systematic review. Glob Health Action 2022; 15:2075576. [PMID: 35946304 PMCID: PMC9373766 DOI: 10.1080/16549716.2022.2075576] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Oral health problems among people with diabetes mellitus are an emerging public health problem. Despite the rising concerns of oral health and diabetes mellitus comorbidity, there is a lack of dental health care professionals such as dentists, to address this problem, especially at the primary care level in low- and middle-income countries. OBJECTIVE This review systematically synthesizes the current evidence in terms of the involvement of non-dental health care professionals in promoting oral health among people with type 2 diabetes mellitus and assessed the effectiveness of such programs. METHODS Six electronic databases (CINAHL, Cochrane, Embase, PsycINFO, PubMed, and Scopus) and Google Scholar were systematically searched. The inclusion criteria were: 1) had an intervention promoting oral health; 2) targeted but not limited to people with type 2 diabetes mellitus; 3) intervention led but not limited to by non-dental health care professionals; 4) published in English language between January 2000 and July 2021. This review was registered in PROSPERO (#CRD42021248213). RESULTS A total of five studies from four countries (Finland, Thailand, Iran, and the Netherlands) met the inclusion criteria. The interventions included oral health education, a dental care reminder system, and the implementation of oral health care protocols in general practices, all of which were mainly implemented by nurses. All interventions improved clinical outcomes, including decreased probing depth, attachment loss, and plaque index scores, and non-clinical outcomes such as enhanced knowledge, attitudes, and behaviors. Three studies also reported an improvement in diabetes mellitus outcomes. CONCLUSION This review suggests that non-dental health care professionals play a promising role in promoting oral health among people with type 2 diabetes mellitus. Our findings support the potential for integrating oral health promotion programs in primary health care, as such programs could bring better oral health and diabetes mellitus outcomes.
Collapse
Affiliation(s)
- Yuriko Harada
- Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Dilip Prajapati
- Department of Community and Public Health Dentistry, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Nepal
| | - Prakash Poudel
- School of Nursing and Midwifery, Western Sydney University, Liverpool, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,Drug Health Services, South Western Sydney Local Health District (SWSLHD), Cabramatta, NSW, Australia
| | - Biraj Karmacharya
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Kathmandu University, Nepal
| | - Tomohiko Sugishita
- Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Lal Rawal
- School of Health, Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Australia.,Physical Activity Research Group, Appleton Institute, Central Queensland University, Australia.,Translational Health Research Institute, Western Sydney University, NSW, Australia
| |
Collapse
|
29
|
Li Y, Nazari N, Sadeghi M. Internet delivered, non-inferiority, two-arm, assessor-blinded intervention comparing mindfulness-based stress reduction and cognitive-behavioral treatment for insomnia: a protocol study for a randomized controlled trial for nursing staff with insomnia. Trials 2022; 23:1020. [PMID: 36527137 PMCID: PMC9756716 DOI: 10.1186/s13063-022-06986-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 12/06/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Insomnia and poor sleep quality are highly prevalent conditions related to coronavirus disease 2019 (COVID-19) complications among clinical nurses. Although cognitive behavioral therapy for insomnia (CBT-I) is a first-line treatment, CBT-I suffers from several major drawbacks. This study investigates whether the application of the internet-delivered mindfulness-based stress reduction (iMBSR) intervention will produce effects that are non-inferior to the internet-delivered CBT-I (iCBT-I) intervention in reducing the severity of insomnia in clinical nurses with insomnia at the end of the study. METHODS This study protocol presents an internet-delivered, parallel-groups, assessor-blinded, two-arm, non-inferiority randomized controlled trial. The primary outcome is sleep quality, assessed by the Insomnia Severity Index. Secondary outcomes include depression, dysfunctional beliefs, five facets of mindfulness, and client satisfaction. CONCLUSION It is expected that this study may address several gaps in the literature. The non-inferiority study design is a novel approach to evaluating whether a standardized, complementary treatment (i.e., MBSR) is as practical as a gold standard treatment rather than its potential benefits. This approach may lead to expanded evidence-based practice and improve patient access to effective treatments. TRIAL REGISTRATION Trial registration number: ISRCTN36198096 . Registered on 24th May 2022.
Collapse
Affiliation(s)
- Yaling Li
- grid.499351.30000 0004 6353 6136Mental Health Education and Counseling Center, Shenzhen Technology University, Shenzhen, 518118 Guangdong China
| | - Nabi Nazari
- grid.411406.60000 0004 1757 0173Department of Psychology, Faculty of Human Sciences, Lorestan University, Khorramabad, Iran
| | - Masoud Sadeghi
- grid.411406.60000 0004 1757 0173Department of Psychology, Faculty of Human Sciences, Lorestan University, Khorramabad, Iran
| |
Collapse
|
30
|
Essilini A, Le Dref G, Bocquier A, Kivits J, Welter A, Pulcini C, Thilly N. French general practitioners’ and patients’ acceptability of a public commitment charter and patient information leaflets targeting unnecessary antibiotic use: a qualitative study. Antimicrob Resist Infect Control 2022; 11:32. [PMID: 35135624 PMCID: PMC8822724 DOI: 10.1186/s13756-022-01065-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/11/2022] [Indexed: 11/28/2022] Open
Abstract
Background The ‘AntibioCharte’ randomised controlled study aimed at assessing the impact of a multifaceted antibiotic stewardship intervention targeting French general practitioners with higher-than-average antibiotic use. The intervention included a public commitment charter signed by the general practitioner, a non-prescription pad, and a patient information leaflet. Objectives We conducted a qualitative study to evaluate general practitioners’ fidelity in the intervention and its acceptability by patients and general practitioners. Methods This investigation was performed in northeastern France from July 2019 to May 2020, among the AntibioCharte intervention group after a 1-year implementation period. General practitioners’ fidelity in the charter was assessed by direct observations; general practitioners’ fidelity in the other tools, and acceptability of both general practitioners and patients were assessed through semi-structured face-to-face individual interviews. Results Twenty-seven general practitioners and 14 patients participated. General practitioners’ fidelity varied according to the tool: the charter was clearly displayed in most waiting rooms; the non-prescription pad was used throughout the intervention period by most general practitioners while the leaflet was used by fewer general practitioners. Both general practitioners and patients found the charter’s content and form relevant, but few general practitioners felt themselves publicly engaged. The waiting room may not be appropriate to display the charter as some general practitioners forgot it and patients did not always read the displayed documents. General practitioners appreciated the pad and found that it could help them change their practices. It was perceived as a good tool to educate patients and manage their expectations for antibiotics. Patients appreciated the pad too, especially information on the infections’ symptoms and their duration. Still, some patients feared that it could encourage doctors not to prescribe antibiotics. Unlike general practitioners, who considered the leaflet redundant with the information given during the consultation, patients found it useful to raise awareness on antibiotics’ specificities and risks, and remind them of good practices. Conclusions The AntibioCharte intervention was overall well accepted by general practitioners and patients. The non-prescription pad was the best perceived tool. Trial registration number ClinicalTrials.gov: NCT04562571. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-022-01065-3.
Collapse
|
31
|
Simeoni M, Saragosa M, Laur C, Desveaux L, Schwartz K, Ivers N. Coping with ‘the grey area’ of antibiotic prescribing: a theory-informed qualitative study exploring family physician perspectives on antibiotic prescribing. BMC PRIMARY CARE 2022; 23:188. [PMID: 35902821 PMCID: PMC9330951 DOI: 10.1186/s12875-022-01806-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 07/20/2022] [Indexed: 11/21/2022]
Abstract
Background Unnecessary antibiotic use is associated with adverse side effects and rising rates of resistance at the individual and population level. This study used a theory-informed approach to identify potentially modifiable determinants of antibiotic prescribing for patients presenting to primary care with upper respiratory tract infection symptoms. Methods Qualitative interviews were conducted with primary care physicians in Ontario, Canada who were identified as medium- or high-volume antibiotic prescribers (high volume defined as top 20th percentile versus “medium” defined as 40th to 60th percentile). The interview guide and analysis were informed by the Theoretical Domains Framework. Each interview was coded by two research team members. Sampling and analysis continued until thematic saturation was achieved. Results Twenty family physicians were interviewed. Physicians felt that many decisions about prescribing for upper respiratory tract infection symptoms were straightforward (i.e., black and white). However, intention to avoid prescribing in cases where an antibiotic was not indicated clinically did not always align with the provider action or expectation of the patient. Clinical decisions were influenced by the Theoretical Domain Framework domains that were both internal to the physician (Knowledge, Skills, Social/Professional Role, and Belief about Capabilities) and external to the physician (Social Influence, Belief about Consequences, Reinforcement, Emotions, and Behavioural Regulation). The Environmental Context and Resources played a key role. Physicians reported significant differences in their approach to antibiotic prescribing within episodic (walk-in) or continuity of care settings, as the presence (or not) of longitudinal physician–patient relationships seemed to moderate the role of these factors on the decision-making process in cases of uncertainty. Conclusions Antibiotic prescribing in primary care is a complex decision-making process in which context may outweigh biology during encounters featuring clinical uncertainty. Differential skill in handling uncertainty and tactics used to operationalize guideline recommendations in the real world seems to contribute to observed variation in prescribing patterns, as much or more than differences in knowledge of best practices. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01806-8.
Collapse
|
32
|
Paradigm shifting of education system during COVID-19 pandemic: A qualitative study on education components. Heliyon 2022; 8:e11927. [PMCID: PMC9708613 DOI: 10.1016/j.heliyon.2022.e11927] [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: 03/28/2022] [Revised: 06/24/2022] [Accepted: 11/18/2022] [Indexed: 12/04/2022] Open
Abstract
The COVID-19 pandemic has had a far-reaching effect on the education system, leading to some changes in the conventional education system. Educational institutions are adopting alternative methods to adapt to the changed situation. The purpose of this study is to explore the changes that have taken place in the education system due to the pandemic situation. A qualitative phenomenological approach has been used to conduct the study. To get a complete picture of the shifting paradigm of the education system, two interview methods such as In-depth Interviews (IDI), Key Informant Interviews (KII) have been adopted. Interviews were taken from 15 respondents. A purposive sampling technique has been used to reach the target sample. A semi-structured questionnaire has been developed to collect necessary data. The findings of this study showed that COVID-19 pandemic has led to changes in various components of the education system. Curriculum, syllabus, assessment method, teaching method, learning method, etc., have changed in the education system. The elements of education are shifting from offline to online. The use of online-based learning materials is increasing. The curriculum has been made more flexible with a more compressed and shortened syllabus to suit the students learning under such unforeseen circumstances. Faculty should promote online study groups so that those groups can assist in providing additional support throughout specific courses. The education policy should be changed by the Bangladesh government to adapt to the changed situation.
Collapse
|
33
|
Gordon NP, Yao JH, Brickner LA, Lo JC. Prevalence of sleep-related problems and risks in a community-dwelling older adult population: a cross-sectional survey-based study. BMC Public Health 2022; 22:2045. [PMID: 36348296 PMCID: PMC9644466 DOI: 10.1186/s12889-022-14443-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022] Open
Abstract
Background Despite evidence of adverse health consequences of inadequate restorative sleep for older adults, assessment of sleep quantity, quality, and use of sleep aids is not routinely done. We aimed to characterize sleep problems, sleep risks, and advice received about sleep in a community-dwelling older adult population, overall and in subgroups with health conditions and functional difficulties. Methods This cross-sectional study used weighted self-report data for 5074 Kaiser Permanente Northern California members aged 65-79y who responded to a 2017 or 2020 Member Health Survey. We estimated usual amount of sleep (< 6, 6 to < 7, ≥7 hours) and prevalence of sleep problems (frequent insomnia, frequent daytime fatigue, poor quality sleep, and potential sleep apnea (OSA) symptoms (frequent very loud snoring, apnea episodes)) for older adults overall, by self-rated health, and in subgroups reporting hypertension, diabetes, heart disease, frequent problems with balance/walking, and frequent memory problems. We also estimated percentages who regularly used sleep aids and had discussed sleep adequacy with a healthcare professional in the past year. Results Approximately 30% of older adults usually got less than the recommended ≥7 hours sleep per day, and 9% experienced frequent daytime fatigue, 13% frequent insomnia, 18% frequent insomnia/poor quality sleep, and 8% potential OSA symptoms. Prevalence of frequent insomnia was higher among women than men (16% vs. 11%). Higher percentages of those in fair/poor health and those with frequent balance/walking and memory problems reported sleeping < 6 hours per day and having all four types of sleep problems. Nearly 20% of all older adults (22% of women vs. 17% of men) and 45% of those with frequent insomnia (no sex difference) reported regular sleep aid use. Only 10% of older adults reported discussing sleep with a healthcare professional whereas > 20% reported discussing diet and exercise. Conclusions Large percentages of older adults experience sleep problems or get less sleep than recommended for optimal sleep health. Older patients should routinely be assessed on multiple components of sleep health (sleep hygiene, quantity, quality, problems, and sleep aid use) and educated about sleep hygiene and the importance of getting adequate restorative sleep for their overall health and wellbeing.
Collapse
|
34
|
Manalili K, Scott CM, Hemmelgarn B, O'Beirne M, Bailey AL, Haener MK, Banerjee C, Peters SP, Chiodo M, Aghajafari F, Santana MJ. Co-designing person-centred quality indicator implementation for primary care in Alberta: a consensus study. RESEARCH INVOLVEMENT AND ENGAGEMENT 2022; 8:59. [PMID: 36348406 PMCID: PMC9641306 DOI: 10.1186/s40900-022-00397-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 10/28/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND We aimed to contribute to developing practical guidance for implementing person-centred quality indicators (PC-QIs) for primary care in Alberta, Canada. As a first step in this process, we conducted stakeholder-guided prioritization of PC-QIs and implementation strategies. Stakeholder engagement is necessary to ensure PC-QI implementation is adapted to the context and local needs. METHODS We used an adapted nominal group technique (NGT) consensus process. Panelists were presented with 26 PC-QIs, and implementation strategies. Both PC-QIs and strategies were identified from our extensive previous engagement of patients, caregivers, healthcare providers, and quality improvement leaders. The NGT objectives were to: 1. Prioritize PC-QIs and implementation strategies; and 2. Facilitate the participation of diverse primary care stakeholders in Alberta, including patients, healthcare providers, and quality improvement staff. Panelists participated in three rounds of activities. In the first, panelists individually ranked and commented on the PC-QIs and strategies. The summarized results were discussed in the second-round face-to-face group meeting. For the last round, panelists provided their final individual rankings, informed by the group discussion. Finally, we conducted an evaluation of the consensus process from the panelists' perspectives. RESULTS Eleven primary care providers, patient partners, and quality improvement staff from across Alberta participated. The panelists prioritized the following PC-QIs: 'Patient and caregiver involvement in decisions about their care and treatment'; 'Trusting relationship with healthcare provider'; 'Health information technology to support person-centred care'; 'Co-designing care in partnership with communities'; and 'Overall experience'. Implementation strategies prioritized included: 'Develop partnerships'; 'Obtain quality improvement resources'; 'Needs assessment (stakeholders are engaged about their needs/priorities for person-centred measurement)'; 'Align measurement efforts'; and 'Engage champions'. Our evaluation suggests that panelists felt that the process was valuable for planning the implementation and obtaining feedback, that their input was valued, and that most would continue to collaborate with other stakeholders to implement the PC-QIs. CONCLUSIONS Our study demonstrates the value of co-design and participatory approaches for engaging stakeholders in adapting PC-QI implementation for the primary care context in Alberta, Canada. Collaboration with stakeholders can promote buy-in for ongoing engagement and ensure implementation will lead to meaningful improvements that matter to patients and providers.
Collapse
Affiliation(s)
- Kimberly Manalili
- Department of Community Health Sciences, Cumming School of Medicine, 3D10, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
- Patient Engagement Platform - Alberta Strategy for Patient Oriented Research, University of Calgary, 3280 Hospital Drive NW, Cal Wenzel Precision Health Building, Calgary, AB, Canada.
| | - Catherine M Scott
- Department of Community Health Sciences, Cumming School of Medicine, 3D10, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Department of Sociology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Brenda Hemmelgarn
- Faculty of Medicine and Dentistry, University of Alberta, 2J2.00 Walter C Mackenzie Health Sciences Centre 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada
| | - Maeve O'Beirne
- Department of Community Health Sciences, Cumming School of Medicine, 3D10, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Department of Family Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Allan L Bailey
- Department of Family Medicine, University of Alberta, 5-16 University Terrace, 8303 112 St., Edmonton, AB, T6G 1K4, Canada
| | - Michel K Haener
- Grande Prairie Primary Care Network, 11745 105 St #104, Grande Prairie, AB, T8V 8L1, Canada
| | - Cyrene Banerjee
- Patient and Community Engagement Research Program (PaCER), University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Sue P Peters
- Health Quality Council of Alberta, 210, 811 14 St NW, Calgary, AB, T2N 2A4, Canada
| | - Mirella Chiodo
- Department of Family Medicine, University of Alberta, 5-16 University Terrace, 8303 112 St., Edmonton, AB, T6G 1K4, Canada
| | - Fariba Aghajafari
- Department of Community Health Sciences, Cumming School of Medicine, 3D10, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Department of Family Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Maria J Santana
- Department of Community Health Sciences, Cumming School of Medicine, 3D10, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Department Paediatrics, Alberta Children's Hospital, University of Calgary, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
| |
Collapse
|
35
|
Almatrudi TA, Rabbani U. Awareness, attitude, and practice of evidence-based medicine among primary healthcare physicians in Buraidah, Saudi Arabia. J Family Med Prim Care 2022; 11:5457-5463. [PMID: 36505615 PMCID: PMC9730996 DOI: 10.4103/jfmpc.jfmpc_1182_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/19/2021] [Accepted: 04/20/2022] [Indexed: 12/15/2022] Open
Abstract
Context Evidence-based medicine (EBM) is essential for safe and cost-effective care provision to the population. Aims To assess the awareness, attitude and practices and barriers among primary care physicians about EBM in Buraidah, Qassim. Settings and Design Cross-sectional study in Primary Health Care centers (PHCCs) of Buraidah, Qassim. Materials and Methods The study was conducted among physicians working in PHCCs of Buraidah. Data were collected online through Google forms. Statistical Analysis Used Descriptive analysis was carried out to measure the frequencies and proportions. Chi-square test was used to compare barriers based on gender, academic degree, and experience categories. Results A total of 96 out of 144 physicians (66.7%) responded to the invitation. About 82.3% of the participants welcomed the promotion of EBM and 92% of the physicians knew about concept of EBM. About 94.8% of the physicians agreed that EBM will improve patient outcomes. The reported barriers were; patient load (87.5%), time availability (70.8%), computer availability (33.3%), internet availability (45.8%), and 56.3% stated updated clinical letters, journals, or guidelines are not available. Conclusions This study found that there was high self-reported knowledge about the EBM concept; however, the knowledge about tools was poor. A number of barriers were found such as patient load, time, availability of clinical guidelines and journals and other resources such as internet and computers. Primary care physicians should be trained and facilitated for EBM.
Collapse
Affiliation(s)
- Thamer A. Almatrudi
- Family Medicine Academy, Qassim Health Cluster, Saudi Arabia,Address for correspondence: Thamer A. Almatrudi, Family Medicine Academy, Qassim Health Cluster, Saudi Arabia. E-mail:
| | - Unaib Rabbani
- Family Medicine Academy, Qassim Health Cluster, Saudi Arabia
| |
Collapse
|
36
|
Alnaeem MM, Bawadi HA. Systematic Review and Meta-Synthesis about Patients with Hematological Malignancy and Palliative Care. Asian Pac J Cancer Prev 2022; 23:2881-2890. [PMID: 36172649 PMCID: PMC9810313 DOI: 10.31557/apjcp.2022.23.9.2881] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The current study aims to review, appraise, and synthesize the available studies and recommend the significant clinical implications for healthcare professionals to understand the existing findings of palliative care experience among patients with hematology malignancy. METHODS After excluding the registered or ongoing systematic reviews in the PROSPERO database regarding the lived experience of palliative care among patients with HM, our systematic review and meta-analysis protocol was registered in PROSPERO [CRD42021270311]. A search for published articles in English between January 2000 and December 2020 was conducted among different electronic databases using PRISMA guidelines 2020. Meta-synthesis was accomplished using the JBI meta-aggregation method to synthesize the findings. The implemented approach involved all qualitative research and mixed-method studies that included a qualitative part. RESULTS This review contained eight studies which led to 25 codes and seven categories. Finally, three synthesized themes were developed: (1) Approaching the end of life among patients with Hematology Malignancy, (2) submission and surrender of patients with Hematology Malignancy during their terminal stage, and (3) Entrance to the palliative care world. Therefore, realizing the importance of palliative care services to patients with Hematology Malignancy by providing evidence-based education and timely referral is crucial. CONCLUSION There was a substantial increase in the HMs rate with late referral to palliative care services. The results of this review may draw attention to some issues reported by patients with Hematology Malignancy. Scaling up palliative care services for those patients is essential to minimize end-of-life suffering and the long-term impact of inadequate palliative care for patients with Hematology Malignancy.
Collapse
Affiliation(s)
| | - Hala A. Bawadi
- School of Nursing, The University of Jordan Amman, Jordan.
| |
Collapse
|
37
|
Mather M, Pettigrew LM, Navaratnam S. Barriers and facilitators to clinical behaviour change by primary care practitioners: a theory-informed systematic review of reviews using the Theoretical Domains Framework and Behaviour Change Wheel. Syst Rev 2022; 11:180. [PMID: 36042457 PMCID: PMC9429279 DOI: 10.1186/s13643-022-02030-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding the barriers and facilitators to behaviour change by primary care practitioners (PCPs) is vital to inform the design and implementation of successful Behaviour Change Interventions (BCIs), embed evidence-based medicine into routine clinical practice, and improve quality of care and population health outcomes. METHODS A theory-led systematic review of reviews examining barriers and facilitators to clinical behaviour change by PCPs in high-income primary care contexts using PRISMA. Embase, MEDLINE, PsychInfo, HMIC and Cochrane Library were searched. Content and framework analysis was used to map reported barriers and facilitators to the Theoretical Domains Framework (TDF) and describe emergent themes. Intervention functions and policy categories to change behaviour associated with these domains were identified using the COM-B Model and Behaviour Change Wheel (BCW). RESULTS Four thousand three hundred eighty-eight reviews were identified. Nineteen were included. The average quality score was 7.5/11. Reviews infrequently used theory to structure their methods or interpret their findings. Barriers and facilitators most frequently identified as important were principally related to 'Knowledge', 'Environmental context and resources' and 'Social influences' TDF domains. These fall under the 'Capability' and 'Opportunity' domains of COM-B, and are linked with interventions related to education, training, restriction, environmental restructuring and enablement. From this, three key areas for policy change include guidelines, regulation and legislation. Factors least frequently identified as important were related to 'Motivation' and other psychological aspects of 'Capability' of COM-B. Based on this, BCW intervention functions of persuasion, incentivisation, coercion and modelling may be perceived as less relevant by PCPs to change behaviour. CONCLUSIONS PCPs commonly perceive barriers and facilitators to behaviour change related to the 'Capability' and 'Opportunity' domains of COM-B. PCPs may lack insight into the role that 'Motivation' and aspects of psychological 'Capability' have in behaviour change and/or that research methods have been inadequate to capture their function. Future research should apply theory-based frameworks and appropriate design methods to explore these factors. With no 'one size fits all' intervention, these findings provide general, transferable insights into how to approach changing clinical behaviour by PCPs, based on their own views on the barriers and facilitators to behaviour change. SYSTEMATIC REVIEW REGISTRATION A protocol was submitted to the London School of Hygiene and Tropical Medicine via the Ethics and CARE form submission on 16.4.2020, ref number 21478 (available on request). The project was not registered on PROSPERO.
Collapse
Affiliation(s)
- Melissa Mather
- Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells Hospital, Tonbridge Road, Pembury, Tunbridge Wells, Kent, TN2 4QJ, UK.
| | - Luisa M Pettigrew
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, London, WC1H 9SH, UK.,UCL Department of Primary Care and Population Health, UCL Medical School, Upper Third Floor, Rowland Hill Street, London, NW3 2PF, UK
| | - Stefan Navaratnam
- Northern Devon Healthcare NHS Trust, North Devon District Hospital, Raleigh Heights, Barnstaple, EX31 4JB, UK
| |
Collapse
|
38
|
Song Y, Ryan GW, Lee D, Kim H, Martin JL, Kramer BJ, Hays RD, Choi SE. Experiences of Sleep Problems Among Older Korean Immigrants. Res Gerontol Nurs 2022; 15:193-202. [PMID: 35609258 PMCID: PMC9355790 DOI: 10.3928/19404921-20220518-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Despite poor sleep among older adults, little is known about the sleep habits of older immigrants living in the United States. The current pragmatic qualitative descriptive study explored sleep among older Korean immigrants, using a focus group with six participants and individual phone interviews with 22 Korean immigrants aged ≥60 years. Transcripts were coded to identify underlying themes. Several thematic categories were identified under six domains: daytime function, getting ready for bed, falling asleep, awakenings during sleep, going back to sleep, and seeking advice from peers. Unhealthy sleep behaviors were found during daytime and bedtime, particularly among those who were retired/unemployed or living alone. Seeking advice from peers was common but none of the advice helped participants sleep. Sleep education programs in Korean-speaking communities can be used to target those who are socially isolated and may benefit older Korean immigrants with sleep difficulties. [Research in Gerontological Nursing, xx(x), xx-xx.].
Collapse
Affiliation(s)
- Yeonsu Song
- School of Nursing, University of California Los Angeles, California
- David Geffen School of Medicine, University of California Los Angeles, California
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, California
| | - Gery W. Ryan
- Kaiser Permanente Bernard J. Tyson School of Medicine, Los Angeles, California
| | - Diane Lee
- David Geffen School of Medicine, University of California Los Angeles, California
| | | | - Jennifer L. Martin
- David Geffen School of Medicine, University of California Los Angeles, California
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, California
| | - B Josea Kramer
- David Geffen School of Medicine, University of California Los Angeles, California
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, California
| | - Ron D. Hays
- David Geffen School of Medicine, University of California Los Angeles, California
- Fielding School of Public Health, University of California Los Angeles, California
| | - Sarah E. Choi
- School of Nursing, University of California Los Angeles, California
| |
Collapse
|
39
|
Gruner D, Feinberg Y, Venables MJ, Shanza Hashmi S, Saad A, Archibald D, Pottie K. An undergraduate medical education framework for refugee and migrant health: Curriculum development and conceptual approaches. BMC MEDICAL EDUCATION 2022; 22:374. [PMID: 35578195 PMCID: PMC9109444 DOI: 10.1186/s12909-022-03413-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 04/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND International migration, especially forced migration, highlights important medical training needs including cross-cultural communication, human rights, as well as global health competencies for physical and mental healthcare. This paper responds to the call for a 'trauma informed' refugee health curriculum framework from medical students and global health faculty. METHODS We used a mixed-methods approach to develop a guiding medical undergraduate refugee and migrant health curriculum framework. We conducted a scoping review, key informant interviews with global health faculty with follow-up e-surveys, and then, integrated our results into a competency-based curriculum framework with values and principles, learning objectives and curriculum delivery methods and evaluation. RESULTS The majority of our Canadian medical faculty respondents reported some refugee health learning objectives within their undergraduate medical curriculum. The most prevalent learning objective topics included access to care barriers, social determinants of health for refugees, cross-cultural communication skills, global health epidemiology, challenges and pitfalls of providing care and mental health. We proposed a curriculum framework that incorporates values and principles, competency-based learning objectives, curriculum delivery (i.e., community service learning), and evaluation methods. CONCLUSIONS The results of this study informed the development of a curriculum framework that integrates cross-cultural communication skills, exploration of barriers towards accessing care for newcomers, and system approaches to improve refugee and migrant healthcare. Programs should also consider social determinants of health, community service learning and the development of links to community resettlement and refugee organizations.
Collapse
Affiliation(s)
- Douglas Gruner
- Faculty of Medicine, Department of Family Medicine, University of Ottawa, Ottawa, ON Canada
| | - Yael Feinberg
- Faculty of Medicine, Department of Family Medicine, University of Ottawa, Ottawa, ON Canada
| | - Maddie J. Venables
- Department of Family Medicine, C.T. Lamont Primary Health Care Centre, University of Ottawa, Ottawa, ON Canada
| | - Syeda Shanza Hashmi
- Faculty of Medicine, Department of Family Medicine, University of Ottawa, Ottawa, ON Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Ammar Saad
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON Canada
| | - Douglas Archibald
- Department of Family Medicine, C.T. Lamont Primary Health Care Centre, University of Ottawa, Ottawa, ON Canada
- Bruyere Research Insitute, Ottawa, ON Canada
| | - Kevin Pottie
- Department of Family Medicine, C.T. Lamont Primary Health Care Centre, University of Ottawa, Ottawa, ON Canada
- Institut Savoir Montfort, Ottawa, ON Canada
- Family Medicine, Western University, London, ON Canada
| |
Collapse
|
40
|
Spek M, Venekamp R, De Groot E, Geersing GJ, Erkelens DC, van Smeden M, Rutten FH, Zwart DL. Optimising telephone triage of patients calling for acute shortness of breath during out-of-hours primary care: protocol of a multiple methods study (Opticall). BMJ Open 2022; 12:e059549. [PMID: 35450911 PMCID: PMC9024277 DOI: 10.1136/bmjopen-2021-059549] [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: 11/04/2022] Open
Abstract
INTRODUCTION Callers with acute shortness of breath (SOB) are a challenge for telephone triage at out-of-hours primary care (OHS-PC) as SOB could be the sign of a potentially life-threatening disease, yet mostly is a symptom of a broad range of self-limiting disorders. Current telephone triage practice is mainly expert based and clear evidence on accuracy, safety and efficiency of the use of the Netherlands Triage Standard (NTS) by triage nurses based on the eventual clinical outcome is lacking for this domain. METHODS AND DATA ANALYSIS Multiple methods study in five OHS-PC services in the Utrecht region, the Netherlands. Data will be collected from OHS-PC electronic health records (EHR) and backed up tapes of telephone triage conversations, which will be linked to routine primary care EHR data. In cross-sectional studies, we will (1) validate the NTS urgency classification for adults with SOB against final diagnoses and (2) develop diagnostic prediction models for urgent diagnoses (eg, composite endpoint of urgent diagnoses, pulmonary embolism, acute coronary syndrome, acute heart failure and pneumonia). We will develop improvement measures for the use of the NTS by triage nurses through practice observations and semistructured interviews with patients, triage nurses and general practitioners (GPs). In an action research approach, we will, in collaboration with these stakeholders, implement and evaluate our findings in both GP and triage nurse educational programmes as well as in OHS-PC services. ETHICS AND DISSEMINATION The Medical Ethics Review Committee Utrecht, the Netherlands, approved the study protocol (protocol 21/361). We will take into account the 'code of conduct for responsible research' of the WHO, the EU General Data Protection Regulation and the 'Dutch Medical Treatment Contracts Act'. Results will be disseminated in peer-reviewed publications and at (inter)national meetings. TRIAL REGISTRATION NUMBER NL9682.
Collapse
Affiliation(s)
- Michelle Spek
- Department of General Practice, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Roderick Venekamp
- Department of General Practice, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Esther De Groot
- Department of General Practice, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Geert-Jan Geersing
- Department of General Practice, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Daphne Carmen Erkelens
- Department of General Practice, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Maarten van Smeden
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Frans H Rutten
- Department of General Practice, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| | - Dorien L Zwart
- Department of General Practice, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
| |
Collapse
|
41
|
Song Y, Ta Park VM, Martin JL. Future directions to address sleep health disparity among Asian American immigrants. Sleep 2022; 45:zsac024. [PMID: 35089343 PMCID: PMC8996020 DOI: 10.1093/sleep/zsac024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Yeonsu Song
- School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Van M Ta Park
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, USA
- Asian American Research Center on Health (ARCH), University of California San Francisco, San Francisco, CA, USA
| | - Jennifer L Martin
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| |
Collapse
|
42
|
A Feasibility Study: Testing Whether a Sleep Application Providing Objective Sleep Data to Physicians Improves Patient-Physician Communication Regarding Sleep Experiences, Habits, and Behaviors. Adv Ther 2022; 39:1612-1629. [PMID: 35133630 PMCID: PMC8989828 DOI: 10.1007/s12325-021-02013-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/02/2021] [Indexed: 11/14/2022]
Abstract
Introduction Sleep tracker data have not been utilized routinely in sleep-related disorders and their management. Sleep-related disorders are common in primary care practice and incorporating sleep tracker data may help in improving patient care. We conducted a pilot study to assess the feasibility of a sleep program using the Fitbit Charge 2™ device and SleepLife® application. The main aim of the study was to examine whether a program using a commercially available wearable sleep tracker device providing objective sleep data would improve communication in primary care settings between patients and their providers. Secondary aims included whether patient satisfaction with care would improve as result of the program. Methods A prospective, randomized, parallel group, observational pilot study was conducted in 20 primary care clinics in Indianapolis, IN from June 2018 to February 2019. Inclusion criteria included patients over the age of 18, have a diagnosis of insomnia identified by electronic medical record and/or a validated questionnaire, and were on a prescription sleep aid. The study was not specific to any sleep aid prescription, branded or generic, and was not designed to evaluate a drug or drug class. Each primary care clinic was randomized to either the SleepLife® intervention or the control arm. All patients were provided with a Fitbit Charge 2™ device. Only patients in the intervention arm were educated on how to use the SleepLife® application. Physicians in the intervention arm were set up with the SleepLife® portal on their computers. Results Forty-nine physicians and 75 patients were enrolled in the study. Patients had a mean age of 57 (SD 12.8) years and 61% were female. Mean age of physicians was 47 (SD 10.6) years. Patients showed high rates of involvement in the program with 83% completing all survey questions. Physician survey completion rate was 55%. Only one physician logged into the SleepLife portal to check their patients’ sleep status. At the end of the 6-week intervention, patients’ composite general satisfaction scores with sleep health management decreased significantly in the intervention arm when compared to controls (p = 0.03). Patients’ satisfaction with communication also decreased significantly in the intervention group (p = 0.01). The sleep outcomes, which were calculated on the basis of study questionnaire answers, improved significantly in the intervention group as compared to the control group (p = 0.04). Physician communication satisfaction scores remained unchanged (p = 0.12). Conclusions SleepLife® and its related physician portal can facilitate physician–patient communication, and it captures patient sleep outcomes including behaviors and habits. Patients were highly engaged with the program, while physicians did not demonstrate engagement. The study design and questionnaires do not specifically address the reasons behind the decreased patient satisfaction with care and communication, but it was perceived to be a result of physician non-responsiveness. Sleep quality scores on the other hand showed an improvement among SleepLife® users, suggesting that patients may have implemented good sleep practices on their own. Given that it was a feasibility study, and the sample size was small, we were not able to make major inferences regarding the difference between sleep disorder types. Additionally, we excluded patients with a history of alcohol use, substance abuse, or depression because of concerns that they may affect sleep independently. To promote the growth of technology in primary care, further research incorporating results from this study and physician engagement techniques should be included. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-02013-0.
Collapse
|
43
|
Rajabi M, Ebrahimi P, Aryankhesal A. Role of nongovernmental organizations in Iran's health system: What do they do and what can they do? JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:101. [PMID: 35573612 PMCID: PMC9093630 DOI: 10.4103/jehp.jehp_584_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/24/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Nongovernmental organizations (NGOs) as entities out of the health sector can play various roles and functions at different levels of the health systems. The present study was conducted to investigate NGOs' potential and actual functions in Iran's health system. MATERIALS AND METHODS This exploratory study was carried out in two parts from April 2020 to December 2020 in Tehran, Iran. For the first part, the statute of 65 NGOs was used for document review, and in the second part, the required data were collected using semi-structured interviews with 26 key informants from the governmental sector and NGOs. Data were analyzed using the framework analysis method and MAXQDA software. RESULTS According to data analysis, the results of this study were classified into two sections of NGOs' current functions and expected functions in Iran's health system. The current functions of NGOs in Iran's health system include service delivery, educational, research, and information activities, financing, supportive and facilitation activities, and advocacy. Other functions in which NGOs could play a role include health system management, education, and service providing and support activities. CONCLUSION In this study, the various roles of NGOs in Iran's health system were explained. NGOs can act actively as the consulting and executive hand alongside the public sector in the lowest to the highest levels of Iran's health system. Hence, health sector managers and policymakers must facilitate NGOs' involvement in the health sector and use their capacities and capabilities to improve health and increase public access to health-care services.
Collapse
Affiliation(s)
- Mohanna Rajabi
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Parvin Ebrahimi
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aidin Aryankhesal
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
44
|
Lee EKP, Zhu M, Chan DCC, Yip BHK, McManus R, Wong SYS. Comparative accuracies of automated and manual office blood pressure measurements in a Chinese population. Hypertens Res 2022; 45:324-332. [PMID: 34811481 DOI: 10.1038/s41440-021-00779-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/03/2021] [Accepted: 09/04/2021] [Indexed: 11/09/2022]
Abstract
We aimed to assess the difference in the accuracy of readings from automated office blood pressure machines with each other or with manual office blood pressure measurements in Chinese individuals. We collected awake 48-h ambulatory blood pressure monitoring, two automated office blood pressure device (BpTRU and WatchBP) readings, and manual office blood pressure measurements in Chinese patients (n = 135) with hypertension in a randomized sequence. Differences were compared using paired t-tests and Bland-Altman plots. The sensitivity and specificity of the techniques for detecting elevated blood pressure were calculated using awake ambulatory blood pressure monitoring as the reference standard. The WatchBP device's and awake ambulatory blood pressure readings were similar. The BpTRU device provided significantly lower mean systolic (P < 0.001) and diastolic (P < 0.001) blood pressure readings, while manual office BP provided significantly higher mean systolic (P = 0.008) and diastolic (P < 0.001) blood pressure readings than the awake automated office blood pressure readings. Automated and manual office blood pressure measurements showed similar sensitivity, specificity, and 95% limits of agreement as based on Bland-Altman plots. The mean systolic (P < 0.001) and diastolic (P < 0.02) blood pressure readings of WatchBP and BpTRU differed, and their diagnostic performances were not superior than those of manual office blood pressure measurements in Chinese patients. Therefore, automated office blood pressure measurements cannot be routinely recommended for Chinese individuals in clinical practice. More studies are needed to confirm these results.
Collapse
Affiliation(s)
- Eric K P Lee
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - MengTing Zhu
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Dicken C C Chan
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Benjamin H K Yip
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Richard McManus
- Nuffield Department of Primary Care and Health Sciences, The University of Oxford, Oxford, United Kingdom
| | - Samuel Y S Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
45
|
Lee S, Lim J, Lee S, Heo Y, Jung D. Group-tailored feedback on online mental health screening for university students: using cluster analysis. BMC PRIMARY CARE 2022; 23:19. [PMID: 35172741 PMCID: PMC8790855 DOI: 10.1186/s12875-021-01622-6] [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] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The method by which mental health screening result reports are given affects the user's health behavior. Lists with the distribution of scores in various mental health areas is difficult for users to understand, and if the results are negative, they may feel more embarrassed than necessary. Therefore, we propose using group-tailored feedback, grouping people of similar mental health types by cluster analysis for comprehensive explanations of multidimensional mental health. METHODS This cross-sectional, observational study was conducted using a qualitative approach based on cluster analysis. Data were collected via a developed mental screening website, with depression, anxiety, sleep problems, perfectionism, procrastination, and attention assessed for 2 weeks in January 2020 in Korea. Participants were randomly recruited, and sample size was 174. Total was divided into 25 with severe depression/anxiety (SDA+) and 149 without severe depression/anxiety (SDA-) according to the PHQ-9 and GAD-7 criteria. Cluster analysis was conducted in each group, and an ANOVA was performed to find significant clusters. Thereafter, structured discussion was performed with mental health professionals to define the features of the clusters and construct the feedback content initially. Thirteen expert counselors were interviewed to reconstruct the content and validate the effectiveness of the developed feedback. RESULTS SDA- was divided into 3 using the k-means algorithm, which showed the best performance (silhouette score = 0.32, CH score = 91.67) among the clustering methods. Perfectionism and procrastination were significant factors in discretizing the groups. SDA+ subgroups were integrated because only 25 people belonged to this group, and they need professional help rather than self-care. Mental status and treatment recommendations were determined for each group, and group names were assigned to represent their features. The developed feedback was assessed to improve mental health literacy (MHL) through integrative and understandable explanations of multidimensional mental health. Moreover, it appeared that a sense of belonging was induced to reduce reluctance to face the feedback. CONCLUSIONS This study suggests group-tailored feedback using cluster analysis, which identifies groups of university students by integrating multidimensions of mental health. These methods can help students increase their interest in mental health and improve MHL to enable timely help.
Collapse
Affiliation(s)
- Seonmi Lee
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, 50, UNIST-gil, Ulsan, 44919 Republic of Korea
| | - Jiwoo Lim
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, 50, UNIST-gil, Ulsan, 44919 Republic of Korea
| | - Sangil Lee
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, 50, UNIST-gil, Ulsan, 44919 Republic of Korea
| | - Yoon Heo
- Hyperconnect, Seoul, Yeongdong-daero, Ulsan, Republic of Korea
| | - Dooyoung Jung
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, 50, UNIST-gil, Ulsan, 44919 Republic of Korea
| |
Collapse
|
46
|
Ramar K, Malhotra RK, Carden KA, Martin JL, Abbasi-Feinberg F, Aurora RN, Kapur VK, Olson EJ, Rosen CL, Rowley JA, Shelgikar AV, Trotti LM. Sleep is essential to health: an American Academy of Sleep Medicine position statement. J Clin Sleep Med 2021; 17:2115-2119. [PMID: 34170250 PMCID: PMC8494094 DOI: 10.5664/jcsm.9476] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 11/13/2022]
Abstract
CITATION Sleep is a biological necessity, and insufficient sleep and untreated sleep disorders are detrimental for health, well-being, and public safety. Healthy People 2030 includes several sleep-related objectives with the goal to improve health, productivity, well-being, quality of life, and safety by helping people get enough sleep. In addition to adequate sleep duration, healthy sleep requires good quality, appropriate timing, regularity, and the absence of sleep disorders. It is the position of the American Academy of Sleep Medicine (AASM) that sleep is essential to health. There is a significant need for greater emphasis on sleep health in education, clinical practice, inpatient and long-term care, public health promotion, and the workplace. More sleep and circadian research is needed to further elucidate the importance of sleep for public health and the contributions of insufficient sleep to health disparities. CITATION Ramar K, Malhotra RK, Carden KA, et al. Sleep is essential to health: an American Academy of Sleep Medicine position statement. J Clin Sleep Med. 2021;17(10):2115-2119.
Collapse
Affiliation(s)
- Kannan Ramar
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - Raman K. Malhotra
- Sleep Medicine Center, Washington University School of Medicine, St. Louis, Missouri
| | - Kelly A. Carden
- Saint Thomas Medical Partners - Sleep Specialists, Nashville, Tennessee
| | - Jennifer L. Martin
- Veteran Affairs Greater Los Angeles Healthcare System, North Hills, California
- David Geffen School of Medicine at the University of California, Los Angeles, California
| | | | - R. Nisha Aurora
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Vishesh K. Kapur
- Division of Pulmonary Critical Care and Sleep Medicine, University of Washington, Seattle, Washington
| | - Eric J. Olson
- Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
| | - Carol L. Rosen
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Anita V. Shelgikar
- University of Michigan Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan
| | - Lynn Marie Trotti
- Emory Sleep Center and Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
47
|
Arnold C, Koetsenruijter J, Forstner J, Peters-Klimm F, Wensing M. Influence of physician networks on prescribing a new ingredient combination in heart failure: a longitudinal claim data-based study. Implement Sci 2021; 16:84. [PMID: 34454547 PMCID: PMC8401102 DOI: 10.1186/s13012-021-01150-y] [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] [Received: 04/16/2021] [Accepted: 08/05/2021] [Indexed: 12/11/2022] Open
Abstract
Background Since 2016, the combination of sacubitril/valsartan, which combines an angiotensin receptor and neprilysin inhibitor (ARNI), has been recommended in the guidelines for the treatment of heart failure. The adoption of new drugs may be influenced by collaboration and exchange between physicians. We aimed to determine whether characteristics of the professional networks of prescribing physicians were associated with the prescribing of ARNI in Germany. Methods We conducted a longitudinal analysis based on claims data in 2016–2018 in Germany. The characteristics of ambulatory care physicians’ networks were determined in the analysis of the patient-sharing networks of physicians in 2017. Binary logistic regression analysis with the outcome ‘prescribes ARNI in 2018’ (present or absent) was carried out, using network characteristics as predictors, adjusted for specialty and sociodemographic characteristics of physicians. Results The network analysis included 8370 physicians, who had 144,636 connections. Prescribers had more connections to other physicians compared to non-prescribers (median 31 vs. 23). Regression analysis showed that the numbers of linkages to prescribers of ARNI were positively associated with prescribing ARNI. For 6–10 connections, the average marginal effect (AME) was 0.04 (confidence interval [CI] 95% 0.01–0.06) and for > 10 links the AME 0.07 (CI 95% 0.05–0.10) compared to 0–5 connections to prescriber. Conclusion Physicians who shared patients with many other physicians were more likely to prescribe ARNI, independent of physicians’ specialty. This suggested that collaboration and exchange on the basis of patient-sharing with other physicians influenced their medication prescribing decisions. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-021-01150-y.
Collapse
Affiliation(s)
- Christine Arnold
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| | - Jan Koetsenruijter
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Johanna Forstner
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Frank Peters-Klimm
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| |
Collapse
|
48
|
Kasteleyn MJ, Versluis A, van Peet P, Kirk UB, van Dalfsen J, Meijer E, Honkoop P, Ho K, Chavannes NH, Talboom-Kamp EPWA. SERIES: eHealth in primary care. Part 5: A critical appraisal of five widely used eHealth applications for primary care - opportunities and challenges. Eur J Gen Pract 2021; 27:248-256. [PMID: 34432601 PMCID: PMC8405089 DOI: 10.1080/13814788.2021.1962845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Given the pressure on modern healthcare systems, eHealth can offer valuable opportunities. However, understanding the potential and challenges of eHealth in daily practice can be challenging for many general practitioners (GPs) and their staff. Objectives To critically appraise five widely used eHealth applications, in relation to safe, evidence-based and high-quality eHealth. Using these applications as examples, we aim to increase understanding of eHealth among GPs and highlight the opportunities and challenges presented by eHealth. Discussion eHealth applications can support patients while increasing efficiency for GPs. A three-way division (inform, monitor, track; interaction; data utilisation) characterises many eHealth applications, with an increasing degree of complexity depending on the domain. All applications provide information and some have extra functionalities that promote interaction, while data analysis and artificial intelligence may be applied to support or (fully) automate care processes. Applications in the inform domain are relatively easy to use and implement but their impact on clinical outcomes may be limited. More demanding applications, in terms of privacy and ethical aspects, are found in the data utilisation domain and may potentially have a more significant impact on care processes and patient outcomes. When selecting and implementing eHealth applications, we recommend that GPs remain critical regarding preconditions on safe, evidence-based and high-quality eHealth, particularly in the case of more complex applications in the data utilisation domain.
Collapse
Affiliation(s)
- Marise J Kasteleyn
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands
| | - Anke Versluis
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands
| | - Petra van Peet
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands
| | - Ulrik Bak Kirk
- The Research Unit for General Practice, Aarhus, Denmark.,The European Society for Quality and Safety in Family Practice (EQuiP), Aarhus, Denmark
| | - Jens van Dalfsen
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands
| | - Eline Meijer
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands
| | | | - Kendall Ho
- Faculty of Medicine, eHealth Strategy Office, University of British Columbia, Vancouver, Canada
| | - Niels H Chavannes
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands
| | - Esther P W A Talboom-Kamp
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands.,Saltro Diagnostic Center, Utrecht, The Netherlands
| |
Collapse
|
49
|
Zhang X, Li C, Yue C, Jiang X, Cao J, Ten Cate O. Why clinical training in China should improve: a cross-sectional study of MD graduates. BMC MEDICAL EDUCATION 2021; 21:266. [PMID: 33971857 PMCID: PMC8108351 DOI: 10.1186/s12909-021-02647-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 04/05/2021] [Indexed: 05/22/2023]
Abstract
BACKGROUND China is experiencing major medical education reforms that include establishing national training standards, standards for health professionals, and advanced health delivery system requirements. Graduate medical education (GME) is being piloted as a merger of Doctor of Medicine (MD) with PhD programs to improve academic research and clinical training. However, the academic degree-centred system has led to a preoccupation with research rather than clinical training. Unfortunately, there is a shortage of quality information regarding the clinical training of MD graduates from Chinese medical schools. To fill this gap, this general investigation aims to provide the perspective of recent MD graduates in China for the different subspecialties of clinical training as experienced in different contexts. METHODS There were 432 MD graduates who participated in an online survey regarding their clinical training. Information collected included overall satisfaction, educational supervision, supervised learning events, curriculum coverage, local teaching, teamwork, educational governance, workload, supportiveness of the environment, feedback, clinical experience, patient safety, handovers, and reporting systems. RESULTS Only 37.4% reported satisfaction with the overall clinical training quality; 54.6% rated the informal and bedside quality as "good"; 64.4% reported they knew who provided clinical supervision; but only 35.5% rated the quality of clinical supervision as high; 51.8% reported that they judged senior physicians as "not competent"; 41.9% agreed that the staff treated each other respectfully; 97.4% admitted that they worked beyond the mandatory hours and claimed they were regularly short of sleep; 84.2% raised concerns about patient safety; 45.3% reported that they received regular informal feedback; 48.1% believed that their concerns about education and training would be addressed. CONCLUSIONS This study suggests that the quality of clinical training for MD graduates should be improved. While the overall satisfaction with the teaching quality was acceptable, the quality of many clinical training aspects scored poorly. A major problem seems an undue focus on research in MD/PhD training at the cost of the quality of clinical training, due to career perspectives that undervalue clinical competence. The findings of this study should benefit from a deeper investigation to understand the causes and possible remediation. Suggestions include defining subspecialties and training lengths; monitoring, evaluation, and integration SST with MD degree; providing funds or rewards for academic and clinical training; establishing supervising teams to guide clinical training; and establishing physician scientist task force to help overcome challenges.
Collapse
Affiliation(s)
- Xiaoning Zhang
- School of Nursing, Xuzhou Medical University, Xuzhou, China.
- Department of Neonatology, he Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
- School of Nursing, Capital Medical University, Beijing, China.
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China.
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China.
| | - Chong Li
- Graduate School, Xuzhou Medical University, Xuzhou, China
| | - Cailing Yue
- Graduate School, Xuzhou Medical University, Xuzhou, China
| | - Xue Jiang
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Junli Cao
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China.
- Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China.
| | - Olle Ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
50
|
Côté A, Abasse KS, Laberge M, Gilbert MH, Breton M, Lemaire C. Orthopedist involvement in the management of clinical activities: a case study. BMC Health Serv Res 2021; 21:299. [PMID: 33794873 PMCID: PMC8017788 DOI: 10.1186/s12913-021-06299-2] [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: 06/16/2020] [Accepted: 03/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rapid shift in hospital governance in the past few years suggests greater orthopedist involvement in management roles, would have wide-reaching benefits for the efficiency and effectiveness of healthcare delivery. This paper analyzes the dynamics of orthopedist involvement in the management of clinical activities for three orthopedic care pathways, by examining orthopedists' level of involvement, describing the implications of such involvement, and indicating the main responses of other healthcare workers to such orthopedist involvement. METHODS We selected four contrasting cases according to their level of governance in a Canadian university hospital center. We documented the institutional dynamics of orthopedist involvement in the management of clinical activities using semi-structured interviews until data saturation was reached at the 37th interview. RESULTS Our findings show four levels (Inactive, Reactive, Contributory and Active) of orthopedist involvement in clinical activities. With the underlying nature of orthopedic surgeries, there are: (i) some activities for which decisions cannot be programmed in advance, and (ii) others for which decisions can be programmed. The management of unforeseen events requires a higher level of orthopedist involvement than the management of events that can be programmed. CONCLUSIONS Beyond simply identifying the underlying dynamics of orthopedists' involvement in clinical activities, this study analyzed how such involvement impacts management activities and the quality-of-care results for patients.
Collapse
Affiliation(s)
- André Côté
- Centre de recherche en gestion des services de santé, Université Laval, Québec City, Canada.,Faculté des sciences de l'administration (FSA), Université Laval, Québec, QC, G1V 0A6, Canada.,Centre de recherche en soins et services de première ligne- Université Laval, Québec, Canada.,Centre de recherche du centre hospitalier de l'Université Laval, Québec, Canada.,Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Québec, Canada
| | - Kassim Said Abasse
- Centre de recherche en gestion des services de santé, Université Laval, Québec City, Canada. .,Faculté des sciences de l'administration (FSA), Université Laval, Québec, QC, G1V 0A6, Canada. .,Centre de recherche en soins et services de première ligne- Université Laval, Québec, Canada. .,Centre de recherche du centre hospitalier de l'Université Laval, Québec, Canada. .,Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Québec, Canada.
| | - Maude Laberge
- Faculté des sciences de l'administration (FSA), Université Laval, Québec, QC, G1V 0A6, Canada.,Centre de recherche en soins et services de première ligne- Université Laval, Québec, Canada.,Centre de recherche du centre hospitalier de l'Université Laval, Québec, Canada.,Département d'opérations et systèmes de décision
- , Faculté des sciences de l'administration (FSA) Université Laval, Québec, QC, G1V 0A6, Canada
| | - Marie-Hélène Gilbert
- Centre de recherche en gestion des services de santé, Université Laval, Québec City, Canada.,Faculté des sciences de l'administration (FSA), Université Laval, Québec, QC, G1V 0A6, Canada
| | - Mylaine Breton
- Université de Sherbrooke, Longueuil Campus, Sherbrooke, Canada
| | - Célia Lemaire
- EM Strasbourg Business School, Université de Strasbourg, HuManiS (UR 7308), Strasbourg, France
| |
Collapse
|