Patients' and caregivers' perspectives of the atopic dermatitis journey

BACKGROUND

Understanding the patient journey is important to optimize care for patients with atopic dermatitis (AD) and overcome challenges in diagnosis and management.

OBJECTIVE

To explore patient and caregiver perspectives regarding their experience with AD.

METHODS

Patients and caregivers of patients with AD completed a pre-meeting survey and were invited to join an advisory board meeting in their country (China, Hong Kong, Ireland, Japan and Lebanon) to discuss the survey results. Data were analyzed descriptively.

RESULTS

The survey included 31 participants (patients and caregivers) from Hong Kong (n = 7), China (n = 7), Ireland (n = 6), Japan (n = 6) and Lebanon (n = 5). The most challenging factors in the AD journey were management of symptoms before a confirmed diagnosis (68%), sudden recurrence of flares or worsening of symptoms (68%) and lifestyle changes (52%). In terms of overall AD management, 35% of participants indicated that AD was managed well, 23% had a clear treatment plan and 19% were generally satisfied with disease management. A collaborative relationship with healthcare professionals was favored.

CONCLUSION

A holistic assessment of AD includes understanding patient and caregiver preferences, needs, experiences and disease perceptions. Addressing the identified gaps may improve the management of AD.

Mobile robots for isolation-room hospital settings: A scenario-based preliminary study

Isolated patients pose physical challenges to medical staff owing to the need for protective gear. Additionally, communication issues arise within isolation rooms, hampering patient care. Mobile robots offer potential solutions, allowing for contactless communication and efficient task delegation, thereby reducing the risk of cross-contamination and minimizing staff workload. This preliminary study assessed the usability, acceptability, and potential for improvement of mobile robots in clinical nursing scenarios, focusing on nurses' perspectives. A preliminary test was conducted using mobile robots in a simulated hospital environment with 30 experienced nurses responsible for isolated patient care. Data were collected through interviews, surveys, and scenario-based tasks. Two scenarios were designed to evaluate the usability and effectiveness of mobile robots in real-world nursing situations. Nurses regarded mobile robots as highly usable and useful in healthcare settings. Robots efficiently handled tasks like remote supply delivery and medication distribution. Nurses recognized the potential for improved communication and efficiency with mobile robots; however, concerns were raised about the robots' limitations in providing emotional support and potential safety issues during emergencies. This research emphasizes the promising role of mobile robots in enhancing healthcare delivery within isolation rooms. While these findings indicate the potential for mobile robots, careful planning, training, and scenario development are crucial for their safe and effective integration into clinical settings. Further research, tailored scenarios, and a reevaluation of the evolving role of nurses in a technology-augmented healthcare environment are necessary, emphasizing the importance of understanding the capabilities and limitations of robotic assistance in patient care.

Potential for GPT Technology to Optimize Future Clinical Decision-Making Using Retrieval-Augmented Generation

Advancements in artificial intelligence (AI) provide many helpful tools for healthcare, one of which includes AI chatbots that use natural language processing to create humanlike, conversational dialog. These chatbots have general cognitive skills and are able to engage with clinicians and patients to discuss patients' health conditions and what they may be at risk for. While chatbot engines have access to a wide range of medical texts and research papers, they currently provide high-level, generic responses and are limited in their ability to provide diagnostic guidance and clinical advice to patients on an individual level. The essay discusses the use of retrieval-augmented generation (RAG), which can be used to improve the specificity of user-entered prompts and thereby enhance the detail in AI chatbot responses. By embedding more recent clinical data and trusted medical sources, such as clinical guidelines, into the chatbot models, AI chatbots can provide more patient-specific guidance, faster diagnoses and treatment recommendations, and greater improvement of patient outcomes.

Association of quality of nursing care with violence load, burnout, and listening climate

BACKGROUND

Violence against nurses is common. Previous research has recommended further development of the measurement of violence against nurses and integration of the individual and ward-related factors that contribute to violence against hospital nurses. This study was designed to address these issues by investigating the associations between violence, the listening climate of hospital wards, professional burnout, and perceived quality of care. For this purpose, we used a new operationalization of the violence concept.

METHODS

We sought nurses to participate in the study through social media which yielded 765 nurses working in various healthcare systems across Israel who volunteered to complete a self-administered online questionnaire. 80% of the sample were hospital nurses, and 84.7% were female. The questionnaire included validated measures of burnout, listening climate, and quality of care. Instead of using the traditional binary measure of exposure to violence to capture the occurrence and comprehensive impact of violence, this study measured the incremental load of violence to which nurses are subjected.

RESULTS

There were significant correlations between violence load and perceived quality of care and between constructive and destructive listening climates and quality of care. Violence load contributed 14% to the variance of burnout and 13% to the variance of perceived quality of care. The ward listening climate moderated the relationship between burnout and quality of care.

CONCLUSIONS

The results of this study highlight the impact of violence load among nurses and the ward listening climate on the development of burnout and on providing quality care. The findings call upon policymakers to monitor violence load and allocate resources to foster supportive work environments to enhance nurse well-being and improve patient care outcomes.

Bacterial diversity dominates variable macrophage responses of tuberculosis patients in Tanzania

The Mycobacterium tuberculosis complex (MTBC) comprises nine human-adapted lineages that differ in their geographical distribution. Local adaptation of specific MTBC genotypes to the respective human host population has been invoked in this context. We aimed to assess if bacterial genetics governs MTBC pathogenesis or if local co-adaptation translates into differential susceptibility of human macrophages to infection by different MTBC genotypes. We generated macrophages from cryopreserved blood mononuclear cells of Tanzanian tuberculosis patients, from which the infecting MTBC strains had previously been phylogenetically characterized. We infected these macrophages ex vivo with a phylogenetically similar MTBC strain ("matched infection") or with strains representative of other MTBC lineages ("mismatched infection"). We found that L1 infections resulted in a significantly lower bacterial burden and that the intra-cellular replication rate of L2 strains was significantly higher compared the other MTBC lineages, irrespective of the MTBC lineage originally infecting the patients. Moreover, L4-infected macrophages released significantly greater amounts of TNF-α, IL-6, IL-10, MIP-1β, and IL-1β compared to macrophages infected by all other strains. While our results revealed no measurable effect of local adaptation, they further highlight the strong impact of MTBC phylogenetic diversity on the variable outcome of the host-pathogen interaction in human tuberculosis.

Impact of health and digital health literacy on quality of life following radical prostatectomy for prostate cancer: prospective single-center cohort study

PURPOSE

The importance of health literacy (HL) and digital health literacy (e-HL) in promoting healthy behavior and informed decision making is becoming increasingly apparent. This study aimed to assess the effects of HL and e-HL on the quality of life (QoL) of men who underwent radical prostatectomy (RP) for localized prostate cancer.

MATERIALS AND METHODS

This prospective observational study included 104 patients who underwent RP for localized prostate cancer. HL and e-HL were evaluated using the validated eHealth Literacy Scale and European Health Literacy Survey Questionnaire Short Form before RP. We evaluated patients' physical, psychological, social, and global QoL using the validated EORTC QLQ-C30 8 weeks after RP. The exclusion criterion was any difficulties in language and comprehension. We employed one-way ANOVA to compare continuous variables across groups in univariate analysis and used MANOVA for exploring relationships among multiple continuous variables and groups in the multivariate analysis.

RESULTS

Multivariate analyses showed that poorer e-HL and HL were associated with being older (p = 0.019), having less education (p < 0.001), and not having access to the internet (p < 0.001). Logistic regression analysis revealed significant associations between improved e-HL (p = 0.043) and HL (p = 0.023), better global health status, and higher emotional functioning (p = 0.011). However, the symptom scales did not differ significantly between the e-HL and HL groups.

CONCLUSION

Our study showed a positive association between self-reported HL/e-HL and QoL, marking the first report on the impact of HL/e-HL on the QoL in men who underwent RP for clinically localized prostate cancer.

R425 first year student nurses 'experience of encounters with death of a patient during clinical placement

BACKGROUND

In the course of caring, nurses often experience the death of patients, and this experience has an effect on the nurse. Every nurse responds to this experience in a different way, and it can be either a negative emotional response, or a positive emotional response. As part of their curriculum, R425 first-year student nurses are placed in clinical facilities to acquire competency in nursing skills, and here they may be exposed to patients dying. R425 is a South African Nursing Council regulation relating to the approval of and the minimum requirements for the education and training of a nurse (General, Psychiatric, and Community) and Midwife, leading to registration. End-of-life care can be rewarding, yet emotionally and psychologically challenging. Little is known about R425 first-year student nurses' experiences of patients dying while being cared for by nurses on clinical placement. The study, therefore, explored and describes R425 first-year student nurses' experiences of the death of a patient during clinical placement.

METHOD

A qualitative exploratory descriptive and contextual research design was adopted, and a purposive, nonprobability sampling approach applied. Data were collected through unstructured individual interviews with 15 R425 first-year student nurses. Data were analysed using content analysis.

RESULTS

Four themes emerged, namely, knowledge, psychological trauma, low self-esteem, and nutritional disorders, and subthemes were identified. Results reveal both negative and positive responses to encountering the death of patients, with more negative responses, and fewer positive responses.

CONCLUSION

Results show that first-year student nurses struggle to cope with the death of a patient, mainly because they lack knowledge and the skills required to provide end-of-life nursing. It is the requirement for student nurses to be competent in a skill, 'last office', which involves laying out of a dead person. Such skill can be deferred in the first year of study, and can only be introduced at a later stage, either in third year or fourth year of study, when students are better equipped with knowledge and skills relating to dealing with death. There is a need to review the curriculum of R425 first-year student nurses, so that outcomes such as death and dying can be introduced in the third or fourth year of study.

The Role of Spirituality in Stroke Survivors and Their Caregivers: A Systematic Review

Although several studies have analyzed the effects of spirituality on stroke survivors' physical functioning and their caregiver's outcomes, no systematic review or meta-synthesis was found to identify the lived experiences of stroke survivors and caregivers regarding spirituality. For these reasons, this study aimed to analyze quantitively and qualitatively research relating to stroke survivors' and caregivers' experiences. The included studies were RCT studies, quasi-experimental studies, qualitative, descriptive, ethnographic, and phenomenological studies, and cross-sectional studies (n = 37), with a total of 6850 stroke survivors and 1953 caregivers enrolled. Spirituality appears to play an important role in improving the quality of life and decreasing anxiety and depression of both stroke survivors and their caregivers.

The effects of illness perception on death anxiety and satisfaction with life in patients with advanced gastrointestinal cancer

OBJECTIVES

This study was conducted to determine the effects of illness perception on death anxiety and satisfaction with life in patients with advanced gastrointestinal cancer.

METHODS

This cross-sectional and correlational study was conducted with 125 patients with cancer who were admitted to the oncology clinic of a university hospital in the Central Anatolian Region of Turkey between March and December 2022 and who met the research criteria and accepted to participate in the study. The data were collected with "Patient descriptive information form," "Brief Illness Perception Questionnaire (BIPQ)," "Scale of Death Anxiety (SDA)," and "Satisfaction with Life Scale (SWLS)."

RESULTS

It was found that mean BIPQ score of the patients was 39.54 ± 12.82, the mean SDA score was 8.02 ± 3.16, and the mean SWLS score was 14.74 ± 5.19. BIPQ total score was found to affect SDA total score positively (β = .751) and SWLS total score negatively (β = - .591). SDA total score was found to affect SWLS total score negatively (β = -.216) (p < .05).

SIGNIFICANCE OF RESULTS

It was found that patients with advanced gastrointestinal cancer had moderate level of illness perception and life satisfaction, and high death anxiety. It was found that as illness perception of the patients increased, their death anxiety increased and satisfaction with life decreased. In addition, it was found that as the death anxiety of patients increased, their satisfaction with life decreased.

Bridging Communication Gaps Between Radiologists, Referring Physicians, and Patients Through Standardized Structured Cancer Imaging Reporting: The Experience with Female Pelvic MRI Assessment Using O-RADS and a Simulated Cohort Patient Group

RATIONALE AND OBJECTIVES

This study aimed to evaluate whether implementing structured reporting based on Ovarian-Adnexal Reporting and Data System (O-RADS) magnetic resonance imaging (MRI) in women with sonographically indeterminate adnexal masses improves communication between radiologists, referrers, and patients/caregivers and enhances diagnostic performance for determining adnexal malignancy.

MATERIALS AND METHODS

We retrospectively analyzed prospectively issued MRI reports in 2019-2022 performed for characterizing adnexal masses before and after implementing O-RADS MRI; 56 patients/caregivers and nine gynecologic oncologists ("referrers") were surveyed about report interpretability/clarity/satisfaction; responses for pre- and post-implementation reports were compared using Fisher's exact and Chi-squared tests. Diagnostic performance was assessed using receiver operating characteristic curves.

RESULTS

A total of 123 reports from before and 119 reports from after O-RADS MRI implementation were included. Survey response rates were 35.7% (20/56) for patients/caregivers and 66.7% (6/9) for referrers. For patients/caregivers, O-RADS MRI reports were clearer (p < 0.001) and more satisfactory (p < 0.001) than unstructured reports, but interpretability did not differ significantly (p = 0.14), as 28.0% (28/100) of postimplementation and 38.0% (38/100) of preimplementation reports were considered difficult to interpret. For referrers, O-RADS MRI reports were clearer, more satisfactory, and easier to interpret (p < 0.001); only 1.3% (1/77) were considered difficult to interpret. For differentiating benign from malignant adnexal lesions, O-RADS MRI showed area under the curve of 0.92 (95% confidence interval [CI], 0.85-0.99), sensitivity of 0.81 (95% CI, 0.58-0.95), and specificity of 0.91 (95% CI, 0.83-0.96). Diagnostic performance of reports before implementation could not be calculated due to many different phrases used to describe the likelihood of malignancy.

CONCLUSION

Implementing standardized structured reporting using O-RADS MRI for characterizing adnexal masses improved clarity and satisfaction for patients/caregivers and referrers. Interpretability improved for referrers but remained limited for patients/caregivers.

Intermittent fasting and its impact on toxicities, symptoms and quality of life in patients on active cancer treatment

Intermittent fasting is a dietary intervention that is increasingly being tested for positive outcomes in patients receiving cancer treatment. In this review, we examine the impact of intermittent fasting on symptoms, toxicities, and quality of life in patients undergoing cancer therapy and highlight unmet investigative areas to prompt future research. While current evidence is preliminary and conclusions mixed, some promising clinical studies suggest that intermittent fasting interventions may improve fatigue and reduce gastrointestinal toxicities in certain patients with cancer. Emerging clinical evidence also demonstrates that intermittent fasting may reduce off-target DNA damage, and induce favorable cellular-level immune remodeling. Furthermore, intermittent fasting has the potential to lower hyperglycemia and the ratio of fat to lean body mass, which may benefit patients at risk of hyperglycemia and weight-related adverse effects of some common pharmacological cancer treatments. Larger controlled studies are necessary to evaluate intermittent fasting in relation to these endpoints and determine the effectiveness of intermittent fasting as an adjunct intervention during cancer care. Future cancer trials should evaluate intermittent fasting diets in the context of multimodal diet, exercise, and nutrition strategies, and also evaluate the impact of intermittent fasting on other important areas such as the circadian system and the gut microbiome.

Implementing advance care planning in palliative and end of life care: a scoping review of community nursing perspectives

BACKGROUND

Advance care planninganning (ACP) is a priority within palliative care service provision. Nurses working in the community occupy an opportune role to engage with families and patients in ACP. Carers and family members of palliative patients often find ACP discussions difficult to initiate. However, community nurses caring for palliative patients can encourage these discussions, utilising the rapport and relationships they have already built with patients and families. Despite this potential, implementation barriers and facilitators continue to exist. To date, no research synthesis has captured the challenges community nurses face when implementing ACP, nor the facilitators of community nurse-led ACP. Considering this, the review question of: 'What factors contribute to or hinder ACP discussion for nurses when providing care to palliative patients?' was explored.

METHOD

To capture challenges and facilitators, a global qualitative scoping review was undertaken in June 2023. The Arksey and O'Malley framework for scoping reviews guided the review methodology. Six databases were searched identifying 333 records: CINAHL (16), MEDLINE (45), PUBMED (195), EMBASE (30), BJOCN (15), IJOPN (32). After de-duplication and title and abstract screening, 108 records remained. These were downloaded, hand searched (adding 5 articles) and subject to a full read. 98 were rejected, leaving a selected dataset of 15 articles. Data extracted into a data extraction chart were thematically analysed.

RESULTS

Three key themes were generated: 'Barriers to ACP', 'Facilitators of ACP' and 'Understanding of professional role and duty'. Key barriers were - lack of confidence, competence, role ambiguity and prognostic uncertainty. Key facilitators concerned the pertinence of the patient-practitioner relationship enabling ACP amongst nurses who had both competence and experience in ACP and/or palliative care (e.g., palliative care training). Lastly, nurses understood ACP to be part of their role, however, met challenges understanding the law surrounding this and its application processes.

CONCLUSIONS

This review suggests that community nurses' experience and competence are associated with the effective implementation of ACP with palliative patients. Future research is needed to develop interventions to promote ACP uptake in community settings, enable confidence building for community nurses and support higher standards of palliative care via the implementation of ACP.

Non-pharmacological strategies to alleviate dysgeusia in patients undergoing chemotherapy: A systematic review

PURPOSE

Dysgeusia is a common side effect in oncology patients, significantly impacting their quality of life. This systematic review aims to evaluate the effectiveness of non-pharmacological strategies in treating dysgeusia in patients undergoing chemotherapy or radiotherapy.

METHODS

Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a comprehensive literature search across five databases: PubMed, Embase, Cochrane Library, CINAHL, and the British Nursing Database. We used the Joanna Briggs Institute Critical Appraisal Tools to assess the quality of the included studies. A harvest plot was used to synthesise evidence about the differential effects of population-level interventions.

RESULTS

Nine studies of non-pharmacological strategies to manage dysgeusia were included. These studies encompassed a variety of interventions, including oral applications and supplements, instrumental techniques, and educational programs. The review identified promising interventions such as cryotherapy and Miraculine supplementation, which showed potential in mitigating taste alterations. Instrumental techniques like photobiomodulation therapy and complementary and integrative medicine approaches, including acupuncture and herbs, were also found to be beneficial. Educational and self-management strategies emerged as effective interventions for empowering patients to manage dysgeusia. Despite the diversity of interventions and the limitations of the included studies, such as small sample sizes and geographical differences, these findings underscore the potential of non-pharmacological strategies in managing dysgeusia.

CONCLUSION

The results support the integration of these strategies into clinical practice, highlighting the importance of multidisciplinary approaches to improve patient care. Further research should prioritize rigorous studies to enhance evidence and explore long-term effects.

Perceived attitudes toward LGBTQ + physicians among individuals with psychiatric illness in the religiously diverse Southern Region of Thailand: a multihospital-based survey

OBJECTIVES

This study purposed to analyze perceived attitudes toward LGBTQ + physicians and related factors among individuals with psychiatric illnesses in southern Thailand.

MATERIALS AND METHODS

From May to July 2023, a cross-sectional study was conducted at four psychiatric outpatient clinics in Southern Thailand. The questionnaires utilized were: 1) a demographic information questionnaire, 2) a questionnaire regarding attitudes toward LGBTQ + physicians, 3) a questionnaire evaluating individuals' attitudes toward LGBTQ + physicians while receiving medical attention, and 4) a patient-doctor relationship questionnaire. All data were analyzed using descriptive statistics, and the factors associated with perceived attitudes toward LGBTQ + physicians were analyzed using the Wilcoxon rank sum test, the Kruskal-Wallis test, and linear regressions. The analyses were conducted using the R Foundation for Statistical Computing software, version 4.3.1. Statistical significance was defined as a p-value of less than 0.05.

RESULTS

Among our 542 participants, the mean age was 36.3 ± 14.1 years. The majority were female (64.6%), Buddhist (62.4%), and diagnosed with depression (46.3%). Approximately three-quarters showed a good doctor-patient relationship (74.0%). The median (IQR) score of the perceived attitudes toward LGBTQ + physicians was 75 (66, 88). Predominantly, the LGBTQ + physicians were perceived as normal (76.3%) and being a viable part of society (88.7%). Moreover, our participants disagreed with the view that being an LGBTQ + physician was a sin (70.6%) or immoral (68.2%). They felt comfortable during history taking (79.0%), physical examination not involving private parts of the body (72.5%), and management for both medical (78.4%) and psychiatric conditions (81.4%) at the hands of LGBTQ + physicians. However, they reported feeling uncomfortable during history taking involving private matters (6.3%) and the physical examination of private parts (16.4%). Older age, absence of LGBTQ + close relatives/friends, and being a Muslim were associated with lower scores of perceived attitudes toward LGBTQ + physicians. Conversely, a higher level of education and a reported mismatch between the patient's sex and gender were associated with higher scores.

CONCLUSIONS

Most participants reported positive perceived attitudes toward LGBTQ + physicians. However, some age groups and adherents of Islam showed lower perceived attitude scores and reported feeling uncomfortable receiving medical treatment from LGBTQ + physicians. On the one hand, LGBTQ + physicians have cause to be concerned about this point; on the other hand, finding appropriate approaches to promote positive attitudes toward LGBTQ + physicians among these groups of people remains a necessity.

Social concordance and patient reported experiences in countries with different gender equality: a multinational survey

BACKGROUND

Patient reported experiences (PREMs) are important indices of quality of care. Similarities in demography between patient and doctor, known as social concordance, can facilitate patient-doctor interaction and may be associated with more positive patient experiences. The aim of this research is to study associations between gender concordance, age concordance and PREMs (doctor-patient communication, involvement in decision making, comprehensiveness of care and satisfaction) and to investigate whether these associations are dependent on a countries' Gender Equality Index (GEI).

METHODS

Secondary analysis on a multinational survey (62.478 patients, 7.438 GPs from 34 mostly European countries) containing information on general practices and the patient experiences regarding their consultation. Multi-level analysis is used to calculate associations of both gender and age concordance with four PREMs.

RESULTS

The female/female dyad was associated with better experienced doctor-patient communication and patient involvement in decision making but not with patient satisfaction and experienced comprehensiveness of care. The male/male dyad was not associated with more positive patient experiences. Age concordance was associated with more involvement in decision making, more experienced comprehensiveness, less satisfaction but not with communication. No association was found between a country's level of GEI and the effect of gender concordance.

CONCLUSION

Consultations in which both patient and GP are female are associated with higher ratings of communication and involvement in decision making, irrespective of the GEI of the countries concerned. Age concordance was associated with all PREMs except communication. Although effect sizes are small, social concordance could create a suggestion of shared identity, diminish professional uncertainty and changes communication patterns, thereby enhancing health care outcomes.

Using expressive writing to improve cancer caregiver and patient health: A randomized controlled feasibility trial

PURPOSE

This study examined the feasibility and preliminary efficacy of Expressive Writing (EW) in improving informal cancer caregiver (IC) and patient health, and enhancing ICs' emotion regulation.

METHOD

Fifty-eight breast cancer ICs and patients participated in a randomized controlled feasibility trial of remote EW. ICs were randomly assigned to the EW or control group and completed 3 weekly writing sessions. ICs and patients completed health and emotion regulation assessments at baseline, intervention completion, and 3 months post-intervention. Screening, recruitment, assessment process, randomization, retention, treatment adherence, and treatment fidelity were computed for feasibility. Effect sizes were calculated using the PROMIS Depression Short Form, RAND Short Form 36 Health Survey, Breast Cancer Prevention Trial Hormonal Symptom checklist, healthcare utilization, and the Emotion Regulation Questionnaire for efficacy.

RESULTS

Of the 232 interested individuals, 82 were screened, and 60 enrolled (6 monthly). Two individuals withdrew and 19 were lost to follow-up, leaving 39 individuals. ICs completed at least one assessment and two sessions, and patients completed at least two assessments. All sessions were administered as intended. ICs generally followed instructions (88%-100%), wrote the full time (66.7%-100%), and were engaged (M(SD) = 3.00(1.29)-4.00(0.00)). EW had small-to-medium effects in improving IC health (g = -0.27-0.04) and small-to-large effects in improving patient health (g = -0.28-0.86). EW moderately decreased suppression (g = 0.53-0.54) and slightly increased reappraisal, at least 3 months post-intervention (g = -0.34-0.20).

CONCLUSIONS

Remote EW may be feasible with cancer ICs and improve cancer IC and patient health. However, it can benefit from additional retention strategies and rigorous testing.

TRIAL REGISTRATION

CenterWatch Clinical Trials Listing Service (#TX217874); ClinicalTrials.gov (#NCT06123416).

Health-related social needs information in the emergency department: clinician and patient perspectives on availability and use

BACKGROUND

Patient health-related social needs (HRSN) complicate care and drive poor outcomes in emergency department (ED) settings. This study sought to understand what HRSN information is available to ED physicians and staff, and how HRSN-related clinical actions may or may not align with patient expectations.

METHODS

We conducted a qualitative study using in-depth semi-structured interviews guided by HRSN literature, the 5 Rights of Clinical Decision Support (CDS) framework, and the Contextual Information Model. We asked ED providers, ED staff, and ED patients from one health system in the mid-Western United Stated about HRSN information availability during an ED encounter, HRSN data collection, and HRSN data use. Interviews were recorded, transcribed, and analyzed using modified thematic approach.

RESULTS

We conducted 24 interviews (8 per group: ED providers, ED staff, and ED patients) from December 2022 to May 2023. We identified three themes: (1) Availability: ED providers and staff reported that HRSNs information is inconsistently available. The availability of HRSN data is influenced by patient willingness to disclose it during an encounter. (2) Collection: ED providers and staff preferred and predominantly utilized direct conversation with patients to collect HRSNs, despite other methods being available to them (e.g., chart review, screening questionnaires). Patients' disclosure preferences were based on modality and team member. (3) Use: Patients wanted to be connected to relevant resources to address their HRSNs. Providers and staff altered clinical care to account for or accommodate HRSNs. System-level challenges (e.g., limited resources) limited provider and staff ability to address patients HRSNs.

CONCLUSIONS

In the ED, HRSNs information was inconsistently available, collected, or disclosed. Patients and ED providers and staff differed in their perspectives on how HSRNs should be collected and acted upon. Accounting for such difference in clinical and administrative decisions will be critical for patient acceptance and effective usage of HSRN information.

IUPHAR ECR review: Cancer-related anorexia-cachexia in cancer patients: Pathophysiology and treatment

Cancer-related anorexia-cachexia (CRAC) comprises one of the most common syndromes of advanced cancer patients. The prevalence of CRAC increases from 50% to 80% before death. CRAC is associated not only with impaired quality of life in patients and family members but also with shorter survival. The management of CRAC is a great challenge in clinical practice. There are no definite practice guidelines yet for the prevention and treatment of CRAC. A multimodal strategy is the most effective way to treat anorexia-cachexia. Numerous medications have been suggested and used in clinical trials, while others are still being studied on experimental animals. These medications include branched-chain amino acids, eicosapentaenoic acid, thalidomide, cytokine inhibitors, steroids, antiserotoninergic medications, and appetite stimulants. The benefits of supportive care interventions and the advancement of exciting new pharmacological medicines for anorexia-cachexia are becoming more widely recognized. Health care professionals need to be aware of the psychosocial and biological effects of anorexia-cachexia, even though knowledge of the underlying molecular causes of the disorder has advanced significantly.

Transdiagnostic psychopathology in the light of robust single-trial event-related potentials

Recent evidence indicates that event-related potentials (ERPs) as measured on the electroencephalogram (EEG) are more closely related to transdiagnostic, dimensional measures of psychopathology (TDP) than to diagnostic categories. A comprehensive examination of correlations between well-studied ERPs and measures of TDP is called for. In this study, we recruited 50 patients with emotional disorders undergoing 14 weeks of transdiagnostic group psychotherapy as well as 37 healthy comparison subjects (HC) matched in age and sex. HCs were assessed once and patients three times throughout treatment (N = 172 data sets) with a battery of well-studied ERPs and psychopathology measures consistent with the TDP framework The Hierarchical Taxonomy of Psychopathology (HiTOP). ERPs were quantified using robust single-trial analysis (RSTA) methods and TDP correlations with linear regression models as implemented in the EEGLAB toolbox LIMO EEG. We found correlations at several levels of the HiTOP hierarchy. Among these, a reduced P3b was associated with the general p-factor. A reduced error-related negativity correlated strongly with worse symptomatology across the Internalizing spectrum. Increases in the correct-related negativity correlated with symptoms loading unto the Distress subfactor in the HiTOP. The Flanker N2 was related to specific symptoms of Intrusive Cognitions and Traumatic Re-experiencing and the mismatch negativity to maladaptive personality traits at the lowest levels of the HiTOP hierarchy. Our study highlights the advantages of RSTA methods and of using validated TDP constructs within a consistent framework. Future studies could utilize machine learning methods to predict TDP from a set of ERP features at the subject level.

Prediction of the acceptance of telemedicine among rheumatic patients: a machine learning-powered secondary analysis of German survey data

Telemedicine (TM) has augmented healthcare by enabling remote consultations, diagnosis, treatment, and monitoring of patients, thereby improving healthcare access and patient outcomes. However, successful adoption of TM depends on user acceptance, which is influenced by technical, socioeconomic, and health-related factors. Leveraging machine learning (ML) to accurately predict these adoption factors can greatly contribute to the effective utilization of TM in healthcare. The objective of the study was to compare 12 ML algorithms for predicting willingness to use TM (TM try) among patients with rheumatic and musculoskeletal diseases (RMDs) and identify key contributing features. We conducted a secondary analysis of RMD patient data from a German nationwide cross-sectional survey. Twelve ML algorithms, including logistic regression, random forest, extreme gradient boosting (XGBoost), and neural network (deep learning) were tested on a subset of the dataset, with the inclusion of only RMD patients who answered "yes" or "no" to TM try. Nested cross-validation was used for each model. The best-performing model was selected based on area under the receiver operator characteristic (AUROC). For the best-performing model, a multinomial/multiclass ML approach was undertaken with the consideration of the three following classes: "yes", "no", "do not know/not answered". Both one-vs-one and one-vs-rest strategies were considered. The feature importance was investigated using Shapley additive explanation (SHAP). A total of 438 RMD patients were included, with 26.5% of them willing to try TM, 40.6% not willing, and 32.9% undecided (missing answer or "do not know answer"). This dataset was used to train and test ML models. The mean accuracy of the 12 ML models ranged from 0.69 to 0.83, while the mean AUROC ranged from 0.79 to 0.90. The XGBoost model produced better results compared with the other models, with a sensitivity of 70%, specificity of 91% and positive predictive value of 84%. The most important predictors of TM try were the possibility that TM services were offered by a rheumatologist, prior TM knowledge, age, self-reported health status, Internet access at home and type of RMD diseases. For instance, for the yes vs. no classification, not wishing that TM services were offered by a rheumatologist, self-reporting a bad health status and being aged 60-69 years directed the model toward not wanting to try TM. By contrast, having Internet access at home and wishing that TM services were offered by a rheumatologist directed toward TM try. Our findings have significant implications for primary care, in particular for healthcare professionals aiming to implement TM effectively in their clinical routine. By understanding the key factors influencing patients' acceptance of TM, such as their expressed desire for TM services provided by a rheumatologist, self-reported health status, availability of home Internet access, and age, healthcare professionals can tailor their strategies to maximize the adoption and utilization of TM, ultimately improving healthcare outcomes for RMD patients. Our findings are of high interest for both clinical and medical teaching practice to fit changing health needs caused by the growing number of complex and chronically ill patients.

A Cross-Sectional Comparative Study of Nurses' and Family Members' Perceptions on Priority and Satisfaction in Meeting the Needs of Family Members at the Emergency Department

INTRODUCTION

Family members experience considerable physiological, psychological, and emotional pressure when accompanying a critically ill relative in the emergency department. The culture and context of care influence the needs of the family, and a thorough understanding of these needs by health care professionals is essential to providing patient- and family-centered care. This study aimed to compare nurses' and family members' perceptions of the priorities of family member needs and their satisfaction with meeting those needs in the emergency department.

METHODS

A comparative, cross-sectional descriptive study was conducted. Participants were 140 family members of patients receiving care and 122 nurses working in the emergency department in hospitals of Tabriz University of Medical Science, in Iran. The data were collected through Critical Care Family Needs Inventory-ED and analyzed with SPSS Statistics software.

RESULTS

Family members rated their care needs as significantly greater than did nurses (129.45 [31.5] vs 124.45 [24.8], P = .003). Families rated their needs as having been met significantly less than the nurses estimated (103.6 [17.6] vs 110.8 [19.61], P < .05).

DISCUSSION

The perceived importance of the patient's family's needs differed from the viewpoints of the patient's family members and the nurses. In addition, emergency nurses overestimated the extent to which family members' needs were met compared with family members. To more adequately gauge and meet the needs of family members, nurses need to acquire more knowledge about patient family needs in the emergency department.

Patient Versus Physician Perspective in the Management of Chronic Myeloid Leukemia During Treatment with Tyrosine Kinase Inhibitors

INTRODUCTION

Chronic myeloid leukemia (CML) is a chronic disease with treatment-free remission (TFR) increasingly regarded as a feasible goal of treatment. However, various factors may influence adherence to international guidelines for CML management. This study aimed to compare the reporting of care between patients with CML and their treating doctors.

METHODS

Parallel patient and physician online surveys were conducted between September 22, 2021, and March 15, 2022, which focused on the perceptions of 1882 adult patients with CML and 305 physicians regarding tyrosine kinase inhibitor (TKI) treatment options, monitoring and toxicities, TFR, and challenges faced.

RESULTS

Among the enrolled patients, 69.9% received first-line imatinib treatment, 18.6% received nilotinib, and 4.7% received dasatinib. Among the patients treated with imatinib, 36.7% switched to other TKIs due to imatinib resistance/intolerance (71.1%), exploration of more potent TKIs to achieve TFR (8.9%), and treating physicians' recommendation (14.0%), with a median duration of initial treatment of 14 months [interquartile range (IQR) 6-36]. Most (91.8%) physicians agreed that the breakpoint cluster region-Abelson 1 (BCR::ABL1) transcript level should be assessed every 3 months, but only 42.7% of individuals committed to 3-monthly testing and only 17.8% strictly followed their treating physicians' recommendation. Half of the patients aimed for TFR; however, just 45.2% of physicians considered TFR as one of the top three goals for their patients. The major concern in obtaining TFR was patients' adherence. Fatigue was often distressing for patients with TKIs, while physicians were more concerned about platelet and neutrophil counts. A total of 12% and 20.8% of patients reported moderate/severe anxiety and depression, respectively, while only 53.7% of physicians had concerns about their patients' mental health. During the coronavirus disease 2019 (COVID-19) pandemic, 69.2% of patients reported a reduction in their income. Among these patients, 61.8% maintained their current treatment, while 7.3% switched to cheaper alternatives or discontinued treatment, with over 80% of these patients belonging to the low-income group.

CONCLUSIONS

Overcoming challenges in patient-physician communication and treatment access is key to improving disease management and quality of life, especially for patients with low income.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT05092048.

An Evaluation on the Attitude Toward Using Patient Rights and Satisfaction Levels in Emergency Department Patients

INTRODUCTION

In emergency health care services, patient satisfaction is one of the fundamental indicators of quality emergency care, making it essential to identify factors that can impact this component of care. This study aimed to determine emergency service patients' attitudes toward using patient rights, their satisfaction levels with emergency service, and related factors.

METHODS

The cross-sectional study was conducted with 382 patients who presented to the emergency department between November 2022 and March 2023. Data were collected using the Patient Description Form, the Emergency Department Patient Satisfaction Scale, and the Scale of Patient Rights Using Attitude. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for reporting.

RESULTS

The mean score of the Emergency Department Patient Satisfaction Scale was 53.88 ± 6.88 (minimum score, 30; maximum score, 68), and the mean score of the Scale of Patient Rights Using Attitude was 108.89 ± 11.90 (minimum score, 73; maximum score, 135). As a result of the regression analysis, it was found that the Scale of Patient Rights Using Attitude scores and frequency of ED visits significantly contributed to the Emergency Department Patient Satisfaction Scale scores. Younger patients who had higher educational status presented to the emergency department more frequently and had chronic diseases were associated with positive attitudes about using patient rights and had higher levels of ED patient satisfaction (P < .001).

DISCUSSION

The study has provided valuable information for assessing the attitudes of ED patients toward exercising their patient rights and their satisfaction levels. Respect for patient rights and their effective utilization by patients can enhance the quality of ED services and increase patient satisfaction.

Patients' sense of security from clinical factors in Iran: a cross-sectional study

BACKGROUND

One of the clinical responsibilities and goals of hospitals is to provide patients with comfort and security. The present study aims to assess patients' sense of security among patients in Iranian hospitals.

METHODS

The present research employed a cross-sectional design. The sample consisted of 830 patients visiting public, private, and social security hospitals in Mazandaran in the North of Iran. The required data were collected using a questionnaire developed by the researcher of this study.This questionnaire consisted of 4 dimensions:nursing, medical, advanced facilities and patient rights. The participants were selected using a proportional stratified random sampling method. Exploratory factor analysis, confirmatory factor analysis, descriptive statistics, and ANOVA were used for data analysis using SPSS version 22.

RESULTS

The mean scores of patients' sense of security in social security, private, and public hospitals were 4.16 ± 0.89, 3.78 ± 0.67, and 3.60 ± 0.89, respectively. Medical factors with a mean and standard deviation of 3.92 ± 0.76, advanced facilities and equipment with 3.89 ± 0.89, nursing factors with 3.87 ± 0.73, and patient rights with 3.71 ± 0.90 were the highest to the lowest scores, respectively. The results showed that the type of hospital significantly affected the mean dimensions of security (p < 0.05).

CONCLUSIONS

The study revealed variations in the sense of securityacross the sampled hospitals. Particularly, the sense of security attributed to the patient rights factors was lower than other factors. Therefore, to enhance the sense of security for patients, it is recommended to focus on staff training and fostering a culturethat emphasizes obtaining informed consent, demonstrating respect for the patient, and introducing the medical team to the patient before initiating any treatment.

Advanced patient-specific microglia cell models for pre-clinical studies in Alzheimer's disease

BACKGROUND

Alzheimer's disease (AD) is an incurable neurodegenerative disorder with a rapidly increasing prevalence worldwide. Current approaches targeting hallmark pathological features of AD have had no consistent clinical benefit. Neuroinflammation is a major contributor to neurodegeneration and hence, microglia, the brain's resident immune cells, are an attractive target for potentially more effective therapeutic strategies. However, there is no current in vitro model system that captures AD patient-specific microglial characteristics using physiologically relevant and experimentally flexible culture conditions.

METHODS

To address this shortcoming, we developed novel 3D Matrigel-based monocyte-derived microglia-like cell (MDMi) mono-cultures and co-cultures with neuro-glial cells (ReNcell VM). We used single-cell RNA sequencing (scRNAseq) analysis to compare the transcriptomic signatures of MDMi between model systems (2D, 3D and 3D co-culture) and against published human microglia datasets. To demonstrate the potential of MDMi for use in personalized pre-clinical strategies, we generated and characterized MDMi models from sixteen AD patients and matched healthy controls, and profiled cytokine responses upon treatment with anti-inflammatory drugs (dasatinib and spiperone).

RESULTS

MDMi in 3D exhibited a more branched morphology and longer survival in culture compared to 2D. scRNAseq uncovered distinct MDMi subpopulations that exhibit higher functional heterogeneity and best resemble human microglia in 3D co-culture. AD MDMi in 3D co-culture showed altered cell-to-cell interactions, growth factor and cytokine secretion profiles and responses to amyloid-β. Drug testing assays revealed patient- and model-specific cytokine responses.

CONCLUSION

Our study presents a novel, physiologically relevant and AD patient-specific 3D microglia cell model that opens avenues towards improving personalized drug development strategies in AD.

A latent profile analysis of resilience and their relation to differences in sleep quality in patients with lung cancer

PURPOSE

Sleep problems are a significant issue in patients with lung cancer, and resilience is a closely related factor. However, few studies have identified subgroups of resilience and their relationship with sleep quality. This study aimed to investigate whether there are different profiles of resilience in patients with lung cancer, to determine the sociodemographic characteristics of each subgroup, and to determine the relationship between resilience and sleep quality in different subgroups.

METHODS

A total of 303 patients with lung cancer from four tertiary hospitals in China completed the General Sociodemographic sheet, the Connor-Davidson Resilience Scale, and the Pittsburgh Sleep Quality Index. Latent profile analysis was applied to explore the latent profiles of resilience. Multivariate logistic regression was used to analyze the sociodemographic variables in each profile, and ANOVA was used to explore the relationships between resilience profiles and sleep quality.

RESULTS

The following three latent profiles were identified: the "high-resilience group" (30.2%), the "moderate-resilience group" (46.0%), and the "low-resilience group" (23.8%). Gender, place of residence, and average monthly household income significantly influenced the distribution of resilience in patients with lung cancer.

CONCLUSION

The resilience patterns of patients with lung cancer varied. It is suggested that health care providers screen out various types of patients with multiple levels of resilience and pay more attention to female, rural, and poor patients. Additionally, individual differences in resilience may provide an actionable means for addressing sleep problems.

Personal and perceived stigma in relation to diverse domains of quality of life among patients with major depressive disorder having residual symptoms: a hospital-based cross-sectional study in Thailand

PURPOSE

Depression is a debilitating disease with residual symptoms that negatively impact patients' quality of life (QoL). Stigma is associated with poor QoL; however, knowledge regarding stigma subtypes and each QoL domain concerning residual depression is limited. We aimed to investigate the association of residual depression symptoms with QoL and stigma among patients with major depressive disorder (MDD).

METHODS

This cross-sectional study was conducted at an outpatient clinic among patients with MDD (March-July 2022). We administered the Thai version of the Patient Health Questionnaire-9, World Health Organization Quality of Life Brief, and Mental Health Consumers' Experience of Stigma to assess patients' levels of depression, QoL, and personal and perceived stigma, respectively. We performed correlational and logistic regression analyses to evaluate the association of demographics, QoL, stigma, and stress with residual depression.

RESULTS

Of 384 patients with MDD (median age = 39.5, females = 73.2%), 54.4% had residual depression. Among those with residual depression, depression was negatively correlated with QoL (ρ = - 0.58, p < 0.001) and positively correlated with stigma (ρ = 0.24, p < 0.001). The risk of residual depression decreased as the QoL score increased (adjusted OR per 1-point increase 0.93 [0.91, 0.96], p < 0.001); residual depression was significantly associated with personal stigma.

CONCLUSION

Stigma and QoL exhibit an inverse relationship. Physical-, psychological-, and environmental-health domains of QoL and personal stigma are key contributing factors to residual MDD symptoms. Improvement of QoL and stigma requires further theoretical research and should be of concern in clinical practice. Longitudinal studies on relatively diverse populations and subsyndromal symptoms are needed.

Patient Experience and Preferences for the Assessment of Olfaction: The Patient International Clinical Assessment of Smell Survey

INTRODUCTION

Olfactory dysfunction (OD) is common and carries significant personal and societal burden of disease. Accurate assessment of olfaction is required for good clinical care and affords patients insight into their condition. However, the accuracy of assessment varies with technique used, and there is presently little standardisation of clinical practice. We therefore aimed to determine experience of and preferences for olfactory assessment in healthcare-seeking adults.

METHODS

An anonymous patient co-produced survey was developed in collaboration with a UK-based OD charity. Distribution was via their social media patient forum. "Healthcare seeking" adults (i.e., who had undergone olfactory assessment by a healthcare professional [any care level/speciality] or may do so in the future) were included.

RESULTS

576 people (88.5% female, mean 46 years) responded. Hyposmia, parosmia, and retronasal OD were most frequently reported. 55.2% had been assessed by a healthcare professional - GP most commonly, followed by ENT. Importantly, only 15.6% and 16.9% of respondents had undergone systematic assessment with smell tests or symptom questionnaires, respectively. Most respondents had not undergone imaging. Mean satisfaction was higher in those seen by ENT. Interestingly, respondents prioritise orthonasal odour identification over other forms of smell test. Unfortunately, many felt that healthcare professionals (across specialities) were dismissive towards OD and lacked appropriate knowledge of both its pathophysiology and effects. We propose simple steps that can be taken to improve olfactory assessment, including education and establishment of robust referral networks.

CONCLUSION

We hope these results and supporting practical recommendations will inform future service planning, funding allocation and research, as well as better aligning patient and clinician priorities.

Epidemiology of patients assessed for trauma by Swedish ambulance services: a retrospective registry study

BACKGROUND

There is a lack of knowledge regarding the epidemiology of severe trauma assessed by Swedish emergency medical services (EMS).

AIM

To investigate the prevalence of trauma in Sweden assessed by EMS from a national perspective and describe patient demography, aetiology, trauma type, prehospital triage and clinical outcomes.

METHODS

Data from two national quality registries, the Swedish Ambulance Registry and the Swedish Trauma Registry (SweTrau) were collected from January 1 to December 31, 2019. Inclusion criteria were an Emergency Symptoms and Signs code equivalent to trauma in the Swedish Ambulance Registry and criteria fulfilled for SweTrau inclusion. Exclusion criteria were patients < 18 years old, those not transported to a hospital and those without a personal identification number.

RESULTS

In total, 53,120 patients with trauma were included (14% of primary EMS missions involving a personal identification number). Of those, 2,278 (4.3%) patients (median age: 45 years; 32% women) were reported in SweTrau to have severe or potentially severe trauma (penetrating: 7%, blunt: 93%). In terms of including all causes of trauma, the code for 'trauma alert activation' was most frequent (55%). The most frequent injury mechanism was an injury caused by a car (34%). Most (89%) cases were assigned Priority 1 (life-threatening condition) at the dispatch centre. 62% were regarded as potentially life threatening upon EMS arrival, whereas 29% were assessed as non-life-threatening. Overall, 25% of the patients had new injury severity scores > 15. 12% required invasive treatment, 11% were discharged with severe disability and the 30-day mortality rate was 3.6%.

CONCLUSION

In this cross-sectional study, 14% of the primary EMS missions for one year were caused by trauma. However, only a small proportion of these cases are severe injuries, and the risk of severe disabilities and death appears to be limited. The most frequent aetiology of a severe trauma is injury caused by a car, and most severe traumas are blunt. Severe traumas are given the highest priority at the dispatch centre in the vast majority of cases, but nearly one-third of these cases are considered a low priority by the EMS nurse. The latter leaves room for improvement.

Opinions of professors, dental students, and patients for publishing the patient images in the articles

INTRODUCTION

The journals must have an instruction for writers to observe the essential ethical principles like privacy-preserving, secrecy, and keeping the patients' identities hidden. Even though patient secrecy is an important ideology in medicine's ethics, most journals have a little guide on this topic for the authors. According to the absence of such studies in dentistry and limited studies in medicine, our goal in this article is to review the opinions of professors, Kerman dentistry students, and patients for publishing the patient images in the articles.

METHOD

This research is an analytical, sectional, and descriptive study. The studied society includes the professors of the dentistry faculty (54 people), the 4th to 6th years dentistry students (122 people), and 129 patients who referred to the offices, the faculty, and other clinics in Kerman city base on simple random sampling method. A query including the personal questions, and questions related to the participants' opinions about publishing the images was given to contributors. Abundance, average tables, chi-square (χ 2) test, T-test, and SPSS 21 software were used for data description.

RESULTS

The contributors' attitudes were different in three groups of participants: more than half of the patients (58.91%), 39.5% of students, and 31.38% of professors believed that no permission is needed. While, 64.34% of the patients, 89.34% of students, and 83.3% of professors believed that written permission is needed for publishing.

CONCLUSION

From the participants' viewpoints, more strict forms are needed by increasing identity recognizability. The professors are more eager than the patients to receive patients' permission for any kind of image. By reducing the level of identification, doctors and students are more eager than patients to receive approvals.

"You always think the worst …" Family members' experiences during the COVID-19 emergency: A qualitative descriptive study

AIM

The aim of this study was to explore the experiences of family members of patients admitted to the intensive care unit (ICU) for COVID-19 during the first and second waves of the pandemic in Switzerland.

DESIGN

A qualitative descriptive approach was used in this study.

METHODS

Face-to-face in-depth semistructured interviews were used to explore the experiences of family members of surviving COVID-19 patients, who were admitted to the ICU. Interviews were transcribed verbatim and wereanalysed using Braun and Clarke thematic analysis. In our context, family visits were prohibited during the first and second waves of the pandemic.

FINDINGS

Fifteen family members participated. Interviews were conducted between October 2020 and March 2021. Data analysis identified three main themes: (i) becoming a pillar of support for all; (ii) dealing with uncertainty; and (iii) a trajectory of emotions. Five subthemes are reported within these themes. The primary concern was the need for information due to visitation restrictions. This led to stress as many became the main communication source for other family members and friends. Coping strategies to support the ongoing uncertainty included daily routines, work, and prayer. The inability to visit and the lack of information led to a range of conflicting emotions, such as feeling of helplessness, which were countered by the gratitude that their loved ones had survived.

CONCLUSION

This study highlights the profound impact of the COVID-19 pandemic on the family members of ICU patients. It emphasises their struggle for information, adaptation to new roles, and coping mechanisms amidst uncertainty. Although they experienced predominantly negative emotions, the recovery and return of their loved ones triggered a sense of gratitude. This study sheds light on the crucial role of social support. Such findings may have implications for nursing practice in effectively addressing the concerns and priorities of family members in similar emergency situations, thereby improving clinical outcomes.

Individuals' invisible work continues after epilepsy surgery: A qualitative interview study

OBJECTIVE

How do persons with epilepsy (PWE) experience their everyday lives after epilepsy surgery?

METHODS

Qualitative thematic interviews were conducted with eight PWEs (30 to 60 years old). They were recruited when coming for post-operative control 1 to 5 years after epilepsy surgery. The interviews were transcribed. They were analysed by thematic analysis and inspired by Goffman who examines everyday life activities as a theatre play.

RESULTS

Before surgery, a substantial invisible and hidden work of adjustments was performed to prevent seizures, to secure help from others if seizures occurred, and to protect oneself from others' gaze during a seizure. This invisible work continued after surgery even for those who became seizure-free; but now for the purpose of protecting oneself from relapse of epilepsy. From the participants perspective there was no or minor change in daily activities among those not becoming seizure-free after surgery. In contrast, those who became seizure-free enjoyed the freedom to participate in social activities without planning or restrictions.

CONCLUSIONS

A striking finding was that daily life after surgery comprises considerably invisible work to protect a social self, and this preventive and protective invisible work continued, although those who became seizure-free were living an ordinary socially healthy life.

New Neuroimaging Findings in Patients with Molybdenum Cofactor Deficiency Type A: A Case Report and Literature Review

INTRODUCTION

Molybdenum cofactor deficiency (MoCD-A) is an extremely rare autosomal recessive disease that presents with intractable seizures. The diagnosis poses challenges due to the limited number of cases reported worldwide. Magnetic resonance imaging (MRI) is a useful diagnostic tool that can detect brain injury associated with the disorder. The prognosis of MoCD-A is poor partly because most cases are initially misdiagnosed as HIE (hypoxic ischemic encephalopathy), emphasizing the need for an early and accurate diagnosis to improve quality of life and provide adequate genetic counseling to avoid new cases in the future.

CASE REPORT

This report presents a case of molybdenum cofactor deficiency type A (MoCD-A) caused by MOCS1 gene mutations. A male newborn was admitted on the 10th day of birth due to uncontrolled seizures and feeding difficulties. Brain MRI showed severe cerebral damage with multiple foci that did not enhance upon contrast administration. The diagnosis was confirmed by genetic analysis and the patient received rehabilitation. His parents also received genetic counseling. To the best of our knowledge, this is the first reported MoCD-A case that had enhanced MR imaging with Gd-DTPA (0.1 mmol/kg). In addition, we reviewed the clinical and neuroimaging features of 25 newborns diagnosed with MoCD-A, as documented in the existing literature.

CONCLUSION

MRI is crucial in the diagnosis of MoCD-A. A correct diagnosis can provide the family with timely genetic counseling to prevent future cases.

Exercises for fibromyalgia syndrome: what YouTube tells us as a source of information for patient and physician education

OBJECTIVE

YouTube, a popular worldwide source to access health information online, may have an impact in enhancing exercise therapy for fibromyalgia patients. This study is aimed to investigate the quality and reliability of exercise videos prepared for fibromyalgia syndrome on YouTube.

METHODS

A thorough search on YouTube using six search terms related to fibromyalgia treatment and exercise was conducted. The videos with content on exercises for fibromyalgia, acceptable audio-video quality, and are in English language were included, whereas duplicates were excluded from the analysis. Quality was determined using the Global Quality Scale (GQS) and JAMA system, and reliability using the mDISCERN criteria.

RESULTS

Out of a total of 600 videos, 70 videos that met the inclusion criteria were included in the analysis. Physicians were found to produce content mostly in high and medium quality (%70.2), other medical professionals mostly in low and medium quality (93.8%), while non-medical users mostly in low quality (86.7%). Ninety percent of the videos targeted patients, while 10% targeted healthcare professionals as an audience, and the majority (93.7%) of videos targeting patients were of low and medium quality, as most (85.7%) of the videos targeting healthcare professionals were of high quality.

CONCLUSION

YouTube can be used as a tool to increase exercise adherence in fibromyalgia patients, as it offers a wide range of content that is easily accessible and useful at times. To implement this tool, physicians need to upload more content online as they stand for pioneers of high-quality information dissemination on the internet. KeyPoints • This research emphasizes the need for high-quality online healthcare information which is accessed by a vast number of individuals and the implementations that effectively address and prevent the spread of misinformation. • Additionally, it presents suggestions for the future regarding the uploading of such content on the internet. • Physicians hold the key responsibility in ensuring the availability of high-quality online health content, thereby carrying significant implications for its overall impact.

A Prospective Study to Compare Caregivers' Knowledge and Perception of Cancer Pain with Patients' Pain Assessment and to Evaluate their Quality of Life

Objectives

Family caregivers (FCGs) play a crucial role in the home care of terminally ill patients. Therefore, evaluating their comprehension of patients' symptoms and doctors' advice becomes crucial. Moreover, this might negatively impact their quality of life (QOL). Thus, the purpose of the study was to examine FCGs' perception and understanding of cancer pain in relation to patients' pain assessments, as well as the effect this has on their own QOL.

Materials and Methods

The family pain questionnaire (FPQ) and patient pain questionnaire (PPQ) were used for both patient as well as their FCGs. The scores for each subscale, knowledge, and experience were calculated. Furthermore, FCGs' own QOL was assessed using the caregiver quality of life index-cancer (CQOLC) questionnaire. Results were statistically analysed.

Results

The FCGs of 93 individuals were examined. The Cronbach alphas for the current dataset showed that the FPQ (0.754) and PPQ (0.759) overall reliability scales were satisfactory. The knowledge, experience, and total average scores for the PPQ (FPQ) subscales were reported as 35.91 (35.31), 27.19 (26.86), and 63.10 (62.17), respectively. The knowledge, experience, and overall scales of the PPQ (FPQ) were evaluated to provide median scores of 37 (36), 28 (25), and 65 (62) correspondingly. A t-test was used to determine the significance of the observed average differences (d) for knowledge (0.602), experience (0.333), and overall (0.935). The results showed that there were no significant differences (P > 0.05). An inverse relationship was elicited between the total QOL and the pain assessment scores of FCGs, as well as the age of the patient. The difference was, however, majorly statistically non-significant (P > 0.5). Further, statistical significance was found only between the burden component of the CQOLC and the age of the patients (P = 0.034), as well as total pain knowledge (P = 0.007) and total pain scores (P = 0.001) of the FCGs'.

Conclusion

As per our analysis, FCGs had less knowledge and experience of patients' pain, though statistically , it was not significant. The age of the patient, as well as total pain knowledge and total pain scores of the FCGs' were found to affect the QOL of FCGs'. Studies with large sample sizes might help in strengthening the findings.

Lost in the loop - a qualitative study on patient experiences of care in standardized cancer patient pathways

BACKGROUND

The Norwegian health authorities introduced standardized cancer patient pathways (CPPs) in 2015, aiming to reduce practice variations across hospitals and regions, and improve the continuity, coordination and overall quality of the health care service provided to cancer patients. There has been few studies investigating this change, and that have looked into the organisational and economic benefits of standardized pathways, however the element of care and the patient perspective has been especially neglected. This study explored the care element in cancer patient pathways through an in-depth study of patient experiences.

METHODS

The patients were enrolled approximately three years after the introduction of standardized CPPs in Norway. Through a qualitative design with in-depth interviews, a total of 21 interviews were conducted with seven patients between 2018 and 2020. The first interview took place after the diagnosis was established and before treatment, the second interview during treatment, and the final interview approximately one year after the completion of active treatment. The empirical catchment area was eastern Norway. Data were analysed using a theoretical thematic analysis.

RESULTS

This study sheds light on the complex challenges patients' faces, while navigating CPPs, including the need for better transition support, improved coordination and continuity in care, and a more holistic approach that encompasses emotional well-being and family support. Three overarching themes were identified: [1] Navigating CPPs: patient care and transition challenges, [2] Fragmented cancer care: challenges in coordination and continuity [3] Unmet needs and overlooked opportunities in CPPs.

CONCLUSIONS

Patients experience that cancer patient pathways offer good medical treatment, but that the care element deserves more attention. Current CPPs are trapped in a logic of choice, preventing room for the element of care to receive the attention it requires for the patient to truly experience holistic person-centred care and continuous, well-coordinated services. Based in our study we argue there is a need to look into the missed opportunities for using the CPPs as points of departure for more holistic collaborative models for cancer care.

Attitudes, expectations, and lived experiences of cancer patients receiving dendritic cell vaccine therapy in Japan

Objective

Immunotherapeutic approaches to cancer, such as dendritic cell vaccine therapy, promise to improve survival rate but may present unique challenges to patients. However, there is no research on the lived experiences of cancer patients receiving dendritic cell vaccine therapy. The aim of this study was to explore the attitudes, expectations, and experiences of cancer patients receiving dendritic cell vaccine therapy in Japan.

Methods

This was an exploratory qualitative study. A descriptive phenomenological approach was used to investigate the experiences of eight advanced-stage cancer patients (median age: 59.5 years). Data were collected between July 2018 and March 2020 using in-depth semi-structured interviews. Data were analyzed according to Colaizzi's seven-step phenomenological strategy, and EQUATOR's Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for qualitative studies were followed.

Results

Four themes emerged from the data analysis: strong concerns about chemotherapy, faith in dendritic cell vaccine therapy, motivation to succeed, and physical and mental changes. The first two themes related to pretreatment attitudes and expectations. The latter two themes expressed participants' experiences during and after therapy.

Conclusions

Dendritic cell vaccine therapy patients expressed fears about the effects of standard treatment, and hope and uncertainty regarding immunotherapy treatment decisions and efficacy. The findings suggest that such patients require nursing care that includes prevention and reduction of chemotherapy side effects, careful observation of patients' well-being, management of patients' expectations and uncertainty, formation of patient-health care practitioner partnerships, and team medicine.

Impact of COVID-19 on the capacity to self-manage health and chronic conditions

Objective

To investigate well-being, lifestyle behaviors, self-management capacity and healthcare utilization among adults with chronic conditions at the outbreak of the COVID-19 pandemic.

Methods

Data was collected from two interviewer-administered telephone surveys conducted between March 27 - May 22, 2020. Participants were patients at Chicago-area clinics. Self-report and validated measures were used for study-related outcomes.

Results

A total of 553 participants (age range 23-88) completed data collection at both timepoints. One in five (20.7%) participants experienced stress due to the coronavirus most or all the time and rates of negative well-being were high (WHO-5 Index mean = 58.7%). Almost a quarter (22.3%) engaged in hazardous drinking and 79.7% reported insufficient physical activity. Nearly one in four participants (23.7%) avoided seeking medical care due to worry about COVID-19. In multivariable analyses, greater COVID-19 related stress was associated with less physical activity, lower self-efficacy, greater difficulty managing health and medications, and delays in seeking medical care due to the coronavirus.

Conclusions

Mental well-being, lifestyle behaviors, self-management capacity, and healthcare utilization were impacted in the months following the COVID outbreak.

Innovation

These findings suggest health systems should implement proactive measures for detecting and treating emotional and behavioral COVID-related concerns.

Self-care behaviors and associated factors among individuals with type 2 diabetes in Ghana: a systematic review

BACKGROUND

Self-care remains an effective model for diabetes management and care in low-and-middle-income countries due to the limited resources available for the clinical management of the disease and its complications This study examined adherence to self-care behaviors and associated factors among people with type 2 diabetes in Ghana.

METHODS

PubMed, PsycINFO, Scopus, Web of Science, Embase and Google scholar were used to identify quantitative observational studies published between 1990 and September 30, 2023. Studies exclusive to persons with type 2 diabetes ≥ 18 years of age in a Ghanaian setting were included in this review. Findings of primary studies were analyzed using narrative synthesis.

RESULTS

Twelve studies, presenting data on a total of 2,671 persons with type 2 diabetes, were included. All the studies were published in the last decade (2015-2022) and a majority of them were from the Greater Accra Region. The mean number of days (per week) participants adhered to a self-care behavior were in the ranges of 3.9-4.4 for diet, 4.2-4.8 for physical activity, 0.5-2.2 for self-monitoring of blood glucose (SMBG), and 2.9-5.0 for foot care. Adherence rates for medication were in the range of 33.5-84.5%. Patient-related factors, sociodemographic/economic-related factors, condition-related factors, and healthcare system-related factors were associated with various self-care behaviors.

CONCLUSION

Adherence to self-care behaviors among persons with type 2 diabetes in Ghana remains an ongoing challenge with significant variations in adherence among patients with different characteristics.

Evaluation of patients´ perspective on a multimorbidity patient-centered care model piloted in the chilean public health system

BACKGROUND

The progressive multimorbidity explosion has challenged Chile's health systems and worldwide. The Centro de Innovación en Salud ANCORA UC implemented a new Multimorbidity Patient-Centered Care Model in Chile.

OBJECTIVE

Evaluate the perspective of high-risk patients about the core elements of the model.

METHODOLOGY

We conducted a cross sectional telephone-based survey that considered the application of a 13 items questionnaire. Of them, nine were Likert scale questions with scores from 1 to 7, one dichotomic question, and three open-ended questions. 231 high-risk patients who received care through the model at primary care centers participated in the study. Quantitative data were encoded, consolidated, and analyzed with the SPSS software. We performed descriptive and analytic statistics techniques to assess different variables and their potential associations. Thematic analysis was conducted for qualitative data.

RESULTS

The overall score was 5.84 (range: 1 to 7), with a standard deviation of 1.25. Questions with the best scores were those related with personalized care and the primary care teams. The lowest scored was for the item regarding the continuity of care between primary nurses and inpatient care at the hospital. There was a difference in patient outcomes depending on their health center. Regarding sociodemographic characteristics, age did not significantly affect the results.

CONCLUSIONS

The study reveals the perceptions about a complex multimorbidity intervention from the patient's perspective. It complements the impact on health services utilization evaluation that supports decision-makers currently scaling up a similar strategy in our country and could be considered in other countries dealing with non-communicable diseases.

Patients' opinion on violence against healthcare workers and their level of satisfaction in emergency department in Turkey: A cross-sectional study

BACKGROUND

Violence, with an increasing rate of cases in the health care system which adversely affects the quality of provision of services, has become a social health issue that also has negative impacts both on healthcare workers and patients. This study was conducted to determine the opinion of patients, who had been admitted to the emergency department, towards violence against healthcare workers, and their level of satisfaction with health services.

METHODS

The study employed a cross-sectional design and was conducted with 348 patients who had received healthcare services in the adult emergency department in Turkey. The Emergency Department Patient Satisfaction Survey and An eight-item questionnaire prepared by the researchers consisting of the patient's characteristics and their statements on violence were used to collect the data.

RESULTS

Among the patients, 26.7% stated that they had been violent toward healthcare workers. It was determined that 91.4% of the cases were verbal and 8.6% were physical. Among the patients, 82.2% had not known about the legal sanctions for violence against healthcare workers. The low level of propensity for violence in patients who were satisfied with the emergency department service was statistically significant (p < 0.05).

CONCLUSIONS

As a result of the study, it was found that one in four patients had been violent to healthcare workers, and the vast majority had a lack of information about legal sanctions. Policymakers should take deterrent measures to prevent the occurrence of violence and develop more critical sanctions.

Patients 'acceptance' of chronic wound-associated pain - A qualitative descriptive study

Chronic wound-associated pain negatively impacts the quality of life of individuals and their families. To date, little research exists that has explored collectively how individuals describe wound pain, strategies they use to manage pain, and the perceived effectiveness of such strategies. Therefore, qualitative, semi-structured interviews were carried out between June and August 2021 with 13 individuals to gain a deeper understand of the experience and impact of chronic wound-associated pain in this population. Data were analyzed following Braun and Clarke's approach for reflexive thematic analysis using MAXQdA®. Two themes and subthemes were identified. Theme 1 reflects participants' characterization of pain and how wound-associated pain affected their daily life and how they learned to accept it. Participants felt functionally impaired. In theme 2, participants described how they accepted to live with such a pain even though they received support to manage their chronic wound-associated pain, especially during the dressing-changes. Patients depended on their health care professionals and family support networks to cope with the pain. Coping with pain is exhausting contributing to poorer quality of life. Health care professionals should be aware of wound-associated pain during dressing changes. Patients recommended the need for further research on dressings and not drugs to manage pain.

Aiding the Adoption of Master Protocols by Optimizing Patient Engagement

Master protocols (MPs) are an important addition to the clinical trial repertoire. As defined by the U.S. Food and Drug Administration (FDA), this term means "a protocol designed with multiple sub-studies, which may have different objectives (goals) and involve coordinated efforts to evaluate one or more investigational drugs in one or more disease subtypes within the overall trial structure." This means we now have a unique, scientifically based MP that describes how a clinical trial will be conducted using one or more potential candidate therapies to treat patients in one or more diseases. Patient engagement (PE) is also a critical factor that has been recognized by FDA through its Patient-Focused Drug Development (PFDD) initiative, and by the European Medicines Agency (EMA), which states on its website that it has been actively interacting with patients since the creation of the Agency in 1995. We propose that utilizing these PE principles in MPs can make them more successful for sponsors, providers, and patients. Potential benefits of MPs for patients awaiting treatment can include treatments that better fit a patient's needs; availability of more treatments; and faster access to treatments. These make it possible to develop innovative therapies (especially for rare diseases and/or unique subpopulations, e.g., pediatrics), to minimize untoward side effects through careful dose escalation practices and, by sharing a control arm, to lower the probability of being assigned to a placebo arm for clinical trial participants. This paper is authored by select members of the American Statistical Association (ASA)/DahShu Master Protocol Working Group (MPWG) People and Patient Engagement (PE) Subteam. DahShu is a 501(c)(3) non-profit organization, founded to promote research and education in data science. This manuscript does not include direct feedback from US or non-US regulators, though multiple regulatory-related references are cited to confirm our observation that improving patient engagement is supported by regulators. This manuscript represents the authors' independent perspective on the Master Protocol; it does not represent the official policy or viewpoint of FDA or any other regulatory organization or the views of the authors' employers. The objective of this manuscript is to provide drug developers, contract research organizations (CROs), third party capital investors, patient advocacy groups (PAGs), and biopharmaceutical executives with a better understanding of how including the patient voice throughout MP development and conduct creates more efficient clinical trials. The PE Subteam also plans to publish a Plain Language Summary (PLS) of this publication for clinical trial participants, patients, caregivers, and the public as they seek to understand the risks and benefits of MP clinical trial participation.

Holistic multimodal care for patients with cancer cachexia and their family caregivers

Patients with cancer cachexia frequently suffer from physical symptoms and psychological symptoms of illness, which can lead to emotional distress in patients and family caregivers. Although there is no standard care to manage cancer cachexia despite its high prevalence and negative impact on quality of life in patients and family caregivers, there is accumulating evidence showing the importance of holistic multimodal care for cancer cachexia. However, there is no agreement on the essential components of holistic multimodal care. Therefore, the aims of this review are to give an overview of what is known about the holistic multimodal care and to suggest the composition of a multidisciplinary team to achieve holistic interventions. Holistic multimodal care for cancer cachexia is defined as an approach that addresses physical health through medical, pharmacological, nutritional, and rehabilitative interventions as well as psychological, emotional, and social well-being issues according to the needs of patients and family caregivers. Moreover, an ideal multidisciplinary team is proposed to achieve holistic interventions based on patient- and family-centered care. However, the development of educational programs on cancer cachexia for both clinicians and patients and family caregivers is needed. Furthermore, measurements to assess the benefits of holistic multimodal care also need to be established.

Adolescent and caregiver preferences for juvenile idiopathic arthritis treatment: a discrete-choice experiment

BACKGROUND

This study aimed to elicit and quantify preferences for treatments for juvenile idiopathic arthritis (JIA).

METHODS

We conducted a discrete-choice experiment among adolescents with JIA in the United States (US) (n = 197) and United Kingdom (UK) (n = 100) and caregivers of children with JIA in the US (n = 207) and UK (n = 200). In a series of questions, respondents chose between experimentally designed profiles for hypothetical JIA treatments that varied in efficacy (symptom control; time until next flare-up), side effects (stomachache, nausea, and vomiting; headaches), mode and frequency of administration, and the need for combination therapy. Using a random-parameters logit model, we estimated preference weights for these attributes, from which we derived their conditional relative importance.

RESULTS

On average, respondents preferred greater symptom control; greater time until the next flare-up; less stomachache, nausea, and vomiting; and fewer headaches. However, adolescents and caregivers in the US were generally indifferent across varying modes and frequencies of administration. UK adolescents and caregivers preferred tablets, syrup, or injections to intravenous infusions. US and UK adolescents were indifferent between treatment with monotherapy or combination therapy; caregivers in the UK preferred treatment with combination therapy to monotherapy. Subgroup analysis showed preference heterogeneity across characteristics including gender, treatment experience, and symptom experience in both adolescents and caregivers.

CONCLUSIONS

Improved symptom control, prolonged time to next flare-up, and avoidance of adverse events such as headache, stomachache, nausea, and vomiting are desirable characteristics of treatment regimens for adolescents with JIA and their caregivers.

Validation of an Adapted Version of the Veterans RAND 12-Item Health Survey for Older Adults Living in Long-Term Care Homes

BACKGROUND AND OBJECTIVES

The Veterans RAND 12-Item Health Survey (VR-12) is a generic patient-reported outcome measure of physical and mental health status. An adapted version of the VR-12 was developed for use with older adults living in long-term residential care (LTRC) homes in Canada: VR-12 (LTRC-C). This study aimed to evaluate the psychometric validity of the VR-12 (LTRC-C).

RESEARCH DESIGN AND METHODS

Data for this validation study were collected via in-person interviews for a province-wide survey of adults living in LTRC homes across British Columbia (N = 8,657). Three analyses were conducted to evaluate validity and reliability: (1) confirmatory factor analyses were conducted to validate the measurement structure; (2) correlations with measures of depression, social engagement, and daily activities were examined to evaluate convergent and discriminant validity; and (3) Cronbach's alpha (r) statistics were obtained to evaluate internal consistency reliability.

RESULTS

A measurement model with 2 correlated latent factors (representing physical health and mental health), 4 cross-loadings, and 4 correlated items resulted in an acceptable fit (root-mean-square error of approximation = 0.07; comparative fit index = 0.98). Physical and mental health were correlated in expected directions with measures of depression, social engagement, and daily activities, though the magnitudes of the correlations were quite small. Internal consistency reliability was acceptable for physical and mental health (r > 0.70).

DISCUSSION AND IMPLICATIONS

This study supports the use of the VR-12 (LTRC-C) to measure perceived physical and mental health among older adults living in LTRC homes.

Assessment of Legibility of Handwritten Prescriptions and Adherence to W.H.O. Prescription Writing Guidelines in Ahmadu Bello University Teaching Hospital Zaria - Kaduna State, Nigeria

Introduction: The issues of incorrectness and incompleteness for written prescriptions may result to dispensing errors and unintended outcomes of care. The objective of the study was to assess the legibility of handwritten prescriptions and adherence to W.H.O. prescription writing guidelines in Ahmadu Bello University Teaching Hospital Zaria. Method: A cross-sectional prospective study design was used, and existing prescriptions were sampled from selected in-patient and outpatient pharmacy units of Ahmadu Bello University Teaching Hospital Zaria. This was approved by the ethics and research committee of the institution. The prescriptions were then evaluated for quality based on the layout, legibility, and clarity of the details in the prescriptions and screened for medication errors. Result: The extent of prescribing drugs by generic name was (68.37%), the legibility percentage was moderate and the percentage of prescriptions in which details of the drug, route of administration, and duration of treatment were complete was 85.23%, 80.80%, and 82.40%, respectively. The doctor's signature (84.87%) was present in the prescriptions. Many of the prescribers did not use to indicate patients' weight, age, and clinic on prescriptions, these are deviations from good prescribing practices while total medication error was 38.01%. Conclusion: Prescribers have a duty of care to their patient and a professional duty to their colleagues (pharmacists) to ensure drug prescriptions are readily identifiable. Interventional techniques such as the use of printed or electronic prescriptions can improve the ease of interpreting information and reduce medication errors.

Nurses' intention to care for patients with infectious disease: a content analysis study

OBJECTIVE

This present study was designed to explain the concept of nurses intention to care of patients with infectious diseases.

METHODS

This study is a deductive content analysis study that was performed from May 2022 to Jun 2022 in three hospitals in Iran. In total 21 nurses were chosen by purposive sampling and for deta collection used semi-structured interviews. Data analysis was done using Elo and Kingas method.

RESULTS

This study have revealed the formation of seven distinct themes, namely Job satisfaction, Professional ethics, Personal values, Standard precautions, Preserving health, Support, and Attitude of patients and their families. These themes are comprised of 17 categories and 59 subcategories.

CONCLUSION

By comprehending the dimensions of nurses' intentions to care for patients with infectious diseases, it is possible to develop suitable planning and strategies to meet the healthcare requirements of such patients. Managers can take action by examining the issues and demands of nurses, and by providing job security, they can establish a Healthcare service systems with high security that can effectively respond during an outbreak of infectious diseases. Additionally, Nursing managers can prevent nurses from leaving their jobs by taking appropriate intervention, increasing their motivation, and enhancing their satisfaction.

Work-related experiences and unmet needs of patients with a malignant glioma and relevant professionals: the BrainWork study

PURPOSE

Many patients with a malignant (i.e., grade II-IV) glioma are of working age, yet they are rarely included in "cancer and work" studies. Here, we explored (1) the work-related experiences and unmet needs of patients with a malignant glioma and (2) the experiences and needs of relevant healthcare and occupational (health) professionals ("professionals") in providing work-related support to this patient group.

METHODS

Individual semi-structured interviews were held with patients with a malignant glioma who were of working age and had an employment contract at diagnosis, and relevant professionals. Interviews were transcribed verbatim and analysed thematically.

RESULTS

Patients (n = 22) were on average 46 ± 13 years of age (64% male) and diagnosed with a grade II (n = 12), III (n = 4), or IV glioma (n = 6). Professionals (n = 16) had on average 15 ± 9 years of relevant work experience with the patient group. Four themes emerged from the data: (1) having a malignant glioma: experienced consequences on work ability, (2) communicating about the consequences of a malignant glioma at work, (3) distilling the right approach: generic or tailored work-related support, and (4) accessibility of work-related support.

CONCLUSIONS

Glioma-specific consequences on patients' work ability necessitate better communication between, and tailored guidance for, patients, relevant professionals, and the workplace. Suggestions for improvement, e.g., the periodic use of comprehensive neuropsychological assessments, are provided in the article.

IMPLICATIONS FOR CANCER SURVIVORS

Patients with a malignant glioma would benefit from tailored and proactive outreach about work-related issues bv relevant professionals.

Investigation of illness perception and pregnancy avoidance in sexually active women with epilepsy

AIM

The aim of the study was to examine the perception of illness and avoidance of pregnancy in sexually active women with epilepsy.

METHODS

This study was completed with 82 women with epilepsy who were sexually active and who were admitted to the neurology clinic and outpatient clinic between June and September 2022. The descriptive information form, Brief Illness Perception Questionnaire (IPQ-B), and Pregnancy Avoidance Scale (PAS) were used to collect the data.

RESULTS

The mean age of the patients in the study was 32.96 ± 5.92 years and the mean disease duration was 11.19 ± 7.46 years. Among the patients, 75.6% had previous pregnancies, 70.7% did not have miscarriage or abortion, 69.5% previously gave birth, 61% used a contraceptive method (condom, intrauterine device (IUD), pills, etc.) in their last sexual intercourse, 52.4% had good communication with their spouses, 20% had two children, 51.2% had three or more seizures, and 86.6% used antiseizure medications (ASMs). The mean PAS score of the patients was 2.31 ± 1.14 and the mean IPQ-B score was 35.10 ± 13.16. The regression analysis found that the perception of illness was a significant positive predictor of avoidance of pregnancy and explained 17% of it.

CONCLUSION

Women with epilepsy avoided pregnancy and had negative illness perceptions. Moreover, negative illness perception increased pregnancy avoidance in women with epilepsy.